Fidelia A. A. Dake

Background: In Ghana and sub‐Saharan Africa, there is limited understanding of how people's subjective perceptions influence the broader conceptualisation of ageing and disability. Cultural and social factors play a critical role in shaping these perceptions, but existing research has not adequately explored this relationship. This study addresses this gap by using the newly developed Subjective Perception of Ageing and Disability Scale (SPADS) and the Conceptualisation of Ageing and Disability Scale (CADS) to examine how individual beliefs and functional abilities interact with cultural and social contexts to shape views on ageing and disability in Ghana. Methods: An exploratory sequential mixed‐methods research design explored how ageing symptoms are associated with disability among residents of Dodowa in the Shai Osudoku District, Greater Accra region. The initial qualitative phase involved 14 participants, followed by a quantitative phase with 175 participants. Themes from the qualitative study informed the development of instruments for the quantitative study. SPADS and CADS developed through Cronbach's α analysis and exploratory factor analysis. An Independent samples t ‐test, analysis of variance (ANOVA) and structural equation modelling assessed subjective perceptions of ageing and disability and their broader conceptualisation, respectively. Findings: The findings indicate a close relationship between subjective perceptions of ageing and disability in Ghana. Ageing symptoms identified in the qualitative phase—cognition, physical attributes, sensory impairment, and potential disability—were associated with disability. Most participants associated disability with ageing symptoms as reflected in their SPADS responses. SPADS was a strong predictor of CADS, with a positive relationship between the two scales. Most participants conceptualised ageing as being inherently linked to disability. Conclusion: Ageing is predominantly perceived as being associated with disability. The findings suggest a lack of adequate knowledge about ageing and disability. Educational campaigns are recommended to improve understanding of these phenomena. Future research should explore longitudinal changes in perception and rural–urban differences.

Research on malnutrition in sub-Saharan Africa, including Ghana, has primarily focused on women and children, with less attention paid to men. We estimate

Despite global commitment and investment in improving maternal and child health, inequities in antenatal care (ANC) persist, especially in sub-Saharan Africa (SSA), but evidence on variations in ANC initiation at the global SSA level is limited. This study analyzed variations in ANC initiation and examined the associated factors among women of reproductive age in SSA. The data were drawn from the most recent Demographic and Health Survey conducted between 2007 and 2019 in thirty-six (36) countries. The analytical sample consisted of 123,134 women who had births in the two years preceding the survey and made at least one ANC visit during the index pregnancy. The association between the timing of ANC initiation and each independent variable was examined using the Pearson chi-square test. Kaplan-Meier survivor curves were generated to examine the extent to which ANC initiation occurred over time. Event history analysis models were specified using the discrete-time logit function to examine the unadjusted and adjusted effects of each covariate on ANC initiation. The results indicate that only 36.9% of the women initiated ANC within the first trimester during the index pregnancy and a little less than 1 in 10 (8.2%) did not initiate ANC until the third trimester. The country-specific results show wide variations in the initiation of ANC. For example, ANC initiation in the first month of pregnancy was least common in Niger (0.2%) and most common in Liberia (16.6%). The time to initiation of ANC visits at any time interval was greater for women in rural areas, those with no education or primary education and women who had no exposure to mass media. Among several covariates, increased involvement of females in household decision-making and household wealth status were found to be associated with ANC initiation. Women who participated in making three and four household decisions were more likely to initiate ANC (aOR = 1.02, p < 0.05 and 1.03, p < 0.01 respectively) compared to women who did not participate in household decision-making. Women who belonged to higher wealth status categories showed higher odds of ANC initiation compared to those in the poorest category. The findings of the present study indicate that early initiation and universal coverage of ANC among women of reproductive age in SSA continues to be a challenge. Policies that target female education up to at least the secondary level and interventions that improve the socioeconomic status of women can empower women to make decisions for themselves, which could increase the chances of early and timely ANC initiation.

Objectives: Low- and middle-income countries are challenged by high rates of food and nutrition insecurity. Suboptimal production, distribution, availability, and affordability of nutritious foods, especially at the local level, disproportionately affect nutritionally vulnerable groups. We identified nutrient deficiencies among women, young children, and adolescents as part of the NutriShed project implemented in Ghana. Design: Using a survey design, dietary behavior was assessed by administering an interactive multi-pass 24-hour recall tool. Setting: This study was conducted in Asesewa and Takoradi, in GhanaParticipants: Survey participants were adult women (18 years and older), young children (2–5 years) and adolescents (12–18 years) living in the two communities. Main outcome measures: Data from 581 participants, comprising 187 women, 197 children, and 197 adolescents were analyzed. Estimated Average Requirements (EAR) were determined for each nutrient using data on the type and quantity of food consumed during the 24-hour period preceding the recall. The median EAR was compared to reference EAR for each nutrient. Limiting nutrients were identified based on age-sex specific cut-off reference EAR values.Results: Calcium, folic acid, and riboflavin were identified as key limiting micronutrients in the diets of women, children, and adolescents in both Asesewa and Takoradi. However, inadequacy for the three limiting nutrients was more prevalent in Asesewa than in Takoradi.Conclusions: The findings highlight the need for targeted strategies that address suboptimal diets in urban communities in Ghana. Particularly, strategies are needed to address nutrient inadequacy among women and adolescents, in Asesewa, who may be at greater risk.

As urbanization accelerates, towns and cities worldwide face the challenge of planning nutrition security for their growing populations, in the context of their local food systems. Urban food systems in low- and middle-income countries are often complex, with large geospatial spread in the flow of foods. This complexity is compounded by the frequently informal nature of the markets and value chains governing flows, and the changing climate. Urban planners could benefit from tools to plan their nutrition security in such settings, but there is little research on such methods and tools.Our study proposes a novel approach, NutriShed, to map the origins and flows of key micronutrients, and illustrates its application in two Ghanaian cities: Takoradi and Assesewa. Nutrished involves objectively identifying vulnerabilities within nutrient supply chains and food systems infrastructure as a means to unravel the flow of food into and through cities. The NutriShed approach is guided by a framework designed to track the spatial flows of essential nutrients into and out of the study communities, focusing on nutrient gaps, regional production deficits, and food system vulnerabilities. The NutriShed approach is structured in several stages: Stage I identifies nutrient gaps using dietary surveys of vulnerable population sub-groups. In stage II, quantifies nutrient flows by surveying food markets, traders, and food transport systems. Stage III utilizes geospatial tools to map nutrient flows and assess food system infrastructure and climate vulnerabilities. Stage IV examines nutrient flow vulnerabilities in relation to road density, climate risks, and infrastructure usage. Stage V identifies nutrition-sensitive interventions using GIS techniques to propose strategies for enhancing nutrient supply and bolstering food system resilience. Throughout the process, it is important to engage with relevant stakeholders to ensure participation and uptake of findings for planning and implementation.

Fertility in sub-Saharan Africa (SSA) continues to be among the highest in the world. Studies on fertility in SSA have examined dimensions such as marital versus non-marital fertility and fertility in monogamous versus polygamous unions. Very few studies have examined variations based on wife rank. This study explores fertility variations based on wife rank among women of reproductive age in Ghana. Descriptive statistics and Poisson regression techniques were used in analysing data on 8,136 women (weighted sample) aged 15-49 years who were surveyed in the 2022 Ghana Demographic Health Survey. The findings indicate that fertility varies significantly based on the rank of wives. After controlling for some proximate determinants of fertility and the sociodemographic characteristics of women and their partners, being a second and higher order wife was found to be associated with lower fertility compared to being the only wife in the union. Partners’ characteristics did not significantly predict the fertility of their spouse regardless of the rank of the wives. These findings suggest that fertility is not always higher among women in polygamous unions when the rank of co-wives is considered, as such there is the need for more focused research to aid our understanding of the underlying factors and dynamics in fertility among women in polygamous unions, especially in similar sociocultural context where polygamy is commonly practiced. Keywords: Fertility; Wife rank, Ghana

Objective Energy poverty contributes to the general well-being of households; however, there is representational paucity on its role in household nutrition across sub-Saharan Africa (SSA). This study examined the influence of different domains of energy poverty and a Multidimensional Energy Poverty Index (MEPI) on household burden of malnutrition in SSA. Setting Secondary data from the most recent Demographic and Health Survey conducted in 18 SSA countries were analysed. Design A cross-sectional design was used to examine the relationship between household energy poverty and household burden of malnutrition. Methods Different dimensions of household energy poverty and an MEPI were computed from the sources of energy used for cooking, lighting, entertainment and accessing information by households. Household burden of malnutrition was coded as a binary categorical dependent variable using indicators of undernutrition, overnutrition and anaemia among women of reproductive age (15–49 years) and children under five years in the household. Results More than nine in ten households were energy poor in terms of cooking fuel and about three in four were energy poor in terms of lighting. Considering the various domains of energy poverty, lack of electricity for lighting, using biofuels, not owning a refrigerator/freezer, not owning a television/radio and not owning a mobile phone were associated with increased odds of a household experiencing undernutrition. Similarly, deprivation in these domains was associated with a lower likelihood of households experiencing overnutrition, the only exception being using biofuels. Overall, households that were most energy poor on the MEPI were more likely to be undernourished and double and triple burden malnutrition households but less likely to suffer from overnutrition. Conclusion These results highlight the complex and multifaceted nature of the relationship between energy poverty and household burden of malnutrition and provides guidance for appropriate interventions to address energy poverty and malnutrition in SSA.