Leveraging the potential of wild food for healthy, sustainable, and equitable local food systems: Learning from a transformation lab in the Western Cape region

Food insecurity and diet-related diseases do not only have detrimental efects to human health, but are also underpinned by food systems that are environmentally unsustainable and culturally disconnected. Ensuring access to a healthy, afordable, and sustainable diet is one of the greatest challenges facing many low- and middle-income countries such as South Africa. These challenges in accessing a diverse diet often persist despite biocultural richness. For example, South Africa is globally recognised for its rich biodiversity, an ecologically unrivalled coastline, and a rich body of traditional knowledge amongst wild-food users. In this paper, we explore the potential that coastal wild foods as neglected and underutilised species (NUS) can play in local food systems in South Africa’s Western Cape Province

The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities

The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities

Household economic burden of type-2 diabetes and hypertension comorbidity care in urban-poor Ghana:a mixed methods study

Background: Non-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra. Methods: A convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion. Results: Out of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55–118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden. Conclusion: The economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions

The prevalence and correlates of the double burden of malnutrition among women in Ghana

CITATION: Kushitor, S. B., Owusu, L. & Kushitor, M. K. 2020. The prevalence and correlates of the double burden of malnutrition among women in Ghana. PLoS ONE, 15(12): e0244362, doi:10.1371/journal.pone.0244362.The original publication is available at https://journals.plos.org/plosone/Publication of this article was funded by the Stellenbosch University Open Access FundAnaemia and underweight or overweight/obesity are major public health problems driving maternal and child mortality in low- and middle-income countries. While the burden of these conditions is recognised, the evidence for the co-occurrence of these conditions is fragmented and mixed, especially at the individual level. Further, many studies have focused on families and communities. The different pathways for the occurrence of anaemia and BMI challenges indicate that an individual can potentially live with both conditions and suffer the complications. This study examined the prevalence and factors associated with the co-occurrence of anaemia and BMI challenges among a cohort of women in Ghana. Data from the 2014 Ghana Demographic and Health Survey were used. The sample size was 4 337 women aged 15–49 years who were not pregnant during the survey. Women who suffered simultaneously from underweight or overweight/obesity and anaemia were considered as having the double burden of malnutrition. The data were analysed using descriptive statistics, Chi-square test and logistic regression in STATA. One-fifth of the participants were overweight (21%), 4% were underweight and about one-tenth were obese (12%). The prevalence of anaemia was 41%. Only one in three women had normal weight and was not anaemic (34%). About 14% of the women experienced the double burden of malnutrition. Being overweight and anaemic (57%) was the most common form of this double burden. Age, marital status, parity, and wealth were t key risk factors associated with the double burden of malnutrition. The findings from this study show that women experience multiple nutritional challenges concurrently and that only a few women had healthy nutritional status. This information is particularly important and can be introduced into health education programmes to help address misconceptions about body weight and health.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244362Publisher's versio

Treatment of malaria, hypertension and diabetes by facility characteristics, 2011.

<p>Treatment of malaria, hypertension and diabetes by facility characteristics, 2011.</p

Characteristics of health facities in 2011.

<p>Characteristics of health facities in 2011.</p

Trends in malaria, hypertension and diabetes treatment services at health facilities in Ghana, 2007–2011.

<p>Trends in malaria, hypertension and diabetes treatment services at health facilities in Ghana, 2007–2011.</p

Availability of RDT, glucometer and blood pressure monitor by facility characteristics, 2011.

<p>Availability of RDT, glucometer and blood pressure monitor by facility characteristics, 2011.</p

Hypertension prevalence, awareness, treatment and control in Ghanaian population: Evidence from the Ghana demographic and health survey.

Hypertension is a major cause of cardiovascular disease morbidity and mortality in Ghana. This study examines the prevalence, awareness, treatment and control of hypertension among Ghanaian aged 15-49 years. This cross-sectional study retrieved data from the 2014 Ghana Demographic and Health Survey (GDHS). The sample, comprising of 13,247 respondents aged 15-49 years, was analysed using descriptive statistics, Chi-Square tests, independent sample t-tests and binary logistic regressions. The overall prevalence of hypertension was 13.0% (12.1% for males and 13.4% for females). Among respondents who had hypertension, 45.6% were aware of their hypertension status; 40.5% were treating the condition while 23.8% had their blood pressure controlled (BP <140/90 mmHg). Socio-economic and demographic factors, health insurance coverage and recent visit to health facilities played significant roles in hypertension prevalence and awareness. While region of residence and health facility visits were predictors of hypertension treatment, age and region of residence predicted hypertension control in this population. This study suggests that in order to address the increasing burden of hypertension in Ghana, there should be an expansion of the National Health Insurance Scheme and development of measures to reduce health inequities. Also, some of the determining factors such as age, gender, marital status are similar to other cultures; therefore, existing interventions from those cultures could be adapted in addressing hypertension prevalence, awareness, treatment and control in Ghana