Document is current

Article History

Received: 1 February 2026

Accepted: 8 May 2026

First Online: 25 May 2026

Declarations

:

: All Ghana Demographic and Health Survey (GDHS) protocols were approved by the Ghana Health Service Ethical Review Committee and ICF Institutional Review Board. The surveys were conducted in accordance with the ethical standards of these committees and in line with relevant international guidelines and regulations for research involving human participants, including the U.S. Department of Health and Human Services regulations. This study used de-identified, publicly available GDHS datasets (2003, 2008, 2014, and 2022) accessed through the WHO Health Equity Assessment Toolkit (HEAT) version 6.1, with data use authorised by The DHS Program. No additional ethical approval was required for this secondary analysis.

: Informed consent was obtained from all participants by the DHS Program prior to data collection. For participants under the age of 18 years, informed consent was obtained from a parent or legal guardian, in accordance with procedures approved by the Ghana Health Service Ethical Review Committee and the ICF Institutional Review Board. Further details on DHS ethical procedures are available at: .

: Not applicable. This study used anonymised, publicly available data and does not contain identifiable individual information.

: All authors contributed to the study conception, design, analysis, drafting, and revision of the manuscript, and approved the final version.

: The authors confirm that this manuscript has not been published elsewhere and is not under consideration by another journal.

: No third-party copyrighted material has been included in this manuscript.

: Artificial intelligence (AI) tools were used solely for grammatical and language refinement of the manuscript. The AI tool did not contribute to the study design, data collection, data analysis, interpretation of findings, or the generation of scientific content. All intellectual contributions and responsibility for the manuscript rest entirely with the authors.

: The authors declare no competing interests.