Adolescents In Ghana Research Articles

Predicting risk and protective factors of generalized anxiety disorder: a comparative study among adolescents in Ghana

ABSTRACT In this study, we investigated psychosocial factors associated with Generalized Anxiety Disorder (GAD) among adolescents in two socioeconomically and ethnically different communities in Ghana. We examined two objectives; to test the predictors of GAD and to examine differences between the two groups on the predictors of GAD. We studied 300 adolescents aged between 13 and 19 years who responded to a six-scale questionnaire that measured GAD, parental perception, adolescent coping, adolescent religiosity, peer pressure, and self-esteem. We found a higher prevalence of GAD in Obuasi and consistent patterns of risks and protection in both communities. Non-productive coping and low parental involvement were found to be risk factors while self-esteem was found to be a protective factor against GAD. We discuss these findings in the context of socioeconomic and psychological differences among the adolescent population in Ghana.

Sexual and reproductive rights violations at sexual debut of male and female adolescents in Ghana.

To examine the social and ethical challenges in enforcing sexual and reproductive rights of male and female adolescents abused at sexual debut in Ghana. This was a secondary analysis of cross-sectional survey data on 278 sexually experienced male and female teenagers from 12 communities selected by cluster random sampling in the Ejisu-Juben district. We extracted relevant data from a 2009 academic thesis project involving 481 respondents. We assessed differences between sexual debut experiences of males and females using Pearson's chi-square and ANOVA tests. P-values ≤0.05 were considered significant. Mean ages at sexual debut for males and females were 16.05±1.8 and 15.98±1.47years respectively (P=0.719). Adolescents of both sexes experienced defilement and forced sexual debut; similar proportions had early sexual debut. Females who had early sexual debut were more likely than their older counterparts to have low educational attainment and induced abortion. Many male and female adolescents experience sexual and reproductive rights breaches at sexual debut. Prevailing circumstances hinder optimization of sexual and reproductive rights of juveniles in Ghana. We recommend making clear provisions for young persons in the law on sexual offences in the criminal code to facilitate development of interventions to improve access to justice for offenders and victims.

Cannabis and amphetamine use and its psychosocial correlates among school-going adolescents in Ghana

BackgroundThe aim of this study was to examine the prevalence of cannabis and amphetamine use and to determine its associated factors among school-going adolescents in Ghana.MethodThe 2012 Ghanaian Global School-based Student Health Survey on 3632 adolescents aged 11–19 years (mean = 15.1 years; SD = 1.4) was used. Participants for this study were sampled from selected junior (JHS) and senior high schools (SHS) in all the 10 administrative regions of Ghana. A two-stage cluster sampling design was used to select 25 senior high schools to represent all the 10 regions of Ghana. Information was collected with a self-administered structured questionnaire that contained information on demographics, alcohol, tobacco and other drug use, violence, and a range of other health-related behaviours.ResultsThe result showed that past-month cannabis use was 5.3% and lifetime amphetamine use was 7.1% among students. In multivariate model, after controlling for other variables, school truancy and current cigarette smoking were associated with both past-month cannabis and lifetime amphetamine use. The number of close friends was associated with only past-month cannabis use. School environment factors (bullying victimisation and having been attacked) and parental substance use were associated with lifetime amphetamine use.ConclusionThis study identified a number of risk factors, including parental substance use and various risk behaviours, for both past-month cannabis and lifetime amphetamine use. School-based health intervention programmes should be developed taking into consideration the risk factors associated with cannabis and amphetamine use among school-going adolescents.

Generalised anxiety disorder in adolescents in Ghana: Examination of the psychometric properties of the Generalised Anxiety Disorder-7 scale

The Generalised Anxiety Disorder-7 (GAD-7) is a self-report scale used to assess general anxiety symptoms. Although the GAD-7 has been found to be a valid scale among adults, studies examining its psychometric properties among adolescents in high-income countries are notably limited and particularly non-existent in low- and middle-income countries. The current study addresses this lacuna by investigating the factorial validity, construct validity, internal consistency and discriminant accuracy of the GAD-7. Data were collected from 553 adolescents (boys = 231; average age = 16.85) recruited from a senior high school in Ghana, a sub-Saharan African country, using cross-sectional self-report methodology. The result supports a unidimensional structure of the GAD-7 that was invariant across gender. The GAD-7 correlates significantly with measures of anxiety, suicidal tendencies and mental well-being, suggesting construct validity. The internal consistency of the GAD-7, based on the mean inter-item correlation value of 0.24 and Cronbach’s a = 0.69, is adequate. The GAD-7 similarly discriminated between individuals at high risk of suicidal tendencies and depression from those with low or no risk, with area under curve values of 0.71 and 0.70, respectively. The GAD-7 is a reliable and valid measure to screen for generalised anxiety disorder among adolescents in Ghana.

Factors that Promote Resilience in Homeless Children and Adolescents in Ghana: A Qualitative Study.

Several studies conducted on street youth have focused on causes of homelessness, their engagement in risky sexual behaviours and the prevalence of STIs, including HIV/AIDS. Although homeless youth are considered resilient, sparse literature exists on factors that promote resilience in this vulnerable group. Using a qualitative approach, semi-structured interviews were conducted with 16 purposively selected homeless children and youth (with a mean age of 14 years) from the Central Business District of Accra, Ghana. Thematic analysis was used to analyse the data. Findings showed that a strong religious belief, sense of humour, engagement in meaningful social interactive activities, reciprocal friendship, adherence to cultural norms and support from community-based organizations were identified as factors that help homeless youth cope with the multiple challenges of street life. Strengthening such protective factors could help ameliorate the impact of adverse conditions of these street youth.

Depressive symptomatology in adolescents in Ghana: Examination of psychometric properties of the Patient Health Questionnaire-9

BackgroundThe Patient Health Questionnaire (PHQ-9) has been used extensively in research and clinical settings. However, there is limited information regarding the psychometric properties of the PHQ-9 among adolescents, particularly in sub-Saharan Africa. MethodsData were collected from 553 adolescents (girls = 322, 58.1%) using a cross-sectional survey design to investigate the factorial validity, construct validity and internal consistency of the PHQ-9 in Ghana. ResultsConfirmatory factor analysis (CFA) and multi-group CFA support a one-factor structure of the PHQ-9 that was invariant across gender. The PHQ-9 correlates significantly with measures of anxiety, depression, mental wellbeing, and suicidal behavior. The internal consistency of the PHQ-9 was 0.71. LimitationThe study did not include a gold standard measure of depression to assess the diagnostic properties (e.g., sensitivity and specificity) of the PHQ-9. ConclusionThe results suggest that major depressive disorder, measured by the PHQ-9, is a homogeneous construct across gender and that the PHQ-9 can be used to screen for depressive symptoms in adolescent boys and girls in Ghana.

Alcohol use by school-going adolescents in Ghana: Prevalence and correlates

This study investigated the risk factors that are associated with alcohol use among a nationally representative sample of school-going adolescents in Ghana. The 2012 version of the Ghanaian Global School-based Student Health Survey on adolescents aged 11–19 years old (N = 1984) was used. Logistic regression was employed to study the relationship between alcohol use variables and socio-demographic characteristic, mental health problems, psychosocial variables and parental involvement. The prevalence of alcohol use behaviours were 6.8%, 11.1% and 12.6% for alcohol problem, lifetime drunkenness and current alcohol use respectively. Loneliness, suicidal ideation and suicidal attempts were found to independently increase the odds of alcohol use behaviours (current alcohol use, lifetime drunkenness and alcohol problems) among adolescents. Similarly behavioural problems such as truancy, current smoking of cigarette, being bullied, being physically attacked, being involved in a physical fight were found to independently increase the odds of alcohol use behaviours (current alcohol use, lifetime drunkenness and alcohol problems). Having close friends was protective of current alcohol use but not for drunkenness and alcohol problems. These results underline the need for the development of school-based health interventions for early identification of adolescents who may be at-risk for alcohol-related problems.

Determinants of risky sexual behaviours among adolescents in Central African Republic, Eswatini and Ghana: evidence from multi-indicator cluster surveys

Despite the declining HIV/AIDS prevalence globally, nearly half of all new HIV infections still occur among youth, especially in sub-Saharan Africa. While determinants of risky sexual behaviour have received copious attention in the literature, we still lack multi-country studies that track regional changes in sexual risk among youth in sub-Saharan Africa. This study seeks to fill part of this gap by identifying the determinants of risky sexual behaviours among adolescents in Ghana, Central African Republic (CAR) and Eswatini (formerly Swaziland). We used nationally representative sample data from the Multi Indicator Cluster survey, round four (MICS4). Results of the descriptive analysis show that overall consistent condom use is still extremely low in sub-Saharan Africa. In Ghana, only 8.5% of male youth and 7% of female youth consistently use condoms. In CAR this figure is 8% and 4% in male youth and female youth respectively. In Eswatini, with one of highest HIV prevalence in the world, the prevalence of consistent condom use is at 29% in males and 20% in females, higher than both in Ghana and CAR. Results of hierarchical models show that age at first sex does not predict risky sexual behaviour in Ghana, but it does predict risky sexual behaviour in CAR although only among young males. In Swaziland, age at first sex predicts risky sexual behaviour in both male and female youth but the relationship is not in the expected direction. Low socio-economic status predicts inconsistent condom use in all the three countries, but only among young females. This paper provides relevant policy lessons and recommendations.

Prevalence and correlates of truancy among in-school adolescents in Ghana: evidence from the 2012 Global School-based Student Health Survey

This study examined the prevalence and correlates of truancy among adolescents in Ghana using the 2012 Global School-based Health Survey. A sample of 1 430 adolescents was used for the study. The prevalence of truancy was 31%. In the multivariate analysis, we found that those in grade 4 of senior high school (OR = 4.0, 95% CI = 2.81, 5.83), those who felt hungry in school (OR = 1.49, 95% CI = 1.14, 1.94), those who used tobacco (OR = 2.31, 95% CI = 1.32, 4.03), those who used alcohol (OR = 2.32, 95% CI = 1.63, 3.29), those who engaged in physical fights (OR = 1.75, 95% CI = 1.31, 2.27), and those who sustained an injury (OR = 1.33, 95% CI = 1.02, 1.73) were respectively more likely to report being truant than those in grade 1 of senior high school, those who did not go hungry in school, those who did not use tobacco, those who did not use alcohol, those who did not sustain an injury, and those who did not engage in physical fights. Adolescents whose parents or guardians checked their homework were also less likely (OR = 0.66, 95% CI = 0.51, 0.84) to report being truant, compared to those whose parents did not check their homework. We found a high prevalence of truancy among adolescents in Ghana. These findings underscore the need for all stakeholders to actively intervene to reduce truancy among school adolescents, taking into consideration the associated factors.

The importance of self-efficacy and educational aspirations for academic achievement in resource-limited countries: Evidence from Ghana

IntroductionResearch on the influence of academic self-efficacy and educational aspirations on academic performance is underdeveloped in resource-limited countries. This study replicates and expands on earlier research that investigated a complex network of relationships between academic self-efficacy, educational aspirations, and academic performance. MethodsData from 4282 adolescents in Ghana and path analysis were used to test the causal pathways, and path invariance analysis was used to assess the moderation role of gender. Instrumental variable techniques were used to validate the path models. ResultsIncrease in academic self-efficacy indirectly accounts for improvement in academic performance through the mediational role of educational aspirations. The effects of self-efficacy on educational aspirations, and educational aspirations were stronger for boys than for girls. ConclusionsThese findings suggest that in resource-limited countries where the financial burden of schooling tends to be a demotivating factor, interventions that target adolescents' academic self-efficacy may be an effective means to boost educational aspirations and academic performance. Interventions should be tailored to meet the needs of all students so that all children can think of school as an important part of their lives and aspire to achieve, now and in the future.

Developmental Assets and Academic Performance of Adolescents in Ghana, Kenya, and South Africa

BackgroundOverall, youth well-being is crucial, particularly in developmental contexts, such as sub-Saharan Africa, which is experiencing the largest growth in the youth population internationally. The Positive Youth Development (PYD) framework considers the importance of positive experiences, positive relationships and positive environments regarding developmental (further distinguished as internal and external) assets. These assets are important for promoting positive outcomes among youth.ObjectiveThe objective of this study is to examine the importance of developmental assets for academic performance in three sub-Saharan African contexts, represented by Ghana, Kenya, and South Africa.MethodIn a cross-sectional study, youth from these three countries completed a questionnaire on sociodemographic measures, such as age, gender, parental education (as a proxy for socioeconomic status), measures of developmental assets and academic performance. We used Analysis of Variance to examine mean differences in developmental assets across countries and academic performance.ResultsResults indicated that Ghanaian students reported fewer assets than Kenyan and South African students and that across all countries, adolescents who perform academically better reported more developmental assets, in particular, internal assets.ConclusionThis is one of the few studies, which consider developmental assets within the PYD framework beyond the Western context. While we found that mainly internal assets were associated with academic performance, it is important to reiterate that both internal and external assets are theoretically associated with positive outcomes, such as academic performance. Future research may benefit from testing interventions to improve academic performance in the sub-Saharan African contexts by fostering both types of assets. Research is needed to extend the framework to consider more culturally appropriate and contextually relevant assets.

The accessibility of health services to young deaf adolescents in Ghana.

Quality health care is a fundamental human right, which is enshrined in several international and domestic legislative instruments. In the Ghanaian context, there are reports that adults with disabilities encounter barriers in their attempts to access health care. However, scholarly attention is yet to explore the perspectives of young people and adolescents with disabilities. Therefore, this quantitative study was conducted from the perspective of critical disability studies, where young deaf adolescents (YDAs) were regarded as right bearers, and where they shared their perspectives on health accessibility decisions, barriers, and needs. Sixty-seven participants, made up of 44 male and 23 female students, took part in this quantitative study. Although many YDAs who took part in this study indicated that it was not difficult to access health facilities, they claim to have encountered communication barriers. Sign language interpreters in health facilities and introduction of sign language courses in health training institutions to improve communication between health professionals and deaf patients have been suggested as ways of addressing the barriers faced by YDAs in Ghana.

High prevalence of non-adherence to antiretroviral therapy among undisclosed HIV-infected children in Ghana

ABSTRACTAdherence to antiretroviral therapy (ART) remains one of the greatest obstacles in pediatric HIV care. We sought to determine the prevalence of adherence to ART among undisclosed HIV-infected children and adolescents in Ghana. We analyzed baseline data from HIV-infected children and adolescents aged 7–18 years old enrolled in the SANKOFA Pediatric HIV disclosure intervention study in Ghana. Antiretroviral medication adherence was measured using caregiver 3-day recall; child 3-day recall; and pharmacy records for antiretroviral time-to-refill. Four hundred and twenty child-caregiver dyads were enrolled from January 2013 to June 2016. The median adherence (interquartile range), as measured by time-to-refill, was 93.2% (68.0%–100.0%). However, only 47.5% of children had ≥95% adherence (“good adherence”) using time-to-refill data. Children of caregivers who had received secondary or higher level of education versus no school (aOR, 2.90, 95% Confidence Interval, CI 1.29–6.56), p = 0.010) or elementary education only (aOR, 2.20, CI, 1.24–3.88, p = 0.007) were more likely to have “good adherence” (≥95%). In this cohort of children unaware of their HIV positive status, median ART adherence rate was sub-optimal (by World Health Organization definition) while 38% had poor adherence (<85%).

Agro-ecological zone and farm diversity are factors associated with haemoglobin and anaemia among rural school-aged children and adolescents in Ghana.

Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school‐aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6–9 years; n = 323) and adolescents (10–17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro‐ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro‐ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro‐ecological zone and age were predictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro‐ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.

Bullying victimization as a predictor of suicidal ideation and suicide attempt among senior high school students in Ghana: Results from the 2012 Ghana Global School-Based Health Survey

ABSTRACTThis paper examined the effect of bullying victimization on suicidal ideation and suicide attempt among adolescents in Ghana. Data on 1,633 students ages 14–18 years (50.6% males) were analyzed using logistic regression. We found that 17% of the 1,633 adolescents examined reported experiencing suicidal thoughts and about 21% of the 1,633 adolescents attempted suicide at some point during the past year. Prevalence of bullying was reported among 40% of the adolescents. Importantly, we found that the experience of bullying victimization was a significant predictor of both suicidal ideation and suicide attempt. While factors such as loneliness, anxiety, and use of illicit substances were positively associated with suicidal behaviors, participating in physical activity, having friends, and parental support reduced the likelihood of experiencing suicidal ideation. We make several policy recommendations, including educational programs on suicidal behaviors, antibullying interventions, and social support programs within schools and other social settings.

Skin-lightening practices among female high school students in Ghana

ObjectiveThe practice of skin lightening (SL) persist despite warnings about its harmful health effects. Adolescents are particularly vulnerable and at risk of prolonged use of SL products. We explored SL practices among high school students in Ghana, West Africa. Study designCross-sectional survey. MethodsWe used a self-administered questionnaire in a survey on SL practices among randomly selected female students in five Senior High Schools in the Brong Ahafo Region of Ghana. We determined prevalence and used bivariate and multivariate analysis to identify factors associated with the practice. ResultsA total of 410 students with a mean age of 17.6 years (±1.6) participated in the study. While 71.5% of students indicated that they had been approached by relatives and friends to use SL creams, 65.6% admitted to actually using it. Most (85.5%) students identified at least five friends who were using SL products at the time of the survey. Between 22.0% and 44.0% of students knew female teachers who practiced SL. Students in first year were twice as likely to practice SL compared with students in third year (odds ratio [OR] = 1.90, 95% confidence interval [CI] 1.15–3.13). Compared with those who had never been approached, students who had been approached by relatives and friends to use SL products were likely to be using it (OR = 2.24, 95% CI 1.43–3.53). Students who had sisters who used SL products were twice as likely to be users themselves (OR = 1.82, 95% CI 1.12–2.95). ConclusionThe practice of SL among female students in this study is high, and about the same as reported among adults in Ghana and other parts of sub-Saharan Africa. This suggests that the practice is well entrenched. A ban on the sale of SL products to adolescents in Ghana should be considered.

Predicting delinquency by self-reported impulsivity in adolescents in Ghana.

Impulsivity is one of several variables associated with delinquent and criminal acts, but its utility depends on the psychometric properties of the measure used. To investigate the latent structure of the abbreviated Barratt Impulsivity Scale (ABIS) and its convergent validity with measures of aggression and psychopathy in a Ghanaian sample. In a cross-sectional survey, high school students were recruited from two randomly selected schools in Ghana and asked to respond to the ABIS and measures of delinquency, aggression and psychopathy. Three hundred and sixty-three young people, aged 15-19 were recruited, 149 (41%) boys. Findings supported a three-factor (attention, motor and non-planning) structure of impulsivity, which did not differ by sex. Motor and attentional impulsivity were associated with both violent and general delinquent behaviours. Impulsivity scores also correlated with aggression and psychopathy scores, thus providing evidence of convergent validity. The ABIS was shown to have sound psychometrics in a standard Ghanaian secondary school sample. Even in this group, where delinquency and antisocial behaviours were of low frequency, its motor and attention impulsivity scores were shown to have some relationship with violent and general delinquent behaviours, suggesting that the ABIS could be a useful tool across cultures for identifying adolescents at high risk of such problems and intervening early to limit damage. Copyright © 2017 John Wiley & Sons, Ltd.

Factorial and convergent validity of the Youth Psychopathic Traits Inventory‐Short Version in Ghana

Studies have shown the existence of psychopathy construct in Western cultures. However, there is a general lack of research on this topical issue in non-Western countries, specifically sub-Saharan Africa. Consequently, this study investigated the factorial and convergent validity of the Youth Psychopathic Traits Inventory-Short Version (YPI-S) in 327 adolescents in Ghana. Confirmatory factor analysis supported a three-factor structure (interpersonal, behavioural and affective) of psychopathy that was invariant across gender. These results were replicated in a cross-validation sample comprising 363 adolescents. The YPI-S factors correlated significantly and positively with reactive and proactive aggression, thus bolstering its construct validity. The YPI-S and Big-Five domains were related differently, and where significant correlations were observed, their directions generally confirmed and extended previous studies. All in all, the result generally suggested the existence of psychopathy construct among Ghanaian youth which can be described along interpersonal, affective and behavioural domains. However, the alterations made to the YPI-S, coupled with its relatively low factor loadings and internal consistency largely, indicate cultural influences on the assessment of cross-cultural traits. This study illuminated the problem of exporting Western-based measures and their findings to non-Western contexts.

A free lunch or a walk back home? The school food environment and dietary behaviours among children and adolescents in Ghana.

Food environments can play an important roles in shaping nutrition and health outcomes. One such environment that has potential to affect youth is the school food environment. In contrast to higher-income countries, however, there is a critical evidence gap on the role of school food environments on children and adolescents in low- and middle-income countries. This mixed-methods study contributes to filling this gap by investigating the role of school food environments on dietary behaviours of children and adolescents in Ghana. It draws on data from household and school questionnaires as well as focus group discussions collected as part of the baseline for an impact evaluation of the Ghana School Feeding Programme (GSFP).Multi-level regression models were fitted with random intercepts at the individual, household and community levels. Excerpts from the focus group discussions provided a deeper understanding of quantitative findings. Children and adolescents who received free school meals provided by the GSFP or who lived further away from school were less likely to go home for lunch. More than half of sampled schools reported offering foods for sale by independent vendors, the most common being meals followed by confectionery, fruit and sugar-sweetened beverages. Predictors of bringing money to school to buy food included non-receipt of free school meals, adolescence, greater commuting distance from home, household asset score, and urban location. Policy efforts focusing on the school food environment may contribute to healthy dietary behaviours for children and adolescents with positive impacts over the lifecourse.

Condom use negotiation among high school adolescents in Ghana: the role of gender

Gender has a profound effect on the sexual risk preventive intentions and behaviour of young people. However, little is known about the role of gender on condom use negotiation among adolescents in Ghana. This study explored gender differences in condom use negotiation among school-going adolescents in Ghana. Participants ( n = 684) completed self-report measures based on attitudes towards condom use, subjective norms regarding condom use, perceived behavioural control over condom use, intentions to use condoms, and on actual condom use behaviour. Results revealed statistically significant differences in condom use by gender. Specifically, attitudes towards condom use were more favourable among male students than they were among female students. Male students perceived slightly greater control over condom use than did female students. Moreover, male students reported slightly more condom-protected sexual behaviour than did female students. These results highlight the usefulness of designing gender-specific sexual risk reduction programmes among high school adolescents in Ghana.