On mapping urban community resilience: Land use vulnerability, coping and adaptive strategies in Ghana.

Cities across the globe are prioritizing resilience in the wake of increasing climate change-related disasters. About 44% of these disasters are floods and their manifestation in cities is more pronounced, threatening urban social, ecological, and economic systems. This study draws on community resilience and participatory GIS, to examine land use vulnerability to flooding and local coping and adaptive strategies to achieve resilience. Using Ghana as a case study, the results show that participatory mapping offers community resilience benefits by providing context to community resilience challenges and potentials, enabling a deeper understanding of socio-environmental coupling that contributes to flood vulnerability and builds on community adaptive strategies through harnessing local community knowledge. We identified that topography, poor drainage and road network, rainfall variability, residents' land use practices, and land use planning conundrum drive disparities in land use vulnerability to flooding. Participants underscored the necessity of critical urban infrastructure in facilitating community adaptability to floods. The findings indicate that socio-spatial inequities threaten urban community resilience, especially in increasingly cosmopolitan urban contexts, by putting the marginalized urban population in a more vulnerable position. We recommend the prioritization of recognitional equity in community resilience planning efforts to allow for the targeting of resilient interventions that reflect and respect social differentiation in the urban environment so that outcomes will not exacerbate or generate new urban socio-spatial inequalities.

Do self-rated health and previous vaccine uptake influence the willingness to accept MPOX vaccine during a public health emergency of concern? A cross-sectional study.

Monkeypox (MPOX) was declared a global public health emergency of international concern in July 2022. Vaccinations may be an essential strategy to prevent MPOX infections and reduce their impact on populations, especially among at-risk populations. However, less is known about the factors associated with people's willingness to accept the MPOX vaccine in resource-constrained settings. In this study, we examine the associations between self-rated health, previous vaccine uptake, and people's willingness to accept the MPOX vaccine using cross-sectional data from four major cities in Ghana. The data were analyzed using descriptive and logistic regression techniques. We found that the acceptance of the MPOX vaccine is generally low (approximately 32%) in Ghana. The regression analysis reveals that individuals who did not receive vaccines in the past are much less likely to get the MPOX vaccine (AOR:.28; 95% CI:.62-2.37). The association between self-rated health and vaccine acceptance (AOR: 1.22; 95% CI:.62-2.37) disappeared after we accounted for covariates. Based on these findings, we conclude that vaccine uptake history may be critical to people's uptake of the MPOX vaccine.

Exposure to mass media chronic health campaign messages and the uptake of non-communicable disease screening in Ghana.

The main goal of this study was to examine the relationship between exposure to mass media health campaign massages and the uptake of non-communicable diseases (NCDs) screening services in Ghana and whether this relationship differs by place of residence. Available evidence suggests a general low uptake of NCDs screening in developing country settings. Unfortunately, many NCDs evolve very slowly and are consequently difficult to detect early especially in situations where people do not screen regularly and in settings where awareness is low. In this study, we contribute to understanding the potential role of the media in scaling up NCDs screening in developing countries. We fitted multivariate logistic regression models to a sample of 1337 individual surveys which were collected at the neighborhood level in three Ghanaian cities. Overall, the results show that exposure to mass media chronic NCD health campaign messages was significantly associated with increased likelihood of screening for NCDs. The results further highlight neighborhood-level disparities in the uptake of NCDs screening services as residents of low-income and deprived neighborhoods were significantly less likely to report being screened for NCDs. Other factors including social capital, knowledge about the causes of NCDs and self-rated health predicted the likelihood of chronic NCDs screening. The results demonstrate mass media can be an important tool for scaling up NCDs screening services in Ghana and similar contexts where awareness might be low. However, place-based disparities need to be addressed.

"The Critical Services Are Out of Reach": Diabetes Management and the Experiences of South Asian Immigrants in Ontario.

Type 2 diabetes is a serious chronic condition affecting millions of people worldwide. South Asians (individuals originating from Pakistan, India, Bangladesh, Sri Lanka, and Nepal) represent a high-risk ethnicity for developing type 2 diabetes (T2D) and experience a high prevalence of the disease, even in migrant populations. The objective of this study was to investigate perceptions and experiences of South Asians living with T2D in Ontario, and their utilization of diabetes related services within the provincial healthcare system. Data were obtained from 20 in-depth interviews with South Asian participants diagnosed with T2D and living in the Greater Toronto Area. Our findings indicate a dissatisfaction with Ontario's coverage for diabetes services; varying uptake of recommended health tests, exams, and monitoring equipment; low utilization of additional resources (diabetes centers); and a need for primary care physicians to better facilitate awareness and utilization of available coverages and resources in the community. This study provides support for the fact that even in Canada's universal healthcare system, disparities exist, particularly for ethnic minorities, and that a universal prescription drug coverage component is a crucial step forward to ensure equitable access to health services utilization for all.

Determinants of COVID-19 knowledge and self-action among African women: Evidence from Burkina Faso, the Democratic Republic of Congo, Kenya, and Nigeria.

Knowledge of infectious diseases and self-action are vital to disease control and prevention. Yet, little is known about the factors associated with knowledge of and self-action to prevent the coronavirus disease (COVID-19). This study accomplishes two objectives. Firstly, we examine the determinants of COVID-19 knowledge and preventive knowledge among women in four sub-Saharan African countries (Kenya, Nigeria, the Democratic Republic of Congo, and Burkina Faso). Secondly, we explore the factors associated with self-action to prevent COVID-19 infections among these women. Data for the study are from the Performance for Monitoring Action COVID-19 Survey, conducted in June and July 2020 among women aged 15-49. Data were analysed using linear regression technique. The study found high COVID-19 knowledge, preventive knowledge, and self-action among women in these four countries. Additionally, we found that age, marital status, education, location, level of COVID-19 information, knowledge of COVID-19 call centre, receipt of COVID-19 information from authorities, trust in authorities, and trust in social media influence COVID-19 knowledge, preventive knowledge, and self-action. We discuss the policy implications of our findings.

Epidemiologic transition and the double burden of disease in Ghana: What do we know at the neighborhood level?

Many developing countries including Ghana are currently experiencing dual disease burdens emerging from an unprecedented risk overlap that drive their epidemiological transitions. Yet, siloed and disintegrated approaches continue to take precedence in health research and policy programs that drive competition for limited resources to address competing health problems. The objective of this study was to offer empirical evidence in support of a cogent argument for an integrated framework for the study and management of infectious and chronic health conditions in Ghana. We did so by examining the prevalence, determinants, and neighborhoods trajectories of the double burden of disease using data from a cross-sectional neighborhood-based study in Ghana. We fitted multinomial multilevel multivariate models to a sample of 1377 individual surveys and the results presented as odds ratios. Findings show that amidst a rising burden of NCDs, infectious diseases remain the most common health condition and participants in deprived neighborhoods were significantly more likely to report poor health outcomes. Risk factors such as tobacco and alcohol consumption were significantly associated with NCDs and infectious diseases and respondents who reported being diagnosed with NCDs and infectious diseases in the past year were likely to engage in leisure time physical activities and eat healthy. Based on our findings, we recommend health reforms in Ghana and argue for the design and implementation of an integrated framework for the study and management of the double burden of disease in Ghana and similar developing country settings.

Understanding perceptions of neighborhood health and non-communicable disease risk in urban contexts in Ghana.

Global health surveillance reports show Africa's epidemiologic transition from one dominated by higher burdens of nutritional, maternal, and communicable diseases to one increasingly dominated by non-communicable diseases (NCDs). Debates on the increasing cases of NCDs in the African context have focused on individualistic risk factors to the neglect of other similar important determinants such as the living environment. Drawing on theoretical tenets of the protection motivation theory and using cross-sectional data, we examined neighborhood risk perceptions and self-rated risk of developing NCDs in Ghana. The dependent variable 'self-rated risk of developing NCDs' was measured as a binary outcome and the focal independent variable - perceived neighborhood health risk - as an index. We fitted multivariate multilevel regression models to a sample of 1376 individuals across 9 neighborhoods. Results show that respondents who perceived their neighborhoods as risky were more likely to rate their risk of developing NCDs high. A unit increase in neighborhood violence was associated with 8% likelihood of self-rated risk of developing NCDs. However, a unit increase in the aesthetic quality of respondent's neighborhood was associated with lower likelihood of self-rated risk of developing NCDs. Engaging in regular physical activity, and non-tobacco use were associated with a lower likelihood of perceived NCDs risk. We suggest policy agendas intended for reducing the burden of NCDs in Ghana and other LMICs could incorporate programs that target improving environmental characteristics to minimize risks and offer people the opportunity to make healthy choices.

Immigrants Serving in Local Government: A Systematic Review and Meta-Analysis of Factors Affecting Candidacy and Election.

Descriptive representation, the extent to which politicians reflect the descriptive characteristics (e.g., ethnicity or gender) of their constituents, has been studied at various scales since it was first introduced in Hanna Pitkin's seminal work several decades ago. In recent years, scholars have also begun to investigate immigrant representation in politics, including at the local, state, and national levels of government. This study evaluates the current research on the factors affecting the election of immigrant candidates to municipal government. In addressing the lack of data-driven reviews in this type of research, the paper employs a scoping review methodological framework. Fifty-six distinct factors are identified as important for immigrants' electoral fortunes. The factors are classified under: Macro-level electoral structures and situational elements, meso-level immigrant group dynamics, and micro-level individual candidate characteristics. The most salient factors are elaborated on, together with a discussion on policy implications and future potential areas of inquiry.

Immigrant generational status and the uptake of HIV screening services among heterosexual men of African descent in Canada: Evidence from the weSpeak study.

Objective: Canada became a preferred destination for many non-European and non-American migrants since the introduction of favorable immigration policies in the late 1960 s. Blackimmigrants from the African and Caribbean regions however are a known vulnerable population to HIV infection in Canada. Even though first-generation immigrants might differ from subsequent generations in terms of culture and beliefs which are important for health outcomes and behaviors, research examining disparities in their use of preventative healthcare is limited. This study aimed to examine generational disparities in the uptake of HIV screening services among a sample of heterosexual Black men in Ontario, Canada. Methods: We used data from a cross-sectional survey sample (n = 829) that was collected from heterosexual Black men in four Ontarian cities (Toronto, Ottawa, London and Windsor) between March 2018 and February 2019. We used the negative log-log link function of the binomial family to examine the independent relationship between immigration status and the uptake of HIV testing and the cumulative effect of other predictor variables on HIV testing in nested models. Results: Findings from multivariate analysis show second-generation immigrants were significantly less likely to test for HIV compared with their first-generation immigrant counterparts. After controlling for theoretically relevant variables, the second-generation immigrants were 53% less likely to test for HIV. We further observed that participants with good knowledge of HIV transmission (OR=1.05; p > 0.05) and those who were older were more likely to test for HIV. Those with masculine tendencies (OR=0.98; p > 0.05) and those who reported not having sexual partner were less likely to test (OR=0.57; p > 0.01). Religion emerged as a significant predictor of HIV testing as Christians (OR=1.62; p > 0.05) and other believers (OR=1.59; p > 0.05) were more likely to test for HIV when compared to their Muslim counterparts. Conclusion: HIV prevention policies may need not only prioritize first-generation immigrants, but the wellbeing of their descendants as well. This could be achieved by implementing programs that will enhance second-generation immigrants' use of HIV screening services. Additionally, HIV educational programs would be of relevance and especially so as respondents with good knowledge of HIV transmission consistently demonstrated higher likelihood of testing for their HIV status.

Examining the Relationship Between Occupational Physical Activity and Hypertension Status: Evidence from the Ghana WHO Study on Global Ageing and Adult Health.

The employment landscape has changed significantly over the past few years in emerging economies including Ghana where many people are rapidly transitioning from livelihood activities that originally involved physical exertion to work environments where performance of duties are mostly non-physical. Working under non-active conditions could, however, exacerbate the risk of developing chronic diseases that are increasingly becoming problematic in many developing countries. Drawing on a cross-sectional nationally representative sample data of 4425 adult Ghanaian workers collected by the WHO Study on Global Ageing and Adult Health in developing countries, we examined the relationship between occupational physical activity and hypertensive status. We employed the complementary log-log analysis technique to build nested models with results presented in odds ratios. After controlling for several relevant variables, the results show that performing sedentary related work (AOR = 1.23, CI = 1.06-1.42) is significantly associated with a higher likelihood of being hypertensive compared with those whose work involved moderate physical activity. Other factors that were significantly associated with being hypertensive included tobacco use (AOR = 1.33, CI = 1.05-1.70), living in an urban environment (AOR = 1.15, CI = 1.01-1.32), and being a female (AOR = 1.18, CI = 1.01-1.37) and being an older person. Policies on reducing the risk of developing chronic conditions especially hypertension need to recognize the contributions of the work environment in emerging developing economies.

Global COVID-19 lockdown highlights humans as both threats and custodians of the environment.

The global lockdown to mitigate COVID-19 pandemic health risks has altered human interactions with nature. Here, we report immediate impacts of changes in human activities on wildlife and environmental threats during the early lockdown months of 2020, based on 877 qualitative reports and 332 quantitative assessments from 89 different studies. Hundreds of reports of unusual species observations from around the world suggest that animals quickly responded to the reductions in human presence. However, negative effects of lockdown on conservation also emerged, as confinement resulted in some park officials being unable to perform conservation, restoration and enforcement tasks, resulting in local increases in illegal activities such as hunting. Overall, there is a complex mixture of positive and negative effects of the pandemic lockdown on nature, all of which have the potential to lead to cascading responses which in turn impact wildlife and nature conservation. While the net effect of the lockdown will need to be assessed over years as data becomes available and persistent effects emerge, immediate responses were detected across the world. Thus, initial qualitative and quantitative data arising from this serendipitous global quasi-experimental perturbation highlights the dual role that humans play in threatening and protecting species and ecosystems. Pathways to favorably tilt this delicate balance include reducing impacts and increasing conservation effectiveness.

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

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

Childhood Adversity and Psychosocial Health Outcomes in Later Life Among Immigrants in Canada.

Childhood adversity is known to have an enduring effect on health outcomes of victims. The objective of the study was to examine the association between childhood adversity and psychosocial health outcomes among immigrants in Canada. Using descriptive and inferential statistics and fitting negative loglog regression models to the 2014 General Social Survey, the paper examined the relationship between experience of childhood adversity (i.e. physical and sexual abuse before age 15) and its association with psychosocial health outcomes (i.e. psychological-mental condition and self-rated mental health) among immigrants in Canada. After accounting for relevant socioeconomic and demographic factors, the results show that physical abuse during childhood resulted in 29% and 31% increased likelihood of having a psychological mental condition and poor self-rated mental health, respectively. Also, sexual abuse during childhood was associated with 28% increased likelihood of poor self-rated mental health. In conclusion, the findings show that experience of physical and sexual abuse during childhood is associated with negative mental health outcomes in later life.

Modern or traditional health care? Understanding the role of insurance in health-seeking behaviours among older Ghanaians.

AIM: This paper examined the association between wealth and health insurance status and the use of traditional medicine (TM) among older persons in Ghana. BACKGROUND: There have been considerable efforts by sub-Saharan African countries to improve access to primary health care services, partly through the implementation of risk-pooling community or national health insurance schemes. The use of TM, which is often not covered under these insurance schemes, remains common in many countries, including Ghana. Understanding how health insurance and wealth influence the use of TM, or otherwise, is essential to the development of equitable health care policies. METHODS: The study used data from the first wave of the World Health Organisation's Study of Global Ageing and Adult Health conducted in Ghana in 2008. Descriptive statistics and negative loglog regression models were fitted to the data to examine the influence of insurance and wealth status on the use of TM, controlling for theoretically relevant factors. FINDINGS: Seniors who had health insurance coverage were also 17% less likely to frequently seek treatment from a TM healer relative to the uninsured. For older persons in the poorest income quintile, the odds of frequently seeking treatment from TM increased by 61% when compared to those in the richest quintile. This figure was 46%, 62% and 40% for older persons in poorer, middle and richer income quintiles, respectively, compared to their counterparts in the richest income quintile. CONCLUSION: The findings indicate that TM was primarily used by the poor and persons who were not enrolled in the National Health Insurance Scheme. TM continues to be a vital health care resource for the poor and uninsured older adults in Ghana.

Health insurance enrolment in the Upper West Region of Ghana: Does food security matter?

Toward achieving universal health coverage, Ghana's national health insurance has been acclaimed as a pro-poor scheme, yet been criticized for leaving the poor behind. Arising from this is how poverty has been operationalized and how poor people are targeted for enrolment into the scheme. We examine the role of food insecurity (not currently considered) as a multidimensional vulnerability concept on enrolment into Ghana's health insurance using binary logistics regression on cross-sectional survey of household heads (n = 1438) in the Upper West Region of Ghana. Our analyses show that heads of severely food-insecure households were significantly less likely to enroll in national health insurance scheme (NHIS) relative to households who reported being food-secure (OR = 0.36, P < .05). We also found education, occupation, and religion as significant predictors of health insurance enrolment. Based on our findings, it is crucial to incorporate food security status in the identification of vulnerable people for free enrolment in Ghana's health insurance.

Does place matter? A multilevel analysis of victimization and satisfaction with personal safety of seniors in Canada.

Studies on the victimization and abuse of seniors in Canada have largely ignored the influence of place-based variations in social bonds and socioeconomic characteristics. Using the 2014 General Social Survey (GSS) data on Canadians' safety, we examine neighborhood, social capital, and socioeconomic characteristics as predictors of the incidence of victimization among seniors and their satisfaction with personal safety from crime. Generally, seniors with poor neighborhood ties and social capital were more likely to have experienced victimization and have a lower satisfaction with personal safety. Seniors who viewed people in their neighborhood as unhelpful were more likely to have experienced some form of victimization and more likely to have a lower satisfaction with personal safety. Highly educated and high-income seniors were also more likely to have experienced some form of victimization. Paradoxically, such seniors were less likely to have lower satisfaction with personal safety. The results also show that place, defined as population centers (urban and rural) may have a significant influence on variations in victimization and satisfaction with personal safety. A significant proportion of the variance in victimization (38%) and satisfaction with personal safety (23%) are largely the result of differences in place of residence (urban and rural). Our findings suggest that there is the need to improve neighborhood social capital, reduce neighborhood disorder and improve the socioeconomic status of community-dwelling seniors in order to minimize their susceptibility to victimization as well as to improve their sense of safety from crime.

Predictors of basic self-care and intermediate self-care functional disabilities among older adults in Ghana.

The number of older adults in Ghana is growing rapidly. Associated with this growth, is the rise in age-related chronic diseases such as cardiovascular and musculoskeletal conditions. However, there is limited knowledge in the Ghanaian context on the effect of chronic diseases on functional disabilities among older adults. In this study, we examine the association between chronic diseases, socioeconomic status, and functional disabilities. Data from 4107 Ghanaian older adults (persons aged 50 years and above) who participated in the World Health Organization's Global Ageing and Adult Health survey (SAGE-Wave 1) were used to fit random effect multivariate logistic and complementary log-log regression. Stroke was significantly associated with difficulty in performing both basic self-care functions and intermediate self-care functions. Hypertension and arthritis, on the other hand, were associated with basic self-care functional disability only. Socioeconomically vulnerable groups such as females, those with less education and low-incomes were more likely to have functional disabilities associated with basic self-care and intermediate self-care activities. In order to reduce functional disabilities among older persons in Ghana, efforts should be aimed at reducing chronic conditions as well as improving socioeconomic status.

Timing and utilisation of antenatal care service in Nigeria and Malawi.

As the world draws curtains on the implementation of Millennium Development Goals (MDGs), there is increasing interest in evaluating the performance of countries on the goals and assessing related challenges and opportunities to inform the upcoming Sustainable Development Goals (SDGs). This study examined changes in the timing and utilisation of maternal health care services in Nigeria and Malawi; using multivariate negative log-log and logistic regression models fitted to demographic and health survey data sets. Predicted probabilities were also computed to observe the net differences in the likelihood of both the first and the required number of antenatal care (ANC) visits for each of the three analysis years. Women in Nigeria were 7% less likely in 2008 compared to 2003, and in Malawi, 32% more likely in 2013 compared to 2000, to utilise ANC in the first trimester of pregnancy. Timing of first ANC visit was strongly influenced by wealth in Nigeria but not in Malawi. The findings in our case studies show how various contextual factors may enable or inhibit policy performance. Maternal and child health, SDGs should incorporate both wealth and degrees of urbanicity into country level implementation strategies.

Utilisation of skilled birth attendants over time in Nigeria and Malawi.

Despite recent modest progress in reducing maternal and infant mortality rates in sub-Saharan Africa, Nigeria and Malawi were still in the top 20 countries with highest rates of mortalities globally in 2015. Utilisation of professional services at delivery - one of the indictors of MDG 5 - has been suggested to reduce maternal mortality by 50%. Yet, contextual, socio-cultural and economic factors have served as barriers to uptake of such critical service. In this paper, we examined the impact of residential wealth index on utilisation of Skilled Birth Attendant in Nigeria (2003, 2008 and 2013), and Malawi (2000, 2004 and 2010) using Demographic and Health Survey data sets. The findings from multivariate logistic regressions show that women in Nigeria were 23% less likely to utilise skilled delivery services in 2013 compared to 2003. In Malawi, women were 75% more likely to utilise skilled delivery services in 2010 than in 2000. Residential wealth index was a significant predictor of utilisation of skilled delivery services over time in both Nigeria and Malawi. These findings illuminate progress made - based on which we make recommendations for achievement of SDG-3: ensure healthy lives and promote well-being for all at all ages in Nigeria and Malawi, and similar context.

Examining risk factors for hypertension in Ghana: evidence from the Study on Global Ageing and Adult Health.

Like most countries in sub-Saharan Africa, hypertension contributes substantially to morbidity and mortality in Ghana, yet nationally representative studies that examine the odds of becoming hypertensive among Ghanaians are conspicuously missing. We aimed to fill this void in the literature. The data used for analysis came from the first wave of the Study on Global Ageing and Adult Health (SAGE), collected in Ghana from January 2007 to December 2008 by the World Health Organization (WHO). A total of 5573 respondents were sampled for the study. Random-effects C-log-log models were employed in examining socio-economic, lifestyle and psychosocial factors on the odds of becoming hypertensive in Ghana. Separate models were run for male and females. Results indicated there were strong significant associations between socio-economic, lifestyle and psychosocial factors on the likelihood of becoming hypertensive, among Ghanaian men and women. Compared with the poorest, Ghanaians from wealthy households were significantly more likely to be hypertensive. Educated women, as compared with the uneducated, were also more likely to be hypertensive. Ghanaians who engaged in vigorous or intensive activities continuously, for at least 10 minutes, were significantly less likely to be hypertensive, compared to those who did not. Happier men had lower odds of becoming hypertensive, and depressed women had increased odds of reporting they were hypertensive.