{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:43:24Z","timestamp":1789753404097,"version":"4.0.1"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T00:00:00Z","timestamp":1642204800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T00:00:00Z","timestamp":1642204800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-008737"],"award-info":[{"award-number":["INV-008737"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Reprod Health"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women\/girls in urban slums who have had sexual and reproductive health education would likely utilize contraception. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691, made up of respondents who provided responses to the question on ever used contraception, sex education as well as those with complete information on all the other variables of interest was considered in this study. Binary logistic regression models were fitted to examine association between sexual and reproductive health education and ever use of contraception. Crude odds ratios (cOR) and adjusted odds ratios (aOR) at p-value less than 0.05 were used to assess the strength of the association between the outcome and independent variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>More than half (56.73%) of the women have never received sexual and reproductive health education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sexual and reproductive health education had lower odds of ever using contraception (OR\u2009=\u20090.641, 95% CI 0.443, 0.928) and this persisted after controlling for the effect of demographic factors (AOR\u2009=\u20090.652, 95% CI 0.436, 0.975] compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers\/radio\/television) were also more likely to use contraceptives in slums in Accra, Ghana.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study revealed a relatively low prevalence of sex education among women in urban slums in Accra. However, sex education was found to increase the odds of ever use of contraception. These findings call for intensified sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12978-021-01322-5","type":"journal-article","created":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T03:02:51Z","timestamp":1642215771000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Sexual and reproductive health education and its association with ever use of contraception: a cross-sectional study among women in urban slums, Accra"],"prefix":"10.1186","volume":"19","author":[{"given":"Abdul-Aziz","family":"Seidu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward Kwabena","family":"Ameyaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bright Opoku","family":"Ahinkorah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Baatiema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Dery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustine","family":"Ankomah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8382-3437","authenticated-orcid":false,"given":"John Kuumuori","family":"Ganle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,15]]},"reference":[{"issue":"4","key":"1322_CR1","doi-asserted-by":"publisher","first-page":"e380","DOI":"10.1016\/S2214-109X(18)30029-9","volume":"6","author":"J Bearak","year":"2018","unstructured":"Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet Glob Health. 2018;6(4):e380\u20139.","journal-title":"Lancet Glob Health"},{"issue":"8","key":"1322_CR2","doi-asserted-by":"publisher","first-page":"e0220970","DOI":"10.1371\/journal.pone.0220970","volume":"14","author":"EK Ameyaw","year":"2019","unstructured":"Ameyaw EK, Budu E, Sambah F, Baatiema L, Appiah F, Seidu AA, Ahinkorah BO. Prevalence and determinants of unintended pregnancy in sub-Saharan Africa: a multi-country analysis of demographic and health surveys. PloS One. 2019;14(8):e0220970.","journal-title":"PloS One"},{"key":"1322_CR3","unstructured":"WHO. Maternal mortality. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality. Retrieved on February 14, 2021."},{"key":"1322_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1363\/4100115","volume":"41","author":"M Skiles Priedeman","year":"2015","unstructured":"Skiles Priedeman M, et al. The effect of access to contraceptive services on injectable use and demand for family planning in Malawi. Int Perspect Sex Reprod Health. 2015;41:1.","journal-title":"Int Perspect Sex Reprod Health"},{"key":"1322_CR5","unstructured":"WHO. Contraception: evidence brief. 2019. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/112319\/WHO_RHR_14.07_eng.pdf?ua=. Accessed 12 Feb 2021."},{"key":"1322_CR6","unstructured":"Wang W, Staveteig S, Winter R, et al. Women\u2019s Marital Status, Contraceptive Use, and Unmet Need in Sub-Saharan Africa, Latin America, and the Caribbean, 2017. https:\/\/dhsprogram.com\/pubs\/pdf\/CR44\/CR44.pdf. Accessed 12 Feb 2021."},{"key":"1322_CR7","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1186\/s12905-018-0649-2","volume":"18","author":"P Beson","year":"2018","unstructured":"Beson P, Appiah R, Adomah-Afari A. Modern contraceptive use among reproductive-aged women in Ghana: prevalence, predictors, and policy implications. BMC Women\u2019s Health. 2018;18:157.","journal-title":"BMC Women\u2019s Health"},{"key":"1322_CR8","doi-asserted-by":"publisher","first-page":"956","DOI":"10.11564\/28-0-549","volume":"28","author":"J Nonvignon","year":"2014","unstructured":"Nonvignon J, Novignon J. Trend and determinants of contraceptive use among women of reproductive age in Ghana. Afr Popul Stud. 2014;28:956\u201367.","journal-title":"Afr Popul Stud"},{"key":"1322_CR9","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/S0140-6736(12)60478-4","volume":"380","author":"S Ahmed","year":"2012","unstructured":"Ahmed S, Li Q, Liu L, et al. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012;380:111\u201325.","journal-title":"Lancet"},{"key":"1322_CR10","unstructured":"United Nations. Transforming our world: the 2030 agenda for Sustainable Development. United Nations, 2015; Contract No.: A\/RES\/70\/1."},{"issue":"43","key":"1322_CR11","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1111\/padr.12038","volume":"2017","author":"D Beguy","year":"2017","unstructured":"Beguy D, Ezeh AC, Mberu BU, Emina JB. Changes in use of family planning among the urban poor: evidence from Nairobi slums. Popul Dev Rev. 2017;2017(43):216\u201334.","journal-title":"Popul Dev Rev"},{"key":"1322_CR12","unstructured":"Kenya National Bureau of Statistics (KNBS) and ICF Macro. Kenya Demographic and Health Survey, 2008\u201309. Maryland: KNBS and ICF Macro; 2010."},{"key":"1322_CR13","unstructured":"D'Souza R. Factors influencing the use of contraception in an urban slum in Karachi, Pakistan; 2003."},{"issue":"1","key":"1322_CR14","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12905-016-0314-6","volume":"16","author":"R Ochako","year":"2016","unstructured":"Ochako R, Izugbara C, Okal J, Askew I, Temmerman M. Contraceptivemethod choice among women in slum and non-slum communities in Nairobi, Kenya. BMC Women\u2019s Health. 2016;16(1):35. https:\/\/doi.org\/10.1186\/s12905-016-0314-6.","journal-title":"BMC Women\u2019s Health"},{"key":"1322_CR15","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1186\/s12905-020-01010-9","volume":"20","author":"K Yadav","year":"2020","unstructured":"Yadav K, Agarwal M, Shukla M, et al. Unmet need for family planning services among young married women (15\u201324 years) living in urban slums of India. BMC Women\u2019s Health. 2020;20:187.","journal-title":"BMC Women's Health"},{"issue":"4","key":"1322_CR16","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1007\/s11524-011-9667-1","volume":"89","author":"IS Speizer","year":"2012","unstructured":"Speizer IS, Nanda P, Achyut P, Pillai G, Guilkey DK. Family planning use among urban poor women from six cities of Uttar Pradesh, India. J Urban Health. 2012;89(4):639\u201358.","journal-title":"J Urban Health"},{"issue":"3","key":"1322_CR17","doi-asserted-by":"publisher","first-page":"627","DOI":"10.5455\/2320-1770.ijrcog20140946","volume":"3","author":"S Begum","year":"2014","unstructured":"Begum S, Nair S, Donta B, Prakasam C. Prevalence of unmet need for contraception in urban slum communities, Mumbai. Int J Reprod Contracept Obstet Gynecol. 2014;3(3):627\u201330.","journal-title":"Int J Reprod Contracept Obstet Gynecol"},{"issue":"2","key":"1322_CR18","doi-asserted-by":"publisher","first-page":"NP2661","DOI":"10.1177\/1010539511421194","volume":"27","author":"SMM Kamal","year":"2015","unstructured":"Kamal SMM. Socioeconomic factors associated with contraceptive use and method choice in urban slums of Bangladesh. Asia Pac J Public Health. 2015;27(2):NP2661\u201376. https:\/\/doi.org\/10.1177\/1010539511421194.","journal-title":"Asia Pac J Public Health"},{"issue":"2","key":"1322_CR19","doi-asserted-by":"publisher","first-page":"46","DOI":"10.3329\/jopsom.v38i2.47864","volume":"38","author":"J Tazneen","year":"2019","unstructured":"Tazneen J, Hamid S, Rahman M. Unmet need of postpartum contraceptives use in urban slums. J Prev Social Med. 2019;38(2):46\u201352.","journal-title":"J Prev Social Med"},{"key":"1322_CR20","unstructured":"Awusabo-Asare K, Stillman M, Keogh S, Doku TD, Kumi-Kyereme A, Esia-Donkoh K, Leong E, Amo-Adjei J, Bankole A. From paper to practice: sexuality education policies and their implementation in Ghana, New York: Guttmacher Institute. 2017. https:\/\/www.guttmacher.org\/report\/sexuality-education-ghana."},{"issue":"5","key":"1322_CR21","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.jadohealth.2016.11.025","volume":"60","author":"N Jaramillo","year":"2017","unstructured":"Jaramillo N, Buhi ER, Elder JP, Corliss HL. Associations between sex education and contraceptive use among heterosexually active, adolescent males in the United States. J Adolesc Health. 2017;60(5):534\u201340.","journal-title":"J Adolesc Health"},{"issue":"4","key":"1322_CR22","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.jadohealth.2011.12.028","volume":"51","author":"LD Lindberg","year":"2012","unstructured":"Lindberg LD, Maddow-Zimet I. Consequences of sex education on teen and young adult sexual behaviors and outcomes. J Adolesc Health. 2012;51(4):332\u20138.","journal-title":"J Adolesc Health"},{"issue":"4","key":"1322_CR23","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jadohealth.2007.08.026","volume":"42","author":"PK Kohler","year":"2008","unstructured":"Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adolesc Health. 2008;42(4):344\u201351.","journal-title":"J Adolesc Health"},{"issue":"2","key":"1322_CR24","doi-asserted-by":"publisher","first-page":"100048","DOI":"10.1016\/j.conx.2020.100048","volume":"1","author":"A Cheedalla","year":"2020","unstructured":"Cheedalla A, Moreau C, Burke AE. Sex education and contraceptive use of adolescent and young adult females in the United States: an analysis of the National Survey of Family Growth 2011\u20132017. Contraception. 2020;1(2):100048.","journal-title":"Contraception"},{"key":"1322_CR25","unstructured":"Awusabo-Asare K, Ekuban G and Agbemefoh F. Family life education in the new educational system of Ghana. J Special Educ. 1992; 6(1)."},{"issue":"1","key":"1322_CR26","first-page":"88","volume":"9","author":"EY Danso-Wiredu","year":"2017","unstructured":"Danso-Wiredu EY, Midheme E. Slum upgrading in developing countries: lessons from Ghana and Kenya. Ghana J Geography. 2017;9(1):88\u2013108.","journal-title":"Ghana J Geography"},{"key":"1322_CR27","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1186\/s12939-021-01518-y","volume":"20","author":"JK Ganle","year":"2021","unstructured":"Ganle JK, Baatiema L, Ayamah P, Ofori CAE, Ameyaw KE, Seidu AA, Ankomah A. Family planning for urban slums in low- and middle-income countries: a scoping review of interventions\/service delivery models and their impact. Int J Equity Health. 2021;20:186. https:\/\/doi.org\/10.1186\/s12939-021-01518-y.","journal-title":"Int J Equity Health"},{"key":"1322_CR28","unstructured":"Guttmacher Institute. Sexuality Education in Ghana: New Evidence from Three Regions. 2017. https:\/\/www.guttmacher.org\/fact-sheet\/sexuality-education-ghana. Accessed 11 Feb 2021"},{"key":"1322_CR29","doi-asserted-by":"crossref","unstructured":"Miedema E, Oduro GY. Sexuality education in Ghana and Mozambique: an examination of colonising assemblages informing school-based sexuality education initiatives. In The Palgrave Handbook of Sexuality Education. London: Palgrave Macmillan, 2017; pp. 69\u201393.","DOI":"10.1057\/978-1-137-40033-8_4"},{"issue":"1","key":"1322_CR30","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/j.1467-9493.2011.00417.x","volume":"32","author":"AM Oberhauser","year":"2011","unstructured":"Oberhauser AM, Yeboah MA. Heavy burdens: gendered livelihood strategies of porters in Accra, Ghana. Singapore J Trop Geography. 2011;32(1):22\u201337.","journal-title":"Singapore J Trop Geography"},{"issue":"13","key":"1322_CR31","doi-asserted-by":"publisher","first-page":"2903","DOI":"10.1177\/0042098016686526","volume":"55","author":"C Amoako","year":"2018","unstructured":"Amoako C, Inkoom DKB. The production of flood vulnerability in Accra, Ghana: re-thinking flooding and informal urbanisation. Urban Studies. 2018;55(13):2903\u201322.","journal-title":"Urban Studies"},{"key":"1322_CR32","doi-asserted-by":"crossref","unstructured":"Morrison N. Struggling for the right to be recognized: the informal settlement of Old Fadama, Accra, Ghana, In: Geographies of Forced Eviction. London: Palgrave Macmillan, 2017; pp. 25\u201345","DOI":"10.1057\/978-1-137-51127-0_2"},{"key":"1322_CR33","volume-title":"Sampling techniques","author":"WG Cochran","year":"2007","unstructured":"Cochran WG. Sampling techniques. New Jersey: Wiley; 2007."},{"key":"1322_CR34","unstructured":"Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF. Ghana Maternal Health Survey 2017. Accra, Ghana: GSS, GHS, and ICF, 2018."},{"issue":"3","key":"1322_CR35","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1080\/14681811.2018.1533460","volume":"19","author":"C Panchaud","year":"2019","unstructured":"Panchaud C, Keogh SC, Stillman M, Awusabo-Asare K, Motta A, Sidze E, Monz\u00f3n AS. Towards comprehensive sexuality education: a comparative analysis of the policy environment surrounding school-based sexuality education in Ghana, Peru, Kenya and Guatemala. Sex Educ. 2019;19(3):277\u201396.","journal-title":"Sex Educ"},{"issue":"7","key":"1322_CR36","doi-asserted-by":"publisher","first-page":"e0200513","DOI":"10.1371\/journal.pone.0200513","volume":"13","author":"SC Keogh","year":"2018","unstructured":"Keogh SC, Stillman M, Awusabo-Asare K, Sidze E, Monz\u00f3n AS, Motta A, Leong E. Challenges to implementing national comprehensive sexuality education curricula in low-and middle-income countries: case studies of Ghana, Kenya, Peru and Guatemala. PloS One. 2018;13(7):e0200513.","journal-title":"PloS One"},{"key":"1322_CR37","doi-asserted-by":"crossref","unstructured":"Amo-Adjei J. Toward an Understanding of optimal grade for starting sexuality education programme for in-school children and adolescents: insights from Ghana. Am J Sexuality Educ. 2021; 1\u201321.","DOI":"10.1080\/15546128.2021.1892006"},{"key":"1322_CR38","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2021.1894588","author":"J Amo-Adjei","year":"2021","unstructured":"Amo-Adjei J. Local realities or international imposition? Intersecting sexuality education needs of Ghanaian adolescents with international norms. Glob Public Health. 2021. https:\/\/doi.org\/10.1080\/17441692.2021.1894588.","journal-title":"Glob Public Health"},{"issue":"3","key":"1322_CR39","doi-asserted-by":"publisher","first-page":"29","DOI":"10.46281\/aijssr.v5i3.667","volume":"5","author":"R Akter","year":"2020","unstructured":"Akter R. Contraceptive use among slum women in slums of Dhaka City. Am Int J Social Sci Res. 2020;5(3):29\u201335.","journal-title":"Am Int J Social Sci Res"},{"issue":"3","key":"1322_CR40","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1007\/s11524-013-9856-1","volume":"91","author":"M Kamndaya","year":"2014","unstructured":"Kamndaya M, Thomas L, Vearey J, Sartorius B, Kazembe L. Material deprivation affects high sexual risk behavior among young people in urban slums, South Africa. J Urban Health. 2014;91(3):581\u201391.","journal-title":"J Urban Health"},{"issue":"5","key":"1322_CR41","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1177\/0042098010368575","volume":"48","author":"MJ Greif","year":"2011","unstructured":"Greif MJ, Dodoo FNA, Jayaraman A. Urbanisation, poverty and sexual behaviour: the tale of five African cities. Urban Studies. 2011;48(5):947\u201357.","journal-title":"Urban Studies"},{"issue":"1","key":"1322_CR42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12978-020-00998-5","volume":"17","author":"YD Wado","year":"2020","unstructured":"Wado YD, Bangha M, Kabiru CW, Feyissa GT. Nature of, and responses to key sexual and reproductive health challenges for adolescents in urban slums in sub-Saharan Africa: a scoping review. Reprod Health. 2020;17(1):1\u201314.","journal-title":"Reprod Health"},{"key":"1322_CR43","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012249","author":"LM Lopez","year":"2016","unstructured":"Lopez LM, Bernholc A, Chen M, Tolley EE. School-based interventions for improving contraceptive use in adolescents. Cochrane Database Syst Rev. 2016. https:\/\/doi.org\/10.1002\/14651858.CD012249.","journal-title":"Cochrane Database Syst Rev"},{"key":"1322_CR44","doi-asserted-by":"publisher","first-page":"100554","DOI":"10.1016\/j.ssmph.2020.100554","volume":"10","author":"F Appiah","year":"2020","unstructured":"Appiah F, Seidu AA, Ahinkorah BO, Baatiema L, Ameyaw EK. Trends and determinants of contraceptive use among female adolescents in Ghana: analysis of 2003\u20132014 demographic and health surveys. SSM Popul Health. 2020;10:100554.","journal-title":"SSM Popul Health"}],"container-title":["Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12978-021-01322-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12978-021-01322-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12978-021-01322-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T03:06:51Z","timestamp":1642216011000},"score":1,"resource":{"primary":{"URL":"https:\/\/reproductive-health-journal.biomedcentral.com\/articles\/10.1186\/s12978-021-01322-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,15]]},"references-count":44,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["1322"],"URL":"https:\/\/doi.org\/10.1186\/s12978-021-01322-5","relation":{},"ISSN":["1742-4755"],"issn-type":[{"value":"1742-4755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,15]]},"assertion":[{"value":"3 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol has been approved by the Ghana Health Service Ethics Review Committee (Protocol ID NO: GHS-ERC 001\/06\/20). During the data collection, written informed consent was obtained from all participants, including those below 18\u00a0years. Waiver of parental consent for those under the age of 18 was justified on grounds that many of the residents of Agbogbloshie and Old Fadama, including those aged 15 to 17, are migrants. While these individuals are legally minors, they could be considered emancipated adults because they live and work independently in Accra.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflict of interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"7"}}