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 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-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.Item Inequalities in urban air pollution in sub-Saharan Africa: an empirical modeling of ambient NO and NO2 concentrations in Accra, Ghana(Enviromental Research Letters, 2024) Wang, J.; Ezzati, M.; Hughes, A.F.; et al.Road traffic has become the leading source of air pollution in fast-growing sub-Saharan African cities. Yet, there is a dearth of robust city-wide data for understanding space-time variations and inequalities in combustion related emissions and exposures. We combined nitrogen dioxide (NO2) and nitric oxide (NO) measurement data from 134 locations in the Greater Accra Metropolitan Area (GAMA), with geographical, meteorological, and population factors in spatio-temporal mixed effects models to predict NO2 and NO concentrations at fine spatial (50 m) and temporal (weekly) resolution over the entire GAMA. Model performance was evaluated with 10-fold cross-validation (CV), and predictions were summarized as annual and seasonal (dusty [Harmattan] and rainy [non-Harmattan]) mean concentrations. The predictions were used to examine population distributions of, and socioeconomic inequalities in, exposure at the census enumeration area (EA) level. The models explained 88% and 79% of the spatiotemporal variability in NO2 and NO concentrations, respectively. The mean predicted annual, non-Harmattan and Harmattan NO2 levels were 37 (range: 1–189), 28 (range: 1–170) and 50 (range: 1–195) µg m−3 , respectively. Unlike NO2, NO concentrations were highest in the non-Harmattan season (41 [range: 31–521] µg m−3 ). Road traffic was the dominant factor for both pollutants, but NO2 had higher spatial heterogeneity than NO. For both pollutants, the levels were substantially higher in the city core, where the entire population (100%) was exposed to annual NO2 levels exceeding the World Health Organization (WHO) guideline of 10 µg m−3 . Significant disparities in NO2 concentrations existed across socioeconomic gradients, with residents in the poorest communities exposed to levels about 15 µg m−3 higher compared with the wealthiest (p < 0.001). The results showed the important role of road traffic emissions in air pollution concentrations in the GAMA, which has major implications for the health of the city’s poorest residents. These data could support climate and health impact assessments as well as policy evaluations in the city.Item Significant human health co-benefits of mitigating African emissions(Atmos. Chem. Phys, 2024) Wells, C.D.; Ezzati, M.; Kasoar, M.; et al.Future African aerosol emissions, and therefore air pollution levels and health outcomes, are unknown and understudied. Understanding the future health impacts of pollutant emissions from this region is crucial. Here, this research gap is addressed by studying the range of future health impacts of aerosol emissions from Africa in the Shared Socioeconomic Pathway (SSP) scenarios, using the UK Earth System Model Version 1 (UKESM1), along with human health concentration-response functions. The effects of Africa following a high-pollution aerosol pathway are studied relative to a low-pollution control, with experiments varying aerosol emissions from industry and biomass burning. Using present-day demographics, annual deaths within Africa attributable to ambient particulate matter are estimated to be lower by 150 000 (5th–95th confidence interval of 67 000–234 000) under stronger African aerosol mitigation by 2090, while those attributable to O3 are lower by 15 000 (5th–95th confidence interval of 9000–21 000). The particulate matter health benefits are realised predominantly within Africa, with the O3-driven benefits being more widespread, though still concentrated in Africa, due to the longer atmospheric lifetime of O3. These results demonstrate the important health co-benefits from future emission mitigation in AfricaItem Social consequences of planned relocation in response to sea level rise: impacts on anxiety, well‑being, and perceived safety(Scientifc Reports, 2024) Abu, M.; Codjoe, S.N.A; Heath, S.C.; et al.Governments globally are adapting to sea level rise through a range of interventions to improve everyday lives of communities at risk. One prominent response is planned relocation, where people and communities are enabled to move from localities exposed to coastal erosion and inundation as a result of sea level rise. Managed retreat has significant social consequences, including underreported impacts on health, well-being and social identity. Here, we adopt well-established measures of well-being and document the outcomes of planned relocation on well-being in the Volta Delta region of Ghana. Data from a bespoke survey for individuals (n= 505) in relocated and non-relocated communities demonstrate that planned relocation negatively impacts well-being and anxiety of those relocated when compared to a community that is equally exposed but has not moved. Individuals in the relocated community reported significantly lower levels of overall wellbeing. higher levels of anxiety and lower perceptions of safety, compared to non-relocated community members. These outcomes are explained as being related to the disruption of community connection. identities, and feelings of efficacy. Relocated community members reported significantly lower levels of attachment to the local area and home, significantly lower levels of community-based self-efficacy, and significantly lower levels of overall community-based identity. The results demonstrate that planned relocation to address sea level rise has multiple social consequences with outcomes for well-being that are not straightforwardly related to risk reductionItem Micro-scale transformations in sustainability practices: Insights from new migrant populations in growing urban settlements(Global Environmental Change, 2024) Abu, M.; Codjoe, S.N.; Adger, W.N.; et al.Development that is inclusive and sustainable requires significant social and environmental transformations from current trajectories, building on demographic realities such as changing profiles of populations, and increased levels of mobility. Migration is a major driving force of urbanisation in all global regions, partly facilitated through emerging technologies and declining costs of movement and communication. Social transformations associated with increased migration are highly uneven but include shifts in the location of economic activities, major urban growth, and changing individual incentives and social constraints on sustainability trajectories. Yet, there is limited empirical evidence on how observed population movements can both challenge and promote sustainable transformations. This paper examines how migration transforms places and societies, by providing new evidence on the behaviours and practices of individuals who are part of such transformations as they assimilate, converge or remain distinctive to prior populations. Focusing on individuals in rapidly expanding cities in the Global South, this study uses new biographical life-history survey data from Accra, Ghana, to examine the barriers and enablers of sustainability practices among diverse types of migrants and a sample of non-migrants. The study uses data from 1,163 individuals: international migrants from the West African sub region (559), internal migrants (299), and non-migrants (305) in Accra. The findings show that sustainabil ity practices established before migration are predictors of current sustainability practices, including proactive recycling, conservation activities, and choice of mode of transportation, but that there is some convergence between behaviours, reflecting assimilation, place attachment and other factors. Internal migrants in Accra exhibit stronger sustainability practices than international migrants. Individual levels of poverty, poor infra structural development, and perceptions about life satisfaction in the neighbourhood negatively affect sustain ability practices among all respondents. These results suggest that poverty and social exclusion are critical to addressing sustainability issues in urban contexts. It is important for policy makers to address issues of urban poverty, cumulative deprivation, and inequality as strong barriers to the adoption of sustainability practices in urban areas.Item Impact Of Health System Strengthening Interventions On Child Survival In Sub-Saharan Africa: A Systematic Review Protocol(Systematic Reviews, 2024) Agula, C.; Bawah, A.A.; Asuming, P.O.; et al.Background Strengthening healthcare systems is a practical approach to enhancing healthcare delivery and services. Although there has been a rise in the number of health systems strengthening (HSS) interventions in sub-Saharan In Africa (SSA), there is limited evidence on the causal effect of these activities on child survival. Furthermore, the findings reported so far have been varied, and how they relate to each other remains unclear. This systematic review study aims to assess all available evidence to understand the impact of HSS activities on child survival in SSA. Methods: We developed a search strategy to retrieve all relevant studies from electronic databases such as PubMed. MEDLINE, Web of Science, and African Journals Online. We will use a combination of search terms, such as under-fve mortality,” “child mortality,” “infant mortality,” “neonatal mortality,” “child survival,” and health systems strengthening." The review will include studies that establish a causal relationship between HSS interventions and child survival. This will include studies with designs such as randomized controlled trials and quasi-experimental methods like difference-in-difference. Two reviewers will independently screen all citations, abstracts, and full-text data and a third The reviewer will act as a tiebreaker in cases of disagreement. The primary outcome of interest is the impact of HSS activities on under-five survival. We will evaluate the quality of each study using the Bradford Hill criteria for causation. Discussion Our systematic review will identify and evaluate all relevant evidence that establishes a causal relationship between HSS activities and the survival of children under five years old in SSA. The review’s findings regarding the impact of HSS activities on child survival could be of significant interest to the donor community and policy actors in the region. We also anticipate that the review’s conclusions could serve as a valuable guide for the development of future health system interventions and strategies in SSA.
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