Climate Change (Mal)Adaptation as Governmentality: The Case of the Ada Sea Defense System in the Volta River Delta of Ghana

River deltas are complex natural environments that represent a confluence of many physical, biological and human processes vulnerable to the impacts of climate change. The likely biophysical impacts of climate change on deltas have received substantial attention. However, relatively little attention has been paid to the ways in which the different stakeholders of deltaic environments frame the vulnerability of residents of deltas to climate change. The Volta River Delta (VRD) of Ghana is a compelling site in which to conduct such an examination because of the clear climaterelated changes taking place in the Delta, and the fact that like many major delta areas in the world, the VRD is at the end of a managed river system heavily influenced by an upstream dam. This study aims to further our understanding of how the identification of climaterelated vulnerabilities, and the selection of interventions to address those vulnerabilities, can result in unintended outcomes that enhance, instead of ameliorate, vulnerabilities related to climate change, but also proceeding from other sources. It does so by applying the theoretical framework of governmentality in examining the different positions of various actors relative to the Ada Sea Defense System (AdSDS) in order to understand how the perceptions of these actors construct the vulnerability of a particular place and its population to the impacts of climate change, identify sea defense systems (SDS) as an adaptation to climate change, and understand, experience, and respond to the outcomes of that sea defense system – particularly outcomes one could consider as maladaptive. This exploration of vulnerability and adaptation to coastal erosion in the VRD demonstrates that the complex environments of river deltas require multidimensional approaches through which to attempt to trace observed processes of (mal)adaptation and give reason for the outcomes, good and bad, that result. This dissertation contributes to this process – in particular the politics of adaptation; and how an analysis of such politics can assist in our understanding of maladaptation. Such understanding can enable future adaptation decisions that promote the sustainability and well-being of coastal populations in Ghana and beyond

Ethnography in agricultural research: a tool for diagnosing problems and sustaining solutions

In order to meet the future challenges of African agriculture, scientists and policy makers will need to move away from prescriptive measures, to more adaptive ways of understanding and addressing problems based on local capabilities and resources. Ethnographic frameworks and methods are one adaptive tool that researchers can use in parsing out complex situations within the context of local practice and culture. This paper highlights the use of an ethnographic framework called the Livelihoods as Intimate Government (LIG) approach and its application in Ghana and Malawi. The authors demonstrate how without preconceived ideas about what challenges exist, the LIG approach is able to illuminate some of the most pressing needs that affect the livelihoods of rural smallholder farmers. Preconceived notions tend to lead to poor diagnosis of problems, which then results in misplaced solutions and misapplication of funds to implement recommended strategies. Use of LIG sets parameters that are specific to the local context, which promotes development of appropriate policies, and sustainability of food security programs, ensuring that limited funds are used appropriately.Keywords: Ethnography, field methods, Ghana, Malaw

The contribution of Ghanaian pharmacists to mental healthcare: current practice and barriers

<p>Abstract</p> <p>Background</p> <p>There is scant knowledge of the involvement of developing country pharmacists in mental healthcare. The objectives of this study were: to examine the existing role of Ghanaian community and hospital pharmacists in the management of mental illness, and to determine the barriers that hinder pharmacists' involvement in mental healthcare in Ghana.</p> <p>Method</p> <p>A respondent self-completion questionnaire was randomly distributed to 120 superintendent community pharmacists out of an estimated 240 pharmacists in Kumasi, Ashanti Region of Ghana. A purposive sampling method was utilized in selecting two public psychiatric hospital pharmacists in Accra, the capital city of Ghana for a face-to-face interview. A semi-structured interview guide was employed.</p> <p>Results</p> <p>A 91.7% response rate was obtained for the community pharmacists' questionnaire survey. Approximately 65% of community pharmacists were not involved in mental health provision. Of the 35% who were, 57% counseled psychiatric patients and 44% of these dispensed medicines for mental illness. Perceived barriers that hindered community pharmacists' involvement in the management of mental health included inadequate education in mental health (cited by 81% of respondents) and a low level of encounter with patients (72%). The psychiatric hospital pharmacists were mostly involved in the dispensing of medicines from the hospital pharmacy.</p> <p>Conclusion</p> <p>Both community and hospital pharmacists in Ghana were marginally involved in the provision of mental healthcare. The greatest barrier cited was inadequate knowledge in mental health.</p

Herbal medicine: women's views, knowledge and interaction with doctors: a qualitative study

BACKGROUND: There is growing concern that serious interactions are occurring between prescribed/over the counter and herbal medicines and that there is a lack of disclosure of herbal use by patients to doctors. This study explores women's perspectives about the safety of herbal remedies, herb-drug interactions and communication with doctors about herbal medicines. METHODS: Qualitative, cross-sectional study, with purposive sampling which took place in Cheshire, UK. Eighteen in depth semi-structured interviews were conducted with female herbal medicine users aged 18 years and above. RESULTS: The large majority did not inform their GPs of their use of herbal medicines. This was due to lack of physician enquiry, perception of importance and fear of a negative response. Several women were not aware that herbal remedies could interact with prescribed or over the counter medicines. Of the women who had experienced adverse effects none had reported them, believing them of low importance. CONCLUSION: The women had little knowledge about herb-drug interactions and rarely disclosed use of herbal medicines to their doctor. Doctors' communication and openness regarding herbal medicines needs to improve and there should be increased access to accurate information on herbal medicines in the public and health care domain

Navigating tensions in climate change-related planned relocation

The planned relocation of communities away from areas of climate-related risk has emerged as a critical strategy to adapt to the impacts of climate change. Empirical examples from around the world show, however, that such relocations often lead to poor outcomes for affected communities. To address this challenge, and contribute to developing guidelines for just and sustainable relocation processes, this paper calls attention to three fundamental tensions in planned relocation processes: (1) conceptualizations of risk and habitability; (2) community consultation and ownership; and (3) siloed policy frameworks and funding mechanisms. Drawing on the collective experience of 29 researchers, policymakers and practitioners from around the world working on planned relocations in the context of a changing climate, we provide strategies for collectively and collaboratively acknowledging and navigating these tensions among actors at all levels, to foster more equitable and sustainable relocation processes and outcomes

Using community pharmacies to expand access to screening for noncommunicable diseases in suburban Ghana-A facility-based survey on client needs and acceptability.

BACKGROUND: Many of the 28 million deaths from noncommunicable diseases (NCDs) in low- and middle-income countries each year could be prevented through early detection and intervention. The introduction of screening for NCDs in community pharmacies (CPs) in Ghana could enhance access to early detection. METHODS: We surveyed clients in three districts in suburban Ghana to assess perceived need for screening, willingness to be screened in CPs, and willingness to receive NCD health promotion information through text messages (NCD m-Health). We performed regression analysis to identify predictors of NCD m-Health acceptability. RESULTS: We interviewed 330 clients in six CPs, 134 (42.3%) of whom were females. The median age was 34 years (interquartile range, 27-43). Fifty-four (16.4%) had no formal education. Although most respondents knew obesity (74.9%), smoking (81.9%), and excessive dietary salt (91.7%) were risk factors for NCDs, only 27.0% knew family history carried similar risk. Most respondents, 61.6% and 70.6%, respectively, had not had their weight and blood pressure (BP) checked for more than 12 months. These included about a third of respondents who were known hypertensives. Similarly, 71.3% of 80 participants with a family history of hypertension had not had their BPs checked. Screening for NCDs in CPs and the sending of NCD m-Health messages was deemed acceptable to 98.5% and 83.1% of the participants, respectively. Formal education beyond junior high school (Grade 9) was the strongest independent predictor of NCD m-Health acceptance (OR = 4.77; 95% CI, 1.72-13.18; P value < 0.01). One hundred and twenty-five (39.4%) participants indicated they would consider unsolicited NCD m-Health messages an invasion of their privacy. CONCLUSION: An urgent need exists to promote access to NCD screening in these communities. Its introduction into CPs is acceptable to nearly all the clients surveyed. The introduction of NCD m-Health as an accompaniment requires consideration for the privacy of clients

Migration as a form of workforce attrition: a nine-country study of pharmacists

Background There is a lack of evidence to inform policy development on the reasons why health professionals migrate. Few studies have sought to empirically determine factors influencing the intention to migrate and none have explored the relationship between factors. This paper reports on the first international attempt to investigate the migration intentions of pharmacy students and identify migration factors and their relationships. Methods Responses were gathered from 791 final-year pharmacy students from nine countries: Australia, Bangladesh, Croatia, Egypt, Portugal, Nepal, Singapore, Slovenia and Zimbabwe. Data were analysed by means of Principal Components Analysis (PCA) and two-step cluster analysis to determine the relationships between factors influencing migration and the characteristics of subpopulations most likely and least likely to migrate. Results Results showed a significant difference in attitudes towards the professional and sociopolitical environment of the home country and perceptions of opportunities abroad between those who have no intention of migrating and those who intend to migrate on a long-term basis. Attitudes of students planning short-term migration were not significantly different from those of students who did not intend to migrate. These attitudes, together with gender, knowledge of other migrant pharmacists and past experiences abroad, are associated with an increased propensity for migration. Conclusion Given the influence of the country context and environment on migration intentions, research and policy should frame the issue of migration in the context of the wider human resource agenda, thus viewing migration as one form of attrition and a symptom of other root causes. Remuneration is not an independent stand-alone factor influencing migration intentions and cannot be decoupled from professional development factors. Comprehensive human resource policy development that takes into account the issues of both remuneration and professional development are necessary to encourage retention

Alternative patterns of sex chromosome differentiation in Aedes aegypti (L).

BACKGROUND: Some populations of West African Aedes aegypti, the dengue and zika vector, are reproductively incompatible; our earlier study showed that divergence and rearrangements of genes on chromosome 1, which bears the sex locus (M), may be involved. We also previously described a proposed cryptic subspecies SenAae (PK10, Senegal) that had many more high inter-sex FST genes on chromosome 1 than did Ae.aegypti aegypti (Aaa, Pai Lom, Thailand). The current work more thoroughly explores the significance of those findings. RESULTS: Intersex standardized variance (FST) of single nucleotide polymorphisms (SNPs) was characterized from genomic exome capture libraries of both sexes in representative natural populations of Aaa and SenAae. Our goal was to identify SNPs that varied in frequency between males and females, and most were expected to occur on chromosome 1. Use of the assembled AaegL4 reference alleviated the previous problem of unmapped genes. Because the M locus gene nix was not captured and not present in AaegL4, the male-determining locus, per se, was not explored. Sex-associated genes were those with FST values ≥ 0.100 and/or with increased expected heterozygosity (H exp , one-sided T-test, p < 0.05) in males. There were 85 genes common to both collections with high inter-sex FST values; all genes but one were located on chromosome 1. Aaa showed the expected cluster of high inter-sex FST genes proximal to the M locus, whereas SenAae had inter-sex FST genes along the length of chromosome 1. In addition, the Aaa M-locus proximal region showed increased H exp levels in males, whereas SenAae did not. In SenAae, chromosomal rearrangements and subsequent suppressed recombination may have accelerated X-Y differentiation. CONCLUSIONS: The evidence presented here is consistent with differential evolution of proto-Y chromosomes in Aaa and SenAae