Determinants of obesity in Ghana

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonBackground There is a limited understanding of factors determining obesity in Sub-Saharan Africa, particularly Ghana. This thesis, therefore, aimed to contribute to knowledge on obesity determinants in Ghana to guide evidence-informed obesity policies. Methods Multiple approaches were used in this study. These approaches included a literature review, two stakeholder engagements, a survey, Geospatial Information Systems (GIS) techniques and regression analyses. First, a literature review was conducted to identify literature gaps on determinants of obesity to direct this study. Then, key stakeholders were engaged to prioritise the literature gaps whose exploration was critical for obesity policies in Ghana. After, a multi-stage sampling approach was used to generate a current obesity dataset to address the stakeholder-prioritised research questions. Geospatial Information Systems (GIS) techniques and regression analyses were then conducted to identify single and multi-level determinants of obesity in Ghana. Finally, the stakeholders were engaged again to explore interventions to tackle the identified obesity determinants. Results The literature review showed gaps in multi-level determinants of obesity, the interrelationship between obesity and other lifestyle behaviours and the relationship between religion, culture, and obesity. The analysis of these gaps showed that a unit increase in the number of fast-food joints and supermarkets within a shorter radius (2km & 5km) increases the odds of obesity in Ghana. Additionally, being a Muslim (correlation coefficient (r) = 0.45) or Ga (r = 0.39) is associated with a 11% and 9% increased risk of obesity, respectively. Diet and physical activity are also interconnected lifestyle determinants of obesity. These lifestyle factors are determined by factors like sex, income status and perceptions. For example, individuals who perceive obesity as an inherited condition are less likely to consume a healthy diet (r = -0.24 and engage in physical activity (r = -0.29). However, those earning 2,000 Ghana cedis and above are more likely to eat healthily (r = 0.46) and exercise (r = 0.49). Additionally, men are 16% more likely to engage in physical activity and 5% less likely to consume a healthy diet, indicating that the predictors of the lifestyle determinants are comparable but dissimilar in some instances. Finally, the thesis also showed that obesity is prevalent in Ghana (53%), and about 45% of the population are neither physically active nor consume healthy diets. Conclusion Obesity is determined by religion, ethnicity, physical activity & diet, and the local food environment. These determinants could be mitigated by a trade-off between awareness campaigns and economic regulations, like taxation and food subsidies. Therefore, the government of Ghana and other relevant agencies should factor in these determinants and interventions when reviewing and implementing obesity policies in Ghana

Climate-Smart Agricultural Practices in Ghana

The contribution of the agricultural sector to Ghana's economy has been dwindling in relative terms from a high of 39 per cent in 1990s to about 21 per cent in 2014 (ISSER, 2015). This reduction to the sector’s GDP notwithstanding, sector continues to play a major role in the country’s socio-economic growth. However, the sector is threatened by the effects of climate variability and climate change. There are already efforts being made at various levels to address this threat through the adoption and adaption of various technologies and practices. This paper profiles technologies and practices that respond to CSA principles and characteristics in the northern Guinea savannah and Forest agro-ecological zones of Ghana. Two regional workshops were held in Wa and Kumasi for the savannah and forest zones respectively. Over 200 participants consisting of farmers, NGOs, FBOs, MoFA directors and extension workers, traditional rulers, District Chief Executives, Academia and researchers were involved in the technology identification and profiling employing a matrix-ranking tool in the working groups at the various workshops. Participants identified 61 and 21 CSA technologies and practices in the Guinea Savannah and the Forest zones respectively and recommended scaling up of these technologies in the various zones. While the traditional rulers and farmers bemoaned the lack of synergy among the institutions involved in CSA and the lack of policy continuity, policy makers called for strengthening of collaboration between the stakeholders for CSA. The policy and decision makers further called on scientists to make CSA accessible at the farmer level through demonstrations and fact sheets for awareness creation and education and promised to support research and extension with the needed funds. Representatives of Academia and Research on their part pledged solutions that are sustainable and have climate change adaptation and mitigation effects for profit and the well-being of farmers

Scaling up of CSA Platforms at the Subnational (District) Levels in Ghana: a Progressive Achievement of Theghana CCAFS Science-Policy Platform

Globally the picture on climate change and its effects on humanity appear quite disturbing as food systems and consumption patterns are sliding towards low against prediction values. In Ghana population expansion as a driver has quadrupled now and calls for more food and fibre needs than ten decades ago (Karbo et al, 2015). The awareness of climate change on socio-economic development among development workers, scientists and policy decision makers appears high though more attention has been given to the search for biophysical solutions than the policy institutional environment enabling their uptake. The CCAFS programme in West Africa coordinated by ICRISAT, Bamako involving Ghana, Mali and Senegal was able to set up national multi-stakeholder platforms for sharing information on climate change and related policy issues. The platforms also provide a linkage mechanism between research, policy decision makers and community level actors in order to positively influence climate change investments and project trajectory in agriculture with effective adaptive, resilient and mitigation outcomes at the farmer level. The Ghana CCAFS Science –Policy Platform formation preceded with a meeting held in Burkina Faso in 2013 where a three member team from Ghana was involved with subsequent drafting and submission of proposal in request for funding leading to its establishment. The Ghana national climate change science policy platform as a multi-stakeholder institutional innovation came into being in 2013 with the support of CCAFS West Africa, set out to bridge science-policy literacy gap at the national and sub-national levels. In 2014, Ghana through the collaborative efforts of the national Platform implemented CCAFS Flagship4 activities which sought to deepen interaction at all levels. This culminated into the establishment of platforms at Lawra, Jirapa and Nandom districts with the view to strengthen climate change discourse, attitudinal change and actions at that level while maintaining a vibrant functional linkage mechanism with the national platforms for policy influence. An assessment of climate change policy and institutional context by Essegbey 2014, in these three districts, revealed that large gap exists between the national and subnational levels in terms of policy development and dissemination. The report identified weaknesses in harnessing societal grassroots inputs for policy formulation process and lack of awareness and knowledge about the policy especially in the decentralized levels of society in these three districts (Essegbey 2014). This suggests that policy literacy is very low and could pose challenge to effective implementation of the NCCP. The establishment of these platforms were necessary to help bridge the policy literacy gap. Today, these platforms provide soft landing for research activities and projects such ASSAR project, Water and Land Ecosystem project etc. The platforms also provide inputs into the districts level development annual plans. Effective networking with other local and international bodies have also been recognised. This info note seeks to give a process description of the scaling up of district sciencepolicy platforms in Ghana, the structures, the perceptions of the actors with particular reference to the platform, perceived functions, fears and organizational leadership diversities

Systems and Operations of the Ghana Science-Policy Dialogue Platform on Climate Change, Agriculture and Food Security

The threat posed by climate change and its variability within sub-Saharan Africa especially West Africa is compounded by its weak economies and high dependence on Agriculture as a major driver of economic growth. Ghana has since 2010 undertaken several initiatives towards development of comprehensive programmes (strategies) to enhance national adaptation to climate change. Diverse governmental and academic/research institutions, private sector and individuals have initiated programmes and projects aimed at delivering on CSA to enhance livelihoods, increased agricultural production and sustainable socio-economic development. However, the activities of these stakeholders in the climate change arena appeared isolated, disjointed and uncoordinated to reap desired benefits. In response, the CCAFS programme in West Africa coordinated by ICRISAT, Bamako involving Ghana, Mali and Senegal was able to set up national multi-stakeholder platforms for information sharing and learning on climate change and related policy issues. The Ghana CCAFS Science-Policy Dialogue Platform having been operational since November 2012 has wealth of experiences to share. This note is therefore designed to highlight the profile of Ghana’s platform, its structure and composition and the key achievements over the past 4-5 years of existence

Strategies for Gaining and Maintaining Employee Trust in Private and Public Institutions. The Case of University of Derby (UK) and Valley View University (Ghana)

Trust in the relation of the employer to employee is a key determinant to the success of every organization. Several research has been done on this subject matter but little attention is paid to educational instituitions. Therefore, the objective of this research is to identify and examine the strategies for gaining and employee trust in with emphasis on large organizations, and also to determine the impact of employee trust in both private and public educational institutions. Both quantitative and qualitative techniques are deployed to perform analysis on data collected from respondents from University of Derby, United Kingdom; and Valley View University, Ghana. Factors common to both case studies for gaining employee trust are the use of consistent approach, managers been role models, equal treatment of employees, similar work load, and team praise. Some recommendations are made to further improve the work. Keywords: Employee trust, Organizational performance, employee outcomes DOI: 10.7176/EJBM/11-33-09 Publication date: November 30th 201

Scenario-Guided Review of the Ghana Livestock Policy

Climate change impacts are manifesting throughout the world and they are especially significant in developing countries, including Ghana, that are particularly vulnerable. The impacts of climate change are complex and uncertain in nature that the usual conventional planning often falls short to address. In agriculture in particular, planning should be purposively done to effectively address climate change impacts especially for the livestock sub-sector that always seem to be insufficiently catered for. To address the uncertainty of future developments in an adequate way, a methodology that acknowledges the uncertainty and complexity is essential. Scenario-building methodology is a tried-and-tested approach in that regard. It is based on systems science and seeks to recognize and explore uncertainty and complexity in the decision-makers’ context. In multi-stakeholder contexts, exploratory scenarios engage multiple legitimate perspectives involved in framing and addressing unclear challenges related to food security and the environment. This leads to an extensive overview of plausible futures, articulating complex interactions between socio-economic factors, political developments, climate change, and the global context. Policy making needs a methodology that appropriately delivers visionary options. For Ghana’s livestock sub-sector such visionary options are vital. And in order to produce a new and robust version of Ghana’s livestock policy, currently being finalized by the Ministry of Food and Agriculture (MoFA), MoFA in collaboration with the International Crop Research Institute for the Semi-Arid Tropics (ICRISAT), the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS) and the Council for Scientific and Industrial Research (CSIR) has successfully organized a Three-Day Workshop from 13th to 15th July, 2016 at the Forest Hotel. The scenario-guided review workshop was conducted through a participatory approach which brought relevant stakeholders from the Government (MoFA, etc), academia, civil society and the private sector together to review the livestock policy. The CCAFS West Africa scenarios workshops informed the process in Ghana. In order to address specific issues in Ghana, these West Africa scenarios were downscaled and adapted to the level of Ghana by the Ghanaian stakeholders. These downscaled Ghana scenarios were then used for reviewing the livestock policy with the objective to produce a new, robust version in the face of future uncertainty. Dignitaries in attendance were Dr. Kwame Oppong-Anane, the Consultant for the Drafting of the Livestock Policy, who was the chairman for the workshop, Dr. E .K. Adu (Director, CSIR- ARI) who delivered the welcome address, Dr. Victor Agyeman (Director General, CSIR, Ghana), Dr. Robert Zougmore (CCAFS West Africa), and Mr. Kwamena Akorful (Director, APD , MoFA) who each delivered statements. Facilitators for the workshop included Dr. Samuel Partey, Dr. Karbo Naaminong, Dr.George Owusu Essegbey, Mr. Delali Nutsukpo, Mr. Vincent Ansah Botchway, Ms. Mavis Akuffobea and Kingsley Odum Sam who worked under the guidance of CCAFS’ Scenarios technical expert, Dr. Lucas Rutting, based at the Environmental Change Institute of the University of Oxford, UK

Implementation, usage, and effectiveness of Ghana climate change policies: an assessment of the national CSA Action Plan and CSA Investment Framework

" Five years after the adoption of CSA Action Plan, followed by a CSA Investment Framework, it was crucial to assess the level of implementation and usage and draw lessons on the effectiveness of these two policy documents. This study aims to provide a scientific-based assessment of the level of implementation, usage, and effectiveness of the above-mentioned two Ghana climate change policy documents. Due to low awareness of stakeholders, the implementation of the CSA Action Plan and CSA Investment Framework is low (19% of studied districts). The usage of the CSA Action Plan focuses more on crop value chain development followed by livestock and fish value chains. The CSA Investment Framework was used to mobilize resource to develop climate-resilient cropping systems, alternative livelihood systems, post-harvest management, market systems, and water conservation activities. The effectiveness of the CSA Action Plan and CSA Investment Framework depends on the number of target beneficiaries, budget allocation and funds mobilized. Multipurpose policy instruments are critical for bringing about a conducive environment to address climate change and related risks. Increasing awareness of the CSA Action Plan is a key pathway to enhance its usage, implementation and effectiveness across scales. To enable effective use of the CSA Investment Framework, there is a need to enhance the capacity of key stakeholders on the development of bankable proposal

The role of digital surveillance during outbreaks: the Ghana experience from COVID‑19 response

Over the years, Ghana has made notable strides in adopting digital approaches to address societal challenges and meet demands. While the health sector, particularly the disease surveillance structure, has embraced digitization to enhance case detection, reporting, analysis, and information dissemination, critical aspects remain to be addressed. Although the Integrated Disease Surveillance and Response (IDSR) structure has experienced remarkable growth in digitization, certain areas require further attention as was observed during the COVID-19 pandemic. Ghana during the COVID-19 pandemic, recognized the importance of leveraging digital technologies to bolster the public health response. To this end, Ghana implemented various digital surveillance tools to combat the pandemic. These included the “Surveillance Outbreak Response Management and Analysis System (SORMAS)”, the digitalized health declaration form, ArcGIS Survey123, Talkwalker, “Lightwave Health information Management System” (LHIMS), and the “District Health Information Management System (DHIMS)”. These digital systems significantly contributed to the country's success in responding to the COVID-19 pandemic. One key area where digital systems have proved invaluable is in the timely production of daily COVID-19 situational updates. This task would have been arduous and delayed if reliant solely on paper-based forms, which hinder efficient reporting to other levels within the health system. By adopting these digital systems, Ghana has been able to overcome such challenges and provide up-to-date information for making informed public health decisions. This paper attempts to provide an extensive description of the digital systems currently employed to enhance Ghana's paper-based disease surveillance system in the context of its response to COVID-19. The article explores the strengths and challenges or limitations associated with these digital systems for responding to outbreaks, offering valuable lessons that can be learned from their implementation

Epidemiology of malaria among pregnant women during their first antenatal clinic visit in the middle belt of Ghana: a cross sectional study.

BACKGROUND: Malaria during pregnancy may result in unfavourable outcomes in both mothers and their foetuses. This study sought to document the current burden and factors associated with malaria and anaemia among pregnant women attending their first antenatal clinic visit in an area of Ghana with perennial malaria transmission. METHODS: A total of 1655 pregnant women aged 18 years and above with a gestational age of 13-22 weeks, who attended an antenatal care (ANC) clinic for the first time, were consented and enrolled into the study. A structured questionnaire was used to collect socio-demographic and obstetric data and information on use of malaria preventive measures. Venous blood (2 mL) was collected before sulfadoxine-pyrimethamine administration. Malaria parasitaemia and haemoglobin concentration were determined using microscopy and an automated haematology analyser, respectively. Data analysis was carried out using Stata 14. RESULTS: Mean age (SD) and gestational age (SD) of women at enrolment were 27.4 (6.2) years and 16.7 (4.3) weeks, respectively. Overall malaria parasite prevalence was 20.4% (95% CI 18.5-22.4%). Geometric mean parasite density was 442 parasites/µL (95% CI 380-515). Among women with parasitaemia, the proportion of very low (1-199 parasites/µL), low (200-999 parasites/µL), medium (1000-9999 parasites/µL) and high (≥ 10,000 parasites/µL) parasite density were 31.1, 47.0, 18.9, and 3.0%, respectively. Age ≥ 25 years (OR 0.57, 95% CI 0.41-0.79), multigravid (OR 0.50, 95% CI 0.33-0.74), educated to high school level or above (OR 0.53, 95% CI 0.33-0.83) and in household with higher socio-economic status (OR 0.34, 95% CI 0.21-0.54) were associated with a lower risk of malaria parasitaemia. The prevalence of anaemia (< 11.0 g/dL) was 56.0%, and the mean haemoglobin concentration in women with or without parasitaemia was 9.9 g/dL or 10.9 g/dL, respectively. CONCLUSION: One out of five pregnant women attending their first ANC clinic visit in an area of perennial malaria transmission in the middle belt of Ghana had Plasmodium falciparum infection. Majority of the infections were below 1000 parasites/µL and with associated anaemia. There is a need to strengthen existing malaria prevention strategies to prevent unfavourable maternal and fetal birth outcomes in this population