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Abstract Introduction Type 1 diabetes mellitus (T1DM) is mostly diagnosed among young people. Despite the evidence that T1DM is disruptive, and affects individuals’ health and cognitive ability, there is dearth of knowledge on the impact of T1DM on schooling in LMICs including Ghana. In this research, we explored the impact of T1DM on the schooling of young people living with the disease, and discussed the results within health selection, social support, and artefactual perspectives of inequality. Methods Data were extracted from a qualitative project on T1DM lived experiences in southern Ghana. The study participants were young persons living with T1DM (n = 28) and their caregivers (n = 12). They were purposively recruited to participate in the study using maximum variation and snowball sampling techniques and interviewed in their support group centres, homes, or healthcare facilities using semi-structured interview guides. A computer-assisted qualitative data analysis was performed using QSR NVivo 14 software, and the results were categorised into themes. Results Three themes were identified from the transcripts. These themes were school and classroom attendance, choice of school, and school/academic performance. T1DM was a major reason for patients’ limited contact hours with teachers, school drop-out, preference for day schools rather than boarding, opting for vocational training instead of continuation of formal education, limited concentration at school, and delayed educational progression. Conclusion T1DM impacted the schooling of young people living with the disease. The mechanisms of these impacts, and young peoples lived experiences are not artefactual, but rather support discourses on health selection and inadequate social support for young people living with the disease. The results call for the need to develop educational and social interventions to address these barriers. The full implementation of the Inclusive Education Policy (IEP) may contribute to reducing educational and social inequalities caused by ill-health.

The 2023 World Menstrual Hygiene Day (WMHD) celebration at the University of Health and Allied Sciences (UHAS) sought to create awareness about menstruation. Toward normalizing menstruation, the 3-day event brought together key stakeholders and engaged community members on various topics relating to menstruation. Among the stakeholders were basic school teachers (13), school children (155), in a 2:1 female vs. male ratio within the ages of 10–17 years, School Health and Education Program Coordinators (2), Health Officers (4), Academicians (15), University students (35), Media representatives (3), and Civil society representatives (130). Particular among these discussions were the biology of menstruation, nutrition related facts during menstruation, sociocultural, and mental health issues surrounding menstruation. These discussions were intended to incite more conversations about menstruation, and contribute toward the agenda 2030 goal of making menstruation a normal fact of life. The paper describes activities conducted to improve menstrual health, reduce period poverty, and involve men in breaking the stigma around menstruation. This contributes to creating supportive environments for menstruating individuals. Meanwhile, the lessons from the activities to celebrate WMHD in Ghana are relevant for other communities to consider replicating with consideration for contextual differences.

Sustainable Development Goal (SDG)-10 opines that all countries should reduce inequality (being it gender, income, regional or emission inequality) by 2030. However, the exacerbating effect of climate variability seems to widen gender inequality in developing countries such as Sub-Saharan Africa. It is on this backdrop that the UNFCCC mentioned the need for gender mainstreaming in raising climate finance to support developing countries. The main purpose of the study is to find out whether climate finance and rainfall variability impacts gender inequality among 46 Sub-Saharan Africa countries. Data was analysed using system generalised method of moment, to deal with the endogeneity problem inherent in the model. Sensitivity of the estimates was carried out to test the robustness of our results using panel quantile regression. The findings indicate that, SSA countries experiencing high rainfall variability are facing worsening gender inequality both in the short-run and long-run. For climate finance, it showed a significant gender equality strengthening effect in SSA both in the short-run and long-run. This indicates that, CF geared toward developing countries is not only helping mitigate and adapt to climate change, but bridging the gender gap too. Based on that, several policy implications are discussed.

Few studies exist on the early care and education (ECE) of children who are deaf in low-to-middle-income countries, and none examine the roles of deaf adults in such provision. A research base is needed to inform contextually sensitive "deaf-infused" models of ECE in such contexts that build on indigenous deaf community experience, knowledge, and local expertise. This paper discusses the development of ECE in Ghana in sub-Saharan Africa focusing specifically on the perspectives of deaf adults on their roles in ECE support and leadership. Seventeen deaf adults with different leadership and advocacy roles in Ghana were interviewed about their perceptions of ECE priorities in this context, and the role of deaf adults in the development and delivery of early support. The participants expressed diverse views on ECE for the children and their families and suggested ways of building capacity and leadership among deaf adults to support ECE for the children and their families.

Abstract Objective Studies are paying increasing attention to complex social determinants in explaining the variation in the rates COVID-19 vaccine uptake. This study examines the influence of various individual, contextual, and vaccine-related factors on COVID-19 vaccine uptake behaviour in a resource-scarce and vulnerable setting using a quantitative research approach. Using a multi-staged cluster sampling approach, 408 individuals from 204 households in Cape Coast, Ghana’s tourism hub, were surveyed. Probit and logistic regression models were estimated to test the vaccine-related factors. Results A significant difference is observed between wait time and vaccination status (χ2 = 21.17; p = 0.000). Moreover, age and religion, as controlled variables, equally played significant roles in influencing the adoption of the vaccine. Other factors encompass the perceived risk of contracting COVID-19, the perceived benefits of the vaccine in relation to its side effects, and the level of trust individuals have in the concern of vaccine producers for their health. These findings call for targeted campaigns by the Ministry of Health, health facilities and other institutions promoting the COVID-19 vaccine. These actors should emphasize the benefits of vaccination, prioritize trust-building initiatives, and provide clear guidance on vaccination schedules, and manage waiting time.

Abstract Background In Low-Middle-Income Countries (LMICs), young people living with Type 1 Diabetes Mellitus (T1DM) face structural barriers which undermine adequate T1DM management and lead to poor health outcomes. However, research on the barriers faced by young people living with T1DM have mostly focused on patient factors, neglecting concerns regarding plausible barriers that may exist at the point of healthcare service delivery. Objective This study sought to explore barriers faced by young people living with T1DM and their caregivers at the point of healthcare service delivery. Methods Data were drawn from a qualitative research in southern Ghana. The research was underpinned by a phenomenological study design. Data were collected from 28 young people living with T1DM, 12 caregivers, and six healthcare providers using semi-structured interview guides. The data were collected at home, hospital, and support group centres via face-to-face interviews, telephone interviews, and videoconferencing. Thematic and framework analyses were done using CAQDAS (QSR NVivo 14). Results Eight key barriers were identified. These were: shortage of insulin and management logistics; healthcare provider knowledge gaps; lack of T1DM care continuity; poor healthcare provider-caregiver interactions; lack of specialists’ care; sharing of physical space with adult patients; long waiting time; and outdated treatment plans. The multiple barriers identified suggest the need for an integrated model of T1DM to improve its care delivery in low-resource settings. We adapted the Chronic Care Model (CCM) to develop an Integrated Healthcare for T1DM management in low-resource settings. Conclusion Young people living with T1DM, and their caregivers encountered multiple healthcare barriers in both in-patient and outpatient healthcare facilities. The results highlight important intervention areas which must be addressed/improved to optimise T1DM care, as well as call for the implementation of a proposed integrated approach to T1DM care in low-resource settings.

Abstract Background Systems of across the world have developed and implemented patient rights policies to protect and improve the provider-patient relationship. The Patient Charter of Ghana was developed in 2002 to improve service quality and protect patients’ rights. However, it is not yet known whether those at the frontline of healthcare delivery can read and understand the contents of the charter. While studies have explored the socioeconomic and institutional level factors related to awareness and knowledge of the Patient Rights Charter, there is a lack of literature on its readability and comprehensibility among nurses. This study assesses nurses’ knowledge of the Patient Rights Charter and associated literacy-related factors. Method An exploratory cross-sectional design and quantitative methods were used to collect data on knowledge, comprehension, and readability of the Patient Rights Charter. 205 nurses from four district hospitals in the Central Region were recruited using proportional and total enumeration sampling. Data were collected using structured questionnaires and were processed using SPSS (version 26) and an online text readability consensus calculator (version 2.0). Descriptive and inferential statistical analyses were performed, and data were presented using simple frequencies, readability statistics, and regression output. Results The results show the charter is written at a higher reading grade level; Flesch-Kincaid Grade Level (13.36), Simple Measure of Gobbledygook (11.57), and Coleman-Liau Readability Index (14.2). The average reading grade level score was 14. The Gunning Fox Index (15.40) and the Flesch Reading Ease Score (34%) show the patient charter is difficult to read and will require at least 14 years of education to be able to read. 87.3% of nurses were able to read and comprehend the charter. Very few (8.3%) read at frustration level. Nurses’ actual comprehension of the charter was the only significant predictor of knowledge of the charter. Conclusion Comprehension of the patient charter is an important predictor of its knowledge. The results emphasize the need to enhance the readability and comprehensibility of the charter for providers. Hospitals can stimulate nurses’ knowledge of the charter by simplifying the charter’s language and deliberately educating nurses on its content.

ABSTRACTOur study provides fresh insights into FDI's impact on carbon emissions across 51 African nations. Analysing data from 1990 to 2021, we use ARDL estimates and wavelet coherence analysis. While ARDL shows insignificant cointegration for most countries, wavelet coherence reveals: (i) 17 countries with a positive FDI-emissions link, (ii) 16 countries with a negative association, and (iii) 18 countries with ‘sign switching’ nonlinear dynamics. With no clear regional patterns, our main policy implication stresses the need for aligning regional efforts, like AfCFTA, with tailored country-specific strategies to guide capital flows towards cleaner industries. We advocate for industry-level FDI data in Africa to pinpoint sectors needing monitoring for greener production. On the global policymaking level, we assert that FDI cannot significantly address climate justice for most African countries.

AbstractThis study seeks to find out whether climate finance (CF) geared toward 35 Sub Saharan Africa (SSA) countries is assisting to achieve food security in the continent. To achieve this objective, we adopted FAO’s classification of food security of 4 main dimensions: food availability, access, stability and utilization and use principal component analysis (PCA) to generate food security indexes corresponding to the different dimensions of food security. The data was analyzed using system generalized methods of moments (GMM) whereas panel quantile regression (PQR) was employed as a sensitivity analysis. Our findings show that climate finance is more useful in securing food availability but fails to enhance food access, stability and utilization. Further analysis shows that other factors such as foreign direct investment and government readiness have more impact in enhancing the different dimensions of food security whilst rural population, agricultural spending, agricultural land and capacity have more adverse effects on food security. Relevant policy implications based on our analysis are discussed.

Aims Graves’ disease, an autoimmune illness, is one of the most common causes of thyrotoxicosis and often presents with classic symptoms of hyperthyroidism. However, patients can rarely present for the first time with psychiatric symptoms, including psychotic and mood symptoms or a combination of both, and there is limited data on the most effective treatment. Methods Here, we report the case of a 24-year-old black British female who had no previous psychiatric or medical history, presenting for the first time with one week history of poor sleep, disordered thought, and bizarre and violent behaviour towards family. Collateral history describes her premorbid personality as “anxious and perfectionist”, with the only recent stressors identified being preparations for her best friend's wedding. Her mental state on presentation was remarkable for tangential and circumstantial speech, incongruent affect, and lack of insight into illness. She was admitted to an acute adult ward under Section 2 of the Mental Health Act (MHA) after being “medically cleared” but before the results of her thyroid function tests were available. She was transferred back to the acute medical ward a day into psychiatric admission, where she was treated medically for thyrotoxicosis and discharged with the support of the Home Treatment Team after an almost complete recovery in her mental state. Initial symptoms recurred two weeks after discharge, culminating in another admission cycle initially to a psychiatric unit under the MHA, where she was treated with oral risperidone and a medical ward for further medical investigations. Her mental state improved significantly again, and she was discharged home to the concerted care of both a community mental health team and follow-up with the endocrinology team. On outpatient psychiatric review a year following discharge, the patient remains stable in her mental state and has achieved a euthyroid state with plans to taper off and withdraw risperidone gradually. Results This case shows the importance of a thorough physical health assessment and investigation before making psychiatric management decisions. It also points out the drawback of the divide between physical and mental health services, the impact this has on patient care and experience within the National Health Service, and the mixed success of medical management in controlling psychiatric symptoms. Conclusion This case describes the rare presentation and successful management of psychosis induced by thyrotoxicosis in a female patient with Graves’ disease. It highlights the need for prompt, interdisciplinary care to diagnose and safely manage such patients correctly.

Cardiovascular diseases (CVD) are the leading cause of death worldwide, with 80% of these deaths occurring in low-middle income countries (LMICs). In Ghana and across Africa, CVDs have emerged as the leading causes of death primarily due to undetected and under treated hypertension, yet less than 5% of resources allocated to health in these resource-poor countries go into non-communicable diseases (NCD) including CVD prevention and management. Consequently, most countries in Africa do not have contextually appropriate and sustainable health system framework to prevent, detect and manage CVD to achieve Universal Health Coverage (UHC) in CVD care through improved Primary Health Care (PHC) with the aim of achieving Sustainable Development Goals (SDG) in CVD/NCD. In view of this, the Ghana Heart Initiative (GHI) was envisaged as a national strategy to address the identified gaps using a health system and a population-based approach to reduce the national burden of CVDs. The GHI intervention includes the development of guidelines and training manuals; training, equipment support, establishment of a national call/support center, and improvement in the national data capturing system for CVDs and NCD, management of Hypertension, Deep Vein Thrombosis (DVT) and Heart Failure (HF). Following the implementation of the GHI concept, a national CVD Management Guideline was developed and 300-health facilities across the different levels of care including one teaching hospital, was also supported with basic life-saving equipment. In addition, more than 1,500 healthcare workers also reported improvement in their knowledge and skills in the management and treatment of CVD-related cases in their health facilities. These are key contributions to strengthening the health system for CVD care and learning lessons for scale up.

BackgroundHeart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care. ObjectiveThis study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana. MethodsWe conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring. ResultsThis intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024. ConclusionsThis study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research. Trial RegistrationISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214 International Registered Report Identifier (IRRID)DERR1-10.2196/52616

Abstract Foodborne diseases (FBDs) are a major public health concern, especially in Sub-Saharan African (SSA) countries, such as Ghana, where poor food handling practices (FHPs) are prevalent. To estimate the pooled proportion of good FHPs and the associated factors among Ghanaian food handlers, this systematic review and meta-analysis was conducted to aid scholars, practitioners and policymakers in devising FBD-preventable interventions. The scientific databases PubMed, Google Scholar, Science Direct, African Journals Online, ProQuest, and Directory of Open Access Journals were systematically searched until April 19, 2023, for relevant literature. Observational studies meeting the inclusion criteria of reported good FHPs among food handlers were included. Three authors independently searched the database, assessed the risks of bias and extracted the data from the shortlisted articles. A random-effects model with the DerSimonian and Laird model was used to estimate the pooled effect size of FHPs and the pooled odds ratio (POR) of FHP-associated factors. Out of the 2019 records collated, 33 with a total sample size of 6095 food handlers met the inclusion criteria for meta-analysis. The pooled proportion of good FHPs among Ghanaian food handlers was 55.8% [95% Cl (48.7, 62.8%); I2 = 97.4%; p

Background: The implementation of task sharing and shifting (TSTS) policy as a way of addressing the shortage of physicians and reducing the burden of hypertension in Africa birthed the idea of the African School of Hypertension (ASH). The ASH is saddled with the responsibility of training non-physician health workers across Africa continent in the management of uncomplicated hypertension. Aim: To get feedback from some faculty members and students who participated in the first ASH programme. Methods: This was a cross-sectional exploratory qualitative study conducted among eight students and eight faculty members. Feedback from the program was obtained by conducting in-depth interviews centred on description of course content; expectations and knowledge acquired from ASH; level of interaction between students and faculty members; challenges faced during the ASH; level of implementation of acquired training; and suggestions to improve subsequent ASH programs Results: The course content of the ASH was described as simple, appropriate and adequate while interaction between students and faculty members were highly cordial and engaging. New knowledge about hypertension management was acquired by the students with different levels of implementation post-graduation. Some identified challenges with the ASH program were poor internet connectivity during lectures, non-uniformity of TSTS policies and hypertension management guidelines across Africa, technical problems with hypertension management app and low participation from other African countries apart from Nigeria. Some recommendations to improve ASH program were development of a uniform hypertension management guideline for Africans, wider publicity of the ASH, interpretation of lectures into French and Portuguese languages and improvement of internet connectivity. Conclusion: The ASH programme has largely achieved its objectives with the very encouraging feedback received from both faculty members and the students. Steps should be taken to address the identified challenges and implement the suggested recommendations in subsequent ASH program to sustain this success.

In Ghana, Nile tilapia is one of the most commonly cultivated fish species. Bacterial infections, which mostly occur in intensive fish farming, are considered to be the most significant health issue facing these culture systems in Ghana's aquaculture industry. To prevent, and treat bacterial infections and promote fish growth, antimicrobials are often used, and in most cases at unregulated doses. However, this misuse and neglect of withdrawal durations for such antimicrobials may result in drug residues showing up in fish edible tissue, posing a risk to human consumers. To evaluate the risk to consumers, this study screened for antibiotic residues in popular tilapia fish sold at a retail outlet in Tema. Using ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC/MS/MS), the study analysed the levels of 12 antibiotics present in 24 tilapia samples sold at a retail outlet in Tema. Erythromycin, tetracycline, oxytetracycline, and amoxicillin were detected at varying levels, with frequencies of 20.8 %, 62.5 %, 58.3 %, and 54.2 %, respectively. The highest concentration of 3.521 ± 0.32 μg/kg was found for oxytetracycline, while erythromycin had the lowest concentration (0.276 ± 0.11 μg/kg) in the samples. According to the study, the levels of antibiotics detected in the sampled tilapia were lower than the maximum residue limits (MRL) recommended by the WHO. Additionally, both the hazard quotient (HQ) and hazard index (HI) values were less than one. Therefore, consuming retail farmed tilapia purchased from the commercial outlet in Tema metropolis was deemed to pose no significant risk to human health. However, regular monitoring of antibiotics and other contaminants is necessary to minimise their potential impacts on human health.

Summary: Background: Digital health interventions can be effective for blood pressure (BP) control, but a comparison of the effectiveness and application of these types of interventions has not yet been systematically evaluated in low- and middle-income countries (LMICs). This study aimed to compare the effectiveness of digital health interventions according to the World Health Organisation (WHO) classifications of patients in terms of BP control, lifestyle behaviour changes, and adherence to medication in patients with hypertension in LMICs. Methods: In this systematic review and meta-analysis, we searched the PubMed, Scopus, Web of Science, Embase, CINAHL, and Cochrane Library databases for randomised controlled trials (RCTs) published in English, comprised of adults (≥18 years old) with hypertension and the intervention consisted of digital health interventions according to WHO's classifications for patients in LMICs between January 1, 2009, and July 17, 2023. We excluded RCTs that considered patients with hypertension comorbidities such as diabetes and hypertension-mediated target organ damage (HMTOD). The references were downloaded into Mendeley Desktop and imported into the Rayyan web tool for deduplication and screening. The risk of bias was assessed using Cochrane Risk of Bias 2. Data extraction was done according to Cochrane's guidelines. The main outcome measures were mean systolic blood pressure (SBP) and BP control which were assessed using the random-effect DerSimonian-Laird and Mantel-Haenszel models. We presented the BP outcomes, lifestyle behaviour changes and medication adherence in forest plots as well as summarized them in tables. This study is registered with PROSPERO, CRD42023424227. Findings: We identified 9322 articles, of which 22 RCTs from 12 countries (n = 12,892 respondents) were included in the systematic review. The quality of the 22 studies was graded as high risk (n = 7), had some concerns (n = 3) and low risk of bias (n = 12). A total of 19 RCTs (n = 12,418 respondents) were included in the meta-analysis. Overall, digital health intervention had significant reductions in SBP [mean difference (MD) = −4.43 mmHg (95% CI −6.19 to −2.67), I2 = 92%] and BP control [odds ratio (OR) = 2.20 (95% CI 1.64–2.94), I2 = 78%], respectively, compared with usual care. A subgroup analysis revealed that short message service (SMS) interventions had the greatest statistically significant reduction of SBP [MD = −5.75 mm Hg (95% Cl −7.77 to −3.73), I2 = 86%] compared to mobile phone calls [MD = 3.08 mm Hg (−6.16 to 12.32), I2 = 87%] or smartphone apps interventions [MD = −4.06 mm Hg (−6.56 to −1.55), I2 = 79%], but the difference between groups was not statistically significant (p = 0.14). The meta-analysis showed that the interventions had a significant effect in supporting changes in lifestyle behaviours related to a low salt diet [standardised mean difference (SMD) = 1.25; (95% CI 0.64–1.87), I2 = 89%], physical activity [SMD = 1.30; (95% CI 0.23–2.37), I2 = 94%] and smoking reduction [risk difference (RR) = 0.03; (95% CI 0.01–0.05), I2 = 0%] compared to the control group. In addition, improvement in medication adherence was statistically significant and higher in the intervention group than in the control group [SMD = 1.59; (95% CI 0.51–2.67), I2 = 97%]. Interpretation: Our findings suggest that digital health interventions may be effective for BP control, changes in lifestyle behaviours, and improvements in medication adherence in LMICs. However, we observed high heterogeneity between included studies, and only two studies from Africa were included. The combination of digital health interventions with clinical management is crucial to achieving optimal clinical effectiveness in BP control, changes in lifestyle behaviours and improvements in medication adherence. Funding: None.

BackgroundArt therapy allows people to express feelings about any subject through creative work. It is beneficial for people who feel out of touch with their emotions. In Ghana, little is known about art therapy as a therapeutic tool. Herbal treatment, biomedical and faith healing practices are the most common treatment options for mental health. This research aimed to provide new insights into clinical psychologists on their knowledge and use of art therapy in treating clients and identified the enablers and barriers in this therapeutic intervention.MethodTwenty-one clinical psychologists were sampled using the snowball sampling method. They were interviewed over the phone using a semi-structured interview guide which was developed based on the predefined study objectives. Thematic analysis was employed to analyze the data resulting in three central thematic areas.ResultsTwelve of the clinical psychologists were females and eight were male, with an age range between twenty-five to fifty years. The major themes identified were knowledge of art therapy, the use of art therapy and enablers and barriers in using art therapy. The study revealed that clinical psychologists had limited knowledge of art therapy mainly due to lack of training. With the use of art therapy, the participants revealed that they had used some form of art therapy before and they perceived art therapy to be effective on their clients however, they demonstrated low confidence in using it. Practitioner training and the availability of art therapy-related resources were identified as both facilitators and hindrances to the use of art therapy.ConclusionClinical Psychologists are cognizant of art therapy albeit they have limited knowledge. Therefore, training in how to use art therapy and the availability of resources to facilitate art therapy can be provided for Clinical Psychologists by the Ghana Mental Health Authority.

To unearth the influence of climate finance (CF) on women-hunger alleviation in Sub-Saharan Africa (SSA), the study used unbalanced panel data for 43 SSA countries for the period 2006-2018. Data was analysed using system-GMM to deal with the endogeneity problem inherent in the model, among other panel regression estimators. Also, the sensitivity of the estimates was carried out using panel fixed effect quantile regression. The findings showed that CF and its components have a significant effect on women-hunger alleviation in SSA, apart from FDI. Further, control of corruption also showed a significant women-hunger alleviation impact. For the climate variables, areas in SSA with higher temperature are more likely to experience worsened women-hunger. Based on the findings, the study recommends that SSA countries need to strengthen their fight against corruption. More so, donors should extend CF as financial aid or support to government budget, due to their potential of alleviating women-hunger.

Abstract Background Management of type 1 diabetes (T1D) is complex and demanding. It requires patients and their caregivers, particularly those in low-resource settings to adopt productive coping strategies to achieve ideal glycaemic control. Coping and adaptation strategies have far-reaching implications on their behavioural and health outcomes. Yet, it is uncertain how young people living with T1D and their caregivers in low-resource settings cope and adapt to the challenges of T1D management. This study analysed textual and photo evidence on the coping and adaptation strategies employed by young persons living with T1D (warriors) and their caregivers in Ghana. Methods Qualitative data were collected from 28 warriors, 12 caregivers, 6 healthcare providers and other stakeholders in southern Ghana using semi-structured interview guides. Participants were identified at T1D support group centres, hospitals, and their places of residence, and recruited into the study using maximum variation and snowball sampling approaches. Data were collected via face-to-face interviews, photovoice, telephone interviews and videoconferencing and were thematically analysed using QSR NVivo 11. Results Four superordinate themes which are productive coping, non-productive coping, keeping T1D a secret, and coping with costs of care were identified. Productive coping entailed condition acceptance, planning ahead, seeking social support, borrowing insulin, and overcoming the barriers of insulin storage. On the other hand, avoidance, disengagement, and re-use of syringes were the common non-productive coping approaches. Due to stigma and discrimination, the warriors shrouded their condition in secrecy. As a response to the financial burden of T1D care, caregivers/patients borrowed money, took loans, and sold household items. Conclusion Young persons living with T1D and their caregivers adopted coping strategies which both promoted and compromised their T1D management. There was an occasional co-existence of diverse coping strategies (productive and non-productive), and these reflects the personal and contextual stressors they faced. The results call for the need to eliminate barriers of T1D management and equip patients and their caregivers with ongoing T1D coping competencies.

Abstract Introduction Cardiovascular diseases (CVD) remain the leading cause of death worldwide, with over 70% of these deaths occurring in low- and middle-income regions such as Africa. However, most countries in Africa do not have the capacity to manage CVD. The Ghana Heart Initiative has been an ongoing national program since 2018, aimed at improving CVD care and thus reducing the death rates of these diseases in Ghana. This study therefore aimed at assessing the impact of this initiative by identifying, at baseline, the gaps in the management of CVDs within the health system to develop robust measures to bolster CVD management and care in Ghana. Methods This study employed a cross-sectional study design and was conducted from November 2019 to March 2020 in 44 health facilities in the Greater Accra region. The assessment covered CVD management, equipment availability, knowledge of health workers in CVD and others including the CVD management support system, availability of CVD management guidelines and CVD/NCD indicators in the District Health Information Management System (DHIMS2). Results The baseline data showed a total of 85,612 outpatient attendants over the period in the study facilities, 70% were women and 364(0.4%) were newly diagnosed with hypertension. A total of 83% of the newly diagnosed hypertensives were put on treatment, 56.3% (171) continued treatment during the study period and less than 10% (5%) had their blood pressure controlled at the end of the study (in March 2020). Other gaps identified included suboptimal health worker knowledge in CVD management (mean score of 69.0 ± 13.0, p

Abstract Background Despite the large volume of scientific evidence on the rapid spread of the COVID-19 pandemic and associated high morbidity and mortality, little is known about the sociocultural disruptions which ensued. The current study explored the nuanced navigation of the COVID-19-related death and burial protocols and its impact on traditional burial and funeral rites in Ghana. Methods This qualitative study was based on the ‘focused’ ethnographic design. Data were collected using key informant interviews from nineteen COVID-19-related bereaved family members and public health officials involved in enforcing adherence to COVID-19-related death and burial protocols in the Cape Coast Metropolis of Central region of Ghana. Recursive analysis was conducted to generate the themes and sub-themes from the data. Results The overarching theme was “Uncultural” connotations ascribed to the COVID-19-related death and burial protocols. The COVID-19-related death and burial protocols were ubiquitously deemed by participants to be ‘uncultural’ as they inhibited deep-rooted indigenous and eschatological rites of separation between the living and the dead. This was fueled by limited awareness and knowledge about the COVID-19 burial protocols, resulting in fierce resistance by bereaved family members who demanded that public health officials release the bodies of their deceased relatives. Such resistance in the midst of resource limitation led to negotiated compromises of the COVID-19-related death and burial protocols between family members and public health officials. Conclusions Insensitivity to socio-cultural practices compromised the implementation of the COVID-19 pandemic control interventions, particularly, the COVID-19-related death and burial protocols. Some compromises that were not sanctioned by the protocols were reached to allow health officials and families respectfully bury their dead. These findings call for the need to prioritize the incorporation of sociocultural practices in future pandemic prevention and management strategies.

Abstract Aims and Objective We sought to investigate knowledge and skills of type 1 diabetes (T1D) management among young people living with the disease and their caregivers. Our aim is to provide baseline evidence to inform T1D self‐management education for young people living with the disease and their caregivers. Background Both local and international guidelines recommend ongoing T1D self‐management education for people living with the disease. This is because T1D often develops among young people who rarely have the competencies to adequately manage their condition. However, the extent to which young people living with T1D and their caregivers can self‐manage this chronic disease in a low‐resource country like Ghana is unknown. Methods Using a phenomenological study design, semi‐structured interviews were conducted with 28 young people living with type 1 diabetes, 12 caregivers and 6 healthcare providers in southern Ghana. Data were collected at homes, hospitals and support group centres of participants via face‐to‐face interviews, photovoice and video‐conferencing. The data were analysed thematically using QSR NVivo 11. Results The young people living with T1D and their caregivers demonstrated knowledge and skills in the self‐monitoring of blood glucose, and the treatment of hyperglycaemia. Areas of more marginal or lack of knowledge were concerning carbohydrate counting, severe hypoglycaemia and the management of intercurrent illnesses. Young persons living with T1D and their caregivers received their management information from healthcare and non‐healthcare providers. Access to diabetes self‐management education influenced T1D management knowledge and practices. Conclusion Young people living with type 1 diabetes and their caregivers possessed limited scope of knowledge on type 1 diabetes self‐management. Multiple sources of T1D knowledge were found, some of which may not be helpful to patients. The knowledge gaps identified compromises transitional independence and self‐management capacity. Relevance to Clinical Practice It is important for clinicians and organizations that provide T1D education to provide diabetes self‐management education also on managing hypoglycaemia, carbohydrate counting and managing T1D during intercurrent life events among young people living with T1D. No Patient or Public Contribution Patients and their caregivers were interviewed as research participants. They did not conceptualize, analyse, interpret or prepare the manuscript.

This study explores the potential impact of climate finance (cf) on food prices in Sub-Saharan Africa (SSA) as climate change continues to create food scarcity and increase food prices. The study analyses data from 43 SSA countries between 2006 and 2018 using a panel fixed effect model with Driscoll-Kraay standard errors and methods of moments quantile regressions (MMQR). The findings indicate that countries in SSA that receive more cf, improve their fight against corruption, have good rainfall patterns, experience reduced extreme temperatures, have depreciated currencies, larger populations and higher GDP growth, reduce food imports, increase domestic food supply, and demonstrate high governance and social readiness are likely to experience stable or reduced food prices. Based on these results, the study recommends that SSA governments prioritise anticorruption efforts to earn donor trust and increase CF, ultimately leading to lower food prices in the sub-region. Further, the findings indicate that good rainfall patterns reduce food prices: this shows the need for SSA countries to invest in policies that lead to reliablewater supply as irrigation.

Fusarium wilt disease limits tomato production, especially in Ghana. In managing the Fusarium wilt disease, two rootstocks (Solanum torvum and Solanum macrocarpon) were used in grafting experiments. Plant growth, yield, disease severity and incidence of both grafted plants, and non-grafted plants were evaluated in a pot experiment and also under a naturally infected open field condition at Berekum. During the early stage (14 days after inoculation) under artificial inoculation conditions, grafted plants exhibited higher photosynthetic rates (10.41 μmol−2s−1) compared to the non-grafted plants (8.36 μmol−2s−1). Under naturally infested field conditions, chlorophyll content and photosynthetic rate of non-grafted plants decreased. Solanum lycopersicum grafted onto S. macrocarpon and S. torvum were moderately susceptible (20%–40%) to Fusarium oxysporum. However, the non-grafted plants were highly susceptible (50%–100%). Yield from the pot experiment for S. lycopersicum grafted onto S. macrocarpon was significantly higher (453.1 g/plant), compared to S. lycopersicum grafted onto S. torvum (350.3 g/plant) and the non-grafted plant (205 g/plant). However, in naturally infected field, the grafted plants increased in fruit yield compared to the non-grafted tomato plants. Solanum macrocarpon and S. torvum as rootstocks offered resistance against F. oxysporum and showed significantly lower disease progression, than the non-grafted plants (P