Risk of Sleep Problems in Middle-Aged and Older Adults Experiencing Bodily Pains: Serial Multiple Mediation Estimates of Emotional Distress and Activity Limitations.

OBJECTIVES: Pain is increasingly becoming common among middle-aged and older adults. While research on the association between pain characteristics and sleep problems (SP) is limited in low- and middle-income countries, the underlying mechanisms of the association are poorly understood. This study examines the association of bodily pain intensity and pain interference with SP and investigates the mediating role of activity limitation and emotional distress in this association. METHODS: We analyzed population-based data, including 1,201 individuals aged ≥50 (mean [SD] age 66.14 [11.85] years) from the 2016-2018 AgeHeaPsyWel-HeaSeeB study in Ghana. Multiple OLS regressions and serial multiple mediation modeling using bootstrapping analyses examined direct and indirect effects from pain to SP through activity limitation and emotional distress. RESULTS: Regressions demonstrated that pain intensity and interference were significantly associated with higher levels of activity limitation, emotional distress, and SP (range: ß = 0.049-0.658). Bootstrapping analysis showed that activity limitation and emotional distress serially mediated the relationship between pain intensity and SP (total effect: ß = 0.264, Bootstrap 95% confidence interval [CI] = 0.165-0.362; direct effect: (ß = 0.107, Bootstrap 95% CI = 0.005-0.210; total indirect effect: ß = 0.156, Bootstrap 95% CI = 0.005-0.210) accounting for ∼59%. Activity limitation and emotional distress mediated pain interference and SP association (total effect: ß = 0.404, Bootstrap 95% CI = 0.318-0.490; direct effect: ß = 0.292, Bootstrap 95% CI = 0.201-0.384; and total indirect effect: ß = 0.112, Bootstrap 95% CI = 0.069-0.156) yielding ∼28%. CONCLUSION: Our data suggest that activity limitation and emotional distress may convey stress-related risks of pain on SP. Future research should evaluate if activity limitation and emotional distress could be effective targets to reduce the effect of pain on sleep in later-life.

Improving fire risk communication between authorities and micro-entrepreneurs: A mental models study of Ghanaian central market fires.

This study conceptualizes how fire management authorities can empower nonexpert public to participate in fire risk communication processes and increase their own responsibilities for managing fire preventive, protective and recovery processes effectively. Drawing narratives from 10 disaster management experts working at government institutions and nine micro-entrepreneurs operating self-sustaining businesses in different merchandized lines in Ghana, we analyzed the data thematically and explored new insights on mental models to generate a two-way fire risk communication model. The findings suggest that fire management authorities planned fire disasters at the strategic level, collaborated with multiple stakeholders, disseminated information through many risk communication methods, and utilized their capabilities to manage fire at the various stages of fire risk communication, but the outcomes were poor. The micro-entrepreneurs sought to improve fire management outcomes through attitude change, law enforcement actions, strengthened security and better public trust building. The study has implications for policymakers, governments, and risk communication authorities of developing countries to strengthen their fire disaster policies to minimize commercial fire incidents and address the damaging effects of fire on people's livelihoods, businesses, properties, and environments. Our proposed two-way fire risk communication model is a new theoretical lens for experts and the nonexpert public to assess each other's beliefs about risk information and manage fire risk communication effectively at all stages.

Exploring the Challenges Facing Women with Disabilities in Exclusive Breastfeeding in a Metropolitan Area in Ghana: A Qualitative Study.

OBJECTIVES: Whereas extant literature abounds with works on breastfeeding and its implications for child health and survival, there is very limited research on the challenges faced by disabled women in breastfeeding their infants and children. This study explored the challenges facing disabled women in the Kumasi Metropolis in exclusively breastfeeding their infants using qualitatibve research design. METHODS: Using a sample of 55 from the communities and key informants the snowballing and purtposive sampling techniques were used. The thematic approach was used in the analysis which was done manually. RESULTS: Most disabled women have Caesarean deliveries which could challenge exclusively breastfeed their infants. It was observed that disabled mothers generally have a low level of education, mostly unmarried and not gainfully employed. Secondly, most disabled mothers go through a Caesarean section during birth which makes it pretty difficult for them to exclusively breastfeed their infants. Apart from disabilities such as physical impairment, deafness and blindness which could challenge women exclusively breatfeed their children, additionally some health professionals discourage them from doing so. Some women and relatives of the disabled discourage them from exclusively breastfeeding their infants either through lack of awareness of the efficacy of the practice or the stress their involvement in exclusive breastfeeding brings upon the women themselves. CONCLUSIONS: Various forms of disability, and dsiscouragement from some health professionals and family members may constrain disabled women from exclusively breatfeeding their infants. Recommendations include, implementing the Disability Act, creating special wards for disabled women in the health institutions and orienting the medical staff on their professional responsibilities in taking care of the disabled.

The Role of a Health Protection Scheme in Health Services Utilization Among Community-Dwelling Older Persons in Ghana.

OBJECTIVES: This study examines the relationships between National Health Insurance Scheme (NHIS) enrollment and the frequency and "timing" of health services utilization among community-dwelling older Ghanaians. It also investigates whether the NHIS policy has improved equity in access to health care in later life. METHODS: Cross-sectional data were derived from an Ageing, Health, Psychological Wellbeing and Health-seeking Behavior Study collected between August 2016 and January 2017 (N = 1,200). Descriptive and bivariate analyses described the sample. Generalized Poisson and logit regression models, respectively estimated the predictors of frequency of health services utilization and time from onset of illness to health facility use and during last illness episode. RESULTS: Older persons with active NHIS membership frequently used health facilities (ß = 0.237, standard error [SE] = 0.0957, p ˂ .005), but the association was largely a function of health-related factors. The NHIS enrollees were more likely to attend health facility earlier (ß = 1.347, SE = 0.3437, p ˂ .001) compared with nonenrollees, after adjusting for theoretically relevant covariates. Moreover, given the NHIS enrollment, the rich (eß = 2.149, SE = 0.240, p ˂ .005), social support recipients (eß = 1.366, SE = 0.162, p ˂ .05) and those living with relevant others (eß = 2.699, SE = 0.175, p ˂ .001) were more likely to consume health services. DISCUSSION: Ghana's NHIS policy generally increases health services utilization but at present lacks the capability to improve equitable access to health care, especially between poor and nonpoor older adults. This may hamper the progress toward universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.

Sociocultural hegemony, gendered identity, and use of traditional and complementary medicine in Ghana.

This study investigated gender differences in the use of traditional and complementary medicine (TCM) in Ghana. Using an interviewer-administered questionnaire, we collected data from March to June 2013 from 324 randomly sampled adults in the Ashanti region. The prevalence of TCM use in the prior 12 months was 86 percent. Females constituted the majority (61 percent) of TCM users. Female TCM users were more likely than male users to have had only a basic education, been traders (p Ë‚ .0001), and have health insurance (p Ë‚ .05). Using multiple logistic regression, TCM use was associated with urban residence for females (odds ratio [OR] = 7.82; 95 percent confidence interval [CI]: 1.28-47.83) but negatively related for males (OR = 0.032; 95 percent CI: 0.002-0.63). Being self-employed was associated with TCM use among males (OR = 7.62; 95 percent CI: 1.22-47.60), while females' TCM use was associated with higher income (OR = 3.72; 95 percent CI: 1.21-11.48) and perceived efficacy of TCM (OR = 5.60; 95 percent CI: 1.78-17.64). The African sociocultural structure vests household decision-making power in men but apparently not regarding TCM use, and the factors associated with TCM use largely differed by gender. These findings provide ingredients for effective health policy planning and evaluation. Adoption and modernization of TCM should apply a gendered lens.

Gender and the utilisation of health services in the Ashanti Region, Ghana.

The survey seeks to structure a model for gender-based health services utilisation for the Ashanti Region of Ghana, and in addition, recommend intervention measures to ensure gender equity in the utilisation of health services. A sample size of 650 covered over 3108 houses, and the main research instruments were the questionnaire and formal interview. A multiple regression model is used for the analysis of the relationship between the complex independent variables and utilisation by gender. Results show that although females have a greater need for health services than males, they do not utilise health services as much. Secondly, whereas quality of service, health status, service cost and education have greater effect on male utilisation than females, distance and income have higher impact on female utilisation. It is recommended that, to ensure equity in health care utilisation, females be empowered through increased access to formal education and sustainable income opportunities. The introduction of a national health insurance scheme is also recommended to ensure adequate access by both sexes.

An analysis of the determinants of maternal mortality in sub-Saharan Africa.

OBJECTIVE: To establish what population characteristics affect the high maternal mortality rate in the sub-Saharan Africa region and to propose possible solutions to reduce this rate. METHODS: This study is a secondary analysis of existing data sources from the World Bank, the World Health Organization (WHO), as well as direct and indirect sources from UNAIDS, the United Nations, Demographic and Health Surveys (DHS), Macro International, and national statistical offices. Instead of looking at continentwide or individual nation models, it develops a regional model. Sociodemographic population variables are used as independent variables to predict the dependent variable, maternal mortality. Additionally, a new country-specific political stability independent variable is introduced into the model. Data from 28 sub-Saharan African countries are used. Bivariate correlations are used to establish associations among the variables, whereas cross-tabulations, using Kendall's tau-c values, and regression lines are used to establish impacts. RESULTS: In the sub-Saharan Africa region, births attended by skilled health personnel and life expectancy at birth strongly correlate with maternal mortality. Gross national product (GNP) per capita and health expenditure per capita also have strong association with maternal mortality. CONCLUSIONS: The availability of skilled delivery personnel, life expectancy, national economic wealth, and health expenditure per capita predict the maternal mortality rate of a country. Based on these findings, it is recommended that structural arrangements be made to train skilled health personnel to take care of maternal health problems. In view of the high cost of training physicians, middle-level health personnel may offer an affordable alternative to handle emergency obstetrical cases to address the shortage of physicians. In addition, the allocation of adequate resources to the health sector could improve maternal mortality. The economic wealth of a country and life expectancy at birth are less modifiable through short-term specific interventions. Additionally, it is recommended that country-specific interventions are needed to correct the problem of lack of critical data for analysis.

Water needs and women's health in the Kumasi metropolitan area, Ghana.

This paper examines the impact of water fetching by women and the quality of water during periods of water scarcity on the health of women in the Kumasi metropolitan area. A sample of 210 women drawn using systematic random procedure is used for the study. Formal interview is the main instrument used. The survey has established that income, quality of water, hours spent fetching water during scarcity and age are the main factors influencing women's health in the metropolis during water scarcity. In both the core and periphery, the water-related problem influencing health is hours spent fetching water during scarcity. An empirical model on water needs and women's health has emerged from the survey. Recommendations have been made on strategies to ensure regular volume of surface water, effective management of scarce water resources with the participation of women, and ensuring gender equity in domestic services.

Mothers' education and childhood mortality in Ghana.

The significant extent to which maternal education affects child health has been advanced in several sociodemographic-medical literature, but not much has been done in analysing the spatial dimension of the problem; and also using graphic and linear regression models of representation. In Ghana, very little has been done to relate the two variables and offer pragmatic explanations. The need to correlate the two, using a regression model, which is rarely applied in previous studies, is a methodological necessity. The paper examines the impact of mothers' education on childhood mortality in Ghana using, primarily, Ghana Demographic and Health Survey data of 1998 and World Bank data of 2000. The survey has emphatically established that there is an inverse relationship between mothers' education and child survivorship. The use of basic health facilities that relate to childhood survival shows a direct relationship with mothers' education. Recommendations for policy initiatives to simultaneously emphasise the education of the girl-child, and to ensure adequate access to maternal and child health services, have been made. The need for an experimental project of integrating maternal education and child health services has also been recommended. A linear regression model that illustrates the relationship between maternal education and childhood survival has emerged.

Analysing the primacy of distance in the utilization of health services in the Ahafo-Ano South district, Ghana.

Although the distance factor has been identified as key in the utilization of health services in rural areas of developing countries, it has been analysed without recourse to related factors of travel time and transport cost. Also, the influence of distance on vulnerable groups in utilization has not been an object of survey by researchers. This paper addresses the impact of distance on utilization, and how distance compares with travel time and transport cost that are related to it in the utilization of health services in the Ahafo-Ano South (rural) district in Ghana. The study, a cross-sectional survey, also identifies the position of distance among other important factors of utilization. A sample of 400, drawn through systematic random technique, was used for the survey. Data were analysed using the regression model and some graphic techniques. The main instruments used in data collection were formal (face-by-face) interview and a questionnaire. The survey finds that distance is the most important factor that influences the utilization of health services in the Ahafo-Ano South district. Other key factors are income, service cost and education. The effect of travel time on utilization reflects that of distance and utilization. Recommendations to reduce distance coverage, improve formal education and reduce poverty have been made.