Research Articles
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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community
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Item What influences cancer treatment service access in Ghana? A critical interpretive synthesis(BMJ Open, 2022) Tuck, C.Z.; Aryeetey, R.N.O.; Akparibo, R.; et al.Objectives Multiple social-cultural and contextual factors influence access to and acceptance of cancer treatment in Ghana. This research aimed to assess the existing literature on how these factors interplay and could be susceptible to local and national policy changes. Design This study uses a critical interpretive synthesis approach to review qualitative and quantitative evidence about access to adult cancer treatment services in Ghana, applying the socioecological model and candidacy framework. Results Our findings highlighted barriers to accessing cancer services within each level of the socioecological model (intrapersonal, interpersonal community, organizational and policy levels), which are dynamic and interacting, for example, community-level factors influenced individual perceptions and how they managed financial barriers. Evidence was lacking about determinants of treatment non-acceptance across all cancers and in the most vulnerable societal groups due to methodological limitations. Conclusions Future policy should prioritize multilevel approaches, for example, improving the quality and affordability of medical care while also providing collaboration with traditional and complementary care systems to refer patients. Research should seek to overcome methodological limitations to understand the determinants of accessing treatment in the most vulnerable populations.Item Equity and expertise in the UN Food Systems Summit(BMJ Global Health, 2021) Nisbett, N.; Aryeetey, R.; Friel, S.; et al.The UN Food Systems Summit is bold but controversial, with important implications for global food systems and public health. ► Alongside claims of corporate capture, many have noted insufficient attention paid to human rights and to rebalancing power in the food system. ► These issues speak to wider issues of participation and equity in the summit itself. Narrow definitions of equity only consider income inequities in outcomes and coverage. Broader definitions consider why such inequities persevere and are interlinked via process es that can be historical and intergenerational. ► The summit’s science group is slanted in disciplinary expertise: it lacks sufficient expertise in equity, health, and noncommunicable diseases, or representatives with expertise in Indigenous knowledge. ► It is not too late to rectify this in the summit structures, as we approach the September summit meeting.Item Exploring soil pollution patterns in Ghana’s northeastern mining zone using machine learning models(Journal of Hazardous Materials Advances, 2025) Kwayisi, D.; Kazapoe, R.W.; Alidu, S.; et al.This study assessed the pollution status and effectiveness of machine learning models in predicting pollution indices in soils from a mining area in Northeastern Ghana. 552 soil samples were analysed with an Energy Dispersive X-ray Fluorescence (ED-XRF) spectrometer for their elemental concentrations. Four pollution indices; Nemerow Integrated Pollution Index (NIPI), degree of contamination (Cdeg), modified degree of contamination (mCdeg) and Pollution Load Index (PLI). Additionally, the Multivariate Adaptive Regression Splines (MARS) machine learning approach were used. The high CV%, skewness, and kurtosis values show a high degree of variability and uneven distribution patterns which denotes dispersed hotspots that can be interpreted as an influence of gold anomalies and illegal mining activities in the area. V (120.86 mg/L), Cr (242.42 mg/L), Co (30.92 mg/L) Ba (337.62 mg/L), and Zn (35.42 mg/L) recorded values higher than the global and regional contaminant thresholds. The NIPI shows that 46.74% and 26.81% of samples are slightly and moderately polluted respectively. The Cdeg analysis supports these findings, with 36.96% and 41.49% of samples classified as having “moderate” to “considerable” contamination, respectively. The PLI indicates progressive soil quality deterioration (43.84%) of samples reflecting substantial environmental disturbance. The pollution indices show the effect of illegal mining on Shaega, Buin and other areas in the eastern boundary of the study. The MARS models developed for the study demonstrated high predictive capabilities with an R2 value of 0.9665 for model 1 (NIPI), and RMSE and MAE values of 0.8227 and 0.4287 respectively. For model 2 (Cdeg), R2 value of 0.9863, RMSE and MAE of 1.0416 and 0.6181, respectively. Model 3 (mCdeg) produced an R2 value of 0.9844, RMSE and MAE of 0.1225 and 0.0670. These findings suggest MARS models can be an integral tool for soil quality analysis in cooperation with pollution indices. The study suggests that remedial and legislative measures be implemented to address the issue of illegal mining in the area.Item Urban physical food environments drive dietary behaviours in Ghana and Kenya: A photovoice study(Health and Place, 2021) Pradeilles, R.; Laar, A.; Irache, A.; et al.We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Economic access was perceived as a major barrier to accessing nutritionally safe and healthy foods. Home gardening supplemented household nutritional needs, particularly in Nairobi. Policies to enhance food safety in neighbourhood environments are required. Home gardening, food pricing policies and social protection schemes could reduce financial barriers to safe and healthy diets.Item The burden of iatrogenic obstetric fistulas in Sub-Saharan Africa: Systematic review and meta-analysis protocol(PLOS ONE, 2024) Imakando, M.M.; Maya, E.; Owiredu, D.; et al.Background Obstetric fistulas are abnormal open connection(s) between the vagina and the urinary tract or the rectum resulting from tragic injuries sustained by mothers during childbirth that lead to urine and/or faecal incontinence. Due to the rapidly growing middle class in sub-Saharan Africa (SSA) and the corresponding quest for hospital delivery and caesarean section, surgery-related (iatrogenic) obstetric fistulas are on the rise. Worryingly, there is scanty data on surgery-related fistulas. This review aims to collate empirical evidence on the magnitude of iatrogenic obstetric fistulas in SSA, generate country-specific data and explore factors that influence obstetric surgery-related fistulas. Methods All relevant databases, PubMed, LILACS, CINAHL, SCOPUS and Google Scholar will be searched from 1st January 2000 to 31st March 2024 using search terms developed from the major concepts in the title without restrictions by language. The Cochrane Library, African Journals Online, Data Base of African Thesis and Dissertations Including Research (DATAD-R D Space) and preprint repositories will also be searched. Reference lists of relevant studies will be searched and experts in the field will be contacted for additional (unpublished) studies. The search output will be exported to Endnote where duplicate studies will be removed. The deduplicated studies will be exported to Rayyan where study screening and selection will be conducted. At least two authors will independently select studies, extract data and assess quality in the included studies using pretested tools. Disagreements between reviewers will be resolved through discussion. Data analysis will be performed with RevMan 5.4. Comparative binary outcomes will be reported as odds ratio (OR) or risk ratio (RR) and for continuous outcomes, mean difference and standard deviations (SDs) will be used. Non-comparative studies will be analysed as weighted proportions. Heterogeneity between studies will be assessed graphically and statistically, and where a significant level is detected, the random-effects model meta-analysis will be performed. All estimates will be reported with their 95% confidence intervals (CIs). Where data permit, we will conduct sub group and sensitivity analyses to test the robustness of the estimates on key quality domains. The overall quality of the evidence will be assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).Item Situational assessment and epidemiology of HIV, HBV and HCV among people who use and inject drugs in Ghana(PLOS ONE, 2024) Guure, C.; Dery, S.; da Silva, C.B.; et al.Introduction People who inject drugs (PWID) and people who use drugs (PWUD) are an important popu lation group that remain under-served in Ghana. Though PWID and PWUD are among the key populations most-at-risk to acquire sexually transmitted or blood-borne diseases, they are among those with the least access to human immunodeficiency (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses’ prevention, care and treatment services in Ghana due to lack of data on them. We provide a rapid assessment of the PWUD and PWID situation in Ghana. Methods This rapid cross-sectional design undertook consultative meetings between the study team and relevant stakeholders, including Civil Society Organizations (CSO) working with PWUD/PWID. The assessment considered a representative sample of PWID and PWUD. It was conducted in four (4) selected regions of Ghana (Greater Accra, Ashanti, Western, and Northern). Overall, 323 participants were interviewed using respondent-driven sampling (RDS) approach. Information obtained from participants were demographics, HIV risk behaviors, human immunodeficiency (HIV) and sexually transmitted infections (STI)-related knowledge HIV/HCV/HBV screening, attitude, and practices among others. Analyses were conducted using Stata version 17 and RDSAT version 7.1.46 software. Findings Drug use was found to be more prevalent among the youth with a median age of 37 years. Majority of the respondents were males (86%). About 28% of the female respondents identi fied themselves as sex workers, while about 74% have been involved in transactional sex. The median age at which respondents started using and injecting drugs was 20 and 22 years respectively. Majority (68%) of the respondents consume drugs through smoking, with 20% through snorting, inhaling or swallowing and 12% through injection. The drug mostly used among the respondents was heroin (52%). The most commonly injected drug was cocaine (55%). About 64.7% of respondents reported mixing two or more drugs. HIV prevalence among respondents was 2.5%, 12.3% among women and 17.7% among women engaged in sex work, highlighting the overlap vulnerability. The prevalence of hepa titis C was 6.0%, and Hepatitis B was 4.5%. Access to care is limited, with 63% of the respondents never been tested for HIV. Conclusion These rapid assessment findings reveal the challenging conditions for people who use and inject drugs coupled with a relatively high prevalence of HIV and Hepatitis C compared to the general population. However, it also reveals that Ghana has a window of opportunity to prevent an exponential spread of HIV and Hepatitis in this population. Therefore, there is the need to implement prevention and treatment programs for HIV and hepatitis among people who use and inject drugs including essential strategies for an enabling environment in Ghana.Item Assessing Children’s Autonomic Nervous System Activity During Structured Tasks: A Feasibility and Reliability Study in Ghana(Developmental Psychobiology, 2024) Bentil, H.J.; Daang, E.M.; Amponsah, B.; et al.The significance of physiological regulation in relation to behavioral and emotional regulation is well documented, but primarily in economically advantaged contexts. Few studies have been conducted in low- and middle-income countries. We investigated the feasibility and reliability of measuring autonomic nervous system (ANS) activity and behavior during challenge tasks in 30 children aged 8–10 years in Ghana during two visits, 1 week apart. Completeness of ANS data ranged from 80% to 100% across all tasks. There was low-to-moderate test–retest reliability of video mood induction (VMI) emotion ratings and balloon analog risk task (BART) pumps (r = 0.34–0.52). VMI elicited higher targeted emotion ratings in Visit 2 than Visit 1. Respiratory sinus arrhythmia (RSA) was higher, and pre-ejection period (PEP) was longer at Visit 2 than Visit 1 for baseline and both tasks. RSA was higher at baseline than during the VMI anger scene at Visit 1, whereas PEP was shorter at baseline than during all VMI emotion scenes at Visit 2. RSA was higher at baseline than during BART at both visits. In conclusion, ANS data collection within evocative and arousing challenge tasks was feasible in Ghana, and the tasks were generally reliable and effective in eliciting target emotions and risk-taking behavior in this sample.Item Tuberculosis patients with diabetes co-morbidity experience reduced Mycobacterium tuberculosis complex clearance(Heliyon, 2024) Danso, E. K.; Asare, P.; Osei-Wusu, S.; et al.Objective: This study aimed to investigate the impact of diabetes mellitus (DM) on tuberculosis (TB) treatment response using bacterial clearance as a surrogate marker. Method: We compared smear microscopy, culture, and tuberculosis molecular bacterial load assay (TB-MBLA) for treatment monitoring. Following that, bacterial clearance was longitudinally monitored among TB-only (TB without DM) and TB-diabetes (TBDM) patients using TB-MBLA. Results: Ninety-three participants, including 59 TB-only and 34 TBDM patients, were enrolled. TB only patients exhibited higher upper zone infiltrations (32/35 vs 16/22, p = 0.059) suggesting a trend towards significance, and significantly more cavitation in the same zone (16/18 vs 7/13, p = 0.028). There was a high proportion of Mycobacterium africanum (Maf) among the TBDM cohort (p = 0.0044). At baseline, TB-only patients exhibited a higher average bacterial burden (4.49 logeCFU/mL) compared to the TBDM group (3.91 logeCFU/mL) (p = 0.042). The bacterial load in the TB-only group decreased significantly during treatment but the TBDM group experienced delayed clearance throughout the intensive phase of anti-TB treatment even at day 56 (p = 0.028). The TB-only group demonstrated a shorter median time to TB-MBLA conversion to negative (57 days) compared to the TBDM group (62 days) (p = 0.022). Conclusion: These findings underscore the urgent call for understanding the interplay between diabetes and TB, emphasizing the need for tailored interventions in optimizing TB care for individuals comorbid with diabetes.Item Mobile Phone-Assisted Agricultural Extension Services: User Competency And Usage Frequency In Eastern Ghana(African Journal of Food, Agriculture, Nutrition and Development, 2021) Nyaplue-Daywhea, C.; Adjei-Nsiah, S.; Ahiakpa, J.K.; et al.Adoption studies have mainly focused on econometric and quantitative modeling that usually assume smallholder farmers competently adopt agricultural technologies. This study provides novel insights on user competency and frequency of usage of mobile telephony for agricultural extension services among smallholder farmers and agricultural extension agents (AEAs) and key factors that impede the adoption process. The study examined users’ competencies and mobile phone usage frequency for access and delivery of agricultural extension services in Eastern Ghana. A multi-stage sampling procedure was used to select 95 AEAs and 330 smallholder farmers in five districts of the Eastern region of Ghana and data were collected through semi-structured interviews. Descriptive statistics, Pearson correlation, and regression analyses were performed to analyze the data. Results showed substantial differences between AEAs and smallholder farmers’ competency in the use of mobile phones for agricultural extension services. Socio-demographic characteristics of smallholder farmers and AEAs correlated with the usage frequency of mobile phones for access to extension services and delivery. Educational level, amount of weekly expenditure of money on mobile phone use, mobile phone network quality, income level, and age of both AEAs and smallholder farmers had positive and significant correlations with the frequency of usage of mobile phones. User competency differentially impacts the frequency of mobile phone use in agricultural extension services between AEAs and smallholders. High call tariffs and access to recharge cards are major challenges in using mobile phones for agricultural extension in the study areas. The study shows components of the adoption theory of compatibility, and complexity where an innovation fits within the socio-cultural framework and perceived difficulty of use. Thus, the frequent use of voice calls is indicative of the early stages of the diffusion process and may diversify into other applications in the future. Farmer-based organizations should be resourced to support the training of farmers to use mobile phones to improve access to agricultural information dissemination. Integrating voice-based agricultural information services (IVRs) into the current SMS-based agricultural extension services in Ghana could potentially boost extension service delivery to smallholder farmers in the Eastern region and across the country. The Ministry of Food and Agriculture may partner with key stakeholders and mobile service providers to offer hands-on capacity building to smallholder farmers and AEAs in video calling/conferencing, multimedia service, and social media to enhance their competencies for improved agricultural extension services.Item Design and methodology of a mixed methods follow-up study to the 2014 Ghana Demographic and Health Survey(Global Health Action, 2017) Staveteig, S.; Aryeetey, R.; Anie-Ansah, M.; et al.Background: The intended meaning behind responses to standard questions posed in large-scale health surveys is not always well understood. Systematic follow-up studies, particularly those that pose a few repeated questions followed by open-ended discussions are well positioned to gauge the stability and consistency of data and to shed light on the intended meaning behind survey responses. Such follow-up studies require extensive coordination and face challenges in protecting respondent confidentiality during the process of recontacting and reinterviewing participants. Objectives: We describe practical field strategies for undertaking a mixed methods follow-up study during a large-scale health survey. Methods: The study was designed as a mixed methods follow-up study embedded within the 2014 Ghana Demographic and Health Survey (GDHS). The study was implemented in 13 clusters. Android tablets were used to import reference data from the parent survey and to administer the questionnaire, which asked a mixture of closed- and open-ended questions on reproductive intentions, decision-making, and family planning. Results: Despite several obstacles related to recontacting respondents and concern about respondent fatigue, over 92 percent of the selected sub-sample were successfully recontacted and reinterviewed; all consented to audio recording. A confidential linkage between GDHS data, follow-up tablet data, and audio transcripts was successfully created for analysis. Conclusions: We summarize the challenges in follow-up study design, including ethical considerations, sample size, auditing, filtering, successful use of tablets, and sharing lessons learned for future follow-up surveys.