Department of Population, Family and Reproductive Health
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Item The Effect Of Mobile Health Communication Intervention On Female Teachers’ Knowledge On Cervical Cancer And Cervical Screening Uptake In Accra Metropolis(University of Ghana, 2022-08) Mustapha, S.A.Background: Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death among women. Without significant intervention, the global burden is expected to increase to nearly 700,000 cases and 400,000 deaths by 2030, Ninety percent of these occur in sub-Saharan Africa including Ghana. Mobile health is an emerging technology around the world that can be effective in improving knowledge on cervical cancer and cervical cancer screening uptake. Because mobile phone adoption is growing at an exponential rate in low- and middle-income nations, employing mobile phones to promote cervical cancer services might reach a larger number of individuals in resource-constrained settings than traditional healthcare delivery methods. Objective: This study sought to assess the effect of mhealth communication intervention on female teachers’ knowledge on cervical cancer and cervical cancer screening uptake. Methodology: The study employed a cluster randomized design with baseline and endline stages. Multistage cluster randomized sampling was used to select 237 teachers from 61 private and government schools in 4 sub-districts in Accra metropolis. Two cross sectional surveys were carried out at baseline and endline across all intervention arms with control. SMS only (40), WhatsApp (50), SMS+WhatsApp (80) and Control ( 67). Questionnaire was the main tool for data collection. Modified ordinary least square regression(OLS) with Difference in Difference analysis and robust standard error were used to determine the effect of the mhealth communication intervention on cervical cancer knowledge and cervical screening uptake Results: The study assessed the effectiveness of WhatsApp only, SMS only, and WhatsApp + SMS with control on knowledge of cervical cancer and cervical cancer screening uptake. The results showed that, receiving at least one intervention, increased knowledge score on cervical cancer and overall knowledge of cervical screening by 11.5% and 19% respectively respectively y(p<0.001). Among the three interventions, WhatsApp text yielded the largest improvement on knowledge. It increased knowledge on cervical cancer by 17.34% (p<0.001), Knowledge on risk factors by 18.26% (p<0.001) and overall knowledge by 17.53% (p<0.001) and the three interventions had a significant effect on knowledge on cervical cancer but did not have significant effect on cervical screening uptake Conclusion This study concludes that SMS and WhatsApp interventions had an impact on knowledge of risk factors of cervical cancer and general knowledge of cervical cancer. However, WhatsApp was the most effective in terms of raising awareness on cervical cancerItem Institutional Approaches to Research Integrity in Ghana(Science and Engineering Ethics, 2020) Laar, A.K.; Redman, B.K.; Ferguson, K.; Caplan, A.Research misconduct (RM) remains an important problem in health research despite decades of local, national, regional, and international efforts to eliminate it. The ultimate goal of every health research project, irrespective of setting, is to produce trustworthy findings to address local as well as global health issues. To be able to lead or participate meaningfully in international research collaborations, individual and institutional capacities for research integrity (RI) are paramount. Accordingly, this paper concerns itself not only with individuals’ research skills but also with institutional and national policies and governance. Such policies and governance provide an ethical scaffold for the production of knowledge and structure incentives. This paper’s operational definition of research therefore draws from the Institute of Medicine’s articulation of health research as an inquiry that aims to produce knowledge about the structure, processes, or effects of personal health services; and from an existing health systems framework. The paper reviews the research regulatory environment and the ethics apparatus in Ghana and describes a project jointly undertaken by Ghanaian researchers in collaboration with New York University to assess the perceived adequacy of current institutional practices, opportunities, and incentives for promoting RI.Item 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.alBackground: 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.Item 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.Item Policy Action Within Urban African Food Systems to Promote Healthy Food Consumption: A Realist Synthesis in Ghana and Kenya(International Journal of Health Policy and Management, 2021) Booth, A.; Laar, A.; Barnes, A.; et.alBackground: Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa, driven by urbanization and changing food environments. Policy action has been limited - and influenced by high-income countries. Socioeconomic/political environments of African food systems must be considered to understand what policy might work to prevent NR-NCDs, for whom, and under what circumstances. Methods: A realist synthesis of five policy areas to support healthier food consumption in urban Africa: regulating trade/foreign investment; regulating health/nutrition claims/labels; setting composition standards for processed foods; restricting unhealthy food marketing; and school food policy. We drew upon Ghana and Kenya to contextualize the evidence base. Program theories were generated by stakeholders in Ghana/Kenya. A two-stage search interrogated MEDLINE, Web of Science, and Scopus. Program theories were tested and refined to produce a synthesized model. Results: The five policies operate through complex, interconnected pathways moderated by global-, national- and local contexts. Consumers and the food environment interact to enable/disable food accessibility, affordability, and availability. Consumer relationships with each other and retailers are important contextual influences, along with political/ economic interests, stakeholder alliances, and globalized trade. Coherent laws/regulatory frameworks and government capacities are fundamental across all policies. The increasing importance of convenience is shaped by demographic and sociocultural drivers. Awareness of healthy diets mediates food consumption through comprehension, education, literacy, and beliefs. Contextualized data (especially food composition data) and inter-sectoral collaboration are critical to policy implementation. Conclusion: Evidence indicates that coherent action across the five policy areas could positively influence the healthiness of food environments and consumption in urban Africa. However, drivers of (un)healthy food environments and consumption reflect the complex interplay of socio-economic and political drivers acting at diverse geographical levels. Stakeholders at local, national, and global levels have important, yet differing, roles to play in ensuring healthy food environments and consumption in urban Africa.Item Diet Quality And Cardiovascular Disease Risk Factors Among People Living With Hiv.(University of Ghana, 2022-10) Abdulai, K.Introduction: With improved life expectancy, people living with HIV (PLHIV) are burdened with cardiovascular diseases (CVD) as a result of prolonged exposure to the traditional risk factors for CVD (smoking, obesity, alcohol, and sedentary lifestyle), and complications associated with HIV infection such as inflammation, endothelial dysfunction, hyper-coagulation, and immune activation. The role of diet and prolonged use of antiretroviral medications (ARVs) in CVD is also well established. Interactions between dietary habits, HIV infection itself, and ART may escalate the risk of developing CVDs among PLHIV. These complex relationships between HIV, diet, and CVD risk factors among PLHIV is yet to be comprehensively studied in Ghana. Aim: To assess diet quality and cardiovascular disease risk factors among ARV-exposed PLHIV. Methodology: A multi-methods study was conducted; a systematic review and meta-analysis, and a facility-based analytical cross-sectional design study. The systematic review and meta-analysis preceded the facility-based analytical cross-sectional study. Cochrane Central, Scopus, PubMed, and Google Scholar databases were systemically searched for papers that compared prevalence of CVD risk factors (diabetes, hypertension, dyslipidemia, and obesity) between PLHIV on ART and PLHIV who are ART-naive in low and middle-income countries (LMIC). Papers that satisfied the inclusion criteria were included in the meta-analysis. Pooled estimates for prevalence were generated using random fixed effects models. The cross-sectional study was conducted among 440 adults living with HIV randomly selected from two hospitals - St. Martins De Porres Hospital and Atua Government Hospital - providing specialized HIV care in the Lower Manya Krobo Municipality of the Eastern Region, Ghana. Medline, Cochrane, A structured questionnaire was administered to collect data on socio-demographic information, and lifestyle factors. Dietary intake of participants was measured with a two-day 24-hour recall of their usual food intake (one weekday and one weekend). Individual Dietary Diversity Score (IDDS) was used to measure diet quality of the participants. Height was measured with a stadiometer calibrated to 1.0 cm. Omron Body Composition Monitor and Scale (Model HBF-516) was used to determine weight, Body Mass Index (BMI), percentage muscle mass, percentage body fat, and visceral fat of the participants. Three measurements of participants’ blood pressure were taken at a minute’s interval in the right arm with participants sitting upright using the Omron HEM 907 oscillometric monitor (Matsusaka, Japan). Lipid Profile and blood glucose were checked using LipidPlus Lipid Profile and Glucose Monitoring System and Blood glucose with OneTouch Select glucometer respectively. Mean and standard deviations of continuous variables were determined. Frequencies and percentages were used to describe categorical variables. Univariate, bivariate, and multivariate analyses were conducted using Chi-square test, independent Student’s t-test, binary logistic regression, and ordinal logistic regression. Statistical significance was set at p < 0.05. Data analyses were conducted using SPSS for windows version 20, and Microsoft Excel 2016. Results: Results from the systematic review and meta-analysis showed an association between ART intake and prevalence of hypertension, dyslipidemia, and obesity among PLHIV (p<0.01 for all). Results from the cross-sectional study showed that proportion of PLHIV with high IDDS (diet quality) was about 14 percent, proportion of those having diet needing improvement was 56 percent, whiles about 30 percent actually had low IDDS (poor diet). Prevalence of cardiovascular risk factors including diabetes, hypertension, and dyslipidemia were found to 20.1%, 33.3%, and 63.5% respectively. The average IDDS (diet quality) was significantly higher among PLHIV whoItem Influence Of Temperature On The Growth, Development And Susceptibility Of Anopheles Gambiae (S.L.) Mosquitoes To Pyrethroids.(University of Ghana, 2023-02) Peprah Agyekum, T.Background: Anopheles mosquitoes are responsible for transmitting malaria and lymphatic filariasis. They are among the notable vector species for their crucial role in transmitting malaria. The survival of the vector is of great interest as it affects its ability to transmit diseases. The biology and ecology of mosquitoes are strongly dependent on ambient temperature. The mosquito's life cycle includes four stages: egg, larva, pupa and adult. Indeed, the rearing temperature of the immature stages (egg, larva, and pupa) can significantly impact the completion of the life cycle, the overall fitness of the adult, and ability to transmit disease. In recent years, global warming and possible future warmer climate have prompted many studies to focus on the effects of elevated temperatures on both the morphology and the biology of various species, including vectors. Despite the importance of temperature variability on An. gambiae (s.l.) mosquito's development and survival, there is still the need to explore how and whether or not elevated temperatures associated with climate change is likely to reduce or increase the vector's population dynamics by modifying the life cycle, reduce the efficacy of insecticides, and increase the expression of metabolic enzymes in An. gambiae (s.l.) mosquitoes. Objective: This study aimed to investigate the influence of elevated temperatures on the growth and development of An. gambiae (s.l.) mosquitoes, and the effectiveness of pyrethroid insecticides in such higher temperatures. Methods: Anopheles gambiae (s.l.) eggs were obtained from colonies established in the laboratory and were incubated, hatched and reared under eight temperature regimes (25, 28, 30, 32, 34, 36, 38 and 40 °C) using climate-controlled incubators (RTOP-1000D, Zhejiang, China), with photoperiod of 12:12 (L:D) and 80 ± 10% relative humidity. Larvae were fed 10 mg of TetraFin goldfish flakes (Tetra Werke, Melle, Germany). All adults were fed with a 10% sugar solution soaked in cotton wool. In addition, female mosquitoes used to estimate fecundity and longevity were blood-fed using a guinea pig on day four (4) post-emergence. Larvae were monitored daily for development to the next stage. The time to pupation, pupation success, number of adults produced, and sex ratio of the newly emerged adult was recorded. Molecular identification of An. gambiae (s.l.) mosquitoes was done using polymerase chain reaction (PCR) to identify the composition of sibling species in the An. gambiae complex. Larval survival and adult longevity were monitored every 24 hours, and data were analyzed using Kaplan-Meier survival analysis. Furthermore, analysis of variance (ANOVA) was used to assess the relationship between temperature and development time, time to pupation, length of the gonotrophic cycle, biting rate and fecundity. Kruskal-Wallis test was also used to assess the relationship between temperature and pupation success, pupal mortality, the number of adults produced, and sex ratio. Digital images of larvae, pupae, adult wings and proboscis were captured using stereo microscope with inbuilt camera (Leica EZ4 HD, Leica Microsystems Limited, Switzerland) and body parts were measured using Leica Application Software, version 3.4.0 (Leica Microsystems Limited, Switzerland). Data on larval, and pupal weight and size, adult weight, size and proboscis length were log-transformed and analyzed using ordinary least square (OLS) regression with robust standard errors. In addition, three to five-day-old non-blood-fed An. gambiae (s.l.) mosquitoes were used for insecticide susceptibility test following the WHO bioassay protocol. Batches of 20 – 25 non-blood-fed female adult An. gambiae (s.l.) mosquitoes from each temperature regime (25 – 32 °C) were exposed to two pyrethroid insecticides (0.75% permethrin and 0.05% deltamethrin). The knockdown rate after 60 min and mortality at 24 h were recorded. The levels of four metabolic enzymes (MFO, GST, α-EST and β-EST) were examined in both mosquitoes that were not exposed and those exposed to pyrethroids. mosquitoes and provides helpful information for modelling vector population dynamics in a future warmer climate.Item Pre-Packaged Food Labelling And Use Among Households In Accra(University Of Ghana, 2021-09) Asalu, G.A.The rate of diet-related non-communicable diseases (NCDs) is increasing rapidly in Africa. Consumption of pre-packaged foods which are nutrient-poor and calorie-rich is one of the main drivers of NCDs. Food labels can guide consumers to make healthy food choices. In Ghana, there is paucity of evidence on the type of nutrition and health-related label information that consumers are exposed to, and whether consumers use such information in their purchase decisions. Therefore, this study assessed label characteristics of pre-packaged foods, and determined the drivers of label use among consumers in urban Accra. This study employed a quantitative cross-sectional multi-method design. A survey of food labels was conducted in community-based retail shops. Information on labels of pre-packaged foods were obtained by taking pictures and analysing the contents based on the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support’s (INFORMAS) taxonomy. Besides, respondents (510) were selected using a multi-stage sampling technique. Participants were interviewed, using a structured pre-tested questionnaire. Questions assessed consumers’ pre-packaged food use behaviour, their perceptions of health-related label information, understanding of food labels and socio-demographic covariates. Three hundred and fifty-one (N=351) pre-packaged foods were sampled. Out of 343 labelled products, 68.8% had nutrition declaration information. Back- of-Pack (BOP) nutrition label formats were dominant (87.3%) compared to the Front-of -Pack (FOP) format. Guideline Daily Amount (GDA) was the commonest FOP identified. Nutrition claims were twice as frequent as health claims. Most products (>84%) with health and nutrition claims complied with FDA and Codex Alimentarius standards. Although the disclosure of nutrition and health-related information was appreciable it did not meet the current recommendations set out by Codex and INFORMAS in promoting a healthy environment. Majority of survey respondents (79.4%) were females and had at least secondary school-level education (65.3%). Most households (77%) purchased pre-packaged foods from traditional markets or corner shops and a few (7%) purchased from supermarkets. Most consumers had a positive perception of food labels, and their purchase behaviour was driven more by taste and price. Although most (62%) respondents reported adequate understanding of labels, objective assessments showed a lower (9%) consumer knowledge and skill in using labels. Only a third of respondents were food label users. Labels were used mainly to ascertain product safety and less likely for nutrition and health reasons. Higher proportions (45%) of non-label users indicated technical nature of label information and limited understanding as reasons for not using labels. In multiple logistic regression modelling, being part of a larger household (AOR: 2.41; 95% CI: 1.16-4.99), having tertiary education (AOR: 6.75; 95% CI: 1.99-22.88), adequate nutrition-related knowledge of labels (AOR: 1.92; 95% CI: 1.15-3.20) and food label understanding (AOR: 2.51; 95% CI: 1.19-5.29) as well as individuals with self-reported understanding of labels (AOR: 10.06; 95% CI: 2.40-42.27) predicted food label use. However, a multiple linear regression analysis the following variables: levels of education, individuals with food allergies, those who had a previous education on the use of labels, those who perceived labels are easy to understand and individuals who self-reported adequate food label understanding showed positive association with the use of health-related label information. Therefore, these findings suggest that educational interventions and labelling policy reforms are needed to encourage, enable, and improve consumer use of nutrition and health-related information on food labels in Ghana.Item Substance Use Disorders And Rehabilitation Among Youth In Ghana And Effects On The Family(University Of Ghana, 2022-10) Assah-Offei, V.E.INTRODUCTION Substance use disorders (SUDs) is a chronic, relapsing brain disorder that is characterized by compulsive seeking and use of addictive substances. SUDs among the youth continue to be a global public health concern. Treatment of SUDs places a heavy burden on public health systems. This study assessed the factors associated with substance use disorders and examine the effects and cost burden of SUDs and drug rehabilitation on families in Ghana. METHODS The study used an embedded concurrent mixed-method design. It was conducted among 101 participants drawn from four (4) drug rehabilitation centres in the Greater Accra and Eastern Regions of Ghana, from December 2018 to February 2019. The quantitative component relied on a matched case-control design. One hundred and one (101) cases were enrolled from the only existing rehabilitation centres in Ghana, whereas 303 controls consisted of persons living in the same community as the cases but who had never used substances. A closed-ended questionnaire and semi-structured interview guide were used for face-to-face quantitative and qualitative data collection. Quantitative data were analysed using STATA version 15, and qualitative data were analysed using a thematic approach. The cost burden of substance use rehabilitation was calculated by summing the direct and indirect costs of managing drug users. The student t-test and one-way ANOVA test were used to compare average costs. Bivariate and multivariate analyses were done to test statistical relationships between outcome and observed explanatory variables. Statistical significance was set at a p-value of 0.1%, 1% and 5%. RESULTS Multiple logistic regression analysis showed that sex, age, highest educational level, employment status, residential status, and friendship with drug users had a statistically significant association with SUDs. Male participants had 1.5 (95% CI:1.2-2.5, p=0.001) times higher odds of SUDs than female participants. Participants aged above 20 years had lower odds of substance use disorders compared to those aged below 20 years (p<0.01). The estimated average household cost of rehabilitation was GHS 4,445.60 per month. The mean monthly indirect cost incurred by urban substance users (472.1 } 196.40) was statistically significantly higher (p<0.05) than that of rural substance users (181.2 } 100.30). Of 101 family members of substance users, 57.4% experienced a high intangible burden. Overall, the mean UNODC standard rehabilitation compliance was 3.0 ( }0.0), signifying that the compliance standards at the rehabilitation facilities were inadequate. CONCLUSION Males, rural dwellers and younger age have a higher risk of SUDs. Hence public health strategies must target such vulnerable groups. To reduce the high-cost burden associated with the rehabilitation of substance users, the government and stakeholders must subsidize rehabilitation registration costs which contribute more than half of the economic burden of rehabilitation. KEYWORDS: Substance use disorder, drug abuse, rehabilitation, youth, economic cost, Ghana.Item The Effect Of Mobile Health Communication Intervention On Female Teachers’ Knowledge On Cervical Cancer And Cervical Screening Uptake In Accra Metropolis(University Of Ghana, 2022-08) Mustapha, S.A.Background: Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death among women. Without significant intervention, the global burden is expected to increase to nearly 700,000 cases and 400,000 deaths by 2030, Ninety percent of these occur in sub-Saharan Africa including Ghana. Mobile health is an emerging technology around the world that can be effective in improving knowledge on cervical cancer and cervical cancer screening uptake. Because mobile phone adoption is growing at an exponential rate in low- and middle-income nations, employing mobile phones to promote cervical cancer services might reach a larger number of individuals in resource-constrained settings than traditional healthcare delivery methods. Objective: This study sought to assess the effect of mhealth communication intervention on female teachers’ knowledge on cervical cancer and cervical cancer screening uptake. Methodology: The study employed a cluster randomized design with baseline and endline stages. Multistage cluster randomized sampling was used to select 237 teachers from 61 private and government schools in 4 sub-districts in Accra metropolis. Two cross sectional surveys were carried out at baseline and endline across all intervention arms with control. SMS only (40), WhatsApp (50), SMS+WhatsApp (80) and Control ( 67). Questionnaire was the main tool for data collection. Modified ordinary least square regression(OLS) with Difference in Difference analysis and robust standard error were used to determine the effect of the mhealth communication intervention on cervical cancer knowledge and cervical screening uptake Results: The study assessed the effectiveness of WhatsApp only, SMS only, and WhatsApp + SMS with control on knowledge of cervical cancer and cervical cancer screening uptake. The results showed that, receiving at least one intervention, increased knowledge score on cervical cancer and overall knowledge of cervical screening by 11.5% and 19% respectively(p<0.001). Among the three interventions, WhatsApp text yielded the largest improvement on knowledge. It increased knowledge on cervical cancer by 17.34% (p<0.001), Knowledge on risk factors by 18.26% (p<0.001) and overall knowledge by 17.53% (p<0.001) and the three interventions had a significant effect on knowledge on cervical cancer but did not have significant effect on cervical screening uptake Conclusion This study concludes that SMS and WhatsApp interventions had an impact on knowledge of risk factors of cervical cancer and general knowledge of cervical cancer. However, WhatsApp was the most effective in terms of raising awareness on cervical cancer
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