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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    Cervical cancer screening practices among women in Ghana: evidence from wave 2 of the WHO study on global AGEing and adult health
    (BMC Women's Health, 2020-03-05) Aheto, J.M.K.; Calys-Tagoe, B.N.L.; Mensah, G.; Biritwum, R.B.; Yawson, A.E.
    Background: Cervical cancer is the third most common cancer that affects women worldwide. It has been and remains the leading cause of cancer mortality among women in Ghana. Despite the fact that cervical cancer is preventable through early detection and treatment of precancerous lesions, anecdotal evidence from gynaecological clinics in Ghana indicates that most patients present with a late stage of the disease. This study assesses the cervical cancer screening practices among women in Ghana. Methods: Data from the World Health Organization’s (WHO) multi-country Study on AGEing and adult health (SAGE) wave 2 conducted between 2014 and 2015 in Ghana was used. We employed binary logistic regression models to analyse data on 2711 women to examine factors associated with having pelvic examination among women aged ≥18 years. Among those who had pelvic examination, we applied binary logistic regression models to analyse factors associated with receiving Pap smear test as a subgroup analysis. Results: Of the 2711 women aged 18 years or older surveyed, 225 (8.3%) had ever had a pelvic examination and only 66 (2.4%) of them reported ever having done a Pap smear test. For those who had pelvic examination, only 26.94% had Pap smear test. Ethnic group, marital status, father’s educational level and difficulty with self-care were independently associated with undergoing pelvic examination. Only age and healthcare involvement were independently associated with pelvic examination within the past 5 years to the survey. Marital status, satisfaction with healthcare and healthcare involvement were independently associated with Pap smear test. Conclusion: Even though cervical cancer is preventable through early detection of precancerous lesions using Pap smear test, the patronage of this screening test is still very low in Ghana. Factors influencing the low patronage in Ghana include the marital status of women, their level of satisfaction with healthcare as well as their level of involvement with healthcare. These may be the consequences of a weak health system and the lack of a national policy on cervical cancer screening.
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    Annual transition probabilities of overweight and obesity in older adults: Evidence from World Health Organization Study on global AGEing and adult health
    (Social Science & Medicine, 2020-01-28) Biritwum, R.B.; Lartey, S.T.; Si, L.; Otahal, P.; de Graaff, B.; Boateng, G.O.; Minicuci, N.; Kowal, P.; Magnussen, C.G.; Palmer, A.J.
    Overweight/obesity is becoming increasingly prevalent in sub-Saharan Africa including Ghana. However, transition probabilities, an essential component to develop cost-effective measures for weight management is lacking in this population. We estimated annual transition probabilities between three body mass index (BMI) categories: normal weight (BMI ≥18.5 and <25.0 kg/m2), overweight (BMI ≥25.0 and <30.0 kg/m2), and obesity (BMI ≥30.0 kg/m2), among older adults aged ≥50 years in Ghana. Data were used from a nationally representative, multistage sample of 1496 (44.3% females) older adults in both Waves 1 (2007/8) and 2 (2014/ 15) of the Ghana WHO SAGE. A multistage Markov model was used to estimate annual transition probabilities. We further examined the impact of specific socio-economic factors on the transition probabilities. At baseline, 22.8% were overweight and 11.1% were obese. The annual transition probability was 4.0% (95% CI: 3.4%, 4.8%) from normal weight to overweight, 11.1% (95% CI: 9.5%, 13.0%) from overweight to normal weight and 4.9% (95% CI: 3.8%, 6.2%) from overweight to obesity. For obese individuals, the probability of remaining obese, transitioning to overweight and completely reverting to normal weight was 90.2% (95% CI: 87.7%, 92.3%), 9.2% (95% CI: 7.2%, 11.6%) and 0.6% (95% CI: 0.4%, 0.8%) respectively. Being female, aged 50–65 years, urban residence, having high education and high wealth were associated with increased probability of transitioning into the overweight or obese categories. Our findings highlight the difficulty in transitioning away from obesity, especially among females. The estimated transition probabilities will be essential in health economic simulation models to determine sustainable weight management interventions
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    Mammography examination among women aged 40 years or older in Ghana: evidence from wave 2 of the World Health Organization’s study on global AGEing and adult health multicountry longitudinal study
    (Public Health, 2020-01-12) Calys-Tagoe, B.N.L.; Aheto, J.M.K.; Mensah, G.; Biritwum, R.B.; Yawson, A.E.
    Objective: To determine the uptake of mammography among Ghanaian women aged 40 years or older and to examine critical risk factors that influence the uptake. Study design: A cross-sectional survey. Methods: A nationally representative sample of 2787 women and 1948 men aged 18 years were surveyed in the Wave 2 (2014-2015) of the World Health Organization's multicountry study on AGEing and adult health in Ghana. Of the 2787 women aged 18 years, data on a total of 2301 women aged 40 years were included in this study. Univariable and multivariable logistic regression models were applied to examine critical risk factors for mammogram examination. Results: Of the 2301 women sampled, only 83 (3.61%) ever had mammogram. The odds of mammogram examination were lower for women aged 70 years (odds ratio [OR] 0.42, 95% confidence interval [CI]: 0.19, 0.93), being self-employed (OR ¼ 0.21, 95% CI: 0.11, 0.42) and being informal sector employee (OR ¼ 0.26, 95% CI: 0.12, 0.57) in the multivariable analyses. Belonging to the Ewe ethnic group (OR¼3.41, 95% CI:1.88, 6.16) compared to the Akan group was associated with increased odds of mammogram examination in the multivariable analysis. Women aged 70 years, being self-employed, being an informal employee and belonging to the Ewe ethnic group were independently associated with mammography examination. Conclusion: The prevalence of screening for breast cancer using mammography among Ghanaian women aged 40 years and older was 3.6%. Age, type of employer and ethnicity were associated with an older adult woman's likelihood to access mammography screening. Overall, our study provided critical data to encourage and promote good health-seeking behaviour in terms of breast cancer screening among older adult women. Further qualitative studies are warranted to explore why some of these factors influence mammography.
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    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 surveillance
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    Evaluation of the Association Between Health State Utilities and Obesity in Sub-Saharan Africa: Evidence From World Health Organization Study on Global AGEing and Adult Health Wave 2
    (Value in Health, 2019-06-13) Biritwum, R.B.; Lartey, S.T.; Si, L.; De Graaff, B.; Magnussen, C.G.; Ahmad, H.; Campbell, J.; Minicuci, N.; Kowal, P.; Palmer, A.J.
    Background: Obesity is a major public health challenge and its prevalence has increased across the age spectrum from 1980 to date in most parts of the world including sub-Saharan Africa. Studies that derive health state utilities (HSUs) stratified by weight status to support the conduct of economic evaluations and prioritization of cost-effective weight management interventions are lacking in sub-Saharan Africa. Objectives: To estimate age- and sex-specific HSUs for Ghana, along with HSUs by weight status. Associations between HSUs and overweight and obesity will be examined. Study Design: Cross-sectional survey of the Ghanaian population. Methods: Data were sourced from theWorld Health Organization Study of Global AGEing and Adult Health (WHO SAGE), 2014 to 2015. Using a “judgment-based mapping” method, responses to items from the World Health Organization Quality-of-Life (WHOQOL-100) used in the WHO SAGE were mapped to EQ-5D-5L profiles, and the Zimbabwe value set was applied to calculate HSUs. Poststratified sampling weights were applied to estimate mean HSUs, and a multivariable linear regression model was used to examine associations between HSUs and overweight or obesity. Results: Responses from 3966 adults aged 18 to 110 years were analyzed. The mean (95% confidence interval) HSU was 0.856 (95% CI: 0.850, 0.863) for the population, 0.866 (95% CI: 0.857, 0.875) for men, and 0.849 (95% CI: 0.841, 0.856) for women. Lower mean HSUs were observed for obese individuals and with older ages. Multivariable regression analysis showed that HSUs were negatively associated with obesity (20.024; 95% CI: 20.037, 20.011), female sex (20.011; 95% CI: 20.020, 20.003), and older age groups in the population. Conclusions: The study provides HSUs by sex, age, and body mass index (BMI) categories for the Ghanaian population and examines associations between HSU and high BMI. Obesity was negatively associated with health state utility in the population. These data can be used in future economic evaluations for Ghana and sub-Saharan African populations.
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    Leveraging ongoing research to evaluate the health impacts of South Africa's salt reduction strategy: A prospective nested cohort within the WHO-SAGE multicountry, longitudinal study
    (BioMed Central Ltd., 2016) Charlton, K.; Ware, L.J.; Menyanu, E.; Biritwum, R.B.; Naidoo, N.; Pieterse, C.; Madurai, S.L.; Baumgartner, J.; Asare, G.A.; Thiele, E.; Schutte, A.E.; Kowal, P.
    Introduction: Attempting to curb the rising epidemic of hypertension, South Africa implemented legislation in June 2016 mandating maximum sodium levels in a range of manufactured foods that contribute significantly to population salt intake. This natural experiment, comparing two African countries with and without salt legislation, will provide timely information on the impact of legislative approaches addressing the food supply to improve blood pressure in African populations. This article outlines the design of this ongoing prospective nested cohort study. Methods and analysis: Baseline sodium intake was assessed in a nested cohort of the WHO Study on global AGEing and adult health (WHO-SAGE) wave 2 (2014-2015), a multinational longitudinal study on the health and well-being of adults and the ageing process. The South African cohort consisted of randomly selected households (n=4030) across the country. Spot and 24-hour urine samples are collected in a random subsample (n=1200) and sodium, potassium, creatinine and iodine analysed. Salt behaviour and sociodemographic data are captured using face-to-face interviews, alongside blood pressure and anthropometric measures. Ghana, the selected control country with no formal salt policy, provided a nested subsample (n=1200) contributing spot and 24-hour urine samples from the SAGE Ghana cohort (n=5000). Follow-up interviews and urine collection (wave 3) in both countries will take place in 2017 (postlegislation) to assess change in population-level sodium intake and blood pressure. Ethics and dissemination: SAGE was approved by the WHO Ethics Review Committee (reference number RPC149) with local approval from the North-West University Human Research Ethics Committee and University of the Witwatersrand Human Research Ethics Committee (South Africa), and University of Ghana Medical School Ethics and Protocol Review Committee (Ghana). The results of the study will be published in peer-reviewed international journals, presented at national and international conferences, and summarised as research and policy briefs.