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Thanatologists who have researched mortuary beliefs and practices from around the world posit that many societies differentiate between good and bad deaths. The current study utilized in-depth interviews with 30 Akan culture experts to investigate what the Akan ethnic group of Ghana considers to be good death. The results show that Akan good death is natural harmonious death that occurs at advanced age. The deceased would also have experienced a meaningful life devoid of immorality or turpitude. While the bodies of decedents of Akan bad deaths are interred without much ceremony, good deaths are associated with elaborate burial rites and funerary obsequies that serve to honor the decedent. Findings show that Akans generally aspire to achieve a good death, be granted solemn burial rites, and to receive a fitting funerary celebration that would launch them on a journey to join ancestral kin in the hereafter., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

African immigrants remain underrepresented in research due to challenges in recruitment. Mobile instant messaging applications, such as WhatsApp, present novel, and cost-effective opportunities for conducting health research across geographic and temporal distances, potentially mitigating the challenges of maintaining contact and engagement in research with migrant populations. Moreover, WhatsApp has been found to be commonly used by African immigrant communities. However, little is known about the acceptability and use of WhatsApp as a tool for health research among African immigrants in the US. In this study, we examine the acceptability and feasibility of WhatsApp as a tool for research among Ghanaian immigrants- a subset of the African immigrant population group. We used WhatsApp to recruit 40 participants for a qualitative interview about their use of the mobile messaging application. Three distinct themes related to the acceptability and feasibility of WhatsApp emerged from the interviews: (1) preference for using WhatsApp as a medium of communication; (2) positive perception of WhatsApp; and (3) preference for using WhatsApp for research. The findings indicate that for African immigrants in the US, WhatsApp is a preferred method for recruiting and collecting data. It remains a promising strategy to utilize in future research involving this population., (© 2023. W. Montague Cobb-NMA Health Institute.)

Background: Breast cancer is currently the most commonly diagnosed cancer in Ghana and the leading cause of cancer mortality among women. Few published empirical evidence exist on cultural beliefs and perceptions about breast cancer diagnosis and treatment in Ghana. This systematic review sought to map evidence on the socio-cultural beliefs and perceptions influencing the diagnosis and treatment of breast cancer among Ghanaian women., Methods: This review was conducted following the methodological guideline of Joanna Briggs Institute and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. The literature search was conducted in PubMed, CINAHL via EBSCOhost, PsycINFO, Web of Science, and Embase. Studies that were conducted on cultural, religious, and spiritual beliefs were included. The included studies were screened by title, abstract, and full text by three reviewers. Data were charted and results were presented in a narrative synthesis form., Results: After the title, abstract, and full-text screening, 15 studies were included. Three categories were identified after the synthesis of the charted data. The categories included: cultural, religious and spiritual beliefs and misconceptions about breast cancer. The cultural beliefs included ancestral punishment and curses from the gods for wrongdoing leading to breast cancer. Spiritual beliefs about breast cancer were attributed to spiritual or supernatural forces. People had the religious belief that breast cancer is a test from God and they resorted to prayers for healing. Some women perceived that breast cancer is caused by spider bites, heredity, extreme stress, trauma, infections, diet, or lifestyle., Conclusion: This study adduces evidence of the socio-cultural beliefs that impact on the diagnosis and treatment of breast cancer among women in Ghana. Taking into consideration the diverse cultural and traditional beliefs about breast cancer diagnosis and treatment, there is a compelling need to intensify nationwide public education on breast cancer to clarify the myths and misconceptions about the disease. We recommend the need to incorporate socio-cultural factors influencing breast cancer diagnosis and treatment into breast cancer awareness programs, education, and interventions in Ghana., (© 2024. The Author(s).)

Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans., Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI., Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively ( P <0.0001)., Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

The Fatty Liver Index (FLI) is a proxy for the steatotic component of non-alcoholic fatty liver disease (NAFLD). For sub-Saharan African populations, the contribution of dietary factors to the development of NAFLD in the etiology of type 2 diabetes mellitus (T2DM) remains to be clarified. We identified sex-specific dietary patterns (DPs) related to the FLI using reduced ranked regression (RRR) and evaluated the associations of these DPs with T2DM. This analysis used data from the RODAM, a multi-center cross-sectional study of Ghanaian populations living in Ghana and Europe. The daily intake frequencies of 30 food groups served as the predictor variables, while the FLI was the response variable. The odds ratios and 95% confidence intervals for T2DM were calculated per one standard deviation increase in the DP score using logistic regression. In males, the DP score explained 9.9% of the variation in their food intake and 16.0% of the variation in the FLI. This DP was characterized by high intakes of poultry, whole-grain cereals, coffee and tea, condiments, and potatoes, and the chance of T2DM was 45% higher per 1 DP score-SD (Model 2). Our results indicate that the intake of modernized foods was associated with proxies of NAFLD, possibly underlying the metabolic pathways to developing T2DM.

Dietary acculturation may explain the increasing risk of diet-related diseases among African immigrants in the United States (US). We interviewed twenty-five Ghanaian immigrants (Youth n 13, Age (Mean ± sd) 20 y ± 5⋅4, Parents ( n 6) and Grandparents ( n 6) age 58⋅7 ± 9⋅7) living in New York City (NYC) to (a) understand how cultural practices and the acculturation experience influence dietary patterns of Ghanaian immigrants and (b) identify intergenerational differences in dietary acculturation among Ghanaian youth, parents and grandparents. Dietary acculturation began in Ghana, continued in NYC and was perceived as a positive process. At the interpersonal level, parents encouraged youth to embrace school lunch and foods outside the home. In contrast, parents preferred home-cooked Ghanaian meals, yet busy schedules limited time for cooking and shared meals. At the community level, greater purchasing power in NYC led to increased calories, and youth welcomed individual choice as schools and fast food exposed them to new foods. Global forces facilitated nutrition transition in Ghana as fast and packaged foods became omnipresent in urban settings. Adults sought to maintain cultural foodways while facilitating dietary acculturation for youth. Both traditional and global diets evolved as youth and adults adopted new food and healthy social norms in the US., (© The Author(s) 2021.)

Abstract: Although anxiety and depression have been central topics for scholars and clinicians in the United States, few studies have examined their correlates in sub-Saharan Africa and none have examined large urban slums. Using face-to-face interviews in two African cities, we analyze self-reported symptoms of anxiety and depression in a community-based sample (n = 495). Ordinary least squares regression was used to analyze a variety of demographic and social predictors including sex, child-rearing, marital status, education, income, age, and neighborhood for residents of Agbogbloshie (Accra, Ghana) and Kangemi (Nairobi, Kenya). Controlling for other factors, two personal network dimensions were significant. Total network size is positively associated with symptoms of anxiety and depression in Kenya but not in Ghana. However, one factor was predictive of symptoms of anxiety and depression in both locations: the reported percentage of ties with older persons. Higher levels of anxiety and depression are associated with a larger share of older individuals in one's personal network., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Maternal mortality is high in Ghana, averaging 310 maternal deaths per 100,000 live births in 2017. This is partly due to inadequate postnatal care especially among rural communities. Ghana can avert the high maternal deaths if women meet the World Health Organisation's recommended early postnatal care check-up. Despite the association between geographical location and postnatal care utilisation, no study has been done on determinants of postnatal care among rural residents in Ghana. Therefore, this study determined the prevalence and correlates of postnatal care utilization among women in rural Ghana., Methods: The study utilised women's file of the 2014 Ghana Demographic and Health Survey (GDHS). Following descriptive computation of the prevalence, binary logistic regression was fitted to assess correlates of postnatal care at 95% confidence interval. The results were presented in adjusted odds ratio (AOR). Any AOR less than 1 was interpreted as reduced likelihood of PNC attendance whilst AOR above 1 depicted otherwise. All analyses were done using Stata version 14.0., Results: The study revealed that 74% of the rural women had postnatal care. At the inferential level, women residing in Savanna zone had higher odds of postnatal care compared to those in the Coastal zone [AOR = 1.80, CI = 1.023-3.159], just as among the Guan women as compared to the Akan [AOR = 7.15, CI = 1.602-31.935]. Women who were working were more probable to utilise postnatal care compared to those not working [AOR = 1.45, CI = 1.015-2.060]. Those who considered distance as unproblematic were more likely to utilise postnatal care compared to those who considered distance as problematic [AOR = 1.63, CI = 1.239-2.145]., Conclusions: The study showed that ethnicity, ecological zone, occupation and distance to health facility predict postnatal care utilisation among rural residents of Ghana. The study points to the need for government to increase maternal healthcare facilities in rural settings in order to reduce the distance covered by women in seeking postnatal care.

Globally, cervical cancer constitutes a substantial public health concern. Evidence recommends regular cervical cancer screening (CCS) for early detection of "precancerous lesions."Understanding the factors influencing screening participation among various groups is imperative for improving screening protocols and coverage. This study aimed to explore barriers and facilitators to CCS participation in women of Nigerian, Ghanaian, Cameroonian, and Kenyan origin in Finland. We utilized a qualitative design and conducted eight focus group discussions (FGDs) in English, with women aged 27-45 years ( n = 30). The FGDs were tape-recorded, transcribed verbatim, and analyzed utilizing the inductive content analysis approach. The main barriers to CCS participation included limited language proficiency, lack of screening awareness, misunderstanding of screening's purpose, and miscomprehension of the CCS results. Facilitators were free-of-charge screening, reproductive health services utilization, and women's understanding of CCS's importance for early detection of cervical cancer. In conclusion, among women, the main barriers to CCS participation were language difficulties and lack of screening information. Enhancing screening participation amongst these migrant populations would benefit from appropriate information about the CCS. Those women with limited language skills and not utilizing reproductive health services need more attention from healthcare authorities about screening importance. Culturally tailored screening intervention programs might also be helpful., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of this study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

In this study, 268 samples for unrelated males belonging to the five major human subpopulation groups in Ghana (Akan, Ewe, Mole-Dagbon, Ga-Dangme and Guang) were genetically characterised for 23 Y chromosome short tandem repeat (STR) loci using the Powerplex® Y23 STR kit. A total of 263 complete haplotypes were recorded of which 258 were unique. The haplotype diversity, discriminating capacity and match probability for the pooled population data were 0.9998, 0.9627 and 0.0039, respectively. The pairwise genetic distance (R ST ) for the Ghanaian datasets and other reference populations deposited in the Y-STR Haplotype Reference Database (YHRD) were estimated and mapped using multidimensional scaling (MDS) plot. The Guang and Ewe were significantly different from the Akan, Mole-Dagbon and Ga-Dangme. However, the five Ghanaian datasets were all plotted close together with other African populations in the MDS data mapping.

The aim of this case report is to share with the forensic science community the experience of a rare complication of sickle cell anemia: acute chest syndrome. In October 2016, at the port of the city of Trapani (Sicily, Italy), the landing of an ONG "Médecins Sans Frontières" ship took place with 548 non-EU citizens and a corpse on board. The man, in the hours before his death, complained of severe chest pain and respiratory difficulties, and, despite of the therapeutic aids and resuscitation maneuvers, lastly died. The Public Prosecutor ordered that autopsy be executed on the corpse of the young Ghanaian, and it was to be supplemented by histological, toxicological, genetic investigations, and the dating of the biological age. The autoptic examination findings were indicative of bilateral bronchopneumonia, and were also confirmed by the histological findings, which identified a condition of massive adipose pulmonary embolism, due to the presence of extramedullary hematopoietic tissue, site of endovascular thrombosis secondary to hemolysis of sickle cells. The spleen appeared of small volume, with fibrotic phenomena. The predisposition to infections, thrombosis, extramedullary hematopoiesis are all complications of sickle cell anemia. The severe pulmonary condition characterized by vaso-occlusive findings and pulmonary inflammation with infiltrate, symptoms like fever, chest pain and severe systemic hypoxia allowed to ascribe the plausible cause of death as acute chest syndrome, a rare complication of sickle cell anemia. The peculiarity of this clinical case is also related to the methods of medical intervention (boat with non-governmental medical support for assistance to migrants).

Objective: Ethnic minorities report different levels of drinking and smoking and higher rates of depression compared to native populations. In this study we aimed to investigate in six ethnic groups whether tobacco and alcohol use were associated with depressive symptoms, which are more prevalent in ethnic minorities. Methods: Cross-sectional data from the multi-ethnic Healthy Life in an Urban Setting (HELIUS) study sample ( N  = 22,471) was used, comprising 4,580 native Dutch participants which were compared with participants from five ethnic minority groups (3,259 South Asian Surinamese, 4,292 African Surinamese, 2,262 Ghanaian, 3,891 Turkish, and 4,187 Moroccan). Results: Alcohol misuse was positively associated with depressed mood in all ethnic groups except for the Dutch and the Ghanaians. Nicotine dependence was positively associated with depressed mood in all ethnic groups except for the Ghanaian group. Conclusions: Alcohol misuse and nicotine dependence were significantly associated with depressed mood in most but not all ethnic groups and especially in men. However, across all groups the contribution of alcohol misuse and nicotine dependence to depressed mood was small. Prospective multi-ethnic studies should confirm whether the relations are causal and elucidate their direction.

More people are migrating than ever before. There are an estimated 1 billion migrants globally-of whom, 258 million are international migrants and 763 million are internal migrants. Almost half of these migrants are women, and most are of reproductive age. Female migration has increased. The socioeconomic contexts of women migrants need investigation to better understand how migration intersects with accessing health care. We employed a focused ethnography design. We recruited 29 women from three African countries: Ghana, Nigeria, and South Africa. We used purposive and convenient sampling techniques and collected data using face-to-face interviews. Interviews were audio-recorded and transcribed verbatim. Data were analyzed with the support of ATLAS.ti 8 Windows (ATLAS.ti Scientific Software Development GmbH), a computer-based qualitative software for data management. We interviewed 10 women from both South Africa and Ghana and nine women from Nigeria. Their ages ranged between 24 and 64 years. The four themes that developed included social connectedness to navigate access to care, the influence of place of origin on access to care, experiences of financial accessibility, and historical and cultural orientation to accessing health care. It was clear that theses factors affected economic migrant women's access to health care after migration. Canada has a universal health care system but multiple research studies have documented that migrants have significant barriers to accessing health care. Most migrants indeed arrive in Canada from a health care system that is very different than their country of origin. Access to health care is one of the most important social determinants of health.

In this study, we analyzed the M. tuberculosis complex (MTBc) population structure among multidrug-resistant TB (MDR-TB) patients in Niger and tested whether the Cameroon family displayed a slower response to MDR-TB treatment. We genotyped baseline clinical isolates that had been collected from pulmonary MDR-TB patients recruited consecutively between 2008 and 2016 in Niger. Spoligotyping was used to analyze the genetic diversity of mycobacterial lineages, and Kaplan Meier's analysis to compare treatment outcomes. A total of 222 MTBc isolates were genotyped; 204 (91,9%) were identified as the Euro-American L4 lineage, with the Ghana family (106, 47,4%) and the Cameroon family (63, 28,4%) being predominant. Patients infected by Cameroon family isolates 61(96,8%) showed faster conversion (log-rank p < 0.01) than those infected with Ghana family isolates (91,5%), and were more likely to experience favorable outcome (adjusted odds ratio [aOR] 4.4; 95%CI 1.1-17.9]; p = 0.015). We found no association between MTBc families and second-line drug resistance profiles (p > 0.05). Our findings show that MDR-TB in Niger is caused by major spoligotypes of the Euro-American L4; with more rapid smear and culture conversion in patients infected with the Cameroon family. These first insights may alert clinicians that slow conversion may be associated with the type of infecting strain., Competing Interests: Declaration of competing interest The authors stated that they have no competing interests., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Hepatitis B virus (HBV) is a public health threatening virus and is classified into more than eight genotypes and more than forty subgenotypes., Objectives: To characterize and propose novel strains assigned as A8 and D12., Methods: Four out of 133 HBV complete genome sequences, isolated from Belgian chronic carriers with African origin were phylogenetically analyzed., Results: Phylogenetic analyses of HBV genotypes A and D strains exhibited separate clusters supported by significant bootstrap values. The two genotype A strains isolated from Congolese patients, and two genotype D strains isolated from Ghanaian carriers clustered separately from the other known subgenotypes A (A1-A6 and quasi-subgenotypes) and subgenotypes D (D1-D11). The mean inter-subgenotypic nucleotide divergence over the full-length genome sequence between the novel strains (A8 and D12) and A1-A7 and D1-D11 subgenotypes was higher than 4%., Conclusions: Phylogenetic analysis of the full-length HBV genome sequences revealed a novel subgenotype and quasi-subgenotype based on the nucleotide divergence and identification of novel amino acids motifs in different ORFs. We identified two strains of the novel subgenotype A8 and two strains of the novel quasi-subgenotype D12. Notably, the analysis demonstrated that the subgenotype A8 strains are a basal lineage that diverged before the other African subgenotypes A., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: In the advent of rapid urbanisation, migration and epidemiological transition, the extent to which serum uric acid (sUA) affects cardiovascular disease (CVD) risk among Africans is not well understood. We assessed differences in sUA levels and associations with CVD risk among migrant Ghanaians in Europe and non-migrant Ghanaians in rural and urban Ghana., Methods: Baseline data from 633 rural, 916 urban and 2315 migrant participants (40-70 years) from the cross-sectional RODAM study were analysed. Hyperuricaemia was defined as sUA >7 mg/dl in men and >6 mg/dl in women. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was calculated using the American College of Cardiology (ACC)/American Heart Association (AHA) risk score which takes into account ethnic minority populations. High CVD risk was defined as ASCVD risk scores ≥7.5%. Logistic regressions were used to assess associations between hyperuricaemia and CVD risk., Results: Prevalence for hyperuricaemia in rural, urban and migrant participants was 17.4%, 19.1% and 31.7% for men, and 15.9%, 18.2% and 33.2% for women, respectively. Hyperuricaemia was positively associated with elevated CVD risk among rural residents (adjusted OR for men 3.28, 95% CI: 1.21-8.96, 6.36, 95% CI: 2.98-13.56 for women), urban residents (1.12, 95% CI: 0.45-2.81 for men, 2.11, 95% CI: 1.26-3.52 for women) and migrants (1.73, 95% CI: 1.01-2.96 for men, 4.61, 95% CI: 3.05-6.97 for women)., Conclusion: Our study shows variations of sUA levels in different African contexts. Hyperuricaemia is associated with elevated 10-year CVD risk in both migrants and non-migrants. Further studies should identify factors driving associations between sUA and CVD risk in Africans., (© 2019 John Wiley & Sons Ltd.)

Background: Since the National Malaria Elimination Action Plan was launched in China in 2010, local malaria transmission has decreased rapidly. Zero indigenous cases were reported since 2017. However, after 2010, the proportion of imported cases in China increased from 45.7% in 2010 to 99.9% in 2016, and almost all provinces of China have reported imported cases in recent years. Prevention of the reintroduction of malaria into China is crucial for the maintenance of its malaria-free status. Hence, it is of utmost importance to correctly identify the source of malaria infections within the country., Case Introduction and Response: In 2016 and 2017, three laboratory-confirmed cases of malaria caused by Plasmodium falciparum were identified in patients with no previous travel history to endemic areas were reported in Jiangsu Province, China, where malaria due to P. falciparum was eliminated about 30 years ago. These were diagnosed after 41, 31 and 39 days of seeking treatment, respectively, and all of them had received blood transfusions. Further investigations indicated that two of the cases had received blood from foreign students (from Indonesia and Ghana), and the other had received blood from an individual who had worked in Equatorial Guinea. All three blood donors were traced, and found to be carrying asymptomatic P. falciparum infections by microscopic examination and PCR. Furthermore, five polymorphic microsatellite markers (C1M4, C4M62, C13M13, C14M17, and C13M63) were typed and used to link parasites from the donors with those of the transfusion-receiving patients., Conclusions: Three transfusion-transmitted malaria cases were identified in China, all of which were due to the transfusion of blood donated by individuals who had contracted malaria outside the country. These cases can provide a reference for those faced with similar challenges in malaria case identification and classification in other regions. In addition, a stricter screening policy including the use of appropriate detection methods for malaria parasites should be developed and adopted for blood donation in regions undergoing malaria elimination.

Objective: This study examined the role of migration and acculturation in the diet of Ghanaian migrants in Europe by (1) comparing food intake of Ghanaian migrants in Europe with that of Ghanaians living in Ghana and (2) assessing the association between acculturation and food intake., Design: Data from the cross-sectional multicenter study Research on Obesity and Diabetes among African Migrants were used. Food intake was assessed using a Ghana-specific food propensity questionnaire (134 items and 14 food groups); foods were grouped based on a model of dietary change proposed by Koctürk-Runefors., Setting: Ghana, London, Amsterdam, and Berlin., Participants: A total of 4,534 Ghanaian adults living in Ghana and Europe, with complete dietary data. Of these, 1,773 Ghanaian migrants had complete acculturation data., Main Outcome Measure: Food intake (the weighted intake frequency per week of food categories)., Analysis: Linear regression., Results: Food intake differed between Ghanaians living in Ghana and Europe. Among Ghanaian migrants in Europe, there were inconsistent and small associations between acculturation and food intake, except for ethnic identity, which was consistently associated with intake only of traditional staples., Conclusions and Implications: Findings indicate that migration is associated with dietary changes that cannot be fully explained by ethnic, cultural, and social acculturation. The study provides limited support to the differential changes in diet suggested by the Koctürk-Runefors' model of dietary change., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The Dutch multi-ethnic Healthy Life in an Urban Setting study recently showed that alcohol consumption was lower in ethnic minority groups than those of Dutch origin, but that binge drinking in drinkers of Turkish and Moroccan origin was relatively high. The aim of the current study is to examine factors that may contribute to the differences in drinking patterns and how they relate to the relationship between drinking patterns and alcohol dependence (AD) across ethnic groups., Methods: The rate of last year alcohol use, alcohol use patterns and AD was assessed in 4,635 Dutch, 4,317 Moroccan, 4,036 Turkish, 2,459 Ghanaian, 4,426 African Surinamese and 3,357 South-Asian Surinamese participants (both men and women) born in Amsterdam, the Netherlands., Results: Compared to the Dutch, the prevalence of (regular) drinking is substantially lower in all ethnic minority groups and regular drinkers among most ethnic minority groups have a lower adjusted risk to develop binge drinking and AD than the Dutch. For the prevalence of regular drinking, the ethnic differences are bigger than for the prevalence of current drinking. However, regular drinkers of Moroccan origin have a risk similar to the Dutch to develop binge drinking and AD; a finding that could not be explained by group differences in age, sex, religiosity, perceived discrimination, depression or guilt feelings about drinking., Discussion: The prevalence data show that current drinking is lower and that regular drinking is much lower in ethnic minorities and - with the exception of those of Moroccan origin - ethnic minority regular drinkers also have a significant lower risk to develop binge drinking or AD than regular drinkers of Dutch origin. This implies that the magnitude of problematic alcohol use is substantially smaller in ethnic minorities than in the ethnic Dutch population of Amsterdam. Unfortunately, no explanation was found for the special risk situation of regular drinkers of Moroccan origin., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Purpose: Psychosocial stress is associated with obesity in some populations, but it is unclear whether the association is related to migration. This study explored associations between psychosocial stress and obesity among Ghanaian migrants in Europe and non-migrant Ghanaians in Ghana., Methods: Cross-sectional data from the RODAM study were used, including 5898 Ghanaians residing in Germany, the UK, the Netherlands, rural Ghana, and urban Ghana. Perceived discrimination, negative life events and stress at work or at home were examined in relation to body mass index (BMI) and waist circumference (WC). Linear regression analyses were performed separately for migrants and non-migrants stratified by sex., Results: Perceived discrimination was not associated with BMI and WC in both migrants and non-migrants. However, negative life events were positively associated with BMI (β = 0.78, 95% CI 0.34-1.22) and WC (β = 1.96, 95% CI 0.79-3.12) among male Ghanaian migrants. Similarly, stress at work or at home was positively associated with BMI (β = 0.28, 95% CI 0.00-0.56) and WC (β = 0.84, 95% CI 0.05-1.63) among male Ghanaian migrants. Among non-migrant Ghanaians, in contrast, stress at work or at home was inversely associated with BMI and WC in both males (β = - 0.66, 95% CI - 1.03 to - 0.28; β = - 1.71 95% CI - 2.69 to - 0.73, respectively) and females (β = - 0.81, 95% CI - 1.20 to - 0.42; β = - 1.46, 95% CI - 2.30 to - 0.61, respectively)., Conclusions: Negative life events and stress at work or at home are associated with increased body weight among male Ghanaians in European settings, whereas stress at work or at home is associated with reduced body weight among Ghanaians in Ghana. More work is needed to understand the underlying factors driving these differential associations to assist prevention efforts.

The effect of mother-infant skin-to-skin contact on Ghanaian infants' developing social expectations for maternal behavior was investigated. Infants with high and low mother-infant skin-to-skin contact experience in the infants' first month engaged with their mothers in a Still Face Task at 6 weeks of age. Infants with high skin-to-skin contact experience, but not those with low skin-to-skin contact experience, demonstrated the still face effect with their smiles. Infants with both high and low skin-to-skin contact experience demonstrated the still face effect with their visual attention. The behaviors of the Ghanaian infants and their mothers during the task were compared to archival evidence of Canadian mother-infant dyads' behaviors in skin-to-skin and control groups who engaged in the Still Face Task at the infant ages of 1 and 2 months. Similarities and differences between the behaviors of the mother-infant dyads in the two cultures were assessed., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Several viruses have been described as causes of acquired inflammatory myopathies; however, the mechanisms by which they cause muscle disease are still unclear. The aim of this study was to describe the laboratory features of benign acute myositis in a small case series., Methods: A detailed pathological and serological analysis was performed in five African migrants who developed an acute viral myositis complicated by rhabdomyolysis., Results: Muscle biopsies clearly documented an inflammatory myopathy with histological features similar to polymyositis including CD8+ T cells surrounding and invading nonnecrotic muscle fibers, CD68+ macrophages and major histocompatibility complex class I antigen upregulation. In addition, positivity for myositis-specific antibodies (MSA), in particular anti-aminoacyl tRNA synthetases, was found in the serum of two patients., Conclusions: Our study demonstrated that T-cell mediated injury occurs in muscle of patients with acute viral myositis, and that MSA may be present in the serum of these patients., (© 2019 Wiley Periodicals, Inc.)

Background: Metabolic syndrome (MetSyn) is an important risk factor for cardiovascular diseases and type 2 diabetes. It is unknown whether the MetSyn prevalence differs within a homogenous population residing in different settings in Africa and Europe. We therefore assessed the prevalence of MetSyn among Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in Europe., Methods: We used data from the cross-sectional multi-centre RODAM study that was conducted among Ghanaian adults aged 25-70 years residing in rural- and urban-Ghana and in London, Amsterdam and Berlin (n = 5659). MetSyn was defined according to the 2009 harmonized definition. Geographical locations were compared using age-standardized prevalence rates, and prevalence ratios (PRs), adjusted for age, education, physical activity, and smoking and stratified for sex., Results: In men, the age-standardized prevalence of MetSyn was 8.3% in rural Ghana and showed a positive gradient through urban Ghana (23.6%, adjusted PR = 1.85, 95% confidence interval 1.17-2.92) to Europe, with the highest prevalence in Amsterdam (31.4%; PR = 4.45, 2.94-6.75). In women, there was a rural-to-urban gradient in age-standardized MetSyn prevalence (rural Ghana 25%, urban Ghana 34.4%, PR = 1.38, 1.13-1.68), but small differences in MetSyn prevalence between urban-Ghanaian and European-Ghanaian women (Amsterdam 38.4%; London 38.2%)., Conclusion: MetSyn is highly prevalent in Ghana as well as in Ghanaian migrants in Europe. To assist prevention efforts, further research is needed to understand the mechanisms driving the geographical differences in MetSyn prevalence between migrant and non-migrant Ghanaians., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association.)

Studies have suggested that in African countries, symptoms of cognitive decline are commonly seen as part of "normal ageing" or attributed to supernatural causes. The impact of folk beliefs about causality upon help-seeking is unclear. Likewise, there is a lack of evidence relating to how families cope with living with an older resident with dementia. Our study's aim was to explore the sociocultural beliefs, understandings, perceptions and behaviours relating to living with dementia in Kintampo, Ghana. We conducted in-depth interviews with a total of 28 people, using a series of case studies among 10 older people living with dementia and their families. Results revealed that symptoms of cognitive impairment were generally linked to inexorable bodily decline understood to be characteristic of "normal" ageing. Stigma was therefore perceived to be non-existent. Whilst managing the costs of care was often a challenge, care-giving was largely accepted as a filial duty, commonly shared among female residents of large compound households. Families experimented with biomedical and traditional medicine for chronic conditions they perceived to be treatable. Our findings suggest that whilst families offer a holistic approach to the needs of older people living with chronic conditions including dementia, health and social policies offer inadequate scaffolding to support this work. In the future, it will be important to develop policy frameworks that acknowledge the continued social and economic potential of older people and strengthen the existing approach of families, optimising the management of non-communicable diseases within primary care.

Objective: Hypertension (HTN) control is a major obstacle among sub-Saharan African populations partly due to poor self-management. We explored and compared how persons' social and physical context shapes their illness representations regarding HTN and the coping strategies they develop and adapt to mitigate challenges in self-managing HTN., Methods: A cross sectional multisite qualitative study using semi-structured interviews among 55 Ghanaians with HTN living in The Netherlands and urban and rural Ghana. A thematic approach was used in data analysis., Results: Family HTN history, personal experiences with HTN and outcomes of using biomedical and traditional treatments shaped participants' illness representations and coping strategies. Migrants and urban non-migrants modified medication schedules and integrated taking medication into daily routine activities to cope with experienced side effects of taking antihypertensive medication while rural non-migrants used traditional remedies and medicines to mitigate experienced medication side effects and/or in search for a cure for HTN., Conclusion: Contextual factors within participants' social and physical environments shape their illness representations and coping strategies for HTN though interactive phrases., Practice Implications: Health professionals should harness the relationships within peoples' social and physical environments, encourage implementation of family-wide behavioural changes and involve family and communities in HTN treatment to enhance patients' self-management of HTN., (Copyright © 2019 Elsevier B.V. All rights reserved.)

In the UK, ethnic minority groups tend to have higher levels of poverty than the white British population and therefore may be at high risk of food insecurity. Ghanaians, living in Ghana or as migrants are thought to have a high level of social support in their communities, but the role of this resource in relation to food security is unknown. We explored participants' perceptions of social and economic factors influencing food security among Ghanaian migrants in Greater Manchester. Participants aged ≥25 years (n = 31) of Ghanaian ancestry living in Greater Manchester were interviewed using a semi-structured interview guide developed by the researchers. Participants varied in socioeconomic status (SES), gender and migration status. Interviews were transcribed verbatim and analysed thematically using a framework approach. Participants offered similar accounts of the social and economic factors influencing food security. Accounts were based on participants' perceptions and/or personal experiences of food insecurity within the community. Participants indicated that they and their fellow Ghanaians can 'manage' even when they described quite challenging food access environments. This has negative implications on their food choices in the UK. Participants reported food insecure households may be reluctant to make use of food banks for fear of 'gossip' and 'pride'. Paradoxically, this reluctance does not extend to close network. Many participants described the church and other social groups as a trusted base in which people operate; support given through these channels is more acceptable than through the 'official context'. Government assisted food banks could partner with the social groups within this community given that these are more trusted. Keywords: food insecurity; food choice; social networks; Ghanaians; healthy eating; migrants., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To investigate subtype-specific risk of germline alleles associated with triple negative breast cancer (TNBC) in African ancestry populations., Background: Breast cancer (BC) mortality is higher in African American (AA) compared to White American (WA) women; this disparity is partly explained by 2-fold higher TNBC incidence., Methods: We used a surgically maintained biospecimen cohort of 2884 BC cases. Subsets of the total (760 AA; 962 WA; 910 West African/Ghanaian; 252 East African/Ethiopian) were analyzed for genotypes of candidate alleles. A subset of 417 healthy controls were also genotyped, to measure associations with overall BC risk and TNBC., Results: TNBC frequency was highest in Ghanaian and AA cases (49% and 44% respectively; P < 0.0001) and lowest in Ethiopian and WA cases (17% and 24% respectively; P < 0.0001). TNBC cases had higher West African ancestry than non-TNBC (P < 0.0001). Frequency of the Duffy-null allele (rs2814778; an African ancestral variant adopted under selective pressure as protection against malaria) was associated with TNBC-specific risk (P < 0.0001), quantified West African Ancestry (P < 0.0001) and was more common in AA, Ghanaians, and TNBC cases. Additionally, rs4849887 was significantly associated with overall BC risk, and both rs2363956 and rs13000023 were associated with TNBC-specific risk, although none as strongly as the Duffy-null variant., Conclusions: West African ancestry is strongly correlated with TNBC status, as well as germline variants related to BC risk. The Duffy-null allele was associated with TNBC risk in our cohort.

Hypertension (HTN) control is crucial in preventing HTN-related complications such as stroke and coronary heart disease. Yet, HTN control remains suboptimal particularly among sub-Saharan African (SSA) populations partly due to poor self-management. Self-management of HTN is influenced by social support, but the evidence on the role of social support on HTN control particularly among SSA populations is limited. This study assessed the association between multiple proxies for social support and HTN control among Ghanaians resident in Ghana and Europe. The Research on Obesity and Diabetes among African Migrants (RODAM) study participants with HTN and who self-reported HTN (n = 1327) were included in this analysis. Logistic regression was used to assess the association between proxies of social support and HTN control (SBP < 140 mmHg and DBP < 90 mmHg) with adjustments for age and socioeconomic status (SES). Among Ghanaian males in both Europe and Ghana, cohabiting with more than two persons was associated with increased odds of having HTN controlled. Male hypertensive patients cohabiting with ≥ 5 persons had the highest odds of having HTN controlled after adjustment for age and SES (OR 0.30; 95% CI 0.16-0.57; 0.60; 0.34-1.04, respectively). This association was not observed among females. Relationship status, frequency of religious activity attendance and satisfaction with social support did not show any significant association with HTN control. Our study shows that cohabitation is significantly associated with HTN control but in males only. The other proxies for social support appeared not to be associated with HTN control. Involving persons living with Ghanaian men with HTN in the treatment process may help to improve adherence to HTN treatment. Further research is needed to explore in-depth, how these social support proxies could contribute to improved HTN control among SSA populations.

Objectives: The association between psychosocial stressors (PS) and chronic kidney disease (CKD) among sub-Saharan African (SSA) populations is unknown. We examined the association between PS and CKD prevalence among rural and urban Ghanaians and Ghanaian migrants living in three European cities. We also assessed if the influence of PS on CKD is partially mediated by primary risk factors (hypertension and diabetes) of CKD., Design: A multi-centred cross sectional data from the Research on Obesity and Diabetes among African Migrants study., Setting: Rural and urban Ghana and three European cities (Amsterdam, Berlin and London)., Participants: A random sample of 5659 adults (Europe 3167, rural Ghana 1043 and urban Ghana 1449) aged 25-70 years., Explanatory Measures: PS defined by negative life events, perceived discrimination, perceived stress at work/home and depressive symptoms. Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification. Comparisons between PS and CKD outcomes were made using logistic regression analyses across all sites., Results: We observed higher proportion of negative life events (68.7%) and perceived permanent stress (15.9%) among Ghanaians living in Ghana than Ghanaians living in Europe. Depressive symptoms (7.5%) and perceived discrimination (29.7%) were more common among Ghanaians living in Europe than Ghanaians living in Ghana. No significant association was observed between any of the PS constructs and CKD outcomes across sites except for positive association between stress at work/home and albuminuria (2.81, 95% CI 1.46 to 5.40) and CKD risk (2.78, 95% CI 1.43 to 5.43) among Ghanaians living in Berlin., Conclusion: Our study found a positive association between stress at work/home and albuminuria and CKD risk. There was no convincing evidence of associations between the other PS constructs and the prevalence of CKD risk. Further studies are needed to identify potential factors driving the high prevalence of CKD among these populations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Aims: To compare microvascular and macrovascular complication rates among Ghanaians with type 2 diabetes (T2D) living in Ghana and in three European cities (Amsterdam, London and Berlin)., Methods: Data from the multicenter Research on Obesity and Diabetes among African Migrants (RODAM) study were analyzed. 650 Ghanaian participants with T2D (206 non-migrant and 444 migrants) were included. Logistic regression analyses were used to determine the association between migrant status and microvascular (nephropathy and retinopathy) and macrovascular (coronary artery disease (CAD), peripheral artery disease (PAD) and stroke) complications with adjustment for age, gender, socioeconomic status, alcohol, smoking, physical activity, hypertension, BMI, total-cholesterol, and HbA1c., Results: Microvascular and macrovascular complications rates were higher in non-migrant Ghanaians than in migrant Ghanaians (nephropathy 32.0% vs. 19.8%; PAD 11.2% vs. 3.4%; CAD 18.4% vs. 8.3%; and stroke 14.5% vs. 5.6%), except for self-reported retinopathy (11.0% vs. 21.6%). Except nephropathy and stroke, the differences persisted after adjustment for the above-mentioned covariates: PAD (OR 7.48; 95% CI, 2.16-25.90); CAD (2.32; 1.09-4.93); and retinopathy (0.23; 0.07-0.75)., Conclusions: Except retinopathy, the rates of microvascular and macrovascular complications were higher in non-migrant than in migrant Ghanaians with T2D. Conventional cardiovascular risk factors did not explain the differences except for nephropathy and stroke., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Psychosocial stress could be an underlying factor for emerging risk of cardiovascular diseases (CVD) in Africans. We assessed the association between psychosocial stress and estimated CVD risk among non-migrant Ghanaians and migrant Ghanaians living in Europe., Methods: Data from the Research on Obesity and Diabetes among African Migrants (RODAM) study, involving 2315 migrant and 1549 non-migrants aged 40-70 years were used for this study. Psychosocial stress included self-reported stress at work and home, recent negative life events and perceived discrimination. CVD risk was estimated using the pooled cohort equations with estimates ≥7.5% over 10 years defining high CVD risk. Adjusted Odds Ratios (AOR) and 95% confidence intervals (95% CI) were calculated by logistic regression with adjustments for socioeconomic status., Results: Prevalence for migrant and non-migrants were; 72.5% and 84.9% for psychosocial stress and 35.9% and 27.4% for high estimated CVD risk. Stress at work and home was not associated with a high estimated CVD risk in either group. Recent negative life events were associated with a high estimated CVD risk in non-migrants only (AOR 1.29, 95%CI 1.02-1.68, p = 0.048). Higher levels of perceived discrimination were associated with a high estimated CVD risk in migrants only (AOR 2.74, 95%CI 1.95-3.86, p < 0.001)., Conclusions: Among migrant populations, higher levels of perceived discrimination were associated with a high estimated CVD risk, and this was also true for recent negative life events among non-migrant populations. Further research is needed to identify context specific mechanisms that underlie associations between psychological characteristics and CVD risk., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background and Aims: African populations have a favourable lipid profile compared to European populations. However, the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the lipid profiles of Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in three European countries., Methods: We used data from a multi-centre, cross-sectional study among Ghanaian adults residing in rural- and urban-Ghana and London, Amsterdam and Berlin (n = 5482). Dyslipidaemias were defined using the 2012 European Guidelines on Cardiovascular Prevention. Comparisons between groups were made using age-standardised prevalence and prevalence ratios (PRs) with adjustments for important covariates., Results: In both sexes, the age-standardised prevalence of high total cholesterol (TC) and LDL-cholesterol (LDL-C) was lower in rural- than in urban-Ghana and Ghanaian migrants in Europe. Adjusted PRs of high TC and LDL-C were higher in urban-Ghana (TC PR = 2.15, 95%confidence interval 1.69-2.73) and Ghanaian migrant men (TC PR = 2.03 (1.56-2.63)) compared to rural-Ghana, but there was no difference between rural- and Ghanaian migrant women (TC PR = 1.01 (0.84-1.22)). High triglycerides levels were as prevalent in rural-Ghana (11.6%) as in urban-Ghana (12.8%), but were less prevalent in Ghanaian migrant women (2.0%). In both sexes, low HDL-cholesterol was most prevalent in rural-Ghana (50.1%) and least prevalent in Europe (12.9%)., Conclusion: The lipid profile varied among ethnically homogeneous African populations living in different geographical locations in Africa and Europe. Additional research is needed to identify factors driving these differential risks to assist prevention efforts., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Child sexual abuse is increasingly becoming an issue of concern in most societies across the globe, including Ghana. This is a phenomenological study that sought to describe the lived experiences of victims of child sexual abuse in Ghana, using the Ga community as a case study. Purposive and snowball sampling techniques were used to identify 17 sexually abused children in the Ga Community. Using the interpretative phenomenological analysis (IPA), four main themes described the experiences of the victims: (a) forced sex (b) incest (c) joleying and (d) transactional sex. The findings illustrate the different circumstances in which children were sexually abused in the community studied. It also presents socio-cultural factors that normalizes the sexual abuse of children in the Ga Community. These findings underline the need for effective preventive programs and community interventions to protect children and support victims of child sexual abuse.

Parental autonomy support has been related to positive adolescent outcomes, however, its relation to outcomes in collectivist cultural groups is unclear. This study examined relations of specific autonomy supportive behaviors and outcomes among 401 adolescents (M age  = 12.87) from the United States (N = 245) and collectivist-oriented Ghana (N = 156). It also examined whether adolescents' self-construals moderated the relations of specific types of autonomy support with outcomes. Factor analyses indicated two types of autonomy support: perspective taking/open exchange and allowance of decision making/choice. In both countries, perspective taking/open exchange predicted positive outcomes, but decision making/choice only did so in the United States. With regard to moderation, the more independent adolescents' self-construals, the stronger the relations of decision making/choice to parental controllingness and school engagement., (© 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.)

African migrants are underrepresented as blood donors in many Western countries, which can lead to shortages of specific blood types for transfusion. More insight in the reasons for this underrepresentation is required to improve blood donor recruitment and retention strategies. The aim of this qualitative study was to explore barriers and motivators for donating blood among migrants of African background. The research population consisted of first and second generation African-Surinamese (n = 20) and Ghanaian (n = 16) migrants living in the Netherlands. In semi-structured personal interviews performed in 2016 and 2017, their experiences and opinions regarding blood donation, barriers, and motivators to (not) become a blood donor and their suggestions to improve recruitment were explored. Data collection was continued until data saturation was achieved. The interviews revealed that although all participants knew about blood donation in general, only four had previously heard of the Dutch national blood bank organisation. Participants expected that if blood was needed, the blood bank would directly approach them, as in their country of origin. Other main blood donation barriers were fear (e.g., of needles, losing too much blood) and issues related to health and non-eligibility to donate. Main motivators were mainly of altruistic nature (e.g., saving a life) and an increased awareness of the need via personal recruitment appeals. It is concluded that expectations regarding donor recruitment-derived from the country of origin-and unawareness of the need for blood can act as important barriers in blood donation among African migrants. Contrary to studies in the United States and Australia, perceived discrimination and social exclusion did not seem to be a donation deterrent among migrants in the Netherlands. Creating awareness of the need of blood by actively approaching, and informing migrants about the donation procedure in the host country, should be considered by blood banks., (© 2018 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

African migrants in Europe and continental Africans are disproportionately affected by type 2 diabetes (T2D). Both groups develop T2D at a younger age, and have higher morbidity and mortality from T2D and complications, compared to European populations. To reduce risk, and avoidable disability and premature deaths, culturally congruent and context specific interventions are required. This study aimed to: (a) assess perceptions and knowledge of T2D among Ghanaian migrants in Europe and their compatriots in Ghana and (b) identify specific perceptions and knowledge gaps that might predispose migrants to higher risk of diabetes. Data was gathered through 26 focus groups with 180 individuals, aged 21 to 70, from Amsterdam, Berlin and London and rural and urban Ashanti Region, Ghana. Thematic analysis of the data was informed by Social Representations Theory, which focuses on the sources, content and functions of social knowledge. Three key insights emerged from analysis. First, there was general awareness, across migrant and non-migrant groups, of T2D as a serious chronic condition with life threatening complications, and some knowledge of biomedical strategies to prevent diabetes (e.g healthy eating) and diabetes complications (e.g medication adherence). However, knowledge of T2D prevention and reduction of diabetes complications was not comprehensive. Secondly, knowledge of biomedical diabetes theories and interventions co-existed with theories about psychosocial and supernatural causes of diabetes and the efficacy of herbal and faith-based treatment of diabetes. Finally, migrants' knowledge was informed by both Ghanaian and European systems of T2D knowledge suggesting enculturation dynamics. We discuss the development of culturally congruent and context-specific T2D interventions for the research communities., Competing Interests: The authors have declared that no competing interests exist.

Little is known about adult-onset asthma in different ethnic groups. The aim of this study was to examine ethnic differences in the prevalence of adult-onset asthma and factors associated with this phenotype. Cross-sectional data of 23,356 participants of the HELIUS study were used, including Dutch, South-Asian Surinamese, African Surinamese, Moroccan, Turkish and Ghanaian origin participants. Adult-onset asthma was defined as: self-reported asthma symptoms or start of asthma-medication at age ≥18 years combined with a smoking history <10 pack years. The prevalence of adult-onset asthma and its association with potential risk factors were assessed by logistic regression analyses. The adjusted prevalence of adult-onset asthma was higher in the Turkish, Moroccan and South-Asian Surinamese groups (4.9-6.0%) compared to the Dutch, Ghanaian and African Surinamese origin groups (2.4-2.6%). In addition to ethnicity, age, female sex, BMI, and doctors' diagnosis of nasal allergy/hay fever and chronic sinusitis/polyps were independently associated with adult-onset asthma. There are significant differences in the adjusted prevalence of adult-onset asthma among six ethnic groups., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Herbal medicine has become the panacea for many rural pregnant women in Ghana despite the modern western antenatal care which has developed in most parts of the country. To our knowledge, previous studies investigating herbal medicine use have primarily reported general attitudes and perceptions of use, overlooking the standpoint of pregnant women and their attitudes, and utilisation of herbal medicine in Ghana. Knowledge of herbal medicine use among rural pregnant women and the potential side effects of many herbs in pregnancy are therefore limited in the country; this qualitative study attempts to address this gap by exploring the perceptions of herbal medicine usage among pregnant women in rural Ghana., Methods: A sample of 30, conveniently selected pregnant women, were involved in this study from April 11 to June 22, 2017. Data from three different focus group discussions were thematically analysed and presented based on an a posteriori inductive reduction approach., Results: The main findings were that pregnant women used herbal medicine, most commonly ginger, peppermint, thyme, chamomile, aniseeds, green tea, tealeaf, raspberry, and echinacea leaf consistently throughout the three trimesters of pregnancy. Cultural norms and health beliefs in the form of personal philosophies, desire to manage one's own health, illness perceptions, and a holistic healing approach were ascribed to the widespread use of herbs., Conclusion: We recommend public education and awareness on disclosure of herbal medicine use to medical practitioners among pregnant women.

A 22-year-old HIV-negative man from Ghana was diagnosed with severe hemophagocytic lymphohistiocytosis (HLH) induced by multiorgan tuberculosis with peritoneal, hepatic, pericardial, myocardial, pleural, pulmonary, and bone manifestation. His body mass index was 12.9 m 2 /kg. Bioptic material of a peritoneal biopsy grew M. tuberculosis, sensitive to all first-line antituberculous drugs. HLH resolved with antituberculous therapy, without additional anti-inflammatory therapy being given. The initial CT scan of his brain was normal. After 5 months of antituberculous treatment, he developed a paralysis of the left arm. A cerebral MRT showed ring-enhanced lesions. Blood cultures and lumbar puncture revealed Cryptococcus neoformans var. grubi. The HIV test was repeatedly negative. Antituberculous treatment was continued for a total of 9 months, and additional treatment with antifungal therapy was established. He recovered fully after 14 months of antifungal treatment.

Background: The use of traditional/alternative medicine for health care in Africa has been examined for various conditions. However, there is limited research about traditional/alternative health care for intellectual disability. The present authors explored the explanatory models (EMs) of intellectual disability held by traditional/faith healers in Ghana., Methods: Using a case vignette, the present authors conducted semi-structured interviews with 36 traditional/faith healers in Accra, Ghana. Using the EMs of illness framework as a guide, participants were asked questions to examine their beliefs about the nature, causes, course and recommended treatment of intellectual disability., Results: The healers' causal explanations included maternal negligence during pregnancy and spiritual factors. They also believed that intellectual disability was a congenital, lifelong condition which could not be cured., Conclusions: Unlike other conditions which traditional healers claimed to cure, participants admitted that intellectual disability was not curable. The present authors suggest that the findings highlight opportunities that exist for collaboration between biomedicine and traditional medicine., (© 2018 John Wiley & Sons Ltd.)

Background and Aims: Cardiovascular disease (CVD) risk factors may occur among a substantial proportion of normal weight individuals, particularly among some ethnic minorities. It is unknown how many of these individuals would be missed by commonly applied eligibility criteria for cardiovascular risk screening. Thus, we aim to determine cardiovascular risk and eligibility for cardiovascular risk screening among normal weight individuals of different ethnic backgrounds., Methods and Results: Using the HELIUS study (Amsterdam, The Netherlands), we determined cardiovascular risk among 6910 normal weight individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Moroccan and Turkish background. High cardiovascular risk was approximated by high metabolic risk based on blood pressure, HDL, triglycerides and fasting glucose. Eligibility criteria for screening were derived from Dutch CVD prevention guidelines and include age ≥ 50 y, family history of CVD, or current smoking. Ethnic group comparisons were made using logistic regression. Age-adjusted proportions of high metabolic risk ranged from 12.6% to 38.4% (men) and from 2.7% to 11.5% (women). This prevalence was higher among most ethnic minorities than the Dutch, especially among women. For most ethnic groups, 79.9%-86.7% of individuals with high metabolic risk were eligible for cardiovascular risk screening. Exceptions were Ghanaian women (58.8%), Moroccan men (70.9%) and Moroccan women (45.0%), although age-adjusted proportions did not differ between groups., Conclusion: Even among normal weight individuals, high cardiovascular metabolic risk is more common among ethnic minorities than among the majority population. Regardless of ethnicity, most normal weight individuals with increased risk are eligible for cardiovascular risk screening., (Copyright © 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: This paper explored the health beliefs and behaviours of families towards the health needs of children with intellectual and developmental disabilities (IDD) in Accra, Ghana. The aim was to inform health promotion strategies for the children and their families., Method: Twenty-two parents of children with IDD participated in this study. Semi-structured interviews were the primary means of data collection. The interviews were analysed using constant comparison., Results: The signs that alerted the parents that the children might be ill included high temperature, vomiting and excessive sleep. The parents explained that some children expressed feelings of ill-health through verbal or non-verbal communication. Most of the parents self-prescribed medication for the children or waited for symptoms to persist for a while before accessing health care because they experienced difficulties managing the behavioural challenges associated with the IDD of the children in public and attitudinal barriers when accessing health care. The parents did not often patronise health facilities in their neighbourhoods due to private health insurance requirements for accessing care at designated facilities, poor confidence in neighbourhood facilities and long-term established relationships with facilities elsewhere. Further, many parents did not patronise religious interventions for the children. However, some parents explained that in addition to seeking medical care to address the physical symptoms of the children's disabilities and/or illnesses, they sought religious interventions because they believed that there could be a spiritual dimension to the situation., Conclusion: The findings highlight key areas to address in health promotion for children with IDD and their families in Accra, Ghana., (© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Background: In the Netherlands, there are strong disparities in Chlamydia trachomatis (CT) prevalence between ethnic groups. The current study aims to identify whether socioeconomic status, sexual risk behavior and sexual healthcare seeking behavior may explain differences in CT seroprevalence between ethnic groups., Methods: We used 2011-2014 baseline data of the HELIUS (HEalthy LIfe in an Urban Setting) study, a multi-ethnic population-based cohort study in Amsterdam, the Netherlands, including participants from Dutch, African Surinamese, South-Asian Surinamese, Ghanaian, Moroccan and Turkish origin. For this analysis, we selected sexually active, heterosexual participants aged 18-34 years old. CT seroprevalence was determined using a multiplex serology assay. The CT seroprevalence ratios between different ethnicities are calculated and adjusted for potential indicators of socioeconomic status, sexual risk behavior and sexual healthcare seeking behavior., Results: The study population consisted of 2001 individuals (52.8% female) with a median age of 28 years (IQR 24-31). CT seropositivity differed by ethnicities and ranged from 71.6% (African Surinamese), and 67.9% (Ghanaian) to 31.1% (Turkish). The CT seroprevalence ratio of African Surinamese was 1.72 (95% CI 1.43-2.06) and 1.52 (95% CI 1.16-1.99) of Ghanaian as compared to the Dutch reference group, after adjustment for socioeconomic status, sexual risk behavior and sexual healthcare seeking behavior., Conclusions: Indicators of socioeconomic status, sexual risk behavior, and sexual health seeking behavior could not explain the higher CT seroprevalence among African Surinamese and Ghanaian residents of Amsterdam.

Background: Health-related stigma is a great challenge to the treatment of diseases. In epilepsy like other conditions, it causes affected individuals to conceal their illness. In this study, we described stigma perceived by patients with epilepsy at the Korle Bu Teaching Hospital (KBTH), a tertiary referral facility, and the Accra Psychiatry Hospital in Ghana (APH). We then compared the perception of stigma in patients with epilepsy to stigma perceived by persons living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) (PLWHA), a chronic communicable disease stigmatized in Ghana., Methods: A total of 351 patients with epilepsy were recruited from both sites by systematic random sampling and interviewed. The Kilifi Stigma Scale for Epilepsy was used to determine individual patient's stigma score. Statistical analysis was done using multiple logistic regression analysis to control for the effect of measured independent variables that were significant on univariate analysis: age, gender, marital status, income, type of epilepsy, and the frequency of seizures, on the outcome variable. Comparative analysis of the mean stigma score in patients with epilepsy and persons living with HIV/AIDS was done using the Student's t-test and Mann-Whitney U test (Wilcoxon rank sum test)., Results: The presence of perceived stigma using the Kilifi Stigma Score Estimation was 32.02% (62), 33.33% (49), and 28.88% (54) among respondents from KBTH, APH, and PLWHA respectively. Results from Wilcoxon rank sum test showed that the median stigma score between the three groups was significant; KBTH and APH (p-value; 0.0258), KBTH and PLWHA (p-value; 0.00001), and APH and PLWHA (p-value; 0.0000). Age (<40 years), seizure frequency, ethnic group (Ewe and Guan), and being divorced showed high odds for perceived stigma among KBTH patients with epilepsy. Having tertiary education led to lower odds for perceived stigma in epilepsy for APH patients with epilepsy., Conclusion: This study showed that epilepsy is associated with a high stigma perception. The perceived stigma was greater than stigma in PLWHAs in Accra. Stigma was affected by unemployment, ethnicity (Ewe and Guan), and uncontrolled seizures. Increasing age reduced perceived stigma and the management of patients with epilepsy in a psychiatric facility might have impacted negatively on the perceived stigma., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: The importance of dietary diversification for type 2 diabetes (T2D) risk remains controversial. We investigated associations of between- and within-food group variety with T2D, and the role of dietary diversification for the relationships between previously identified dietary patterns (DPs) and T2D among Ghanaian adults., Methods: In the multi-center cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) Study (n = 3810; Ghanaian residence, 56%; mean age, 46.2 years; women, 63%), we constructed the Food Variety Score (FVS; 0-20 points), the Dietary Diversity Score (DDS; 0-7 points), and the Diet Quality Index-International (DQI-I) variety component (0-20 points). The associations of these scores, of a "rice, pasta, meat and fish" DP, of a "mixed" DP, and of a "roots, tubers and plantain" DP with T2D were calculated by logistic regression., Results: The FVS was inversely associated with T2D, adjusted for socio-demographic, lifestyle, and anthropometric factors [odds ratio (OR) for T2D per 1 standard deviation (SD) increase: 0.81; 95% confidence interval (CI) 0.71-0.93]. The DDS and the DQI-I variety component were not associated with T2D. There was no association of the "mixed" DP and the "roots, tubers and plantain" DP with T2D. Yet, the "rice, pasta, meat and fish" DP is inversely associated with T2D (OR for T2D per 1 SD increase: 0.82; 95% CI 0.71-0.95); this effect was slightly attenuated by the FVS., Conclusions: In this Ghanaian population, between-food group variety may exert beneficial effects on glucose metabolism and partially explains the inverse association of the "rice, pasta, meat and fish" DP with T2D.

The burden of cardiovascular disease (CVD) risk in ethnic minorities in the United States (US) is high. Acculturation may worsen or improve cardiovascular health in immigrants. We sought to examine the association between acculturation and elevated cardiovascular disease risk in African immigrants, a growing immigrant population in the US. We conducted a cross-sectional study of Ghanaian and Nigerian born-African immigrants in the US. To determine whether acculturation was associated with having elevated CVD risk (defined as ≥3 CVD risk factors or Pooled Cohort Equations score ≥7.5%), we performed unadjusted and adjusted logistic regression analyses. For both outcomes, sex-specific models were fitted. Participants (N = 253) were aged 35-74 years and resided in Baltimore-Washington-D.C. The mean age (SD) was 49.5 (9.2) years and 58% were female. Residing in the US for ≥10 years was associated with an almost fourfold (95% CI 1.05-14.35) and eightfold (95% CI 2.09-30.80) greater odds of overweight/obesity and elevated CVD risk respectively in males. Females residing in the US for ≥10 years had 2.60 times (95% CI 1.04-6.551) greater odds of hypertension than newer residents. Participants were classified according to acculturation strategies: Integrationists, 166 (66%); Traditionalists, 80 (32%); Marginalists, 5 (2%); and Assimilationists, 2 (1%). Integrationists had a 0.46 (95% CI 0.24-0.87) lower odds of having ≥3 CVD risk factors and 0.38 (95% CI 0.18-0.78) lower odds of having elevated CVD risk (Pooled Cohort Equations score ≥7.5%) than Traditionalists. Although longer length of stay was associated with CVD risk, Integrationists had lower CVD risk than Traditionalists. Our results suggest that coordinated public health responses to the epidemic of CVD risk factors in the US should target this understudied population. Acculturation should be considered as a meaningful contributor of increased CVD risk and acculturation strategies may be used to tailor interventions in African immigrants. Promoting successful integration may reduce immigrants' CVD risk.

Purpose: Depression and posttraumatic stress disorder (PTSD) may be linked to the metabolic syndrome (MetS). Consistency of this association across ethnic groups and the influence of comorbidity of depression/PTSD were examined., Methods: Cross-sectional baseline data from the HELIUS study were used (4527 Dutch, 2999 South-Asian Surinamese, 4058 African Surinamese, 2251 Ghanaian, 3522 Turkish and 3825 Moroccan participants). The Patient Health Questionnaire-9 (PHQ-9) (score range 0-27) measured depressive symptoms. A 9-item questionnaire (score range 0-9) measured PTSD symptoms. The MetS was defined according to the International Diabetes Federation. The association of a depressed mood (PHQ-9 sum score ≥ 10) and severe PTSD symptoms (sum score ≥ 7) with the MetS was examined using logistic regression. Interaction with ethnicity and between a depressed mood and severe PTSD symptoms was tested., Results: A depressed mood was associated with the MetS [OR (95% CI) = 1.37 (1.24-1.51)] in the total sample and consistent across ethnic groups (p values for interaction all > 0.05). Severe PTSD symptoms were significantly associated with the MetS in the Dutch [OR (95% CI) = 1.71 (1.07-2.73)]. The South-Asian Surinamese, Turks and Moroccans showed weaker associations than the Dutch (p values for interaction all < 0.05). A depressed mood and severe PTSD symptoms did not interact in the association with the MetS (p values for interaction > 0.05)., Conclusions: A depressed mood was consistently associated with the MetS across ethnic groups, but the association between severe PTSD symptoms and the MetS maybe ethnicity dependent. The association with the MetS was not different in case of depressed mood/severe PTSD symptoms comorbidity.

This study is the first to employ panel data to examine well-being outcomes-self-rated health, happiness, life satisfaction, and school enjoyment-of children in transnational families in an African context. It analyzes data collected in 2013, 2014, and 2015 from secondary schoolchildren and youth (ages 12-21) in Ghana (N = 741). Results indicate that children with fathers, mothers, or both parents away and those cared for by a parent, a family, or a nonfamily member are equally or more likely to have higher levels of well-being as children in nonmigrant families. Yet, there are certain risk factors-being a female, living in a family affected by divorce or by a change in caregiver while parents migrate-that may decrease child well-being., (© 2017 The Authors. Child Development published by Wiley Periodicals, Inc. on behalf of Society for Research in Child Development.)