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Social groups and identities significantly influence mental health outcomes, yet their impact in resource-poor communities remains understudied. We explored the role of social group memberships and identities in shaping mental health experiences in two urban poor communities in Ghana. Data from 77 participants were analyzed thematically, revealing widespread engagement in social groups that provide access to both material and symbolic resources. However, these groups also serve as sources of tension and contribute to the stigmatization and marginalization of vulnerable members. Those affected include individuals with severe mental disorders, men experiencing depression, young men involved in substance abuse, family caregivers, migrant and tenant households, and otherwise healthy individuals with recurring psychosocial challenges. The groups exacerbate mental health challenges and restrict access to care among marginalized populations. The findings underscore the need for targeted interventions aimed at enhancing mental health support and reducing stigma in resource-poor settings.
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Objective: This study examines explanatory models (EMs) of stroke and its complications among people living with stroke, and their caregivers, in two urban poor communities in Accra (Ga Mashie) and Korle Bu Teaching Hospital (KBTH), Accra.Methods: Twenty-two stroke survivors and 29 caregivers were recruited from 2 urban poor communities in Accra and KBTH. Qualitative data were obtained using semi-structured interviews that lasted between 45 minutes and 2 hours. The interviews were audiotaped, transcribed and analysed thematically, informed by the concept of EMs of illness.Results: Participants referred to stroke as a sudden event and they expressed different emotional responses after the stroke onset. Stroke survivors and their caregivers attributed stroke with poor lifestyle practices, high blood pressure, unhealthy diet and dietary practices, supernatural causes, stress, family history, other chronic diseases, and delay in treatment of symptoms. While the stroke survivors associated stroke complications with physical disability and stigmatisation, the caregivers associated these with physical disability, behavioural and psychological changes, cognitive disability and death. These associations were mostly influenced by the biomedical model of stroke.Conclusion: The biomedical model of stroke is important for developing interventions that will be accepted by the stroke survivors and the caregivers. Nevertheless, sociocultural explanations of stroke need to be taken into consideration during delivery of medical information to the participants. This study proposes an integrated biopsychosociocultural approach for stroke intervention among the study participants.
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Cuidadores , Accidente Cerebrovascular , Cuidadores/psicología , Emociones , Ghana/epidemiología , Humanos , Accidente Cerebrovascular/psicología , Sobrevivientes/psicologíaRESUMEN
BACKGROUND AND OBJECTIVE: Efforts to improve the adoption of evidence-based interventions for optimal patient outcomes in low-/middle-income countries (LMICs) are persistently hampered by a plethora of barriers. Yet, little is known about strategies to address such barriers to improve quality stroke care. This study seeks to explore health professionals' views on strategies to improve quality stroke care for people who had a stroke in a LMIC. METHODS: A qualitative interview study design was adopted. A semi-structured interview guide was used to conduct in-depth interviews among forty stroke care providers in major referral centres in Ghana. Participants were from nursing, medical, specialist and allied health professional groups. A purposive sample was recruited to share their views on practical strategies to improve quality stroke care in clinical settings. A thematic analysis approach was utilized to inductively analyse the data. RESULTS: A number of overarching themes of strategies to improve quality stroke care were identified: computerization and digitization of medical practice, allocation of adequate resources, increase the human resource capacity to deliver stroke care, development of clinical guideline/treatment protocols, institutionalization of multidisciplinary care and professional development opportunities. These strategies were however differentially prioritized among different categories of stroke care providers. CONCLUSION: Closing the gap between existing knowledge on how to improve quality of stroke care in LMICs has the potential to be successful if unique and context-specific measures from the views of stroke care providers are considered in developing quality improvement strategies and health systems and policy reforms. However, for optimal outcomes, further research into the effectiveness and feasibility of the proposed strategies by stroke care providers is needed.
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Personal de Salud , Accidente Cerebrovascular , Humanos , Pobreza , Investigación Cualitativa , Calidad de la Atención de Salud , Accidente Cerebrovascular/terapiaRESUMEN
PURPOSE: Psychosocial stress is associated with obesity in some populations, but it is unclear whether the association is related to migration. This study explored associations between psychosocial stress and obesity among Ghanaian migrants in Europe and non-migrant Ghanaians in Ghana. METHODS: Cross-sectional data from the RODAM study were used, including 5898 Ghanaians residing in Germany, the UK, the Netherlands, rural Ghana, and urban Ghana. Perceived discrimination, negative life events and stress at work or at home were examined in relation to body mass index (BMI) and waist circumference (WC). Linear regression analyses were performed separately for migrants and non-migrants stratified by sex. RESULTS: Perceived discrimination was not associated with BMI and WC in both migrants and non-migrants. However, negative life events were positively associated with BMI (ß = 0.78, 95% CI 0.34-1.22) and WC (ß = 1.96, 95% CI 0.79-3.12) among male Ghanaian migrants. Similarly, stress at work or at home was positively associated with BMI (ß = 0.28, 95% CI 0.00-0.56) and WC (ß = 0.84, 95% CI 0.05-1.63) among male Ghanaian migrants. Among non-migrant Ghanaians, in contrast, stress at work or at home was inversely associated with BMI and WC in both males (ß = - 0.66, 95% CI - 1.03 to - 0.28; ß = - 1.71 95% CI - 2.69 to - 0.73, respectively) and females (ß = - 0.81, 95% CI - 1.20 to - 0.42; ß = - 1.46, 95% CI - 2.30 to - 0.61, respectively). CONCLUSIONS: Negative life events and stress at work or at home are associated with increased body weight among male Ghanaians in European settings, whereas stress at work or at home is associated with reduced body weight among Ghanaians in Ghana. More work is needed to understand the underlying factors driving these differential associations to assist prevention efforts.
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Peso Corporal/etnología , Obesidad/psicología , Estrés Laboral/etnología , Estrés Psicológico/etnología , Migrantes/psicología , Adulto , Índice de Masa Corporal , Estudios Transversales , Femenino , Alemania , Ghana/etnología , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Países Bajos , Obesidad/etnología , Estrés Laboral/complicaciones , Población Rural , Estrés Psicológico/complicaciones , Reino Unido , Población UrbanaRESUMEN
BACKGROUND: Metabolic syndrome (MetSyn) is an important risk factor for cardiovascular diseases and type 2 diabetes. It is unknown whether the MetSyn prevalence differs within a homogenous population residing in different settings in Africa and Europe. We therefore assessed the prevalence of MetSyn among Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in Europe. METHODS: We used data from the cross-sectional multi-centre RODAM study that was conducted among Ghanaian adults aged 25-70 years residing in rural- and urban-Ghana and in London, Amsterdam and Berlin (n = 5659). MetSyn was defined according to the 2009 harmonized definition. Geographical locations were compared using age-standardized prevalence rates, and prevalence ratios (PRs), adjusted for age, education, physical activity, and smoking and stratified for sex. RESULTS: In men, the age-standardized prevalence of MetSyn was 8.3% in rural Ghana and showed a positive gradient through urban Ghana (23.6%, adjusted PR = 1.85, 95% confidence interval 1.17-2.92) to Europe, with the highest prevalence in Amsterdam (31.4%; PR = 4.45, 2.94-6.75). In women, there was a rural-to-urban gradient in age-standardized MetSyn prevalence (rural Ghana 25%, urban Ghana 34.4%, PR = 1.38, 1.13-1.68), but small differences in MetSyn prevalence between urban-Ghanaian and European-Ghanaian women (Amsterdam 38.4%; London 38.2%). CONCLUSION: MetSyn is highly prevalent in Ghana as well as in Ghanaian migrants in Europe. To assist prevention efforts, further research is needed to understand the mechanisms driving the geographical differences in MetSyn prevalence between migrant and non-migrant Ghanaians.
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Emigrantes e Inmigrantes/estadística & datos numéricos , Síndrome Metabólico/etnología , Adulto , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etnología , Europa (Continente)/epidemiología , Femenino , Ghana/etnología , Humanos , Masculino , Síndrome Metabólico/epidemiología , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/etnología , PrevalenciaRESUMEN
Background: Chronic kidney disease (CKD) is a major burden among sub-Saharan African (SSA) populations. However, differences in CKD prevalence between rural and urban settings in Africa, and upon migration to Europe are unknown. We therefore assessed the differences in CKD prevalence among homogenous SSA population (Ghanaians) residing in rural and urban Ghana and in three European cities, and whether conventional risk factors of CKD explained the observed differences. Furthermore, we assessed whether the prevalence of CKD varied among individuals with hypertension and diabetes compared with individuals without these conditions. Methods: For this analysis, data from Research on Obesity & Diabetes among African Migrants (RODAM), a multi-centre cross-sectional study, were used. The study included a random sample of 5607 adult Ghanaians living in Europe (1465 Amsterdam, 577 Berlin, 1041 London) and Ghana (1445 urban and 1079 rural) aged 25-70 years. CKD status was defined according to severity of kidney disease using the combination of glomerular filtration rate (G1-G5) and albuminuria (A1-A3) levels as defined by the 2012 Kidney Disease: Improving Global Outcomes severity classification. Comparisons among sites were made using logistic regression analysis. Results: CKD prevalence was lower in Ghanaians living in Europe (10.1%) compared with their compatriots living in Ghana (13.3%) even after adjustment for age, sex and conventional risk factors of CKD [adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.56-0.88, P = 0.002]. CKD prevalence was markedly lower among Ghanaian migrants with hypertension (adjusted OR = 0.54, 0.44-0.76, P = 0.001) and diabetes (adjusted OR = 0.37, 0.22-0.62, P = 0.001) compared with non-migrant Ghanaians with hypertension and diabetes. No significant differences in CKD prevalence was observed among non-migrant Ghanaians and migrant Ghanaians with no hypertension and diabetes. Among Ghanaian residents in Europe, the odds of CKD were lower in Amsterdam than in Berlin, while among Ghanaian residents in Ghana, the odds of CKD were lower in rural Ghana (adjusted OR = 0.68, 95% CI 0.53-0.88, P = 0.004) than in urban Ghana, but these difference were explained by conventional risk factors. Conclusion: Our study shows important differences in CKD prevalence among Ghanaians living in Europe compared with those living in Ghana, independent of conventional risk factors, with marked differences among those with hypertension and diabetes. Further research is needed to identify factors that might explain the observed difference across sites to implement interventions to reduce the high burden of CKD, especially in rural and urban Ghana.
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Población Negra/estadística & datos numéricos , Insuficiencia Renal Crónica/epidemiología , Migrantes/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Femenino , Ghana/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Factores de Riesgo , Población Rural , Población UrbanaRESUMEN
BACKGROUND: In Ghana, about 3.5 million cases of malaria are recorded each year. Urban poor residents particularly have a higher risk of malaria mainly due to poor housing, low socio-economic status and poor sanitation. Alternative treatment for malaria (mainly African traditional/herbal and/or self-medication) is further compounding efforts to control the incidence of malaria in urban poor communities. This study assesses factors associated with seeking alternative treatment as the first response to malaria, relative to orthodox treatment in three urban poor communities in Accra, Ghana. METHODS: This cross-sectional study was conducted in three urban poor localities in Accra, Ghana among individuals in their reproductive ages (15-59 years for men and 15-49 years for women). The analytic sample for the study was 707. A multinomial regression model was used to assess individual, interpersonal and structural level factors associated with treatment-seeking for malaria. RESULTS: Overall, 31% of the respondents sought orthodox treatment, 8% sought traditional/herbal treatment and 61% self-medicated as the first response to malaria. At the bivariate level, more males than females used traditional/herbal treatment and self-medicated for malaria. The results of the regression analysis showed that current health insurance status, perceived relative economic standing, level of social support, and locality of residence were associated with seeking alternative treatment for malaria relative to orthodox treatment. CONCLUSIONS: The findings show that many urban poor residents in Accra self-medicate as the first response to malaria. Additionally, individuals who were not enrolled in a health insurance scheme, those who perceived they had a low economic standing, those with a high level of social support, and locality of residence were significantly associated with the use of alternative treatment for malaria. Multi-level strategies should be employed to address the use of alternative forms of treatment for malaria within the context of urban poverty.
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Conocimientos, Actitudes y Práctica en Salud , Malaria/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Población Urbana , Adolescente , Adulto , Estudios Transversales , Femenino , Ghana , Humanos , Malaria/prevención & control , Masculino , Persona de Mediana Edad , Población Urbana/estadística & datos numéricos , Poblaciones Vulnerables/psicología , Adulto JovenRESUMEN
BACKGROUND: Poor communities in low and middle income countries are reported to experience a higher burden of chronic non-communicable diseases (NCDs) and nutrition-related NCDs. Interventions that build on lay perspectives of risk are recommended. The objective of this study was to examine lay understanding of healthy and unhealthy food practices, factors that influence food choices and the implications for developing population health interventions in three urban poor communities in Accra, Ghana. METHODS: Thirty lay adults were recruited and interviewed in two poor urban communities in Accra. The interviews were audio-taped, transcribed and analysed thematically. The analysis was guided by the socio-ecological model which focuses on the intrapersonal, interpersonal, community, structural and policy levels of social organisation. RESULTS: Food was perceived as an edible natural resource, and healthy in its raw state. A food item retained its natural, healthy properties or became unhealthy depending on how it was prepared (e.g. frying vs boiling) and consumed (e.g. early or late in the day). These food beliefs reflected broader social food norms in the community and incorporated ideas aligned with standard expert dietary guidelines. Healthy cooking was perceived as the ability to select good ingredients, use appropriate cooking methods, and maintain food hygiene. Healthy eating was defined in three ways: 1) eating the right meals; 2) eating the right quantity; and 3) eating at the right time. Factors that influenced food choice included finances, physical and psychological state, significant others and community resources. CONCLUSIONS: The findings suggest that beliefs about healthy and unhealthy food practices are rooted in multi-level factors, including individual experience, family dynamics and community factors. The factors influencing food choices are also multilevel. The implications of the findings for the design and content of dietary and health interventions are discussed.
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Alimentos , Conocimientos, Actitudes y Práctica en Salud , Áreas de Pobreza , Población Urbana , Adulto , Femenino , Ghana , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
Approximately one-third of early childhood pupils in Ghana are struggling with meeting basic behavioral and developmental milestones, but little is known about mechanisms or factors that contribute to poor early childhood development. With a lack of developmental research to guide intervention or education program and policy planning, this study aimed to address these research gaps by examining a developmental mechanism for early childhood development. We tested a mediational mechanism model that examined the influence of parental wellbeing on parenting and children's development. Two hundred and sixty-two Ghanaian parents whose children attended early childhood classes (nursery to 3rd grade) were recruited. Data were gathered through parent interviews and Structural Equation Modeling was utilized to examine pathways of the model. Results support the mediational model that Ghanaian parents' depression was associated with less optimal parenting, and in turn greater child externalizing behavioral problems. This study adds new evidence of cross cultural consistency in early childhood development.
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Desarrollo Infantil , Depresión , Educación no Profesional , Responsabilidad Parental , Calidad de Vida , Apoyo Social , Adulto , Preescolar , Depresión/diagnóstico , Depresión/prevención & control , Depresión/psicología , Educación no Profesional/métodos , Educación no Profesional/organización & administración , Femenino , Ghana/epidemiología , Humanos , Masculino , Evaluación de Necesidades , Responsabilidad Parental/etnología , Responsabilidad Parental/psicología , Padres/psicologíaRESUMEN
BACKGROUND: Half of the estimated annual 28 million non-communicable diseases (NCDs) deaths in low- and middle-income countries (LMICs) are attributed to weak health systems. Current health policy responses to NCDs are fragmented and vertical particularly in the African region. The World Health Organization (WHO) led NCDs Global action plan 2013-2020 has been recommended for reducing the NCD burden but it is unclear whether Africa is on track in its implementation. This paper synthesizes Africa's progress towards WHO policy recommendations for reducing the NCD burden. METHODS: Data from the WHO 2011, 2014 and 2015 NCD reports were used for this analysis. We synthesized results by targets descriptions in the three reports and included indicators for which we could trace progress in at least two of the three reports. RESULTS: More than half of the African countries did not achieve the set targets for 2015 and slow progress had been made towards the 2016 targets as of December 2013. Some gains were made in implementing national public awareness programmes on diet and/or physical activity, however limited progress was made on guidelines for management of NCD and drug therapy and counselling. While all regions in Africa show waning trends in fully achieving the NCD indicators in general, the Southern African region appears to have made the least progress while the Northern African region appears to be the most progressive. CONCLUSION: Our findings suggest that Africa is off track in achieving the NCDs indicators by the set deadlines. To make sustained public health gains, more effort and commitment is urgently needed from governments, partners and societies to implement these recommendations in a broader strategy. While donors need to suit NCD advocacy with funding, African institutions such as The African Union (AU) and other sub-regional bodies such as West African Health Organization (WAHO) and various country offices could potentially play stronger roles in advocating for more NCD policy efforts in Africa.
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Control de Enfermedades Transmisibles/normas , Enfermedades Transmisibles/epidemiología , Política de Salud , Disparidades en Atención de Salud , Área sin Atención Médica , Organización Mundial de la Salud , África/epidemiología , Control de Enfermedades Transmisibles/organización & administración , Salud Global , HumanosRESUMEN
BACKGROUND: Rising rates of obesity and type 2 diabetes (T2D) are impending major threats to the health of African populations, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of obesity and T2D among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in different European countries. METHODS: A multi-centre cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25-70 years residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin). Comparisons between groups were made using prevalence ratios (PRs) with adjustments for age and education. RESULTS: In rural Ghana, the prevalence of obesity was 1.3 % in men and 8.3 % in women. The prevalence was considerably higher in urban Ghana (men, 6.9 %; PR: 5.26, 95 % CI, 2.04-13.57; women, 33.9 %; PR: 4.11, 3.13-5.40) and even more so in Europe, especially in London (men, 21.4 %; PR: 15.04, 5.98-37.84; women, 54.2 %; PR: 6.63, 5.04-8.72). The prevalence of T2D was low at 3.6 % and 5.5 % in rural Ghanaian men and women, and increased in urban Ghanaians (men, 10.3 %; PR: 3.06; 1.73-5.40; women, 9.2 %; PR: 1.81, 1.25-2.64) and highest in Berlin (men, 15.3 %; PR: 4.47; 2.50-7.98; women, 10.2 %; PR: 2.21, 1.30-3.75). Impaired fasting glycaemia prevalence was comparatively higher only in Amsterdam, and in London, men compared with rural Ghana. CONCLUSION: Our study shows high risks of obesity and T2D among sub-Saharan African populations living in Europe. In Ghana, similarly high prevalence rates were seen in an urban environment, whereas in rural areas, the prevalence of obesity among women is already remarkable. Similar processes underlying the high burden of obesity and T2D following migration may also be at play in sub-Saharan Africa as a consequence of urbanisation.
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Diabetes Mellitus Tipo 2/epidemiología , Obesidad/epidemiología , Adulto , África del Sur del Sahara/epidemiología , África del Sur del Sahara/etnología , Anciano , Población Negra , Estudios Transversales , Diabetes Mellitus Tipo 2/etnología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/etnología , Prevalencia , Migrantes/estadística & datos numéricosRESUMEN
BACKGROUND: The current Ebola Virus Disease (EVD) epidemic has ravaged the social fabric of three West African countries and affected people worldwide. We report key themes from an agenda-setting, multi-disciplinary roundtable convened to examine experiences and implications for health systems in Ghana, a nation without cases but where risk for spread is high and the economic, social and political impact of the impending threat is already felt. DISCUSSION: Participants' personal stories and the broader debates to define fundamental issues and opportunities for preparedness focused on three inter-related themes. First, the dangers of the fear response itself were highlighted as a threat to the integrity and continuity of quality care. Second, healthcare workers' fears were compounded by a demonstrable lack of societal and personal protections for infection prevention and control in communities and healthcare facilities, as evidenced by an ongoing cholera epidemic affecting over 20,000 patients in the capital Accra alone since June 2014. Third, a lack of coherent messaging and direction from leadership seems to have limited coordination and reinforced a level of mistrust in the government's ability and commitment to mobilize an adequate response. Initial recommendations include urgent investment in the needed supplies and infrastructure for basic, routine infection control in communities and healthcare facilities, provision of assurances with securities for frontline healthcare workers, establishment of a multi-sector, "all-hazards" outbreak surveillance system, and engaging directly with key community groups to co-produce contextually relevant educational messages that will help decrease stigma, fear, and the demoralizing perception that the disease defies remedy or control. The EVD epidemic provides an unprecedented opportunity for West African countries not yet affected by EVD cases to make progress on tackling long-standing health systems weaknesses. This roundtable discussion emphasized the urgent need to strengthen capacity for infection control, occupational health and safety, and leadership coordination. Significant commitment is needed to raise standards of hygiene in communities and health facilities, build mechanisms for collaboration across sectors, and engage community stakeholders in creating the needed solutions. It would be both devastating and irresponsible to waste the opportunity.
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Planificación en Desastres , Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/epidemiología , Ghana/epidemiología , Personal de Salud , HumanosRESUMEN
BACKGROUND: Globally, there is an increasing prevalence of high blood pressure (HBP) among adults and youth. However, the mechanisms of how the risk factors (physical inactivity and obesity) relate with blood pressure (BP) are not well known especially among the urban poor youth in low and middle income countries. Meanwhile childhood and adolescent physical inactivity and obesity, particularly in conditions of poverty, predispose individuals to cardiovascular diseases (CVDs) in later life. The aim of this study was to assess the BP levels and to examine its associations with physical activity (PA) and body mass index (BMI) amongst urban poor youth in Accra, Ghana. METHODS: We studied 201 youth aged 15-24 years in three urban poor communities in Accra, Ghana. Height, weight and BP were measured in all subjects. PA levels were assessed using the Edulink Urban Health and Poverty project questionnaire. Multiple linear regression analysis was used to determine the factors influencing BP levels. RESULTS: The proportion of pre-hypertension and hypertension among the youth was 32.3% and 4%, respectively. The rates of pre-hypertension (42.0 vs. 24.8) and hypertension (6.8 vs. 1.8) were higher in males than in females. More than three-quarters (84.1%) of the youth were not physically active. Females were more physically inactive compared to the males (94.7% vs. 70.5%). The average BMI was 22.8 kg/m(2). For overweight (17.7 vs. 6.8) and obesity (13.3 vs. 2.3), females had higher rates than males. BMI was positively related to systolic BP, and significantly associated with systolic BP (ß = 1.4, p < 0.000 and ß = 0.8, p < 0.000; respectively for male and female youth) compared to diastolic BP. Youth with low PA had raised BP. CONCLUSION: The positive association of BMI and BP in the study communities suggests the need for health measures to tackle their increase and related public health consequences. Further studies on BP and other risk factors among the youth of rural populations and other developing countries will be important to stall the rising prevalence and implications for adult morbidity and mortality.
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Índice de Masa Corporal , Ejercicio Físico/fisiología , Hipertensión/epidemiología , Pobreza , Prehipertensión/epidemiología , Salud Urbana , Adolescente , Estudios Transversales , Femenino , Ghana/epidemiología , Humanos , Hipertensión/etiología , Masculino , Prehipertensión/etiología , Prevalencia , Factores de Riesgo , Distribución por Sexo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: The objective of the study was to examine explanatory models of diabetes and diabetes complications among urban poor Ghanaians living with diabetes and implications for developing secondary prevention strategies. DESIGN: Twenty adults with type 2 diabetes were recruited from three poor communities in Accra. Qualitative data were obtained using interviews that run between 40 and 90 minutes. The interviews were audio-taped, transcribed and analysed thematically, informed by the 'explanatory model of disease' concept. RESULTS: Respondents associated diabetes and its complications with diet, family history, lifestyle factors (smoking, excessive alcohol consumption and physical inactivity), psychological stress and supernatural factors (witchcraft and sorcery). These associations were informed by biomedical and cultural models of diabetes and disease. Subjective experience, through a process of 'body-listening,' constituted a third model on which respondents drew to theorise diabetes complications. Poverty was an important mediator of poor self-care practices, including treatment non-adherence. CONCLUSIONS: The biomedical model of diabetes was a major source of legitimate information for self-care practices. However, this was understood and applied through a complex framework of cultural theories of chronic disease, the biopsychological impact of everyday illness experience and the disempowering effects of poverty. An integrated biopsychosocial approach is proposed for diabetes intervention in this research community.
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Diabetes Mellitus Tipo 2/etnología , Conocimientos, Actitudes y Práctica en Salud/etnología , Pobreza/psicología , Adulto , Complicaciones de la Diabetes/etnología , Complicaciones de la Diabetes/etiología , Diabetes Mellitus Tipo 2/etiología , Diabetes Mellitus Tipo 2/psicología , Dieta/efectos adversos , Dieta/psicología , Femenino , Ghana , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estrés Psicológico/complicacionesRESUMEN
BACKGROUND: The rising burden of chronic non-communicable diseases in low and middle income countries has major implications on the ability of these countries to achieve universal health coverage. In this paper we discuss the impact of cardiovascular diseases (CVD) on primary healthcare services in urban poor communities in Accra, Ghana. METHODS: We review the evidence on the evolution of universal health coverage in Ghana and the central role of the community-based health planning services (CHPS) programme and the National Health Insurance Scheme in primary health care. We present preliminary findings from a study on community CVD knowledge, experiences, responses and access to services. RESULTS: The rising burden of NCDs in Ghana will affect the achievement of universal health coverage, particularly in urban areas. There is a significant unmet need for CVD care in the study communities. The provision of primary healthcare services for CVD is not accessible, equitable or responsive to the needs of target communities. CONCLUSIONS: We consider these findings in the context of the primary healthcare system and discuss the challenges and opportunities for strengthening health systems in low and middle-income countries.
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Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/terapia , Atención Primaria de Salud/economía , Cobertura Universal del Seguro de Salud/organización & administración , Enfermedad Crónica , Servicios de Salud Comunitaria/economía , Ghana , Investigación sobre Servicios de Salud , Humanos , Áreas de Pobreza , Servicios Urbanos de Salud/economíaRESUMEN
Ghanaian women's food beliefs and practices during pregnancy and the scope for developing more effective maternal health interventions were explored in this study. Thirty-five multiethnic Ghanaian women between the ages of 29 and 75 were interviewed about pregnancy food beliefs and practices. I show that, based on the data analysis, their knowledge about food was drawn from lifeworlds (family and friends), educational settings, health professionals, mass media, and body-self knowledge (unique pregnancy experiences). Core lay ideas converged with expert knowledge on maternal health nutrition. Multiple external factors (e.g., economics, cultural representations of motherhood) and internal factors (e.g., the unpredictable demands of the pregnant body) influenced pregnancy food practices. I suggest and discuss a need for culturally situated multilevel interventions.
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Conducta Alimentaria/etnología , Alimentos , Bienestar Materno/etnología , Mujeres Embarazadas/etnología , Adulto , Anciano , Cultura , Femenino , Ghana , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Embarazo , Mujeres Embarazadas/psicología , Investigación Cualitativa , Factores SocioeconómicosRESUMEN
BACKGROUND: The COVID-19 pandemic has significantly impacted frontline health workers. However, a neglected dimension of this discourse was the extent to which the pandemic impacted frontline healthcare workers providing non-communicable diseases (NCDs) care. This study aims to understand the experiences of healthcare workers with no prior exposure to pandemics who provided care to people living with NCDs (PLWNCDs). METHODS: A qualitative study design was employed, using a face-to-face in-depth interviews. Interviews were conducted in primary healthcare facilities in three administrative regions of Ghana, representing the Northern, Southern and Middle Belts. Only frontline health workers with roles in providing care for PLWNCDs were included. Purposive snowballing and convenience sampling methods were employed to select frontline health workers. An open-ended interview guide was used to facilitate data collection, and thematic content analysis was used to analyse the data. RESULTS: A total of 47 frontline health workers were interviewed. Overall, these workers experienced diverse patient-driven and organisational challenges. Patient-level challenges included a decline in healthcare utilisation, non-adherence to treatment, a lack of continuity, fear and stigma. At the organisational levels, there was a lack of medical logistics, increased infection of workers and absenteeism, increased workload and burnout, limited motivational packages and inadequate guidelines and protocols. Workers coped and responded to the pandemic by postponing reviews and consultations, reducing inpatient and outpatient visits, changing their prescription practices, using teleconsultation and moving to long-shift systems. CONCLUSION: This study has brought to the fore the experiences that adversely affected frontline health workers and, in many ways, affected the care provided to PLWNCDs. Policymakers and health managers should take these experiences into account in plans to mitigate the impact of future pandemics.
Asunto(s)
COVID-19 , Personal de Salud , Enfermedades no Transmisibles , Investigación Cualitativa , Humanos , COVID-19/epidemiología , Ghana/epidemiología , Enfermedades no Transmisibles/terapia , Enfermedades no Transmisibles/epidemiología , Femenino , Masculino , Personal de Salud/psicología , Adulto , SARS-CoV-2 , Actitud del Personal de Salud , Persona de Mediana Edad , Pandemias , Entrevistas como AsuntoRESUMEN
Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.
Asunto(s)
Diabetes Mellitus , Enfermedades no Transmisibles , Embarazo , Adulto , Humanos , Femenino , Ghana/epidemiología , Prevalencia , Diabetes Mellitus/epidemiología , Factores de RiesgoRESUMEN
Diabetes remains a major, global clinical and public health threat with consistent rises in prevalence around the world over the past four decades. Two-thirds of the projected increases in global diabetes prevalence to 2045 are expected to come from low- and middle-income countries, including those in sub-Saharan Africa. Ghana is typical of this trend. However, there are gaps in evidence regarding the appropriate development of interventions and well-targeted policies for diabetes prevention and treatment that pay due attention to relevant local conditions and influences. Due consideration to community perspectives of environmental influences on the causes of diabetes, access to appropriate health services and care seeking for diabetes prevention and management is warranted, especially in urban settings. The 'Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana' project is a mixed methods study in Ga Mashie, Accra. An epidemiological survey is described elsewhere. Six qualitative studies utilising a range of methodologies are proposed in this protocol to generate a contextual understanding of type 2 diabetes mellitus in an urban poor population. They focus on community, care provider, and policy stakeholder perspectives with a focus on food markets and environmental influences, the demand and supply of health services, and the history of the Ga Mashie community and its inhabitants. The results will be shared with the community in Ga Mashie and with health policy stakeholders in Ghana and other settings where the findings may be usefully transferable for the development of community-based interventions for diabetes prevention and control.
Main findings: Diabetes is a major, global health threat with rises in incidence projected in low- and middle-income countries, including Ghana, yet evidence gaps remain related to the development of contextually appropriate interventions and policies for diabetes prevention and treatment.Added knowledge: Sitting within a larger, mixed methods study entitled 'Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana', this study design paper introduces six complementary qualitative studies designed to address this gap in Ga Mashie, Accra.Global health impact for policy and action: Robust methods to describe diabetes burdens and dissemination of evidence are crucial for health policy and impact.