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 Effect of Infrastructure and Foreign Direct Investment on Economic Growth in Sub-Saharan Africa(Global Journal of Emerging Market Economies, 2019-11-19) Nketiah-Amponsah, E.; Sarpong, B.This article investigates the effect of infrastructure and foreign direct investment (FDI) on economic growth in Sub-Saharan Africa (SSA) using panel data on 46 countries covering the period 2003– 2017. The data were analyzed using fixed effects, random effects, and system generalized method of moments (GMM) estimation techniques. Based on the system GMM estimates, the results indicate that a 1 percent improvement in electricity and transport infrastructure induces growth by 0.09 percent and 0.06 percent, respectively. Additionally, FDI proved to be growth enhancing only when interacted with infrastructure. The interactive effect of FDI and infrastructure improves economic growth by 0.016 percent. The results suggest that public provision of economic infrastructure reduces the cost of production for multinational enterprises, thus providing an incentive to increase investment in the domestic economy to sustain economic growth. The results also suggest that the impact of FDI on economic growth is maximized when some level of economic infrastructure is available. Our findings thus provide ample justification on the need for a significant government investment in infrastructure to provide a less costly business environment for both local and multinational enterprises to improve economic growth.Item Trends in utilisation and inequality in the use of reproductive health services in Sub- Saharan Africa(BMC Public Health, 2019-11-21) Abekah-Nkrumah, G.Background: The paper argues that unlike the income literature, the public health literature has not paid much attention to the distribution of substantial improvements in health outcomes over the last decade or more, especially, in the Sub-Saharan African (SSA) context. Thus, the paper examines current levels of utilisation, changes in utilisation as well as inequality in utilisation of reproductive health services over the last 10 years in SSA. Methods: The paper uses two rounds of Demographic and Health Survey (DHS) data from 30 SSA countries (latest round) and 21 countries (earlier round) to compute simple frequencies, cross-tabulated frequencies and concentration indices for health facility deliveries, skilled delivery assistance, 4+ antenatal visits and use of modern contraceptives. Results: The results confirm the fact that utilisation of the selected reproductive health services have improved substantially over the last 10 year in several SSA countries. However, current levels of inequality in the use of reproductive health services are high in many countries. Interestingly, Guinea’s pro-poor inequality in health facility delivery and skilled attendance at birth changed to pro-rich inequality, with the reverse being true in the case of use of modern contraceptives for Ghana, Malawi and Rawanda. The good news however is that in a lot of countries, the use of reproductive health services has increased while inequality has decreased within the period under study. Conclusion: The paper argue that whiles income levels may play a key role in explaining the differences in utilisation and the levels of inequality, indepth studies may be needed to explain the reason for differential improvements and stagnation or deterioration in different countries. In this way, best practices from better performing countries can be documented and adapted by poor performing countries to improve their situation.Item Rapidly increasing prevalence of overweight and obesity in older Ghanaian adults from 2007-2015: Evidence from WHO-SAGE Waves 1 & 2(Plos One, 2019-08-19) Biritwum, R.B.; Lartey, S.T.; Magnussen, C.G.; Si, L.; Boateng, G.O.; de Graaff, B.; Minicuci, N.; Kowal, P.; Blizzard, L.; Palmer, A.J.Background Studies on changes in the prevalence and determinants of obesity in older adults living in sub-Saharan Africa are scarce. We examined recent changes in obesity prevalence and associated factors for older adults in Ghana between 2007/08 and 2014/15. Methods Data on adults aged 50 years and older in Ghana were drawn from the WHO SAGE 2007/ 08 (Wave 1; n = 4158) and 2014/15 (Wave 2; n = 1663). The weighted prevalence of obesity, overweight, normal weight and underweight, and of high central adiposity were compared in 2007/08 and 2014/15. Multinomial and binomial logistic regressions were used to examine whether the determinants of weight status based on objectively measured body mass index and waist circumference changed between the two time periods. Results The prevalence of overweight (2007/08 = 19.6%, 95% CI: 18.0–21.4%; 2014/15 = 24.5%, 95% CI: 21.7–27.5%) and obesity (2007/08 = 10.2%, 95% CI: 8.9–11.7%; 2014/15 = 15.0%, 95% CI: 12.6–17.7%) was higher in 2014/15 than 2007/08 and more than half of the population had high central adiposity (2007/08 = 57.7%, 95% CI: 55.4–60.1%; 2014/15 = 66.9%, 95% CI: 63.7–70.0%) in both study periods. While the prevalence of overweight increased in both sexes, obesity prevalence was 16% lower in males and 55% higher in females comparing 2007/08 to 2014/15. Female sex, urban residence, and high household wealth were associated with higher odds of overweight/obesity and high central adiposity. Those aged 70+ years had lower odds of obesity in both study waves. In 2014/15, females who did not meet the recommended physical activity were more likely to be obese. Conclusion Over the 7-year period between the surveys, the prevalence of underweight decreased and overweight increased in both sexes, while obesity decreased in males but increased in females. The difference in obesity prevalence may point to differential impacts of past initiatives to reduce overweight and obesity, potential high-risk groups in Ghana, and the need to increase surveillanceItem Cultural orientation, perceived support and participation of female students in formal entrepreneurship in the sub-Saharan economy of Ghana(International Journal of Gender and Entrepreneurship, 2019-06-12) Anlesinya, A.; Adepoju, O.A.; Richter, U.H.Purpose – This purpose of this paper is to examine cultural orientations and intention of Ghanaian women to engage in entrepreneurship while assessing the role of perceived support system. The aim is to contribute to the literature in the sub-Saharan African context where women entrepreneurs are generally underresearched, despite their increasing significant roles in socio-economic development in the continent even in the face of huge cultural barriers. Design/methodology/approach – The study uses a hierarchical regression analysis and Hay’s PROCESS moderation technique to analyze survey data from 190 female students fromGhana, Africa. Findings – The results indicate that uncertainty avoidance and power distance cultural orientations have significant positive and negative effects, respectively, on women’s participation in formal entrepreneurship. However, collectivism and masculine cultural orientations do not have any effect on their intention to engage in formal entrepreneurial activity. The study further shows that perceived support system has a buffering effect on the destructive consequences of power distance culture on formal entrepreneurship intentions. On the contrary, perceived support does not moderate the relationship between uncertainty avoidance, collectivism and masculine cultural and formal entrepreneurial intention. Practical implications – Given the fact that most African governments are making efforts to accelerate the growth and development of their economies via entrepreneurship and economic empowerment, this study’s findings encourage stakeholders to implement measures to leverage on the positive dimensions of cultures to facilitate the development of formal entrepreneurship among Ghanaian women while mitigating the negative consequences of cultural practices. The findings further highlight the need to evaluate the current level of support given to women in Ghana. The study suggests that provision of sufficient level of support can make women more willing to challenge the status quo in power distance cultures and take personal initiatives, thereby leading to more formal entrepreneurial actions. Originality/value – This study is a significant addition to women entrepreneurship literature because the role of culture in females’ intention to participate in entrepreneurship is generally an under-researched area. Besides, our examination of national cultural variation at the individual level on formal entrepreneurshipintention in a heterogeneous setting is novel. The study also highlights the buffering roles of perceived support on the destructive consequences of power distance cultural orientation on formal entrepreneurial development among womenItem Financial regulation and financial inclusion in Sub-Saharan Africa: Does financial stability play a moderating role?(Research in International Business and Finance, 2019-07-26) Abor, J.Y.; Anarfo, E.B.; osei, K.A.This study examines the impact of financial regulation on financial inclusion in Sub-Saharan Africa, considering the moderating role of financial stability. By analysing the relationship between financial inclusion and the most prominent macro-prudential regulation (capital adequacy), we find that tightening prudential regulations could negatively impact access to finance, thereby conflicting with Sub-Saharan African economies’ financial inclusion goals. More specifically, the capital adequacy requirement tremendously reduces banks’ capacity to provide financial services and this could lead to credit rationing thereby reducing financial inclusion. The results also indicate that, the interaction of financial regulation with financial stability positively impacts financial inclusion. Thus, financial stability augments financial regulation to have an affirmative impact on financial inclusion. The practical implications of this paper are that, one of the ways central governments and policy makers in Sub-Saharan African countries can increase and get the most out of financial inclusion is to formulate policies targeted at reducing capital adequacy requirements of financial institutions and other constraints that limit the operations and efficiency of financial institutions. Such policies should also aim at creating an enabling environment to promote financial stability.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 Clinical characteristics of males with systemic lupus erythematosus (SLE) in an inception cohort of patients in Ghana(Ghana medical journal, 2019-03-01) Dey, D.; Ofori, E.; Hutton-Mensah, K.A.; Akutek, M.L.K.; Okine, R.; Amoaba, I.; Agyemang-Duah, K.; Kwarko, H.BACKGROUND: Systemic Lupus Erythematosus (SLE) is said to be rare in Sub-Saharan Africa and even rarer in males worldwide. SLE is mostly considered a disease of women, though men may also be affected, and this may lead to a delay in diagnosis in men. The result is a greater burden of inflammation and subsequent organ damage over time. METHOD: Data from the medical records of 13 male patients diagnosed with SLE at the Rheumatology Clinic of Korle- Bu Teaching Hospital between January 2014 and January 2017 was retrospectively analyzed. RESULTS: A total of 13 male patients out of a total of 134 SLE patients were included in our analysis. The mean age was 30.62 ± SD 8.47 years (range of 17 to 46 years). All of them (100%) presented with constitutional features. The most common ACR criteria observed was 61.5 % rash, 54.5 % oral ulcers, 92.3% arthritis, 61.5 % serositis and 38.5% renal involvement, 46.2 % CNS involvement. Looking at their serological profile, 91.7 % had a positive antinuclear antibody (ANA). 33.3 % had positive anti-dsDNA and 58.3 % extractable nuclear antigens. The mean duration from onset of symptoms to diagnosis was 21.31 months. Five patients were diagnosed with lupus nephritis, all at the time of diagnosis. There were no mortalities. CONCLUSION: Male SLE patients in Ghana are comparable to other populations, with arthritis and constitutional features being predominant early features and lupus nephritis being the main early indicator of organ damage. This should warrant aggressive management in male patients.Item The President's Malaria Initiative contributed to reducing malaria burden in sub-Saharan Africa between 2004 and 2014: Evidence from generalized estimating equation analysis(PLOS ONE, 2019-05-03) Duah, D.; Ye, Y.The President’s Malaria Initiative (PMI) launched in 2005 as a key player in malaria prevention and treatment in sub-Saharan Africa (SSA). Several country-specific evaluations have demonstrated great progress in reducing under-five mortality associated with scaling up malaria interventions in PMI priority countries. Documentation of PMI’s specific contributions was limited, until the publication of Jakubowski, et al., which used difference-in-difference analysis to show a higher reduction of under-five mortality in PMI-supported countries than in others. To generate more evidence, this study used rigorous statistical analyses to assess the reduction in mortality attributable to PMI support. The study used generalized estimating equations and a series of matching procedures to evaluate the impact of PMI on under-five mortality and on population coverage of insecticide-treated nets (ITNs), indoor residual spraying (IRS), and artemisinin-based combination therapy (ACT) in SSA. The analyses used country-level secondary data and controlled for several country-level characteristics assumed to influence outcome measures of interest, PMI program participation, or both. The Mahalanobis distance metric, with 1:1 nearest neighbor matching adjusting for bias in population size in the particular country, showed a reduction in under-five mortality by approximately 12 per 1,000 live births (95% Confidence Interval [CI]: 20.6–3.1; p = 0.012). There were statistically significant increases in the population coverage of ITNs, IRS, and ACTs in PMI countries over the implementation period. ITN use in the population was 0.23% higher (95% CI average treatment effect on the treated: 0.17–0.30; p<0.001) in PMIrecipient countries than in non-PMI countries. The findings show that PMI contributed significantly to increasing the coverage of malaria control interventions and reducing under-five mortality in SSA.Item Availability of integrated family planning services in HIV care and support sites in sub-Saharan Africa: A secondary analysis of national health facility surveys(Reproductive Health, 2019-05-29) Laar, A.; Kanyangarara, M.; Sakyi, K.Background: Integrating family planning (FP) with HIV care and treatment programs is a strategy to expand FP service delivery and prevent unintended pregnancies among women living with HIV. However, little is known about the extent to which FP services are available in health facilities providing HIV services across sub-Saharan Africa. In this study, we assessed the availability of integrated FP services and the associated factors in HIV care and support sites across sub-Saharan Africa. Methods: We conducted a secondary analysis of nationally representative facility-level data from Service Availability and Readiness Assessments (SARA) and Service Provision Assessments (SPA) conducted in 10 sub-Saharan African countries between 2012 and 2015. We used six indicators that reflect the structure and process of care essential for FP service delivery in HIV care and support facilities to define the outcome of interest - onsite availability of integrated FP services. Multivariate logistic regression was used to explore facility-level characteristics associated with the outcome. Results: Among the 3161 health facilities offering HIV care and support services, most reported also offering FP services at the same location. The availability of three FP methods was higher than the availability of FP guidelines and trained staff. Onsite availability of integrated FP services ranged from 10 to 61%. Results of multivariate logistic regression indicated that the odds of having onsite integrated FP services available was higher in HIV care and support sites that were operated by the government, classified as a tertiary level care facility, and provided services for PMTCT, antenatal care and basic surgery. Conclusions: Our findings indicate critical shortcomings in the preparedness of HIV care and support sites to deliver onsite integrated FP services. Renewed efforts are needed to address these supply-side barriers and ensure that integrated FP and HIV services meet the unique needs of HIV clients.Item The transformation of urban food systems in Ghana: Findings from inventories of processed products(Outlook on Agriculture, 2018-09) Andam, K.S.; Tschirley, D.; Asante, S.B.; Al-Hassan, R.M.; Diao, X.Urban food systems in Ghana are changing, along with rapid urbanization and growth in household incomes. Using data from retail inventories of packaged products carried out in eight cities in 2015 and 2016, we find that the interplay of urbanization, imports and domestic processing and packaging has led to some surprising outcomes. Imports are dominant, especially for milled rice and tomato paste, and the shares are higher in smaller cities than in Accra. Imported products are more prevalent in traditional retail outlets than in modern retail outlets. Moreover, imported products come mainly from East Asia; excluding South Africa, which accounts for 6% of imports, less than 3% of imported products were from other African countries.