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Abstract Anticipation of surgical procedures has been noted to be a major cause of anxiety, particularly in children and their parents. Preoperative anxiety in children is associated with complications before, during, and after surgery. There is therefore the need to identify predictors of preoperative anxiety in children, for early identification and development of interventions. This study aimed at determining predictors of preoperative anxiety in children. A total of 70 children with their parents, scheduled for general pediatric surgery in two teaching hospitals in Ghana, were recruited using a convenience sampling technique. Parental anxiety, perception of quality of healthcare, and preoperative anxiety in children were measured using the State Section of the State Trait Anxiety Inventory, the Pediatric Quality of Life—Healthcare Satisfaction Module, and the modified Yale Preoperative Anxiety Scale, respectively. Previous surgical experience, age and type of surgery were obtained by demographic questionnaire and hospital records. Majority of children who participated in the study were between ages 2 and 7 years (82.9%). 84.3% of parents in the study were females. Parental anxiety (β = 0.953, pp = 0.000) and perceived quality of healthcare (β = −0.257, p = 0.031) predicted preoperative anxiety in children. Older children scheduled for major surgery were more anxious in the preoperative period than younger children scheduled for major surgery (F = 6.75, p = 0.012). Comprehensive anxiety‐alleviation protocols for pediatric surgery should involve parents as well as improving perceptions of quality of healthcare.

The continuous use of fertilizers and fungicides has triggered copper (Cu) contamination in cacao soils in Ghana, which is a critical issue for the ecological risk and health safety of cacao products. In this study, we investigated Cu pollution, bioavailability, and ecological risk in soil and determined the Cu levels in the cacao nib, shell, and pod husk. Soils were collected at two soil depths (0–15 ​cm and 15–30 ​cm) from 20 cacao farms, under conventional (CCM: chemical-based fertilizers) and organic (OCM: organic-based fertilizers) management practices together with pods. The total Cu concentration ranged from 67.6 to 96.8 ​mg ​kg−1 in OCM and 28.5–33.9 ​mg ​kg−1 in CCM soil, which decreased with soil depth. The enrichment factor revealed minimal Cu enrichment, which was attributed to anthropogenic activity (fungicide and fertilizer applications). The contamination factor and geoaccumulation index values were low for the CCM soils, and moderate for the OCM soils. Both management systems pose a low potential ecological risk to soil biota activity. Bioavailable Cu extracted with CaCl2, NH4OAc, and DTPA was dominant in CCM soil and decreased with soil depth. The Cu concentration in cacao plants decreased in the order of shell > pod husk > nib, with nib-Cu being below the threshold (50.0 ​mg ​kg−1) of contamination. The results from the pairwise correlation analysis show that CaCl2-available Cu is better for evaluating the Cu content in cacao plants. This study reveals the pollution levels associated with cacao management practices, thus providing valuable insights for developing appropriate mitigation strategies.

Abstract Globally, evidence has shown that many adolescents are victims of substance use, mainly cigarette smoking, and it has been associated with suicidal ideation. However, the mechanisms underlying this association are poorly understood. This study examines whether truancy mediates and gender moderates the association of cigarette smoking with suicide attempts among adolescents in 28 countries. Data from the Global School-Based Student Health Survey were used. Hierarchical multiple logistic regression analyses were used to estimate the effect-modification of gender on cigarette smoking and suicide attempt. The mediating effect of truancy on the association between cigarette smoking and suicidal attempt was assessed using the generalized decomposition method. Cigarette smoking was associated with suicide attempts after adjusting for several confounding variables (aOR = 1.21; 95% CI = 1.09–1.33). The bootstrap results from the generalized decomposition analysis indicated that truancy partially mediated the association of cigarette smoking with a suicide attempt, contributing 21% of the total effect among in-school adolescents. Hierarchical regression analyses suggested that gender moderated the effect of cigarette smoking on suicidal attempts: female adolescents who smoked had 36% higher odds of suicidal attempts compared to male adolescents. The findings suggest possible pathways for designing and implementing interventions to address adolescents' cigarette smoking and truancy to prevent suicidal attempts.

Abstract Background Religion performs a doubled edged role in a suicide crisis. On the one hand, it elicits empathic responses towards suicidal persons. On the other, it condemns and shames them. Although there is evidence that religion promotes better health and general wellbeing, little attention has been given to its role in recovery, especially after a suicide attempt. The current study explored how religion facilitated recovery among suicide attempt survivors. Methods Using a semi-structured interview guide, we interviewed suicide attempt survivors who had attended a psychiatric unit. Thematic analysis was used to analyse the data. Results Ten suicide attempters were interviewed, six females and four males. Three major themes were identified: Reasons in context, Religion in the recovery process and Renewed commitment to religious rituals/practices. Conclusions The role of religion in suicide prevention as a resource, is a complex one. Suicide preventionists need to carefully guide and gauge their prevention efforts in context where religion is rife to provide suicide attempt survivors the most effective religious resource in their recovery trajectory.

Abstract Background This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs). Methods A total of 1189 mother-infant dyads from the Evidence for Better Lives Study cohort were recruited. Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions was performed. Results Three high-risk classes and one low-risk class emerged: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Pairwise comparisons between classes indicate higher probabilities of prenatal drug use in the highly maltreated and emotionally abused classes compared with the low household dysfunction and abuse class. Additionally, the emotionally and physically abused with intra-familial violence exposure class had higher probability of low birthweight than the three remaining classes. Conclusion Our results highlight the multifaceted nature of ACEs and underline the potential importance of exposure to childhood adversities on behaviors and outcomes in the perinatal period. This can inform the design of antenatal support to better address these challenges.

Abstract Background Emotional regulation forms an integral part of healthcare delivery. In the performance of the core duties of nursing and midwifery, health professionals are expected to enhance occupationally/organisationally required emotions. The purpose of this study is to explore. The meaning nurses and midwives give to emotional labour as well as the coping resources employed by these professionals in order to manage the emotional demands of their profession. Method A qualitative study was conducted using a semi-structured interview guide with fifteen (15) purposively selected nurses and midwives. Interviews were recorded and simultaneously translated and transcribed. Thematic analysis was used to analyse the data. Results Our findings showed that participants conceptualized emotional labour as display of rules. Sadness, abuse and bullying, poor incentivisation, emotional exhaustion and emotional mix bag were reported by the participants as emotional demands and deficits. Nurses and midwives coped with emotional labour through the use of five (5) main resources: psychological capital, routinisation of emotions, religious resources, social support and job security. Conclusion Nursing and midwifery professional duties are accompanied with emotional regulations which tend to have consequential effects on a myriad of work-related issues. Clinical healthcare training needs to intensify and equip professionals with the skills of regulating and managing their emotions since managing emotional demands are central to effective healthcare delivery.

Abstract Background Little/no research has been conducted in Uganda in particular and sub-Saharan Africa in general on the health professional’s perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with a double burden of HIV/AIDS and mental distress. Aim To explore health professionals’ perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with HIV/AIDS and mental distress in Masaka, Uganda. Method Qualitative research design using key informant interviews with health service managers and staff in agencies working with children and adolescents with HIV/AIDS in Masaka district, Uganda. Results Barriers to treatment seeking reported by health care professionals were quite enormous and are summarized under: family, individual, community and health systems level barriers. The crosscutting finding here is that the societal informal and formal systems of care had been affected by the HIV/AIDs epidemic, and, mental distress aggravates this challenge for the individuals afflicted and families affected by mental distress. Conclusion Children and adolescents with both HIV/AIDS and mental distress are vulnerable due to constraints at family, community and health systems levels. Effective public health interventions to address the double burden of HIV/AIDS and mental distress will be vital in the study communities addressing the constraints at family, community and institutional level. Public health interventions should aim at increased access and effective utilization of services for both HIV/AIDS and mental health services. Stigma reduction strategies at individual, family and community levels are also recommended.

Background: Research evidence on suicide in Ghana so far has focused mostly on suicide in the adult population and less work on the younger population such as university students and other vulnerable groups such as children, youth and the aged. Aims: This study was conducted to determine lifetime and current prevalence of suicidal ideation or attempts and identify the associated risks and protective factors among university students in Ghana. Methods: Using a cross-sectional design, 1003 university students (507 males and 496 females) with a mean age of 20.5 years (SD = 5.95) were administered questionnaires that measured suicide, psychological distress, self-esteem and subjective wellbeing. Results: We found the following prevalence rates of suicidal behaviours: ideations 15.2%, attempted 6.3%, death wishes 24.3% and suicidal plan 6.8%. Psychological distress was a risk factor for both suicidal ideation and suicidal attempt. Subjective wellbeing was protective of suicide attempt while self-esteem was protective of suicidal ideation. Conclusions: These findings underscore the need for school-based mental health-promoting programmes that enhance young people’s self-esteem, reduce psychological distress and boost subjective wellbeing.

There is an increased need for COVID-19 vaccination since the world is gradually returning to normal. Current evidence supports vaccination activity more towards viral suppression than COVID-19 prevention. This has led to divergent views regarding vaccination which may influence anti-vaccine attitudes and vaccine hesitancy. The study examined the role of personality traits, anti-vaccine attitudes and illness perceptions on vaccine hesitancy. The study was a cross-sectional survey using snowball and convenience sampling to recruit 492 participants via social media platforms. Multivariate analysis of variance and regression analysis were used to test the hypotheses. The study found that some facets of illness perception (identity, concern, emotional representation and treatment control), extraversion, experience with COVID-19 and anti-vaccine attitudes (mistrust, profiteering, worries about unforeseen effects of vaccine) predicted vaccine hesitancy. The outcomes from this study have implications for achieving public health goals and developing strategies for reaching optimal vaccination targets and attaining herd immunity. Health-promoting programs need to be intensified and could include psychosocial perspectives on vaccine hesitancy so that specific target groups can be reached to be vaccinated.

Suicidal behavior is condemned by religions and tradition, and suicide attempts are criminalized by law in several African countries, including Ghana and Uganda. Suicide and suicide attempts may have severe consequences for both the entire family and the community. Religion is known to act as a protective coping force that helps people to make meaning and find comfort when dealing with stressful life events or situations like suicide. In this article, we focus on the cultural interpretations of the dominating religion in Ghana and Uganda, Christianity, and whether these affect attitudes toward suicidal behavior, meaning making, and coping possibilities for people who have attempted suicide or are bereaved by suicide. This article is based on data material from previous studies on the mentioned topics by the authors.

Abstract Aim The present study was set out to establish the link between emotional labour (surface and deep acting) and job attitudes (job satisfaction organizational commitment) by introducing perceived organizational support as a moderating variable. Design The study made use of a cross‐sectional design by sampling three hundred and forty‐two (342) nurses and midwives from six health facilities in Ghana. Methods The study employed a quantitative approach to examine the relationships between the study variables. Results The study disclosed that whereas surface acting related negatively with job satisfaction but not with organizational commitment, deep acting did not relate significantly with both job satisfaction and organizational commitment. Perceived organizational support as a moderating variable showed a significant moderating effect between surface acting and job attitudes. However, Perceived organizational support moderated the relationship between deep acting and organizational commitment but not job satisfaction. The findings pose much contextual relevance to health professionals where emotional regulations are core responsibilities of health care.

Abstract Background Family members are key in detecting early suicide warning signs. This study compared the reasons for suicidality as reported by attempt survivors with their family folks in Ghana. Methods A qualitative design was used to select a sample size of 20 (10 family members and 10 suicide attempt survivors). Thematic analysis was used to analyse the data. Results Analysis of the data showed two major themes: 1) Similar Reasons (where both families and attempt survivors consistently reported similar reasons for suicidality and 2) Different Reasons (where there were sharp divergences). Conclusions Findings from this study help to understand the readiness of attempt survivor family members to intervene early during suicidal crisis.

Introduction Violence against children is a health, human rights and social problem affecting approximately half of the world’s children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- and middle-income countries—Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam—to support effective intervention to reduce violence against children. EBLS-Foundational Research (EBLS-FR) tests critical aspects of the planned EBLS, including participant recruitment and retention, data collection and analysis. Alongside epidemiological estimates of levels and predictors of exposure to violence and adversity during pregnancy, we plan to explore mechanisms that may link exposure to violence to mothers’ biological stress markers and subjective well-being.Methods and analyses EBLS-FR is a short longitudinal study with a sample of 1200 pregnant women. Data are collected during the last trimester of pregnancy and 2 to 6 months after birth. The questionnaire for participating women has been translated into nine languages. Measures obtained from mothers will include, among others, mental and physical health, attitudes to corporal punishment, adverse childhood experiences, prenatal intimate partner violence, substance use and social/community support. Hair and dry blood spot samples are collected from the pregnant women to measure stress markers. To explore research participation among fathers, EBLS-FR is recruiting 300 fathers in the Philippines and Sri Lanka.Ethics and dissemination The study received ethical approvals at all recruiting sites and universities in the project. Results will be disseminated through journal publications, conferences and seminar presentations involving local communities, health services and other stakeholders. Findings from this work will help to adjust the subsequent stages of the EBLS project.

Suicide is recognised as the third leading cause of death among adolescents globally. There is however limited data on the prevalence and factors associated with suicide particularly in Ghana. To explore the prevalence and risk and protective factors associated with suicide in Ghana, a nationwide Global School-based Student Health Survey data collected among senior high school adolescents in Ghana was used. The prevalence of suicidal behaviours was 18.2%, 22.5% and 22.2% for suicidal ideation, suicidal plan and suicidal attempt respectively. In the final analysis, anxiety increases the odds of suicidal behaviour, even after controlling for other variables. Loneliness increases the odds of suicidal behaviour but after adjusting for other factors the odds remained for only suicidal plan. Being bullied, physically attacked, involved in a physical fight and food insecurity remained risk factors for suicidal behaviour (i.e. ideation, plan and attempt) after adjusting for other factors. Truancy was found as a risk factor for both suicidal ideation and plans but such effect diminished for suicidal plan after adjusting for other variables. Increasing number of close friends remained a risk factor for both suicidal plan and attempt but such effect diminished for suicidal ideation after adjusting for other variables. Parental understanding of adolescents’ problems and worries remained a significant protective factor for all the indices of suicidal behaviour after adjusting for other variables. Parental respect for privacy was protective of suicidal attempt but was not significant after adjusting for other variables. Early identification and intervention for at-risk adolescents in senior high schools, for example those experiencing different forms of physical abuse, drug and substance use and hunger can potentially reduce the prevalence of suicide among this population in Ghana.

Abstract Background Home-based care for HIV patients is popular in contexts severely affected by the epidemic and exacts a heavy toll on caregivers. This study aimed at understanding the experiences of caregivers and their survival strategies. Methods A total of 18 caregivers (3 males and 15 females) were interviewed using a semi-structured interview guide, and thematic analysis was used to analyse the data. Results Analysis suggests that the caregivers are burdened with insecure provisions for food and difficulties in accessing health care. They however survived these strains through managing their relationships, sharing burden with care-recipients, social networks and instrumental spirituality. These findings are discussed under two major themes: 1). Labour of caregiving and 2). Survivalism. Conclusions Home-based care presents huge opportunities for community response to the HIV/AIDS epidemic in African settings. It is however burdensome and thus should not be left for families alone to shoulder. There is therefore an urgent need for protecting home-based care for HIV children in Uganda. Implications for improving and strengthening social interventions in home-based care of HIV/AIDS in the Ugandan context are addressed.

Abstract Background This study is part of a longitudinal study among children and adolescents with HIV in both urban and rural Uganda: ‘Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (CHAKA)’. Method The study is constructed of both quantitative and qualitative components. In this article we report a qualitative study on the experiences of 21 adolescents (twelve to seventeen years) living with HIV in Uganda. The purpose of the study was to investigate both the protective and the risk factors in HIV-infected adolescents’ care environment in order to understand what might contribute to negative outcomes and what might provide a protective buffer against harmful life events. Semi-structured interviews with vignettes about mental disorders were employed and a phenomenological analysis was done. Results The findings uncovered that the adolescents’ families were mostly characterized by instability and diffuse relationships that provided an insecure basis for secure attachment and emotional support. Even in stable and secure family environments, there was no guarantee for getting sufficient emotional support in order to develop a positive self-concept due to the fate being the only infected child in the family. Both secure attachment and positive self-concept are known psychological protective mechanisms that provide the individual with resilience. The adolescents in this study seemed hampered in the development of protective mechanisms and consequently seemed psychologically vulnerable and badly equipped for coping with challenges, which paves the way for the possible development of mental disorders. Conclusion To change the focus towards strengthening the children and adolescents’ development of psychological protective mechanisms implicates a change in focus from illness to health and has consequences for both treatment and prevention. Psychological health promotion must be systemic and aim at strengthening the family environment, but also to establish peer group support.

Abstract Background Ghana’s socio-cultural landscape proscribes suicidal behaviour, and this has serious ramifications for attempt survivors and their families. The objective of this qualitative study was to understand the experiences of the families of attempt survivors and how they cope with the aftermath of the attempt. Methods Ten families with attempted suicides agreed to participate in the study, hence they were interviewed. The information gathered was manually analyzed according to Interpretative Phenomenological Analysis (IPA) resulting in three major thematic areas. Results Three major themes emerged two of which addressed negative experiences and reactions towards the attempts: Experiencing shame and stigma, and Reactive affect. The third theme addressed the coping resources of these informants under the theme: Surviving the stress of attempt. The specific coping resources included personalized spiritual coping, social support, and avoidance. Conclusions Family systems theory is used to explain some of the findings of this study, and the implication for clinical practice and designing postvention programs for families after a suicide attempt are addressed.

Abstract Background Previous research revealed high prevalence of psychological symptoms among sickle cell disease (SCD) patients in the West and Europe. In some Black SCD populations such as Nigeria and Jamaica, anxiety and depression had low prevalence rates compared to Europe. With difficulty locating research data on the prevalence of psychological symptoms in Ghana, this study aimed at exploring psychological symptoms among adults with SCD in a Teaching Hospital in Accra, Ghana. Methods Two hundred and one participants (males 102 and females 99) who were HbSS (n = 131) and HbSC (n = 70), aged 18 years and above were purposively recruited. Using the Brief Symptom Inventory (BSI) in a cross-sectional survey, the research answered questions about the prevalence of psychological symptoms. It also examined gender and genotype differences in psychological symptoms scores. Results Results indicated that adults with SCD had non-distress psychological symptoms scores. Although paranoid ideation as a psychological symptom indicated “a little bit” score, its prevalence was only 1 %. The prevalence of psychological symptoms as indexed by the Positive Symptom Total (PST) was 10 %. Anxiety, hostility, and depression were psychological symptoms with low scores. Furthermore, except psychoticism scores, males did not differ significantly from females in other psychological symptoms. On the contrary, HbSS participants differed significantly, reporting more psychological symptoms than their HbSC counterparts. Conclusions The study concluded that there was low prevalence of psychological symptoms among adults with SCD in this Ghanaian study. Although psychological symptoms distress scores were not observed among study participants at this time, females differed significantly by experiencing more psychoticism symptoms than males. HbSS participants also differed significantly by experiencing more depression, phobic anxiety, paranoid ideation, psychoticism, and additional symptoms such as poor appetite, trouble falling asleep, thoughts of dying, and feeling guilty, than their HbSC counterparts. Implications for further study and clinical practice were discussed.

This study examines the direct and indirect effects of interpersonal fairness on employees’ willingness-to-stay and organisation-based self-esteem through affective commitment among manufacturing workers in Tema, Ghana. Using the survey design, 300 manufacturing workers in Tema were conveniently sampled for the study. The confirmatory factor analysis and structural equation modelling were used to analyse the data. Results indicated that affective commitment partially mediated the relationship between interpersonal fairness and employees’ willingness-to-stay. Affective commitment also fully mediated the interpersonal fairness-organisation-based self-esteem relationship. Results further showed that organisation-based self-esteem partially mediated the affective commitment and willingness-to-stay relationship, such that, an increase in organisation-based self-esteem leads to a decrease in employees’ willingness-to-stay. These findings emphasised the roles of interpersonal fairness and affective commitment in organisations, where affective commitment increases as a result of an increase in interpersonal fairness and makes employees have an intention-to-stay. The findings imply that employees who are very confident and have higher organisation-based self-esteem stand lower chances of staying in their current organisations. This study is the first to examine how affective commitment transfers the effects of interpersonal fairness unto employees’ intention-to-stay among manufacturing workers in Ghana.

Background. Hypertension is a major health problem that remains a significant threat to the health and general wellbeing of many people all over the world. In some patients, the etiology and prognosis of hypertension have been linked to psychological factors including personality traits. One primary goal of management is to improve the health-related quality of life (HRQoL) of patients with hypertension. This study aimed to examine the association between personality traits, clinical characteristics, and HRQoL in hypertension. Methods. A hospital-based cross-sectional quantitative study was conducted in a sample of 331 individuals with hypertension. Data on sociodemographic characteristics, clinical information, personality traits, and HRQoL were obtained from participants using an interviewer administered questionnaire. Results. The number of participants with a 1–10 years’ duration of diagnosis for hypertension was highest (56.8%), with 52.9% having comorbidities such as diabetes (40.2%) and dyslipidaemia (20.9%). The average number of medications taken per patient was 2.14 (SD±0.79) and about 47.1% of the participants reported adequate medication adherence. Significant associations for age, education, monthly income, number of years with hypertension, and HRQoL were observed. While conscientiousness was significantly associated with all HRQoL domains, extraversion and agreeableness were significantly related to only the environmental domain. Conclusion. This study has demonstrated that clinical characteristics and patients’ perception of their personality are relevant to their health-related quality of life outcomes. The findings suggest that when intervention efforts to improve the quality of life of patients with hypertension are being considered, a biopsychosocial approach should be employed. The implication is that treatment of hypertension in Ghana should be broadened to include the expertise of mental health professionals.

Adolescent suicide is now a major health concern for many countries. However, there is paucity of systematic studies and lack of official statistics on adolescent suicide in Ghana. Mass media coverage of adolescent suicide (even though crude), at least, may reflect the reality of the phenomenon. With an ecological orientation, this study used qualitative content analysis to analyse the pattern of 44 media reports of adolescent suicide in Ghana from January 2001 through September 2014. Results showed that hanging was the dominant method used. The behaviour usually takes place within or near the adolescent's home environment. The act was often attributed to precursors within the microsystem (family and school) of the deceased. This study serves a seminal function for future empirical studies aimed at deeper examination of the phenomenon in order to inform prevention programmes.

The penal code of Ghana condemns suicide attempt. The present study sought to explore the views of the police on persons who attempt suicide and the law criminalizing the act. Qualitative in-depth interviews were used to explore the views of 18 officers of the Ghana Police Service. Data were analyzed using thematic analysis technique. Findings showed that the police officers profiled suicide attempters as needy , enigmatic , ignorant , and blameworthy . Majority ( n = 14) of them disagreed with the law and suggested a repeal, whereas only four of them agreed with the law. Regardless of their positions on criminalization, they showed an inclination to help , rather than arrest , when confronted with such persons in line of their duty. Educating the police on suicidal behavior may help to deepen their understanding and help improve the way they handle suicidal persons. This may also strengthen police suicide prevention gatekeeping obligations.

One way of furthering our understanding of suicidal behaviour is to examine people's attitudes towards it and how they conceive the act. The aim of this study was to understand how lay persons conceive the impact of suicide on others and how that influences their attitudes towards suicide; and discuss the implications for suicide prevention in Ghana. This is a qualitative study, using a semi-structured interview guide to investigate the attitudes and views of 27 lay persons from urban and rural settings in Ghana. Interpretative Phenomenological Analysis was used to analyse the data. Findings showed that the perceived breach of interrelatedness between people due to suicidal behaviour influenced the informants’ view of suicide as representing a social injury. Such view of suicide influenced the negative attitudes the informants expressed towards the act. The negative attitudes towards suicide in Ghana are cast in consequential terms. Thus, suicide is an immoral act because it socially affects others negatively. The sense of community within the African ethos and The Moral Causal Ontology for Suffering are theoretical postulations that are used to offer some explanations of the findings in this study.