Measurement invariance of a household water insecurity metric in Greater Accra, Ghana: Implications for test-retest reliability.

The mitigation of household water insecurity is recognized as an important component of global poverty alleviation, but until recently was difficult to measure. Several new metrics of household water insecurity have been proposed and validated, but few have been field-tested for reliability in diverse contexts. We used confirmatory factor analysis to test the psychometric equivalence of one such metric-the Household Water Insecurity Experiences (HWISE) scale-across two survey waves administered 18 months apart in similar climatic conditions among households in a peri-urban community outside of Accra, Ghana. The HWISE metric was not equivalent across survey waves, which may be attributable to the metric itself, sample size, subtle instrumentation changes, or other unobserved factors. Test-retest reliability may also be difficult to achieve given the dynamic nature of household water use, and we discuss the implications of using household water insecurity metrics as longitudinal measures of well-being in global anti-poverty programs.

Exploring the development of a household cholera-focused health literacy scale in James Town, Accra.

BACKGROUND: Foodborne diseases are significant reasons for in-patient and out-patient morbidity in Ghana. Of the foodborne illnesses reported in the country, cholera incidence and outbreaks have resulted in food-related mortality since the disease was first reported in the 1970s. Cholera is now endemic in the country. This study attempts to develop and pilot a tool to measure household health literacy among the urban poor in James Town, a cholera endemic neighborhood. METHODS: A survey questionnaire was developed based on four of the World Health Organization's (WHO) recommendations on issues for measurement of health literacy in low- and middle-income countries. The instrument was administered to 401 households in the community. We undertook reliability and validity analyses. T-test, Kruskal Wallis test, and Mann-Whitney test were used to examine the association between the health literacy scores of the scale and subscales and the demographic characteristics of households. RESULTS: The reliability analyses showed that the instrument was internally consistent (Cronbach alpha=0.762). All the subscales were reliable except the beliefs about health and healthcare subscale. Based on content and construct validity analyses, 13 items were used for further examination of health literacy. We found that majority of households know about the information, education, and communication materials and 52% of households indicated that these materials remind them about the dangers of cholera. About 39% of the households decide together as a unit on steps to avoid getting cholera during an outbreak. Overall health literacy scores and the subscales were significantly associated with sex, age, marital status, and educational level of household head. Specifically, females, being married, increasing age and higher household income had a significant association with higher health literacy scores. CONCLUSION: Household units in James Town impacts individual health literacy through: family discussions; access to information, education, and communication materials on cholera; and intentional efforts made to get information on cholera risk factors.

Sachet water quality and brand reputation in two low-income urban communities in greater Accra, Ghana.

Sachet water has become an important primary source of drinking water in western Africa, but little is known about bacteriologic quality and improvements to quality control given the recent, rapid evolution of this industry. This report examines basic bacteriologic indicators for 60 sachet water samples from two very low-income communities in Accra, Ghana, and explores the relationship between local perceptions of brand quality and bacteriologic quality after controlling for characteristics of the vending environment. No fecal contamination was detected in any sample, and 82% of total heterotrophic bacteria counts were below the recommended limit for packaged water. Sachets from brands with a positive reputation for quality were 90% less likely to present any level of total heterotrophic bacteria after controlling for confounding factors. These results contrast with much of the recent sachet water quality literature and may indicate substantial progress in sachet water regulation and quality control.