System, institutional, and client-level factors associated with formal healthcare utilisation among older adults with low income under a social protection scheme in Ghana.

BACKGROUND: In sub-Saharan African context, effect of system, institutional and client-level factors on formal healthcare utilisation among older adults with low income, especially those under a social protection scheme (called Livelihood Empowerment against Poverty [LEAP] programme) is least explored in the literature. However, an adequate understanding of how these factors contribute to formal healthcare utilisation among older adults who are classified as poor (in terms of low income) is important to inform health policy decisions. The aim of this study, therefore, was to examine the contributions of system, institutional and client-level factors in formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. METHODS: Data associated with this study were obtained from an Ageing, Health, Lifestyle and Health Services survey conducted between 1 and 20 June 2018 (N = 200) in the Atwima Nwabiagya Municipal and Atwima Nwabiagya North District of Ghana. Multivariable logistic regressions were used to determine system, institutional and client-level factors associated with formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. The significance of the test was set at a probability value of 0.05 or below. RESULTS: The study revealed that participants who relied on the LEAP programme and/or health insurance subscription to cater for their healthcare expenses (AOR: 11.934, CI: 1.151-123.777), those whose family/caregivers decided on when and where to use formal healthcare (AOR:12.409; CI: 2.198-70.076) and those who did not encounter communication problem with healthcare providers (AOR: 1.358; CI: 1.074-3.737) were significantly more likely to utilise formal healthcare services compared with their counterparts. The study further found that participants who perceived the attitude of healthcare providers as poor (AOR: 0.889; CI: 0.24-0.931) and those who spent 20-40 minutes at the healthcare facility were significantly less likely to utilise formal healthcare services compared with their counterparts (AOR: 0.070; CI: 0.006-0.195). CONCLUSION: Our findings suggest that reducing waiting time at healthcare facilities, improving social protection and/or health insurance schemes, improving patient-doctor communication and promoting attitudinal change programmes (such as orientations and supportive supervision) for healthcare providers may help to facilitate the use of needed formal healthcare services by older adults with low income in Ghana.

Protecting the patches from the footprints: examining the land use factors associated with forest patches in Atewa range forest reserve.

BACKGROUND: Land use practices are noted to contribute to changes in forest landscape composition. However, whereas studies have reported the intermix of land uses and forest patches and measured the direct impacts of land uses on forest patches, little is known regarding the spatially-explicit association between the most recent forest patches and land use footprints in protected areas. In this study, we use methods from GIS, remote sensing, and statistics to model the spatial relationship between footprints of land uses and patches of forest cover by drawing on geospatial data from the Atewa range forest reserve (ARFR). RESULTS: The study finds that forest patches that are within 1 km from agricultural land use footprints (AOR = 86.625, C.I. 18.057-415.563, P = 0.000), logging sites (AOR = 55.909, C.I. 12.032-259.804, P = 0.000), mine sites (53.571, C.I. 11.287-254.255, P = 0.000), access roads (AOR = 24.169, C.I. 5.544-105.357, P = 0.000), and human settlement footprints (AOR = 7.172, C.I. 1.969-26.128, P = 0.003) are significantly more likely to be less than the mean patch area (375,431.87 m2 = 37.54 ha) of forest cover. A ROC statistic of 0.995 achieved in this study suggests a high predictive power of the proposed model. CONCLUSION: The study findings suggest that to ensure sustainable land uses and ecological integrity, there is a need for land use policies and land management strategies that ensure responsible livelihood activities as well as further restrictions on logging and mining in the globally significant biodiversity area.

Measuring forest change patterns from oil and gas land use dynamics in northeastern British Columbia, 1975 to 2017.

Information about forest change patterns from oil and gas (OG) activities could improve our understanding of the land use-land cover change nexus, aid in predicting future forest changes, and prompt the need for more mitigation measures in reducing impacts from the activities. However, little is known about forest change patterns from OG infrastructure development in northeastern British Columbia (BC). In this study, we assess forest change from the impacts of OG infrastructure development using a geospatial approach. The study finds that forest cover was reduced by 0.234% between 1975 and 2017. However, we show that forest cover change (- 0.182%) from OG infrastructure development between 1995 and 2017 was faster compared to that of the two decades before 1995. The faster change, however, coincides with the period of the OG boom in BC. Between time points and locations, we measured a larger amount of forest fragmentation in the land cover for the year and location with larger quantities of human-induced land classes. The differences in the quantity of human-induced land cover types between time points and locations could account for the differences in the amount of fragmentation. Our findings suggest that forest fragmentation is likely to reduce if land managers would make relentless effort to reduce the quantity of anthropogenic-induced land cover classes and increase forest recovery programs in the forest areas.