Consistent condom use among sexually active young adults in Ghana: an analysis of prevalence and associated factors.

Consistent and proper condom use offers a safer, economically cheap and practically effective means of preventing HIV infection. Using the 2014 Ghana Demographic and Health Survey with a sample of 2779 sexually active youth (males = 682 and females = 2,097) in the age range 15-24, this study explored the prevalence of, and factors associated with consistent condom use among sexually active young adults in Ghana. Multivariate logistic regression was used to analyse the data. Our results showed that approximately 11% of the respondents reported consistent condom use in their previous sexual activity. Females were more likely than males to have used a condom consistently. The logistic regression results showed that females who had tested for HIV were less likely to use a condom consistently. However, those who have obtained family planning information from print media and those from the northern part of Ghana were more likely to practise consistent condom use. Furthermore, males who professed the Traditional African religion were less likely to use a condom consistently. In contrast, males in the rich wealth category were more likely to use a condom consistently. These findings underscore the need for behavioural change campaigns targeting young adults, particularly those who are sexually active, to encourage consistent condom use. These interventions should target young adults with less family planning knowledge, those who know their HIV status and those who profess the Traditional African religion.

Adolescent suicidal behaviour in Namibia: a cross-sectional study of prevalence and correlates among 3,152 school learners aged 12-17 years.

BACKGROUND: While adolescent suicidal behaviour (ideation, planning, and attempt) remains a global public health concern, available county-specific evidence on the phenomenon from African countries is relatively less than enough. The present study was conducted to estimate the 12-month prevalence and describe some of the associated factors of suicide behaviour among school-going adolescents aged 12-17 years old in Namibia. METHODS: Participants (n = 4531) answered a self-administered anonymous questionnaire developed and validated for the nationally representative Namibia World Health Organization Global School-based Student Health Survey conducted in 2013. We applied univariate, bivariable, and multivariable statistical approaches to the data. RESULTS: Of the 3,152 analytical sample, 20.2% (95% confidence interval [CI]: 18.3-22.2%) reported suicidal ideation, 25.2% (95% CI: 22.3-28.4%) engaged in suicide planning, and 24.5% (95% CI: 20.9-28.6%) attempted suicide during the previous 12 months. Of those who attempted suicide, 14.6% (95% CI: 12.5-16.9%) reported one-time suicide attempt, and 9.9% (95% CI: 8.1-12.1%) attempted suicide at least twice in the previous 12 months. The final adjusted multivariable models showed physical attack victimisation, bullying victimisation, loneliness, and parental intrusion of privacy as key factors associated with increased likelihood of suicidal ideation, planning, one-time suicide attempt, and repeated attempted suicide. Cannabis use showed the strongest association with increased relative risk of repeated attempted suicide. CONCLUSION: The evidence highlights the importance of paying more attention to addressing the mental health needs (including those related to psychological and social wellness) of school-going adolescents in Namibia. While the current study suggests that further research is warranted to explicate the pathways to adolescent suicide in Namibia, identifying and understanding the correlates (at the individual-level, family-level, interpersonal-level, school context and the broader community context) of adolescent suicidal ideations and non-fatal suicidal behaviours are useful for intervention and prevention programmes.

Mental health literacy of school-going adolescents in sub-Saharan Africa: a regional systematic review protocol.

INTRODUCTION: Assessing mental health literacy has implications for the identification and treatment of mental health problems. Adolescents have been identified as a particularly important target group for initiating and improving mental health literacy. However, much of what we know about adolescent mental health literacy comes from high-income countries. This proposed review seeks to synthesise the available published primary evidence from sub-Saharan Africa on the status and measurement of mental health literacy among school-going adolescents. METHODS AND ANALYSIS: We will perform a systematic review reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-2020). We will systematically search selected global databases (EMBASE, PsycINFO, PubMed and MEDLINE) and regional electronic databases (African Index Medicus and African Journals OnLine) up to December 2021 for observational and qualitative studies published in English and French. The standard quality assessment criteria for evaluating primary research papers from a variety of fields (QualSyst criteria) will be used to appraise the methodological quality of the included studies. The Petticrew-Roberts 3-step approach to narrative synthesis will be applied to the included studies. ETHICS AND DISSEMINATION: We will not seek ethical approval from an institutional review board, as this is a systematic review of available and accessible literature. When completed, the full report of this review will be submitted to a journal for peer-reviewed publication; the key findings will be presented at local and international conferences with-partial or full-focus on (adolescent) mental health (literacy). PROSPERO REGISTRATION NUMBER: CRD42021229011.

Self-reported injuries and correlates among school-going adolescents in three countries in Western sub-Saharan Africa.

BACKGROUND: Unintentional injuries among adolescents constitute a significant public health problem globally. Injured adolescents may face negative outcomes ranging from poor academic performance to short- and long-term physical and psychosocial health struggles, and even death. The aim of this study was to estimate the prevalence and describe the correlates and most frequent causes of injuries among school-going adolescents in three West African countries - Benin, Ghana, and Liberia. METHODS: We analysed self-reported data provided by 8,912 school-going adolescents who participated in the Global School-based Student Health Survey in Ghana (2012), Benin (2016), and Liberia (2017). Students responded to questions on sociodemographic factors, family involvement factors, mental health factors, school environment factors and injury behaviours. RESULTS: The overall 12-month prevalence estimate of serious injuries in adolescents was 40.9% (Benin = 27.3%; Ghana = 46.1%; Liberia = 49.2%). The most frequently reported injury type was a broken bone or dislocated joint (33% in Benin), cuts or stab wounds (31.7% in Ghana), and non-specified injuries (35.2% in Liberia). Prevalence of serious injuries was higher among males and increased with age. In the multivariable logistic regression analysis, interpersonal aggression outside the family context (bullying victimisation, engaging in physical fights, and having been physically attacked) emerged as key correlates of increased odds of serious injuries. CONCLUSION: The relatively higher prevalence estimates of serious injury reported in this study underscore the need for the included countries to develop interventions aimed at reducing and preventing physical injuries among adolescents.

Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study.

BACKGROUND: Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS: We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS: Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS: Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.

The mediating role of social support in the relationship between stigma and emotional distress among homeless adolescents in Ghana.

Research on youth homelessness has showed a link between emotional distress and social stigma. However, the mechanisms underlying this relationship have received little empirical attention. This study was conducted to examine the mediating effect of social support that accounts for the link. Standard questionnaires that assessed emotional distress, stigma and social support were interviewer-administered to 193 homeless adolescents (50.4% male; Mean = 13.21 (SD = 2.06). The Pearson product-moment correlation coefficient and mediation analyses were used to analyse the data. The study revealed that both self-blame and general stigma were positively related to emotional distress; but negatively related to social support. In the mediation analysis, general stigma significantly predicted decreased perceived social support and had a direct positive influence on emotional problems. However, the levels of self-blame was neither significantly associated with perceived social support nor had a significant indirect influence on the level of emotional problems. Both self-blame and general stigma also did not have a significant indirect influence on the level of emotional problems through perceived social support. These findings call for further research to examine the complex mechanism underlying stigma and mental health outcomes.

To Keep the Law or to Repeal It: Views of Parliamentarians On the Call to Decriminalise Attempted Suicide in Ghana.

We explored the views of members of parliament (MPs) in Ghana on the call to decriminalise attempted suicide. We applied reflexive thematic analysis to Parliamentary Hansards (2017-2020) on calls to decriminalise attempted suicide in Ghana. 11 MPs shared their stance for or against the call. We developed three major themes that entailed, often, opposing views: (1) deterrent effect of the law (against: the law punishes and deters to protect life; for: the law is insensitive and has ironic effects), (2) enforcement of the law (against: leave things as they are, the law is not enforced, anyway; for: crime is not self-inflicted) and (3) prioritisation of suicide prevention (against: focus on more pressing issues, but resource support systems; for: the law and legitimate support systems cannot co-exist). The findings indicate two needs: to extend suicide literacy to Ghanaian MPs, and to initiate a public/private member's bill on attempted suicide decriminalisation.

Self-harm and suicidal behaviour in Ghana: a systematic review protocol.

INTRODUCTION: Self-harm and suicidal behaviour represent major global health problems, which account for significant proportions of the disease burden in low-income and middle-income countries, including Ghana. This review aims to synthesise the available and accessible evidence on prevalence estimates, correlates, risk and protective factors, the commonly reported methods and reasons for self-harm and suicidal behaviour in Ghana. METHODS AND ANALYSIS: We will conduct a systematic review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (2009) recommendations. Regional and global electronic databases (African Journals OnLine, African Index Medicus, APA PsycINFO, Global Health, MEDLINE and PubMed) will be searched systematically up to December 2021 for observational studies and qualitative studies that have reported prevalence estimates, correlates, risk and protective factors, methods and reasons for self-harm and suicidal behaviour in Ghana. The electronic database searches will be supplemented with reference harvesting and grey literature searching in Google Scholar and ProQuest Dissertations & Theses Global for postgraduate dissertations. Only records in English will be included. The Mixed Methods Appraisal Tool (2018) will be used to assess the methodological quality of included studies. Meta-analysis or narrative synthesis or both will be used, contingent on the extent of heterogeneity across eligible observational studies. ETHICS AND DISSEMINATION: Considering that this is a systematic review of accessible and available literature, we will not seek ethical approval. On completion, this review will be submitted to a peer-reviewed journal, be disseminated publicly at (mental) health conferences with focus on self-harm and suicide prevention. The important findings would also be shared with key national stakeholder groups in Ghana: Ghana Association for Suicide Prevention, Ghana Mental Health Authority, Ghana Psychological Association, Centre for Suicide and Violence Research, Accra and the Parliamentary Select Committee on Health. PROSPERO REGISTRATION NUMBER: CRD42021234622.

Epidemiology of suicidal behaviours amongst school-going adolescents in post-conflict Sierra Leone.

BACKGROUND: Children and young people living in post-conflict contexts are at an increased risk of suicidal behaviours (ideations and attempts). Not much is known about the extent of suicidal behaviours amongst adolescents in most notable post-conflict countries in sub-Saharan Africa, including Sierra Leone. METHODS: We performed a secondary analysis of data from the 2017 Sierra Leone World Health Organisation Global School-based Student Health Survey conducted amongst students in secondary schools nationwide. We estimated the 12-month prevalence and performed bivariable and multivariable analyses to assess the correlates of suicidal behaviours. RESULTS: Of the 2,798 analytic sample, 14.6% (males = 15.1%, females = 14.0%) reported suicidal ideation, and the 12-month prevalence estimate of suicide attempt was 19.6% (male = 20.9%, females =17.8%). The factors associated with suicidal behaviours were multi-layered. While no statistically significant gender association with suicide ideation or attempt was observed at the personal level, being aged 18 or older, loneliness, and health risk behaviours (cannabis use, and leisure time sedentary behaviour) were associated with increased odds of suicidal behaviours. Within the family context, parental monitoring was associated with increased odds of suicidal ideation, but parental supervision was associated with reduced odds of suicide ideation. LIMITATIONS: The cross-sectional nature of the data did not support causal inferences. CONCLUSIONS: Taken together, professional mental healthcare would be helpful in treating adolescent emotional problems (e.g., depression and loneliness) related to suicidal behaviours; but prevention and intervention programmes targeted at addressing adolescent health risk behaviours, and familial and interpersonal problems may yield more favourable outcomes.

Association between loneliness, physical activity, and participation in physical education among adolescents in Amazonas, Brazil.

Loneliness is an individual and social problem associated with an unhealthy lifestyle among adolescents. We examined the association between loneliness, physical activity, and participation in physical education lessons among school-going adolescents. Participants included 2517 adolescents aged 14-19 years selected from state public high schools in Amazonas, Brazil. Participants answered a questionnaire containing demographic information, physical activity, and participation in physical education lessons and loneliness. Our results showed that physically inactive adolescents and those who did not participate in physical education lessons were more likely to feel lonely. These findings underscore the need to target physically inactive adolescents and those non-engaged in physical education lessons when developing interventions to address loneliness.

Mental health policy and system preparedness to respond to COVID-19 and other health emergencies: a case study of four African countries.

As a result of a long colonial history and subsequent developmental and economic challenges, many African countries have struggled to put in place adequate policies, systems, and associated infrastructures to address the health and social needs of their citizens. With the COVID-19 pandemic threatening human lives and livelihoods, concerns are raised about the preparedness and readiness of health policies and systems in African countries to deal with these kinds of health calamities. More particularly, questions can be asked about the preparedness or even existence of mental health policies and associated systems to help individuals and communities in Africa to deal with the consequences of COVID-19 and other health emergencies. In this article, we analyse the existing mental health policies of four African countries paying attention to the capacity of these legislative provisions to enable psychology professionals to deal with psychosocial problems brought about by COVID-19. We use Walt and Gilson's Policy Triangle Framework to frame our analysis of the existing mental health policies. In line with this conceptual framework, we review the role played by the different factors in shaping and influencing these mental health policies. We further explore the challenges and opportunities associated with existing legislation and mental health policies. We also reflect on the reports obtained from each of the four countries about the role that psychologists are playing to deal with the associated psychosocial problems. Based on our policy analysis and country reports, we highlight strengths and gaps in these policies and give recommendations on how mental health policies in these countries can be strengthened to respond to COVID-19 and future health emergencies.

Suicidal behaviours among adolescents in Liberia.

BACKGROUND: Whereas suicide remains in the top 12 leading causes of death among young people aged 10-24 in sub-Saharan Africa, little is known about suicidal behaviours among adolescents in Liberia. We aimed to estimate the 12-month prevalence and describe some of the correlates of suicide behaviours (ideation, planning, and attempt) among school-going adolescents in Liberia. METHODS: We analysed data from the 2017 Liberia Global School-based Student Health Survey conducted nationwide among secondary school students. We performed bivariate and multivariable analyses to assess the correlates of suicidal ideation, planning, and attempt in the previous 12 months. RESULTS: Of the 2744 students, 26.8% reported suicidal ideation, 36.5% made a specific plan to attempt suicide and 33.7% attempted suicide during the 12 months preceding the survey. In the final adjusted logistic models, bullying victimisation and food insecurity were associated with increased odds of ideation, planning, and attempt. Whereas no factor was uniquely associated with suicidal ideation, having many close friends, and parental monitoring were associated with the increased odds of suicidal planning only. Leisure-time sedentary behaviour was associated with increased odds of suicidal planning and attempt. Cannabis use, alcohol drunkenness, being physically attacked, and parental supervision were uniquely associated with increased odds of suicidal attempt, while parental understanding and having a smaller number of close friends were uniquely associated with reduced odds of suicidal attempt. CONCLUSIONS: The relatively high prevalence estimates of suicide behaviours and the multi-contextual nature of the associated factors warrant the need for the design and implementation of universal and multi-level, collaborative targeted intervention efforts towards the prevention of the onset of ideation, planning, and attempt, and the possible transition to deaths by suicide among school-going adolescents in Liberia.

Illness perception and coping among women living with breast cancer in Ghana: an exploratory qualitative study.

OBJECTIVE: Illness perception has been shown to have significant influence on the well-being and coping strategies of persons living with chronic medical conditions. Understanding of how women living with breast cancer cognitively and emotionally represent their illness and coping strategies used is likely to help in designing focused psychosocial interventions aimed at improving their health and well-being. This study explored the illness perceptions and coping strategies among women receiving care for breast cancer. DESIGN: A qualitative phenomenological study (using semi-structured in-depth interviews). SETTING: Oncology department of a tertiary hospital in Ghana. PARTICIPANTS: Eleven women receiving breast cancer treatment were purposively sampled and in-depth individual interviews were conducted with questions based on illness perception and coping literature. RESULTS: In terms of illness perceptions, it emerged that most of the participants lacked adequate factual knowledge about breast cancer and perceived causes but believed in the curability of their illness through medical treatments and the help of God. Spirituality, social support and diversion coping were the key resources for coping among the participants. CONCLUSION: Breast cancer patients lacked adequate factual knowledge of breast cancer and their perception about the causes of breast cancer is rooted in biopsycho-spiritual model of illness. The reliance on spirituality and social support as the main coping strategies suggests the need for psychosocial interventions tailored to the spiritual and psychosocial needs of the patients.

Suicide among university students: prevalence, risks and protective factors.

Background: Research evidence on suicide in Ghana so far has focused mostly on suicide in the adult population and less work on the younger population such as university students and other vulnerable groups such as children, youth and the aged. Aims: This study was conducted to determine lifetime and current prevalence of suicidal ideation or attempts and identify the associated risks and protective factors among university students in Ghana. Methods: Using a cross-sectional design, 1003 university students (507 males and 496 females) with a mean age of 20.5 years (SD = 5.95) were administered questionnaires that measured suicide, psychological distress, self-esteem and subjective wellbeing. Results: We found the following prevalence rates of suicidal behaviours: ideations 15.2%, attempted 6.3%, death wishes 24.3% and suicidal plan 6.8%. Psychological distress was a risk factor for both suicidal ideation and suicidal attempt. Subjective wellbeing was protective of suicide attempt while self-esteem was protective of suicidal ideation. Conclusions: These findings underscore the need for school-based mental health-promoting programmes that enhance young people's self-esteem, reduce psychological distress and boost subjective wellbeing.

Depression, anxiety and quality of life among women living with breast cancer in Ghana: mediating roles of social support and religiosity.

PURPOSE: Depression and anxiety are common mental health comorbidities found among women living with breast cancer. The presence of these mental health comorbidities results in decreased quality of life among patients. However, the indirect effects of depression and anxiety on quality of life have not been fully established. This study therefore examined the direct and indirect effects of depression and anxiety on quality of life through social support and religiosity. METHODS: Using a cross-sectional survey, 205 purposively selected participants were administered measures of depression and anxiety, social support, religiosity and quality of life. The statistical package for the social sciences (SPSS) with PROCESS Macro was used for mediation analyses. RESULTS: Findings showed that there were significant direct negative effects of depression and anxiety on quality of life. Whereas depression had a significant negative indirect effect on quality of life through social support (b = - 0.247, 95% CI = - 0.482 to - 0.071), anxiety had a significant positive indirect effect on quality of life through social support (b = 0.142, 95%CI = 0.011 to 0.324). However, depression and anxiety did not have any significant indirect effect on quality of life through religiosity. CONCLUSION: These findings suggest that there is the need to examine the mental health of women living with breast cancer as part of the routine healthcare, and social support ties should be strengthened to improve their quality of life.

Perceived seriousness mediates the influence of cervical cancer knowledge on screening practices among female university students in Ghana.

BACKGROUND: Cervical cancer knowledge and awareness, as well as an individual's perceptions about cervical cancer have been shown to significantly influence the screening practices of female students. Despite these studies, the mechanisms linking cervical cancer knowledge to screening practices among female students remain unexplored in the literature. Thus, this study examined the direct and indirect influences of cervical cancer knowledge on screening practices through perceptions about cervical cancer as informed by the health belief model. METHODS: A cross-sectional survey design with a purposive sample of 200 female students were used in the study. Standardized questionnaires were used to measure cervical cancer knowledge, perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers and cervical cancer screening behaviours. The Pearson product-moment correlation co-efficient and mediation analyses were used to analyse the data. RESULTS: Our findings showed that cervical cancer knowledge, perceived susceptibility, perceived seriousness and perceived benefits were significant and positively correlated with increased screening behaviours. However, only perceived seriousness significantly mediated the relationship between cervical cancer knowledge and screening behaviour. Cervical cancer knowledge remained a significant direct predictor of screening behaviour in all the models. CONCLUSION: These findings underscore the need for increased awareness with emphasis on the seriousness of cervical cancer among female university students as it plays a key role in influencing their screening behaviours.

Cannabis and amphetamine use and its psychosocial correlates among school-going adolescents in Ghana.

BACKGROUND: The aim of this study was to examine the prevalence of cannabis and amphetamine use and to determine its associated factors among school-going adolescents in Ghana. METHOD: The 2012 Ghanaian Global School-based Student Health Survey on 3632 adolescents aged 11-19 years (mean = 15.1 years; SD = 1.4) was used. Participants for this study were sampled from selected junior (JHS) and senior high schools (SHS) in all the 10 administrative regions of Ghana. A two-stage cluster sampling design was used to select 25 senior high schools to represent all the 10 regions of Ghana. Information was collected with a self-administered structured questionnaire that contained information on demographics, alcohol, tobacco and other drug use, violence, and a range of other health-related behaviours. RESULTS: The result showed that past-month cannabis use was 5.3% and lifetime amphetamine use was 7.1% among students. In multivariate model, after controlling for other variables, school truancy and current cigarette smoking were associated with both past-month cannabis and lifetime amphetamine use. The number of close friends was associated with only past-month cannabis use. School environment factors (bullying victimisation and having been attacked) and parental substance use were associated with lifetime amphetamine use. CONCLUSION: This study identified a number of risk factors, including parental substance use and various risk behaviours, for both past-month cannabis and lifetime amphetamine use. School-based health intervention programmes should be developed taking into consideration the risk factors associated with cannabis and amphetamine use among school-going adolescents.