Application of livelihood vulnerability index in assessing smallholder maize farming households' vulnerability to climate change in Brong-Ahafo region of Ghana

Climate change is adversely affecting smallholder farming households in Africa and in particular in Ghana because their activity depends on climate-regulated water resources. This study examined the vulnerability of smallholder maize farming households to climate change in the Brong-Ahafo region of Ghana by employing the Livelihood Vulnerability Index with particular emphasis on access to and utilization of water resources. The primary data were based on 150 maize farming households, complemented by secondary data on rainfall and temperature over the period 1983–2013. To assess the climate change effects and related vulnerability, a comparative analysis was performed for the Wenchi and Techiman municipalities in the Brong-Ahafo region. The empirical results revealed that farming households in Wenchi municipality were more vulnerable to climate change and weather variability in terms of food, water, and health than those in Techiman municipality. Furthermore, farming households in Wenchi municipality were more vulnerable in terms of adaptive capacity, taking into account the socio-demographic aspects, social networks, and livelihoods of households in the municipality than those in Techiman municipality. These results have implications for the initiation and implementation of climate change adaptation and household resilience projects by the government, donor agencies, and other related organizations in the two municipalities in the region. Keywords: climate change, Ghana, households, livelihood vulnerability, water resource

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways