Department of Biological Sciences
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Item Bullying victimization among in-school adolescents in Sierra Leone: A cross-sectional analysis of the 2017 Sierra Leone Global School-Based Health Survey(Public Library of Science, 2023-12-22) Osborne, AugustusAdolescent bullying victimization is recognized as a public health and mental health problem in many countries. However, data on bullying victimization's prevalence and risk factors is scarce in sub-Saharan Africa Sierra Leone. This research aimed to determine bullying victimization prevalence and its associated factors among Sierra Leonean school-going adolescents. The Sierra Leone 2017 Global School-based Health Survey (GSHS) dataset was analyzed. The outcome variable was the respondent's self-report of bullying victimization ("How many days in the previous 30 days were you bullied?"). Descriptive, Pearson chi-square and binary logistic regression analyses were conducted. The regression analysis yielded adjusted odds ratios (aOR) with 95% confidence intervals (CIs) and a significance level of p 0.05. Bullying victimization was prevalent among 48.7% of the in-school adolescents. Adolescents who drank alcohol \[aOR = 2.48, 95% CI = 1.50-4.10\], who reported feelings of loneliness \[aOR = 1.51, 95% CI = 1.07-2.14\] and who had attempted suicide \[aOR = 1.72, 95% CI = 1.03-2.87\] were also more likely to be bullied. Also, school truancy \[aOR = 1.53, 95% CI = 1.24-1.88\] among teenagers was associated with an increased risk of being bullied. Our findings suggest that bullying is a widespread problem among Sierra Leonean school-aged youth, and alcohol drinking, loneliness, suicide attempt and school truancy are potential risk factors. In light of the aforementioned causes of bullying in schools, policymakers and school administrators in Sierra Leone need to develop and execute anti-bullying policies and initiatives that target the underlying risk factors of bullying among teenagers.Item Women’s knowledge of symptoms of obstetric fistula, experiences, and associated factors in Sierra Leone(Public Library of Science, 2024-10-24) Osborne, AugustusBACKGROUND: Obstetric fistula is a devastating childbirth condition that results from prolonged obstructed labour without timely medical intervention, leading to a tear between the birth canal and the bladder or rectum. It is a public health issue, particularly in low-income countries with limited access to quality maternal healthcare. This study aims to assess knowledge of fistula symptoms among women who had a fistula and its associated factors in Sierra Leone. METHODS: Cross-sectional data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. Our study comprised 15,574 reproductive women aged 15 to 49. Using a four-modelled approach, a mixed-effect multilevel binary logistic regression analysis was performed to assess the factors associated with knowledge of fistula symptoms among women who had a fistula. The results were presented as adjusted odds ratios with a 95% confidence interval. RESULTS: The proportion of knowledge of fistula symptoms among women who had a fistula was 57.5% \[55.3,59.7\] in Sierra Leone. Women aged 20-49, particularly those between 40-44 \[aOR = 2.82; 95% CI: 2.13, 3.73\], were more likely to be aware of knowledge of fistula symptoms among women who had a fistula compared to teenagers (15-19). Women with higher levels of education \[aOR = 2.07; 95% CI: 1.49, 2.88\] were more likely to be aware of knowledge of fistula symptoms among women who had a fistula than those without education. Working women \[aOR = 1.33; 95% CI: 1.14, 1.56\], those who listened to the radio \[aOR = 1.47; 95% CI: 1.30, 1.67\] or used the internet \[aOR = 1.64; 95% CI: 1.32, 2.05\], and those with a high number of lifetime births \[aOR = 2.00; 95% CI: 1.57, 2.54\] were more likely to be aware of knowledge of fistula symptoms among women who had a fistula. Women who had ever had sex \[aOR = 2.19; 95% CI: 1.73, 2.77\], were pregnant \[aOR = 1.37; 95% CI: 1.13, 1.66\] or had terminated a pregnancy \[aOR = 1.30; 95% CI: 1.07, 1.59\] were more likely to be aware of knowledge of fistula symptoms among women who had a fistula. A female household head \[aOR = 1.20; 95% CI: 1.05, 1.38\] was associated with a higher likelihood of knowledge of fistula symptoms among women who had a fistula. On the other hand, larger household sizes \[aOR = 0.86; 95% CI: 0.75, 0.97\] and living in the Western region \[aOR = 0.48; 95% CI: 0.31, 0.75\] were associated with a lower likelihood of knowledge of fistula symptoms among women who had a fistula. CONCLUSION: Most reproductive-aged women in Sierra Leone have knowledge of fistula symptoms among women who had a fistula. Factors such as age, education, occupation, media exposure, parity, sexual activity, pregnancy status, abortion history, ethnicity, household structure, and geographic location influence the knowledge of fistula symptoms among women who had a fistula. Based on these findings, the government and partner organisations in Sierra Leone should implement comprehensive health education programs targeting reproductive-aged women, with a specific focus on obstetric fistula prevention, symptoms, and available treatment options.Item Trends and inequalities in the use of deworming medication during pregnancy in Sierra Leone, 2008–2019(BioMed Central, 2024-11-04) Osborne, AugustusBACKGROUND: Intestinal worm infections are a significant public health concern for pregnant women in low- and middle-income countries. These infections can lead to anaemia, malnutrition, and adverse pregnancy outcomes, including premature birth and low birth weight. Deworming medication during pregnancy is a safe and effective strategy to prevent these complications and improve maternal and child health. This study aims to investigate the trends and inequalities in the use of deworming medication during pregnancy among women in Sierra Leone between 2008 and 2019. METHODS: The study utilised data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. We used the Health Equity Assessment Toolkit developed by the World Health Organisation to calculate various measures of inequality, including difference, ratio, population attributable risk, and population attributable fraction. An inequality assessment was conducted for five stratifiers: age, economic status, level of education, place of residence, and sub-national province. RESULTS: The prevalence of deworming medication during pregnancy was 43.8% in 2008, 72.4% in 2013, and 83.5% in 2019 in Sierra Leone. There was a decrease in age-related inequality from a difference of 3.7% in 2008 to -0.8% in 2019. Economic-related inequality increased from a difference of -8.5% in 2008 to -8.2% in 2019. Both population attributable fraction and population attributable risk were zero in all survey years for economic status, indicating no improvement in the setting average without economic-related inequality. Inequality in education increased from a difference of -8.9% in 2008 to -8.4% in 2019 and decreased from a difference of -2.6% in 2008 to -5.5% in 2019 for place of residence. Provincial inequality decreased from a difference of 29.5% in 2008 to 11.8% in 2019. The population attributable risk for province reveals that the setting average could have been 10.5 percentage points lower in 2008, 8.2 percentage points lower in 2013, and 5.9 percentage points lower in 2019 without provincial inequality. CONCLUSION: The prevalence of deworming medication use during pregnancy substantially increased from 2008 to 2019 (43.8% to 83.5%) in Sierra Leone. This suggests a positive public health trend in maternal healthcare access and education. Inequalities related to economic status and education increased slightly while age-related, place of residence and provincial inequalities decreased. This indicates an inequitable distribution of this essential healthcare intervention across these stratifiers. The government and policymakers should continue efforts to raise awareness and promote the use of deworming medication during pregnancy.Item Trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone(BioMed Central, 2024-10-02) Osborne, AugustusBACKGROUND: Sierra Leone has improved child health outcomes in recent decades. However, diarrhoeal diseases remain a public health concern, particularly among children under five. This study investigates the trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone in 2008, 2013 and 2019. METHODS: The analysis utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. The software utilised for the calculation of various measures of inequality, including simple difference, ratio, population-attributable risk, and population-attributable fraction, was the World Health Organization Health Equity Assessment Toolkit. An inequality assessment was conducted for six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region. RESULTS: Our findings reveal that children under five with diarrhoea receiving oral rehydration therapy and continued feeding increased from 56.5% in 2008 to 59.7% in 2019 in Sierra Leone. Children of mothers aged 20-49 had more coverage over time than those with mothers aged 15-19. Children of mothers who are wealthy, more educated, and living in urban areas show a decrease in coverage with time compared to the poor, the lowly educated, and those residing in rural areas. Male children had higher coverage than female children. Regional inequality decreased slightly from 21.5 percentage points in 2008 to 21.2 percentage points in 2019. CONCLUSION: The findings revealed a mixed picture of progress in oral rehydration therapy and continued feeding for children under five in Sierra Leone. While national coverage has increased, inequalities persist. Children of older mothers and those from disadvantaged backgrounds have experienced improvements, while children of younger, wealthier, and more educated mothers in urban areas have seen a decline in coverage. The gender and regional inequalities remain. Expanding community-based health programs, providing subsidised or free supplies, and strengthening health systems in underserved areas are key strategies to ensure equitable and effective healthcare for all children in Sierra Leone.Item Trends and inequalities in modern contraceptive use among women in Sierra Leone, 2008–2019(BioMed Central, 2024-11-19) Osborne, AugustusBACKGROUND: Despite the known benefits of modern contraceptives in preventing unwanted pregnancies and reducing unsafe abortions, their use remains low among women of reproductive age in several sub-Saharan African countries, including Sierra Leone. This study investigated the inequalities in modern contraceptive use among women in Sierra Leone based on data from 2008 to 2019. METHODS: We used data from the Sierra Leone Demographic Health Survey data rounds (2008, 2013, and 2019). The World Health Organization's Health Equity Assessment Toolkit (WHO's HEAT) software was used to calculate both simple measures; Difference (D) and Ratio (R) and complex measures of inequality: Population Attributable Risk (PAR) and Population Attributable Fraction (PAF). The inequality assessment was done for five stratifiers: age, economic status, level of education, place of residence, and sub-national province. RESULTS: The study found that the prevalence of modern contraceptive use among women in Sierra Leone increased from 6.7% in 2008 to 20.9% in 2019. There was an increase in age-related inequality from a Difference of 5.9 percentage points in 2008 to 7.0 percentage points in 2019. PAF decreased from 5.7% in 2008 to 1.6% in 2019, indicating that the national average of modern contraceptive use would have increased by 5.7% in 2008 and 1.6% in 2019 in the absence of age-related inequalities. For economic status, the Difference decreased from 14.9 percentage points in 2008 to 9.9 percentage points in 2019. PAF decreased from 166.3% in 2008 to 23.3% in 2019, indicating that the national average of modern contraceptive use would have increased by 166.3% in 2008 and 23.3% in 2019 in the absence of economic-related inequalities. For education, the Difference decreased from 15.1 percentage points in 2008 to 12.4 percentage points in 2019. The PAF shows that the national average of modern contraceptive use would have reduced from 189.8% in 2008 to 39.5% in 2019, in the absence of education-related inequality. With respect to place of residence, the Difference decreased from 10.4 percentage points in 2008 to 7.6 percentage points in 2019, and PAF decreased from 111.2% in 2008 to 23.0% in 2019. The decline in PAF indicates that the national average of modern contraceptive use would have increased by 111.2% in 2008 and 23.0% in 2019 without residence-related inequality. Provincial-related inequality decreased from a Difference of 15.5% in 2008 to 8.5% in 2019. The PAF results showed a decrease in inequality from 176.3% in 2008 to 16.7% in 2019, indicating that province would contribute 176.3% and 16.7% in 2008 and 2019 respectively to the national average of modern contraceptive use. CONCLUSION: The use of modern contraceptives among women of reproductive age in Sierra Leone increased between 2008 and 2019 reflecting positive progress in reproductive health initiatives and access to family planning resources. The reductions in inequalities related to economic status, education, residence, and province indicate that efforts to promote equity in contraceptive access are yielding results, although age-related inequalities persist. To build on these advancements, it is recommended that policymakers continue to strengthen educational campaigns and healthcare services, particularly targeting younger women. Additionally, enhancing access to contraceptive methods through community-based programs and addressing socio-economic barriers will be crucial in further reducing inequalities and improving overall reproductive health outcomes in Sierra Leone.Item Trends and inequalities in BCG immunisation coverage among one-year-olds in Sierra Leone, 2008–2019(BioMed Central, 2024-11-30) Osborne, AugustusBACKGROUND: Bacillus Calmette-Guérin (BCG) vaccination is a cornerstone of childhood immunisation programs, protecting against tuberculosis (TB), a major public health concern. Sierra Leone, a West African nation, faces challenges in achieving equitable and high BCG immunisation coverage. This study delves into the trends and inequalities in BCG coverage among one-year-old children in Sierra Leone between 2008 and 2019. METHODS: Three rounds of data from the Sierra Leone Demographic and Health Surveys (2008, 2013, and 2019) were used to analysed to examine the inequalities in BCG coverage. Simple measures of inequality \[Difference (D) and Ratio (R)\] and complex measures of inequality \[Population Attributable Ratio (PAR) and Fraction (PAF)\] were calculated in the World Health Organization's Health Equity Assessment Toolkit (WHO's HEAT) software. The measures were calculated separately for each of the three surveys for age groups of women, level of education, economic status, residential areas, gender, and sub-national provinces, and their estimates were compared. RESULTS: The findings revealed that BCG immunisation coverage in Sierra Leone has increased significantly from 2008 (82.0%) to 2019 (96.3%). Age-related inequalities between children of older mothers (20-49) and younger mothers (15-19) increased from a Difference of -4.7 percentage points in 2008 to 4.8 percentage points in 2019. The PAF increased from zero in 2008 to 0.4% in 2019. This means that in the absence of age-related inequalities, the national average of BCG immunisation coverage would have increased by 0.4%. Economic-related inequalities between children of mothers in Quintile 5 (richest) and Quintile 1 (poorest) decreased from a Difference of 9.2 percentage points in 2008 to 1.2 percentage points in 2019. Educational-related inequalities between children of mothers with secondary/higher education and no education decreased from a Difference of 14.1 percentage points in 2008 to 0.4 percentage points in 2019. The PAF decreased from 13.3% in 2008 to 0.2% in 2019, indicating that without educational-related inequalities the setting average of BCG immunisation coverage would have increased by 0.2%. Place of residence-related inequalities between children of mothers living in urban areas and rural areas decreased from a Difference of 9.3 percentage points in 2008 to 0.7 percentage points in 2019. The PAF decreased from 8.5% in 2008 to 0.5% in 2019 indicating that the national average of BCG immunisation coverage would have increased by 0.5% without place of residence-related inequalities. The sex of the child-related inequalities between male and female children decreased from a Difference of 5.4 percentage points in 2008 to 0.7 percentage points in 2019. The PAF decreased from 3.3% in 2008 to 0.4% in 2019 indicating that the national average of BCG immunisation coverage would have increased by 0.4% without sex of the child-related inequalities. Provincial inequalities decreased from a Difference of 18.5 percentage points in 2008 to 2.3 percentage points in 2019. The PAF decreased from 14.3% in 2008 to 1.1% in 2019 indicating that the national average of BCG immunisation coverage would have increased by 1.1% without provincial inequalities. CONCLUSION: The findings indicate a substantial improvement in BCG immunisation coverage in Sierra Leone among one-year-olds, reflecting successful public health initiatives. However, age-related inequalities have worsened, with coverage among children of younger mothers declining relative to those of older mothers, suggesting a need for targeted interventions for this population. In contrast, economic, educational, sex, and place of residence-related inequalities have notably decreased, indicating progress in equitable access to immunisation across different socioeconomic strata. Additionally, provincial inequalities have decreased significantly, yet a difference of 2.3 percentage points remains, highlighting the need for continued efforts to ensure that all provinces, receive adequate healthcare resources and outreach. The absence of economic-related inequality by 2019 is particularly encouraging, as it suggests that economic barriers to immunisation have been effectively addressed. Furthermore, the reduction in educational and provincial inequalities highlights the effectiveness of strategies aimed at improving access and awareness in underserved areas.Item Trends and inequalities in adequate antenatal care coverage among women in Sierra Leone, 2008–2019(BioMed Central, 2024-11-13) Osborne, AugustusBACKGROUND: Prenatal care is a critical component of maternal and child health, providing essential preventive, diagnostic, and therapeutic services to pregnant women. Adequate antenatal care has been linked to reduced maternal and infant mortality and improved birth outcomes. Despite its importance, disparities in antenatal care coverage persist globally, including Sierra Leone, with significant implications for maternal and child health. This study examined the trends and inequalities in antenatal care utilisation in Sierra Leone. METHODS: We used data from the 2008, 2013, and 2019 Sierra Leone Demographic and Health Surveys. Simple inequality measures (Difference and Ratio) and complex measures (Population Attributable Risk and Population Attributable Fraction) were computed using the World Health Organization's Health Equity Assessment Toolkit software. Inequality in antenatal care was calculated on six stratefiers: age groups for women, birth order, educational levels, economic status, residential areas, and sub-national province. RESULTS: There was a significant increase in adequate antenatal care coverage from 2008 (15.2%) to 2013 (36.5%) but a decrease in 2019 (22.1%). The inequality in age increased over time from a Difference of 2.7 percentage points in 2008 to a Difference of 5.3 percentage points in 2019, indicating age-related inequalities. The Population Attributable Fraction decreased from 2.7% in 2008 to zero in 2013, indicating no further improvement in the national average of adequate antenatal care coverage can be achieved in the absence of age-related inequalities. However, it increased to 7.7% in 2019, indicating that the national average of adequate antenatal care coverage would have increased by 7.7% in the absence of age-related inequalities. The birth order inequality increased from a Difference of - 5.2 percentage points in 2008 to 2.6 percentage points in 2019. The Population Attributable Fraction was zero in 2008 and 3.4% in 2019, showing that the national average of adequate antenatal care coverage would have increased by 3.4% if there was no parity-based inequality. Inequality in economic status decreased from 32.1 percentage points in 2008 (Difference = 32.1) to 2.8 percentage points in 2019 (Difference = 2.8). The Population Attributable Fraction revealed that the national average could have been 164.4% higher in 2008 and 20.8% higher in 2013; however, it was zero in 2019, indicating that no further improvement can be achieved in the national average if there was no inequality related to economic status. Inequality for education decreased from 49.9 percentage points in 2008 (Difference = 49.9) to 11.0 percentage points in 2019 (Difference = 11.0). Inequality decreased from a Difference of 20.8 percentage points in 2008 to a Difference of 1.7 percentage points in 2019 for place of residence inequality, showing a reduction in inequality. Provincial inequality decreased from a Difference of 33.9 percentage points in 2008 to 8.5 percentage points in 2019. CONCLUSION: While there have been notable improvements in antenatal care coverage in Sierra Leone, adequate antenatal care coverage is still below the WHO target of 78% in 2016, and significant inequalities persist. Addressing these inequalities requires a multifaceted approach considering demographic, economic, educational, and geographic indicators considered in this study. Sustained efforts and targeted interventions are critical by the Sierra Leone government to ensure that all women, regardless of their background, have access to essential antenatal care services up to at least eight visits.Item The paternal influence on early childhood development in Africa: implications for child and adolescent mental health(BioMed Central, 2024-12-06) Osborne, AugustusThis commentary examines the influence of fathers in early childhood development in Africa and its implications for child and adolescent mental health. Historically overshadowed by maternal influence, research increasingly highlights the multifaceted impact of paternal involvement on children's cognitive, emotional, social, and behavioural development. Fathers contribute uniquely to children's mental growth through stimulating play and rich language interaction. Their emotional engagement fosters children's self-esteem and resilience. Moreover, fathers influence social skills by modelling interactions and encouraging exploration. Paternal involvement is linked to improved behaviour regulation. Beyond direct interaction, factors such as paternal mental health, economic stability, and co-parenting dynamics also shape child outcomes. Despite the impact of engaged fatherhood on children's cognitive, emotional, and social development, many fathers encounter barriers such as economic pressures, cultural norms, and migration. These challenges often hinder their ability to participate actively in their children's lives, resulting in a disconnect that can affect family dynamics and child well-being. Addressing cultural and societal barriers to father involvement is crucial to optimise child development. To address these issues, the paper outlines several key policy implications aimed at promoting paternal involvement. This commentary serves as a foundation for further exploration of fathers' complex and vital role in shaping children's lives.Item Spatial distribution and factors associated with HIV testing among adolescent girls and young women in Sierra Leone(BioMed Central, 2024-10-22) Osborne, AugustusBACKGROUND: Sierra Leone faces a significant challenge in addressing HIV/AIDS, particularly among adolescent girls and young women. This age group is considered highly vulnerable due to biological factors and social inequalities. Understanding the prevalence of HIV testing in this demographic is crucial for designing effective prevention and treatment strategies. This study investigated the spatial distribution of HIV testing and its associated factors among adolescent girls and young women in Sierra Leone. METHODS: Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. The sample comprised 6,062 adolescent girls and young women between the ages of 15 and 24. Spatial autocorrelation and Moran's I statistic were employed to analyze the spatial distribution of HIV testing. An analysis utilising mixed-effect multilevel binary logistic regression was performed to determine the factors associated with HIV testing. The findings were presented as adjusted odds ratios (aOR) and a 95% confidence interval (CI). RESULTS: The national prevalence of HIV testing among adolescents and young women in Sierra Leone was 42.1% \[40.3,43.9\]. Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts were found to be statistically significant hotspot for HIV testing. Whereas, Karene, Falaba, Bo, kenema, and some parts of Pujuhun were statistically cold spot districts. Adolescent girls and young women aged 20-24 \[aOR = 1.63, 95% CI = 1.29, 2.07\] had higher odds of HIV testing than those aged 15-19. Those with secondary/higher education \[aOR = 1.87, 95% CI = 1.40, 2.51\] had higher odds of HIV testing than those with no education. The odds of HIV testing was higher among adolescent girls and young women who use the Internet \[aOR = 1.75, 95% CI = 1.32, 2.33\] than those who did not use internet. Adolescent girls and young women with one \[aOR = 16.56, 95% CI = 12.31, 22.29\] and two or more parity \[aOR = 16.37, 95% CI = 10.86, 24.68\] had higher odds of HIV testing than those with no parity. The likelihood of HIV testing was higher among adolescent girls and young women who had sex below 18 \[aOR = 4.54, 95% CI = 3.25, 6.34\] and those who had sex at 18+ \[aOR = 5.70, 95% CI = 3.84, 8.45\] compared to those who had never had sex. Adolescent girls and young women who visited health facilities in the past 12 months \[aOR = 1.82, 95% CI = 1.46, 2.26\] had higher odds of HIV testing than those who did not. CONCLUSION: Despite some positive trends, HIV testing rates among adolescent girls and young women in Sierra Leone remain moderate. Spatial autocorrelation analysis consistently revealed hotspots and cold spots for HIV testing, with Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts remaining persistent hotspots. Age, education, internet use, sexual history, parity, and healthcare access are significant factors influencing testing behaviour. To improve testing rates, the government and policymakers should prioritize educational campaigns, expand internet access, integrate HIV testing into routine healthcare, and address stigma associated with HIV.Item Spatial distribution and factors associated with high completed fertility among women aged 40–49 years in Ghana: evidence from the 2022 Ghana Demographic Health Survey(BioMed Central, 2024-07-11) Osborne, AugustusBACKGROUND: High completed fertility among married and cohabiting women has profound consequences, including straining resources, increasing healthcare challenges, and contributing to educational and gender inequalities. This study examined the factors associated with high completed fertility among married and cohabiting women aged 40-49 years in Ghana. METHODS: Data for the study was sourced from the 2022 Ghana Demographic and Health Survey (GDHS). A spatial map was used to present the women's geographic variations in high completed fertility. A mixed-effect multilevel binary logistic regression analysis was performed to identify the factors associated with high completed fertility. The findings were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). RESULTS: The national proportion of high completed fertility among married and cohabiting women aged 40-49 years in Ghana was 52.0% \[48.8, 55.2\]. Women who were Ga/Dangme/Ewe by tribe \[aOR = 2.32, 95% CI = 1.06, 5.08\] had higher odds of high completed fertility than Akans. Women who indicated 6 + as their ideal number of children had a higher \[aOR = 5.60, 95% CI = 2.90, 10.82\] likelihood of high completed fertility compared to those whose ideal number of children was 0-3. Those who were using contraceptives at the time of the survey had a higher \[aOR = 2.31, 95% CI = 1.17, 4.55\] likelihood of high completed fertility compared to those who were not using contraceptives. Women with secondary/higher education \[aOR = 0.32, 95% CI = 0.17, 0.58\] had lower odds of high completed fertility than those without no formal education. Women with females as household heads \[aOR = 0.56, 95% CI = 0.33, 0.95\] had lower odds of high completed fertility than males. Women in Volta, Western North, Ahafo, and Bono regions had lower odds of high completed fertility compared to those living in the Northeast region, with the lowest odds among those living in the Volta region \[aOR = 0.08, 95% CI = 0.02, 0.40\]. CONCLUSION: High completed fertility is prevalent in Ghana, with more than half of married and cohabiting women having at least five or more children. The government and policymakers in Ghana should promote education for women, increase culturally sensitive family planning programs, increase access to family planning resources, address ideal family size preferences, and improve understanding of contraceptive use.