Impact of Urbanization on Health and Well-Being in Ghana. Status of Research, Intervention Strategies and Future Directions: A Rapid Review.

Introduction: Ghana like other African countries is facing multiple health threats due to expansion of urban populations. Globally, the urbanization phenomenon has received considerable attention and modest steps have been undertaken to address it. Ghana is stalling on implementation of policies and interventions targeted at alleviating the menace. Objectives: This review examined research evidence, interventions, and policies relating to urbanization and threats to health and well-being of people living in Ghana. The review focused on three areas including urbanization threats to health and well-being, health risks associated with urbanization, and interventions and policies. Materials and Methods: The search spanned from year 2000 to February 2022 covering documents related to urbanization, health, and well-being. Databases used for the search include African Journals Online, Annual Reviews (Biomedical, Life & Physical sciences, Social Sciences), BioMedCentral, BioOne, BLDS digital library, Cambridge University Press, ClinicalKey, CINAHL, University of Ghana Digital Collections/UGSpace, JSTOR, Medline and Wiley Online Library. Results: Environmental risk factors, urban planning, water-related, behavior-related, and socioeconomic factors were important urbanization threats to health and well-being. Health risks identified include airborne diseases, waterborne diseases, malaria, and non-communicable diseases such as hypertension and lung cancer. Additionally, there is evidence of non-implementation and/or non-enforcement of existing interventions and policies. Conclusion and Recommendation: Evidence from this rapid review shows that urbanization impacts on health and well-being of people in Ghana. Urbanization threats that expose populations to health risks could be reduced through commitment to implementation, surveillance and monitoring of policies and interventions. Communities and individuals must be equipped to take control of their health and well-being.

An Examination of the Latent Structure and Reproducibility of the Life Skills Scale for Sport in Botswana and Ghana.

With the growing interest in sport-based positive youth development (PYD) programs across the African continent, there is a need to establish suitable measures to evaluate the success of these programs in fostering PYD. The Life Skills Scale for Sport (LSSS) was recently developed as a sport-specific measure of life skills development. Despite its good psychometric properties among British youth sport participants, cross-cultural evidence indicates differences in the conceptualization of the eight factors measured by the LSSS. To determine the suitability of the LSSS for use in the African youth sport context, this study examined the latent structure and reproducibility of scores produced by the scale in a sample of youth sport participants from Botswana and Ghana. Cross-sectional data from a sample of 495 youth athletes (male = 51.72%), aged 12-21 years (M = 16.76, SD = 1.58), from junior and senior secondary schools was used in this study. Confirmatory factor analysis and exploratory structural equation modeling were conducted, and conventional fit indices were used to assess model fit. Results on the original LSSS model indicated the need for model re-specification in the current sample. A re-specified LSSS, consisting of the original eight factors, but only 34 of the original 43 items, demonstrated improved fit and adequate internal consistency. Scores derived from the re-specified LSSS proved to be a valid estimate of life skills development in the current sample of youth sport participants. This has important implications for the utility of the LSSS in different cultures.

Effects of a sport-based positive youth development program on youth life skills and entrepreneurial mindsets.

Sport-based life skills interventions offer compelling pathways to understanding the role of physical activity and sport on youth psychosocial and other development outcomes. This is because of evidence that shows the benefits of sport programs to health and well-being of youth, and more lately other areas such as academic achievement and various life skills such as teamwork, leadership and goal setting. However, much of the research in this area of youth development is largely descriptive, with limited capacity to infer causal relationships and application across contexts. Therefore, this study examines the effects of a sport-based intervention program on life skills and entrepreneurial mindsets of youth from three African countries (n = 146, average age = 15.9 years, female = 48.6%). Half of the recruited participants were assigned to a three-week life skills intervention program and the remaining half to a sport-only control program. Both groups completed a demographic information questionnaire, Life Skills for Sport Scale and the General Enterprising Tendency v2 test. Two-way mixed ANOVAs showed significant post-intervention changes in life skills for both groups but changes in entrepreneurial mindsets for the intervention group only. This demonstrates the relevance of sport-based interventions to youth development outcomes in different contexts and the transformative potential of youth sport reported in previous studies. The findings have important implications for intentional and targeted delivery of programs to enhance specific youth development outcomes.

The International Impact of the Active Healthy Kids Global Alliance Physical Activity Report Cards for Children and Youth.

BACKGROUND: In response to growing concerns over high levels of physical inactivity among young people, the Active Healthy Kids Global Alliance developed a series of national Report Cards on physical activity for children and youth to advocate for the promotion of physical activity. This article provides updated evidence of the impact of the Report Cards on powering the movement to get children and youth moving globally. METHODS: This assessment was performed using quantitative and qualitative sources of information, including surveys, peer-reviewed publications, e-mails, gray literature, and other sources. RESULTS: Although it is still too early to observe a positive change in physical activity levels among children and youth, an impact on raising awareness and capacity building in the national and international scientific community, disseminating information to the general population and stakeholders, and on powering the movement to get kids moving has been observed. CONCLUSIONS: It is hoped that the Report Card activities will initiate a measurable shift in the physical activity levels of children and contribute to achieving the 4 strategic objectives of the World Health Organization Global Action Plan as follows: creating an active society, creating active environments, creating active lives, and creating active systems.

Assessment of Physical Activity Indicators for Children and Youth in Ethiopia: Evidence from the Global Matrix 3.0 Study (2017-2018).

BACKGROUND: Regular physical activity is vital for children's health, well-being, and development. However, evidence is scant about physical activity indicators for children and youth in Ethiopia. This study aimed to assess physical activity indicators among children and youth in Ethiopia. METHODS: This study was conducted as part of the Active Healthy Kids Global Alliance's "Global Matrix 3.0" which included 49 countries. Data were collected from December 2017 to April 2018. The country research team included different disciplines related to physical activity. Data were retrieved from pre-reviewed literature, government policy documents, and an expert interview panel. Data were analyzed using the ten physical activity indicators for children and youth. The grading system was done through a harmonized process and the standard grading rubric of the Global Matrix 3.0 study ((A = ≥ 80%, B = 60%-79%, C = 40%-59%, D = 20%-39%, F = < 20%, INC = incomplete data). RESULTS: For the overall physical activity indicator, 28% of children and youth in Ethiopia met the recommended physical activity of 60 min per day which resulted in a "D" grade. Likewise, the school and government indicator received a "D" grade. Almost 32% of schools in Ethiopia had access to infrastructures and multipurpose spaces for physical activity including outdoor play. The government policy partially existed in the non-communicable diseases agenda but had less focus on children and youth. The active play indicator scored the highest grade of "B." About 71% of children and youth were involved in active play for at least 2 h a day before, during, and after school. About 50% of children and youth were engaging in organized sport participation, and this indicator was graded a "C." Similarly, 48% of children and youth walked to and from school as a means of active transportation resulting in a "C" for this indicator. Three indicators (sedentary behavior, family and peers, and community and environment) were graded as an "F." Approximately 8% of children and youth were living in communities and environments that did not support opportunities for physical activity. Only 13% of children and youth spent less than 2 h per day in sedentary screen time. There was no adequate information to grade the physical fitness indicator. CONCLUSION: This study showed that Ethiopian's children and youth have received low grades for majority of physical activity indicators. Therefore, urgent actions should be taken by the government, policymakers, researchers, and key stakeholders to address the suggested priority areas.

Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth: Results and Analysis From 49 Countries.

BACKGROUND: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5-17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. METHODS: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations' human development index (HDI) classification (low or medium, high, and very high HDI). RESULTS: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of "C-," "D+," and "C-" was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. CONCLUSIONS: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed.

Indicators of Physical Activity Among Children and Youth in 9 Countries With Low to Medium Human Development Indices: A Global Matrix 3.0 Paper.

BACKGROUND: This study compares results of physical activity report cards from 9 countries with low to medium human development indices, participating in the Global Matrix 3.0 initiative. METHODS: Country-specific report cards were informed by relevant data and government policy documents, reporting on 10 core indicators of physical activity for children and youth. Data were synthesized by report card working groups following a harmonized process. Grade assignments for each indicator utilized a standard grading rubric. Indicators were grouped into one of 2 categories: daily behaviors and settings and sources of influence. Descriptive statistics (average grades) were computed after letter grades were converted into interval variables. Spearman's rank correlation coefficients were calculated for all correlation analyses. RESULTS: Mean grades for daily behaviors were higher (C) than those for settings and sources of influence (D+). Twenty-nine out of the possible 90 grades were assigned an incomplete. There were moderate to strong positive and negative relationships between different global indices and overall physical activity, organized sport and physical activity, active play, family, community and environment, and government. CONCLUSIONS: Findings demonstrate an urgent need for high-quality data at the country level in order to better characterize the physical activity levels of children and youth in countries with low to medium human development indices.

Construct Validity of the Neighborhood Environment Walkability Scale for Africa.

PURPOSE: The development of valid measures of built environments relevant for physical activity is an important step toward controlling the global epidemic of physical inactivity-related noncommunicable diseases and deaths. This study assessed the construct validity of a self-report neighborhood environment walkability scale adapted for Africa (NEWS-Africa), by examining relationships with self-reported walking for transportation and recreation using pooled data from six sub-Saharan African countries. METHODS: NEWS was systematically adapted to assess urban, periurban, and rural environments in sub-Saharan Africa. Adults (n = 469, 18-85 yr, 49.7% women) from Cameroon, Ghana, Mozambique, Nigeria, South Africa, and Uganda were purposively recruited from neighborhoods varying in walkability and socioeconomic status, with some from villages. Participants completed the 76-item (13 subscales) NEWS-Africa by structured interview and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire. RESULTS: The overall "walkability" index had a positive relationship with both walking for transportation (η = 0.020, P = 0.005) and recreation (η = 0.013, P = 0.028) in the pooled analyses. The mixed-use access and stranger danger scales were positively related with transport walking (η = 0.020, P = 0.006 and η = 0.021, P = 0.040, respectively). Proximity of recreational facilities (η = 0.016, P = 0.015), road/path connectivity (η = 0.025, P = 0.002), path infrastructure (η = 0.021, P = 0.005), and overall places for walking and cycling (η = 0.012, P = 0.029) scales were positively related to recreational walking. Country-specific results were mostly nonsignificant except for South Africa and Uganda. CONCLUSIONS: Of 14 NEWS-Africa scales, 7 were significantly related to walking behavior in pooled analyses, providing partial support for the construct validity of NEWS-Africa. However, effect sizes appeared to be lower than those from other continents. Further study with larger and more diverse samples is needed to determine whether the instrument performs well in each country.

Results From Ghana's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: Currently, there is limited evidence on estimates for physical activity (PA) behavior and sedentary behavior (SB) in Ghana. This report card (RC) is intended to increase awareness and sensitivity about issues surrounding PA and SB in Ghana. METHODS: Data were collected from peer-reviewed literature, graduate students' theses, physical education and sports documents, and a survey of opinions of stakeholders covering the 10 key RC indicators and benchmarks. The principal investigator harmonized all grades. A consensus meeting of the RC team was held to assign the final grades. RESULTS: School and Community grades declined from a D in 2014 to an F in 2016. SB declined from B to D. Family and Active Play were not graded in 2014 and now received an F and a B, respectively. Family and Built Environment were graded F, Active Transportation received a C, and Government and Overall PA were graded D. CONCLUSIONS: A conscious national investment effort can increase overall PA among children.

NEWS for Africa: adaptation and reliability of a built environment questionnaire for physical activity in seven African countries.

BACKGROUND: Built environment and policy interventions are effective strategies for controlling the growing worldwide deaths from physical inactivity-related non-communicable diseases. To improve built environment research and develop African specific evidence, it is important to first tailor built environment measures to African contexts and assess their psychometric properties across African countries. This study reports on the adaptation and test-retest reliability of the Neighborhood Environment Walkability Scale in seven sub-Saharan African countries (NEWS-Africa). METHODS: The original NEWS comprising 8 subscales measuring reported physical and social attributes of neighborhood environments was systematically adapted for Africa through extensive input from physical activity and public health researchers, built environment professionals, and residents in seven African countries: Cameroon, Ghana, Kenya, Mozambique, Nigeria, South Africa and Uganda. Cognitive testing of NEWS-Africa was conducted among diverse residents (N = 109, 50 youth [12 - 17 years] and 59 adults [22 - 67 years], 69 % from low socioeconomic status [SES] neighborhoods). NEWS-Africa was translated into local languages and evaluated for 2-week test-retest reliability in adult participants (N = 301; female = 50.2 %; age = 32.3 ± 12.9 years) purposively recruited from neighborhoods varying in walkability (high and low walkable) and SES (high and low income) and from villages in six of seven participating countries. RESULTS: The original 67 NEWS items was expanded to 89 scores (76 individual NEWS items and 13 computed scales). Several modifications were made to individual items, and some new items were added to capture important attributes in the African environment. A new scale on personal safety was created, and the aesthetics scale was enlarged to reflect African specific characteristics. Over 95 % of all NEWS-Africa scores (items plus computed scales) demonstrated evidence of "excellent" (ICCs > .75 %) or "good" (ICCs = 0.60 to 0.74) reliability. Seven (53.8 %) of the 13 computed NEWS scales demonstrated "excellent" agreement and the other six had "good" agreement. No items or scales demonstrated "poor" reliability (ICCs < .40). CONCLUSIONS: The systematic adaptation and initial psychometric evaluation of NEWS-Africa indicates the instrument is feasible and reliable for use with adults of diverse demographic characteristics in Africa. The measure is likely to be useful for research, surveillance of built environment conditions for planning purposes, and to evaluate physical activity and policy interventions in Africa.

Physical activity of children: a global matrix of grades comparing 15 countries.

The Active Healthy Kids Canada (AHKC) Report Card on Physical Activity for Children and Youth has been effective in powering the movement to get kids moving by influencing priorities, policies, and practice in Canada. The AHKC Report Card process was replicated in 14 additional countries from 5 continents using 9 common indicators (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and Built Environment, and Government Strategies and Investments), a harmonized process and a standardized grading framework. The 15 Report Cards were presented at the Global Summit on the Physical Activity of Children in Toronto on May 20, 2014. The consolidated findings are summarized here in the form of a global matrix of grades. There is a large spread in grades across countries for most indicators. Countries that lead in certain indicators lag in others. Overall, the grades for indicators of physical activity (PA) around the world are low/poor. Many countries have insufficient information to assign a grade, particularly for the Active Play and Family and Peers indicators. Grades for Sedentary Behaviors are, in general, better in low income countries. The Community and Built Environment indicator received high grades in high income countries and notably lower grades in low income countries. There was a pattern of higher PA and lower sedentary behavior in countries reporting poorer infrastructure, and lower PA and higher sedentary behavior in countries reporting better infrastructure, which presents an interesting paradox. Many surveillance and research gaps and weaknesses were apparent. International cooperation and cross-fertilization is encouraged to tackle existing challenges, understand underlying mechanisms, derive innovative solutions, and overcome the expanding childhood inactivity crisis.

Results from Ghana's 2014 Report Card on Physical Activity for Children and Youth.

BACKGROUND: Limited evidence exists on indicators of physical activity (PA) and guidelines for children and youth in Ghana, despite the growing burden of physical inactivity, obesity, and related morbidity. A baseline description of PA indicators of Ghanaian children and youth is hereby presented in the 2014 Ghanaian Physical Activity Report Card. METHODS: Data for the report card were obtained from a very limited available literature on PA among children and youth in Ghana. PA experts independently assigned grades to indicators based on available evidence, which were then harmonized and agreed to by group consensus. RESULTS: The report card is based on limited evidence. Thus, 2 indicators were not graded (Active Play, and Family and Peer Support). For sedentary behavior, a B grade was assigned based on evidence from the 2012 Ghana School Health Survey which indicated that 21% of children and youth were sedentary. Organized Sports was graded a C, while the remainder of indicators (Overall PA levels, Active Transportation, School, Community, and Government) were graded a D. CONCLUSIONS: About one-third of Ghanaian children and youth engage in inadequate PA. More research on PA behavior and enabling environments is needed to better grade the indicators of PA in the future and to inform policy and interventions in Ghana. Appropriate school physical education and after-school sports policies and programs are warranted.