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 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, sur gery-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 Reference lists of relevant studies will be searched and experts in the field will be contacted for additional (unpublished) studies.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). Expected study outcomes This systematic review and meta-analysis uses rigorous methods and best practices to attempt to collate all empirical evidence and estimate country-specific proportions of iatrogenic (surgery-related) fistulas among obstetric fistula patients across countries in SSA. This review will explore context-specific variables, provide insights into their impact and relate them to the type and experience of personnel performing the obstetric procedures that lead to obstetric fistulas. The findings of the full review are expected to inform the development of national and regional Training Programs for Medical Officers, support the development of a consensus “minimum acceptable standard of care” and inform quality assurance standards for clinicians involved in the provision of surgical obstetric care.Item Electricity and informal settlements: Towards achieving SDG 7 in developing countries(Energy Research & Social Science, 2022) Mensah, J.K.Despite many academic discussions on the importance of sustainable and reliable energy to informal settlement dwellers, there is limited evidence on the delivery of electricity in informal settlements, especially in Sub-Saharan Africa. Using the concept of tactical urbanism, this study examined electricity delivery and access to informal settlement dwellers in Accra, Ghana, as an important component of meeting SDG 7. The paper analyses evidence collected through three focus group discussions of thirty informal settlement dwellers in three communities in Accra. The findings showed that, whereas access to electricity in informal settlements has improved significantly; this increase is a result of corruption and connivance with electricity officials and that informal settlement dwellers pay exorbitantly to access and use electricity. This paper contributes to the growing body of scholarship on sustainable electricity in urban informal settlements in the Global South by documenting the experiences of informal settlement dwellers in Accra, Ghana.Item Bank mergers and acquisitions and the post-merger and acquisition performance of combined banks: evidence from Sub-Saharan Africa(Cogent Economics & Finance, 2024) Ayagre, P.; Aboagye, A.Q.Q.; Sarpong-Kumankoma, E.; Asuming, P.O.This study sought to ascertain the effects of bank mergers and acquisitions on the performance of merged banks in Sub-Saharan African (SSA) countries between 2003 and 2019. Specifically, the study aimed to investigate the impact of regulation-induced bank mergers and acquisitions (M&A’s) on the post-merger profitability of merged banks in SSA. The motivation for the study is to provide evidence for or against the regulator’s claims that regulation-induced bank M&As will improve the performance of merged banks in SSA. The article presents the results of the total sample of all mergers and acquisitions examined in the study and two sub-samples: the regulation-induced M&A sub-sample and the voluntary M&A sub-sample. We measure profitability by return on assets, return on equity, and net interest margin. The paper employed a dynamic panel Generalized Methods of Moments approach to analyse the relationship between bank M&As and profitability. The study found no profitability improvement after M&A across all profitability measures for the total sample and the two sub-samples. Instead, the empirical results reveal that bank profitability suffers after mergers and acquisitions across all profitability measures. The results show that, for regulation-induced mergers and acquisitions, a merged bank’s profitability is adversely affected from the beginning of the merger or acquisition to the sixth year of mergers and acquisitions. The findings also reveal that bank risk negatively affect profitability, while liquidity positively affect profitability, except returns on equity. Bank costs-to-income ratios as expected to show negative relationship with profitability. All macroeconomic variables show the expected relationship, positive for GDP growth and negative for inflationItem SARS‑CoV‑2 incidence monitoring and statistical estimation of the basic and time‑varying reproduction number at the early onset of the pandemic in 45 sub‑Saharan African countries(BMC Public Health, 2024) Oduro, M.S.; Arhin‑Donkor, S.; Asiedu, L.; Kadengye, D.T.; Iddi, S.The world battled to defeat a novel coronavirus 2019 (SARS-CoV-2 or COVID-19), a respiratory illness that is transmitted from person to person through contacts with droplets from infected persons. Despite efforts to disseminate preventable messages and adoption of mitigation strategies by governments and the World Health Organization (WHO), transmission spread globally. An accurate assessment of the transmissibility of the coronavirus remained a public health priority for many countries across the world to fight this pandemic, especially at the early onset. In this paper, we estimated the transmission potential of COVID-19 across 45 countries in sub-Saharan Africa using three approaches, namely, R0 based on (i) an exponential growth model (ii) maximum likelihood (ML) estimation and (iii) a time-varying basic reproduction number at the early onset of the pandemic. Using data from March 14, 2020, to May 10, 2020, sub-Saharan African countries were still grappling with COVID-19 at that point in the pandemic. The region’s basic reproduction number ( R0 ) was 1.89 (95% CI: 1.767 to 2.026) using the growth model and 1.513 (95% CI: 1.491 to 1.535) with the maximum likelihood method, indicating that, on average, infected individuals transmitted the virus to less than two secondary persons. Several countries, including Sudan ( R0 : 2.03), Ghana ( R0 : 1.87), and Somalia ( R0 : 1.85), exhibited high transmission rates. These findings highlighted the need for continued vigilance and the implementation of effective control measures to combat the pandemic in the region. It is anticipated that the findings in this study would not only function as a historical record of reproduction numbers during the COVID-19 pandemic in African countries, but can serve as a blueprint for addressing future pandemics of a similar nature.Item Impact Of Health System Strengthening Interventions On Child Survival In Sub-Saharan Africa: A Systematic Review Protocol(Systematic Reviews, 2024) Agula, C.; Bawah, A.A.; Asuming, P.O.; et al.Background Strengthening healthcare systems is a practical approach to enhancing healthcare delivery and services. Although there has been a rise in the number of health systems strengthening (HSS) interventions in sub-Saharan In Africa (SSA), there is limited evidence on the causal effect of these activities on child survival. Furthermore, the findings reported so far have been varied, and how they relate to each other remains unclear. This systematic review study aims to assess all available evidence to understand the impact of HSS activities on child survival in SSA. Methods: We developed a search strategy to retrieve all relevant studies from electronic databases such as PubMed. MEDLINE, Web of Science, and African Journals Online. We will use a combination of search terms, such as under-fve mortality,” “child mortality,” “infant mortality,” “neonatal mortality,” “child survival,” and health systems strengthening." The review will include studies that establish a causal relationship between HSS interventions and child survival. This will include studies with designs such as randomized controlled trials and quasi-experimental methods like difference-in-difference. Two reviewers will independently screen all citations, abstracts, and full-text data and a third The reviewer will act as a tiebreaker in cases of disagreement. The primary outcome of interest is the impact of HSS activities on under-five survival. We will evaluate the quality of each study using the Bradford Hill criteria for causation. Discussion Our systematic review will identify and evaluate all relevant evidence that establishes a causal relationship between HSS activities and the survival of children under five years old in SSA. The review’s findings regarding the impact of HSS activities on child survival could be of significant interest to the donor community and policy actors in the region. We also anticipate that the review’s conclusions could serve as a valuable guide for the development of future health system interventions and strategies in SSA.Item Depressive symptoms among adolescents in six sub-Saharan African countries: A pooled analysis of associated factors(Preventive Medicine Reports, 2023) Partap, U.; Nyundo, A.; Manu, A.There is a need to identify risk factors, including nutrition-related factors, for depressive disorders among sub Saharan African (SSA) adolescents. We examined the association of multiple measures with depressive symp toms among adolescents living across six SSA countries. Building on previous analyses, we used data from a cross-sectional study conducted from 2015 to 2017 among adolescents aged 10–19 years in six SSA countries (N = 7512). Depressive symptoms were defined as highest tertile of the 6-item Kutcher Adolescent Depression Scale score. Using mixed-effects Poisson regression models, we pooled data across sites and examined the association of sociodemographic, nutrition, and other indices with depressive symptoms. We additionally assessed effect modification by sex, age, and school-going status. We observed higher risk of depressive symptoms among girls (adjusted risk ratio [RR]: 1.29, 95 % confidence interval [95 % CI]: 1.05–1.58, P = 0.016), older adolescents (RR for 18–19 years: 1.59, 95 % CI: 1.44–1.76, P < 0.001), and adolescents experiencing bullying (RR: 1.43, 95 % CI: 1.26–1.62, P < 0.001) or violence (RR: 1.34, 95 % CI: 1.24–1.45, P < 0.001). Adolescents experiencing food insecurity also had a higher risk of depressive symptoms (RR: 1.90, 95 % CI: 1.64–2.19, P < 0.001) along with those consuming ≥ 5 servings of fruit and vegetables per day (RR: 1.18, 95 % CI: 1.03–1.34, P = 0.015); conversely, those who consumed grains, roots and tubers in the past day were at decreased risk (RR: 0.73, 95 % CI: 0.69–0.77, P < 0.001). There was no strong evidence of effect modification of associations. This study re inforces the potential role of multiple sociodemographic and nutrition-related measures on risk of depressive symptoms in these populationsItem Business environment and productivity in Africa: macro evidence(International Journal of Emerging Markets, 2023) Haruna, Ï.; Ackah, C.G.Purpose – Africa’s business environment (BE) is characteristically unfriendly and poses severe development challenges. This study evaluates the impact of business climate on productivity in sub-Saharan Africa (SSA). Design/methodology/approach – Macroeconomic data for 51 sub-Saharan African economies from 1990 to 2018 are employed for the analysis. The seemingly unrelated regression model is used to address inter-sectorial linkages. Findings – The study uncovers several findings. First, a high start-up cost substantially leads to productivity losses by limiting the funds available for investment in productivity-enhancing labour and technology and limiting the number of businesses that see the light of day. The productivity impacts of start-up costs are most enormous for industry, followed by services and agriculture. Second, economies with favourable financing environments tend to be more productive economy wide and sector wise. Third, high taxes and tax inefficiency lower productivity by reducing the resource envelope of firms, thus lowering investment amounts. Fourth, poor business infrastructure inflicts the most damage on productivity. Lastly, business administration and macroeconomic environments impact sectoral and economy-wide productivity. Practical implications – SSA economies must strive to lower the cost of starting a business as high start-up costs injure productivity. One way of reducing start-up costs is to create a one-stop shop for registering and formalising a business. Another way is to automate business registration and administrative processes to reduce red tape and corruption. Originality/value – The authors extend the body of knowledge by analysing sectoral and economy-wide productivity effects of various business climate indicators while accounting for inter-sectoral linkages, cross sectional dependence and endogeneity.Item Economic evaluations of non-communicable diseases conducted in Sub-Saharan Africa: a critical review of data sources(Cost Effectiveness and Resource Allocation, 2023) Hollingworth, S.A.; Nonvignon, J.; Fenny, A.P.; et alBackground Policymakers in sub-Saharan Africa (SSA) face challenging decisions regarding the allocation of health resources. Economic evaluations can help decision makers to determine which health interventions should be funded and or included in their benefits package. A major problem is whether the evaluations incorporated data from sources that are reliable and relevant to the country of interest. We aimed to review the quality of the data sources used in all published economic evaluations for cardiovascular disease and diabetes in SSA. Methods We systematically searched selected databases for all published economic evaluations for CVD and diabetes in SSA. We modified a hierarchy of data sources and used a reference case to measure the adherence to reporting and methodological characteristics, and descriptively analysed author statements. Results From 7,297 articles retrieved from the search, we selected 35 for study inclusion. Most were modelled evaluations and almost all focused on pharmacological interventions. The studies adhered to the reporting standards but were less adherent to the methodological standards. The quality of data sources varied. The quality level of evidence in the data domains of resource use and costs were generally considered of high quality, with studies often sourcing information from reliable databases within the same jurisdiction. The authors of most studies referred to data sources in the discussion section of the publications highlighting the challenges of obtaining good quality and locally relevant data. Conclusions The data sources in some domains are considered high quality but there remains a need to make substantial improvements in the methodological adherence and overall quality of data sources to provide evidence that is sufficiently robust to support decision making in SSA within the context of UHC and health benefits plans. Many SSA governments will need to strengthen and build their capacity to conduct economic evaluations of interventions and health technology assessment for improved priority setting. This capacity building includes enhancing local infrastructures for routine data production and management. If many of the policy makers are using economic evaluations to guide resource allocation, it is imperative that the evidence used is of the feasibly highest quality.Item Phenotyping urban built and natural environments with high-resolution satellite images and unsupervised deep learning(Elsevier B.V., 2023) Agyei-Asabere, C.; Metzler, B.; Nathvani, R.; et al.Cities in the developing world are expanding rapidly, and undergoing changes to their roads, buildings, vegetation, and other land use characteristics. Timely data are needed to ensure that urban change enhances health, wellbeing and sustainability. We present and evaluate a novel unsupervised deep clustering method to classify and characterise the complex and multidimensional built and natural environments of cities into interpretable clusters using high resolution satellite images. We applied our approach to a high-resolution (0.3 m/pixel) satellite image of Accra, Ghana, one of the fastest growing cities in sub-Saharan Africa, and contextualised the results with demographic and environmental data that were not used for clustering. We show that clusters obtained solely from images capture dis tinct interpretable phenotyp orientation; length and arrangement of roads) environment, and population, either as a unique defining charac teristic (e.g., bodies of water or dense vegetation) or in combination (e.g., buildings surrounded by vegetation or sparsely populated areas intermixed with roads). Clusters that were based on a single defining characteristic were robust to the spatial scale of analysis and the choice of cluster number, whereas those based on a combina tion of characteristics changed based on scale and number of clusters. The results demonstrate that satellite data and unsupervised deep learning provide a cost-effective, interpretable and scalable approach for real-time track ing of sustainable urban development, especially where traditional environmental and demographic data are limited and infrequent.Item Predictors of mosquito bed net use among children under-fives in Ghana: a multilevel analysis of the 2019 malaria indicator survey(BioMed Central Ltd, 2023) Dzokoto, M.K.; Aheto, J.M. K.; Babah, R.; et al.Abstract Background Morbidities and mortalities due to malaria can be prevented by the use of insecticide-treated mosquito bed nets (ITN), which has been proven for malaria control and elimination. The purpose of this study was to assess the critical factors that predict the use of ITN among children under-fves in Ghana. Methods The study utilized data from the 2019 Ghana Malaria Indicator Survey (GMIS). The outcome variable was mosquito bed net use among children under-fves. To determine critical factors that independently predict ITN use, multilevel multivariable logistic regression was employed using Stata version 16. Odds ratios and associated 95% confdence intervals and p-values were reported. A p<0.05 was used to declare statistical signifcance. Results The overall prevalence of ITN usage was 57.4%. Utilization of bed nets was 66.6% in the rural areas and 43.5% in the urban areas, was highest in the Upper West region (80.6%) even when stratifed to rural (82.9%) and urban areas (70.3%) whilst Greater Accra region (30.5%, rural=41.7%, urban=28.9%) had the least. The community level multilevel analysis showed that bed net utilization was higher among children in rural areas [AOR=1.99, 95% CI 1.32–3.01, p=0.001] and in household with wooden wall materials [AOR=3.29, 95% CI 1.15–9.40, p=0.027]. Bed net utilization was however, less for households with 3+children under-fve [AOR=0.29, 95% CI 0.19–0.46, p<0.001), 4 years old (AOR=0.66, 95% CI 00.48–00.92, p=0.014], without universal access to bed net [AOR=0.52, 95% CI 0.37–0.73, p<0.001], those in the Greater Accra [AOR=0.26, 95% CI 0.13–0.51, p<0.001], Eastern [AOR=0.47, 95% CI 0.23–0.95, p=0.036], Northern [AOR=0.42, 95% CI 0.20–0.88, p=0.022], middle [AOR=0.57, 95% CI 0.35–0.94, p=0.026] and rich/richest [AOR=0.51, 95% CI 0.29–0.92, p=0.025] household wealth quintile. Substantial unobserved household and community level diferences in bed net use were found. Conclusion This study demonstrates the need to intensify promotion of ITN use to those in urban areas, Greater Accra, Eastern and Northern regions, houses without wooden wall materials, middle and rich/richest households. Interventions should be targeted at older children and households with more under-fve children and to ensure full access and use of ITNs among all children under-fves in each household as part of the overall goal of achieving the health-related SDGs.