Skip to content

Advertisement

  • Research article
  • Open Access
  • Open Peer Review

Educational status and beliefs regarding non-communicable diseases among children in Ghana

  • 1Email author,
  • 2,
  • 2,
  • 1,
  • 3 and
  • 4
BMC Public HealthBMC series – open, inclusive and trusted201818:313

https://doi.org/10.1186/s12889-018-5211-5

  • Received: 20 January 2017
  • Accepted: 23 February 2018
  • Published:
Open Peer Review reports

Abstract

Background

Increasing prevalence of non-communicable diseases (NCDs) has been observed in Ghana as in other developing countries. Past research focused on NCDs among adults. Recent researches, however, provide evidence on NCDs among children in many countries, including Ghana. Beliefs about the cause of NCDs among children may be determined by the socioeconomic status of parents and care givers. This paper examines the relationship between educational status of parents and/or care givers of children with NCDs on admission and their beliefs regarding NCDs among children.

Methods

A total of 225 parents and/or care givers of children with NCDS hospitalized in seven hospitals in three regions (Greater Accra, Ashanti and Volta) were selected for the study. Statistical techniques, including the chi-square and multinomial logistic regression, were used for the data analysis.

Results

Educational status is a predictor of care giver’s belief about whether enemies can cause NCDs among children or not. This is the only belief with which all the educational categories have significant relationship. Also, post-secondary/polytechnic (p-value =0.029) and university (p-value = 0.009) levels of education are both predictors of care givers being undecided about the belief that NCDs among children can be caused by enemies, when background characteristics are controlled for. Significant relationship is found between only some educational categories regarding the other types of beliefs and NCDs among children. For example, those with Middle/Juniour Secondary School (JSS)/Juniour High School (JHS) education are significantly undecided about the belief that the sin of parents can cause NCDs among children.

Conclusions

Education is more of a predictor of the belief that enemies can cause NCDs among children than the other types of beliefs. Some categories of ethnicity, residential status and age have significant relationship with the beliefs when background characteristics of the parents and/or care givers were controlled for.

Keywords

  • Non-communicable diseases
  • Children
  • educational status
  • Belief
  • Ghana

Background

The prevalence of non-communicable diseases (NCDs) which were formerly characteristic of developed countries, has become a major public health concern in developing countries also. Currently, more people suffer from NCDs in developing countries, including Ghana, than in developed areas. Three quarters (28 million) of the 38 million deaths from NCDs recorded each year now occur in these countries. Globally, NCDs are associated with the elderly, but evidence shows that children and adults are also having the diseases [13]. In Ghana, clinical manifestations of some NCDs, including diabetes, hypertension, cardiovascular diseases and metabolic syndromes associated with overweight and obesity, have been increasing in the adult population over the past two decades or so [46].

A major area of concern regarding NCDs in Ghana that requires examination by researchers is the explanation of the diseases or what causes them. Even though biomedical explanation and understanding of NCDs have been widespread in the country and patients seek modern health services for treatment, the traditional health system has also been a source of treatment, either solely or in combination with others. This situation has been described as pluralism in health behaviour [7, 8]. In contemporary Ghana, both traditional and scientific health systems do exist and are very different with respect to the explanation of the causes of diseases as well as the approach to their prevention and cure [9]. Moreover, Ghanaian society demonstrates strong adherence to religious beliefs regarding NCDs among both patients and care providers. The findings of a study on health service delivery at the Korle Bu Teaching Hospital, which examined “the role of religious beliefs in the delivery of care in the hospital setting” notes the deep rooted Christian belief in Ghana and how the whole nursing profession and the health delivery behavior of nurses has been motivated by religious convictions. The study pointed out that religious beliefs support the nurses’ capacity to cope with the resource constraints (such as extreme shortage of personnel and equipment) that characterize the health facility and even form the basis of how society excuses the nurses from sub-optimal performance [10, 11]. Religious beliefs about diseases can make parents of children with NCDs resign to fatalistic ideas about them. They may also influence the kind of health service parents and/or care givers access for the treatment of the NCD the child is suffering from.

Under the traditional medical system, the cause of disease is invariably linked to supernatural powers, and for that matter, magico-religious acts and concepts are used to cure diseases of all kinds. However, physical cures and treatment with herbs are also employed [912]. Conditions of malnutrition such as kwashiorkor (a protein-energy deficiency syndrome) and convulsion are attributed to spirits and supernatural forces [13, 14]. Consequently, explanation about some diseases suffered by people, including NCDs among children may be generally attributed to witchcraft, punishment and/or attacks from spiritual sources and ancestors [13, 15]. Stigmatization or discrimination against persons with NCDs also exists as is the case with other diseases, including Human Immunodeficiency Virus (HIV), mental illness and others that are perceived as “abnormal” or capable of causing harm to others or making the patient unfit for human society [16]. It may be expected that formal education can erode traditional beliefs about the causes of NCDs. But the pluralism in health-seeking behavior in Ghana suggests that the traditional explanations of NCDs and associated beliefs prevail among the educated.

In Ghana, traditional perceptions, beliefs and behaviours regarding NCDs prevent some parents from exposing their children in public or taking them to modern health facilities. Consequently, survival of children with NCDs depends on the beliefs of their parents and/or care givers, even when modern health facilities are available and affordable for treatment. The dependence of children on their parents and/or care givers for the treatment or management of non-communicable diseases, therefore, requires that researchers examine parents and/or caregivers’ beliefs regarding NCDs among children.

Also, studies on NCDs in most countries focus on adult populations. Indeed the risk factors associated with such diseases are largely lifestyle or behavioural. Genetic factors that are associated with NCDs have also been recognized. Thus, Ghana’s response to the epidemiological transition and management of these diseases targets nutrition behaviour and related areas, including drinking of adequate amount of water as well as exercise and rest [17, 18].

Recently, however, interest has been growing in research on NCDs among children for two major reasons. Firstly, the age at which NCDs, such as hypertension and diabetes set in has gradually reduced as evident in several studies. Overweight and obesity and elevated blood pressure have been among the most cited conditions among children in Ghana and in different parts of the world, including the United States of America, Canada and Europe [1923]. Secondly, in the case of children in African countries in particular, including Ghana, the introduction of modern medical technology into the countries since the early parts of the Twentieth Century [24] has also contributed to the increasing survival rate of children who suffer from NCDs and congenital conditions. Research interest in them has been increasing.

This paper, therefore, examines beliefs of parents and/or care givers (relatives and non-relatives) regarding NCDs among children at Ghana’s two leading tertiary and teaching hospitals and other hospitals where such children were on admission. The general objective was to find out the influence of the formal educational status of parents and or care givers on beliefs regarding NCDs among children.

Methods

Study sites

The paper is based on a study conducted in three out of the ten regions of Ghana. The health facilities in which the interviews were conducted in the three regions include, Korle Bu Teaching Hospital (KBTH), the Princess Marie Louie Children’s Hospital in Accra (Greater Accra Region) and Komfo Anokye Teaching Hospital (KATH) in Kumasi (Ashanti Region). In the Volta Region, the interviews were conducted in four hospitals, including Ho Regional Hospital, Ho Municipal Hospital, Battor Catholic Hospital, and Mater Ecclesia to attain the minimum number of children required. The three regions were purposively selected in order to include all the major ethnic groups in the country, since beliefs about diseases is determined by cultural practices and beliefs. The two teaching hospitals are the leading referral hospitals for non-communicable diseases in Ghana. The Korle Bu Teaching Hospital also receives referred cases from the West African sub-region because it is the leading hospital in providing some specialist services and medical care in the sub-region.

The study was done at health facilities because it is difficult to conduct such a study in communities as stigma is attached to the NCDs. Parents and/or care givers would not like to participate in the study. However, in the health facilities on the other hand, they were willing to do so. Probably some reached the health facility before they were informed about the disease their children were suffering from.

Sample size determination

The sample size was determined using OpenEpi, Version 3, open source calculator—SSPropor. It was based on the following equation:
$$ Sample\ size\ \boldsymbol{n}=\left[\mathbf{DEFF}\ast \mathbf{Np}\ \left(\mathbf{1}-\mathbf{p}\right)\right]/\left[\right({\mathbf{d}}^{\mathbf{2}}/{\mathbf{Z}}_{\mathbf{1}-\boldsymbol{\upalpha} /\mathbf{2}}^{\mathbf{2}}\ast \left(\mathbf{N}-\mathbf{1}\right)+\mathbf{p}\ast \left(\mathbf{1}-\mathbf{p}\right)\Big] $$

Where,

n = sample size

DEFF = design effect (used in cluster surveys)

N = population size

P = the hypothesized % frequency of outcome factor in the population

q = 1-p

d = confidence limits

Since the respondents were in-patients, it was expedient to determine the sample size from the population of in-patients with NCDs in the hospitals selected, but this was difficult to obtain. However, OpenEpi calculator permits a default population of 1,000,000 as the maximum population size to determine the largest sample size, and a default hypothesized percentage (%) frequency of outcome factor of 50% (http://www.openepi.com/SampleSize/SSPropor.htm). The hypothesized % frequency of outcome factor in the population, provides an educated guess of the percent of the population with the outcome of interest. In this study the outcome variables of interest were three: 1) the belief that NCDs among children can be caused by enemies; 2) the belief that NCDs among children can be caused by parent’s sin; and 3) the belief that NCDs among children can be caused by someone else. Since respondents were supposed to be contacted personally in the hospitals for interview, the study adopted 80% as the hypothesized frequency of patients responding to the questionnaire on the three outcome variables. With the hypothesized frequency of 80% and confidence limits as ±5, the confidence interval would be 80% ±5%, that is, (75%, 85%). Based on these specifications, the sample size generated by OpenEpi calculator for the study was 246. This was rounded off to 250. However, the actual respondents were 225, giving a response rate of 90%.

Data collection

The interviews were conducted after consent forms were administered to the participants. The Institutional Review Board at the Noguchi Medical Research Centre, University of Ghana granted an ethical certificate for the study.

A quantitative research instrument was administered to participants who agreed to be interviewed. The questionnaire consisted of five modules, including socio-demographic background of the participants, knowledge of NCDs, beliefs about NCDs among children, health-seeking behavior of parents and/or care givers of the children and issues on tertiary health delivery policy regarding children in Ghana. The interviews were conducted between January and June 2013. A total of 225 parents and/or care givers, aged 18 years and above, were selected from the hospitals for the interview. None of the children on admission was interviewed at the health facility for this aspect of the study. The paper is based on the module on attitude and beliefs regarding NCDs among children aged 17 years and below. But only the questions on beliefs in the module were used for this paper.

Data analysis

The independent variable is the level of education and the dependent variable is beliefs. Three questions were asked to capture the beliefs of parents in terms of what causes chronic diseases in children: 1) Can children’s NCDs be caused by enemies?; 2) Can the children’s NCDs be caused by parents’ sins?; and 3) Can someone else be responsible for the children’s chronic conditions? The responses for each of the three questions are: 0 = “No”, 1 = “Yes” 2 = “undecided”). A positive response to these questions is considered as accepting the belief or having the belief while a negative response is considered as not holding on to the belief. At the multivariate analysis level, those who responded “No” to each of the questions (do not hold on to the beliefs) were used as the reference category. The control variables are: age, sex, religion, place of residence, and ethnicity.

Frequency tables were used to present the background characteristics of the respondents. At the bivariate level, Chi-Square tests were used to examine the association between level of education of parents and/or care givers’ and beliefs regarding NCDs among the children. Furthermore, multinomial logistic regression was used to show the independent effect of parents and/or care givers’ level of education on the three beliefs, controlling for their background characteristics. The cut-off for statistical significance for the results was p = 0.05.

Limitations of the study

The sample for the study was drawn solely from the health facilities that admit children suffering from non-communicable diseases. It is likely that the parents/care givers may be psychologically influenced by the health facility environment and provide answers to questions superficially to meet the expectations of the researchers or interviewers. In the communities, people’s views are supported by the collective views that are based on the social values and perspectives. There could be differences in the responses from these two settings. The health facility environment has the “natural” setting for the respondents, however, as they are experiencing the situation on which they are giving their views. Their responses are a result of their experience regarding the NCDs among their children, but not imaginations of other people’s situation. But those who do not accept the beliefs probably did so because they are in the hospital environment.

Generalizability of the results is not possible since the study did not include children in the community. At the community level, responses may be different from those at the health facility.

Results and discussion

In all, 225 parents and/or care givers at seven health facilities in three regions of Ghana were interviewed. They were 169 (75.1%) females and 56 males (25%). In Ghana, females are primary care givers to children. They are supported by their kin to perform care tasks. The sex distribution of the parents and/or care givers at the health facilities is a reflection of what pertains in the wider Ghanaian society.

The other socio-demographic/economic characteristics of the participants are shown in Table 1. The vast majority of the participants have formal education, with the highest percentage (42.3%) having primary and middle/Junior Secondary School/Junior High School education. Almost a third (31.8%) have secondary or post-secondary education while close to a fifth (18.2%) have university education. Less than a tenth (7.7%) have no formal education. Compared to the total national population, the educational status of the participants is relatively high. Most (72.9 Percent) of the parents and/or care givers are 44 years and below. Almost 9 out of every 10 (86.6%) of the parents and/or care givers are Christians and the rest are affiliated to Islam (12%) and 1.4% traditional religion. Overall, 90.7% reside in urban areas, while 9.3 are rural dwellers. Most of them are of Akan (55.6%) and Ewe (17.6%) ethnic backgrounds, just as it is for the total national population.
Table 1

Background characteristics of the respondents

Background characteristics

Number

Percentage

Level of education

 No education

17

7.7

 Primary

26

11.8

 Middle/JHS

67

30.5

 Secondary/SHS

41

18.6

 Post-secondary

29

13.2

 University

40

18.2

Age Group

 < 25

31

14.7

 25–34

72

35.5

 35–44

55

22.7

 45–54

20

8.9

 55–64

6

2.7

 65+

4

1.8

Sex

 

3.3

 Male

56

24.9

 Female

169

75.1

Religion

 Catholic

18

8.7

 Protestant/Anglican

76

36.5

 Charismatic/Pentecostal

86

41.4

 Traditional/spiritualist

3

1.4

 Moslem

25

12.0

Place of residence

 Urban

185

90.7

 Rural

19

9.3

Ethnic group

 Akan

125

55.6

 Ga-Dagme

21

9.3

 Ewe

40

17.8

 Mole-Dagbani

17

7.6

 Other Ghanaian

22

9.8

N = 220

Source: January–June 2013

The variation between the background characteristics of the parents and/or care givers and the belief that enemies can cause NCDs among children is presented in Table 2. The focus is on those who believe that their children’s NCDs could be caused by enemies. It can be observed from Table 2 that parents and/or care givers with no education reported the highest proportion of people (58.8%) who have the belief that their children’s NCDs could be caused by enemies while the least is recorded among those with post-secondary education (22.2%). Generally, the proportion having the belief that children’s NCDs could be caused by enemies is lower among those with higher levels of education. Also, the females (33.6%) recorded a little more than twice the percentage of males (16.3%) who believe that NCDs among children could be caused by enemies. In Ghana, females have a far lower educational status than males. Education erodes traditional beliefs about the causes of diseases, so parents and/or care givers with no education should be expected to report the highest proportion of those having that belief.
Table 2

Background characteristics and belief that enemies can cause NCDs on children

Characteristics

No

Yes

Undecided

Chi-Square

P-Values

Level of education

 No education

23.5

58.8

17.7

15.023

0.100

 Primary

61.5

30.8

7.7

  

 Middle/JHS

64.2

26.8

9.0

  

 Secondary/SHS

65.7

28.6

5.7

  

 Post-secondary

66.7

22.2

11.1

  

 University

77.3

22.7

0.0

  

Age Group

 < 20

37.5

25.0

37.5

32.432

0.070

 20–24

66.7

33.3

0.0

  

 25–29

67.9

17.9

14.2

  

 30–34

59.3

37.0

3.7

  

 35–39

71.4

25.7

2.9

  

 40–44

56.7

36.7

6.6

  

 45–49

68.8

31.2

0.0

  

 50–54

45.5

36.4

18.1

  

 55–59

100.0

0.0

0.0

  

 60–64

25.0

50.0

25.0

  

 65–69

50.0

0.0

50.0

  

Sex

 Male

76.7

16.3

7.0

5.277

0.071

 Female

58.0

33.6

8.4

  

Religion

 Catholic

69.2

30.8

0.0

6.115

0.634

 Protestant/Anglican

65.6

26.6

7.8

  

 Charismatic/Pentecostal

56.8

33.8

9.4

  

 Traditional/spiritualist

33.3

33.3

33.4

  

 Moslem

71.4

19.1

9.5

  

Place of residence

 Urban

69.0

22.6

8.4

12.306

0.002

 Rural

37.5

62.5

0.0

  

Ethnic group

 Akan

67.9

24.8

7.3

9.441

0.306

 Ga-Dagme

52.4

42.9

4.7

  

 Ewe

56.0

40.0

4.0

  

 Mole-Dagbani

66.7

20.0

13.3

  

 Other Ghanaian

43.8

37.5

18.7

  

Source: Field work January–June 2013

Regarding religious affiliation, about one-third of the parents and/or care givers who are Catholic (30.8%), Charismatic/Pentecostal (33.8%) and Traditionalist/spiritualist (33.3%) are of the opinion that children’s NCDs could be caused by enemies, whereas, less than 20% of the Moslems (19.1%) have this opinion. In Ghana, belief that non-communicable diseases are caused by spiritual forces, their agents or ancestors is held among Christians, particularly Pentecostal and Charismatic congregations, and this accounts for the patronage of prayer camps by sick persons seeking cure for diseases of all kinds. Further, a higher proportion of parents living in rural areas (62.5%), compared to urban residents, and a higher proportion of those who are Ga-Dagme (42.9%) and Ewe (40.0%) have this belief compared to other ethnic groups. A far lower percentage of parents and/or care givers at the health facilities with urban background (22.6%) compared to those with rural background (62.5%) believe that someone could NCDs among children. Half of the parents who are between the ages of 60–64 years old believe that children’s NCDs are caused by enemies and none of those who are 55–59 years and 65–69 years old has this belief.

Table 3 is on the belief that children’s NCDs could be caused by parents’ sins, by the background characteristics of the parents and/or care givers. The results show that parents and care givers with no education reported the highest percentage (29.4%) of those who believe that children’s NCDs is caused by parents’ sins, while those with Middle/JHS education reported the lowest percentage. A higher proportion (16.3%) of parents and/or care givers who are males compared to females (11.9%) have this belief. Those who are Catholics reported the highest proportion of people who believe that children’s NCD condition is due to parents’ sins. However, none of those in the Traditionalist/Spiritualist category has this belief, though such beliefs characterize that religion. This indicates that affiliation with a religion may not mean acceptance of all its practices and beliefs. Also, some Traditionalists/Spiritualists in contemporary Ghana are highly educated. They may accept biomedical and other explanations of diseases instead of the supernatural explanations that are associated with the Traditionalist/Spiritualist religion. This may also account for the relatively high percentage (33.3%) of those with Traditionalist/Spiritualist religion who were indecisive on their response to the statement. More than one in ten respodents in urban (11.0%) and rural areas (12.5%), believe that a parent’s sin can cause NCDs among children. The Ga-Dagme (23.8%) recorded the highest percentage of those who have this belief. Three-quarters (75.0%) of the parents and or care givers who are 60–64 years have this belief, while no parent and or care giver within the following age groups has this belief: 25–29 years, 55–59 years and 65–69 years.
Table 3

Background characteristics and belief that parents' sin can cause NCDs on children

Characteristics

No

Yes

Undecided

Chi-Square

P-values

Level of education

 No education

52.9

29.4

17.7

13.69

0.188

 Primary

76.9

11.5

11.6

  

 Middle/JHS

86.6

9.0

4.4

  

 Secondary/SHS

77.1

17.1

5.7

  

 Post-secondary

83.3

11.1

5.6

  

 University

90.9

9.1

0.0

  

Age Group

 < 20

87.5

12.5

0.0

39.609

0.012

 20–24

72.2

16.7

11.1

  

 25–29

85.7

0.0

14.3

  

 30–34

92.6

7.4

0.0

  

 35–39

88.6

5.7

5.7

  

 40–44

66.7

26.7

6.6

  

 45–49

87.5

12.5

0.0

  

 50–54

63.6

18.2

18.2

  

 55–59

100.0

0.0

0.0

  

 60–64

25.0

75.0

0.0

  

 65–69

100.0

0.0

0.0

  

Sex

 Male

81.4

16.3

2.3

1.974

0.373

 Female

80.4

11.9

7.7

  

Religion

 Catholic

76.9

23.1

0.0

7.593

0.474

 Protestant/Anglican

84.4

9.4

6.2

  

 Charismatic/Pentecostal

75.7

16.2

8.1

  

 Traditional/spiritualist

66.7

0.0

33.3

  

 Moslem

85.7

9.5

4.8

  

Place of residence

 Urban

82.6

11.0

6.4

0.889

0.641

 Rural

75.0

12.5

12.5

  

Ethnic group

 Akan

86.2

11.0

2.8

16.746

0.033

 Ga-Dagme

66.7

23.8

9.5

  

 Ewe

68.0

12.0

20.0

  

 Mole-Dagbani

93.3

6.7

0.0

  

 Other Ghanaian

68.8

18.8

12.4

  
Table 4 shows the variation between the background characteristics of the parents and/or care givers and the belief that someone else is responsible for NCDs among children. Close to two-thirds (62.5%) of those with no education believe that someone else is responsible for their child’s condition, while about one-third in the other education categories have this belief. A higher percentage of females (40.6%) than males (18.4%) and as high as two-thirds (66.7%) of those who have Traditionalist/Spiritualist religion had this belief. A higher proportion of parents in the rural areas (43.8%) than in urban areas (31.9%) have this belief. Among the ethnic groups, the highest percentage of those who have this belief are Ewe (42.0%). Further, half of the parents aged 60–64 and 65–69 years believe that someone else is responsible for their child’s condition, while none of those aged 55–59 has this belief. It is expected that older parents and/or care givers would hold on to the cultural practices that promote such beliefs.
Table 4

Background characteristics and belief that someone else is responsible NCDs among children

Characteristics

No

Yes

Undecided

Chi-Square

P-values

Level of education

 No education

25.0

62.5

12.5

8.439

0.586

 Primary

52.0

36.0

12.0

  

 Middle/JHS

51.6

32.8

15.6

  

 Secondary/SHS

55.9

32.4

11.7

  

 Post-secondary

63.2

31.6

5.2

  

 University

58.8

35.3

5.9

  

Age Group

  < 20

62.5

25.0

12.5

17.188

0.753

 20–24

52.9

29.4

17.7

  

 25–29

56.0

28.0

16.0

  

 30–34

44.0

48.0

8.0

  

 35–39

44.1

44.1

11.8

  

 40–44

42.9

39.3

17.8

  

 45–49

66.7

33.3

0.0

  

 50–54

63.6

27.3

9.1

  

 55–59

100.0

0.0

0.0

  

 60–64

25.0

50.0

25.0

  

 65–69

50.0

50.0

0.0

  

Sex

 Male

71.1

18.4

10.5

7.437

0.024

 Female

47.1

40.6

12.3

  

Religion

 Catholic

84.6

15.4

0.0

8.268

0.408

 Protestant/Anglican

50.8

34.4

14.8

  

 Charismatic/Pentecostal

47.1

38.2

14.7

  

 Traditional/spiritualist

33.3

66.7

0.0

  

 Moslem

55.0

35.0

10.0

  

Place of residence

 Urban

56.3

31.9

11.8

1.021

0.6

 Rural

43.8

43.8

12.4

  

Ethnic group

 Akan

50.0

37.3

12.7

2.001

0.981

 Ga-Dagme

55.0

35.0

10.0

  

 Ewe

64.0

42.0

8.0

  

 Mole-Dagbani

46.2

38.5

15.3

  

 Other Ghanaian

50.0

37.5

12.5

  

Source: Field work January–June 2013

Level of education and the belief that enemies can cause disease in children

Table 5 shows the relationship between level of education and belief that NDCs can be caused by enemies. The results show that there is a significant relationship between level of education and having this belief. Compared with parents and/or care givers with no education, parents with Primary, Middle/JSS/JHS, Secondary/SHS, Post-Sec/Polytechnic and university education are less likely to believe that NCDs among children can be caused by enemies (75.0%, 79.1%, 78.3%, 83.3% and 85.3%, respectively). Generally, the likelihood of believing that children’s NCDs can be caused by enemies reduces with increase in the level of education. Moreover, those with primary and Middle/JSS/JHS education are significantly less likely (91.1% and 90% respectively) to be undecided about the belief that NCDs among children can be caused by enemies.
Table 5

Level of education and the belief that enemies can cause NCDs among children

Variable

Yes

Undecided about the belief

P-values

Odds ratio

P-values

Odd ratio

Education

 No education (RC)

 

1.000

 

1.000

 Primary

0.047

0.250**

0.011

0.089**

 Middle/JSS/JHS

0.011

0.209**

0.002

0.100**

 Sec/SHS/Vocational

0.022

0.217**

0.051

0.248

 Post-Sec/Polytechnic

0.024

0.167**

0.718

0.774

 University

0.010

0.147**

0.680

0.756

The reference category is “No” (Does not accept the belief

Yes = Accepted belief

N = 225; Nagelkerke R-square = 0.185; Chi-square = 39.636

**p < 0.05

When the other background characteristics of parents and/or care givers were controlled for, as shown in Table 6, the two highest educational categories (post-sec/polytechnic, and university) have statistically significant relationship with the belief that children’s chronic disease can be caused by enemies. Those with Post-secondary education are 84.1% less likely than those with no education to be undecided about the belief that children’s chronic disease can be caused by enemies while those with university education are 94% less likely than those with no education to be undecided about this belief. Some categories of residential status and ethnicity are the only background characteristics that are predictors of care givers’ belief that children’s chronic disease can be caused by enemies when the background characteristics of parents and/or care givers were controlled for. Those with urban residential status are significantly less likely (87.2%) than the rural residents to accept this belief. The Akan and the Ga-Dagme (84% and 96.9%, respectively) are less likely than the Ewe to be undecided about the belief that children’s chronic disease can be caused by enemies.
Table 6

Background characteristics and the belief that enemies can cause disease among children

Variables

Yes

Undecided about the belief

P-values

Odds ratio

P-values

Odd ratio

Education

 No education (RC)

 

1.000

 

1.000

 Primary

0.067

0.221

0.588

1.603

 Middle/JSS/JHS

0.061

0.257

0.676

1.434

 Sec/SHS/Vocational

0.109

0.278

0.368

0.465

 Post-Sec/polytechnic

0.125

0.245

0.029

0.159**

 University

0.091

0.222

0.009

0.060**

Sex

 Male

0.070

0.381

0.428

0.672

 Female (RC)

 

1.000

 

1.000

Religion

 Catholic

0.732

1.410

0.290

0.353

 Protestant/Angl/Presb

0.966

1.032

0.526

0.623

 Charismatic

0.613

1.445

0.417

0.546

 Moslem

0.838

0.788

0.162

0.212

 Traditionalist (RC)

 

1.000

 

1.000

Residence

 Urban

0.000

0.128**

0.059

0.338

 Rural (RC)

 

1.000

 

1.000

Ethnicity

 Akan

0.074

0.378

0.001

0.160**

 Ga-dagme

0.432

1.751

0.004

0.031**

 Other Ghanaians

0.914

1.097

0.726

1.343

 Mole-Dagbani

0.471

0.421

0.660

0.626

 Ewe (RC)

 

1.000

 

1.000

Age group

 < 25 (RC)

 

1.000

 

1.000

 25–34

0.883

0.915

0.598

0.737

 35–44

0.515

1.465

0.268

0.507

 45–54

0.460

1.671

0.198

0.354

 55–64

0.370

0.372

0.728

1.443

 65+

0.911

1.179

0.337

3.675

The reference category is “No”(Does not accept the belief)

Yes = Accepted belief

N = 225; Nagelkerke R-square = 0.421; Chi-square = 102.939

**p < 0.05;

Education and belief that children suffer from NCDs because of the sins of their parents

Table 7 shows that there is no statistically significant relationship between all the educational categories and the belief that children suffer from NCDs because of the sins of their parents, with the exception of those with Middle/JSS/JHS educational status. The parents and/or care givers with Middle/JSS/JHS are significantly 79.3% less likely than those with no education to accept the belief that NCDs among children are caused by the sins of their parents. Again, they are 92.6% significantly to be undecided about the belief compared with those with no education.
Table 7

Education and the belief that children suffer NCDs because of the sins of their parents

Variable

Yes

Undecided about the belief

P-values

Odds ratio

P-values

Odd ratio

Education

 No education (RC)

 

1.000

 

1.000

 Primary

0.145

0.300

0.052

0.214

 Middle/JSS/JHS

0.024

0.207**

0.001

0.074**

 Sec/SHS/Vocational

0.253

0.444

0.177

0.423

 Post-Sec/Polytechnic

0.156

0.267

0.831

1.143

 University

0.081

0.200

0.670

1.286

Note: The reference category is “No” (Does not accept the belief)

Yes = Accepted belief

N = 225; Nagelkerke R-square = 0.205; Chi-square = 41.240

**p < 0.05

However, when the background characteristics of parents were controlled for, as shown in Table 8, the Middle/JSS/JHS educational category is the only predictor of whether or not care givers believe that children suffer from NCDs because of the sins of their parents. Compared with those with no education, those with primary and Middle/JSS/JHS education are less likely to be undecided about believing that children suffer NCDs because of the sins of their parents (87.8% and 93.6% respectively). Parents’ sex, religion, place of residence, and ethnicity do not predict this belief.
Table 8

Background characteristics and belief that children suffer NCDs because of the sins of their parents

Variables

Yes

Undecided about the belief

P-values

Odds ratio

P-values

Odd ratio

Education

 No education (RC)

 

1.000

 

1.000

 Primary

0.233

0.332

0.023

0.122**

 Middle/JSS/JHS

0.062

0.215

0.003

0.064**

 Sec/SHS/Vocational

0.462

0.505

0.922

0.927

 Post-Sec/Polytechnic

0.326

0.338

0.447

1.849

 University

0.237

0.273

0.148

3.186

Sex

 Male

0.591

1.388

0.085

0.379

 Female (RC)

 

1.000

 

1.000

Religion

 Catholic

0.450

2.824

0.354

0.387

 Protestant/Ang/presby

0.767

1.420

0.662

0.727

 Charismatic

0.339

2.959

0.554

0.654

 Moslem

0.609

2.252

0.751

0.711

 Traditionalist (RC)

 

1.000

 

1.000

Residence

 Urban

0.105

0.368

0.234

0.541

 Rural (RC)

 

1.000

 

1.000

Ethnicity

 Akan

0.664

0.712

0.000

0.053**

 Ga-Dagme

0.185

3.672

0.000

0.026**

 Other Ghanaians

0.636

1.651

0.116

0.282

 Mole-Dagbani

0.398

0.260

0.010

0.046**

 Ewe (RC)

 

1.000

 

1.000

Age group

 < 25 (RC)

 

1.000

 

1.000

 25–34

0.077

0.180

0.552

0.712

 35–44

0.573

1.507

0.594

0.725

 45–54

0.652

1.480

0.159

0.294

 55–64

0.416

2.416

0.534

2.053

 65+

0.836

1.386

0.854

1.292

The reference category is “No” (Does not accept the belief)

Yes = Accepted belief

N = 225; Nagelkerke R-square = 0.441; Chi-square = 100.429

**p < 0.05

Education and the belief that someone could be responsible for NCDs among children

Table 9 is on the relationship between level of education and the parents and/or care givers’ belief that someone could be responsible for their children’s NCDs. The results show that there are no significant relationship between education and the belief that someone could be responsible for their children’s illness. When the other background characteristics were controlled for (as shown in Table 10), only a category of the ethnic groups showed a significant relationship with being undecided about this belief, that is whether to accept the belief or reject it. The Ga-Dangme are 85.6% significantly less likely to be undecided about the belief compared with the Ewe.
Table 9

Level of education and the belief that someone could be responsible for the children’s illness

Variable

Yes

Undecided about the belief

P-values

Odds ratio

P-values

Odd ratio

Education

 No education (RC)

 

1.000

 

1.000

 Primary

0.129

0.346

0.064

0.220

 Middle/JSS/JHS

0.062

0.318

0.059

0.281

 Sec/SHS/Vocational

0.063

0.289

0.205

0.414

 Post-Sec/Polytechnic

0.062

0.250

0.556

0.655

 University

0.110

0.300

0.439

1.714

The reference category is “No”(Does not accept the belief)

Yes = Accepted belief

N = 225; Nagelkerke R-square = 0.132; Chi-square = 28.064

**p < 0.05

Table 10

Background characteristics and the belief that someone could be responsible for the children’s illness

Variable

Yes

Undecided about the belief

P-values

Odds ratio

P-values

Odd ratio

Education

 No education (RC)

 

1.000

 

1.000

 Primary

0.155

0.331

0.057

0.184

 Middle/JSS/JHS

0.067

0.272

0.121

0.310

 Sec/SHS/Vocational

0.095

0.272

0.382

0.497

 Post-Sec/Polytechnic

0.160

0.305

0.765

0.782

 University

0.194

0.318

0.409

1.995

Sex

 Male

0.063

0.390

0.690

0.840

 Female (RC)

 

1.000

 

1.000

Religion

 Catholic

0.212

0.280

0.364

0.446

 Protestant/Angl/Presby

0.550

0.676

0.988

1.011

 Charismatic

0.948

0.959

0.880

1.109

 Moslem

0.659

0.642

0.349

0.382

 Traditionalist (RC)

 

1.000

 

1.000

Residence

 Urban

0.076

0.424

0.445

0.679

 Rural (RC)

 

1.000

 

1.000

Ethnicity

 Akan

0.498

1.455

0.144

0.493

 Ga-Dagme

0.507

1.640

0.017

0.144*

 Other Ghanaians

0.695

1.388

0.862

1.143

 Mole-Dagbani

0.512

2.056

0.434

2.208

 Ewe (RC)

 

1.000

 

1.000

Age group

 < 25 (RC)

 

1.000

 

1.000

 25–34

0.349

1.734

0.669

1.255

 35–44

0.143

2.357

0.922

1.055

 45–54

1.000

1.000

0.075

0.264

 55–64

0.465

0.460

0.977

1.027

 65+

0.940

1.108

0.906

1.149

The reference category is “No” (Does not accept the belief)

Yes = Accepted belief

N = 225; Nagelkerke R-square = 0.281; Chi-square = 64.469

**p < 0.05

Conclusion

All the educational categories have significant relationship with the belief that enemies can cause NCDs among children. Significant relationship is found between only some educational categories regarding the other types of beliefs- parents’ sin can cause NCDs among children and someone else is responsible for NCDs among children. For example, those with primary school level of education are significantly undecided about belief that enemies can cause NCDs among children compared with those with no education. Also, those with Middle/JSS/JHS education are significantly undecided about the belief that the sin of parents can cause NCDs among children. When the socio-demographic characteristics of parents were controlled for, educational status had a significant relationship with being undecided about the belief that, enemies can cause NCDs among children at the Post-Sec/polytechnic and university levels of education. Being at an urban place of residence also has a significant relationship about the belief that enemies can cause NCDs among children.

Overall, educational status is not always a predictor of whether or not care givers have the belief, reject it or are undecided about the beliefs regarding causes of NCDs among children. With the exception of ethnic background and urban residential status, the other variables are not statistically significant predictors of the beliefs that NCDs among children are caused by enemies, someone else and the sin of parents.

Previous studies about diseases indicate that people have beliefs about some diseases. NCDs are no exception. Generally, Ghanaian society attributes some diseases, particularly NCDs diseases, to the work of spiritual activities and therefore resort to alternative medicine. Consequently, patients arrive at health facilities when the disease has advanced. Deaths from some diseases such as NCDs and even convulsions and malnutrition among children which could be prevented are not because of delay in seeking health care from modern health facilities. This study corroborates findings related to such behaviours [8, 16].

Orthodox medicine may not be the choice for some parents/care givers for the treatment of their children when they have non-communicable diseases as they hold on to such beliefs. They may arrive at the health facility when the illness has reached advanced stage because they would have tried other forms of treatment that are in accordance with the beliefs that they have regarding the cause(s) of the diseases.

Education on the causes of NCDs has to be integrated into the prenatal and post-natal health care delivery system of Ghana to inform parents about the causes of NCDs. At the community level, such education can be done through a number of channels including the media and faith-based institutions. Some of the ethnic groups which have higher likelihood of having these beliefs should be targeted for such educational campaigns.

Abbreviations

HIV: 

Human immunodeficiency virus

IMMRI-Noguchi: 

Memorial medical research institute

IRB: 

Institutional review board

JHS: 

Juniour high school

JSS: 

Juniour secondary school

KATH: 

Komfo anokye teaching hospital

KBTH: 

Korle bu teaching hospital

NCDs: 

Non-communicable diseases

Declarations

Acknowledgements

The authors are grateful to the Office of Research Innovation and Development (ORID), University of Ghana, Legon for providing the research grant numbered URF/5/LMG-002/2011-2012 for the research project from which this paper was based. The research project was implemented in three regions of Ghana and a number of health facilities (Korle Bu Teaching Hospital, Komfo Anokye Teaching Hospital, the Volta Regional Hospital, Ho Regional Hospital, Ho Municipal Hospital, Battor Catholic Hospital, and Mater Ecclesia). We appreciate the management of the health facilities, the parents, the care givers, and other participants for their support for the study. We also thank the children at the various health facilities.

Funding

The Office of Research Innovation and Development (ORID), University of Ghana provided the research grant numbered URF/5/LMG-002/2011–2012 for the research project.

Availability of data and materials

The data and materials from the research project are at the Regional Institute for Population Studies, University of Ghana, Legon.

Authors’ contributions

DMB, AAA, FAA, AEY, JKA and DAA conceptualized and designed the research project. DMB was the principal author, with AAA, AEY, DAA, JFK and FAA providing assistance for the revision of the paper. DMB monitored the quality of data collection and AAA, FAA and AEY contributed to the data analysis. All the authors read the final revised manuscript and approved it.

Ethics approval and consent to participate

The Institutional Review Board (IRB) of the Noguchi Memorial Medical Research Institute (IMMRI) of the University of Ghana and the Ghana Health Service Institutional Review Board granted ethical clearance for the study. Written informed consent was sought from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests regarding the publication of this paper.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
(2)
Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
(3)
Department of Community Health, University of Ghana Medical School, Legon, Accra, Ghana
(4)
Institute of African Studies, University of Ghana, Legon, Accra, Ghana

References

  1. World Health Organization (WHO) Noncommunicable Diseases. Fact sheet: WHO; 2015. Available at: http://www.who.int/mediacentre/factsheets/fs355/en/
  2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2224–60.View ArticlePubMedPubMed CentralGoogle Scholar
  3. Amuna P. Epidemiology and Nutritional Transition Evolving Trends and Impacts in the Developing Countries. Paper presented at the 2nd Africa Nutrition Epidemiology Conference. Ghana Institute of Management and Professional Studies. 2006.Google Scholar
  4. Dake FA, Tawiah EO, Badasu DM. Sociodemographic correlates of obesity among Ghanaian women. Public Health Nutr. 2011;14(7):1285–91.View ArticlePubMedGoogle Scholar
  5. De-graft A. Ghana’s neglected chronic disease epidemic: a developmental challenge. Ghana Med. J. 2007;41(4):154–9.Google Scholar
  6. Amoah AGB. The Weight of the Nation and its health Implications. Inaugural Lecture, April 14, 2005. University of Ghana.Google Scholar
  7. de- Graft Aikins A, Unwin N, Agyemang C, Allotey P, Campbell C, et al. Tackling Africa’s chronic disease burden: from the local to the global. Commentary. Glob Health. 2010;6:1–7.View ArticleGoogle Scholar
  8. Badasu DM. Care for the seriously sick children at Korle Bu teaching hospital. In: Oppong C, Antwi P, Waerness K, editors. Care of the Seriously Sick and Dying: perspectives from Ghana. Bergen: BRIC; 2009. p. 150–87.Google Scholar
  9. Twumasi PA. Medical Systems in Ghana: a study in medical sociology. Tema: Ghana Publishing Corporation; 1975.Google Scholar
  10. Böhmig C. “There is somebody in heaven who takes care of you!”: nursing and the religiosity in a hospital Ward in Ghana. Medische Anthopology. 2010;22(1):47–61.Google Scholar
  11. Badasu DM. Epidemiological transition, the burden of non-communicable diseases and tertiary health policy for child health Care in Ghana: lessons from a study on children in a Ghanaian teaching hospital. Paper presented at the 10th global conference: health, Illness & Disease. A Making Sense Of: Project, September 6–8, 2011, Oxford, United Kingdom. 2011Google Scholar
  12. Sackey BM. Family networking and relationships in the Care of the Seriously ill. In: Oppong C, Antwi P, Waerness K, editors. Care of the Seriously Sick and Dying: perspectives from Ghana. Bergen: BRIC; 2009. p. 188–210.Google Scholar
  13. Awedoba AK. Kasena norms and reproductive health. Inst Afr Stud Res Rev, Socio Cultural Dimensions of Reproductive Health and Human Development. 2003;18(Suppl. 1):13–26.Google Scholar
  14. Atobrah D. Breast cancer in Ghana: a review of social science perspectives. In: deGraft AA, Agyei-Mensah S, Agyemang C, editors. Chronic non-communicable diseases in Ghana: multidisciplinary perspectives. Accra: Sub-Saharan Publishers; 2013.Google Scholar
  15. Nukunya GK. Kinship and marriage among the Anlo ewe. London School of Economics Monographs on social anthropology 37. London: The Athlone Press; 1969.Google Scholar
  16. Antwi P, Atoborah D. Stigma in the Care of People Living with HIV/AIDS and cancer in Accra. In: Oppong C, Antwi P, Waerness K, editors. Care of the Seriously Sick and Dying: perspectives from Ghana. Bergen: BRIC; 2009. p. 114–49.Google Scholar
  17. Tagoe HA, Dake FAA. Healthy lifestyle behaviour among Ghanaian adults in the phase of a health policy change. Glob Health. 2011;7:1–9.View ArticleGoogle Scholar
  18. Ministry of Health. National Health Policy Creating Wealth through health. Accra: Ministry of Health; 2007.Google Scholar
  19. Salvadori M, Sontrop JM, Garg AX, Truong J, Suri RS, et al. Elevated blood pressure in relation to overweight and obesity among children in rural Canadian community. Pediatr. 2012;122(4):e821–7. https://doi.org/10.1542/peds.2008-0951.View ArticleGoogle Scholar
  20. Lobstein T, Frelut M-L. Prevalence of overweight among children in Europe. Obes. News. 2012;4:195–200.Google Scholar
  21. Agyemang C, Redekop WK, Owusu-Dabo E, Bruijnzeels MA. Blood pressure patterns in rural, semi-urban and urban children in the Ashanti region of Ghana, West Africa. BMC Public Health. 2005;5:114–21.View ArticlePubMedPubMed CentralGoogle Scholar
  22. Mirza NM, Kadow K, Palmer M, Salano H, Roche C, Yanovski JA. Prevalence of overweight among inner city Hispanic-American children and adolescents. Obes. Res. 2004;12(8):1298–310.View ArticlePubMedGoogle Scholar
  23. Lobstein T, Frelut ML. Prevalence of overweight among children in Europe. Obes Rev. 2003;4:195–200.View ArticlePubMedGoogle Scholar
  24. Addae S. Evolution of modern medicine in a developing country: Ghana 1880–1960. Durham: Durham Academic Press Ltd.; 1996.Google Scholar

Copyright

© The Author(s). 2018

Advertisement