Living with familiar hazards: flood experiences of urban households and health implications in Ghana

In low-income and middle-income countries, such as those in sub-Saharan Africa and Latin America, the COVID-19 pandemic has had substantial implications for women's wellbeing. Policy responses to the COVID-19 pandemic have highlighted the gendered aspect of pandemics; however, addressing the gendered implications of the COVID-19 pandemic comprehensively and effectively requires a planetary health perspective that embraces systems thinking to inequalities. This Viewpoint is based on collective reflections from research done by the authors on COVID-19 responses by international and regional organisations, and national governments, in Latin America and sub-Saharan Africa between June, 2020, and June, 2021. A range of international and regional actors have made important policy recommendations to address the gendered implications of the COVID-19 pandemic on women's health and wellbeing since the start of the pandemic. However, national-level policy responses to the COVID-19 pandemic have been partial and inconsistent with regards to gender in both sub-Saharan Africa and Latin America, largely failing to recognise the multiple drivers of gendered health inequalities. This Viewpoint proposes that addressing the effects of the COVID-19 pandemic on women in low-income and middle-income countries should adopt a systems thinking approach and be informed by the question of who is affected as opposed to who is infected. In adopting the systems thinking approach, responses will be more able to recognise and address the direct gendered effects of the pandemic and those that emerge indirectly through a combination of long-standing structural inequalities and gendered responses to the pandemic.

Malnutrition is still a major global public health issue, especially in Sub-Saharan Africa (SSA), where millions of children suffer from stunting, a chronic form of the disease. In addition to limiting physical growth, stunting also impedes social and cognitive development, which frequently has long-term effects. Stunting is still incredibly common in SSA, with notable regional variations, despite international efforts to address hunger. Moreover, no studies have been conducted to assess the spatial distribution of stunting at the SSA level. Therefore, to pinpoint high-burden areas and guide focused treatments; this study intends to investigate the spatial distribution of stunting among breastfeeding children in SSA. The demographic and Health Survey data from 31 SSA nations were used for this study. The investigation included a total of 174,586 breastfeeding children. Stunting clustering and geographic patterns were evaluated using Geographic Information Systems and spatial analytic methods such as Getis-Ord Gi* and Global Moran's I. Stunting prevalence in unsampled areas was predicted using spatial interpolation (Kriging techniques). For the participants, descriptive statistics were calculated. Stunting prevalence in SSA varied from 17.63% to 53.68%, with Madagascar (39.43%), Burundi (42.40%), and the Democratic Republic of the Congo (53.68%) having the highest rates. Significant clustering of stunting was found by spatial analysis (Moran's I: 0.639, p < 0.001), with hotspots primarily located in Central and Eastern Africa, such as Ethiopia, and the Democratic Republic of the Congo. In Southern Africa, cold locations like Namibia and South Africa were found to have lower stunting rates. The significant regional variability in the prevalence of stunting among nursing children in SSA was highlighted by this study. In order to address underlying variables including poverty, food insecurity, and limited access to healthcare, the findings highlighted the necessity of region-specific public health initiatives. To lessen the burden of stunting and its long-term effects, improved geospatial surveillance systems are crucial for locating high-risk locations and directing the distribution of resources.

This study investigates government quality determinants of ICT adoption using Generalised Method of Moments on a panel of 49 sub-Saharan African (SSA) countries for the period 2000-2012. ICT is measured with mobile phone penetration, internet penetration and telephone penetration rates while all governance dimensions from the World Bank Governance Indicators are considered, namely: political governance (consisting of political stability and “voice & accountability”); economic governance (entailing government effectiveness and regulation quality) and institutional governance (encompassing the rule of law and corruption-control). The following findings are established. First, political stability and the rule of law have positive short-run and negative long-term effects on mobile phone penetration. Second, the rule of law has a positive (negative) short-run (long-term) effect on internet penetration. Third, government effectiveness and corruption-control have positive short-run and long-term effects on telephone penetration. Institutional governance appears to be most significant in determining ICT adoption in SSA.

Over the past years, forests have been crucial in shaping economic development patterns by sustaining livelihoods, assisting in economic restructuring, and encouraging sustainable growth. This study assesses the impact of forestry management practices on regional economic benefits and the livelihoods of rural communities in Ghana, focusing on three forest reserves in the Ashanti Region. A mixed-method research design, incorporating both quantitative and qualitative approaches, was employed. A total of 234 respondents were purposively selected based on their availability and willingness to respond to questions, with data collected using a semi-structured questionnaire. The findings indicate a notable improvement in the standard of living, measured by four indicators: household finances, food security, physical health, and social indicators. Despite these improvements, a significant decrease in forest cover was observed in recent years. The decline in forest cover around the three forest reserves in the Ashanti Region of Ghana was attributed to poor management. Communities reported inadequate management and enforcement of forest policies, with forest managers not adhering to regulations, showing high levels of corruption, a trend consistent in 2017 (58.9%) and 2023 (60%). In summary, there has been a significant improvement in the livelihoods of rural communities around the Tano Offin, Nkrabia, and Afram Headwaters forest reserves in the Ashanti Region of Ghana. However, the management of forest resources remains poor and inefficient, leading to a substantial loss of forest cover. This loss threatens biodiversity and ecosystem services. The government should implement proactive forestry management strategies and promote community-based approaches to enhance community involvement in managing their forest resources.

After completing this article, readers should be able to: 1. Describe aberrations in adult health that can result from nutrition in the fetal period and in neonatal life. 2. Review the results of studies from human neonates regarding early nutritional interventions designed for “catch-up” growth. 3. Review results from animal studies regarding early nutrition and “programming” for adult metabolic syndrome. 4. Describe some of the potential epigenetic mechanisms that may be responsible for “programming.” 5. Examine methods for preventing growth delays, the consequences of undernutrition, and the metabolic syndrome related to adverse “programming.” One of the traditional goals of neonatal nutrition is to maintain growth within standardized limits. In the preterm infant, growth between the 10th and 90th percentiles of intrauterine rate has been an ideal goal. More recently, maintenance of lean body mass and bone density; prevention of complications such as chronic lung disease, necrotizing enterocolitis, and infection; and optimization of neurodevelopment and adult health through early nutritional programming have become recognized as more meaningful goals than mere somatic growth. To meet these goals, current nutritional practices require thorough scrutiny in terms of quantity and quality (composition) and how they are customized, if not for the individual patient (which would be ideal), at least for subgroups such as those who are small or appropriate for gestational age, sick or healthy, preterm or term, or male or female. Fetal nutrition and development frequently are used as a template for the low-birthweight infant. A large body of literature on the consequences of fetal undernutrition shows that infants born small for gestational age (SGA) not only have short-term morbidity, but long-term morbidity manifested in what has been termed the “metabolic syndrome.” This syndrome includes abdominal obesity, arterial hypertension, and insulin resistance. Other clinical manifestations can be observed, including thyroid dysfunction, hirsutism, ovarian hyperandrogenism and infertility, dyslipidemia (increased …

Water, sanitation, and hygiene challenges in last-mile artisanal mining communities in Ghana and Uganda

Governance, credit access and clean cooking technologies in Sub-Saharan Africa: Implications for energy transition

The Nature of Technology-Facilitated Violence and Abuse among Young Adults in Sub-Saharan Africa

The largest treatment gap for mental, neurological and substance use (MNS) disorders to date exists in Sub-Saharan Africa (e.g., South Africa, Malawi, Nigeria). While efforts have been made to reduce the global burden of MNS disorders, there remain significant barriers to delivery of equitable mental health care in Africa and the diaspora. These barriers are deeply rooted in a lack of research structures to inform care delivery, few outlets to train in-country mental health professionals, and limited involvement of policymakers in translation of research findings. Given the demonstrated need across domains of research, education, service delivery and policy in Africa, it is in the purview of global leaders and mental health professionals to build the infrastructure necessary to make systematic, targeted strides to develop each of these areas. With this conceptual framework in mind, over fifty global leaders, psychiatrists, mental health professionals and advocates with expertise in cultural psychiatry convened at a global conference in Cape Town, South Africa in 2016 to establish the African Global Mental Health Institute (AGMHI). The AGMHI is an organizational effort that aims to reduce the global burden of mental illness through research, education and training, service delivery, and policy. Aligned with mental health initiatives posited by the World Health Organization (WHO) and the World Bank, the AGMHI represents an opportunity to explore and understand cultural nuance among populations in Africa and the diaspora. This article focuses on the AGMHI’s targeted strategies in the following actions: 1) bolstering training and education programs for clinicians and/or researchers in Africa and the diaspora to increase human capacity for mental health; 2) conducting and disseminating inclusive, culturally-relevant research (e.g., research that involves community stakeholders in its design and conduct) to meet the urgent need for a culturally-relevant evidence base; 3) identifying key stakeholders to promote sustainable mental health care and inform policy; and 4) fostering local and global collaborations (e.g., engaging local and national governments, non-governmental organizations (NGO), academic institutions, etc.) to share methods of improving access to mental health services. In concert with empirical data, these strategies were devised by members of the AGMHI, which is comprised of international leaders with decades of expertise in global psychiatry. While the MNS disorder treatment gap remains at large, the AGMHI believes these specific strategies are a step toward reducing the treatment gap and enhancing mental health care access globally.

The consequences of Sudan’s armed conflict on public health: a closer look at the devastating impact

Editorial commentary: Risks and benefits of tenofovir in the context of kidney dysfunction in sub-Saharan Africa.

Birth weight significantly determines newborns immediate and future health. Globally, the incidence of both low birth weight (LBW) and macrosomia have increased dramatically including sub-Saharan African (SSA) countries. However, there is limited study on the magnitude and associated factors of birth weight in SSA. Thus, thus study investigated factors associated factors of birth weight in SSA using multilevel multinomial logistic regression analysis. The latest demographic and health survey (DHS) data of 36 sub-Saharan African (SSA) countries was used for this study. A total of a weighted sample of 207,548 live births for whom birth weight data were available were used. Multilevel multinomial logistic regression model was fitted to identify factors associated with birth weight. Variables with p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel multinomial logistic regression analysis, the adjusted Relative Risk Ratio (aRRR) with the 95% confidence interval (CI) was reported to declare the statistical significance and strength of association. The prevalence of LBW and macrosomia in SSA were 10.44% (95% CI 10.31%, 10.57%) and 8.33% (95% CI 8.21%, 8.45%), respectively. Maternal education level, household wealth status, age, and the number of pregnancies were among the individual-level variables associated with both LBW and macrosomia in the final multilevel multinomial logistic regression analysis. The community-level factors that had a significant association with both macrosomia and LBW were the place of residence and the sub-Saharan African region. The study found a significant association between LBW and distance to the health facility, while macrosomia had a significant association with parity, marital status, and desired pregnancy. In SSA, macrosomia and LBW were found to be major public health issues. Maternal education, household wealth status, age, place of residence, number of pregnancies, distance to the health facility, and parity were found to be significant factors of LBW and macrosomia in this study. Reducing the double burden (low birth weight and macrosomia) and its related short- and long-term effects, therefore, calls for improving mothers' socioeconomic status and expanding access to and availability of health care.

Hypertension is the most important risk factor for cardiovascular mortality and morbidity in Sub-Saharan Africa. In western populations, high haemoglobin levels are associated with raised BP unlike in Sub-Saharan Africa where there is a paucity of data. Our study examines the association between haematological indices with BP variables. Weight, height, BP, and whole blood indices of viscosity (Hb, haematocrit, RBC count, and MCV) were measured in 921 adults (340 men, 581 women; aged 40–75) in 12 communities in Ghana. Mean values for Hb (12.3 g/dl ± 1.7 SD), haematocrit (36.7% ± 5.2), RBC (4.10 million/μL ± 0.64), and MCV were lower than reference values used in Sub-Saharan Africa. Mean BMI was 21.1 ± 4.1 indicating a lean population. Systolic BP increased by 1.0 mmHg (95% CI 0.5–1.5), p < 0.001, for women and 0.5 (0.1–1.0), p = 0.027, for men per unit increase in haematocrit. Similar relationships were found for Hb and RBC but not for MCV or platelets. The relationships were weaker when adjusted for BMI, 0.7 mmHg (0.2–1.2) in women and 0.5 (0.0–1.0) in men. Findings for diastolic BP were similar. Overall haematological indices were low. We have found a significant, positive relationship between BP, Hb, Haematocrit, and RBC count in our population.

Low-income urban and rural communities in Sub-Saharan Africa are habitats for more than 556 million profoundly poor people, and the United Nations and the African Union are pessimistic that sustainable development goals will be met. The number of people falling into poverty is increasing, and policy initiatives to reduce poverty have been confounded by various economic, political, social, structural, and environmental issues. Despite a wealth of natural and human assets, there is no systematic approach to sustainable development for poverty alleviation in Sub-Saharan Africa. This case study of an urban community in Ghana, West Africa, investigates the potential role of digital twins in a systematic approach to sustainable development for poverty alleviation. Aerial and community surveys of the built environment and social and economic surveys of businesses and households were compiled to inform a virtual representation of the study area. A small e-commerce business intervention was introduced, and data was recorded for studies on the impact of the intervention. A 3D interactive view, extensive video, and fixed images provided a comprehensive view of the built environment. A limited view of the social and economic environment was obtained from a small population sample. It was observed that online transactions increased in the businesses receiving the e-commerce intervention, demonstrating a willingness of businesses and their customers to engage in e-commerce when incentives are provided. A single successful community-centric initiative has little value unless it can be generalized across the broader society. This limited case study focused on developing and testing virtual and physical constructs to enhance a deeper understanding of the community, community engagement, and pathways to sustainability. The scale of the intervention was too small to conclude generalizability. Future research will focus on improving the data collection processes, fidelity of virtual representations, visualization methods, and methodologies for constructing viable virtual interventions.

Background: Context-specific evidence of the spectrum of type 2 diabetes (T2D) burden is essential for setting priorities and designing interventions to reduce T2D morbidity and mortality. However, there are currently limited data on the burden of T2D complications and comorbidity in sub-Saharan Africa (SSA). Using a study of ~6,000 participants, we aimed to estimate the burden and risk factors for T2D complications and comorbidity in sub-Saharan Africans. Methods: Participants (2784 T2D, 3209 controls) were African men and women aged 18 years or older, enrolled from major academic medical centres and surrounding communities in Ghana, Nigeria and Kenya. T2D was defined according to the American Diabetes Association criteria. T2D complications and comorbidities evaluated included cardiometabolic, ocular, neurological and renal characteristics. Logistic regression models were used to identify risk factors and to adjust estimates of risk and prevalence for covariates. Results: T2D participants had a mean age of 56 [SD 11] years and a median duration of T2D of 5 (interquartile range 2-10) years. Among the T2D participants, notable associated complications/comorbidities included hypertension with a prevalence of 71% (95% CI 69-73), obesity 27% (25-29) and hyperlipidemia 34% (32-36). Diabetic retinopathy was found in 15% (13-17) and cataracts in 32% (30-35). About 13% (12-15) had impaired renal function as assessed by eGFR, representing 1 in 8 participants. Erectile dysfunction was a complication in 35% (32-38) of men. Age, duration of T2D and body mass index were significant risk factors for most complications/comorbidities. There was significant heterogeneity between sites in prevalence of most complications/comorbidities after adjusting for covariates. Population-attributable fraction ranged between 6 and 64 percent for most comorbidities. Conclusion: The burden of T2D complications and comorbidity is substantial among sub-Saharan Africans. Interventions to reduce T2D morbidity and mortality in SSA need to prioritise early detection, the maintenance of healthy blood pressure, weight and lipid levels, as well as strengthen health care system capacities to provide treatment and care for neurological and ophthalmological complications of T2D. Funding Statement: The study was supported in part by the Intramural Research Program of the National Institutes of Health in the Center for Research on Genomics and Global Health (CRGGH). The CRGGH is supported by the National Human Genome Research Institute (NHGRI), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Center for Information Technology, and the Office of the Director at the National Institutes of Health (1ZIAHG200362). Support for participant recruitment and initial genetic studies of the AADM study was provided by NIH grant No. 3T37TW00041-03S2 from the Office of Research on Minority Health. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study received ethical approval from the Institutional Review Board at each study site, Howard University and the United States National Institutes of Health.