Neighborhood, social isolation and mental health outcome among older people in Ghana.

OBJECTIVE: Loneliness and living alone have been strongly related to mental health but limited empirical evidence of these relationships exists among older people in Ghana. We examine the pathways of independent and interactive impacts of loneliness and living alone on psychological distress (PD) risk among older people in Ghana and to investigate whether the associations are moderated by neighborhood characteristics. METHODS: Data were analyzed for 1200 community-dwelling adults aged ≥50 years from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study. Mental health and loneliness were respectively assessed using the Kessler Psychological Distress Scale (KPDS-10) and the Three-Item Loneliness Scale of the University of California, Los Angeles. OLS models estimated the associations and interactions. RESULTS: Participants were mostly women (63.3% [95%CI: 60.5-66.0%]) with a mean age of 66.2 ±â€¯11.9. Mean scores for PD and loneliness were 15.9 ±â€¯4.7 and 5.3 ±â€¯3.9 respectively whilst the prevalence of living alone was 38.2% (95%CI: 35.4-41.0%). After full adjustment, the OLS regressions showed that loneliness (ß = 1.474, SE = 0.151, p < 0.001), living alone (ß = 0.381, SE = 0.162, p < 0.05) and the interaction between them (ß = 0.917, SE = 0.308, p < 0.05) significantly increased the PD risk. However, engagement in regular physical activity, family contacts and social participation decreased PD outcomes among the socially isolated. LIMITATION: The cross-sectional nature of the data may prohibit any causal and directional inferences. CONCLUSIONS: Social connectedness and neighborhood engagements strongly buffer against the risk of later life mental disorders in the context of loneliness, and living alone. Moderate-to-rigorous physical activity and social cohesion should be effectively and strategically included in interventions targeted to improve older age mental health.

Prevalence and patterns of skin toning practices among female students in Ghana: a cross-sectional university-based survey.

OBJECTIVE: The use of skin toning products has a deep historical background in low and middle-income countries. Yet, there is no empirical evidence on the prevalence, and patterns of skin toning practices among university students in Ghana. This study sought to examine the prevalence, patterns and socio-demographic factors associated with skin toning practices among female university students in Ghana using a sample of 389 undergraduate female students. RESULTS: 40.9% of respondents had practised skin toning within the last 12 months. Also, 51.3% used skin toning products such as creams (38.9%) and soap or gel (35.5%) to treat a skin disorder. Respondents aged 21 years were more likely to use skin toning products (AOR = 0.400, CI 0.121-1.320), those who had dark skin (AOR = 3.287, CI 1.503-7.187), attended public school (AOR = 1.9, CI 1.1-3.56) and those who attended girls school were more likely to use skin toning products (AOR = 10.764, CI 4.2-27.3). Furthermore, those who were in level 400 (AOR = 49.327, CI 8.48-286.9) and those receiving more than 500 cedis were also more likely to use skin toning products (AOR = 2.118, CI 0.419-10.703). Policy interventions that seek to reduce skin toning practices among university students should consider micro and broader socio-demographic factors.

Geographical Differences in Perceived Health Status Among Older Adults in Ghana: Do Gender and Educational Status Matter?

Studies have constantly reported mixed evidence on the associations between rural/urban differences and self-rated health (SRH) status among older populations. More importantly, the roles of other relevant sociodemographic characteristics such as gender and educational levels in these associations are mostly overlooked. The current study examines the geographical differences in SRH of older cohorts in Kumasi Metropolis and Bosomtwe District of Ghana. Data from a Spatial Health and Healthcare Study (SHHS) were analyzed using chi-square test and ordinal logistic regression models. Although the study discovered a statistically significant difference in SRH between the rural and urban samples, the multivariate analysis found insignificant effect in SRH between urban and rural samples after adjusting for theoretically relevant covariates. However, the interactions indicated that this association significantly strengthens for rural dwellers who were highly educated. Moreover, age, average monthly income, reporting sickness in the past 90 days, and not noticing any change in health status in retrospective to 12 months were independent predictors of SRH. Effective interventions through collaborative efforts by the Ghanaian sociopolitical structure and micro-level dynamics are needed to ensure holistic improvements in health outcomes among vulnerable older persons.

Unconventional medical practices among Ghanaian students: A university-based survey.

Research on unconventional medical practices among students has proliferated lately in the global space, hitherto, little is known explicitly in Ghana. This paper teases out insights for recent utilisation patterns of traditional medical therapies at Kwame Nkrumah University of Science and Technology (KNUST), Ghana. A sample of 754, randomly selected undergraduates were involved in a retrospective cross-sectional survey. Data were analysed using multivariate logistic regression and Pearson's χ2 test with p < 0.05 as significant. Overall prevalence of traditional therapies consumption was 89.1% in the last 12 months. Herbal-based products (67%), prayer healing (15%) and body-mind therapies (11%) were principally used and, accessed through purchases from pharmacy shops (29%) and encounter with faith healers (26%). Although students' knowledge on traditional therapies was acquired through family members (50%) and media (23%), literary materials remained significant information routes for Science related students compared to the Non-science related counterparts (p < 0.001). Pursuing Non-science-related programme [odds ratio (OR) 6.154 (95% confidence interval (CI) 3.745-10.111; p < 0.001)] and having Christian faith [OR 2.450 (95% CI 1.359-4.415; p = 0.003)] were strongly associated with students' traditional therapies use. Although students exhibited positive attitude towards unconventional therapies, there is an urgent need to validate the quality of traditional therapies through randomised clinical trials and regulatory practices to ensure quality control. Health forces should intensify efforts towards intercultural health care system in Ghana.

Pulled in or pushed out? Understanding the complexities of motivation for alternative therapies use in Ghana.

The impact of strong cultural beliefs on specific reasons for traditional medicine (TRM) use among individuals and populations has long been advanced in health care and spatio-medical literature. Yet, little has been done in Ghana and the Ashanti Region in particular to bring out the precise "pull" and "push" relative influences on TRM utilization. With a qualitative research approach involving rural and urban character, the study explored health beliefs and motivations for TRM use in Kumasi Metropolis and Sekyere South District, Ghana. The study draws on data from 36 in-depth interviews with adults, selected through theoretical sampling. We used the a posteriori inductive reduction model to derive broad themes and subthemes. The "pull factors"-perceived benefits in TRM use vis-à-vis the "push factors"-perceived poor services of the biomedical treatments contributed to the growing trends in TRM use. The result however indicates that the "pull factors," viz.-personal health beliefs, desire to take control of one's health, perceived efficacy, and safety of various modalities of TRM-were stronger in shaping TRM use. Poor access to conventional medicine accounted for the differences in TRM use between rural and urban areas. Understanding the treatment and health-seeking behaviour of a cultural-related group is critical for developing and sustaining traditional therapy in Ghana.

Does spatial location matter? Traditional therapy utilisation among the general population in a Ghanaian rural and urban setting.

Despite the recognition for rising consumption rate of traditional medicine (TRM) in health and spatio-medical literature in the global scale, the impact of location in traditional therapy use has been explored least in Ghana. This paper analysed the role of spatial variation in TRM use in Kumasi Metropolis and Sekyere South District of Ashanti Region, Ghana. A retrospective cross-sectional and place-based survey was conducted in a representative sample (N=324) selected through systematic random sampling technique. Structured interviewer-administered questionnaires were espoused as the main research instruments. Data were analysed with Pearson's Chi-square and Fisher's exact tests from the Predictive Analytics Software (PASW) version 17.0. The study found that over 86% reported TRM use. Whilst majority (59.1%) of the respondents had used TRM two or more times within the last 12 months, biologically-based therapies and energy healing were common forms of TRM accessed. Although, the use of TRM did not vary (p>0.05), knowledge about TRM, modalities of TRM and the sources of TRM differed significantly across geographically demarcated rural and urban splits (p<0.005). The study advances our understanding of the spatial dimensions as regards TRM utilisation.

Predictors of traditional medicines utilisation in the Ghanaian health care practice: interrogating the Ashanti situation.

Traditional medicine (TRM) use remains universal among individuals, families and communities the world over but the predictive variables of TRM use is still confounding. This population-based study analysed the predictors of TRM use in Ashanti Region, Ghana. A retrospective cross-sectional quantitative survey involving systematic random sampled participants (N = 324) was conducted. Structured interviewer-administered questionnaires were used as research instruments. Data were analysed with logit regression, Pearson's Chi square and Fisher's exact tests from the PASW for Windows application (V. 17.0). Overall, 86.1 % (n = 279) reported use of TRM with biologically-based and distant/prayer therapies as the major forms of TRM utilised in the previous 12 months. Among the general population, TRM use was predicted by having low-income levels [odds ratio (OR) 2.883, confidence interval (CI) 1.142-7.277], being a trader (OR 2.321, CI 1.037-5.194), perceiving TRM as effective (OR 4.430, CI 1.645-11.934) and safe (OR 2.730, CI 0.986-4.321), good affective behaviour of traditional medical practitioner (TMP) (OR 2.943, CI 0.875-9.896) and having chronic ill-health (OR 3.821, CI 1.213-11.311). The prevalence of TRM use is high. The study provides evidence that people's experience, personal attributes, health beliefs, attitude to TRM, attitude of TMP to clients and medical history are largely accountable for the upsurge use of TRM rather than socio-demographic factors. Understanding the health-seeking behaviour of individuals is exigent to ascribe appropriate medical care by health care providers.

Prevalence and pattern of traditional medical therapy utilisation in Kumasi Metropolis and Sekyere South District, Ghana.

ETHNOPHARMACOLOGICAL RELEVANCE: Whilst over three-quarters of the world׳s population continues to use traditional medicine (TRM) with an increasing trend globally, limited data exist in the Ashanti Region regarding TRM utilisation. This study espoused a retrospective cross-sectional quantitative approach to examine the prevalence and pattern of TRM use among the general population in the Kumasi Metropolis and Sekyere South District, Ghana. MATERIALS AND METHODS: A sample of 324, drawn through systematic random sampling was used. The main instrument for data collection was formal face-to-face interviewer-administered questionnaire. Data were analysed using Chi-square and Fisher's exact tests from the PASW (V.17.0) with p ≤ 0.05 as significant. RESULTS: The survey found that TRM use alongside conventional medicines was pervasive with prevalence of 86.1%. Biologically-based therapies (88.5%) and distant prayer interventions (58.4%) were commonly used modalities through the influence of families (50.3%), friends (19.4%) and the mass media (18.0%). Whilst self-administration and purchases from pharmacy shops remained important sources of TRM, TMPs׳ consultation was less credible (p<0.005). The disclosure rate of TRM use to health care professionals remained low (12.2%; p<0.001). CONCLUSION: Concomitant TRM use with conventional therapies without disclosure may interfere with the potency of treatment regimen and result in drug interactions. Inclusion of alternative medicines on the National Health Insurance Scheme's drug plan will fortify monitoring and professional administration of TRM. Information as regards TRM use needs to be incorporated into clinical and medical practice, hence the need to prioritise patient-physician communication.