Spatial optimization of residential care facility locations in Beijing, China: maximum equity in accessibility.

BACKGROUND: The residential care system is rapidly developing and plays an increasingly important role in care for the elderly in Beijing. A noticeable disparity in the accessibility to existing residential care facilities, however, is demonstrated in existing studies. The spatial optimization of residential care facility (RCF) locations is urgently needed to promote equal access to residential care resources among the elderly population. METHODS: A two-step floating catchment area method with an additional distance-decay function is adopted to measure accessibility to residential care facilities. The spatial optimization model is developed to maximize equity in accessibility by minimizing the total square difference between the accessibility score of each demand location and the weighted average accessibility score. The Particle Swarm Optimization (PSO) method is implemented for the solution. RESULTS: The optimized RCF layouts improve equal spatial access to residential care resources with very low accessibility standard variation (0.0066). A relatively large number of beds (51% of the total beds) to be located in the suburban districts between the central and periphery districts of Beijing are optimized. A smaller number of beds to be located in the central and periphery districts (33% and 16% respectively) are optimized. The gaps between the existing and optimized layouts suggest that more RCF beds (5961 beds) are needed in suburban districts, while the RCF beds in some subdistricts located in the central and periphery districts are oversupplied (5253 and 1584 surplus beds respectively). CONCLUSIONS: The optimized results correspond to the municipal special plan proposed by the Beijing government. The optimization objective of this study is different from traditional facility location optimization models, and the method is efficient in maximizing equal access to residential care facilities. This method can support knowledge-based policy-making and planning of residential care facilities.

Occupation and the process of transition from homelessness.

BACKGROUND: The incorporation of meaningful activity or occupation in supporting those transitioning from homelessness to being housed has been promoted by researchers; however, there is little evidence to support the promotion of initiatives encouraging its use in support models. PURPOSE: This manuscript aims to advocate for further research into the role of occupation in supporting persons transitioning from homelessness to permanent housing. KEY ISSUES: The transition from homelessness to becoming housed can be facilitated through use of occupation as a way of promoting the security of meaningful roles and a "housed identity" among persons experiencing homelessness. IMPLICATIONS: By promoting an emphasis on occupation, persons experiencing homelessness may undergo a positive change in identity. This change may improve housing tenure and the likelihood of a more permanent transition away from homelessness. More research is required to identify the relationship between occupation and the transition from homelessness.

Urban 3D building morphology and energy consumption: empirical evidence from 53 cities in China.

The impact of building morphology on building energy consumption has been extensively studied. However, research on how 3D building morphology affects energy consumption at a macroscopic scale is lacking. In this study, we measured the mean building height (BH), mean building volume (BV), and mean European nearest neighbor distance (MENN) of the city to quantify the 3D building morphology. We then used a spatial regression model to analyze the quantitative impact of urban 3D building morphology on per capita electricity consumption (PCEC). Results indicate that at the macroscopic scale of the city, the BH and the MENN have a significant positive impact on the PCEC, while the BV has a significant negative impact on the PCEC. Moreover, the inclusion of the 3D building morphology greatly improves the model's ability to explain building energy efficiency, surpassing the impact of traditional economic factors. Considering the 3D building morphology indicators together, buildings with a lower height, a larger volume, and a more compact 3D morphology have greater potential for energy savings and are more conducive to electricity conservation. This study offers valuable insights for the energy-efficient arrangement of buildings.

Caregiver burden and health-related quality of life: A study of informal caregivers of older adults in Ghana.

BACKGROUND: Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghana to date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among  informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship  between caregiver burden and HRQoL among informal caregivers of older adults in Ghana. METHODS: We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50 years) in the Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was used to measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of  0.05 or less. RESULTS: The mean age of the informal caregivers was 39.15 years and that of the care recipients was 75.08 years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (ß = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants with no formal education (ß = -1.204, SE= .4085, p value = 0.01), those with primary level of education (ß = -2.390, SE= .5099, p value = 0.001) or junior high school education (ß = -1.113, SE= .3903, p value= 0.01) had a significantly decreased HRQoL compared to those with tertiary level of education. Participants who were between the ages of 18-24 (ß = 2.960, SE= .6306, p value=0.001), 25-34 (ß = 1.728, SE= .5794, p value = 0.01) or 35-44 (ß = 1.604, SE= .5764, p value= 0.01) years significantly had increased HRQoL compared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the past year before the survey significantly had increased HRQoL compared to those who utilized healthcare services five or more times in the past year (ß = 4.786, SE=. 4610, p value= 0.001). CONCLUSION: Consistent with our hypothesis, this study reported a significant negative association between caregiver burden and HRQoL. Our findings partially  support the conceptual model of HRQoL used in this study. We recommend that health and social policy measures to improve HRQoL among  informal caregivers of older adults should consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors.

Environmental health, economy, and amenities interactively drive migration patterns among China's older people.

The increasing number of older adult migrants is rapidly changing regional demographic and social structures in China. There is an urgent need to understand the spatial patterns and factors that influence older adults to migrate, especially the role of environmental health. However, this issue has been under-studied. This study focused on intra-provincial and inter-provincial older adult migrants as research subjects, estimated their spatial concentration index based on the iterative proportional fitting approach, and explored the factors influencing their migration using the GeoDetector Model. The results showed the following: (1) In 2015, more than 76% of inter-provincial older adult migrants were distributed in Eastern China, and most intra-provincial older adult migrants were scattered in sub-provincial cities. (2) Compared to factors relating to economy and amenities, environmental health by itself played a relatively weak role in the migration of older adults, but the interaction among environmental health, economy, and amenities was a key driving force of older adult migration. (3) There were significant differences in the dominant environmental health factors between inter-provincial migration and intra-provincial migration, which were temperature and altitude, respectively. Our findings can help policymakers focus on the composition of older adult migrants based on urban environmental health characteristics and rationally optimize older adult care facilities to promote supply-demand matching.

Self-rated health and life satisfaction among Canadian adults: associations of perceived weight status versus BMI.

PURPOSE: Obesity is associated with impaired health-related quality of life (HRQL). As perceived constructs, self-rated health (SRH) and general life satisfaction (LS) might be more strongly related to perceived weight status than actual weight status. The aim was to assess agreement between perceived weight status and self-reported body mass index (BMI), and to investigate their associations with SRH and LS as indicators of HRQL. METHODS: Cross-sectional data included 87,545 adults aged 18-65 years from the 2005 Canadian Community Health Survey. Agreement between perceived weight status and self-reported BMI was assessed. Prevalence of suboptimal SRH and LS was estimated by perceived weight status and BMI, and adjusted logistic regression used to assess the odds of suboptimal outcomes. RESULTS: Overall agreement between perceived weight status and self-reported BMI was only moderate (females: κ = 0.58; males: κ = 0.42). The lowest prevalences of suboptimal SRH and LS were in those who reported both a healthy weight BMI and "about right" weight perception. Discordance between perceived weight status and BMI status, and congruence (i.e. perceived weight status = BMI) around underweight or overweight/obese were associated with poorer SRH and LS. For weight perceptions of "about right", BMI status had minimal influence on suboptimal SRH or LS, while perceptions of underweight or overweight were associated with higher odds of suboptimal SRH and LS, independent of BMI. CONCLUSIONS: Adults' weight status perceptions often do not agree with their actual weight status, even when self-reported. While both perceived and actual weight status influence self-rated health and life satisfaction, perceptions are more strongly associated with these HRQL indicators and should be considered when informing obesity-targeted policies and programmes.

Perceptions of bottled water consumers in three Brazilian municipalities.

This study presents perceptions of consumers of bottled water in their households in three Brazilian municipalities. Data from interviews were analyzed using the Discourse Collective Subject method. Interviewees spent, on average, the equivalent of 40% of their water bill for the public water supply on the purchase of bottled water. The decision about water consumption in the household was predominantly made by women. Interviewees were particularly concerned with health risks and expressed a strong preference for the safety and organoleptic qualities of bottled water, particularly in cases where the tap water supply did not fully meet the regulated water quality standards. Interviewees were largely unaware of the origin, type, storage, and social and environmental impacts of bottled water. Results highlight the importance of water education efforts among the general population and the key role of women in the processes related to drinking water. The need for gender-specific interventions and the empowerment of women on water issues is noted. Results also strongly support the relevance of ensuring the provision of safe drinking water, from the source to the consumption point, with the trust of consumers.

Healthcare utilization among informal caregivers of older adults in the Ashanti region of Ghana: a study based on the health belief model.

BACKGROUND: Existing global evidence suggests that informal caregivers prioritize the health (care) of their care recipients (older adults) over their own health (care) resulting in sub-optimal health outcomes among this population group. However, data on what factors are associated with healthcare utilization among informal caregivers of older adults are not known in a sub-Saharan African context. Guided by the Health Belief Model (HBM), the principal objective of this study was to examine the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. METHODS: Data were extracted from a large cross-sectional study of informal caregiving, health, and healthcare survey among caregivers of older adults aged 50 years or above (N = 1,853; mean age of caregivers = 39.15 years; and mean age of care recipients = 75.08 years) in the Ashanti Region of Ghana. Poisson regression models were used to estimate the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults. Statistical significance of the test was set at a probability level of 0.05 or less. RESULTS: The results showed that 72.9% (n = 1351) of the participants were females, 56.7% (n = 1051) were urban informal caregivers and 28.6% (n = 530)  had no formal education. The results further showed that 49.4% (n = 916) of the participants utilized healthcare for their health problems at least once in the past year before the survey. The final analysis showed a positive and statistically significant association between perceived susceptibility to a health problem (ß = 0.054, IRR = 1.056, 95% CI = [1.041-1.071]), cues to action (ß = 0.076, IRR = 1.079, 95% CI = [1.044-1.114]), self-efficacy (ß = 0.042, IRR = 1.043, 95% CI = [1.013-1.074]) and healthcare utilization among informal caregivers of older adults. The study further revealed a negative and statistically significant association between perceived severity of a health problem and healthcare utilization (ß= - 0.040, IRR = 0.961, 95% CI= [0.947-0.975]) among informal caregivers of older adults. The results again showed that non-enrollment in a health insurance scheme (ß= - 0.174, IRR = 0.841, 95% CI= [0.774-0.913]) and being unemployed (ß= - 0.088, IRR = 0.916, 95% CI= [0.850-0.986]) were statistically significantly associated with a lower log count of healthcare utilization among informal caregivers of older adults. CONCLUSION: The findings of this study to a large extent support the dimensions of the HBM in explaining healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. Although all the dimensions of the HBM were significantly associated with healthcare utilization in Model 1, perceived barriers to care-seeking and perceived benefits of care-seeking were no longer statistically significant after controlling for demographic, socio-economic and health-related variables in the final model. The findings further suggest that the dimensions of the HBM as well as demographic, socio-economic and health-related factors contribute to unequal healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.

'Enabling places': Rethinking 'community' in ageing-in-community in Beijing, China.

OBJECTIVE(S): To understand how community as 'enabling places' is experienced by older people and brings about enabling resources for supporting ageing in community (AIC). METHODS: From a health geographical perspective, we conceptualize community as enabling places that are produced by the interaction of material, social, and symbolic resources. Focusing on a community-based care centre (CBCC) in Beijing, China, we conducted semi-structured interviews with 17 older persons to examine how a CBCC enabled AIC. RESULTS: The CBCC site created three interdependent spaces and material/social/affective resources for enabling AIC: (1)living space (residential care beds) to create a sense of connection and safety; (2) a CBCC-supported care space at home to create an atmosphere of trust and safety; and (3) a social space to create feelings of belonging and contribution. Variations in how the three resources interacted produced not only different spaces at the same site for various users but also different AIC experiences for the same user. CONCLUSIONS: Community is not simply a static research context or spatial container. Rather, community as an enabling place involves a dynamic process in which spatial/social/affective resources are encountered and interact. Older people's AIC experiences change as their encounters change in the three types of resources we described and thus their capacities for ageing well change correspondingly. Furthermore, the binary idea of community versus institution needs to be expanded to explore how home, community, and institution are related, in order to create enabling spaces for AIC.

A systematic review examining associations between physical activity, sedentary behaviour, and sleep duration with quality of life in older adults aged 65 years and above.

This systematic review examined the associations between movement behaviours (i.e., physical activity, sedentary behaviour, and sleep duration) and quality of life (QOL) in adults ≥65 years of age. Four databases were searched in June 2021. Studies were eligible for inclusion if published within the last 20 years, peer-reviewed, examined apparently healthy older adults, and analysed ≥2 movement behaviours together. QOL was represented by the World Health Organization Quality of Life measure which conceptualizes QOL by distinct domains. Study results were categorized and presented by domain. Risk of bias was completed for all included studies using methods described in the Cochrane Handbook. Thirty-one studies with 307 292 participants were included that examined QOL outcomes across seven domains: superdomain (composite measures), perceived physical health, mental and psychological states, level of independence, social relationships, environment, and general health. Findings indicated that moderate-to-vigorous intensity physical activity was favourably associated with QOL. Time re-allocation studies that showed moving time into physical activity from sedentary behaviour were associated with favourable QOL changes. The evidence regarding sedentary behaviour and sleep duration was inconsistent. The quality of evidence was very low for all domains. In conclusion, there is consistent evidence that physical activity improves QOL in adults ≥65 years of age. International Prospective Register of Ongoing Systematic Reviews (PROSPERO) registration No.: CRD42021260566.

Early-life air pollution and green space exposures as determinants of stunting among children under age five in Sub-Saharan Africa.

BACKGROUND: Childhood malnutrition is a major public health issue in Sub-Saharan Africa (SSA) and 61.4 million children under the age of five years in the region are stunted. Although insight from existing studies suggests plausible pathways between ambient air pollution exposure and stunting, there are limited studies on the effect of different ambient air pollutants on stunting among children. OBJECTIVE: Explore the effect of early-life environmental exposures on stunting among children under the age of five years. METHODS: In this study, we used pooled health and population data from 33 countries in SSA between 2006 and 2019 and environmental data from the Atmospheric Composition Analysis Group and NASA's GIOVANNI platform. We estimated the association between early-life environmental exposures and stunting in three exposure periods - in-utero (during pregnancy), post-utero (after pregnancy to current age) and cumulative (from pregnancy to current age), using Bayesian hierarchical modelling. We also visualise the likelihood of stunting among children based on their region of residence using Bayesian hierarchical modelling. RESULTS: The findings show that 33.6% of sampled children were stunted. In-utero PM2.5 was associated with a higher likelihood of stunting (OR = 1.038, CrI = 1.002-1.075). Early-life exposures to nitrogen dioxide and sulphate were robustly associated with stunting among children. The findings also show spatial variation in a high and low likelihood of stunting based on a region of residence. IMPACT STATEMENT: This study explores the effect of early-life environmental exposures on child growth or stunting among sub-Saharan African children. The study focuses on three exposure windows - pregnancy, after birth and cumulative exposure during pregnancy and after birth. The study also employs spatial analysis to assess the spatial burden of stunted growth in relation to environmental exposures and socioeconomic factors. The findings suggest major air pollutants are associated with stunted growth among children in sub-Saharan Africa.

Epidemiological characteristics and spatiotemporal patterns of hand, foot, and mouth disease in Hubei, China from 2009 to 2019.

BACKGROUND: Hand, foot, and mouth disease (HFMD) is a public health issue in Hubei and studies of- spatiotemporal clustering at a fine scale are limited. The purpose of this research was to analyze the epidemiological characteristics, temporal variation characteristics, and spatiotemporal clustering of HFMD cases at the town level from 2009 to 2019 to improve public health outcomes. METHODS: Mathematical statistics, a seasonal index, wavelet analysis, and spatiotemporal scans were used to analyze epidemiological characteristics, time series trends, and spatiotemporal clusters of HFMD in Hubei. RESULTS: EV-A71 (Enterovirus A71) and CVA16 (Coxsackievirus A16) constitute the two primary pathogens of the HFMD epidemic in Hubei, among which EV-A71 is the dominant pathogen, especially in 2016. In terms of age distribution, a major peak occurred at 0-5 years and a very small increase appeared at 25-35 years, with the former having a higher incidence among males than females and the latter having the opposite difference between males and females. The number/rate of HFMD cases exhibited a considerable increase followed by a moderate decline from 2009 to 2019, with the first large peak in April-July and a smaller peak in November-December. HFMD in Hubei exhibited the characteristics of a 270-day cycle with multiscale nesting, which was similar to the periodicity of HFMD cases caused by EV-A71 (9 months). Cities with a higher incidence of HFMD formed a part of an "A-shaped urban skeleton". Subdistricts had the highest incidence of HFMD, followed by towns and villages. The spatiotemporal scan results showed one most likely cluster and 22 secondary clusters, which was consistent with the geographic location of railways and rivers in Hubei. CONCLUSIONS: These findings may be helpful in the prevention and control of HFMD transmission and in implementing effective measures in Hubei Province.

Spatial access to residential care resources in Beijing, China.

BACKGROUND: As the population is ageing rapidly in Beijing, the residential care sector is in a fast expansion process with the support of the municipal government. Understanding spatial accessibility to residential care resources by older people supports the need for rational allocation of care resources in future planning. METHODS: Based on population data and data on residential care resources, this study uses two Geographic Information System (GIS) based methods--shortest path analysis and a two-step floating catchment area (2SFCA) method to analyse spatial accessibility to residential care resources. RESULTS: Spatial accessibility varies as the methods and considered factors change. When only time distance is considered, residential care resources are more accessible in the central city than in suburban and exurban areas. If care resources are considered in addition to time distance, spatial accessibility is relatively poor in the central city compared to the northeast to southeast side of the suburban and exurban areas. The resources in the northwest to southwest side of the city are the least accessible, even though several hotspots of residential care resources are located in these areas. CONCLUSIONS: For policy making, it may require combining various methods for a comprehensive analysis. The methods used in this study provide tools for identifying underserved areas in order to improve equity in access to and efficiency in allocation of residential care resources in future planning.

Age-Friendly Cities and Older Indigenous People: An Exploratory Study in Prince George, Canada.

Cities around the world are responding to aging populations and equity concerns for older people by developing age-friendly communities plans, following the World Health Organization's guidelines. Such plans, however, often fail to account for the wide diversity of older people in cities, with the result that some older people, including Indigenous older people, do not see their needs reflected in age-friendly planning and policies. This article reports on a study involving 10 older First Nations and Métis women in the city of Prince George, Canada, comparing the expressed needs of these women with two age-friendly action plans: that of the city of Prince George, and that of the Northern Health Authority. Four main categories were raised in a group discussion and interview with these women at the Prince George Native Friendship Centre: availability of health care services, accessibility and affordability of programs and services, special roles of Indigenous Elders, and experiences of racism and discrimination. There are many areas of synergy between the needs expressed by the women and the two action plans; however, certain key areas are missing from the action plans; in particular, specific strategies for attending to the needs of Indigenous and other older populations who often feel marginalized in health care and in age-friendly planning.

Exploring the Climate Temperature Effects on Settlement Intentions of Older Migrants: Evidence from China.

Permanent migration across provinces in China has become an important strategy for Chinese older people to respond to a temperature-unfriendly place of residence in late life. However, the relation between temperature effects and permanent settlements of older migrants remains unclear. Based on the data obtained from China Migrants Dynamic Survey, this paper examined how four temperature effects (i.e., cold effect, heat effect, temperature gap effect, and temperature zone effect) play a role in shaping older migrants' intentions to settle permanently in a destination place by conducting logistic regression analysis. Our findings show that: (1) extreme cold (rather than extreme heat or mild temperature) was found to have significant effects on settlement intentions of older people; (2) relative winter temperature between origin and destination places rather than absolute winter temperature in the destination place has a significant positive effect on the settlement intentions; (3) spatially, older migrants tend to migrate to geographically adjacent temperature zones. Our findings will inform a more effective planning and allocation of services for supporting older people by better understanding trends and intentions of older migrants.

"Old friend and powerful cadre": Doctor-patient relationships and multi-dimensional therapeutic landscapes in China's primary hospitals.

A positive doctor-patient relationship is believed to play a key role in the healing process in clinics. While challenges to the doctor-patient relationship are a global concern, complex social contexts which introduce familial collectivism and totalitarian bureaucracy to maintain a doctor's authority have complicated doctor-patient relationships in China. This study delineates a multi-dimensional therapeutic landscape of hospitals in China, focusing on the doctor-patient relationship performances used to improve patients' healing experiences. Based on fieldwork in two primary hospitals in Eastern China, we find that primary hospitals in China are not only professional spaces, but hybrids of professional and non-professional spaces. In these spaces, both professional and other discourses in various forms of social-environmental engagement affect therapeutic experiences. Varying time and space in hospitals allow doctors to construct multi-dimensional therapeutic landscapes vis-a-vis patients to secure patients' compliance with their recommendations, and thus improve health outcomes. We argue that these dimensions may also cause negative therapeutic experience such as unnecessary health care. This study contributes to the literature on therapeutic landscapes of health care by providing a critical view on the construction of multi-dimensional therapeutic hospital landscapes. Furthermore, it links the critical health geographies literature with China's broader social context to explicate the cultural and social transformation of health care spaces in contemporary China. Findings from this study inform both theoretical and empirical debates regarding therapeutic landscapes of health care by embedding the professional spaces of health care into broader geographical discourses. This calls for health professionals to reflect on ethical concerns in multi-dimensional health care landscapes.

"They Do Not Care about Us Anymore": Understanding the Situation of Older People in Ghana.

While existing research acknowledges copious challenges faced by older adults (people aged 60 and over) in Ghana and most countries in sub-Saharan Africa, they fail to situate the lived experiences of this vulnerable group within the broader context of health geography and public health. This paper draws insights from ecological systems theory and the "geographies of older people" literature to examine the lived experiences of older people in Ghana. Data for the study were gathered using interviews (42) and sharing circles (10). Our findings reveal a complex mix of experiences consistent with the different levels of the environment. Dominant themes include access to social support, functional impairment and poor health status, social status, poor access to water and sanitation services, food insecurity, economic insecurity, and caregiving burden. These findings support the wide-held notion that the experiences of older people are complex and produced by the interplay of both individual and structural factors. Our findings demonstrate that sociocultural, economic, political, and climatic factors are important consideration in promoting elderly wellbeing and quality of life in Ghana.

Moving around a Large City in Latin America: The Mobility Challenges Faced by Older Adults with Disabilities.

A growing body of research has shown that barriers in the urban environment can be disabling by reducing the ability of older people to manage independently in the community, but also because they can negatively affect health by limiting the possibilities to move outside the home. In this study, we ask how obstacles in the urban environment are associated with the need for help to go to places in the community. To respond to this question, we used the Annual Household Survey of the City of Buenos Aires, Argentina 2018, which had a specific questionnaire for people with disabilities. From this sample, we selected adults aged 65 years or older with difficulties in at least one of six domains: vision; hearing; upper and lower body mobility; cognition; self-care; and communication. The final sample consisted of 513 persons (weighted = 109,316). First, we conducted a principal component analysis identifying three factors from variables of obstacles to access and use the urban environment: transportation; outdoor spaces; and information. Second, through a logistic regression model, we observed a direct relationship between these factors and the need for help to move in the community, controlling for sociodemographic characteristics, health status, and number of disabilities. This paper provides evidence on the significance of improving urban spaces to reduce dependent mobility. In Latin America, cities still face many challenges in becoming more age-friendly.

Examining Spatial Variability in the Association Between Male Partner Alcohol Misuse and Intimate Partner Violence Against Women in Ghana: A GWR Analysis.

Globally, it is estimated that about 30% of ever-partnered women have experienced some form of intimate partner violence (IPV)-physical assault, sexual assault, or emotional abuse. The prevalence of IPV in sub-Saharan Africa is considerably higher than the global estimate. In Ghana, it is estimated that 24% of women have experienced physical and/or sexual IPV in their lifetime. Studies point to the association between alcohol misuse by intimate male partners and violence against women. However, there has been no consideration for potential spatial variation or heterogeneity in this association. Using estimates from the 2008 Ghana Demographic and Health Survey Data, we employed geographically weighted regression (GWR) analysis to examine spatial variations in the relationship between male partner's alcohol misuse and IPV among women in Ghana. We fitted three models to assess the relationship using a step-wise approach. The first model has alcohol misuse as the only predictor, whereas the second model included other male partner characteristics, such as post-secondary education and employment status. The final introduced female characteristics as additional covariates. The result of the GWR analysis shows that the effect of alcohol misuse on IPV is elevated in the south-western part of Ghana. The findings suggest the potential influence of place-based or contextual factors on the association between alcohol misuse and women's exposure to IPV.

Social Frailty and Depression Among Older Adults in Ghana: Insights from the WHO SAGE Surveys.

In this study, we examine the association between social frailty and depression among older adults in Ghana over time. We employed longitudinal data analysis to examine the association between social frailty, socioeconomic status and depression using data from the WHO-SAGE survey. Our descriptive and cross-tabulation analyses show that the prevalence of depression and social frailty among older adults decreased considerably in 2014/2015 compared to 2007/2008. The finding also reveals a huge reduction in social frailty among older adults in northern Ghana-the most deprived regions in Ghana-compared to those in southern Ghana. The multivariate panel data analysis reveals that depression was significantly associated with social isolation, financial needs, and physical needs. The findings suggest an over time decline in social frailty and depression among older adults, as well as, reduction in regional differences in social frailty and depression among older adults in Ghana.