Health and well-being of homeless youth in Ghana.

Ph. D. University of KwaZulu-Natal, Durban 2015.Background: Homeless youth have been described as being resilient, and vulnerable to poor mental and behavioural health. However, literature on factors promoting resilience of these homeless youth in an African context, especially in Ghana, is scarce. The main aim of the present study was to examine the mental and behavioural health and well-being of homeless youth and the protective factors that could be strengthened to promote their mental health and reduce risky health related behaviours. Specifically this doctoral thesis investigated: 1) factors fostering resilience among homeless youth, 2) the experiences of homeless youth in relation to their health and well-being, 3) the validation of the factor structure of Connor-Davidson Resilience Scale (CD-RISC), 4) the prevalence of health risk behaviours and status of psychological well-being, and 5) the relationship between resilience and health risk behaviours among homeless youth in Ghana. Method: An exploratory mixed method approach was adopted in which qualitative data was first collected followed by a quantitative survey. For the qualitative study a purposive sample of 16 homeless youth from the Central Business District of Accra were interviewed using a semi-structured interview schedule. A cross-sectional study with an interviewer-administered questionnaire was used to assess the mental health variables from a relatively large sample of 227 conveniently selected homeless youth. The participants were between the ages of 9-19 years, and had lived on the street for a period of between 6 months to 8 years. Interpretive Phenomenological Analysis (IPA) was used to analyse the interview transcripts in the qualitative study whilst exploratory factor analysis, One-Way ANOVA, independent samples t-tests, Chi-Square tests for independence, Pearson- moment correlation coefficient, standard multiple regression and logistic regression models were used to analyse the quantitative data. Data collection lasted for 8 and 12 weeks for the qualitative and quantitative phases of the study respectively. Results: The qualitative results showed that strong religious beliefs, engagement in meaningful activities, peer group support, adherence to cultural norms and support from community-based organizations were important factors that promote resilience among participants. The quantitative results showed that participants exhibited poor mental health with high levels of psychological distress, substance use and suicidal ideation. Clustering of health risk behaviours was found in this study among homeless youth who were using substances and engaging in unprotected sex with multiple sexual partners. Some evidence for the engagement in survival sex was also found. Overall poor psychological functioning was predicted by experiences of perceived stigmatization and discrimination, self-stigma, suicidal ideation and exposure to violence. The results also showed that perceived resilience served as a protective factor for suicidal ideation and having multiple sexual lifetime partners, suggesting that youth with higher perceived resilience were less likely to engage in health risk behaviours. Conclusion: These findings seem to suggest that homeless youth are resilient, but nevertheless are susceptible to various mental health problems, with substance use acting as a gateway for sexual risk behaviours. Development of multilevel prevention interventions are recommended to build resilience in youth through access to psychological counselling and to develop better coping strategies at the individual level; facilitate health enhancing social networks that provide homeless youth with an alternative network to that of gains in social support at the interpersonal level and to address the social determinants of poor mental health at community and societal levels

Identity: Globalization, culture and psychological functioning

This paper examines the influence of globalization on psychological functioning. It noted that globalization is somehow a vital step toward both a more stable world and better lives for people in it. However, human lives are increasingly being challenged and integrated into larger global networks of relationships. The forces of globalization are taxing the youth, families, and cultural systems worldwide. All social systems are contaminated by the need to borrow values, morals, skills, and competencies from the next regions or nations. The process of globalization and its attendant consequences may lead to a stripping away of culture identity. It will lead to a break down in social interaction within a local context, a vital means that used to build a great sense of cultural identity and belongingness. This is because globalization is speeding up social and cultural processes such that time and space are no longer constrain on human activities. Conditions and social interactions are now organized so as to connect presence and absent others. Then also most people in the world now develop a bicultural identity, in which part of their identity is rooted in their local culture while another part stems from an awareness of their relation to the global culture. Furthermore, there is pervasiveness of identity confusion as local cultures change in response to globalization, some young people find themselves at home in neither the local culture nor the global cultur

Cultural adaptation of condom use self efficacy scale in Ghana

Accurate assessment of self-reports of sexual behaviours are vital to the evaluation of HIV prevention and family planning interventions. This investigation was to determine the cross-cultural suitability of the Condom Use Self Efficacy Scale (CUSES) for Ghana. A survey using a sample of 520 aged 17 to 32 years from Ghana completed the anonymous scale. A Principal Component Analysis identified a 14 item scale with four reliable factors labelled Appropriation (Cronbach alpha=.85), Assertive (Cronbach alpha=.90), Pleasure and Intoxicant (Cronbach alpha=.83), and STDs (Cronbach alpha=.81) that altogether explained 73.72% of total variance. The scale correlated well with a measure of actual condom use (r=.73), indicating evidence of construct validity. The factor loadings were similar to the original scale but not identical suggesting relevant cultural variations. The study therefore cautioned researchers against the use of the original CUSES without validation in African settings and context

The interactive effect of gender, residence, and socioeconomic status on early sexual debut among sexually active young adults in Ghana

Aim The objective of this study was to examine the interactive effect of gender, rural–urban residence, and socioeconomic status on early sexual debut among young adults in Ghana. Methods The study used the 2014 Ghana Demographic and Health Survey with a sample of 2746 sexually active youth (males = 670 and females = 2076) aged 15–24. We used multivariate logistic regression to analyse the data. Results Our results showed that female youth in urban areas and those from the wealthiest households were less likely to initiate early sexual debut. Additionally, youth resident in urban areas from rich households are less likely to initiate early debut. However, a 3-way interactive effective revealed that female youth resident in urban areas from rich households were found to be more likely to initiate early debut. Conclusion Our findings underscores that gender-based sexual and reproductive health interventions and programmes may be more appropriate for adolescent females in rich households living in urban areas. These intervention should reach these teenagers before they start engaging in sexual intercourse

The Influence of Apparent Temperature on Mortality in the Kintampo Health and Demographic Surveillance Area in the Middle Belt of Ghana: A Retrospective Time-Series Analysis.

Globally, studies have shown that diurnal changes in weather conditions and extreme weather events have a profound effect on mortality. Here, we assessed the effect of apparent temperature on all-cause mortality and the modifying effect of sex on the apparent temperature-mortality relationship using mortality and weather data archived over an eleven-year period. An overdispersed Poisson regression and distributed lag nonlinear models were used for this analysis. With these models, we analysed the relative risk of mortality at different temperature values over a 10-day lag period. By and large, we observed a nonlinear association between mean daily apparent temperature and all-cause mortality. An assessment of different temperature values over a 10-day lag period showed an increased risk of death at the lowest apparent temperature (18°C) from lag 2 to 4 with the highest relative risk of mortality (RR = 1.61, 95% CI: 1.2, 2.15, p value = 0.001) occurring three days after exposure. The relative risk of death also varied between males (RR = 0.31, 95% CI: 0.10, 0.94) and females (RR = 4.88, 95% CI: 1.40, 16.99) by apparent temperature and lag. On the whole, males are sensitive to both temperature extremes whilst females are more vulnerable to low temperature-related mortality. Accordingly, our findings could inform efforts at reducing temperature-related mortality in this context and other settings with similar environmental and demographic characteristics

Determinants of the varied profiles of Plasmodium falciparum infections among infants living in Kintampo, Ghana.

BACKGROUND: Understanding why some infants tolerate infections, remaining asymptomatic while others succumb to repeated symptomatic malaria is beneficial for studies of naturally acquired immunity and can guide control interventions. This study compared demographic, host and maternal factors associated with being either parasite negative or having asymptomatic infections versus developing symptomatic malaria in the first year of life. METHODS: A birth cohort (n = 1264) was monitored longitudinally over two years for malaria infections in Kintampo, Ghana. Symptomatic and asymptomatic infections were detected actively through monthly home visits, complemented by passive case detection. Light microscopy was used to detect parasitaemia. Based on data from a minimum of eight monthly visits within the first year of life, infants were classified into one of four groups: "parasite negative", "only-asymptomatic", "only-symptomatic" or "alternating" i.e., sometimes symptomatic and other times asymptomatic. The host and maternal characteristics and demographic factors in relation to these four groups were compared. RESULTS: The parasite negative group formed 36% of the cohort, whilst the only-symptomatic were 35%. The alternating group were 22% and the only-asymptomatic were 7% of the cohort. There were significant associations between residence, socio-economic status (SES), parity, IPTp doses, delivery place of infant and having or not having malaria parasites. Maternal factors such as early commencement and frequency of ante-natal care (ANC) were significantly higher in the parasite negative group compared to all others. ITN use in pregnancy increased the odds of infant having only asymptomatic infections ("protected against disease"). Placental malaria was more common in the groups of infants with symptomatic malaria. Urban residence was significantly higher in the parasite negative group, while birth in the malaria transmission season were significantly more common in the alternating and parasite negative groups. Risk factors for infants with symptomatic malaria included low SES, birth in private maternity homes, sickle cell normal variant, lower MUAC, reported intake of anti-malarials and increased morbidity before the first microscopic infection was detected. CONCLUSION: Strengthening ANC by encouraging early and regular attendance, the use of IPTp, maternal bed nets and improving the nourishment of infants help reduce the frequency of symptomatic malaria over the first year of life

Open defecation and attainment of Sustainable Development Goal Six: evidence from Kintampo Surveillance System, Ghana.

OBJECTIVE: This study examined whether the open-defecation (OD) free target is achievable by 2030. DESIGN: Longitudinal study. SETTING: Seven sub-Districts of Kintampo North Municipal, and five sub-Districts of Kintampo South District. DATA SOURCE: Kintampo health and demographic surveillance system PARTICIPANTS: Data was collected from household heads or their representatives over a 12-year period from 2005 to 2016. MAIN OUTCOME: Open-defecation and attainment of OD free by 2030. RESULTS: In an exploratory analysis, the correlation between the total number of households, year, and total number of OD households was obtained. The average percentage yearly increase or decrease in OD was computed and used to project the percentage of OD for the years 2020, 2025 and 2030. In addition, geo-spatial technology was used to visualize variability in OD across the twelve sub-Districts. The results showed that the OD free target is not achievable in 2030 or even if the current trend continues. In 2016, 44.2 per cent of the 31,571 households defecated openly. In six out of the 12 sub-Districts, more than half of the households openly defecated. Four out of these six sub-Districts were in the Kintampo North Municipality.Conclusion: The 2030 OD free target is not achievable in the Kintampo districts of Ghana if the current trend continues

Utilization of the national cluster of district health information system for health service decision-making at the district, sub-district and community levels in selected districts of the Brong Ahafo region in Ghana.

BACKGROUND: There is growing interest in the use of reliable evidence for health decision-making among low-and middle-income countries. Ghana has deployed DHIMS2 to replace the previously existing manual data harmonization processes. METHODS: This cross-sectional study was conducted in 12 districts comprising 12 district directorates, 10 district hospitals, 29 sub-district health centers, and 38 community health facilities in the Brong-Ahafo Region. Data collection tools were developed based on the Measure Evaluate assessment tools designed for evaluating the performance of routine information systems management tools. Utilization was assessed based on documented evidence and data was analyzed using STATA version 14. RESULTS: Although 93% of the health facilities studied submitted data unto the DHIMS2 platform, evidence suggested low use of this data in decision-making, particularly at the community level facilities where only 26% of the facilities used data from DHIMS2 to inform annual action plans and even less than 20% examined findings and issued directives for action. At the district level, 58% issued directives based on DHIMS2 information, 50% used DHIMS2 information for Advocacy purposes and 58% gave feedback reports based on DHIMS2 data for action. Functional computers were lacking across all facilities. CONCLUSIONS: Activities relating to the use of DHIMS2 information skew towards data quality checking with less focus on examining findings, making comparisons, and taking action-based decisions from findings and comparisons. Improving factors like internet access, availability of functional ICTs, frequency of supervisory visits, staff training and the provision of training manuals may facilitate the use of DHIMS2 in decision-making at all levels of the district health system

Mental Toughness in South African Youth: Relationships With Forgivingness and Attitudes Towards Risk

Young people are particularly vulnerable to health risk behaviors and interpersonal violence, stimulating scholars’ attention towards identifying factors that may reduce the likelihood that these actions will occur. Associated with positive outcomes in a variety of domains, mental toughness in young people might protect them from engaging in potentially deleterious interpersonal or health-risk behaviors, while potentially promoting positive psychological behaviors. Within this framework, the present study investigated the relationships between mental toughness, attitudes towards physical and psychological risk-taking, and trait forgiveness in a sample of 123 (males = 54, females = 69) South African youth (M age = 23.97 years, SD = 4.46). Univariate and multivariate analyses indicated higher levels of mental toughness were associated with being more forgiving, (η2pηp2 = .036), perceiving physical risk-taking more positively (η2pηp2 = .062), but having more negative attitudes towards psychological risk-taking (η2pηp2 = .036). These findings give credence to mental toughness as a psychological characteristic involved in youth risk-taking perceptions and interpersonal functioning. Future research might explore the integration of mental toughness into the development of future youth risk behavior interventions