Regional Institute for Population Studies
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Item Towards standardised and valid anthropometric indicators of nutritional status in middle childhood and adolescence(The Lancet Child & Adolescent Health, 2022) Lelijveld, N.; Ezzati, M.; Mates, E.; et al.There is growing recognition of the significance of nutrition across middle childhood (5–9 years) and adolescence (10–19 years), particularly in the context of global food insecurity and rising overweight and obesity. Until now, policymakers have been slow to respond to rapidly changing patterns of malnutrition across these years. One barrier has been a lack of consistent and regular nutrition surveillance systems for this age group. There is ongoing debate around what should be measured, as well as how best to operationalize anthropometric indicators that have been the cornerstone of nutrition surveillance in younger children and adults. Even with consensus on the importance of a given anthropometric indicator, different terminologies, reference data and cut-offs present difficulties in interpreting trends over time and between countries. We highlight the need for revisiting anthropometric indicators across middle childhood and adolescence, a process that will require WHO and UNICEF coordination, with the engagement of national implementors and policymakers, and partnership with the research communities and donors.Item Factors Associated with Adolescent Pregnancy in Sub-Saharan Africa during the COVID-19 Pandemic: A Review of Socioeconomic Influences and Essential Interventions(International Journal Of Sexual Health, 2022) Kons, K.; Biney, A.A.E.; Sznajder, K.Objective: A literature review was conducted to analyze the impact of COVID-19 on documented preexisting determinants of adolescent pregnancy in sub-Saharan Africa, such as poverty, inequitable gender norms, low access to education, and reproductive health services. Methods: The terms “sub-Saharan Africa,” “Gender Norms,” “Poverty,” and “Adolescent Pregnancy” were used to search the literature for preexisting determinants of adolescence pregnancy in academic and grey literature. “COVID-19” was added to investigate the potential consequences of the pandemic. The literature revealed similar experiences in adolescents girls during the Ebola outbreak, which led to the analysis of government and healthcare official responses to previous epidemics. Results: The literature review revealed that the relationship between identified micro (inequitable gender norms, transactional sex, sexual and gender-based violence, early marriage, and menstruation) and macro (poverty, education, and healthcare factors contributing to adolescent pregnancy were exacerbated by the COVID-19 pandemic. Conclusion: Three realistic targets, including expanding and communicating available reproductive health resources, prioritizing the role of women in the economy, and ensuring return to school, should be included as part of current COVID-19 mitigation programs. Additionally, these interventions should be incorporated in future public health preparedness plans to reduce the risk of adolescent pregnancy during public health emergencies.Item Sociodemographic and geophysical determinants of household vulnerability to coastal hazards in the Volta Delta, Ghana(International Journal of Disaster Risk Reduction, 2022) Atiglo, D.Y.; Abu, M.; Jayson-Quashigah, P.; et al.Theoretical emphasis on combining geophysical and socioeconomic characteristics in assessing vulnerability is growing but with little empirical support. Similarly, there is increasing consideration of cumulative vulnerability to multiple stressors, yet empirical studies are scant. This study seeks to assess the geophysical and socioeconomic determinants of households’ vulnerability to the cumulative impacts of three coastal hazards—flooding, erosion and salinity—using evidence from the Volta Delta in Ghana. The study employed multiple linear regression and binary logistic regression functions to assess cumulative vulnerability and exposure to individual hazards, respectively. Results indicate that while exposure to hazards is determined largely by geophysical factors and the socioeconomic and demographic characteristics of households determine the extent of vulnerability to their impacts. In addition, socioeconomic and demographic characteristics of households, particularly higher wealth levels, non-agricultural occupation, and improved drinking water sources are associated with lower levels of vulnerability to the cumulative impacts of coastal hazards. In developing contexts, resilience to coastal hazards requires improved access to social amenities as well as alternative livelihood options.Item Urban Sustainability And The Subjective Well-Being Of Migrants: The Role Of Risks, Place Attachment, And Aspirations(Population, Space and Place, 2021) Szaboova, L.; Abu, M.; Codjoe, S.N.A.; et al.While material conditions of migrant populations on average tend to improve over time as they become established in new destinations, individual trajectories of material and subjective well-being often diverge. Here, we analyse how social and environmental factors in the urban environment shape the subjective well-being of migrant populations. We hypothesize that these factors include (a) perceived social and environmental risk, (b) attachment to place, and (c) migrant aspirations. We analyse data from a cross-sectional survey of 2641 individual migrants in seven cities across Ghana, India, and Bangladesh. The results show that the persistence of inferior material conditions, exposure to environmental hazards, and constrained access to services and employment affect migrants' subjective well-being. Hence, social and environmental risks constitute urban precarity for migrants whose social vulnerability persist in their destination. Meeting migration-related aspirations and developing an affinity to urban destinations have the potential to mitigate negative sentiments from perceived risks. These findings have implications for future urban planning and sustainability.Item Urban Family Planning in Sub‑Saharan Africa: an Illustration of the Cross‑sectoral Challenges of Urban Health(Journal of Urban Health, 2022) Harpham, T.; Biney, A.; Ganle, J.; et al.The multi-sectoral nature of urban health is a particular challenge, which urban family planning in sub-Saharan Africa illustrates well. Rapid urbanisation, mainly due to natural population increase in cities rather than rural-urban migration, coincides with a large unmet urban need for contraception, especially in informal settlements. These two phenomena mean urban family planning merits more attention. To what extent are the family planning and urban development sectors working together on this? Policy document analysis and stakeholder interviews from both the family planning and urban development sectors, across eight sub-Saharan African countries, show how cross-sectoral barriers can stymie efforts, but they can also identify some points of connection which can be built upon. Differentiating historical, political, and policy landscapes means that entry points to promote urban family planning have to be tailored to the context. Such entry points can include infant and child health, female education and employment, and urban poverty reduction. Successful cross-sectoral advocacy for urban family planning requires not just solid evidence but also internal consensus and external advocacy: FP actors must consensually frame the issue per local preoccupations, and then communicate the resulting key messages in concerted and targeted fashion. More broadly, success also requires that the environment be made conducive to cross-sectoral action. example, through clear requirements in the planningItem The Migration Experience and Differential Risks to Sexual and Reproductive Health in Ghana(Health Education & Behavior, 2020) Sznajder, K.K.; Biney, A.A.E.; Dodoo, N.D.Background. Though internal migration in Ghana has become increasingly common in recent years, research has not focused on the gendered experiences and perceptions of migration and the association with sexual and reproductive health risks for male and female migrants. Method. A qualitative study using semistructured interviews among migrant market workers and market leaders working in Agbogbloshie in Accra, Ghana, was completed in April 2018. Interview domains for the migrant interviews included the following: expectations of migration, current working and living conditions, sexual and reproductive health, access to health care, and self-reported health status. Qualitative data were analyzed using a combination of inductive and deductive coding in MAXQDA. Results. Data indicate that migrant workers have a variety of perceptions surrounding their migration experience. In the urban destination, migrants face a number of challenges that negatively affect their health, including poor accommodation, safety concerns, and low levels of social support. Reported risks to sexual and reproductive health were unsafe sexual encounters, such as low condom use and sexual assault. Discussion. The negative sexual and reproductive health outcomes among migrant populations in urban poor settings are a result of a confluence of factors, including perceptions of destination locations, working and living conditions, social support, and gender norms. A complex systems approach to understanding the sexual health of migrants is warranted. Conclusion. Findings from this research illustrate the complexity of health risks among migrants in Agbogbloshie. Further research is needed to explore the increased vulnerability of migrants compared with nonmigrants in urban poverty and the long-term implications of sexual and reproductive health risks in vulnerable migrant communities.Item Explanatory Models of Stroke in Ghana: Perspectives of Stroke Survivors and their Caregivers(Carer Research and Knowledge Exchange Network (CAREN), 2024) Sanuade, O.A.; Dodoo, F.N-A.; Koram, K.; Aikins, A. d-G.Objective: This study examines explanatory models of stroke and its complications among people living with stroke, and their caregivers, in two urban poor communities in Accra (Ga Mashie) and Korle Bu Teaching Hospital, Accra. Methods: Twenty-two stroke survivors and twenty-nine caregivers were recruited from two urban poor communities in Accra and Korle Bu Teaching Hospital (KBTH). Qualitative data were obtained using semi-structured interviews that lasted between 45 minutes and 2 hours. The interviews were audiotaped, transcribed and analysed thematically, informed by the concept of explanatory models of illness. Results: Participants referred to stroke as a sudden event and they expressed different emotional responses after the stroke onset. Stroke survivors and their caregivers attributed stroke with poor lifestyle practices, high blood pressure, unhealthy diet and dietary practices, supernatural causes, stress, family history, other chronic diseases, and delay in treatment of symptoms. While the stroke survivors associated stroke complications with physical disability and stigmatization, the caregivers associated these with physical disability, behavioural and psychological changes, cognitive disability and death. These associations were mostly influenced by the biomedical model of stroke. Conclusion: The biomedical model of stroke is important for developing interventions that will be accepted by the stroke survivors and the caregivers. Nevertheless, sociocultural explanations of stroke need to be taken into consideration during delivery of medical information to the participants. This study proposes an integrated biopsychosociocultural approach for stroke intervention among the study participants.Item Correlates and spatial distribution of the co-occurrence of childhood anaemia and stunting in Ghana(SSM - Population Health, 2020) Christian, A.K.; Agula, C.; Jayson-Quashigah, P-N.Childhood anaemia and stunting are major public health concerns in Ghana. Using the 2014 Ghana Demographic and Health Survey, we evaluated whether childhood anaemia (Haemoglobin concentration < 110 g/L) and stunting (height-for-age z score < − 2) co-occur beyond what is expected in Ghana, and employed spatial analysis techniques to determine if their co-occurrence is spatially correlated. There was no statistically significant dif ference between the observed and expected frequency of co-occurrence. Among 24–35 month and 36–59-month old children, belonging to a high wealth household compared to low wealth household was associated with lower odds of the co-occurrence of childhood anaemia and stunting (OR, 95% CI: 0.3[0.1, 0.8] and 0.2[0.1, 0.5], respectively). Children aged 6–23 months with caregivers who had formerly been in union compared to their counterparts with caregivers who have never been in union had higher odds of co-occurrence of anaemia and stunting (5.1, [1.1, 24.3]). Overall, households with high wealth and having a mother with secondary or more education were associated with lower odds of the co-occurrence of childhood anaemia and stunting (OR, 95% CI: 0.4[0.2, 0.8] and 0.5[0.3, 0.9], respectively). There was substantial spatial clustering of co-occurrence, partic ularly in the northern region of the country. Interventions purposed to improve linear growth and anaemia must identify the specific factors or context which contribute to childhood anaemia and stunting.Item Households’ socio-demographic characteristics, perceived and underestimated vulnerability to floods and related risk reduction in Ghana(Urban Climate, 2021) Christian, A.K.; Dovie, B.D.; Akpalu, W.; Codjoe, S.N.There is a current upsurge of climate-related disasters globally with urban centres emerging as hotspots for climate risks such as floods, underlain by population growth and urbanization challenges. Yet, the literature on urban floods suggests limited estimates of “perceived vulnera bility”, the latter increasingly gaining acceptance in climate change and disaster knowledge communities. Subsequently in this article, the effects of socio-demographic characteristics of households in underestimating their perceived vulnerability to flooding in Ghana is analysed, for informed flood disaster risk reduction. The findings show female headed households and those with college education as relatively more likely to underestimate their vulnerability to floods, compared to male headed households and those with no education, respectively. The age of male household heads determined their underestimation of floods yet the relatiowas non-linear. Additionally, the perceived vulnerability of a household to floods and ability to estimate its status depends on the sex of household head, to potentially influence decision-making and choice of adaptation. In conclusion, differences in the effects of households’ background characteristics on perceived vulnerability and capacity to estimate the outcome suggest context specific mea sures or social interventions in addressing attitudes towards floods disaster risk, and subsequently in formulating disaster risk reduction strategies and policy interventions.Item The migration-sustainability paradox: transformations in mobile worlds(Current Opinion in Environmental Sustainability, 2021) Gavonel, M.F.; Adger, W.N.; Abu, M.; et al.Migration represents a major transformation of the lives of those involved and has been transformative of societies and economies globally. Yet models of sustainability transformations do not effectively incorporate the movement of populations. There is an apparent migration-sustainability paradox: migration plays a role as a driver of unsustainability as part of economic globalisation, yet simultaneously represents a transformative phenomenon and potential force for sustainable development. We propose criteria by which migration represents an opportunity for sustainable development: increasing aggregate well-being; reduced inequality leading to diverse social benefits; and reduced aggregate environmental burden. We detail the dimensions of the transformative potential of migration and develop a generic framework for migration-sustainability linkages based on environmental, social, and economic dimensions of sustainability, highlighting identity and social transformation dimensions of migration. Such a model overcomes the apparent paradox by explaining the role of societal mobility in achieving sustainable outcomes.