Predictors of quality of life of TB/HIV co-infected patients in the Northern region of Ghana.

BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-morbidity continues to be a serious worldwide health issue, particularly in Sub-Saharan Africa. Studies on the quality of life (QOL) of TB/HIV co-infected patients guide stakeholders on the delivery of patient-centred healthcare. This study evaluated QOL of TB/HIV co-infected individuals and its contributing factors. METHODS: We conducted a cross-sectional study among TB/HIV co-infected patients, receiving treatment at clinics in the Northern Region of Ghana. Simple random sampling technique was used to select 213 patients from 32 clinics. We gathered information on patients' QOL using the World Health Organization QOL-HIV BREF assessment tool. At a 5% level of significance, multiple logistic regression analyses were carried out to find correlates of QOL among the patients. RESULTS: The mean age of the patients was (38.99 ± 14.00) years with most, 33.3% (71/213) aged 30-39 years. Males constituted 54.9% (117/213). About 30.0% (64/213) of the patients reported a good QOL. Being employed (aOR = 5.23, 95% CI: 1.87 - 14.60), and adhering to treatment (aOR = 6.36, 95% CI: 1.51 - 26.65) were significantly associated with a good QOL. Being depressed (aOR = 0.02, 95% CI: 0.03 - 0.29), stigmatized (aOR = 0.31, 95% CI : 0.11 - 0.84), and not exercising (aOR = 0.28, 95% CI: 0.12 - 0.67) were negatively associated with a good QOL. CONCLUSION: Less than one-third of TB/HIV co-infected patients in the region have good QOL. To guarantee good QOL, modifiable predictors such as patients' physical activity and medication adherence should be targeted by the National AIDS and TB Control Programs.

Anger and disgust shape judgments of social sanctions across cultures, especially in high individual autonomy societies.

When someone violates a social norm, others may think that some sanction would be appropriate. We examine how the experience of emotions like anger and disgust relate to the judged appropriateness of sanctions, in a pre-registered analysis of data from a large-scale study in 56 societies. Across the world, we find that individuals who experience anger and disgust over a norm violation are more likely to endorse confrontation, ostracism and, to a smaller extent, gossip. Moreover, we find that the experience of anger is consistently the strongest predictor of judgments of confrontation, compared to other emotions. Although the link between state-based emotions and judgments may seem universal, its strength varies across countries. Aligned with theoretical predictions, this link is stronger in societies, and among individuals, that place higher value on individual autonomy. Thus, autonomy values may increase the role that emotions play in guiding judgments of social sanctions.

Emotion regulation strategies and psychological health across cultures.

Emotion regulation is important for psychological health and can be achieved by implementing various strategies. How one regulates emotions is critical for maximizing psychological health. Few studies, however, tested the psychological correlates of different emotion regulation strategies across multiple cultures. In a preregistered cross-cultural study (N = 3,960, 19 countries), conducted during the COVID-19 pandemic, we assessed associations between the use of seven emotion regulation strategies (situation selection, distraction, rumination, cognitive reappraisal, acceptance, expressive suppression, and emotional support seeking) and four indices of psychological health (life satisfaction, depressive symptoms, perceived stress, and loneliness). Model comparisons based on Bayesian information criteria provided support for cultural differences in 36% of associations, with very strong support for differences in 18% of associations. Strategies that were linked to worse psychological health in individualist countries (e.g., rumination, expressive suppression) were unrelated or linked to better psychological health in collectivist countries. Cultural differences in associations with psychological health were most prominent for expressive suppression and rumination and also found for distraction and acceptance. In addition, we found evidence for cultural similarities in 46% of associations between strategies and psychological health, but none of this evidence was very strong. Cultural similarities were most prominent in associations of psychological health with emotional support seeking. These findings highlight the importance of considering the cultural context to understand how individuals from diverse backgrounds manage unpleasant emotions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Coping strategies among adolescents and young adults living with HIV/AIDS in Accra-Ghana.

BACKGROUND: Living with HIV/AIDS is remarkably stressful and has an adverse effect on one's physical and mental health. In Sub-Saharan Africa, the introduction of highly active anti-retroviral therapy has led to an increased number of children with perinatal acquired HIV who are living into adolescence and adulthood. Developing strategies to cope with HIV becomes imperative, especially among these adolescents. The study determined the factors that influence coping strategies among adolescents living with HIV. METHODS: An analytic cross-sectional design was used. A total of 154 adolescents aged 10-19 years living with HIV were systematically sampled at the Fevers Unit of Korle Bu Teaching Hospital from June to December, 2021. The adolescent version of the KidCope tool was used to assess the choice of coping strategies. Stata 16 was used to determine associations between independent variables and the coping strategies identified. Only variables that were significant at p = 0.1 or less in the crude model were used to run the adjusted regression model. The level of significance was set at p = 0.05 with a 95% confidence interval. RESULTS: The mean age of participants was 19.2 ± 0.45 years with 51.9% (80/154) of participants being males. A majority, 57.1% of the participants employed positive coping strategies with 87.0% (135/154) using cognitive restructuring strategy. In an adjusted linear regression model, participants coping strategies were significantly associated with their educational level (p = 0.04) and presence of both parents as caregivers (p = 0.02). CONCLUSION: Participants largely adopted positive coping strategies in managing the disease. Factors that influenced the choice of coping strategies were higher levels of education and the presence of both parents as caregivers. The importance of a good social support structure and pursuing further education needs to be emphasized in counselling adolescents living with HIV as it promotes the choice of positive coping strategies.

Expectations for Children with Autism Spectrum Disorders or Intellectual Disabilities in Ghana: A Comparison Between Service Providers and Parents.

Little is known about care providers' expectations for children with autism spectrum disorders (ASD) and intellectual disabilities (ID) in Ghana. This study used group concept mapping (n = 9) and a quantitative survey (n = 128) to explore and compare service providers' and parents' expectations for children with ASD or ID. Data were analyzed using hierarchical clustering procedures and Multivariate Analysis of Variance (MANOVA). Concept mapping results revealed several expectation clusters, including independence, love and acceptance, equal social rights and opportunities, and professional and caregiver training. MANOVA results revealed significant differences between parents, teachers, and healthcare providers in their perceptions of the importance and likelihood of a child achieving these expectations. Results are discussed in reference to the cultural context, and implications are outlined.

Psychotic-like experiences and adverse life events in young people. Does gender matter?

BACKGROUND: Psychotic-like experiences (PLEs) and adverse life events (ALEs) are highly prevalent in sub-Saharan Africa where gendered practices are also common. There is, however, a paucity of data on how the relationship between PLEs and life adversities is influenced by gender. The current study addressed this gap. METHOD: Data were collected from 1886 school-based young people (1174 females) in Ghana, West Africa using a cross-sectional survey methodology and analyzed using Chi-square, independent t-test, Pearson correlation, and multivariate regression. RESULTS: The results showed that victimization experiences, school stress and having a family member with mental illness were significantly associated with PLEs in both males and females. In contrast, substance misuse and experiences of head trauma correlated significantly with PLEs in females only. CONCLUSION: Life adversities constitute major risk factors for PLEs among school-based young people in Ghana, who could benefit from gender neutral and gender-sensitive intervention programming to remediate the effects of life adversities on PLEs.

Quantifying quality: The impact of measures of school quality on children's academic achievement across diverse societies.

Recent decades have seen a rapid acceleration in global participation in formal education, due to worldwide initiatives aimed to provide school access to all children. Research in high income countries has shown that school quality indicators have a significant, positive impact on numeracy and literacy-skills required to participate in the increasingly globalized economy. Schools vary enormously in kind, resources, and teacher training around the world, however, and the validity of using diverse school quality measures in populations with diverse educational profiles remains unclear. First, we assessed whether children's numeracy and literacy performance across populations improves with age, as evidence of general school-related learning effects. Next, we examined whether several school quality measures related to classroom experience and composition, and to educational resources, were correlated with one another. Finally, we examined whether they were associated with children's (4-12-year-olds, N = 889) numeracy and literacy performance in 10 culturally and geographically diverse populations which vary in historical engagement with formal schooling. Across populations, age was a strong positive predictor of academic achievement. Measures related to classroom experience and composition were correlated with one another, as were measures of access to educational resources and classroom experience and composition. The number of teachers per class and access to writing materials were key predictors of numeracy and literacy, while the number of students per classroom, often linked to academic achievement, was not. We discuss these results in the context of maximising children's learning environments and highlight study limitations to motivate future research. RESEARCH HIGHLIGHTS: We examined the extent to which four measures of school quality were associated with one another, and whether they predicted children's academic achievement in 10 culturally and geographically diverse societies. Across populations, measures related to classroom experience and composition were correlated with one another as were measures of access to educational resources to classroom experience and composition. Age, the number of teachers per class, and access to writing materials were key predictors of academic achievement across populations. Our data have implications for designing efficacious educational initiatives to improve school quality globally.

A case-control and seven-year longitudinal neurocognitive study of adults with sickle cell disease in Ghana.

Ageing in sickle cell disease (SCD) is associated with a myriad of end-organ complications, including cerebrovascular damage and cognitive impairment (CI). Although CI is very common in SCD, little is known about cognitive functioning and how it changes with age. This study examines cognitive patterns of 63 adults with SCD and 60 non-SCD, age- and education-matched controls in Ghana. Of those adults with SCD, 34 completed the neuropsychological battery at baseline and again seven years later. In cross-sectional data, adults with SCD performed worse than controls in all cognitive test domains (p < 0.01 for all). The seven-year follow-up data showed that the group exhibited a significant decline in visuospatial abilities (ranging from Cohen's d = 1.40 to 2.38), and to a lesser extent, in processing speed and executive functioning. Exploratory analyses showed a significant time-by-education interaction, indicating that education may be protective from decline in cognitive performance. These findings have implications for clinical practice. Early neuropsychological surveillance coupled with early assessment and remedial programmes will provide avenues for enhancing the quality of life of adults living with SCD in Ghana.

Does Socio-Economic Status Have Different Impact on Fluid and Crystallized Abilities? Comparing Scores on Raven's Progressive Matrices, Kaufman Assessment Battery for Children II Story Completion and Kilifi Naming Test Among Children in Ghana.

Current literature shows an association between intelligence and socio-cultural or socio-economic factors. The available evidence supports a stronger effect of exogenous factors on measures of crystalized intelligence than on fluid intelligence. Despite this, the sources of variability in fluid and crystalized intelligence have not been explored adequately in intelligence research. The purpose of this study was to compare performance on tests that measure fluid and crystallized intelligence among children selected from public and private schools in Ghana. We tested the assumption that socio-economic status (SES) will have a stronger effect on tests that measure crystallized intelligence than on fluid intelligence. We selected 185 children between 6 and 12 years from private and public schools, and used inclusion in a private or public school as a proxy for SES. We administered the Raven's Coloured Progressive Matrices (RCPM), a fluid intelligence test, the KABC II story completion subtest as a measure of inductive reasoning and crystallized intelligence and the Kilifi Naming Test, a verbal ability measure designed to minimize the effect of school on vocabulary. The results showed age-related improvement in scores on all three tests with effect sizes ranging from 0.42 to 0.52. We also found significant effect for type of school on all the tests with effect sizes ranging from 0.37 to 0.66. The results also showed an increasing disparity in performance on the tests favoring children selected from private schools. These suggest that fluid and crystalized intelligence are affected by socioeconomic factors. The results also showed that SES factors tend to affect crystallized ability more than it affects fluid ability. The results are discussed in the context of differences in socioeconomic resources available to children such as quality of education in low- and middle-income countries.

Examining relations between performance on non-verbal executive function and verbal self-regulation tasks in demographically-diverse populations.

Self-regulation is a widely studied construct, generally assumed to be cognitively supported by executive functions (EFs). There is a lack of clarity and consensus over the roles of specific components of EFs in self-regulation. The current study examines the relations between performance on (a) a self-regulation task (Heads, Toes, Knees Shoulders Task) and (b) two EF tasks (Knox Cube and Beads Tasks) that measure different components of updating: working memory and short-term memory, respectively. We compared 107 8- to 13-year-old children (64 females) across demographically-diverse populations in four low and middle-income countries, including: Tanna, Vanuatu; Keningau, Malaysia; Saltpond, Ghana; and Natal, Brazil. The communities we studied vary in market integration/urbanicity as well as level of access, structure, and quality of schooling. We found that performance on the visuospatial working memory task (Knox Cube) and the visuospatial short-term memory task (Beads) are each independently associated with performance on the self-regulation task, even when controlling for schooling and location effects. These effects were robust across demographically-diverse populations of children in low-and middle-income countries. We conclude that this study found evidence supporting visuospatial working memory and visuospatial short-term memory as distinct cognitive processes which each support the development of self-regulation.

Validation of the Suicidal Behaviors Questionnaire-Revised in adolescents in Ghana.

BACKGROUND: According to the World Health Organization, 85% of global suicides occur in low- and middle-income countries (LMICs). A major factor contributing to the alarming rates of suicides in LMIC is the unavailability of standardized and validated screening measures to screen and identify individuals at heightened risk of suicidal tendencies for early intervention. AIM: To investigate the factorial validity, construct validity and gender invariance of the Suicidal Behavior Questionnaire-Revised (SBQ-R). METHODS: A cross-sectional self-report methodology was employed to gather data from 553 adolescents (average age = 16.85; girls = 322) in Ghana. RESULTS: The result of a multi-group confirmatory factor analysis supported a unidimensional structure of the SBQ-R that did not differ for boys and girls. The SBQ-R demonstrated construct validity for boys and girls by correlating significantly although moderately with measures of depression, anxiety and mental wellbeing. CONCLUSION: The findings of this preliminary study suggest that the SBQ-R can be administered as a valid screening measure for adolescents at high risk for suicide for further assessment and intervention planning in Ghana, regardless of gender. Additionally, the study contributes to the literature on the universality and assessment of suicidal behaviors using SBQ-R.

The multifaceted care-seeking practices among caregivers of children with cerebral palsy: Perspectives from mothers and providers in Ghana.

BACKGROUND: Research on cerebral palsy (CP) has lacked emphasis on knowledge and treatment practices among caregivers, particularly in low- and middle-income countries where socio-cultural contexts encourage a variety of treatment alternatives. In this study, we explored the beliefs and experiences that motivate care-seeking practices among caregivers of children with CP in Ghana. METHODS: Semi-structured interviews were conducted with 25 caregivers, 10 medical providers, and 5 alternative providers in the Greater Accra Region. Participant interviews were analyzed using principles adapted from grounded theory. A conceptual model was constructed to illustrate salient patterns and motivational factors influencing care-seeking practices. RESULTS: Participants' experiences showed that caregivers initially sought physiotherapy and prescription medications from medical providers. Many of them then transitioned to alternative methods to search for a cure or address specific CP symptoms. Over time, most caregivers discontinued both medical and alternative care in favor of at-home treatment. A few withdrew completely from all forms of care. Cost of treatment, caregiver burden, and stigma strongly inhibited care-seeking outside the home. CONCLUSION: Although caregivers were open to exploring a variety of treatment options, at-home treatment was preferred by long-time caregivers for its convenience, low cost, and adaptability to patient and caregiver needs.

Validation of the multidimensional WHOQOL-OLD in Ghana: A study among population-based healthy adults in three ethnically different districts.

OBJECTIVES: Study of well-being of older adults, a rapidly growing demographic group in sub-Saharan Africa, depends on well-validated tools like the WHOQOL-OLD. This scale has been tested on different populations with reasonable validity results but has limited application in Africa. The specific goal of this paper was to examine the factor structure of the WHOQOL-OLD translated into three Ghanaian languages: Ga, Akan, and Kasem. We also tested group invariance for sex and for type of community (distinguished by ethnicity/language). METHODS: We interviewed 353 older adults aged 60 years and above, selected from three ethnically and linguistically different communities. Using a cross-sectional design, we used purpose and convenience methods to select participants in three geographically and ethnically distinct communities. Each community was made up of selected rural, peri-urban, and urban communities in Ghana. The questionnaire was translated into three languages and administered to each respondent. RESULTS: The results showed moderate to high internal consistency coefficient and factorial validity for the scale. Using confirmatory factor analysis, we found that the results supported a multidimensional structure of the WHOQOL-OLD and that it did not differ for males and females, neither did it differ for different ethnic/linguistic groups. CONCLUSIONS: We conclude that the translated versions of the measure are adequate tools for evaluation of quality of life of older adults among the respective ethnic groups studied in Ghana. These results will also enable comparison of quality of life between older adults in Ghana and in other cultures.

Latent structure of psychotic-like experiences in adolescents: Evidence from a multi-method taxometric study of a school-based sample in Ghana.

Psychotic-like experiences (PLEs) are subclinical psychotic symptoms that occur outside the context of sleep or are unrelated to drug use. PLEs of varying severity are reportedly very common in adolescence. However, there are concerns about whether the structure of PLEs among adolescents is latently dimensional or categorical ("taxonic"). The current study investigates the latent structure of PLEs in 1,886 adolescents recruited from senior high schools in Ghana. Four multivariate taxometric procedures (MAMBAC, MAXEIG, l-Mode and MAXSLOPE) were applied to analyze the data. Across the taxometric procedures, there was evidence that a dimensional structure underpins positive PLEs, negative PLEs and a combination of positive and negative PLEs. The findings suggest that PLEs are distributed in the adolescent population at differing degrees/severity and that evidence of discontinuity between milder and more severe PLEs is non-existent. The findings highlight the importance of incorporating a dimensional assessment of PLEs into the existing categorical approach so that differences between people can been seen as quantitative variations along the PLEs continuum.

Perceptions of the appropriate response to norm violation in 57 societies.

Norm enforcement may be important for resolving conflicts and promoting cooperation. However, little is known about how preferred responses to norm violations vary across cultures and across domains. In a preregistered study of 57 countries (using convenience samples of 22,863 students and non-students), we measured perceptions of the appropriateness of various responses to a violation of a cooperative norm and to atypical social behaviors. Our findings highlight both cultural universals and cultural variation. We find a universal negative relation between appropriateness ratings of norm violations and appropriateness ratings of responses in the form of confrontation, social ostracism and gossip. Moreover, we find the country variation in the appropriateness of sanctions to be consistent across different norm violations but not across different sanctions. Specifically, in those countries where use of physical confrontation and social ostracism is rated as less appropriate, gossip is rated as more appropriate.

Depressive symptomatology in adolescents in Ghana: Examination of psychometric properties of the Patient Health Questionnaire-9.

BACKGROUND: The Patient Health Questionnaire (PHQ-9) has been used extensively in research and clinical settings. However, there is limited information regarding the psychometric properties of the PHQ-9 among adolescents, particularly in sub-Saharan Africa. METHODS: Data were collected from 553 adolescents (girls = 322, 58.1%) using a cross-sectional survey design to investigate the factorial validity, construct validity and internal consistency of the PHQ-9 in Ghana. RESULTS: Confirmatory factor analysis (CFA) and multi-group CFA support a one-factor structure of the PHQ-9 that was invariant across gender. The PHQ-9 correlates significantly with measures of anxiety, depression, mental wellbeing, and suicidal behavior. The internal consistency of the PHQ-9 was 0.71. LIMITATION: The study did not include a gold standard measure of depression to assess the diagnostic properties (e.g., sensitivity and specificity) of the PHQ-9. CONCLUSION: The results suggest that major depressive disorder, measured by the PHQ-9, is a homogeneous construct across gender and that the PHQ-9 can be used to screen for depressive symptoms in adolescent boys and girls in Ghana.

Sociodemographic correlates of depressive symptoms: a cross-sectional analytic study among healthy urban Ghanaian women.

BACKGROUND: Studies on healthy individuals that show minor signs of distress and depression-but that are not significant enough to be debilitating or to report to the hospital for treatment-are rare. Our primary objective was to measure the prevalence of depressive symptoms and sociodemographic correlates among healthy women 18 years and above in urban Accra, Ghana. METHOD: We used secondary data from the Women's Health Study of Accra, Wave 1 (WHSA-1), a large scale, analytic, cross-sectional study conducted in Accra, Ghana involving 3183 women. The presence or absence of depressive symptoms within the past 30 days was estimated from the average score on three common symptoms of depression: sleep, anxiety, and sadness. The explanatory variables were age-group, socioeconomic level, marital status, ethnicity, religion, education, employment, and parity. Frequencies and means were used to summarize categorical and continuous variables, respectively. Logistic regression analyses were employed to determine the predictors of depressive symptoms. RESULTS: The prevalence of depressive symptoms within the previous 30 days was 26.5% (95% CI: 25.0-28.1). Women 55 years and older were more likely than women between the ages of 18 and 24 to experience depressive symptoms (AOR 2.8, 95% CI: 2.0-4.0, p < 0.001), whilst women between the ages of 35 and 54 were 1.95 times more likely than women between the ages of 18 and 24 to experience depression (AOR 1.95, 95% CI: 1.40-2.70, p < 0.001). Self-employed women were less likely to report depressive symptoms compared to the unemployed (AOR 0.70, 95% CI: 0.56-0.87, p < 0.01). Akans were less likely to experience depressive symptoms compared to Ga women (AOR 0.75, 95% CI: 0.61-0.92, p < 0.01). Non-orthodox Christians were more likely to report depressive symptoms compared to Orthodox Christians (AOR 1.32, 95% CI: 1.09-1.60, p < 0.01). CONCLUSION: The prevalence of symptoms of depression among healthy urban Ghanaian women is high. Older women, those with low education, and unemployed women appear to be at higher risk for depression and therefore should be targeted for interventions. Groups at risk for depression-especially older adults or individuals under economic strain-should be targeted for mood assessment as part of routine medical care.

Can we measure cognitive constructs consistently within and across cultures? Evidence from a test battery in Bangladesh, Ghana, and Tanzania.

We developed a test battery for use among children in Bangladesh, Ghana, and Tanzania, assessing general intelligence, executive functioning, and school achievement. The instruments were drawn from previously published materials and tests. The instruments were adapted and translated in a systematic way to meet the needs of the three assessment contexts. The instruments were administered by a total of 43 trained assessors to 786 children in Bangladesh, Ghana, and Tanzania with a mean age of about 13 years (range: 7-18 years). The battery provides a psychometrically solid basis for evaluating intervention studies in multiple settings. Within-group variation was adequate in each group. The expected positive correlations between test performance and age were found and reliability indices yielded adequate values. A confirmatory factor analysis (not including the literacy and numeracy tests) showed a good fit for a model, merging the intelligence and executive tests in a single factor labeled general intelligence. Measurement weights invariance was found, supporting conceptual equivalence across the three country groups, but not supporting full score comparability across the three countries.