Ageing, urban marginality, and health in Ghana

The world’s population is rapidly ageing. Global estimates for the next three decades indicate a two-fold increase in the population of older adults aged ≥60 years. Nearly 80% of this growth will occur in low and middle-income countries in Asia and sub-Saharan Africa, where population health is already under threat from poverty, degraded environments, and deficient healthcare systems. Although the world’s poorest region, sub-Saharan Africa, ironically, will witness the fastest growth in older populations, rising by 64% over the next 15 years. Indications are that the majority of this population will live in resource-poor settings, characterized by deficient housing and neighbourhood conditions. Yet, very little research has systematically examined the health and wellbeing of older adults in such settings. Drawing on the ecological theory of ageing, the present study explores the living conditions and quality of life of elderly slum dwellers in Ghana, a sub-Saharan African country with a growing population of older adults. Data collection was undertaken in two phases in two environmentally contrasting neighbourhoods in Accra, Ghana. In Phase 1, we carried out a cross-sectional survey of older adults in a slum community (n = 302) and a non-slum neighbourhood (n = 301), using the World Health Organization quality of life assessment tool (WHOQoL-BREF). The survey data were complemented in Phase 2 with qualitative interviews involving a sample of community dwelling older adults (N = 30), health service providers (N = 5), community leaders (N = 2), and policymakers (N = 5). Preliminary analysis of the survey data revealed statistically significant differences in the social and environment domains of quality of life, while the qualitative data identified multiple health barriers and facilitators in the two neighbourhoods. Insights from the research are expected to inform health and social interventions for older slum dwellers in Ghana

Improving COVID-19 vaccine uptake among Black populations : a systematic review of strategies

Given the growing body of evidence on COVID-19 vaccine hesitancy among Black populations, the aim of this systematic review was to identify the interventions and strategies used to improve COVID-19 vaccine confidence and uptake among Black populations globally. To identify relevant studies, we conducted a systematic review of the literature based on a systematic search of 10 electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Scopus, Cochrane Library, Web of Science, Sociological Abstracts, Dissertations and Theses Global, and SocINDEX. We screened a total of 1728 records and included 14 peer-reviewed interventional studies that were conducted to address COVID-19 vaccine hesitancy among Black populations. A critical appraisal of the included studies was performed using the Newcastle-Ottawa Quality Assessment Scale. The intervention strategies for increasing COVID-19 vaccine uptake were synthesized into three major categories: communication and information-based interventions, mandate-based interventions, and incentive-based interventions. Interventions that incorporated communication, community engagement, and culturally inclusive resources significantly improved vaccine uptake among Black populations, while incentive- and mandate-based interventions had less impact. Overall, this systematic review revealed that consideration of the sociocultural, historical, and political contexts of Black populations is important, but tailored interventions that integrate culture-affirming strategies are more likely to decrease COVID-19 vaccine hesitancy and increase uptake among Black populations

Black Health in Canada: Protocol for a Scoping Review

BackgroundBlack Canadians experience poor health care, poor health outcomes, and a greater burden of health inequalities, much of which is rooted in the unequal distribution of social determinants of health. Despite Canada’s emphasis on social inclusion, Canada’s Black population faces substantial social inequities that affect their health and well-being. These disparities may specifically be attributed to racial discrimination, immigration status, precarious housing, underemployment, and increased poverty among Black Canadians. ObjectiveThis paper describes a protocol for a scoping review that aims to understand the range and nature of research conducted on the health of Black Canadians as well as the gaps in this literature. MethodsArksey and O'Malley’s methodological framework guided the conduct of the scoping review. We searched electronic databases (CINAHL, Embase, Global Health, MEDLINE, PsycINFO, Scopus, Sociological Abstracts, and Web of Science) and grey literature sources for peer-reviewed articles and grey reports on the health of Black Canadians. Six reviewers independently screened the abstracts and full text of studies to determine eligibility for inclusion. According to the PRISMA-ScR (Preferred Reporting Items for Systematics Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, the findings will be synthesized quantitatively and qualitatively through thematic analysis. ResultsTitle, abstract, and full-text screening concluded in October 2022. Data collection is in progress and is expected to be completed by April 2023. Data analysis and drafting of the manuscript will be done thereafter. Findings from the scoping review are expected to be provided for peer review in 2023. ConclusionsThis review will collect important data and evidence related to the health (mental, reproductive, and sexual; social determinants of health) of the Black population in Canada. The findings could help identify existing gaps in the health of Black individuals in Canada and inform future research paradigms. The findings will further inform the development of a knowledge hub on Black Canadians’ health. International Registered Report Identifier (IRRID)PRR1-10.2196/4221

Health, quality of life, and wellbeing of older slum dwellers in sub-Saharan Africa: A scoping review

A growing population of older adults resides in sub-Saharan Africa’s urban slums. Although environmental conditions in slums are adversarial, there is limited knowledge on the wellbeing of older adults residing in these settings. This review sought to understand the scope, extent, and nature of current research on the health and wellbeing of older slum dwellers in sub-Saharan Africa. We searched 8 bibliographic databases for studies examining the health and wellbeing of older slum dwellers in the region. We also completed a grey literature search. The literature search together yielded 3,388 records, of which we selected 25 for review following a rigorous screening process. The included studies covered a variety of health issues of concern to older slum dwellers: (1) disease and injury prevalence; (2) self-assessed health and quality of life status; (3) physical/mental health impairment and disability; (4) healthcare access and utilisation; and (5) sociodemographic disparities in health and wellbeing. The gaps in this literature include a regional bias in research efforts, near absence of non-slum control samples, and limited research on the health impacts of the built environment of slums. Suggestions for future research are presented

The impact of community paramedicine interventions on Transfers from Long Term Care to Emergency Departments: A systematic review

OBJECTIVES: Long term care (LTC) facilities are essential in the provision of daily care needs for older adults experiencing frailty. In times of acute medical distress, LTC residents may require transfer to emergency departments (ED). However, many transfers from the LTC to ED may not be required and residents could instead be treated within LTC utilizing community paramedics (CP). We conducted a systematic review to assess the impact of community paramedicine on the frequency of resident transfer from LTC to ED. METHODS: We searched five electronic databases (Medline, CINAHL, PubMed, Embase, and Cochrane). The search was limited to primary peer-reviewed publications and excluded conference proceedings, review articles, and non-peer review articles. We restricted the search to papers published in English and articles published within the last 30 years. RESULTS: A total of 19,308 titles and abstracts were screened with a total of 181 full text reviews. One study that comprised of 4 articles was included in the review that evaluated the impact of community paramedic interventions in LTC. The study noted a reduction in transfers to the ED attributed to the presence of CP, reducing transports to ED by nearly 30%. CONCLUSIONS: There is a scarcity of research examining the role of CP in LTC. While the current research points towards CP interventions in LTC reducing the number of transfers to ED, further research needs to be conducted on the effectiveness of community paramedicine interventions in improving health outcomes for residence and improving cost efficiency within the health system