Using longitudinal survey and sensor data to understand the social and ecological determinants of clean fuels use and discontinuance in rural Ghana.
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ABSTRACT:
SUBMITTER: Carrion D
PROVIDER: S-EPMC8425314 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Rural Ghanaians rely on solid biomass fuels for their cooking. National efforts to promote the Sustainable Development Goals include the Rural Liquefied Petroleum Gas Promotion Program (RLP), which freely distributes LPG stoves, but evaluations have demonstrated low sustained use among recipients. Our study objective was to assess if cheap and scalable add-on interventions could increase sustained use of LPG stoves under the RLP scheme. We replicated RLP conditions among participants in 27 communities in Kintampo, Ghana, but cluster-randomized them to four add-on interventions: a behavioral intervention, fuel delivery service, combined intervention, or control. We reported on the final 6 months of a 12-month follow-up for participants (n = 778). Results demonstrated increased use for each intervention, but magnitudes were small. The direct delivery intervention induced the largest increase: 280 min over 6 months (p < 0.001), ∼1.5 min per day. Self-reported refills (a secondary outcome), support increased use for the dual intervention arm (IRR = 2.2, p = 0.026). Past literature demonstrates that recipients of clean cookstoves rarely achieve sustained use of the technologies. While these results are statistically significant, we interpret them as null given the implied persistent reliance on solid fuels. Future research should investigate if fuel subsidies would increase sustained use since current LPG promotion activities do not.
| S-EPMC8580155 | biostudies-literature
Project description:BACKGROUND:More than 75% of the population in Ghana relies on biomass fuels for cooking and heating. Household air pollution (HAP) emitted from the incomplete combustion of these fuels has been associated with adverse health effects including respiratory effects in women that can lead to chronic obstructive pulmonary disease (COPD), a major contributor to global HAP-related mortality. HAP is a modifiable risk factor in the global burden of disease, exposure to which can be reduced. OBJECTIVE:This study assessed the prevalence of respiratory symptoms, as well as associations between respiratory symptoms and HAP exposure, as measured using continuous personal carbon monoxide (CO), in nonsmoking pregnant women in rural Ghana. METHODS:We analyzed current respiratory health symptoms and CO exposures upon enrollment in a subset (n = 840) of the population of pregnant women cooking with biomass fuels and enrolled in the GRAPHS randomized clinical control trial. Personal CO was measured using Lascar continuous monitors. Associations between CO concentrations as well as other sources of pollution exposures and respiratory health symptoms were estimated using logistic regression models. CONCLUSION:There was a positive association between CO exposure per 1 ppm increase and a composite respiratory symptom score of current cough (lasting >5 days), wheeze and/or dyspnea (OR: 1.2, p = 0.03). CO was also positively associated with wheeze (OR: 1.3, p = 0.05), phlegm (OR: 1.2, p = 0.08) and reported clinic visit for respiratory infection in past 4 weeks (OR: 1.2, p = 0.09). Multivariate models showed significant associations between second-hand tobacco smoke and a composite outcome (OR: 2.1, p < 0.01) as well as individual outcomes of cough >5 days (OR: 3.1, p = 0.01), wheeze (OR: 2.7, p < 0.01) and dyspnea (OR: 2.2, p = 0.01). Other covariates found to be significantly associated with respiratory outcomes include involvement in charcoal production business and dyspnea, and involvement in burning grass/field and wheeze. Results suggest that exposure to HAP increases the risk of adverse respiratory symptoms among pregnant women using biomass fuels for cooking in rural Ghana.
| S-EPMC7069526 | biostudies-literature
Project description:Aedes aegypti is the main vector of dengue globally. The variables that influence the abundance of dengue vectors are numerous and complex. This has generated a need to focus on areas at risk of disease transmission, the spatial-temporal distribution of vectors, and the factors that modulate vector abundance. To help guide and improve vector-control efforts, this study identified the ecological, social, and other environmental risk factors that affect the abundance of adult female and immature Ae. aegypti in households in urban and rural areas of northeastern Thailand. A one-year entomological study was conducted in four villages of northeastern Thailand between January and December 2019. Socio-demographic; self-reported prior dengue infections; housing conditions; durable asset ownership; water management; characteristics of water containers; knowledge, attitudes, and practices (KAP) regarding climate change and dengue; and climate data were collected. Household crowding index (HCI), premise condition index (PCI), socio-economic status (SES), and entomological indices (HI, CI, BI, and PI) were calculated. Negative binomial generalized linear models (GLMs) were fitted to identify the risk factors associated with the abundance of adult females and immature Ae. aegypti. Urban sites had higher entomological indices and numbers of adult Ae. aegypti mosquitoes than rural sites. Overall, participants' KAP about climate change and dengue were low in both settings. The fitted GLM showed that a higher abundance of adult female Ae. aegypti was significantly (p < 0.05) associated with many factors, such as a low education level of household respondents, crowded households, poor premise conditions, surrounding house density, bathrooms located indoors, unscreened windows, high numbers of wet containers, a lack of adult control, prior dengue infections, poor climate change adaptation, dengue, and vector-related practices. Many of the above were also significantly associated with a high abundance of immature mosquito stages. The GLM model also showed that maximum and mean temperature with four-and one-to-two weeks of lag were significant predictors (p < 0.05) of the abundance of adult and immature mosquitoes, respectively, in northeastern Thailand. The low KAP regarding climate change and dengue highlights the engagement needs for vector-borne disease prevention in this region. The identified risk factors are important for the critical first step toward developing routine Aedes surveillance and reliable early warning systems for effective dengue and other mosquito-borne disease prevention and control strategies at the household and community levels in this region and similar settings elsewhere.
| S-EPMC8199701 | biostudies-literature
Project description:Maternal mortality is the subject of the United Nations' fifth Millennium Development Goal, which is to reduce the maternal mortality ratio by three quarters from 1990 to 2015. The giant strides made by western countries in dropping of their maternal mortality ratio were due to the recognition given to skilled attendants at delivery. In Ghana, nine in ten mothers receive antenatal care from a health professional whereas only 59 and 68% of deliveries are assisted by skilled personnel in 2008 and 2010 respectively. This study therefore examines the determinants of skilled birth attendant at delivery in rural southern Ghana.This study comprises of 1874 women of reproductive age who had given birth 2 years prior to the study whose information were extracted from the Dodowa Health and Demographic Surveillance System. The univariable and multivariable associations between exposure variables (risk factors) and skilled birth attendant at delivery were explored using logistic regression.Out of a total of 1874 study participants, 98.29% of them receive antenatal care services during pregnancy and only 68.89% were assisted by skilled person at their last delivery prior to the survey. The result shows a remarkable influence of maternal age, level of education, parity, socioeconomic status and antenatal care attendance on skilled attendants at delivery.Although 69% of women in the study had skilled birth attendants at delivery, women from poorest households, higher parity, uneducated, and not attending antenatal care and younger women were more likely to deliver without a skilled birth attendants at delivery. Future intervention in the study area to bridge the gap between the poor and least poor women, improve maternal health and promote the use of skilled birth at delivery is recommended.
| S-EPMC5504761 | biostudies-other
Project description:BackgroundAccelerating declines in tuberculosis (TB) incidence is paramount for achieving global goals set for 2030 by the Sustainable Development Goals and the End TB Strategy. The aim of this study was to identify key country-level social determinants of national TB incidence trends.MethodsThis longitudinal ecological study used country-level data extracted from online databases from the period 2005-2015. We used multivariable Poisson regression models allowing for distinct within- and between-country effects to estimate associations between national TB incidence rates and 13 social determinants of health. The analysis was stratified by country income status.ResultsThe study sample included 48 low- and lower-middle-income countries (LLMICs) and 68 high- and upper-middle income countries (HUMICs), with a total of 528 and 748 observations between 2005-2015, respectively. National TB incidence rates declined in 108/116 countries between 2005-2015, with an average drop of 12.95% in LLMICs and 14.09% in HUMICs. Between LLMICs, higher Human Development Index (HDI), social protection spending, TB case detection, and TB treatment success were associated with lower TB incidence. Higher prevalence of HIV/AIDS was associated with higher TB incidence. Within LLMICs, increases in HDI over time were associated with lower TB incidence rates. Between HUMICs, higher HDI, health spending, and diabetes prevalence were associated with lower TB incidence, whereas higher prevalence of HIV/AIDS and alcohol-use were associated with higher TB incidence. Within HUMICs, increases in HIV/AIDS and diabetes prevalence over time were associated with higher TB incidence.ConclusionsIn LLMICs, TB incidence rates remain highest in countries with low human development, social protection spending and TB programme performance, and high rates of HIV/AIDS. Strengthening human development is likely to accelerate declines in TB incidence. In HUMICs, TB incidence rates remain highest in countries with low human development, health spending and diabetes prevalence, and high rates of HIV/AIDS and alcohol use. Here, slowing rising rates of HIV/AIDS and diabetes is likely to accelerate declines in TB incidence.
| S-EPMC9930041 | biostudies-literature
Project description:Using a social-ecological framework, we identify social determinants that interact to influence sleep health, identify gaps in the literature, and make recommendations for targeting sleep health in rural mothers. Rural mothers experience unique challenges and protective factors in maintaining adequate sleep health during the postpartum and early maternal years. Geographic isolation, barriers to comprehensive behavioral medicine services, and intra-rural ethno-racial disparities are discussed at the societal (e.g., public policy), social (e.g., community) and individual levels (e.g., stress) of the social-ecological model. Research on sleep health would benefit from attention to methodological considerations of factors affecting rural mothers such as including parity in population-level analyses or applying community-based participatory research principles. Future sleep health programs would benefit from using existing social support networks to disseminate sleep health information, integrating behavioral health services into clinical care frameworks, and tailoring culturally-appropriate Telehealth/mHealth programs to enhance the sleep health of rural mothers.
| S-EPMC7574991 | biostudies-literature
Project description:Ensuring affordable, reliable, sustainable and modern energy for all by 2030 is part of the internationally agreed Sustainable Development Goals (SDG7). With roughly 3 billion people still lacking access to clean cooking solutions in 2017, this remains an ambitious task. The use of solid biomass such as wood and cow dung for cooking causes household air pollution resulting in severe health hazards. In this context, the Indian government has set up a large program promoting the use of liquefied petroleum gas (LPG) in rural areas. While this has led millions of households to adopt LPG, a major fraction of them continues to rely heavily on solid biomass for their daily cooking. In this paper, we evaluate the effect of simple health messaging on the propensity of these households to use LPG more regularly. Our results from rural Rajasthan are encouraging. They show that health messaging increases the reported willingness to pay for LPG, and substantially increases actual consumption. We measure this based on a voucher, which can only be used if LPG consumption is doubled until a certain deadline. Households exposed to health messaging use the voucher about 30% more often than households exposed to a placebo treatment. We further show that the impact of our very brief, but concrete health messaging is close to the effect of a 10% price reduction for a new LPG cylinder. Finally, our study raises some interesting questions about gender-related effects that would be worth consideration in future research.
| S-EPMC7190100 | biostudies-literature
Project description:Background: The consequences of antibiotic resistance are projected to be most severe in low and middle income countries with high infectious disease burden. This study examined determinants of inappropriate antibiotic use at the community level in rural Ghana. Methods: An observational study involving qualitative and quantitative methods was conducted between July, 2016 and September, 2018 in Ghana. Two household surveys were conducted at two time points (2017 and 2018) among 1,100 randomly selected households over 1 year. The surveys focused on antibiotic use episodes in the past month. Four in-depth interviews and two focus group discussions were performed to further explain the survey results. Determinants of inappropriate antibiotic use were assessed using a mixed effect logistic regression analysis (multilevel analysis) to account for the clustered nature of data. We defined inappropriate antibiotic use as either use without prescription, not completing treatment course or non-adherence to instruction for use. Qualitative data were thematically analyzed. Results: A total of 1,100 households was enrolled in which antibiotics were used in 585 (53.2%) households in the month prior to the surveys. A total of 676 (21.2%) participants out of 3,193 members from the 585 reportedly used antibiotics for 761 episodes of illness. Out of the 761 antibiotic use episodes, 659 (86.6%) were used inappropriately. Paying for healthcare without health insurance (Odds Ratio (OR): 2.10, 95% CI: 1.1-7.4, p-value: 0.026), not seeking healthcare from health centers (OR: 2.4, 95% CI: 1.2-5.0, p-value: 0.018), or pharmacies (OR: 4.6, 95% CI: 1.7-13.0, p-value: 0.003) were significantly associated with inappropriate antibiotic use. Socio-demographic characteristics were not significantly associated with inappropriate antibiotic use. However, the qualitative study described the influence of cost of medicines on inappropriate antibiotic use. It also revealed that antibiotic users with low socioeconomic status purchased antibiotics in installments which, could facilitate inappropriate use. Conclusion: Inappropriate antibiotic use was high and influenced by out-of-pocket payment for healthcare, seeking healthcare outside health centers, pharmacies, and buying antibiotics in installments due to cost. To improve appropriate antibiotic use, there is the need for ministry of health and healthcare agencies in Ghana to enhance healthcare access and healthcare insurance, and to provide affordable antibiotics.
| S-EPMC7105730 | biostudies-literature
Project description:Background:There are wide differences in the uptake of skilled delivery services between urban and rural women in the northern region of Ghana. This study assessed the rural-urban differences in the prevalence of and factors associated with uptake of skilled delivery in the northern region of Ghana. Methods:The study population comprised postpartum women who had delivered within the last three months prior to the study. The dataset was analyzed using the chi-square test and multivariable logistic regression. Results:The odds of skilled birth attendance (SBA) adjusted for confounding variables in urban areas were higher compared with their rural counterparts (AOR?=?1.59; CI: 1. 07-2.37; p=0.02). The determinants of skilled delivery were similar but of different levels and strength in rural and urban areas. The main drivers that explained the relatively high skilled delivery coverage in the urban areas were higher frequency of antenatal care (ANC) attendance, proximity (physical access) to health facility, and greater proportion of women attaining higher educational level of at least secondary school. Distance from health facility less than 4 km was the greatest independent contributor to the variance in skilled delivery in the urban areas, whereas frequency of ANC attendance was the greatest independent contributor in the rural areas. Conclusions:This study identified underlying determinants accounting for rural-urban differences in skilled delivery, and covariate effect was more dominant than coefficient effect. Therefore, urban-rural differences in SBA outcomes were primarily due to differences in the levels of critical determinants rather than the nature of the determinants themselves. Therefore, improving skilled delivery outcomes in this study population and other similar settings will not require different policy frameworks and interventions in dealing with rural-urban disparities in SBA outcomes. However, context-specific tailored approaches and strategies including targeting mechanisms have to be designed differently to reduce the rural-urban differences.
| S-EPMC7238325 | biostudies-literature
Project description:BackgroundQuality surveillance data used to build tuberculosis (TB) transmission models are frequently unavailable and may overlook community intrinsic dynamics that impact TB transmission. Social network analysis (SNA) generates data on hyperlocal social-demographic structures that contribute to disease transmission.MethodsWe collected social contact data in five villages and built SNA-informed village-specific stochastic TB transmission models in remote Madagascar. A name-generator approach was used to elicit individual contact networks. Recruitment included confirmed TB patients, followed by snowball sampling of named contacts. Egocentric network data were aggregated into village-level networks. Network- and individual-level characteristics determining contact formation and structure were identified by fitting an exponential random graph model (ERGM), which formed the basis of the contact structure and model dynamics. Models were calibrated and used to evaluate WHO-recommended interventions and community resiliency to foreign TB introduction.ResultsInter- and intra-village SNA showed variable degrees of interconnectivity, with transitivity (individual clustering) values of 0.16, 0.29, and 0.43. Active case finding and treatment yielded 67%-79% reduction in active TB disease prevalence and a 75% reduction in TB mortality in all village networks. Following hypothetical TB elimination and without specific interventions, networks A and B showed resilience to both active and latent TB reintroduction, while Network C, the village network with the highest transitivity, lacked resiliency to reintroduction and generated a TB prevalence of 2% and a TB mortality rate of 7.3% after introduction of one new contagious infection post hypothetical elimination.ConclusionIn remote Madagascar, SNA-informed models suggest that WHO-recommended interventions reduce TB disease (active TB) prevalence and mortality while TB infection (latent TB) burden remains high. Communities' resiliency to TB introduction decreases as their interconnectivity increases. "Top down" population level TB models would most likely miss this difference between small communities. SNA bridges large-scale population-based and hyper focused community-level TB modeling.
| S-EPMC10410943 | biostudies-literature