Health-related quality of life among women living with breast cancer in Ghana.

Doctor of Philosophy. University of KwaZulu-Natal, Durban.Background: Health-related quality of life has become an important determinant of the effectiveness of medical treatments among persons living with chronic illnesses including breast cancer. Living with breast cancer is associated with several physical, psychosocial and economic challenges that could negatively impact on the health and wellbeing of women receiving treatment for breast cancer. Breast cancer in the second most diagnosed cancer type among women in Ghana and has several implications for the health of these women due to late diagnosis. However, there is lack of comprehensive social science evidence on the health-related quality of life and its associated factors among women living with breast cancer in Ghana. This study examined the predictors of health-related quality of life among women living with breast cancer and further explored the lived experiences of the women with regards to their challenges, illness representation, coping strategies and healthcare satisfactions. Methods: An explanatory sequential mixed method was employed where quantitative data collection precedes qualitative data collection. For the quantitative phase, a total of 205 women living receiving treatment for breast cancer at a Tertiary Hospital in Ghana were conveniently sampled and administered a set of questionnaires measuring the study variables. For the qualitative phase, a total of 11 women were purposively and conveniently sampled. Individual in-depth interviews were conducted with the participants using a semi-structured interview guide. Descriptive statistics, Pearson Product Moment correlations, multiple regression and mediational analyses using PROCESS were used to analyse the quantitative data whereas the interpretative phenomenological approach was used for the qualitative data analyses. Results: Quantitative results showed that access to health information, health literacy, shared decision making, doctor-patient relationship, social support, having a fighting spirit, the use of cognitive avoidance and fatalistic attitude were significant protective factors for improved quality of life. On the contrary the depression, anxiety, the use of hopeless-helpless coping and anxious preoccupation were significant risk factors for poor quality of life. These predictors had both direct and indirect effects on quality of life among the women through other variables. Findings from the qualitative analyses showed that bio-psychosocio-economic challenges such as the burden of medical treatment, alternative/herbal medicine use and breast cancer stigma were the major lived experiences of the women. There was general inadequate knowledge and understanding of breast cancer. Spirituality, social support, diversion coping and breast cancer self-care practices were identified as the main coping strategies among the participants. There was a varied perception about the satisfaction with interaction and communication with the healthcare professionals. Conclusion: The findings from this study suggest that there are several and complex interlinked challenges faced by women living with breast cancer. These challenges could negatively impact on the health and wellbeing of these women if a holistic approach with professionals from different health disciplines to address their needs. The findings underscore the need for cost-effective cognitive-based psychosocial interventions to deal with the psychosocial challenges which affect their emotional states and ultimately their health-related quality of life

The Influence of Social Support on the Levels of Depression, Anxiety and Stress among Students in Ghana

This study examined the impact of social support from family, friends and significant others on the levels depression, anxiety and stress among undergraduate students of University of Ghana.  A total of one hundred and sixty-five (165) students were sampled from all the levels and were administered with standardized questionnaires measuring social support, depression, anxiety and stress. Results from the analysis using descriptive statistics, regression analysis, independent t-test and MANOVA showed that 57% of the respondents reported mild to extremely severe depression, 84% had mild to extremely severe anxiety whilst 49% reported mild to extremely severe stress. The level of depression was significantly predicted by support from friends and significant others, level of anxiety was not significantly predicted by any form of social support whilst level of stress experienced by students was significantly predicted by social support from family. Further analysis showed that significant sex differences exist in the levels of depression, anxiety and stress. However, academic levels of students had a significant effect on level of depression but not on anxiety and stress. It is concluded that students should be encouraged to make use of their counseling and placement centers and peer counselors to help them deal with their psychological issues. Keywords: Social Support, Depression, Anxiety, Stress, Students, Ghana, Universit

"The angel within the devil": COVID-19 silver linings

Coronavirus disease (COVID-19) has impacted every aspect of human existence in a variety of ways. However, depending on how we interpret the impact of the pandemic, we may either despair or embrace challenges with hope. Several empirical findings and expert opinions have highlighted the significant negative impact of COVID-19 on economy, health and wellbeing, education, ecosystem and governance around the world. Amid all these negative effects on human existence, we claim that there are some silver linings across several domains such as health and wellbeing, education, eco-system and social connectedness, with the main benefit being adherence to public health measures which will be retained beyond the pandemic

Emotional intelligence and personal growth initiative effects on subjective happiness among university students

This study examined emotional intelligence and personal growth initiative influences on the level of subjective happiness among university students in Ghana. Two hundred and sixty undergraduate students were participants (female = 69.8%; mean age = 21.72 years, SD = 3.61 years). They responded to measures of emotional intelligence, personal growth initiative, and subjective happiness. After controlling for their demographic characteristics, and following hierarchical regression analysis, results indicate emotional intelligence and intentional behaviour domain of personal growth to predict students' level of subjective happiness. These findings suggest that students' ability to manage and utilise their emotions, as well as their personal growth initiative contribute significantly to their level of happiness

Nutritional status of school children in the South Tongu District, Ghana

Background: Malnutrition is a major public health problem because of the devastating consequences it has on children, their families, and society at large. Our study, therefore, sought to determine the prevalence of undernutrition and overweight/obesity and its associated factors among children aged 6–12 in the South Tongu District, Ghana. Methods: A school-based cross-sectional study was conducted among 423 school children aged 6–12 years in the South Tongu District of Ghana. A multistage sampling method was employed to recruit the school children for the study. A semi-structured questionnaire was used to collect data from the respondents. We used a dual-purpose (height and weight) measuring scale to obtain the anthropometric data. The World Health Organization’s AnthroPlus software was used to generate the z-scores for determining the nutritional status. Percentages were used to present the results of the prevalence of undernutrition and overweight/obesity among school children. Bivariate and multivariable binary logistic regression were used to examine the factors associated with undernutrition and overweight/obesity among school children. The results were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), with their 95% confidence interval (CI). Statistical significance was set at p<0.05. Stata 16.0 was used to perform the analyses. Results: The overall prevalence of undernutrition and overweight/obesity were 21.5% (CI = 17.7, 25.7) and 24.8% (CI = 20.8, 29.2), respectively. Specifically, the prevalence of stunting, thinness, underweight, overweight, and obesity were 10.4%, 12.1%, 3.8%, 11.1%, and 13.7%, respectively. School children whose household used water from non-portable sources were more likely to be undernourished [AOR = 2.03, 95% CI = 1.13, 3.63]. The odds of overweight/obesity was higher among school children whose mothers had attained formal education [AOR = 2.10, 95% CI = 1.09, 4.06], those who consumed beverages between meals per day [AOR = 1.87, CI = 1.08, 3.24], and those who had adequate dietary diversity score [AOR = 1.65, 95% CI = 1.02, 2.67]. School children aged 10–12 were less likely to be overweight/obese [AOR = 0.58, 95% CI = 0.35, 0.94] compared to those aged 6–9. Conclusion: The study showed a relatively high prevalence of undernutrition and overweight/obesity among school children in the South Tongu District. The identified risk factor(s) for undernutrition was the usage of water from non-potable sources whilst those of overweight/obesity were age (10–12 years), maternal formal education, beverage consumption between meals per day, and adequate dietary diversity. The findings reaffirm that malnutrition is still prevalent among school children. Hence, there is a need for the Ministry of Health, Ghana Education Service, and other Non-Governmental Organizations to pay critical attention to these factors to achieve the Sustainable Development Goal 2, target 2.2. Nutritional behavioural change education should be carried out among parents and school children. School health service activities should be intensified with a special focus on nutritional screening

Self-reported breast and cervical cancer screening practices among women in Ghana:predictive factors and reproductive health policy implications from the WHO study on global AGEing and adult health

BackgroundBreast and cervical cancers constitute the two leading causes of cancer deaths among women in Ghana. This study examined breast and cervical screening practices among adult and older women in Ghana.MethodsData from a population-based cross-sectional study with a sample of 2749 women were analyzed from the study on global AGEing and adult health conducted in Ghana between 2007 and 2008. Binary and multivariable ordinal logistic regression analyses were performed to assess the association between socio-demographic factors, breast and cervical screening practices.ResultsWe found that 12.0 and 3.4% of adult women had ever had pelvic screening and mammography respectively. Also, 12.0% of adult women had either one of the screenings while only 1.8% had both screening practices. Age, ever schooled, ethnicity, income quantile, father’s education, mother’s employment and chronic disease status were associated with the uptake of both screening practices.ConclusionNationwide cancer awareness campaigns and education should target women to improve health seeking behaviours regarding cancer screening, diagnosis and treatment. Incorporating cancer screening as a benefit package under the National Health Insurance Scheme can reduce financial barriers for breast and cervical screening

Informal payments and willingness to pay informally for health care among older adults:equity perspectives for geriatric care in Ghana

BackgroundOut-of-Pocket (OOP) payment is one mechanism for funding health care in low- and middle-income countries (LMICs). The wider implications mean OOP payments have the potential to increase, with catastrophic effects for a vulnerable population group such as older adults. This study aimed to determine the prevalence of informal patient payments (IPPs) and willingness and ability to pay informally, and its associated factors among older adults in Ghana.MethodsWe conducted a community-based cross-sectional study to collect data among 462 older adults (60+ years) across three municipal areas in the Volta Region of Ghana. Data were collected using an interviewer-administered semi-structured questionnaire. Binary logistic regression was performed to identify factors associated with IPP. The significance level was set at P &lt; 0.05.ResultsThe prevalence of IPP was 21.2%. About 64.5% of respondents were willing to make IPP if they had good financial standing. Factors significantly associated with IPP were age (75 years and above) (odds ratios [OR], 1.76; 95% confidence interval [CI], 1.37–2.26), being uninsured (OR, 1.68; 95% CI, 1.48–1.91), having a urinary health problem (OR, 2.49; 95% CI, 1.56–3.97), and having a stronger preference for private healthcare facilities (OR, 1.35; 95% CI, 1.26–1.44). Not having a chronic condition (OR, 0.59; 95% CI, 0.41–0.83) and unwillingness to make IPP (OR, 0.48; 95% CI, 0.26–0.87) were associated with lower odds of IPP.ConclusionThe existence IPP reflects important inequity gaps within the formal healthcare system and requires urgent sustainable policy actions to protect economically vulnerable older adults from financial catastrophe. We recommend measures of informal payments and “perceived corruption” in the health system be included in the Ghana Living Standard Surveys and Demographic Health Surveys to inform future policy decisions in this area

Self-reported breast and cervical cancer screening practices among women in Ghana:predictive factors and reproductive health policy implications from the WHO study on global AGEing and adult health

BackgroundBreast and cervical cancers constitute the two leading causes of cancer deaths among women in Ghana. This study examined breast and cervical screening practices among adult and older women in Ghana.MethodsData from a population-based cross-sectional study with a sample of 2749 women were analyzed from the study on global AGEing and adult health conducted in Ghana between 2007 and 2008. Binary and multivariable ordinal logistic regression analyses were performed to assess the association between socio-demographic factors, breast and cervical screening practices.ResultsWe found that 12.0 and 3.4% of adult women had ever had pelvic screening and mammography respectively. Also, 12.0% of adult women had either one of the screenings while only 1.8% had both screening practices. Age, ever schooled, ethnicity, income quantile, father’s education, mother’s employment and chronic disease status were associated with the uptake of both screening practices.ConclusionNationwide cancer awareness campaigns and education should target women to improve health seeking behaviours regarding cancer screening, diagnosis and treatment. Incorporating cancer screening as a benefit package under the National Health Insurance Scheme can reduce financial barriers for breast and cervical screening

Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study

Background Over the last 30 years, South Africa has experienced four ‘colliding epidemics’ of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. Methods We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990–2007 and 2007–2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. Results Across the nine provinces, inequalities in mortality and life expectancy increased over 1990–2007, largely due to differences in HIV/AIDS, then decreased over 2007–2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. Conclusions Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic

Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study.

BACKGROUND: Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS: We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS: Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS: Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic