"We are not invited": Australian focus group results on how to improve ethnic diversity in trials.

OBJECTIVES: Lack of ethnic diversity in trials may contribute to health disparities and to inequity in health outcomes. The primary objective was to investigate the experiences and perspectives of ethnically diverse populations about how to improve ethnic diversity in trials. STUDY DESIGN AND SETTING: Qualitative data were collected via 16 focus groups with participants from 21 ethnically diverse communities in Australia. Data collection took place between August and September 2022 in community-based settings in six capital cities: Sydney, Melbourne, Perth, Adelaide, Brisbane, and Darwin, and one rural town: Bordertown (South Australia). RESULTS: One hundred and fifty-eight purposively sampled adults (aged 18-85, 49% women) participated in groups speaking Tamil, Greek, Punjabi, Italian, Mandarin, Cantonese, Karin, Vietnamese, Nepalese, and Arabic; or English-language groups (comprising Fijian, Filipino, African, and two multicultural groups). Only 10 participants had previously taken part in medical research including three in trials. There was support for medical research, including trials; however, most participants had never been invited to participate. To increase ethnic diversity in trial populations, participants recommended recruitment via partnering with communities, translating trial materials and making them culturally accessible using audiovisual ways, promoting retention by minimizing participant burden, establishing trust and rapport between participants and researchers, and sharing individual results. Participants were reluctant to join studies on taboo topics in their communities (eg, sexual health) or in which physical specimens (eg, blood) were needed. Participants said these barriers could be mitigated by communicating about the topic in more culturally cognizant and safe ways, explaining how data would be securely stored, and reinforcing the benefit of medical research to humanity. CONCLUSION: Participants recognized the principal benefits of trials and other medical research, were prepared to take part, and offered suggestions on recruitment, consent, data collection mechanisms, and retention to enable this to occur. Researchers should consider these community insights when designing and conducting trials; and government, regulators, funders, and publishers should allow for greater innovation and flexibility in their processes to enable ethnic diversity in trials to improve.

Exploring the impact of agricultural digitalization on smallholder farmers' livelihoods in Ghana.

With the government's pursuit of a digitalization agenda, Ghana is at the forefront of championing digital transformation in Africa. However, people in rural areas are being left behind in harnessing the immense benefits of digitalization for their livelihoods. This study contributes to policy efforts aimed at bridging that gap by investigating the drivers of agricultural digitalization (AD) as well as its effects on the livelihoods of smallholder farmers in rural Ghana. Data from a cross-sectional survey of 525 rural farmers across northern, middle and southern Ghana was employed. The study used the probit and tobit estimators to analyze the drivers and intensity of adoption of digital technologies in agriculture and the inverse probability weighting and regression adjustment estimator to mitigate endogeneity concerns. The results show that while female farmers trail male farmers in the intensity of applying digital technologies, higher educational attainment, better perception of digitalization, group/cooperative membership, number of economically active household members, and access to reliable electricity, internet and mobile money services significantly promote the use of digital technologies in agricultural activities. The results further show that AD is significantly associated with perceived improvements in livelihood assets, and ultimately livelihood outcomes of smallholder farmers in rural Ghana. These findings highlight the importance of investing in rural digital infrastructure by policymakers, the private sector and other stakeholders, so as to expand access to and the uptake of digital technologies in agriculture to bolster rural development in Ghana.

Motivations for investigating health inequities in observational epidemiology: a content analysis of 320 studies.

OBJECTIVES: To enhance equity in clinical and epidemiological research, it is crucial to understand researcher motivations for conducting equity-relevant studies. Therefore, we evaluated author motivations in a randomly selected sample of equity-relevant observational studies published during the COVID-19 pandemic. STUDY DESIGN AND SETTING: We searched MEDLINE for studies from 2020 to 2022, resulting in 16,828 references. We randomly selected 320 studies purposefully sampled across income setting (high vs low-middle-income), COVID-19 topic (vs non-COVID-19), and focus on populations experiencing inequities. Of those, 206 explicitly mentioned motivations which we analyzed thematically. We used discourse analysis to investigate the reasons behind emerging motivations. RESULTS: We identified the following motivations: (1) examining health disparities, (2) tackling social determinants to improve access, and (3) addressing knowledge gaps in health equity. Discourse analysis showed motivations stem from commitments to social justice and recognizing the importance of highlighting it in research. Other discourses included aspiring to improve health-care efficiency, wanting to understand cause-effect relationships, and seeking to contribute to an equitable evidence base. CONCLUSION: Understanding researchers' motivations for assessing health equity can aid in developing guidance that tailors to their needs. We will consider these motivations in developing and sharing equity guidance to better meet researchers' needs.

Predictors of Anaemia Prevalence Among Ghanaian Pregnant Women: A Cross-Sectional Study.

Anaemia during pregnancy is a major public health concern. Despite its wide scope and adverse effects including increased maternal and perinatal morbidity and mortality, and long-term adverse effects on the newborn, appropriate interventions using upstream approaches to public health have largely not been implemented. This study investigated the prevalence and associated factors of anaemia among pregnant women in four health facilities in the Kwabre East Municipality. A cross-sectional survey with a two-stage sampling technique was conducted on 220 pregnant women who attended antenatal care at the selected health facilities. Interview-based structured questionnaires were used. Bivariate and multivariate logistic regression were used to identify predictors. The prevalence of anaemia was 11.4%. Few women (25) were anaemic and morphologically, 14 (56%) had normocytic normochromic anaemia and 9 (36%) had microcytic hypochromic anaemia. Iron deficiency was reported in 19 (8.6%) pregnant women. Independent predictors of anaemia were iron sulphate intake (AOR [95% CI] = 3.16 [1.15, 7.37], ANC follow-up during pregnancy (AOR [95% CI] = 3.07 [1.59, 7.99], household size of ≥5 (AOR [95% CI] = 3.58 [1.75, 9.52], folic acid intake (AOR [95% CI] = 5.29 [2.65, 12.39] and the period in pregnancy AOR [95% CI] = ≥36 weeks 3.2 (1.3-4.5). Though anaemia prevalence has been low in urban areas as previously reported, collaborated healthcare measures that aim at eradicating the menace are encouraged. Maternal healthcare interventions including the administration of folic acid, regular iron sulphate intake and intensive education on early ANC are recommended.

A multidimensional study of public satisfaction with the healthcare system: a mixed-method inquiry in Ghana.

BACKGROUND: Many governments in sub-Saharan Africa have recently sought to improve their health systems by increasing investment in healthcare facilities and introducing social insurance programmes. However, little is known about the impact of these intended improvements on public perceptions about the healthcare systems. This article examines whether and why people of different socioeconomic and ideological backgrounds are satisfied (or not) with the current healthcare system in Ghana from a social ecological perspective. METHOD: Data were elicited from a cross-sectional mixed-method study conducted in four regions in Ghana in 2018. We used ordinal logistic regression and thematic analysis techniques to analyse the data. RESULTS: Satisfaction with the healthcare system was generally low. From our quantitative study, intrapersonal factors (e.g., being older and having good health and well-being status); interpersonal factors (e.g., linking social capital); community factors (e.g., living in rural areas); and organisational and public policy factors (e.g., trust in the health system, favouring welfare policies, and being interested in politics) were positively associated with satisfaction with the healthcare system. These were corroborated by the qualitative study, which showed that poor attitudes of health personnel, financial constraints, perceived poor health facilities, and perceived inefficacy of services contribute to dissatisfaction with the healthcare system. CONCLUSION: Strategies to improve satisfaction with the healthcare system in Ghana should incorporate ecological perspectives by considering factors such as demographic profile, health needs, political orientation, issues of trust in the healthcare system, and the dynamics and impact of social relationships of populations concerned.

Association of dietary intake, physical activity, and sedentary behaviours with overweight and obesity among 282,213 adolescents in 89 low and middle income to high-income countries.

BACKGROUND: Adolescent overweight and obesity are well documented in high-income countries (HICs). They are also emerging as a global public health concern in low-and middle-income countries (LMICs), yet there is a lack of reliable, national-level data to inform policies and interventions. This study aimed to estimate the prevalence of overweight and obesity and assess associated lifestyle risk factors amongst school-going adolescents in LMICs as well as HICs. METHODS: A total of 282,213 samples were drawn from 89 LMICs and HICs in the 'latest Global School-based Student Health Survey' of school children, aged 11-17 years, during 2003 to 2015, in the six World Health Organisation (WHO) regions. The prevalence of adolescent overweight and obesity were estimated using the WHO BMI-for-age growth standards. A multinomial logistic regression model was employed to estimate the adjusted (age and sex) association of food patterns, physical activity, and sedentary behaviours with adolescent overweight and obesity. RESULTS: The pooled prevalence of overweight and obesity amongst adolescents was 10.12%, and 4.96%, respectively, ranging from 2.40% in Sri Lanka to 29.08% in Niue for overweight and 0.40% in Sri Lanka to 34.66% in the Cook Islands for obesity. Overweight and obesity were associated with unhealthy dietary intake and lifestyles including respectively fast-food intake (adjusted relative risk ratio, RRR = 1.09; 95% CI: 1.05-1.12 and RRR = 1.32; 95% CI: 1.26-1.38), a high level of carbonated soft drinks consumption (RRR = 1.19; 1.12-1.24 and RRR = 1.28; 1.18-1.38), a low level of physical activity (RRR = 1.11; 1.06-1.17 and 1.20; 1.12-1.28), and high level of sedentary behaviours (RRR = 1.33; 1.27-1.39 and RRR = 1.73; 1.63-1.84). Adolescents who consumed vegetables at least two times per day had a lower risk of overweight (22%) and obesity (17%) than those who did not consume vegetables per day. CONCLUSIONS: Adolescent overweight and obesity represent a global public health problem and can possibly track into adult weight status and morbidity. School-based obesity prevention that promotes environmental and policy changes related to healthy dietary practices and active living are urgently needed to curb the trend.

Lifestyle interventions for type 2 diabetes management among migrants and ethnic minorities living in industrialized countries: a systematic review and meta-analyses.

The objective of this systematic review was to determine the effectiveness of lifestyle interventions to improve the management of type 2 diabetes mellitus (T2DM) among migrants and ethnic minorities. Major searched databases included MEDLINE (via PubMed), EMBASE (via Ovid) and CINAHL. The selection of studies and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the meta-analysis, significant heterogeneity was detected among the studies (I2 >50%), and hence a random effects model was used. Subgroup analyses were performed to compare the effect of lifestyle interventions according to intervention approaches (peer-led vs community health workers (CHWs)-led). A total of 17 studies were included in this review which used interventions delivered by CHWs or peer supporters or combination of both. The majority of the studies assessed effectiveness of key primary (hemoglobin (HbA1c), lipids, fasting plasma glucose) and secondary outcomes (weight, body mass index, blood pressure, physical activity, alcohol consumption, tobacco smoking, food habits and healthcare utilization). Meta-analyses showed lifestyle interventions were associated with a small but statistically significant reduction in HbA1c level (-0.18%; 95% CI -0.32% to -0.04%, p=0.031). In subgroup analyses, the peer-led interventions showed relatively better HbA1c improvement than CHW-led interventions, but the difference was not statistically significant (p=0.379). Seven studies presented intervention costs, which ranged from US$131 to US$461 per participant per year. We conclude that lifestyle interventions using either CHWs or peer supporters or a combination of both have shown modest effectiveness for T2DM management among migrants of different background and origin and ethnic minorities. The evidence base is promising in terms of developing culturally appropriate, clinically sound and cost-effective intervention approaches to respond to the growing and diverse migrants and ethnic minorities affected by diabetes worldwide.

Effective implementation approaches for healthy ageing interventions for older people: A rapid review.

BACKGROUND AND OBJECTIVES: Systematic reviews on healthy ageing interventions have primarily focused on assessing their effectiveness, not the implementation processes underpinning them, and the factors influencing program effectiveness. This has created a knowledge gap about what are effective implementation approaches, and how to scale up such interventions at the population level. Our aim in this rapid review was to synthesise the evidence on implementation of effective healthy ageing interventions, and to identify the factors that influence population-level implementation of these interventions. DESIGN AND METHODS: Following the PRISMA checklist, we searched for papers in six databases: Ovid Medline, Ovid Embase, CENTRAL, CINAHL, PsycArticles and PsycINFO. A narrative synthesis was used to summarise the results. RESULTS: Twenty-nine articles reporting on 21 healthy ageing interventions (studies) were included in the review. The findings show that a wide range of approaches to implementation were used including collaborative partnership, co-design, use of volunteers, person centred-care, and self-directed/professional-led approaches. The key implementation drivers were the use of behavioural change techniques, social interaction, tailoring of interventions, booster sessions, and multi-component and multi-professional team approach to intervention design and delivery. CONCLUSION: The effectiveness of healthy ageing interventions is contingent on a number of factors including the type of implementation approaches used, the context in which programs are implemented, and the specific mechanisms that may be at play at the individual older adult level.

An exploratory study of the acceptability of indoor residual spraying for malaria control in upper western Ghana.

BACKGROUND: Despite the implementation of the World Health Organisation's recommended indoor residual spraying (IRS) intervention in the upper west region of Ghana to reduce malaria morbidity and mortality, the uptake of this intervention remains low. This study explores the facilitators and barriers to the acceptability and community uptake of indoor residual spraying in a highly endemic region of Ghana. METHODS: The health belief model (HBM) and realist evaluation framework were used to inform the study. A qualitative enquiry was conducted between April to October 2016. Data were collected through focus group discussions and semi-structured interviews with program stakeholders including community members, AngloGold Ashanti malaria control (AGA Mal) spray operators, and AGA Mal officials. RESULTS: A total of 101 people participated in the study. Considerable barriers to community acceptance of indoor residual spraying (IRS) were found, including, dislike of spray insecticides, inadequate information, religious and cultural beliefs, perceived low efficacy of IRS, difficulties with packing, unprofessional conduct of IRS spray operators, and other operational barriers to spraying. Facilitators of IRS uptake included a perceived effectiveness of IRS in preventing malaria and reducing mosquito bites, incidental benefits, respect for authority, training and capacity building, and sensitization activities. CONCLUSION: The numerous barriers to indoor residual spraying acceptance and implications show that acceptance levels could be improved. However, measures are required to address householders' concerns and streamline operational barriers to increase community uptake of indoor residual spraying.

Physical activity participation and the risk of chronic diseases among South Asian adults: a systematic review and meta-analysis.

South Asia specific reviews on the role of physical activity (PA) domains on chronic disease prevention are lacking. This study aimed to systematically review published literature to identify the association between PA domains and chronic diseases and to provide summary estimates of the strength of association. Nine electronic databases were searched using the predefined inclusion criteria which included population (South Asian adults 40 years or older), exposure (PA or sedentary behaviour) and outcome (type 2 diabetes mellitus, breast cancer, colorectal cancer, coronary heart disease, stroke, vascular disease and musculoskeletal diseases and their markers). A random-effects meta-analysis was carried out for cardiometabolic outcomes whereas narrative synthesis was completed for other outcome variables. Inactive or less active South Asian adults were at 31% higher risk of being hypertensive. Likewise, the risk of cardiometabolic outcomes was 1.34 times higher among inactive adults. Household PA was found to have a protective effect  on breast cancer risk. Total and leisure time PA had a protective effect on osteoporosis among males and females respectively. Contemporary studies with a longitudinal design, representative samples, valid and reliable assessment of different domains are needed to establish the role of PA in chronic disease prevention in the region.

Cash transfers and the social determinants of health: a conceptual framework.

Cash transfers (CTs) can play a significant role in tackling the social determinants of health (SDoH), but to date there is a lack of conceptual framework for understanding CTs linkages to the SDoH. This article proposes a framework that identifies the linkages between CTs and SDoH, discusses its implications, and argues for active involvement of health promoters in CT design, implementation and evaluation. The development of the framework followed two stages: evidence review and stakeholder involvement. The evidence review entailed a systematic literature search to identify published and unpublished impact evaluation studies of CTs in sub-Saharan Africa. Critical reflection on the evidence synthesized from the literature formed the basis for the development of the framework. Interviews with CT policy makers, managers and development partners were also carried out to help refine the framework. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. The study finds that there is limited recognition of SDoH in CT policy making and implementation. The evidence reviewed, however, points to strong impacts of CTs on SDoH. The framework thus conceptualizes how CTs work to influence a broad range of SDoH and health inequities. It also highlights how CT architecture and contexts may influence program impacts. The proposed framework can be used by policy makers to guide CT design, adaptation and operations, and by program managers and researchers to inform CTs' evaluations, respectively. The framework suggests that to optimize CT impact on SDoH and reduce health inequities, health promoters should be actively engaged in terms of the programs design, implementation and evaluation.

Physical activity participation and the risk of chronic diseases among South Asian adults: protocol for a systematic review and meta-analysis.

BACKGROUND: Chronic diseases contribute to about half of the adult disease burden in the South Asian region. Meanwhile, physical activity levels are declining despite the global evidence of its role in the prevention of chronic diseases. While there are a plethora of systematic reviews on the effects of physical activity on chronic diseases, there has not yet been a synthesis of the evidence concerning the nature of this relationship among people living in South Asian countries incorporating multiple chronic diseases and a focus on physical activity domains. The aim of this protocol is to describe the rationale and methods for a systematic review of published research to identify the association between physical activity and selected chronic diseases and their markers and analysis of the strength of association with a focus on physical activity domains among South Asian adults 40 years and older. METHODS: Nine electronic databases including Medline, PsycINFO, Embase, CENTRAL, CINAHL Plus, AgeLine, SPORTDiscus, Scopus and Web of Science will be systematically searched for papers reporting the association between physical activity and selected chronic diseases (type 2 diabetes mellitus, breast cancer, colorectal cancer, coronary heart disease, stroke, vascular diseases and musculoskeletal diseases (osteoarthritis, osteoporosis, back and neck pain)) and their markers using predefined search terms. Searches will be limited to peer-reviewed, English language papers with a quantitative design. In addition, a manual search of references of relevant systematic reviews as well as citations and references of eligible studies will also be carried out. The methodological appraisal will be performed using the National Institutes of Health quality assessment checklist for observational studies and the Effective Public Health Practice Project quality assessment tool for intervention studies. The overall quality of evidence for the study outcomes across the study designs will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The review results will be presented in the form of narrative synthesis, and a random effects meta-analysis is planned depending on the nature of included studies and available data. DISCUSSION: This review will summarise the strength of the association between physical activity and selected chronic diseases and their markers among South Asian adults 40 years or older. The findings will provide an evidence base to guide public health policy and interventions in the South Asian region and to inform future research to address the rising burden of chronic diseases. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018096505.

Ghanaian media coverage of violence against women and girls: implications for health promotion.

BACKGROUND: Violence against women and girls (VAWG) is an important public health issue. Framing studies indicate that how the news media cover public health issues is critical for designing effective health promotion interventions. Notwithstanding this, there is little research particularly in low-and middle-income country context examining how the news media frame VAWG. This paper examines news coverage of VAWG in Ghana, and the implications of this for health promotion. METHODS: This study used frame analysis as the methodological framework in examining how VAWG in Ghana is represented by the media. Qualitative content analysis approach to frame analysis was performed on 48 news articles which constituted the unit of analysis. RESULTS: The findings indicate that media framing of VAWG was episodic in nature as the acts of violence perpetrated against women and girls were presented as individual cases without reference to the wider social contexts within which they occurred. Similarly, victim blaming language was largely used in the news articles. In framing VAWG as an individual incident and women as helpless victims, the media fail to shape society's perception of VAWG as a social and public health issue. CONCLUSIONS: For the media in Ghana to contribute to the prevention of VAWG, there is the need for news coverage to focus on social construction of the issue, and also raise awareness about support services available to victims.

The impact of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa: a systematic review.

Cash transfers (CTs) are now high on the agenda of most governments in low- and middle-income countries. Within the field of health promotion, CTs constitute a healthy public policy initiative as they have the potential to address the social determinants of health (SDoH) and health inequalities. A systematic review was conducted to synthesise the evidence on CTs' impacts on SDoH and health inequalities in sub-Saharan Africa, and to identify the barriers and facilitators of effective CTs. Twenty-one electronic databases and the websites of 14 key organizations were searched in addition to grey literature and hand searching of selected journals for quantitative and qualitative studies on CTs' impacts on SDoH and health outcomes. Out of 182 full texts screened for eligibility, 79 reports that reported findings from 53 studies were included in the final review. The studies were undertaken within 24 CTs comprising 11 unconditional CTs (UCTs), 8 conditional CTs (CCTs) and 5 combined UCTs and CCTs. The review found that CTs can be effective in tackling structural determinants of health such as financial poverty, education, household resilience, child labour, social capital and social cohesion, civic participation, and birth registration. The review further found that CTs modify intermediate determinants such as nutrition, dietary diversity, child deprivation, sexual risk behaviours, teen pregnancy and early marriage. In conjunction with their influence on SDoH, there is moderate evidence from the review that CTs impact on health and quality of life outcomes. The review also found many factors relating to intervention design features, macro-economic stability, household dynamics and community acceptance of programs that could influence the effectiveness of CTs. The external validity of the review findings is strong as the findings are largely consistent with those from Latin America. The findings thus provide useful insights to policy makers and managers and can be used to optimise CTs to reduce health inequalities.

Evaluation of cash transfer programs in sub-Saharan Africa: A methodological review.

Cash transfer programs (CTs) have been rigorously evaluated since their inception in the 1990s. However, to date, there has been no study critically examining the utility of the methodological approaches used to evaluate CTs. This article reviews the approaches used to evaluate CTs in sub-Saharan Africa (SSA) to provide recommendations for improving future CTs evaluations. We conducted searches for CTs evaluation studies in SSA in the peer-reviewed and grey literature using electronic databases, hand searching of selected journals, organisational websites, Google Scholar and Scirus Internet search engines. The review included 53 evaluation studies which were largely outcome-focused evaluations (95%; n = 50). The studies were undertaken within 24 CT programs comprising 11 unconditional CTs (UCTs), eight conditional CTs (CCTs) and five combined UCTs and CCTs. The review finds that while there is evidence of CTs impacts on a broad range of outcomes, the current evaluation approaches have primarily been experimental designs and have largely failed to provide explanations for mechanisms of change. To improve CTs policy and practice, there is the need to consider theory-based evaluation approaches such as realist evaluation that provide insights about the contexts and mechanisms through which programs generate outcomes in different circumstances.

Health information-seeking behaviours among pregnant teenagers in Ejisu-Juaben Municipality, Ghana.

OBJECTIVE: to examine health information-seeking behaviours among pregnant teenagers. DESIGN: qualitative design using semi-structured interviews and focus groups. The study followed the Consolidated Criteria for Reporting Qualitative Studies (COREQ). SETTINGS/PARTICIPANTS: antenatal clinic at Ejisu Government hospital, Ghana. Twenty eight pregnant teenagers aged 15-19 and one midwife participated in the study. METHOD: the participants were interviewed in person at the antenatal clinic. The individual interviews and focus groups were digitally recorded, transcribed, and then analysed using thematic framework analysis. FINDINGS: three themes emerged from the analysis of the transcripts: information needs, sources of information and barriers to information seeking. Findings indicate unmet information needs among pregnant teenagers including proper understanding of pregnancy stages, infant feeding practices, nutrition, labour and birth and postnatal care. Pregnant teenagers largely relied on traditional sources for information on pregnancy as compared to official sources such as midwives, nurses or doctors. CONCLUSION/IMPLICATIONS FOR PRACTICE: given that traditional sources, such as family and neighbours were the predominant sources of information, to effectively and comprehensively address the information needs of pregnant teenagers, interventions should target both the expecting teenagers and the family and/or the community at large. The findings further point to a need for a shift in maternal health care policy through the establishment of adolescent only antenatal care day to effectively meet the heath information needs of pregnant teenagers.

The impact of cash transfers on social determinants of health and health inequalities in Sub-Saharan Africa: a systematic review protocol.

BACKGROUND: There is increasing pressure to address the social determinants of health (SDoH) and health inequities through the implementation of culturally acceptable interventions particularly in Sub-Saharan Africa (SSA) where health outcomes are generally poor. Available evaluation research on cash transfers (CTs) suggests that the programs may influence the wider determinants of health in SSA; yet, there has been no attempt to synthesize the evidence regarding their contribution to tackling the SDoH and health inequalities. To date, nearly all the reviews on CTs' impact on health have predominantly featured evidence from Latin America with limited transferability to the social, cultural, and political environments in SSA. Therefore, the aim of this study is to undertake a systematic review to assess the role of CTs in tackling the wider determinants of health and health inequalities in SSA. METHODS/DESIGN: A systematic review of published and unpublished literature on CTs' impact on health and health determinants covering the period 2000-2016 will be undertaken. Studies will be considered for inclusion if they present quantitative or qualitative data, including all relevant study designs. The SDoH conceptual framework will be used to guide the data extraction process. EPPI Reviewer software will be used for data management and analysis. Studies included in the review will be analyzed by narrative synthesis and/or meta-analysis as appropriate for the nature of the data retrieved. DISCUSSION: This review will provide empirical evidence on the impact of CTs on SDoH to inform CT policy, implementation, and research in SSA. The protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). SYSTEMATIC REVIEW REGISTRATION: This protocol has been registered with the PROSPERO international prospective register of systematic reviews, reference CRD42015025015 .

Perceived impact of Ghana's conditional cash transfer on child health.

A plethora of studies from sub-Saharan Africa indicate that orphaned and vulnerable children are exposed to adverse health, education and other social outcomes. Across diverse settings, conditional cash transfer (CCT) programmes have been successful in improving health outcomes amongst vulnerable children. This study explored the pathways of CCTs' impact on the health of orphans and vulnerable children in rural Ghana. Due to the multi-dimensional nature of CCTs, the programme impact theory was used to conceptualize CCTs' pathways of impact on child health. A qualitative descriptive exploratory approach was used for this study. This study drew on the perspectives of 18 caregivers, 4 community leaders and 3 programme implementers from two rural districts in Ghana. Semi-structured individual interviews were conducted with the participants. Thematic content analysis was conducted on the interview transcripts to pull together core themes running through the entire data set. Five organizing themes emerged from the interview transcripts: improved child nutrition, health service utilization, poverty reduction and social transformation, improved education and improved emotional health and well-being demonstrating the pathways through which CCTs work to improve child health. The results indicated that CCTs offer a valuable social protection instrument for improving the health of orphans and vulnerable children by addressing the social determinants of child health such as nutrition, access to health care, child poverty and education.

Midwives' perceptions and experiences of health promotion practice in Ghana.

INTRODUCTION: This research explores midwives' perceptions and experiences of health promotion practice in Ghana. METHODS: A qualitative descriptive exploratory design was used in order to gain better insight into midwives' perceptions and experiences of health promotion practice. A total of 21 midwives took part in the study. Data were collected by individual in-depth semi-structured interviews. Thematic analysis was used to analyse the transcript. RESULTS: Five dominant themes emerged from the interview transcripts, namely: health promotion as education, health promotion activities, the value of health promotion, client participation, and midwives' barriers to promoting health. Although midwives underscored the importance of health promotion to their work, their reports indicated that, in practice, midwives mostly delivered health education and behaviour change communication rather than health promotion. The midwives expressed the view that by way of their close association with women, they were in a better position to influence women's health. Health promotion activities engaged by the midwives included weight management, healthy eating, infection prevention, personal hygiene, counselling on family planning, and screening for hazardous and harmful substance use such as alcohol and smoking. All the midwives mentioned that clients participated in their health promotion activities. Factors that were identified by the midwives to enhance client participation were trust, attitude of the midwife, building rapport, creating enabling environment, listening and paying attention to clients and using simple language. The barriers to health promotion identified by the midwives included time, stress, culture, lack of training and inadequate health educational materials. DISCUSSION: Midwives in this study had limited knowledge about health promotion, yet could play a significant role in influencing health; thus there is a need for on-going in-service training for midwives to focus on health promotion.

The impact of conditional cash transfers on child health in low- and middle-income countries: a systematic review.

OBJECTIVES: The review aimed to assess the effectiveness of conditional cash transfers (CCTs) in improving child health in low- and middle-income countries. METHODS: Seven electronic databases were searched for papers: MEDLINE, EMBASE, PubMed, PsychINFO, BIOSIS Previews, Academic Search Complete, and CSA Sociological Abstracts. The included studies comprised of randomised controlled trials and controlled before-and-after studies evaluating the impact of CCTs on child health. Due to the substantial heterogeneity of the studies, a narrative synthesis was conducted on the extracted data. RESULTS: Sixteen studies predominantly from Latin American countries met the inclusion criteria. The outcomes reported by the studies in relation to CCTs' effectiveness in improving child health were reduction in morbidity risk, improvement in nutritional outcomes, health services utilisation, and immunisation coverage. CONCLUSIONS: The review suggests that to a large extent, CCTs are effective in improving child health by addressing child health determinants such as access to health care, child and maternal nutrition, morbidity risk, immunisation coverage, and household poverty in developing countries particularly middle-income countries. Of importance to both policy and practice, it appears that CCTs require effective functioning of health care systems to effectively promote child health.