Department of Social and Behavioural Sciences

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    Implementation and effectiveness outcomes of Community Health Advocacy Teams to improve long-lasting insecticide net distribution and use in six districts in Ghana: A one-group pre-post-test study
    (Plos Global Public Health, 2024) Glozah, F.N.; Tabong, P. T-N.; Hornuvo, R.
    Malaria remains a leading cause of illness and death especially among children and pregnant women in Ghana. Despite the efforts made by the National Malaria Elimination Programme (NMEP), including distribution of Long-Lasting Insecticide Nets (LLINs) to households through periodic Point Mass Distribution (PMD) campaigns and continuous channels (antenatal, schools and postnatal), there is a gap between access and use of LLINs in Ghana. An effective and functional community-based group that would seek to improve the effectiveness of LLIN distribution before, during, after PMD Campaigns and continuous distribution at the community level could help address this gap. This paper assesses the implementation outcomes and short-term effectiveness of the pilot implementation of co-created community health advocacy teams (CHAT) intervention in Ghanaian communities to plan and implement campaigns to increase LLIN use. The study employed a one-group pre-post-study design and measured implementation outcomes (acceptability, appropriateness, and feasibility) and effectiveness outcomes (LLIN awareness, LLIN access, willingness to purchase LLIN, and LLIN use) among 800 community households. The CHAT intervention was implemented for four months across six districts in the Eastern and Volta regions of Ghana. The data were downloaded directly from REDCap and analyzed statistically (descriptive and McNemar test of association) using SPSS 22 software. After the implementation period, the majority of respondents in all six districts indicated that the CHAT intervention was acceptable (89.8%), appropriate (89.5%), and feasible (90%). Also, there was a significant association between baseline and end-line assessment on all four effectiveness outcome measures. Household members’ awareness of, access to, willingness to purchase, and use of LLINs increased significantly over the four-month period that the CHAT intervention was implemented. The study concludes that CHAT is an acceptable, appropriate, and feasible intervention for supporting the National Malaria Programme in LLIN PMD and for engaging in Social and Behaviour Change Communication activities through the continuous channels of distribution. Additionally, the CHAT demonstrates short-term effectiveness outcomes in terms of creating LLIN awareness, providing access to LLIN, and encouraging Ghanaian community members to be willing to purchase and use LLINs. Although the activities of CHAT members were largely voluntary, integration into the existing primary health care system will make it sustainable.
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    Adolescent health and well-being check-up programme in three African cities (Y-Check): protocol for a multimethod, prospective, hybrid implementation-effectiveness study
    (BMJ Open, 2024) Banati, P.; Ross, D.A.; Weobong, B.
    Background During adolescence, behaviours are initiated that will have substantial impacts on the individual’s short-term and long-term health and well-being. However, adolescents rarely have regular contact with health services, and available services are not always appropriate for their needs. We co developed with adolescents a health and well-being check-up programme (Y-Check). This paper describes the methods to evaluate the feasibility, acceptability, short-term effects and cost-effectiveness of Y-Check in three African cities. Method This is a multi-country prospective intervention study, with a mixed-method process evaluation. The intervention involves screening, on-the-spot care and referral of adolescents through health and well-being check-up visits. In each city, 2000 adolescents will be recruited in schools or community venues. Adolescents will be followed-up at 4 months. The study will assess the effects of Y-Check on knowledge and behaviours, as well as clinical outcomes and costs. Process and economic evaluations will investigate acceptability, feasibility, uptake, fidelity and cost effectiveness. Ethics and dissemination Approval has been received from the WHO (WHO/ERC Protocol ID Number ERC.0003778); Ghana Health Service (Protocol ID Number GHS-ERC: 027/07/22), the United Republic of Tanzania National Institute for Medical Research (Clearance No. NIMR/HQ/R.8a/Vol.IX/4199), the Medical Research Council of Zimbabwe (Approval Number MRCZ/A/2766) and the LSHTM (Approval Numbers 26395 and 28312). Consent and disclosure are addressed in the paper. Results will be published in three country-specific peer-reviewed journal publications, and one multicountry publication; and disseminated through videos, briefs and webinars. Data will be placed into an open access repository. Data will be deidentified and anonymised
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    Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study
    (Psychiatry Research, 2024) Baiden, P.; LaBrenz, C.A.; Broni, M.N.; et al.
    Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14–18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing home lessness to ensure early interventions are put in place to prevent suicidal behaviors.
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    Prevalence And Predictors Of Infant And Young Child Feeding Practices In Sub-Saharan Africa
    (International Health, 2023) Aboagye, R.G.; Ahinkorah, B.O.; Cadri, A.; et al.
    Background: This study assessed the prevalence and predictors of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) in sub-Saharan Africa (SSA). Methods: A sample of 87,672 mother-child pairs from the 2010–2020 Demographic and Health Surveys of 32 countries in the SSA were used. A multilevel binary logistic regression analysis was carried out to examine the predictors of MDD, MMF, and MAD. Percentages and adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings. Results: The prevalence of MDD, MMF, and MAD in SSA were 25.3% (95% CI 21.7 to 28.9), 41.2% (95% CI 38.8 to 43.6), and 13.3% (95% CI 11.6 to 15.0), respectively. Children aged 18–23 months were more likely to have MDD and MAD, but less likely to have MMF. Children of mothers with higher education levels were more likely to have MDD, MMF, and MAD. Children who were delivered in a health facility were more likely to have MDD and MAD but less likely to have MMF. Conclusions: Following the poor state of complementary feeding practices for infants and young children, the study recommends that regional and national policies on food and nutrition security and maternal and child nutrition and health should follow the internationally recommended guidelines in promoting, protecting, and supporting age-appropriate complementary foods and feeding practices for infants and young children.
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    Factor Structure Of The Alcohol Expectancies Questionnaire Among Adolescents In Rural Ghana
    (Drug and Alcohol Review, 2023) Weobong, B.; Monk, R.L.; Anyorikeya, M.; et al.
    Introduction: Children’s early experiences with alcohol inform the development of of alcohol-related beliefs which are known to predict alcohol consumption during the critical stage of adolescence. Yet, there has been considerably less research into these alcohol-related cognitions in low- and middle-income countries (LMIC) and existing measures of these beliefs are highly reflective of Western contexts, which may not be fully appropriate for use in LMICs. The aim is to ascertain the construct validity of the Alcohol Expectancies Questionnaire (AEQ) in a non-Western sample. Methods: A cross-sectional diagnostic accuracy study involving 500 adolescents aged 10 to 18 years, randomly selected from the database of the Navrongo Health and Demographic Surveillance System. Participants were administered the locally back translated version of the 34-item AEQ. Confirmatory factor analysis using the lavaan package in R was conducted to generate indices for the factor structure of the AEQ. Results: Confirmatory factor analyses showed that while groupings of positive and negative expectancies were similar to those observed when expectancies have been assessed previously in Western studies, these formed a single ‘alcohol experience’ factor. Questions relating to positive tension reduction and negative physical expectations showed inconsistent responses in this study. Discussion and Conclusions: Commonly used tools for the assessment of alcohol Expectancies may not be suitable for use in Ghana, possibly owing to their development and validation in Western contexts. These findings have implications for the assessment of alcohol-related beliefs in LMIC settings and begin to map out a research agenda to develop more contextually and culturally attuned alcohol assessments.
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    Young people and gambling in sub-Saharan Africa: towards a critical research agenda
    (Journal of the British Academy, 2023) Glozah, F.; Bunn, C.; Sichali, J.M.; et al.
    Recent decades have seen gambling become a highly lucrative industry across sub-Saharan Africa. Fuelled by the democratisation of access to digital finance and internet technologies, this gambling boom has been concentrated in Africa’s urban economies, where expanding youth populations are increasingly connected to global circuits of sport, popu lar culture and speculative forms of consumption. This has engendered growing interest in gambling as a distinct and emerging field of academic enquiry across sub-Saharan Africa. To date, psychiatric, epidemiological and behavioural sciences have provided the dominant frame for measuring the extent of ‘problem gambling’ and addiction, but there remains the need to expand and diversify the field to encompass more critical and interdisciplinary approaches that recognise gambling as a densely significant social and cultural phenomenon. This article aims to provide a point of departure for a critical research agenda on the differentiated impacts of gambling on young people and their communities across the continent.
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    Malaria treatment health seeking behaviors among international students at the University of Ghana Legon
    (PLOS ONE, 2023) Lwenge, M.; Dako-Gyeke, P.; Govule, P.; et al.
    Introduction Appropriate management of malaria demands early health-seeking behaviour upon suspicion of malaria-like symptoms. This study examined malaria treatment-seeking behaviour and associated factors among international students at the University of Ghana. Methods The study used a cross-sectional and quantitative approach. Data collection was undertaken using a structured questionnaire administered to a random sample of 264 international students. Data obtained on malaria treatment and factors influencing treatment Behaviors were analyzed using IBM SPSS Statistics version 22. Associations between individual characteristics and Malaria treatment-seeking behavior was assessed by Pearson Chi-square(X2 test of independence. A binary logistic regression model was built using a backwards Wald approach, with variables retained at Wald p-value <0.05. Results The findings show that 35% of the respondents obtained self-prescribed antimalarial at their first choice of malaria treatment. At bivariate level, a significant relationship between Malaria health-care seeking behaviour and:Respondent continent, X2 (1, N = 264) = 7.936, p = .005; Service accessibility, X2 (1, N = 264) = 7.624, p = .006; Wait time, X2 (1, N = 264) = 22.514, p <0.001; Treatment cost, X2 (1, N = 264) = 97.160, p <0.001; Health insurance, X2 (1, N = 264) = 5.837, p = 0.016, and Perceived staff attitude, X2 (1, N = 264) = 18.557, p < 0.001. At multivariable analysis, inappropriate malaria health-seeking behaviors was associated with low perceived service accessibility (aOR = 6.67). p<0.001), perceived long wait time (30mins), (aOR = 5.94; p = 0.015), perceived treatment PLOS ONE
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    Ending violence against women: Help-seeking behaviour of women exposed to intimate partner violence in sub-Saharan Africa
    (PLOS ONE, 2023) Aboagye, R.G.; Seidu, A-A.; CadriI, A.; et al.
    Introduction Intimate partner violence is a serious public health problem that transcends cultural bound aries in sub-Saharan Africa. Studies have reported that violence characteristics and percep tion are strong predictors of help-seeking among women. We assessed the prevalence and factors associated with help-seeking among female survivors of intimate partner violence in sub-Saharan Africa. Methods We pooled data from the most recent Demographic and Health Surveys (DHS) of eighteen sub-Saharan African countries. The data were extracted from the women’s files in countries with datasets from 2014 to 2021. A weighted sample of 33,837 women in sexual relation ships: married or cohabiting who had ever experienced intimate partner violence within the five years preceding the survey were included in the analysis. Percentages with 95% confi dence interval (CI) were used to present the results of the prevalence of help-seeking for inti mate partner violence. We used a multilevel binary logistic regression analysis to examine the factors associated with help-seeking among survivors of intimate partner violence. The results were presented using adjusted odds ratio (AOR) with their respective 95% CI. Statis tical significance was set at p<0.05. Results Out of the 33,837 women who had ever experienced intimate partner violence in sub-Saha ran Africa, only 38.77% (95% CI = 38.26–39.28) of them sought help. Ethiopia had th lowest prevalence of women who sought help after experiencing intimate partner violence (19.75%; 95% CI = 17.58–21.92) and Tanzania had the highest prevalence (57.56%; 95% CI = 55.86–59.26). Marital status, educational level, current working status, parity, exposure to interparental violence, women’s autonomy in household decision-making, mass media exposure, intimate partner violence justification, wealth index, and place of residence were associated with help-seeking behaviour of intimate partner violence survivors. Conclusion The low prevalence of help seeking among women who have experienced intimate partner violence in sub-Saharan Africa calls for the intensification of formal and informal sources of assistance. Education can play a critical role in empowering girls, which may increase future help-seeking rates. Through media efforts aimed at parental awareness, the long-term ben efits of females enrolling in school could be achieved. However, concentrating solely on indi vidual measures to strengthen women’s empowerment may not bring a significant rise in help-seeking as far as patriarchal attitudes that permit violence continue to exist. Conse quently, it is critical to address intimate partner violence from the dimensions of both the indi vidual and violence-related norms and attitudes. Based on the findings, there should be public awareness creation on the consequences of intimate partner violence. Respective governments must increase their coverage of formal support services to intimate partner violence survivors especially those in rural communities.
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    Pilot implementation of community health advocacy teams to improve the e􀀀ectiveness of long-lasting insecticide net distribution through both campaigns and continuous channels in Ghana: a qualitative study of opportunities and barriers to implementation
    (Frontiers in Public Health, 2023) Dako-Gyeke, P.; Chandi, G.M.; Peprah, N.Y.; Gittelman, D.; et al
    Introduction: In Ghana, the National Malaria Elimination Programme (NMEP) distributes long-lasting insecticide net (LLIN) to households for free through the periodic point mass distribution (PMD) campaign and continuous distribution to populations most vulnerable to malaria. It is known that the existence of e􀀀ective and functional community-based groups could influence positive behaviours regarding health interventions promoted through health campaigns. However, there is no evidence of functional community-based groups that aim to improve the e􀀀ectiveness of LLIN distribution campaigns by transitioning into primary healthcare delivery. This study aimed to explore the opportunities and barriers to the pilot implementation of co-created community health advocacy teams (CHATs) to improve the e􀀀ectiveness of LLIN distribution through both campaigns and continuous channels in Ghana. Methods: A qualitative research approach was used among 43 CHAT members across six communities in the Eastern and Volta regions of Ghana. The CHAT constitutes significant community actors whose roles are centred on key elements of community/social mobilisation and capacity building, all nested in social and behaviour change communication (SBCC) strategies. The CHATs were pilot implemented in all study communities for 4 months after which we identified opportunities and barriers during implementation. CHAT members participated in six focus group discussions which were audio recorded, transcribed verbatim, and analysed thematically using the NVivo 13. Results: CHATs were instrumental in sensitising community members through SBCC strategies. Moreover, there were changes in the behaviour of community members who were receptive towards and participated in CHAT activities. Community members were accurately informed about malaria (e.g., causes and preventive measures). However, the CHAT experienced barriers during implementation, including a lack of financial support to aid in transportation, organisation of meetings, and outreach activities. Additionally, the level of participation by CHAT members in activities and the medium of communication among members were key areas of concern. Conclusion: The CHATs would be instrumental in promoting LLINs’ use during and after PMD campaigns through community outreaches. It is therefore necessary to provide resources to support their operations and a good network to address communication barriers. Finally, continuous capacity strengthening of CHAT members by the NMCP is important.
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    Suicidal Behaviour among School-Going Adolescents in Saint Lucia: Analysis of Prevalence and Associated Factors
    (Behavioral Sciences, 2023) Sarfo, J.O.; Amoadu, M.; Gbordzoe, N.I.; Ofori, C.O.B.; et al.
    Suicide poses a debilitating threat to adolescents’ lives worldwide. Although suicide prevention efforts are evident globally, there is limited evidence on the prevalence and correlations of suicidal behaviour among school-going adolescents in Saint Lucia. We used a dataset from the 2018 Global School-based Student Health Survey to examine the prevalence and associated factors of suicidal behaviour among 1864 students from schools in Saint Lucia. Prevalence rates of 25.5%, 22.1%, and 17.5% were found for suicidal ideation, suicide plan, and suicide attempt, respectively. After adjusting for other factors, being male and having understanding parents were protective against suicidal behaviour. However, suicidal ideation was predicted by being physically attacked and bullied, parental guidance, tobacco use, loneliness, and worry. Moreover, being a victim of physical attacks and bullying, having close friends, being lonely, and worrying were predictive of making suicidal plans among adolescents. Attempting suicide was predicted by cigarette smoking, current use of tobacco and related products, bullying, having close friends, being lonely, and worrying. School-based preventive interventions are required to help address triggers of suicidal behaviour among adolescents in Saint Lucia and to help attain the targets for suicide prevention in the global Sustainable Development Goals.