'Better decisions for food security? Critical reflections on the economics of food choice and decision-making in development economics

With malnutrition recognised as a key public health issue, attention has been placed on how individuals can make better decisions to attain food and nutrition security. Nevertheless, food practice entails a complex set of decisions that are not fully understood. This paper interrogates the focus on food choice by investigating how socio-economic relations shape practices of food provisioning. Given the surge of behavioural approaches in development economics and our focus on a middle-income country, we contextualise food choice in the transformations of the conceptualisations of decision-making in development economics. We draw on mixed-method evidence on food consumption practices among schoolchildren in Accra, Ghana. We find that the food decision-making process is complex in that it entails multiple moments and people, and embodies contradictory motivations. Decisions are negotiated outcomes reflecting social relations of power among the actors involved. Socio-economic inequality fragments the urban food environment and material living conditions. Furthermore, the concentration of capital gives the food industry the power to shape material and cultural relations to food in ways that extraordinarily limit the scope for individual choice. This is a critical case study to understand the contemporary dynamics of malnutrition in the urban Global South, with broader relevance for the analysis of food poverty elsewhere

The Urban Food Question in the Context of Inequality and Dietary Change: A Study of Schoolchildren in Accra

Diets are changing globally, as agricultural and food systems have become globalised. Understanding how patterns of globalisation affect welfare is a key development question, but we know little about the way that the globalisation of food systems impacts different groups. This study explores food security and consumption among schoolchildren in Accra. We use a novel approach based on triangulation of primary data on food consumption and a synthesis of secondary literature on food trade, policy and urban food environment. Thus, we bridge a divide between micro-level analyses of food consumption and macro-level studies of food systems. We find that socio-economic status is a critical dimension, with poorer children more vulnerable to food insecurity and narrow dietary diversity. However, the consumption of packaged and processed foods, often sugar-rich and nutrient-poor, cuts across wealth groups. We argue that the urban food question today is defined by two intersecting phenomena: inequality and dietary change. The urban poor continue to face the fundamental challenge of adequate food access amidst a food environment that provides consumers with unhealthy and cheap food options. Therefore, food policy needs to regulate imports of cheap, unhealthy and enticing food

Genetic relatedness in carbapenem-resistant isolates from clinical specimens in Ghana using ERIC-PCR technique.

AIM: Enterobacterial repetitive intergenic consensus (ERIC) sequence analysis is a powerful tool for epidemiological analysis of bacterial species. This study aimed to determine the genetic relatedness or variability in carbapenem-resistant isolates by species using this technique. METHODS: A total of 111 non-duplicated carbapenem-resistant (CR) Gram-negative bacilli isolates from a three-year collection period (2012-2014) were investigated by enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) in four selected hospital laboratories in Ghana. The isolates were also screened for carbapenemase and extended spectrum β-lactamase genes by PCR. RESULTS: A proportion of 23.4% (26/111) of the genomic DNA extracts were carriers of PCR-positive carbapenemase genes, including 14.4% blaNDM-1, 7.2% blaVIM-1 and 1.8% blaOXA-48. The highest prevalence of carbapenemase genes was from non-fermenters, Acinetobacter baumannii and Pseudomonas aeruginosa. For the ESBL genes tested, 96.4% (107/111) of the CR isolates co-harboured both TEM-1 and SHV-1 genes. The ERIC-PCR gel analysis exhibited 1 to 8 bands ranging from 50 to 800 bp. Band patterns of 93 complex dissimilarities were visually distinguished from the 111 CR isolates studied, while the remaining 18 showed band similarities in pairs. CONCLUSION: Overall, ERIC-PCR fingerprints have shown a high level of diversity among the species of Gram-negative bacterial pathogens and specimen collection sites in this study. ERIC-PCR optimisation assays may serve as a suitable genotyping tool for the assessment of genetic diversity or close relatedness of isolates that are found in clinical settings

Phenotypic and genotypic characterization of carbapenem-resistant gram-negative bacilli pathogens from hospitals in Ghana

In Ghana, surveillance efforts on antibiotic resistance so far have not covered carbapenem resistance. In this study, our aim was to apply phenotypic and genotypic methods to identify and characterize carbapenem-resistant (CR) Gram-negative bacteria from the hospital environment in Ghana. A collection of 3840 isolates of Gram-negative bacilli infections from various clinical specimens was screened for carbapenem resistance by disc diffusion for imipenem, meropenem, and doripenem. Minimum Inhibitory Concentration (MIC) of the CR isolates was determined by E-test for the three carbapenems. All the CR isolates were further screened for carbapenemase activity by modified Hodge and boronic acid disc synergy tests. The CR isolates were investigated for the presence of carbapenemase and extended-spectrum beta-lactamase genes by PCR and confirmed by sequencing. The overall prevalence of CR isolates was 2.9% (111/3840). Based on the disc diffusion test, prevalence of resistance to carbapenems were doripenem (75%), imipenem (66.7%), and meropenem (58%). The highest measurable MIC levels (≥32 μg/mL) were observed in 56.8% of CR isolates with the nonfermenters, Pseudomonas aeruginosa (24.3%) and Acinetobacter species (18.9%), disproportionately represented. Phenotypic identification of carbapenamase activity occurred in 18.9% of the CR isolates by the modified Hodge test and 2.7% by Boronic acid disc synergy test; 21.6% exhibited carbapenemase production by both methods. All the CR isolates carried ESBL genes (blaTEM and blaSHV), whereas 23.4% were carriers of carbapenemase genes, of which 14.4% were blaNDM-1, 7.2% blaVIM-1, and 1.8% blaOXA-48. Phylogenetically, the CR isolates were diverse and showed limited relatedness to isolates from other geographical regions

A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach.

BACKGROUND:Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. OBJECTIVE:This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. METHODS:We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides. RESULTS:We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities. CONCLUSIONS:These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients. TRIAL REGISTRATION:ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485

Perceived environmental risks and insecurity reduce future migration intentions in hazardous migration source areas

This is the author accepted manuscript. The final version is available from Cell Press via the DOI in this record. Environmental change influences population movements at various temporal and spatial scales. Yet individual decisions to migrate involve multiple motivations including perceived environmental risks and economic opportunities. We analyze how perceptions of environmental risks affect migration decisions and future migration intentions. We use cross-sectional household survey data (N = 5,450) from populations engaged in migration in net out-migration areas in four coastal areas in Ghana, Bangladesh, and India to examine ex post-migration motivations and ex ante-future migration intentions. The data include variables on previous migration, migration intentions, well-being, food insecurity, and perceived long-term environmental degradation. The results show that few households identified environmental risks as the primary driver for past migration decisions. Perceived increased severity of drought and household insecurity both reduce stated future migration intentions. Hence, perceptions of environmental risks, including future potential changes, are significant in altering aggregate migration flows from source areas in low-lying coastal regions.Collaborative Adaptation Research Initiative in Africa and Asia (CARIAA)UK Foreign, Commonwealth and Development OfficeInternational Development Research Centre, Ottawa, CanadaBelmont ForumUK Research and Innovatio

Urban sustainability and the subjective well‐being of migrants: The role of risks, place attachment, and aspirations

This is the final version. Available on open access from Wiley via the DOI in this recordData availability statement: The dataset for the analysis presented in the paper can be publicly and freely accessed through the Mendeley Data repository at DOI https://doi.org.10.17632/pr9d2cj2g8.2While material conditions of migrant populations on average tend to improve over time as they become established in new destinations, individual trajectories of material and subjective well-being often diverge. Here, we analyse how social and environmental factors in the urban environment shape the subjective well-being of migrant populations. We hypothesise these factors to include (a) perceived social and environmental risk, (b) attachment to place, and (c) migrant aspirations. We analyse data from a cross-sectional survey of 2641 individual migrants in seven cities across Ghana, India, and Bangladesh. The results show that the persistence of inferior material conditions, exposure to environmental hazards, and constrained access to services and employment affect migrants' subjective well-being. Hence, social and environmental risks constitute urban precarity for migrants whose social vulnerability persist in their destination. Meeting migration-related aspirations and developing an affinity to urban destinations have the potential to mitigate negative sentiments from perceived risks. These findings have implications for future urban planning and sustainability.International Development Research Centr

Monitoring and moderating extreme indoor temperatures in low-income urban communities

Climate change presents significant threats to human health, especially for low-income urban communities in the Global South. Despite numerous studies of heat stress, surprisingly little is known about the temperatures actually encountered by people in their homes, or the benefits of affordable adaptations. This paper examines indoor air temperature measurements gathered from 47 living rooms within eight low-income communities of Accra and Tamale, Ghana. Using multiple temperature indices and a tiered analysis, we evaluate indoor temperature variations linked to roof type, ceiling insulation, presence of fans, and tree shade, for different housing types and locations. Our data reveal indoor temperatures in the range 22.4 ◦C to 45.9 ◦C for Accra, and 22.2 ◦C to 43.0 ◦C in Tamale. Using dummy regression analysis, we find that tree shade reduces the number of very hot days (>40 ◦C) and nights (>30 ◦C) by about 12 and 15 d per year, respectively. Building materials also strongly moderate indoor temperatures but in opposing ways: rooms with traditional mud walls and thatch roofs are on average 4.5 ◦C cooler than rooms in concrete block houses with uninsulated metal roofs during the day but are 1.5 ◦C warmer at night; rooms with ceiling insulation are on average 6.9 ◦C cooler in the day but 1.4 ◦C warmer at night. We conclude that sub-daily data are necessary for reporting extreme indoor temperatures, and that trade-offs between minimum and maximum temperatures require interventions to be assessed carefully before attempting to counter extreme heat inside homes

Perceived stressors of climate vulnerability across scales in the Savannah zone of Ghana: a participatory approach

Smallholder farmers in sub-Saharan Africa are confronted with climatic and non-climatic stressors. Research attention has focused on climatic stressors, such as rainfall variability, with few empirical studies exploring non-climatic stressors and how these interact with climatic stressors at multiple scales to affect food security and livelihoods. This focus on climatic factors restricts understanding of the combinations of stressors that exacerbate the vulnerability of farming households and hampers the development of holistic climate change adaptation policies. This study addresses this particular research gap by adopting a multi-scale approach to understand how climatic and non-climatic stressors vary, and interact, across three spatial scales (household, community and district levels) to influence livelihood vulnerability of smallholder farming households in the Savannah zone of northern Ghana. This study across three case study villages utilises a series of participatory tools including semi-structured interviews, key informant interviews and focus group discussions. The incidence, importance, severity and overall risk indices for stressors are calculated at the household, community, and district levels. Results show that climatic and non-climatic stressors were perceived differently; yet, there were a number of common stressors including lack of money, high cost of farm inputs, erratic rainfall, cattle destruction of crops, limited access to markets and lack of agricultural equipment that crossed all scales. Results indicate that the gender of respondents influenced the perception and severity assessment of stressors on rural livelihoods at the community level. Findings suggest a mismatch between local and district level priorities that have implications for policy and development of agricultural and related livelihoods in rural communities. Ghana’s climate change adaptation policies need to take a more holistic approach that integrates both climatic and non-climatic factors to ensure policy coherence between national climate adaptation plans and District development plans

COVID-19 responses restricted abilities and aspirations for mobility and migration: insights from diverse cities in four continents

This is the final version. Available on open access from Springer Nature via the DOI in this recordData availability: The datasets of interview transcripts generated and analysed during the current study are available from the corresponding author on reasonable request.Research on the impacts of COVID-19 on mobility has focused primarily on the increased health vulnerabilities of involuntary migrant and displaced populations. But virtually all migration flows have been truncated and altered because of reduced economic and mobility opportunities of migrants. Here we use a well-established framework of migration decision-making, whereby individual decisions combine the aspiration and ability to migrate, to explain how public responses to the COVID-19 pandemic alter migration patterns among urban populations across the world. The principal responses to COVID-19 pandemic that affected migration are: 1) through travel restrictions and border closures, 2) by affecting abilities to move through economic and other means, and 3) by affecting aspirations to move. Using in-depth qualitative data collected in six cities in four continents (Accra, Amsterdam, Brussels, Dhaka, Maputo, and Worcester), we explore how populations with diverse levels of education and occupations were affected in their current and future mobility decisions. We use data from interviews with sample of internal and international migrants and non-migrants during the 2020 COVID-19 pandemic outbreak to identify the mechanisms through which the pandemic affected their mobility decisions. The results show common processes across the different geographical contexts: individuals perceived increased risks associated with further migration, which affected their migration aspirations, and had reduced abilities to migrate, all of which affected their migration decision-making processes. The results also reveal stark differences in perceived and experienced migration decision-making across precarious migrant groups compared to high-skilled and formally employed international migrants in all settings. This precarity of place is particularly evident in low-income marginalised populations.Economic and Social Research Council (ESRC)ISSCNational Science Foundation (NSF)NWOVREuropean Union Horizon 202