Regional Institute for Population Studies
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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.Item Phenotyping urban built and natural environments with high-resolution satellite images and unsupervised deep learning(Elsevier B.V., 2023) Agyei-Asabere, C.; Metzler, B.; Nathvani, R.; et al.Cities in the developing world are expanding rapidly, and undergoing changes to their roads, buildings, vegetation, and other land use characteristics. Timely data are needed to ensure that urban change enhances health, wellbeing and sustainability. We present and evaluate a novel unsupervised deep clustering method to classify and characterise the complex and multidimensional built and natural environments of cities into interpretable clusters using high resolution satellite images. We applied our approach to a high-resolution (0.3 m/pixel) satellite image of Accra, Ghana, one of the fastest growing cities in sub-Saharan Africa, and contextualised the results with demographic and environmental data that were not used for clustering. We show that clusters obtained solely from images capture dis tinct interpretable phenotyp orientation; length and arrangement of roads) environment, and population, either as a unique defining charac teristic (e.g., bodies of water or dense vegetation) or in combination (e.g., buildings surrounded by vegetation or sparsely populated areas intermixed with roads). Clusters that were based on a single defining characteristic were robust to the spatial scale of analysis and the choice of cluster number, whereas those based on a combina tion of characteristics changed based on scale and number of clusters. The results demonstrate that satellite data and unsupervised deep learning provide a cost-effective, interpretable and scalable approach for real-time track ing of sustainable urban development, especially where traditional environmental and demographic data are limited and infrequent.Item Spatial modelling and inequalities of environmental noise in Accra, Ghana(Elsevier Inc, 2022) Clark, S.N.; Alli, A.S.; Ezzati, M.; Moses, B.; Agyei-Mensah, S.; Owusu, G.; et al.A B S T R A C T Noise pollution is a growing environmental health concern in rapidly urbanizing sub-Saharan African (SSA) cities. However, limited city-wide data constitutes a major barrier to investigating health impacts as well as implementing environmental policy in this growing population. As such, in this first of its kind study in West Africa, we measured, modelled and predicted environmental noise across the Greater Accra Metropolitan Area (GAMA) in Ghana, and evaluated inequalities in exposures by socioeconomic factors. Specifically, we measured environmental noise at 146 locations with weekly (n = 136 locations) and yearlong monitoring (n = 10 locations). We combined these data with geospatial and meteorological predictor variables to develop highresolution land use regression (LUR) models to predict annual average noise levels (LAeq24hr, Lden, Lday, Lnight). The final LUR models were selected with a forward stepwise procedure and performance was evaluated with cross-validation. We spatially joined model predictions with national census data to estimate population levels of, and potential socioeconomic inequalities in, noise levels at the census enumeration-area level. Variables representing road-traffic and vegetation explained the most variation in noise levels at each site. Predicted dayevening- night (Lden) noise levels were highest in the city-center (Accra Metropolis) (median: 64.0 dBA) and near major roads (median: 68.5 dBA). In the Accra Metropolis, almost the entire population lived in areas where predicted Lden and night-time noise (Lnight) surpassed World Health Organization guidelines for road-traffic noise (Lden <53; and Lnight <45). The poorest areas in Accra also had significantly higher median Lden and Lnight compared with the wealthiest ones, with a difference of ~5 dBA. The models can support environmental epidemiological studies, burden of disease assessments, and policies and interventions that address underlying causes of noise exposure inequalities within Accra.Item Profiling household double and triple burden of malnutrition in sub-Saharan Africa: prevalence and influencing household factors(Cambridge University Press, 2021) Christian, A.K.; Dake, F.A.A.Objective: Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA. Setting: The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017. Participants: The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15–49 years and children under 5 years). Design: Logistic regression analyses were used to determine household correlates of household burden of malnutrition. Results: Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the house hold, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition. Conclusions: The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.Item Is social support associated with hypertension control among Ghanaian migrants in Europe and non-migrants in Ghana? The RODAM study(Internal and Emergency Medicine, 2019-03-14) De‑Graft Aikins, A.; Nyaaba, G.N.; Stronks, K.; Meeks, K.; Beune, E.; Owusu‑Dabo, E.; Addo, J.; Mockenhaupt, F.; Bahendeka, S.; Klipstein‑Grobusch, K.; Smeeth, L.; Agyemang, C.Hypertension (HTN) control is crucial in preventing HTN-related complications such as stroke and coronary heart disease. Yet, HTN control remains suboptimal particularly among sub-Saharan African (SSA) populations partly due to poor selfmanagement. Self-management of HTN is influenced by social support, but the evidence on the role of social support on HTN control particularly among SSA populations is limited. This study assessed the association between multiple proxies for social support and HTN control among Ghanaians resident in Ghana and Europe. The Research on Obesity and Diabetes among African Migrants (RODAM) study participants with HTN and who self-reported HTN (n = 1327) were included in this analysis. Logistic regression was used to assess the association between proxies of social support and HTN control (SBP < 140 mmHg and DBP < 90 mmHg) with adjustments for age and socioeconomic status (SES). Among Ghanaian males in both Europe and Ghana, cohabiting with more than two persons was associated with increased odds of having HTN controlled. Male hypertensive patients cohabiting with ≥ 5 persons had the highest odds of having HTN controlled after adjustment for age and SES (OR 0.30; 95% CI 0.16–0.57; 0.60; 0.34–1.04, respectively). This association was not observed among females. Relationship status, frequency of religious activity attendance and satisfaction with social support did not show any significant association with HTN control. Our study shows that cohabitation is significantly associated with HTN control but in males only. The other proxies for social support appeared not to be associated with HTN control. Involving persons living with Ghanaian men with HTN in the treatment process may help to improve adherence to HTN treatment. Further research is needed to explore in-depth, how these social support proxies could contribute to improved HTN control among SSA populations.Item Ideal cardiovascular health among Ghanaian populations in three European countries and rural and urban Ghana: the RODAM study(Internal and Emergency Medicine, 2018-04) van Nieuwenhuizen, B.; Zafarmand, M.H.; Beune, E.; Meeks, K.; De-Graft Aikins, A.; Addo, J.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Bahendeka, S.; Schulze, M.B.; Danquah, I.et.al.Cardiovascular health (CVH) is a construct defined by the American Heart Association (AHA) as part of its 2020 Impact Goal definition. CVH has, until now, not been evaluated in Sub-Saharan African populations. The aim of this study was to investigate differences in the prevalence of ideal CVH and its constituent metrics among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in three European countries. The AHA definition of CVH is based on 7 metrics: smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and fasting plasma glucose. These were evaluated among 3510 Ghanaian adults (aged 25-70 years) residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin) in the multi-centre RODAM study. Differences between groups were assessed using logistic regression with adjustments for gender, age, and education. Only 0.3% of all participants met all 7 metrics of the AHA's definition of ideal CVH. Compared to rural Ghana (25.7%), the proportions and adjusted odds ratio (OR) of individuals who had 6-7 CVH metrics in the ideal category were substantially lower in urban Ghana, (7.5%; OR 0.204, 95% CI 0.15-0.29), Amsterdam (4.4%; 0.13, 0.08-0.19), Berlin (2.7%; 0.06, 0.03-0.11), and London (1.7%; 0.04, 0.02-0.09), respectively. The proportion of ideal CVH for the various metrics ranged from 96% for all sites in the smoking metric to below 6% in the diet metric. The proportion of ideal CVH is extremely low in Ghanaians, especially among those living in urban Ghana and Ghanaian migrants in Europe.Item Dyslipidaemia among Ghanaian migrants in three European countries and their compatriots in rural and urban Ghana: The RODAM study(Atherosclerosis, 2019-05) van der Linden, E.; Meeks, K.; Beune, E.; de-Graft Aikins, A.; Addo, J.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Bahendeka, S.et.al.Background and aims African populations have a favourable lipid profile compared to European populations. However, the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the lipid profiles of Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in three European countries. Methods We used data from a multi-centre, cross-sectional study among Ghanaian adults residing in rural- and urban-Ghana and London, Amsterdam and Berlin (n = 5482). Dyslipidaemias were defined using the 2012 European Guidelines on Cardiovascular Prevention. Comparisons between groups were made using age-standardised prevalence and prevalence ratios (PRs) with adjustments for important covariates. Results In both sexes, the age-standardised prevalence of high total cholesterol (TC) and LDL-cholesterol (LDL-C) was lower in rural- than in urban-Ghana and Ghanaian migrants in Europe. Adjusted PRs of high TC and LDL-C were higher in urban-Ghana (TC PR = 2.15, 95%confidence interval 1.69–2.73) and Ghanaian migrant men (TC PR = 2.03 (1.56–2.63)) compared to rural-Ghana, but there was no difference between rural- and Ghanaian migrant women (TC PR = 1.01 (0.84–1.22)). High triglycerides levels were as prevalent in rural-Ghana (11.6%) as in urban-Ghana (12.8%), but were less prevalent in Ghanaian migrant women (2.0%). In both sexes, low HDL-cholesterol was most prevalent in rural-Ghana (50.1%) and least prevalent in Europe (12.9%). Conclusion The lipid profile varied among ethnically homogeneous African populations living in different geographical locations in Africa and Europe. Additional research is needed to identify factors driving these differential risks to assist prevention efforts.Item Is social support associated with hypertension control among Ghanaian migrants in Europe and non-migrants in Ghana? The RODAM study(Internal and Emergency Medicine, 2019-03) Nyaaba, G.N.; Stronks, K.; Meeks, K.; Beune, E.; Owusu-Dabo, E.; Addo, J.; de-Graft Aikins, A.; Mockenhaupt, F.; Bahendeka, S.et.alHypertension (HTN) control is crucial in preventing HTN-related complications such as stroke and coronary heart disease. Yet, HTN control remains suboptimal particularly among sub-Saharan African (SSA) populations partly due to poor self-management. Self-management of HTN is influenced by social support, but the evidence on the role of social support on HTN control particularly among SSA populations is limited. This study assessed the association between multiple proxies for social support and HTN control among Ghanaians resident in Ghana and Europe. The Research on Obesity and Diabetes among African Migrants (RODAM) study participants with HTN and who self-reported HTN (n = 1327) were included in this analysis. Logistic regression was used to assess the association between proxies of social support and HTN control (SBP < 140 mmHg and DBP < 90 mmHg) with adjustments for age and socioeconomic status (SES). Among Ghanaian males in both Europe and Ghana, cohabiting with more than two persons was associated with increased odds of having HTN controlled. Male hypertensive patients cohabiting with ≥ 5 persons had the highest odds of having HTN controlled after adjustment for age and SES (OR 0.30; 95% CI 0.16-0.57; 0.60; 0.34-1.04, respectively). This association was not observed among females. Relationship status, frequency of religious activity attendance and satisfaction with social support did not show any significant association with HTN control. Our study shows that cohabitation is significantly associated with HTN control but in males only. The other proxies for social support appeared not to be associated with HTN control. Involving persons living with Ghanaian men with HTN in the treatment process may help to improve adherence to HTN treatment. Further research is needed to explore in-depth, how these social support proxies could contribute to improved HTN control among SSA populations.Item Internal migration to Nairobi's slums: Linking migrant streams to sexual risk behavior(Health and Place, 2011-01) Greif, M.J.; Nii-Amoo Dodoo, F.Despite what is currently the most rapid urbanization on the globe, an alarming growth of impoverished urban slum settlements in Africa, and the highest rates of HIV in the world - with greater prevalence in urban than rural areas - insufficient attention has been paid to the relationship between urban poverty and risky sexual behavior. Although emerging research has focused on how slum residence is linked to risky behavior, there is a paucity of work on how migration to slums is related to risky sex. Using a sample of sexually active women from the 2000 Nairobi Cross-Sectional Slum Survey (NCSS), this paper demonstrates that the relationship between slum residence and risky behavior is a multifaceted one. Beyond the effect of current residence in slums migratory factors, specifically previous place of residence and length of time since arrival, prove to be significant cofactors, with the effect of the former conditioned by the latter. Perhaps more importantly, where migrants moved from appears to influence risky behavior in a non-uniform manner. © 2010 Elsevier Ltd.Item Obesity and type 2 diabetes in sub-Saharan Africans - Is the burden in today's Africa similar to African migrants in Europe? The RODAM study.(2016) Agyemang, C.; Meeks, K.; Beune, E.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Addo, J.; de-Graft Aikins, A.; Bahendeka, S.; Danquah, I.; Schulze, M.B.; Spranger, J.; Burr, T.; Agyei-Baafour, P.; Amoah, S.K.; Galbete, C.; Henneman, P.; Klipstein-Grobusch, K.; Nicolaou, M.; Adeyemo, A.; van Straalen, J.; Smeeth, L.; Stronks, K.BACKGROUND: Rising rates of obesity and type 2 diabetes (T2D) are impending major threats to the health of African populations, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of obesity and T2D among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in different European countries. METHODS: A multi-centre cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25-70 years residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin). Comparisons between groups were made using prevalence ratios (PRs) with adjustments for age and education. RESULTS: In rural Ghana, the prevalence of obesity was 1.3 % in men and 8.3 % in women. The prevalence was considerably higher in urban Ghana (men, 6.9 %; PR: 5.26, 95 % CI, 2.04-13.57; women, 33.9 %; PR: 4.11, 3.13-5.40) and even more so in Europe, especially in London (men, 21.4 %; PR: 15.04, 5.98-37.84; women, 54.2 %; PR: 6.63, 5.04-8.72). The prevalence of T2D was low at 3.6 % and 5.5 % in rural Ghanaian men and women, and increased in urban Ghanaians (men, 10.3 %; PR: 3.06; 1.73-5.40; women, 9.2 %; PR: 1.81, 1.25-2.64) and highest in Berlin (men, 15.3 %; PR: 4.47; 2.50-7.98; women, 10.2 %; PR: 2.21, 1.30-3.75). Impaired fasting glycaemia prevalence was comparatively higher only in Amsterdam, and in London, men compared with rural Ghana. CONCLUSION: Our study shows high risks of obesity and T2D among sub-Saharan African populations living in Europe. In Ghana, similarly high prevalence rates were seen in an urban environment, whereas in rural areas, the prevalence of obesity among women is already remarkable. Similar processes underlying the high burden of obesity and T2D following migration may also be at play in sub-Saharan Africa as a consequence of urbanisation.