ObjectiveDespite the huge financial investment in the free maternal healthcare policy (FMHCP) by the Governments of Ghana and Burkina Faso, no study has quantified the impact of FMHCP on the relative reduction in neonatal and infant mortality rates using a more rigorous matching procedure with the difference in differences (DID) analysis. This study used several rounds of publicly available population-based complex survey data to determine the impact of FMHCP on neonatal and infant mortality rates in these two countries.DesignA quasi-experimental study to evaluate the FMHCP implemented in Burkina Faso and Ghana between 2007 and 2014.SettingDemographic and health surveys and maternal health surveys conducted between 2000 and 2014 in Ghana, Burkina Faso, Nigeria and Zambia.ParticipantsChildren born 5 years preceding the survey in Ghana, Burkina Faso, Nigeria and Zambia.Primary outcome measuresNeonatal and infant mortality rates.ResultsThe Propensity Score Kernel Matching coupled with DID analysis with modified Poisson showed that the FMHCP was associated with a 45% reduction in the risk of neonatal mortality rate in Ghana and Burkina Faso compared with Nigeria and Zambia (adjusted relative risk (aRR)=0.55, 95% CI: 0.40 to 0.76, p<0.001). In addition, infant mortality rate has reduced significantly in both Ghana and Burkina Faso by approximately 54% after full implementation of FMHCP compared with Nigeria and Zambia (aRR=0.46, 95% CI: 0.36 to 0.59, p<0.001).ConclusionThe FMHCP had a significant impact and still remains relevant in achieving Sustainable Development Goal 3 and could provide lessons for other sub-Saharan countries in the design and implementation of a similar policy.

Background: Adolescent cigarette smoking is of public health importance since many adult smokers had initiated the habit as adolescents. This study aims to determine the prevalence of cigarette smoking among in-school adolescents in Yilo Krobo Municipality, Ghana and factors associated with cigarette smoking. Methods: A school-based cross-sectional analytic study was conducted in February 2017 in Yilo Krobo Municipality in the Eastern Region of Ghana. A stratified random sampling method was applied to select 700 students. After obtaining informed consent, structured questionnaires were administered to collect information on demographic characteristics, behaviours, family, peer and school factors. Data was entered into SPSS and analysed with level of significant as p-value of less than 0.05. Univariate, bivariate and multivariate analysis were applied to determine prevalence and risk factors of cigarette smoking. Results: A total of 700 students participated in the study and the prevalence of cigarette smoking was 14.3% (100) and 77.5% (76) were introduced to smoking by their peers. Those who started smoking cigarette at the age of 10 years and below were 32% (32). Factors associated with cigarette smoking were being in JHS 1 (AOR:2.23, p=0.006), close friends smoking cigarette (AOR: 2.26, p=0.001), having drank alcohol before (AOR: 6.0, p<0.001) and having ever used marijuana (AOR: 6.48, p<0.001). However, recognizing marijuana usage to be wrong was protective against cigarette smoking (AOR: 0.58, p=0.006). Conclusion: Cigarette smoking among in-school adolescents exists in Yilo Krobo Municipality and school-based interventions such as counselling services on substance use should be implemented to address these behaviours.

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