Social consequences of planned relocation in response to sea level rise: impacts on anxiety, well-being, and perceived safety.

Governments globally are adapting to sea level rise through a range of interventions to improve everyday lives of communities at risk. One prominent response is planned relocation, where people and communities are enabled to move from localities exposed to coastal erosion and inundation as a result of sea level rise. Managed retreat has significant social consequences including under-reported impacts on health, well-being and social identity. Here we adopt well-established measures of well-being and document the outcomes of planned relocation on well-being in the Volta Delta region of Ghana. Data from a bespoke survey for individuals (n = 505) in relocated and non-relocated communities demonstrate that planned relocation negatively impacts well-being and anxiety of those relocated when compared to a community that is equally exposed but has not moved. Individuals in the relocated community reported significantly lower levels of overall wellbeing, significantly higher levels of anxiety, and lower perceptions of safety, compared to non-relocated community members. These outcomes are explained as being related to the disruption of community connection, identities, and feelings of efficacy. Relocated community members reported significantly lower levels of attachment to the local area and home, significantly lower levels of community-based self-efficacy, and significantly lower levels of overall community-based identity. The results demonstrate that planned relocation to address sea level rise has multiple social consequences with outcomes for well-being that are not straightforwardly related to risk reduction.

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

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.

Health and wellbeing implications of adaptation to flood risk.

Adaptation strategies to ameliorate the impacts of climate change are increasing in scale and scope around the world, with interventions becoming a part of daily life for many people. Though the implications of climate impacts for health and wellbeing are well documented, to date, adaptations are largely evaluated by financial cost and their effectiveness in reducing risk. Looking across different forms of adaptation to floods, we use existing literature to develop a typology of key domains of impact arising from interventions that are likely to shape health and wellbeing. We suggest that this typology can be used to assess the health consequences of adaptation interventions more generally and argue that such forms of evaluation will better support the development of sustainable adaptation planning.

Barriers and facilitators of weight management: Perspectives of the urban poor in Accra, Ghana.

BACKGROUND: Obesity is rising in sub-Saharan Africa and globally, and is a highly significant public health problem that needs urgent attention. To reduce the obesity prevalence levels and associated challenges, public health interventions highlight healthy eating and increased physical activity, which are key elements for weight management. AIM: This study explored perceived factors that hinder or facilitate weight management in an urban poor context in Accra, Ghana. METHODS: A cross-sectional qualitative data was obtained from eight focus group discussions (FGDs) conducted among community members. The FGDs were audio recorded, transcribed, and analysed using thematic analysis. RESULTS: The findings indicate that weight management is mainly inhibited by the perception that healthy foods are expensive and not satisfying, laziness, lack of time to engage in physical activity, and social representation of being fat or slim. On the contrary, personal decision to manage weight and social support facilitated engagement in weight management. CONCLUSION: The findings indicate that weight management is influenced by individual, community, and structural factors. These findings have programmatic implications in terms of health education strategies and messaging.

Exploring positive experiences of primary and secondary caregivers of older persons in resource-limited urban settings in Accra, Ghana.

Family caregivers experience both negative and positive outcomes. However, most studies have mainly focused on the negative outcomes. In addition, few studies have focused on both primary and secondary caregivers. This study explored the positive experiences of primary and secondary caregivers of older persons in resource-limited urban settings in Accra, Ghana. This study used phenomenological design, and thirty-one family caregivers were interviewed in James Town and Ussher Town. The interviews were audio-recorded, transcribed verbatim, and analysed thematically using NVivo 10. The findings show that the primary and secondary caregivers derived tangible and intangible rewards from providing care to older persons. The tangible rewards included gifts, while the intangible include blessings, skills acquisition, enhanced personal attributes, family cohesion, and health consciousness. Positive caregiving experiences can mitigate caregivers' burden and burnout. Therefore, policymakers and social workers should design interventions that will enhance the positive experiences of family caregivers. They should also consider the gender and age of caregivers in designing these interventions.

Annual and intra-annual climate variability and change of the Volta Delta, Ghana.

Deltas are geographically and socio-ecologically distinct systems, with a unique climate and contextually high vulnerabilities to climate dynamics. Hence, they require specific climate change adaptation and policy responses, informed by delta-scale analysis. However, available climate knowledge on deltas is based mainly on broad-scale analysis that masks information unique to deltas. This applies to the Volta Delta system of Ghana. This study presents annual and intra-annual climate variability and trend analysis carried out across the Volta Delta, using the coefficient of variation (CV), anomaly, Mann-Kendall and Pettit statistics. There were time and space differences in climate change and variability. Statistically significant (P < 0.05) positive trends were observed for the major wet season and the mean annual rainfall for Ada and highly significant (P < 0.01) positive trends for Akatsi. These contrasted with the observations in Adidome, which experienced a statistically highly significant (P < 0.01) decreasing trend in rainfall. There were significant (P< 0.05) increases in annual minimum, maximum, and mean temperatures over time in both coastal and inland delta stations. The annual rate of change of mean temperature ranged from 0.03 to 0.05. Ada, the more coastal location, has experienced a narrow range of temperature change, most probably due to the buffering capacity of the ocean. Point changes were observed in the climate data series in four (4) localities. We recommend that adaption and policy actions should include, the provision of small-scale irrigation, encouraging adoption of drought-resistant crop varieties and crop diversification, and also be made responsive to the existing spatiotemporal climate variability and change within the Volta Delta.

"Caring for the Elderly is Very Difficult": Challenges and Coping Strategies of Caregivers in Urban Poor Accra, Ghana.

This study is part of a broader phenomenological study on the experiences of family caregivers and their care recipients. There is a general paucity of research on the experiences of primary and secondary caregivers, and the negative impact of elderly care on caregivers in the urban poor settings in Ghana. This study explored primary and secondary caregivers' challenges and coping strategies in the urban poor context in Accra, Ghana. This study was conducted in Ga Mashie. Thirty-one caregivers were interviewed. A phenomenological analysis was conducted using NVivo 10. Primary and secondary caregivers experienced economic, physical, social, and psychological burdens. Also, caregivers used spirituality and perseverance to cope with their challenges. The findings demonstrate that caregivers' challenges varied by type of caregiver. Researchers and policymakers should consider the type of caregiver when designing interventions to mitigate the negative impacts of family caregiving on caregivers.

Experience and Future Perceived Risk of Floods and Diarrheal Disease in Urban Poor Communities in Accra, Ghana.

Diarrheal disease is a critical health condition in urban areas of developing countries due to increasing urbanization and its associated problems of sanitation and poor access to good drinking water. Increasing floods in cities have been linked to the risk of diarrheal disease. There are few studies that specifically link flooding with diarrhea diseases. This may be due to the fact that secondary data mainly hospital recorded cases, and not individual cases at the household level are used. Furthermore, of the few papers that consider the flood-diarrheal diseases nexus, none have considered risk perceptions in general, and more specifically, whether households that have experienced floods which resulted in a reported case of diarrhea, have higher perceived risks of future occurrences of the two phenomena compared to households that had different experiences. Yet, this is critical for the development of interventions that seek to increase protective behaviors and reduce the risk of contracting diarrhea. We surveyed 401 households in some selected urban poor communities in Accra, the capital of Ghana. Results show that households that experienced floods which resulted in a reported case of diarrhea, have higher perceived risk of future occurrence of the two phenomena compared to other households. We recommend public education that reduces the risk of exposure to flood and diarrhea through flood mitigation measures, including the construction of drains in communities and educating communities on good sanitation.

Urban Household Characteristics and Dietary Diversity: An Analysis of Food Security in Accra, Ghana.

BACKGROUND: The world's population is increasingly becoming urbanized. If the current urban growth rate is to continue, new and unprecedented challenges for food security will be inevitable. Dietary diversity has been used to ascertain food security status albeit at the multicountry and country levels. Thus, household-level studies in urban settings, particularly in sub-Sahara African, are few. Yet, it is imperative that assessments of food security are undertaken particularly in urban settings, due to the projected fast rate of urbanization and the challenges of attaining food security. OBJECTIVE: To examine household characteristics and dietary diversity. METHODS: The study uses data from 452 households from the second round of the Regional Institute for Population Studies (RIPS) EDULINK urban poverty and health study. Bivariate and multivariate analyses are undertaken. RESULTS: Mean dietary diversity for all households is 6.8. Vegetables have the highest diversity, followed by cereal-based and grain products. Household characteristics that have statistically significant associations with dietary diversity include sex and level of education of household head, household wealth quintile, and source of food. CONCLUSIONS: There is high dietary diversity in the study communities of Accra but low consumption of foods rich in micronutrient, such as fruits and milk/dairy products. The study brings to fore issues related to resource-disadvantaged entities of the urban system, namely, females, poor households, and the non-educated who have food insecurity problems.

The association of physical activity, body mass index and the blood pressure levels among urban poor youth in Accra, Ghana.

BACKGROUND: Globally, there is an increasing prevalence of high blood pressure (HBP) among adults and youth. However, the mechanisms of how the risk factors (physical inactivity and obesity) relate with blood pressure (BP) are not well known especially among the urban poor youth in low and middle income countries. Meanwhile childhood and adolescent physical inactivity and obesity, particularly in conditions of poverty, predispose individuals to cardiovascular diseases (CVDs) in later life. The aim of this study was to assess the BP levels and to examine its associations with physical activity (PA) and body mass index (BMI) amongst urban poor youth in Accra, Ghana. METHODS: We studied 201 youth aged 15-24 years in three urban poor communities in Accra, Ghana. Height, weight and BP were measured in all subjects. PA levels were assessed using the Edulink Urban Health and Poverty project questionnaire. Multiple linear regression analysis was used to determine the factors influencing BP levels. RESULTS: The proportion of pre-hypertension and hypertension among the youth was 32.3% and 4%, respectively. The rates of pre-hypertension (42.0 vs. 24.8) and hypertension (6.8 vs. 1.8) were higher in males than in females. More than three-quarters (84.1%) of the youth were not physically active. Females were more physically inactive compared to the males (94.7% vs. 70.5%). The average BMI was 22.8 kg/m(2). For overweight (17.7 vs. 6.8) and obesity (13.3 vs. 2.3), females had higher rates than males. BMI was positively related to systolic BP, and significantly associated with systolic BP (ß = 1.4, p < 0.000 and ß = 0.8, p < 0.000; respectively for male and female youth) compared to diastolic BP. Youth with low PA had raised BP. CONCLUSION: The positive association of BMI and BP in the study communities suggests the need for health measures to tackle their increase and related public health consequences. Further studies on BP and other risk factors among the youth of rural populations and other developing countries will be important to stall the rising prevalence and implications for adult morbidity and mortality.

Climate change and cerebrospinal meningitis in the Ghanaian meningitis belt.

Cerebrospinal meningitis (CSM) is one of the infectious diseases likely to be affected by climate change. Although there are a few studies on the climate change-CSM nexus, none has considered perceptions of community members. However, understanding public perception in relation to a phenomenon is very significant for the design of effective communication and mitigation strategies as well as coping and adaptation strategies. This paper uses focus group discussions (FGDs) to fill this knowledge lacuna. Results show that although a few elderly participants ascribed fatal causes (disobedience to gods, ancestors, and evil spirits) to CSM infections during FGDs, majority of participants rightly linked CSM infections to dry, very hot and dusty conditions experienced during the dry season. Finally, community members use a suite of adaptation options to curb future CSM epidemics.