Theses

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A long essay or dissertation or thesis involving personal research, written by postgraduates of University of Ghana for a university degree.

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Now showing 1 - 9 of 9
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    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.al
    Background: 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.
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    Effect of Enhanced Adherence Package on Early ART Uptake Among HIV-Positive Pregnant Women in Zambia: An Individual Randomized Controlled Trial
    (AIDS and Behavior, 2021) Mubiana-Mbewe, M.; Bosomprah, S.; Kadota, J.L.; et.al
    We evaluated the effect of an option B-plus Enhanced Adherence Package (BEAP), on early ART uptake in a randomized controlled trial. HIV-positive, ART naïve pregnant women in Lusaka, Zambia was randomized to receive BEAP (phone calls/home visits, additional counseling, male partner engagement, and missed-visit follow-up) versus standard of care (SOC). The primary outcome was initiating and remaining on ART for 30 days. Analysis was by intention to treat (ITT) using logistic regression. An additional per-protocol analysis was done. We enrolled 454 women; 229 randomized to BEAP and 225 to SOC. Within 30 days of eligibility, 445 (98.2%) initiated ART. In ITT analysis, 82.5% BEAP versus 80.4% SOC participants reached the primary outcome (crude relative risk [RR] 1.03; 95% confidence interval [CI] 0.91–1.16; Wald test statistic = 0.44; p-value = 0.66). As per protocol analysis, (92 participants (40.2%) were excluded), 91.9% BEAP versus 80.4% SOC participants reached primary outcome (crude RR 1.14; 95% CI 1.02–1.29; Wald test statistic = 2.23; p-value = 0.03). Early ART initiation in pregnancy was nearly universal but there was an early drop out suggesting the need for additional adherence support.
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    Assessment of Agricultural Advisory Messages from Farmer-to Farmer in Making a Case for Scaling Up Production: A Qualitative Study
    (The Qualitative Report, 2020) Kwapong, N.A.; Ankrah, D.A.; Boateng-Gyambiby, D.; et.al
    Inadequate access to agricultural extension services often results in poor farm practices, affecting yields and subsequently the income and well-being of smallholder farmers. Given the high demand for agricultural information and the limited capacity of extension services, a farmer-to-farmer extension approach has been explored by many underserved farmers. In this study, we use a qualitative case study approach to explore how cassava farmers who had limited access to agricultural advisory services from public extension agents managed to up-scale their farming business. Our research question was: what lessons can be learned from the lived experience of these farmers to address the current challenges of cassava farming? The results of our study revealed diversity in advisory messages from farmer to farmer and agricultural extension agents. Farmers’ messages focused on encouraging farmers’ commitment and motivation towards farming business, availability of needed financial resources for the entire production season, willingness to reinvest profits, and access to farmland for future expansion. In contrast, the traditional messages from agricultural extension agents focused on encouraging group formation to address marketing challenges, diversification of farm operations, and good agricultural practices. These results show the need for pluralistic extension approaches to ensure farmers get access to necessary information. Keywords: Agricultural Extension, Case Study, Farmer to Farmer Extension, Social Learning
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    COVID-19, Chronic Conditions and Structural Poverty: A Social Psychological Assessment of the Needs of a Marginalized Community in Accra, Ghana
    (Journal of Social and Political Psychology, 2021) Aikins, G.; Baatiema, L.; Asante, P.Y.; et.al
    In the African region COVID-19 infection and death rates are increasing (writing in May 2020), most deaths have occurred among individuals with chronic conditions, and poor communities face higher risks of infection and socioeconomic insecurities. We assessed the psychosocial needs of a chronic illness support group in Accra, Ghana, within the context of their broader community. The community lives in structural poverty and has a complex burden of infectious and chronic non-communicable diseases (NCDs). Between March and May 2020, we conducted interviews, group discussions, and surveys, with members of the support group and their caregivers, frontline healthcare workers, and religious and community leaders. Data was analyzed through the social psychology of participation framework. Community members understood COVID-19 as a new public health threat and drew on eclectic sources of information to make sense of this. Members of the support group had psychosocial and material needs: they were anxious about infection risk as well as money, food, and access to NCD treatment. Some community members received government food packages during the lockdown period. This support ended after lockdown in April and while anti-poverty COVID policies have been unveiled they have yet to be implemented. We discuss the impact of these representational, relational, and power dynamics on the community’s access to COVID-19 and NCD support. We argue that strategies to address the immediate and post-COVID needs of vulnerable communities have to focus on the politics and practicalities of implementing existing rights-based policies that intersect health, poverty reduction, and social protection.
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    Religion as Meaning-Making Resource in Understanding Suicidal Behavior in Ghana and Uganda
    (Frontiers in Psychology, 2021) Knizek, B.L.; Andoh-Arthur, J.; Osafo, J.; et.al
    Suicidal behavior is condemned by religions and traditions, and suicide attempts are criminalized by law in several African countries, including Ghana and Uganda. Suicide and suicide attempts may have severe consequences for both the entire family and the community. Religion is known to act as a protective coping force that helps people to make meaning and find comfort when dealing with stressful life events or situations like suicide. In this article, we focus on the cultural interpretations of the dominating religion in Ghana and Uganda, Christianity, and whether these affect attitudes toward suicidal behavior, meaning-making, and coping possibilities for people who have attempted suicide or are bereaved by suicide. This article is based on data material from previous studies on the mentioned topics by the authors.
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    Cultural Models of Well-Being Implicit in Four Ghanaian Languages
    (Frontiers in Psychology, 2020) Osei-Tutu, A.; Dzokoto, V.A.; Affram, A.A.; et.al
    This contribution to the collection of articles on “African Cultural Models” considers the topic of well-being. Reflecting modern individualist selfways of North American and European worlds, normative conceptions of well-being in hegemonic psychological science tend to valorize self-acceptance, personal growth, and autonomy. In contrast, given the embedded interdependence of everyday life in many West African worlds, one can hypothesize that cultural models of well-being in many Ghanaian settings will place greater emphasis on sustainability-oriented themes of material sufficiency and successful navigation of normative obligations. To explore this hypothesis, we interviewed local cultural experts who function as custodians of religion and an important source of support for well-being in many Ghanaian settings. We asked participants to identify and explain models of well-being implicit in four Ghanaian languages (Akan, Dagbani, Ewe, and Ga). Participants were 19 men and 15 women (age range 32– 92 years; Mean = 59.83; SD: 14.01). Results reveal some features of local models, including good health and positive affective states, that appear to resonate with standard understandings of well-being in hegemonic psychological science. However, results also provide evidence for other features of local models – specifically, good living (including moral living, material success, and proper relationality) and peace of mind – associated with a sustainability or maintenance orientation to well-being.
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    Financial globalization and institutions in Africa: the case of foreign direct investment, central bank independence and political institutions
    (Journal of Institutional Economics, 2020) Agoba, A.M.; Agbloyor, E.; Gyeke-Dako, A.A.; et.al
    In this paper, we examine the bi-directional relationship between financial globalization (proxied by foreign direct investment (FDI) flows) and economic institutions (proxied by central bank independence (CBI)) taking into consideration the role of political institutions. We test our argument on a sample of 48 African countries (1970–2012) using a two-step System Generalized Methods of Moments, with collapsed instruments and Windmeijer robust standard errors. Using two proxies for CBI, the study finds that while legal CBI does not have a significant impact on FDI, high central bank governor turnover rates have a significantly negative impact on FDI inflows. However, higher levels of political institutions significantly enhance the impact of legal CBI on FDI inflows, and dampen the impact of high central bank governor turnover rates on FDI inflows. The study also shows that higher FDI inflows have a significantly positive impact on both legal and de facto CBI. This impact is accelerated in countries characterized by higher levels of political institutions.
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    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.al
    Background: 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.
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    Urban social assistance: Evidence, challenges and the way forward, with application to Ghana
    (Development Policy Review, 2020) Cuesta, J.; Abdulai, A.G.; Devereux, S.; et.al
    Motivation: Urban areas are growing as is urban poverty, yet few countries have developed comprehensive programmes for social assistance in urban areas. Those programmes that exist, moreover, are often extensions or duplicates of rural schemes. Urban social protection needs to reflect the distinct characteristics and vulnerabilities of the urban poor, especially since they usually work in informal activities and face higher living costs than rural dwellers. Purpose: This article addresses two questions: what is the current evidence on effective social assistance programmes in urban areas? How can such programmes be designed and implemented in practice? The article surveys the challenges of designing social assistance programmes in urban areas, focusing on specific urban vulnerabilities, targeting the urban poor, and setting appropriate payments. Approach and methods: Existing evidence on programmes for urban social assistance, including cases from seven countries, are reviewed. Issues are examined in detail for Ghana, a rapidly urbanizing country. Findings: Ghana’s flagship social assistance programme, Livelihood Empowerment Against Poverty (LEAP), which operates largely in rural areas, can and should be adjusted to urban areas. Registration by using community leaders is less effective in urban than rural areas. Instead, advertising, (social) media, direct text messaging, and identification through local non-governmental organizations (NGOs) would be better options. Targeting can be improved by developing an urban-specific proxy means test. Cash benefits should be increased, and then adjusted regularly to counter inflation. These benefits should possibly be accompanied by subsidies for utilities and services. Policy implications: Several principles to consider when designing urban social assistance emerge. Benefit levels should reflect higher living costs in urban areas and respond to inflation, especially for food and other necessities. Urban social assistance should go beyond cash transfers to focus on generating jobs (especially for young people and women), and to ensure basic services such as health care reach the urban poor, through subsidies, vouchers, or case management. Urban contexts also offer more opportunities to deliver and target social assistance through digital technologies such as mobile phones and automatic teller machines (ATM).