School of Public Health
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Item Farmers’ pesticide use and knowledge of aquatic ecosystem contamination with its perceived health risk from contaminated fish consumption in northern Ghana(Scientific African, 2024) Orou-Seko,A.; Chirawurah,D.; Ndago,J.A.; Nkansah-Baido,M.; Pwatirah,D.; Kolekang,A.S.; Adokiya,M.N.Pesticide residues in agricultural environments pose significant threats to aquatic ecosystems and human health. Most studies investigate the quantity, environmental, and risk assessment of pesticides in agricultural landscapes. However, farmers’ pesticide use and their knowledge on aquatic ecosystem contamination remain limited and poorly documented. This study evaluated pesticide residue concerns in agricultural settings, focusing on farmers’ uses and knowledge. It addressed pesticide application methods and their effects on aquatic ecosystems and human health through fish consumption. A cross-sectional design was employed and 300 farmers were selected using a multi-stage sampling technique from two agricultural districts – Savelugu Municipal and Tamale Metropolis. The study revealed that maize was most cultivated (29.6 %) with extensive pesticide treatment, particularly herbicides in the study setting. Findings revealed pesticide overuse (22.3 %), mixing of pesticides at the water bodies (24.7 %), improper leftover pesticide disposal methods (39.0 %) and inadequate storage practices (63.0 %) among farmers. About 21.3 % and 74.0 % of farmers have insufficient knowledge of the resulting consequences and the discharge of pesticides into the aquatic environment, respectively. Though the farmers are aware of the detrimental impact of pesticides on human health, there is still a lack of comprehension regarding the indirect consequences for aquatic ecosystems and non-target species. In the study setting, extension services may be important sources of knowledge. Thus, emphasizes the significance of improving extension programmes and utilizing peer-to-peer communication channels to support the adoption of best practices in pesticide management such as licenced high-temperature incinerators and cement kilns with sufficient emission controls. Focused training and outreach programmes designed to enhance farmers’ knowledge andItem Limiting spread of COVID-19 in Ghana: Compliance audit of selected transportation stations in the Greater Accra region of Ghana(PLOS ONE, 2021) Bonful, H.A.; Addo-Lartey, A.; Aheto, J.M.K.; et al.Globally, little evidence exists on transmission patterns of COVID-19. Recommendations to prevent infection include appropriate and frequent handwashing plus physical and social distancing. We conducted an exploratory observational study to assess compliance with these recommendations in selected transportation stations in Ghana. A one-hour audit of 45 public transport stations in the Greater Accra region was carried out between 27th and 29th March 2020. Using an adapted World Health Organization (WHO) hand hygiene assessment scale, the availability and use of handwashing facilities, social distancing, and ongoing public education on COVID-19 prevention measures were assessed, weighted, and scored to determine the level of compliance of stations. Compliance with recommendations was categorized as “inadequate” “basic”, “intermediate” and “advanced”, based on the overall score. The majority (80%) of stations in Accra have at least one Veronica Bucket with flowing water and soap, but the number of washing places at each station is not adequate. Only a small minority (18%) of stations were communicating the need to wash hands frequently and appropriately and to practice social/physical distancing while at the station. In most stations (95%), hand washing practice was either not observed, or only infrequently. Almost all stations (93%) did not have alcohol-based hand sanitizers available for public use, while social distancing was rarely practiced (only 2%). In over 90% of the stations, face masks were either not worn or only worn by a few passengers. Compliance with COVID-19 prevention measures was inadequate in 13 stations, basic in 16 stations, intermediate in 7 stations, and advanced in 9 stations. Compliance with COVID-19 prevention measures in public transportation stations in the Greater Accra region remains a challenge. Awareness creation should aim to elevate the COVID-19 risk perception of transportation operators and clients. Transport operators and stations need support and guidance to enforce hand washing and social distancing.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 Types and prevalence of adverse events among obstetric clients hospitalized in a secondary healthcare facility in Ghana(Journal of Patient Safety and Risk Management, 2019-12) Otchi, E.H.; Esena, R.K.; Beyuo, T.; et.alObjective: The main objective of this study was to determine the types and prevalence of adverse events among obstetric clients hospitalized in a secondary health facility in Ghana. Design: A retrospective study that reviewed medical records of obstetric clients on admission at the Obstetrics Unit of a secondary healthcare facility in Ghana. Setting: Clinical environment. The study site is the third largest health facility in Ghana that provides maternity services and serves as the major referral facility for the Greater Accra Region, the capital of Ghana. About 41% (4676) of its total antenatal cases (11,406) in 2015 were referrals from other facilities in Ghana. The medical records were reviewed retrospectively from 1 January to 31 December 2015. A four-stage review process was used: the first and second stages (by nurse/midwife reviewers) involved the identification and exclusion of records that had a length of stay of less than 24 hours and inadequate documentation; and were unlikely to include an adverse event. The third stage by obstetrician-gynecologist reviewers included a full review of all the positive trigger folders to determine the types, causes, and degree of preventability of the adverse events. The fourth stage involved an independent obstetrician-gynecologist review of all records that had discrepancies. Details of the review process are presented in the figure. Participants: Obstetric clients (i.e. pregnant women at any stage of gestation or less than 5 days after delivery who were attended to at the hospital). About a third (1402, 49.3%) met the inclusion criteria and were reviewed. Main outcome measures: The main outcome measure for this study was the prevalence of adverse events among hospitalized obstetric clients. Results: The prevalence of adverse events was 12% (168) out of 1402 records reviewed. The mean maternal age of the clients was 30.0 5.8 years. Among these, the greatest proportion of adverse events was related to surgical interventions (66.3%), and the smallest were related to patient care (0.7%). Conclusions: This study has provided the first documented prevalence (12.0%) and types of adverse events among hospitalized obstetric clients in a secondary health facility in Ghana. It provides a preliminary baseline for the burden of adverse events among the obstetric population in Ghana.Item 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 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.alWe 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.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 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.alIn 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.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.