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A Review of Leadership and Capacity Gaps in Nutrition Sensitive Agricultural Policies and Strategies for Selected Countries in Sub-Saharan Africa and Asia
(Food and Nutrition Bulletin, 2020) Aryeetey, R.; Covic, N.
Background: Agriculture policies and strategies designed, purposefully, to address malnutrition are considered nutrition-sensitive and are a critical component of global efforts to address malnutrition in all its forms. However, limited evidence exists on the extent and how nutrition is being integrated into agriculture sector policies, strategies, and programs. A review was conducted to address 2 questions: How nutrition-sensitive are agriculture policies, plans, and investments in selected Sub-Saharan African (SSA) and Asian countries? and Which capacity and leadership gaps limit scale up of nutrition-sensitive agriculture Policy and programs? Methods: The review of existing policies was conducted for 11 selected focus countries (9 in SSA and 2 from Asia) of the CGIAR (Consultative Group on International Agricultural Research) Collaborative Research Programme on Agriculture for Nutrition and Health led by the IFPRI (International Food Policy Research Institute). The Food and Agriculture Organization (FAO)’s 10-point key recommendation for designing nutrition-sensitive agricultural interventions was used as an analytical framework. Additionally, a rapid systematic review of published peer-reviewed and grey literature was carried out to identify capacity gaps based on the United Nations Development Program’s capacity assessment framework. Results: We found that there is nutrition sensitivity to the policies and strategies but to varying degrees. There is limited capacity for optimum implementation of these policies, programs, and strategies. For most countries, there is a capacity to articulate what needs to happen, but there are important capacity limitations to translate the given policy/program instruments into effective action. Conclusions: The gaps identified constitute important evidence to inform capacity strengthening of nutrition-sensitive actions for desired nutrition and health outcomes in Africa and Asia.
Accessibility to and Utilization of Primary Health Care in the Ga, Dangme East and Dangme West Districts of the Greater Accra Region
(University of Ghana, 2003-11) Mensah, C.M.; Nabila, J.S.; Ardayfio-Schandorf, E.; Awumbila, M.; Agyei-Mensah, S.; University of Ghana, College of Humanities, School of Social Sciences, Department of Geography and Resource Development
The study examined the accessibility and other socio-economic forces that influence the utilization of primary health care services in the rural parts of the Greater Accra Region of Ghana. Three administrative districts, Ga, Dangme West and Dangme East, were selected for study. Both qualitative and quantitative data were used. Questionnaire and interview schedules reinforced by focus group discussions and observations, were the main research instruments. Descriptive and multivariate techniques are the analytical tools. The main factors that influenced utilization as established by the empirical research, have been income, distance, transport and service costs, waiting and travel times, educational status in the analysis. The researcher establishes that, the main factors that influence utilization of primary health care services in the rural parts of Greater Accra Region are income and distance. The other factors are service costs, transport cost and waiting time. Income shows a positive relationship with utilization, whilst service cost exhibits a negative relationship to validate the hypotheses. Income makes a stronger impact than distance, service cost and waiting time. The impact of education, though statistically significant, is weak. There were differences by place of residence, and also by health status (patient and nonpatient). With regard to income, the impact at the Ga District is stronger than that of the Dangme West and Dangme East Districts, whilst non-patients are more affected than patients. With regard to distance and utilization, the Dangme East and Dangme West Districts show a stronger negative impact than the Ga District, whilst the impact of patients is stronger than non-patients. Waiting time and service costs have a greater impact in the Ga District than in the Dangme West and Dangme East Districts. For health status, patients are more affected by distance than non-patients. Several recommendations have been made to enhance utilization and the quality of health and health care. These include among others the strengthening and upgrading of primary health care facilities in the rural districts, improvement of the quantity and quality of medical and paramedical staff and the introduction of a National Health Insurance Scheme.
Acquisition of English Syllable Structure through Explicit Teaching among Hausa Speakers
(University of Ghana, 2019-03) Sadat, M.
The debate between the effectiveness of explicit and implicit teaching has taken a center stage in the second language acquisition literature over a long period of time. Most of such debates center on grammar teaching and very few discuss suprasegmental features especially, syllable structure. All languages have some sort of syllabicity; however, the phonetic characteristics of syllables differ across languages. The difference can be seen in the types of sounds that can cluster together around a single syllabic nucleus. The current work examines the effects of explicit instruction on the acquisition of English syllable structure among native Hausa speakers. The work investigates the efficiency of interventions through explicit teaching on the English syllable structure in a classroom setting. English syllables have some structures that are absent in Hausa and these structures pose some difficulties for Hausa speakers who learn English. This work explores the structures and adopts explicit instruction as an intervention to remedy the difficulties through explicit teaching. The investigation was done on participants who are Ghanaian Hausa speakers learning English. Generally, the work adds to the literature on the efficacy of explicit teaching, and specifically on the teaching of English syllable structure among Hausa speakers. Finally, the work investigates some of the constraints that learners and teachers are faced with in Teaching English as a Second Language (TESL) and offers suggestions for improving the teaching of English pronunciation to Hausa learners. The study discovers that in disyllabic word, there is preference of trochaic syllable over iambic syllable, acquisition of onsets is easier than acquisition of codas and finally, explicit teaching is very effective in classroom.
Acquisition of English Syllable Structure through Explicit Teaching among Hausa Speakers
(University of Ghana, 2019-03) Sadat, M.
The debate between the effectiveness of explicit and implicit teaching has taken a center stage in the second language acquisition literature over a long period of time. Most of such debates center on grammar teaching and very few discuss suprasegmental features especially, syllable structure. All languages have some sort of syllabicity; however, the phonetic characteristics of syllables differ across languages. The difference can be seen in the types of sounds that can cluster together around a single syllabic nucleus. The current work examines the effects of explicit instruction on the acquisition of English syllable structure among native Hausa speakers. The work investigates the efficiency of interventions through explicit teaching on the English syllable structure in a classroom setting. English syllables have some structures that are absent in Hausa and these structures pose some difficulties for Hausa speakers who learn English. This work explores the structures and adopts explicit instruction as an intervention to remedy the difficulties through explicit teaching. The investigation was done on participants who are Ghanaian Hausa speakers learning English. Generally, the work adds to the literature on the efficacy of explicit teaching, and specifically on the teaching of English syllable structure among Hausa speakers. Finally, the work investigates some of the constraints that learners and teachers are faced with in Teaching English as a Second Language (TESL) and offers suggestions for improving the teaching of English pronunciation to Hausa learners. The study discovers that in disyllabic word, there is preference of trochaic syllable over iambic syllable, acquisition of onsets is easier than acquisition of codas and finally, explicit teaching is very effective in classroom.
Acute Febrile Illness: The Role of Respiratory Syncytial Virus and Malaria in an Urban Peadiatric Population in Ghana
(University of Ghana, 2011-10) Malm, K.L.; Koram, K.A.; Gyapong, J.
Introduction: Fever describes an increase in internal body temperature to levels that are above normal (commonly oral/axillary measurement of normal human body temperature is 36.8±0.7 °C or 98.2±1.3 °F) and is the most common response of the body to any insult to the body. The most common cause of fever in our setting is malaria and therefore children get treated for malaria once they have a fever whether the cause is proven (by laboratory confirmation) to be malaria or not. Other common causes of childhood fever, such as respiratory infections are not usually considered, although this has been found to be responsible for a high proportion of childhood illness in the West African Region in places such as The Gambia. Most of these respiratory infections are caused by viral agents including respiratory syncytial virus (RSV). Very little information exists on causes of fever in Ghana and therefore this study was conducted to determine the relative importance of RSV and malaria as causes of Acute Febrile Ilness in children under 5 years presenting at an urban hospital in Accra. Methods: The study recruited children under five years with an axillary temperature≥ 37.5°C who presented to the out-patients department of the La General Hospital from February 2009 to February 2010. A questionnaire was administered to their parents/caretakers (after consenting to allow their children to be part of the study) to elicit the demographic and socioeconomic characteristics of the recruited children and a physical examination conducted all children. Nasopharyngeal aspirates and blood samples were taken for polymerase chain reaction (PCR) for RSV and microscopy for malaria parasites respectively. A case control study was also undertaken to determine the risk factors for RSV infection among acute respiratory infection cases. Cases were children with acute respiratory infection who were positive for RSV and controls were children with acute respiratory infection who were negative for RSV. Results: Malaria, defined as presence of malaria parasites on microscopy, was found in 11.2% of all acute febrile illness. RSV was seen in 15.6% and 17.5% of acute febrile illness and respiratory infections respectively. Seven children representing 1.5% of children with acute febrile illness were positive for both malaria and RSV. Overcrowding and exclusive breastfeeding were significantly positively associated with RSV infection (p-value<0.01), whilst male gender, young age of less than one year and prematurity were also positively associated with RSV infection though not statistically significant. Discussion and Conclusion: The proportion of acute febrile illness due to malaria is lower than has been recorded routinely in children less than five years in this urban hospital. RSV is significantly prevalent in these children. Co-morbid infection with RSV and malaria was low. It is therefore important health practitioners support their diagnosis of malaria with laboratory confirmation, and also look out for other causes of fever such as RSV. The practice of treating almost all cases of fever as malaria needs to be examined critically.
Adaptation of Urban Vegetable Farmers to Urban Change in the Greater Accra Metropolitan Area
(University of Ghana, 2018-07) Tuffour, M.
Ghana’s urban change has been intense and rapid on several fronts over the past years. This has affected several economic activities within the urban space of which one is urban agriculture. Urban agriculture has over the years attracted attention in research due to its significance in the urban space. Notwithstanding the attention given in research, the assessment of urban farmers’ adaptation to the effect of the rapid urban change has not been given a detailed attention in literature. This study, which had an overarching question of how urban farmers are adapting to the effects of urban change on their farming activities within the context of institutional frameworks and roles, was situated in change, resilience and behaviour theories. Using a collective case study design and pragmatist research approach, the study adopted an exploratory sequential mixed method, which had qualitative as the leading research approach and with quantitative following. The sources of the qualitative data used were interviews from farmers, interviews from institutional representatives, and institutional policy documents that influence urban agriculture. The quantitative data was from a survey of 251 farmers, and rainfall, humidity and temperature data from the Ghana Meteorological Agency (GMA). In examining the importance of institutional frameworks and roles in urban agriculture, the effect of urban change on urban farmers’ activities and the adaptation strategies farmers use with respect to urban change, content and thematic analyses of the interviews conducted and government policy documents were mainly used, with some descriptive statistics supporting. In estimating the factors that determine urban farmers’ adaption to urban change, a quantitative approach, which combined principal component analysis and ordinary least squares was used. The following findings were made based on the analyses. Institutional actors are involved in urban agriculture promotion through the training of farmers, provision of logistics and land for production, notwithstanding the fact that the changing urban environment makes it difficult for them to help the farmers. The institutions, which provide lands to the farmers do not have any official agreement with the farmers and sometimes abuse them even though they are a tremendous source of support to farmers. While some of the urban changes have brought only positive or only negative effects to urban farmers, others have brought both to them. The study could not conclude on which set of effects of urban change was more significant. While some adaptation strategies targeted an effect, others targeted more than one effect, which was positive or negative. The ordinary least square estimates proved that production adaptation can be predicted more than marketing and finance adaptation, by personal and farm characteristics of urban farmers in the context of urban change. The study recommends the drafting of a comprehensive urban agriculture policy in Ghana, which focuses on the provision of land and water for urban agriculture, training of urban vegetable farmers and the strengthening of the institutions whose operations affect urban agriculture in the area of coordination, cooperation and promotion of urban agriculture. In the absence of a comprehensive UA policy, MMDAs should consciously make room for UA especially in their spatial planning decisions. Government and urban dwellers as well should also see urban expansion as an opportunity to create urban employment and a way to improve the welfare of city dwellers and this should be integrated into city planning. Institutions must use multi-faceted and targeted strategies in helping farmers to adapt to the positive and negative effects of urban change, and farmers must be encouraged to transfer their knowledge and skill in adaptation to other farmers.
Adaptation to Climate Change: Effects of Productivity Improving Strategies on Cocoa Farmers' Livelihoods in the Central Region, Ghana.
(University Of Ghana, 2019-07) Asare, K.N.
The thesis assessed the capacity of cocoa farmers to adapt to climate change and adopt productivity-improving strategies. It also determines the effect of the adoption of productivity-improving strategies on farmer's livelihoods in the Central Region of Ghana. The key issues addressed in this thesis were: what are the key adaptation strategies; what is the level of farmers' capacity for adopting productivity-improving strategies (PIS); magnitudes in the factors influencing adoption of productivity-improving strategies and the effects of the adoption of PIS on enhancing their livelihoods. Semi-structured questionnaire was used to collect data from 443 cocoa farmers and 11 local institutions. The adaptation strategies known and employed by cocoa farmers were analyzed using relative frequencies. The level of adaptive capacity of farmers was estimated and the Logit model was used in analyzing the magnitudes in the factors of adopting PIS. Ordinary Least Square was used to analyze the effects of PIS on farmer's livelihoods. The results from the study showed that on-farm adaptation strategies known and employed by farmers included the use of improved hybrid seed varieties, changing planting dates as well as the application of chemical fertilizer. Although half (50%) of the farmers were categorized as having moderate adaptive capacity, many adopted the productivity-improving strategies (PIS). The most important factors influencing the adoption of PIS were age, gender, total on-farm income, institutional support, and adaptive capacity. Adoption of PIS had a positive effect on their livelihoods (income). The study recommends that local institutions (cocoa LBCs) should be encouraged to provide support in the form of training and education to improve the low capacity for the key crop management practices required to mitigate climate change resources to farmers to enhance their capacity. Institutions and stakeholders should provide support ( credit, training, and technology transfer) to enhance their adaptive capacity (assets) and also to enhance their technology adoption.
Adaptation to Urban Floods Among the Poor in the Accra Metropolitan Area
(University of Ghana, 2014-12) Abeka, E.A.; Asante, F.A.; Codjoe, S.N.; Laube, W.; University of Ghana, College of Humanities, Institute of Statistical, Social and Economic Research
Urbanisation and climate change are likely to induce more floods in African cities. Nonetheless, studies on public and private adaptation to floods that centre on the urban poor in Africa are scanty. Studies in this area largely reflect the structuralist conception of adaptation. This study departs from this top-down approach as it explores household and public adaptation to urban floods among the poor in Accra from an actor-oriented perspective. Specifically, the study objectives are to: a) analyse the causes of flooding in poor urban communities in Accra from various actor perspectives; b) understand the actions and challenges of actors involved in flood adaptation; and c) determine the correlates of household flood risk and private proactive adaptation choices among the poor in Accra. The study applied both exploratory and cross-sectional designs. Data collection methods under the exploratory design were literature review, in-depth interviews with key informants and focus group discussions in three communities, namely, Glefe, Mpoase and Agbogbloshie. A mini workshop for stakeholders in flood adaptation in Accra was organised to brainstorm on challenges within the network of actors. The study employed Kendall‟s Co-efficient of Concordance, network maps and content analyses of in-depth interviews as well as focus group discussions to achieve the first and second objectives. The cross-sectional aspect of the study involved structured interviews with 330 households selected through multi-stage sampling and using logistic and ordered probability regressions to analyse the results of the household survey to achieve objective three. The study found out that the level agreement on the perceived causes of flooding among actors involved flood adaptation in Accra was rather low. The differences in opinion were influenced by externalisation of blame and responsibility among actors as well as different actor interests. The challenges to public adaptation to urban floods in Accra are legal pluralism, strict adherence to organisational goals among formal institutions involved in flood adaptation and poor integration of local knowledge into formal flood abatement systems. There is also mistrust between local communities and the metropolitan level actors. At the household level, the predictors of flood adaptation choices were tenancy status, home elevation, type of wall material, perceptions about future occurrence of floods, perceived adaptation cost, perceived adaptation efficacy and availability of bonding social capital. The study also found out that taking precautionary measures ahead of floods and living in sandcrete houses away from water bodies and at high elevations reduced household susceptibility to property damage or loss from urban floods. The study recommends streamlining power relations among institutions involved in flood adaptation and integrating informal actors into the formal flood adaptation structures at the metropolitan level. Awareness creation programmes should focus on zoning regulations, future occurrence of floods and construction materials/methods in flood zones. Finally, in-situ community upgrading, flood zone planning and enforcement of zoning regulations is also recommended to minimise exposure to flood risk in the study communities.
Addressing Malnutrition: The Importance of Political Economy Analysis of Power
(International Journal of Health Policy and Management, 2020) Walls, H.; Laar, A.; Nisbett, N.; et.al
Background: The exercise of power is central to understanding global health and its policy and governance processes, including how food systems operate and shape population nutrition. However, the issue of power in food systems has been little explored empirically or theoretically to date. In this article, we review previous work on understanding power in addressing malnutrition as part of food systems that could be used in taking this issue further in future food systems research. In particular, we examine why acknowledging power is vital in addressing food systems for better nutritional outcomes, approaches to assessing power in empirical research, and ways of addressing issues of power as they relate to food systems. Methods: We undertook a narrative review and synthesis. This involved identifying relevant articles from searches of PubMed and Scopus, and examining the reference lists of included studies. We considered for inclusion literature written in English and related to countries of all income levels. Data from the included articles were summarized under several themes. Results: We highlight the importance of acknowledging power as a critical issue in food systems, present approaches that can be taken by food-systems researchers and practitioners in assessing power to understand how power works in food systems and wider society, and present material relating to addressing power and developing strategies to improve food systems for better nutrition, health, and well-being. Conclusion: A range of research approaches exist that can inform the examination of power in food systems, and support the development of strategies to improve food systems for better nutrition, health, and well-being. However, there is considerable scope for further work in this under-researched area. We hope that this review will support the necessary research to understand further power in food systems and drive the much-needed transformative change.
Adherence to Hepatitis B Virus Infection Prevention Protocol among Health Care Workers in Selected Public Health Facilities in the Greater Accra Region
(University Of Ghana, 2019-07) Senoo, V.E.
Introduction: The World Health Organization global disease burden from sharp injuries revealed that 37% of Hepatitis B Virus (HBV) infections among Health Care Workers (HCWs) was as a result of occupational exposures to blood and body fluids. In Sub Saharan Africa alone, about 40-65% of HBV infections among HCWs occur as a result of percutaneous occupational exposures to contaminated blood and body fluids of patients. The prevalence of HBV among the Ghanaian population is high and occupational exposures to blood and body fluids that could potentially result in HBV infection is on a surge among HCWs. International health organizations have made recommendations regarding the prevention of occupational exposure and subsequent acquisition of HBV infection. In Ghana, the occupational health and safety policy guideline for the health sector was developed in accordance with international recommendations with the aim of providing policy direction towards efforts aimed at HCW protection from HBV. Seven years following the development and dissemination of the policy guideline, this present study was undertaken to access the level of adherence to preventive practices among HCWs in the Greater Accra Region. Methods: A hospital based cross-sectional survey involving HCWs drawn from five health institutions in the Greater Accra Region was undertaken between January and April 2018. Stratified random sampling procedure was used to select 363 health care workers for the study. A structured pretested questionnaire was used to collect data from all consenting health care workers. Approximately 5 mls of venous blood was collected from all consenting HCWs and screened qualitatively for the presence of five serological markers of HBV. Enzyme Linked Immunosorbent Assay (ELISA) procedures were subsequently undertaken to detect IgM HBcAb and to quantify anti-HBs. Data were analyzed using SPSS version 20.0. Chi-square test or fisher’s exact were performed followed by binary logistic regression with level of significance set at <0.05. Analysis of variance procedure was undertaken following tests of normality and heterogeneity of variances to determine differences between overall adherence scores and post exposure prophylaxis knowledge. Adherence and knowledge scores were categorized into three levels namely: poor, intermediate and good using three interval scoring system of low (≤50%), intermediate (51-74%) and high (≥75-100%). Results: Complete data were available for 340 out of 363 HCWs sampled for the study giving a response rate of 93.70%. Mean age, height and weight of participants were 34.55 years (SD ±7.68), 162.80cm (SD±7.83) and 72.55 kg (SD±13.83) respectively. Overall HBV vaccination uptake was 60.9% (207/340) (95% CI= 55.7%-66.1%). Complete vaccination measured as adherence to 3 doses regimen was 46.8% (159/340). High risk perception (aOR= 4.0; 95% CI=1.3-12.5) and previous training in infection prevention (aOR= 2.8; 95% CI=1.1-7.5) were both seen to be significantly associated with adherence to receipt of three doses of HBV vaccine. Adherence to recommended vaccination schedule of 0, 1, 6 interval was intermediate 62.3% (159/207). Adherence to post vaccination serological testing was poor 21.3% (44/207) with HCWs working at regional hospital having the least odds of adhering to this vaccination component (aOR= 0.1; 95% CI=0.0-0.6). Overall vaccination adherence mean score was 53.46% (95% CI=49.86-57.05) with no statistically significant difference between the various cadre of staff (F=0.85; P=0.51). Adherence to overall HBV vaccination recommendation was extremely low in the population with 6.2% of the entire HCW population and 3.80% of vaccinated HCWs adhering completely. Post Exposure Prophylaxis (PEP) for HBV knowledge was generally poor (overall mean score was 47.85; 95% CI=44.35-51.35) with significant differences among HCW categories (F=3.11; P=0.010). Exposure reporting was good 76.3% (29/38) with significant difference between the various facility levels (ꭓ 2 =17.990; p=<0.001). All the components of PEP (Evaluation for eligibility for PEP, Timeliness of PEP initiation and post-PEP follow-up visits) were observed to have good level of adherence (adherence was >75%) except PEP usage that was intermediate with a coverage of 70% (7/10). The predominant HBV maker among the population was Anti- HBs; 57.4% (195/340) and the least was HBeAg; 1.5% (5/340). One third (123/340) of the HCWs were naïve to HBV. Lifetime exposure to HBV (Anti-HBc) prevalence was 8.2% (28/340) (95% CI= 5.0%-11.0%). Females had 4 times lower odds of being exposed to HBV (aOR=0.4; 95 % CI=0.1-0.9). HCWs without training in prevention of blood borne infections had almost three times higher odds of being exposed to HBV in their lifetime (aOR=2.6; 95 % CI=1.1-6.4). HCWs in lower level facilities also demonstrated two times higher odds of being exposed to HBV (uOR=2.1; 95 % CI=1.1 -4.7). The overall prevalence of current HBV infection (HBsAg) was 5.9 % (20/340) (95% CI =3%- 8%). Prevalence was highest among males, orderlies and those working at CHPs facility. Conclusions: The findings of this study suggest that despite the high susceptibility to HBV infection among the HCWs, adherence to recommendations regarding HBV vaccination and PEP usage are sub-optimal. Therefore, to avert the serious consequences of HBV infection among HCWs in the Greater Accra Region, immediate interventions are required from employers and all stakeholders. HCWs of all categories working at all the five levels of care would need support to promote adherence to pre and post exposure modalities against HBV infection. Apart from making vaccines and immunoglobulin available to HCWs, training in blood borne infections and programs targeted at increasing risk perception for HBV among HCWs could improve adherence and subsequently prevent new infections.
Adverse Events in Hospitalized Obstetric Clients at the Greater Accra (Ridge) Regional Hospital
(University of Ghana, 2019-10) Otchi, E.H.
Introduction All over the world, obstetric clients are harmed and even die because of unsafe care. The risk of an obstetric client being hurt or dying when receiving care in hospitals because of an adverse event is greater than the risk of dying in aviation or motor vehicle accidents or by breast cancer. Adverse Events (AEs) in obstetrics unlike in medicine and surgery has not been extensively explored. Similarly, there is still little understanding of the types, factors associated with AEs, frequency of occurrence and the degree of preventability of adverse events at the hospital, even in the advent of clinical audits. The objective of this study was to assess adverse events among hospitalized obstetric clients at the Greater Accra Regional Hospital. Method The medical records/folders of obstetric clients who were on admission from January, 1 to December 31, 2015 at the Greater Accra Regional Hospital were reviewed retrospectively. A total of 1402 folders satisfied the inclusion criteria to determine the proportion of adverse events. A case control study of cases (350) and controls (350) were also selected in the determination of the factors associated with AEs and the degree of preventability. Descriptive and inferential statistics were performed. Models were evaluated for goodness-of-fit measures. The reliability and validity of the scale was also tested using Cronbach’s alpha coefficient. Results The mean gestational age of the clients was 37.4 weeks±4.9 weeks. The major types of AEs were related to surgery while the least type of AEs was related to patient care. The proportion of adverse events was 12.0% in the entire sample of 1402 and more than half (93, 55.4%) of these occurred in the labor & delivery ward. AEs increased with increasing age but was not statistically significant (p=0.879). There was about three-fold (OR=3.35; 95% CI=1.21-9.57) increase in odds of developing adverse events among Antenatal Clinic (ANC) non-attendants and this difference was statistically significant (p=0.044). Similarly, the odds of developing adverse events among obstetric clients who had had a previous surgery and post-term were also high and statistically significant (p<0.05). More than half (208, 64.1%) of the AEs that occurred were preventable. Leadership & governance (inadequate use of protocol and adherence) related factors accounted for more than half (149, 53.2%) of the manner in which AEs among obstetric clients could have been prevented. Conclusion The proportion of adverse events among obstetric clients was high. Patient characteristics such as age, surgical history, number of ANC attendance and gestational age are the main factors associated with adverse events among obstetric clients. The degree of preventability of adverse events was also high due to inadequate intrapartum monitoring and lack of adherence to protocols/guidelines. Key Words Obstetric clients, adverse events, patient safety, quality, health systems building blocks, healthcare, confirmatory factor analysis
Aetiology, Malnutrition and Faecal Lactoferrin Levels in Paediatric Diarrhoea
(University of Ghana, 2011-08) Opintan, J.A.; Newman, M.J.; Wilson, M.D.; Guerrant, R.L.; University of Ghana, College of Health Sciences, School of Biomedical and Allied Health Sciences, Department of Medical Microbiology
Diarrhoea is a major public health problem that affects the physical and cognitive development of young children. Anthropometric data was collected from 274 children, 170 with diarrhoea and 104 without diarrhoea. Stool specimens were analyzed by conventional culture, PCR for EAEC, Shigella, Cryptosporidium, Entamoeba, and Giardia species, as well as by ELISA for faecal lactoferrin levels. Additionally, all E. coli recovered from culture were PCR screened for EAEC, and compared with those obtained from the stool DNA. Multiple gene loci (aaiC, aap, attA and aggR) were sought for EAEC. About 50% of the study population was mildly to severely malnourished. Mild to severe malnutrition (WAZ <-l), moderate to severe stunting (HAZ < -2) and moderate to severe wasting (WHZ < -2) were associated with diarrhoea (p = 0.023, 0.026 and 0.062, respectively). In only 1 of 170 diarrhoea stool specimen was Shigella flexneri recovered by culture. EAEC and Cryptosporidium were associated with diarrhoea (p = 0.048 and 0.011, respectively), and malnourished children who had diarrhoea were often co-infected with both Cryptosporidium and EAEC. About 27 % (4/15) C. parvum genotypes were identified by HRM analysis. Faecal lactoferrin levels were higher in children with diarrhoea (p = 0.019). Children who had EAEC infection, with or without diarrhoea had high mean lactoferrin levels irrespective of nutritional status. In conclusion, the current study identified high levels of growth deficits among the children with/without diarrhoea. The use of DNAbiomarkers revealed that EAEC and Cryptosporidium were common intestinal pathogens in Accra, and that elevated faecal lactoferrin was associated with diarrhoea in this group of children. EAEC’s dispersin gene (aap) was significantly associated with diarrhoea in both the faecal and bacterial DNAs, in the children studied (p < 0.05). Publication: Part o f the data presented in this thesis is published as follows: Opintan JA et al. (2010). Pediatric Diarrhea in Southern Ghana: Etiology and Association with Intestinal Inflammation and Malnutrition. Am J. Trop Med Hyg. 83: 936 - 943.
Affordances and Constraints of Seaport Smart Service Systems in a Developing Country: A Case Study from Ghana
(University of Ghana, 2020-10) Amankwah-Sarfo, F.
This study seeks to understand affordances and constraints of seaport smart service systems in a developing country context. Smart service systems refer to configurations of smart technologies, people and processes to co-create value for stakeholders. Examples of smart service systems discussed in information systems literature are smart homes, smart cities, smart health, and smart energy. While traditional service systems relied on people and physical processes, smart service systems rely on sensing and autonomous machine capabilities. Thus, based on their awareness and monitoring capabilities, smart service systems sense and respond to dynamic environmental conditions to co-create value for people, other systems, and themselves. Information Systems (IS) studies on smart service systems are limited in three main ways. First, existing IS research lack theoretical foundation. The focus has rather been on conceptualisations and literature reviews. There is, therefore, the need for in-depth and theory-driven studies to investigate smart service systems' use and effects in an organizational context. Second, extant IS literature on smart service systems has focused more on application areas such as smart health, smart building, smart government, smart grid, smart transportation, smart environment, smart home, and smart lifestyles. The area of seaport smart service system is yet to receive attention in IS research. Third, existing theoretical perspectives in affordance conception conceptualise affordances as action possibilities that emerge from interactions between technologies and goal-oriented actor(s) or user(s) while constraints are hindrances that prevent actors from using the technology to achieve intended goals. However, extant IS studies have concentrated on only the affordance-actualization process. Little or no research focuses on the constraint process of technology affordances theory. To address the research gap, the research questions that guided this study are: (a) why would a developing country seaport deploy smart service systems for security and container handling? (b) how are the uses of smart service systems for developing country seaport enabled or constrained? (c) what are the consequences of using smart service systems in a developing country seaport? Responding to these questions, this thesis employed the interpretivist research paradigm, the qualitative methodology, the case study method, and the technology affordances and constraints theory to understand the use of smart service systems in seaport in Ghana, a developing country. Ghana was selected because its main seaport in Tema had recently deployed smart service systems to address challenges of manual security processes and paper-based container handling systems. Accordingly, this study uses a two-case study comprising a smart seaport security service system and a smart container handling system in Ghana’s Tema Port. The findings show that deployment of smart service systems for seaport can enable autonomous access control, autonomous data capturing, data analytics and dashboard reporting, online submission of documents, and improved security and container handling services. The findings also show that smart service systems can be constrained by inadequate data storage capacity, internet and power supply instability, smart device breakdowns. The study contributes to research, theory and practice. With respect to research, this study extends existing knowledge in smart service systems in two ways. First, the study provides an understanding of affordances, constraints and consequences of using seaport smart service systems in a developing country context. Second, this study has extended the literature from a limited focus on conceptualisations and literature reviews to theory-driven empirical studies on seaport smart security service and container handling service systems. For theory, this study contributes to the technology affordances and constraints theory by refining the theory in two ways. First, the study extends the existing types of technology affordances by introducing smart technology affordance as a new type in smart service system context. Second, the study introduces affordance-constraint process as a complement to the existing affordance-actualization process. This study also extends the application of technology affordances and constraints theory from human as the only actors to include smart objects as actors in smart service systems studies in IS. Based on the research findings, this study offers four implications for practice. First, management can adopt cloud computing to address the constraint of inadequate storage capacity resulting from big data generation. Second, to address the constraint of device breakdowns, management can procure robust smart artefacts as well as establish and enforce risk assessment and maintenance schedule. Third, management can provide standby smart power generators to take over when the national grid goes off. Finally, port authorities can contract multiple internet service providers to address the problem of internet outages.
African Cultural Values and Psychological Health in Adult Persons with Sickle Cell Disease in Ghana
(University of Ghana, 2015-07) Anim, M. T.; Mate-Kole, C. C.; Asumeng, M.; Osafo, J.; University of Ghana, College of Humanities, School of Social Sciences, Department of Psychology; Thesis (PHD) - University of Ghana, 2015
Although spirituality has been found to reduce psychological symptoms, the factors that intervene in the relationship remain unclear. The present study aimed at determining whether African cultural values would moderate the relationship between spirituality and psychological health, and whether this observation was unique to SCD participants. Additionally, the study explored reasons for the use of African cultural values in coping. Finally, the study aimed at developing a model of coping with SCD. The study was cross sectional using quantitative and qualitative methods. The quantitative data was collected through questionnaire administered to a purposive sample of 201 adult SCD participants. Two hundred and three (203) healthy and 201 diabetic participants were used as comparison groups. The qualitative data was obtained from a subsample of 23 SCD interviewees. Significant results that emerged from the quantitative study revealed that first, the three groups generally demonstrated significant differences in the variables studied. Second, SCD participants differed significantly from comparison groups on specific African cultural values subscales and on specific psychological symptoms. Third, specific African cultural values predicted psychological health in specific BSI subscales among SCD participants. The rest of the quantitative results did not find anything significant. In the qualitative analyses, participants reported using specific African cultural values for transcendental, social support, psychological relaxation, and minimum physical exercise purposes to promote psychological health. However, medical treatment was the mainstay. Aspects of African cultural values that did not support these functions were associated with poor psychological health. Some of these observations emerged in the larger sample while others did not. These results implied that there were significant differences between SCD and diabetic or healthy participants on endorsement of specific African cultural values and their effects on psychological health. It further implied that SCD individuals used other strategies to complement African cultural values to promote psychological health. Implications of the two studies were evaluated in a revised conceptual model for SCD. Psychological health of SCD participants was a function of factors in the biopsychosocial-spiritual model and based in African cultural values and in the cultural context of patients. Socio-demographic and disease characteristics and other unknown factors added to the equation. The implications of the findings for future research, clinical practice, patient management, and policy matters, were subsequently discussed.
The African Union and the Quest for Peace and Security in Africa: 2002 -2012
(University of Ghana, 2014-06) Appiah, J. A.; ; Gebe, B. Y.; Antwi-Danso, V.; Ahorsu, K.; University of Ghana, College of Humanities, Legon Centre for International Affairs and Diplomacy
A significant challenge that confronted the Organisation of African Unity (OAU) throughout its establishment was the successful management of intra-state conflicts in member states. The OAU was criticised for its lack of intervention in these conflicts due to its Charter provision of non-interference in the internal affairs of member states. The launch of the African Union in 2002 signalled a new era in the quest for peace and security in Africa. The AU initiated important steps towards the creation of an African Peace and Security Architecture for the management and maintenance of conflicts. The AU’s Constitutive Act further gives the right of intervention in the internal affairs of members to the Union. Since its establishment, the AU has lunched military and diplomatic operations in Burundi, Sudan, Somalia, Comoros, Togo, Ivory Coast, Niger, Madagascar, Kenya, Zimbabwe and Libya among others. The main objective of this study is to assess the African Union’s management of the military and diplomatic interventions in Africa since its inception in order to come to terms with the challenges that confront the AU in the quest for peace and security in Africa. The study hypothesised that although the African Union’s doctrine of non-indifference has galvanized its young institutions of peace and security into making significant strides in the conduct of peace operations on the continent, it has had very limited effect on the success of interventions. The research findings noted that, while the AU has demonstrated commitment to address conflicts in Africa it faces severe capacity constraints. This does not auger well for the Union’s future in peace and security.
Africentric Worldview And Psychological Health Among Primary Caregivers Of Children With Intellectual Disability In Ghana
(University of Ghana, 2015-07) Oti-Boadi, M.
This study examined the extent to which Africentric worldview influence the relationship between stress and psychological health among primary caregivers of children with intellectual disability in Ghana using the mixed methods design. The quantitative phase recruited and assessed 160 primary caregivers using standardized measures assessing Stress, Africentric worldview, Africultural coping, and Psychological health. Results from MANOVA indicated that primary caregivers of children with intellectual disability experience significantly high levels of stress and poor psychological health than primary caregivers of children with sickle cell disease and healthy controls. Results from hierarchical regression analyses on primary caregivers of children with intellectual disability indicated that; first, caring for an intellectually disabled child is associated with high levels of stress which further leads to poor psychological health. Second, spirituality buffered the relationship between stress and anxiety. Third, Africentric values of spirituality and intuition predicted spiritual coping. The qualitative phase adopted semi-structured interviews with 11 primary caregivers of children with intellectual disability to inquire about their stressors and coping strategies. Using thematic analysis, emergent themes included; psychological reactions, caregiving challenges, societal reactions, coping strategies, psychological functioning, knowledge of condition, and perceived cause of disability. Despite the numerous challenges associated with caregiving, primary caregivers of children with intellectual disability reported the significance of their spirituality, family/community support systems, and hope as effective coping strategies in raising their children. Results from both the quantitative and qualitative phases demonstrated the stressful nature of raising a child with intellectual disability and the importance of Africentric values of spirituality and communal support systems in coping. Implications for clinical intervention programmes, research, policy, and psychological education are discussed.
Age-Related Changes in the Anatomy and Histology of Reproductive Organs, and Steroid Hormone Profiles in Male and Female Guinea Fowls (Numida Meleagris)
(University of Ghana, 2013-12) Abdul-Rahman, I.I.; Awumbila, B.; Obese, F.Y.; Jeffcoate, I.; Robinson, J.; Obese, F.Y.
Despite the potentials and contributions of guinea fowls to economic and social life in Ghana, research efforts directed at these birds, particularly, in the area of reproductive biology has been very limited. A study involving a total of 359 local guinea fowls (192 males and 162 females) was conducted, and documented the developmental changes in the external anatomy, gross anatomy and histology of the reproductive organs, and changes in steroid hormone (testosterone in males, and 17 -oestradiol and progesterone in females) synthesis in male and female guinea fowls from hatching until adulthood. These parameters were also compared between breeding and non-breeding birds. The study also determined the stages of spermatogenesis and seminiferous epithelial cycle, biometric, vent and molecular sexing in guinea fowls. Testicular asymmetry and compensatory growth in the testes of guinea fowls were also assessed. Age-related changes were analysed using univariate analysis for completely randomised design and means separated using Tukey's test/ Kruskal-Wallis test and medians separated by Mann-Whitney U-test. Seasonal differences in variables measured and differences between left and right testicular variables were determined using two-tailed t-test/Mann-Whitney U-test. Biometric and vent sexing were accomplished using discriminant function analysis. All comparisons were made at 5% level of significance. External biometric traits and phalli dimensions distinguished between male and female birds at 94% and 98.3% levels of accuracy, respectively. During molecular sexing, females produced 2 bands of 396 bp and 344 bp, while males produced only the larger band. Testicular anatomical biometric traits increased significantly (p<0.0001) from 8 weeks of age, and stabilised between 16 and 20 weeks of age. Total germ cell population per testis and testicular histological morphometric parameters increased significantly (p<0.0001) from 12 weeks of age and stabilised between 20 and 24 weeks of age. All ducts within the epididymal region increased (p<0.0001) in luminal diameters and stabilised from 20 weeks of age. In the female guinea fowl, the ovary and oviduct were discernible and measurable at hatching. Highly significant (p<0.0001) increases were seen in ovarian and relative ovarian weights, and oviducal weights and lengths between 24 and 28 weeks of age. Even though increases in oocyte and follicular diameters were significant (p<0.05) from hatching until 16 weeks of age, the increases were minimal relative to those seen thereafter. On the basis of oocyte diameter, the first phase of yolk deposition occurred between hatching and 20 weeks of age when oocyte diameters ranged between > 0.06 mm to 3.1 mm, the second phase between 20 and 26 weeks of age when the diameter ranged between over 3.1 mm to 6 mm, and the third and final phase between 27 and 28 weeks of age when oocyte diameters grew beyond 6 mm, until a maximum of 22.9 mm was attained, these were yellow follicles. All ovarian follicular morphometric traits showed inconsistent increases until 16 weeks of age. Mucosal folds in all sections of the oviduct increased significantly (p<0.0001), from 4 until 28 weeks of age. Peripheral testosterone concentrations increased gradually from 4 weeks of age, and peaked at 20 weeks of age. In females, plasma 17 -oestradiol decreased gradually to a minimum at 16 weeks of age, and then began to increase gradually until 28 weeks of age when it plateaued. Peripheral progesterone concentrations, on the other hand, fluctuated considerably during sexual development. Eleven steps of spermiogenesis and 9 stages of seminiferous epithelial development were recognised in the guinea fowl testis. Breeding males had significantly (p<0.05) higher anatomical biometric parameters than their non-breeding counterparts. Both qualitative and quantitative histological changes were observed in regressing testis and epididymis. Peripheral testosterone concentrations were also higher (p<0.05) in breeding than non-breeding males. In non-breeding females, all ovarian and oviducal gross anatomical features had significantly (p<0.05) regressed. Marked qualitative histological changes were also noticed. Mucosal folds in all regions of the oviduct except the infundibular lip were higher (p<0.05) in breeding females. Breeding females had higher (p<0.05) peripheral oestradiol levels than non-breeding females. Guinea fowls could be sexed more accurately with molecular than biometric and vent sexing. Testicular anatomical biometric and histological morphometric traits began to stabilise at sexual maturity and 4 weeks following sexual maturity, respectively. Testosterone seems to play a role in the development and stabilisation of these testicular histological variables. Three phases of yolk depositions were found in the guinea fowl. The results of the present study suggest oestradiol might play a role in oviducal growth and yolk deposition. The classification of seminiferous epithelial cycle in the guinea fowl is similar to those in other birds and mammals. The reproductive organs of both male and female birds had regressed in non-breeding birds. Oestradiol and testosterone concentrations in male and female birds, respectively, might play a role in non-breeding of guinea fowls during certain times of the year. Compensatory growth occurred in both the testes.
Akyem Abuakwa C.1874 - 1943: A Study of the Impact of Missionary Activities and Colonial Rule on a Traditional State
(University of Ghana, 1980-04) Addo-Fening, R.
This thesis is a study of the nature and extent of the pressures -social, economic and political - that the Basel Missionaries and British colonial Administrators brought to bear on Akyem Abuakwa society during the period 1874-1943. The study also examines the state's responses to these pressures and the extent to which they were conditioned by her pre-european historical experience, her ethos, the strengths and weaknesses of her institutional arrangements, the quality of her political leadership and her resources. The general conclusions that emerge from this study are that missionary activities and colonial policies brought a great deal of material progress to Akyem Abuakwa society: the quality of life was improved by the spread of western-style education, by the adoption of new skills, by improved medical care and by infrastructural developments; changes in the customary penal system made the administration of justice more humane; while the evolution of a modem-style bureaucracy at the courts of the chiefs and the adoption of certain administrative routines enabled the complicated and diverse functions of modem government to be effectively discharged. Those positive results were, however, off-set by negative and harmful results: the spiritual foundations of Akyem Abuakwa were seriously undermined by widespread and wilful violation of time-honoured customary taboos by missionary converts in the name of religious freedom as well as by the introduction of a dichotomy between 'church’ and ‘state’, between religion and politics; the cohesion and solidarity of Abuakwa society suffered great damage by the creation of salems whose Christian inhabitants held aloof from the life of the wider community; existing social conflicts were sharpened while new, more serious and harmful ones were introduced by the concept of territorial jurisdiction as embodied in the N.J.O., by the distortion of the character and role of chieftaincy, and by the destruction of the religious conformity of the state; the wakening of extended family ties, growing emphasis on individualism and the failure of Christianity to deal adequately with the trauma. of rapid social and. economic change created problems of security which expressed themselves in alcoholism and neurosis; above all the exploitation of Abuakwa’s immense resources -human and natural - for the greater benefit of her alien rulers resulted in the under-development of the state.
Alcohol Use and Mental Health in Ghana
(University of Ghana, 2020-03) Obeng-Dwamena, A.D.
Introduction: Previous research has documented an increase in alcohol and mental ill health-related morbidity and mortality globally. They also suggest a positive association between alcohol use and mental disorders in high and limited income countries, which has implications for future morbidity and mortality trends particularly in limited income countries. Despite these, panel and mixed methods studies, which would help to provide a holistic account of alcohol use and mental health and produce stronger evidence to inform interventions are lacking. This thesis therefore sought to examine the association between alcohol use and mental health among adults in Ghana. Methodology: Qualitative and quantitative data were combined. The quantitative data were used to examine associations between alcohol use and depression in a subsample of individuals interviewed in Wave 1 and followed up in Wave 2 of the nationally representative World Health Organization’s Study on Global Ageing and Adult Health (SAGE) Ghana survey. Among the 1499 participants of which 51% were males with mean age of 48.2±13.0 years in Wave 1, 12-month self-reported depression was assessed using DSM-IV diagnostic criteria yielding a composite outcome variable of counts of depressive symptoms. The categorical alcohol use measure comprised of lifetime abstinence, former use (alcohol not consumed 12 months prior to survey), moderate use (≤14 standard drinks for men, ≤7 standard drinks for women) and hazardous use (≥15 standard drinks for men and ≥8 standard drinks for women). Daily counts of standard drinks of alcohol was the second measure of alcohol use. Data were analysed separately for men and women using cross-sectional, panel descriptive statistics, and Poisson multivariate panel regression models with random effects and robust variance specifications. The qualitative data were used to explore community level understandings of alcohol consumption and mental health. The data comprised of transcripts from 30 focus group discussions (FGDs) on alcohol use and mental health from five communities in five regions in Ghana. Transcripts were analysed using thematic network analysis. The ages of FGD participants ranged from 20 to 80 years. Results: Descriptive statistics showed a 39.5% increase in number of depressive symptoms in the total sample with women reporting more symptoms compared to men over time. Although there was a decline in alcohol consumption among men and women over time, alcohol initiation, use (moderate or heavy use) and discontinuation (former use) was higher among the men than women. Cross-sectional multivariate results showed male former, moderate and heavy drinkers and female heavy drinkers having higher counts of depressive symptoms in Wave 1. Panel analysis, which aimed to test bidirectional associations, showed a unidirectional positive relationship between alcohol use and depression after adjusting for both time- variant and invariant confounding variables. Focus Group Discussions (FGD) of participants’ understandings of causes of mental health problems and alcohol consumption bordered on notions of both normal (biological) and abnormal (spiritual) causation. Participants indicated a bidirectional relationship between alcohol use and mental health. Their accounts of subpopulations such as females, persons living with chronic conditions and individuals undergoing stressful life events being predisposed to depression corroborated cross-sectional and longitudinal quantitative findings on depression. Local terms were used to define and describe mental illness and consequences of mental ill health as well as coping strategies adopted in the various communities were indicated. Participants described the socio-cultural context of alcohol use in their communities revealing that alcohol in contemporary times still formed part of social and religious activities in their communities. Further, they explained the causes and outcomes of alcohol consumption. Conclusions: Quantitative results showed an increased prevalence of depression particularly among females, heavy alcohol use among males, as well as both short term and long-term associations between alcohol use and depression therefore requiring increased gender-specific interventions on alcohol use and depression. In addition, qualitative results depicted community members holding dual notions of mental illness causation different from biomedicine, which in turn influenced their coping strategies and health-seeking behaviour. These findings necessitate increased policy interventions on the adoption of healthy lifestyles, enactment and enforcement of regulations on alcohol distribution, sale and use and collaborations between orthodox and traditional medicine to meet the needs of persons with poor mental health.
Allelochemicals from Sorghum Bicolor that Stimulate Feeding by the Larvae of the Stem Borer Chilo Partellus
(University of Ghana, 1988-08) Torto, B.
Feeding bioassays with cellulose acetate discs impregnated with the hexane, ethyl acetate and methanol extracts of the leaf-whorls of field grown plants of sorghum cultivars IS 18363 (susceptible) and IS 2205 (resistant) showed that the methanol extracts were most stimulatory to the feeding of the third-ins tar larvae of Chilo partellus. Ethyl acetate extracts were intermediate in stimulatory activity whilst hexane extracts were the least stimulatory. Extracts of the more susceptible cultivar were more stimulatory than those of the more resistant cultivar and those of the whorls of the 3 week old plants were more stimulatory to larvae than those of the 6 week old plants. The phagostimulatory compounds in the ethyl acetate extracts were phenolic, p-hydroxybenzaldehyde and phydroxybenzoic acid being the major components and ferulic and caffeic acids being in minor amounts. p-Coumaric acid was also present in minor amounts but was non-stimulatory at all the doses tested. p-Hydroxybenzaldehyde was a more potent feeding stimulant for the larvae relative to some of its possible theoretical biogenetic analogues. Limited structure-activity studies with some hydroxybenzoic acids and their corresponding cinnamic acids showed that the former were more stimulatory to the feeding of the larvae than the latter and that oxygen substitution in the benzene ring was crucial for activity. The phagostimulatory compounds in the methanol extracts were phenolic, identical to those in the ethyl acetate extracts, and sugars. The sugars which were identified in the extracts comprised sucrose, fructose, glucose and xylose. The feeding response of larvae to these sugars followed the order sucrose » glucose fructosei xylose was non-stimulatory. Comparison of the activities of sucrose with mixtures of glucose and fructose showed that the high activity of the disaccharide is due to its total structure and not to a summation of its monosaccharide moieties. Sugars synergised with phenolics to give enhanced feeding response of the third-instar larvae. Chromatographic analyses of the extracts showed that stimulatory and non-stimulatory components in the extracts differed quantitatively rather than qualitatively in the whorls of the two cultivars at the two growth stages. This may have implication in resistance screening and breeding programmes.

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