Academic literature on the topic 'Adolescence – Health and hygiene – Ghana'

The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes.

INTRODUCTION: Menstruation is a phenomenon unique to the females and menstrual hygiene is still a problem for adolescent girls especially in low and middle income countries particularly when attending school. This issue is insufficiently acknowledged and has not received adequate attention in the reproductive health sectors in developing countries including Ghana and its relationship with the achievement of Sustainable Development Goals (SDGs). OBJECTIVES: This study examined the knowledge and practices of menstrual hygiene among adolescent girls, the cultural beliefs that influence menstrual hygiene practices, and the problems adolescent girls face in practicing menstrual hygiene. METHODOLOGY: A quantitative research method using descriptive cross-sectional survey design was employed in the study. Using a multi-staged sampling technique, a sample size of 151 adolescents in Juniors High schools who had reached menarche was selected from four (4) schools located in Asamang, Sekyere south District of Ashanti region of Ghana. Data was collected through a researchers’ constructed and validated questionnaire titled “Adolescents knowledge and practice of menstrual hygiene questionnaire (AKPMHQ)”. Data was analysed using simple frequencies and percentages. RESULTS: The study revealed that 68(45%) of the girls were in the Junior High School three (JHS3) and 88(58.5%) of them ranged between 14-15 years. Most of them (74.2%) had pre-menarche education given by their family members. Most of the parents 94(62.3%) had secondary education. Majority of the girls practiced good menstrual hygiene. Their culture does not exert much influence on their knowledge and practices of menstrual hygiene. However, there were some myths which are not scientifically based. Most of the girls experience some challenges during menstruation such as lower abdominal pain 77(51.0%) and unavailability of facility in school to change during menstruation 61(40.4%). CONCLUSION: The adolescent girls are knowledgeable about menstrual hygiene and also have good menstrual hygiene practices. However, there exist few cultural practices in the community that may have negative effect on their knowledge and practice of menstrual hygiene in the midst of some physical and social challenges experienced by the adolescents during menstruation.

(1) Background: Despite a global call to act to resolve communicable diseases caused by lack of clean water, sanitation, and hygiene, many people in low- and middle-income countries continue to die each year. In this study, we looked at in-school adolescents’ oral and hand hygiene activities in Ghana, as well as the factors that influence them. (2) Methods: This was a cross-sectional study that utilised data on 1348 in-school adolescents from the 2012 global school-based health survey. Using Stata software version 14.2, descriptive and inferential statistics were used to analyze the data. All statistical analyses were considered significant at p-value < 0.05. (3) Results: The prevalence of good hygiene behaviour was 62.6% and 79.9% for good oral hygiene and good hand hygiene, respectively. In-school adolescents who were truant were 31% (AOR = 0.69, 95% CI = 0.51–0.92) and 28% (AOR = 0.72, 95% CI = 0.54–0.87), respectively, less likely to practise good hand and oral hygiene compared to those who were not. Adolescents whose parents supervised their homework, however, had higher probabilities of practising good hand (AOR = 2.30, 95% CI = 1.64–2.31) and oral (AOR = 2.34, 95% CI = 1.80–3.04) hygiene respectively. Adolescents aged 18 years and above were 1.33 times more likely to practice good oral hygiene than younger adolescents (AOR=1.33, 95% CI = 1.07–1.66). Adolescents who were bullied had lower odds of practicing good hand hygiene (AOR = 0.70, 95% CI = 0.52–0.94). (4) Conclusions: While good hygiene behaviour remains a major strategy in decreasing the prevalence of communicable diseases, the less than 65% prevalence of hand hygiene we observed in the current study is indicative of the country’s inability to achieve water, hygiene and sanitation for all by the year 2030. To accelerate progress towards meeting the Sustainable Development Goal 6.2, there is a need for the implementation of innovative interventions which seek to promote good hygiene behaviours among adolescents and the expansion of existing interventions, such as the WASH initiative, in schools. Such interventions should focus more on younger adolescents, those who are truant, and adolescents who suffer from bullying in school.

Background. Traditionally, discussion about sexuality is subdued in proverbs and is earmarked for adults. However, adolescents also need information about their sexuality to make informed choices regarding sexual behaviours. This study, therefore, seeks to explore the experiences of parents discussing sexuality topics with adolescents in the Accra Metropolis, Ghana. Methods. This was a qualitative study that used focus group discussions (FGDs) and in-depth interviews (IDIs) to assess parents’ experiences in discussing sexuality topics with adolescents. The FGDs, consisting of 8-12 parents each, were conducted for one “all fathers”, then another “all mothers”, and finally “fathers and mothers” groups. Parents who were not part of the FGDs were engaged in IDIs. The data was transcribed and analyzed manually. Results. Most of the parent-adolescent sexual discussions were based on physical changes, personal hygiene, abstinence, abortion, and saying “no” to forced sex. Parents discussed sexuality issues with adolescents to prevent them from premarital sex, pregnancy, and sexually transmitted infections. Parents sourced their knowledge about sexuality from books, television, radio, and personal experiences. Parents always seize opportunities such as television scenes to discuss sexual topics with their children. Although some parents expressed some level of comfort discussing sexual topics with adolescents, many still had difficulties explaining some terminologies related to sex. Preferentially, parents were protective of their girls than the boys when discussing issues on sexuality. Most parents received no sexuality education from their parents but a few reminisced precautionary advices on sex. Parents believed training on sexuality issues will help them to better discuss sexual topics with adolescents. Conclusions. Ghanaian parents preferentially discuss sex with their daughters as a protective tool against irresponsible sexual behaviours. Parents still have challenges discussing adolescent sexuality topics; hence equipping parents to effectively discuss such sensitive topics will improve adolescent reproductive health and sexual behaviour.

Background Young women and adolescent girls experience many challenges in their lives related to sanitation, hygiene, and menstruation. These challenges are often seen in a school setting and are more intense in peri-urban areas, where the infrastructure in educational institutions is often outpaced by the population, generating poor sanitary conditions. This can lead to adolescent girls contracting reproductive tract infections, such as candidiasis, as a result of poor menstrual hygiene. This study assessed menstrual hygiene management among students at a senior high school in the Volta Region, Ghana, in order to identify improvements to be made by school authorities to improve the health and comfort of students during menstruation. Methods This cross-sectional, descriptive study was conducted among 265 students aged 13–22 years, who had attained menarche. A pretested, structured questionnaire was used to collect data on their menstruation knowledge and practices, and the available sanitary facilities for menstrual hygiene management in the school. This was followed by an evaluation of the available facilities using a survey process. The Pearson chi-squared test was used to test the association between a student's year group and their knowledge and practices. Results The majority of the girls had accurate knowledge on menstruation (52.8% reported the correct length of a woman's menses, 74.7% correctly reported that a woman's menses comes once a month). However, the majority (63%) of participants reported the belief that menstrual blood is unhygienic and this belief was significantly associated with year group (P<0.00). When reporting on their practices during menstruation, the majority (76.2%) bathed twice a day and most (47.2%) changed their sanitary product twice a day. The frequency of these practices was significantly associated with year group (P=0.017 and P≤0.00, respectively). Only one-third (33.6%) of girls reported always having access to water for washing when menstruating and only 24.9% reported always having access to soap. The survey of facilities revealed that there was no handwashing facility in the school. Conclusions There is a need for Ghanaian educational institutions to provide proper sanitary facilities and for parents to provide sanitary pads or towels, which will allow girls who are menstruating to be comfortable and free of reproductive health infections. To achieve this, school authorities should be educated on the importance of providing the necessary sanitary facilities and parents should be educated on the necessity of provision of sanitary pads.

Abstract Objectives Adolescents are vulnerable to diet-related health risks as they experience major life changes alongside food environment changes. In Ghana, non-communicable diseases (NCDs) are rising, and there is a need to understand what, how and why adolescents eat the way they do. This study explored perspectives of adolescents about healthy and unhealthy eating and relationships to portion sizes. Methods The Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) Project is measuring the nature and extent of unhealthy food marketing to support public sector actions to create healthier food environments for Ghanaian children. In July-August 2020, 48 interviews with students (14–17 years old) in six districts across the Greater Accra Region were conducted in schools. Interviews were done in English, audio recorded, and transcribed verbatim. Transcripts were coded with NVivo12 using a thematic analysis. Results All students demonstrated basic nutrition knowledge and conceptualized healthy eating as “not eating too much”, “a balanced diet,” “not eating late,” and “not eating cold foods.” Connections between NCDs and consumption of foods high in fat, sugar, and salt were rarely made. All students consumed items contrary to what was described as a healthy diet. Students expressed food safety as indicative of healthy food, emphasizing food prepared in a “hygienic environment by a hygienic person,” “a hot temperature,” and “covered.” Participants did not understand portion sizes beyond “too much of anything is bad” and most stated contexts where they would consume smaller or larger portion sizes, such as around strangers (less) or unsure of next meal (more). Participants admitted that peer pressure and food advertising claims informed their food choices and showed minimal knowledge of marketing tactics. Students voiced their limited agency in food choice decisions, citing financial and cultural constraints. Conclusions Students had some nutrition knowledge but limited agency to apply it in daily food choices. Interventions should include educating students and parents on diet-related NCDs and deceptive marketing tactics that promote unhealthy foods. Funding Sources International Development Research Centre's Food, Environment & Health Programme, IDRC-Canada. Office of the Vice President for Research, University of South Carolina.

Objective To assess hand hygiene compliance in selected primary hospitals in Ghana. Design A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients.

Adolescence (10–19 years) is marked by many physiological changes and is vulnerable to health and nutritional problems. Adolescence, particularly, early adolescence is inadequately addressed in our national surveys. The present study aimed to assess the reproductive health awareness, nutrition, and hygiene of marginalized adolescent girls and boys and compare them among early and late adolescents. Our cross-sectional study was a part of a community-based project across India’s five zones, namely North, East, West, Central, and South. Unadjusted and adjusted logistic regression was performed to compare awareness about HIV/AIDS, or Sexually Transmitted Infections (STI), consumption of Iron Folic Acid (IFA) tablets and three meals in a day, safe menstrual hygiene practices, history of anemia, and open defecation practice among early and late adolescents. Data were reported as unadjusted and adjusted odds ratio (aOR) with a 95% confidence interval (95% CI). Among early adolescents, around 58% of girls and boys did not consume IFA tablets, and 28% of girls and 24% of boys defecated in the open. Compared to late adolescents, early adolescent girls had lower odds of awareness about HIV/AIDS (aOR (95% CI): 0.50 (0.47–0.54)) and open defecation (aOR (95% CI): 0.90 (0.83–0.98)) and higher odds of hand hygiene after defecation (aOR (95% CI): 1.52 (1.37–1.68)) and safe menstrual practices (aOR (95% CI): 1.42 (1.23–1.64)). There is a dire need to start public health interventions from early adolescence for long-term benefits throughout adolescence.

Objective: Reproductive health (RH) is a crucial aspect of general health; it is a reflection of health during adolescence and adulthood. The period of adolescence in females is a period of physical and psychological preparation for safe motherhood. As direct reproducers, adolescent girls’ health influences not only their own health but also the health of the future generation. This study aimed to assess knowledge, hygiene practices during menses, and attitudes of female adolescents in Riyadh female secondary schools regarding RH aspects.Methods: A quantitative descriptive cross-sectional design was used for this study conducted on 350 female students selected from governmental secondary schools in Riyadh using multistage random sample type. Two tools were used for data collection in the current study: a self-administered questionnaire and an Attitudinal Assessment scale.Results: The findings showed that more than two-thirds (66.3%) of the participants had inaccurate knowledge, while about one-third (33.7%) of them had correct knowledge regarding RH. With respect to overall hygiene practices during menstruation, about 95.4% had correct menstruation hygiene practice, while only 4.6% had incorrect practices. The majority (88.3%) of students had positive attitudes regarding RH, while only 11.7% had negative attitudes. Mothers are a vital source of information regarding RH.Conclusions: The present study concluded that female adolescents had unsatisfactory knowledge, inadequate hygiene practices, and positive attitudes toward RH. It is recommended to improve adolescents’ knowledge regarding RH issues and involve their parents and teachers to provide appropriate education related to RH issues.

The purpose of the study was to identify the types of working conditions at the Beposo Health Centre, the nature of their working conditions and the effects of hygiene factors on employees’ productivity. Data were drawn from 33 employees of the Health Centre using a questionnaire and analyzed using Predictive Analytical Software to determine the frequency and mean. The study found that employees at the health centre were provided with job security, work-life balance, occupational health and safety and workload. It also ascertained that the physical work environment was not comfortable for the employees although they were provided a considerable amount of workload and high job security. Also, it was revealed that noisy environment, stress and absence of work-life balance were some hygiene factors that affected employees’ productivity. This study has implications for the development of procedures and measures to improve employees working conditions and productivity in the developing country context.

Background: The HIV/AIDS epidemic has contributed to a drastic increase in the number of orphans and vulnerable children in sub-Saharan Africa. However, little is known about the mental health of these children in low prevalence areas such as Ghana. The thesis investigated the relationship between orphanhood, parental HIV/AIDS status and mental health. It further examined the mediating effects of identified risk and protective factors on the relationship between orphanhood/parental HIV/AIDS status and psychological difficulties. Finally, the thesis identified pathways through which HIV/AIDS impacts children by exploring the interactive and cumulative effects of the various risk and protective factors on psychological difficulties. Method: The thesis employed cross-sectional, quantitative interviews that involved 291 children aged 10-18 years and their caregivers that compared children who have lost their parents to AIDS, those who have lost their parents to other causes, those who are living with HIV/AIDS-infected caregivers and children from intact families in the Manya Krobo district in Ghana. ANOVAs, T-tests, General Linear Models, Log-linear Analyses, Chi-Squares and Bivariate Correlations were used to analyze the data that were obtained from both the children and their caregivers. Results After controlling for relevant socio-demographic factors, both children and informants’ reports showed that children orphaned by AIDS and those living with infected parents showed higher delinquency (p <.01), peer problems (p <.001), hyperactivity (p <.01) and lower self esteem (p <.001) than other orphans and children from intact families. AIDS orphans, other orphans and those living with HIV/AIDS-infected parents all reported significantly more depression (p <.001) and relationship problems (p <.001) than those for intact families. Conduct problems as indicated by informants’ reports were generally, significantly higher for orphans and vulnerable children compared to children from intact families. Over 70% of both AIDS orphans and children living with infected parents showed internalising symptoms that were above clinical cut-offs for abnormality. AIDS orphans and children living with infected parents reported more stigma, abuse, child labour and lower levels of SES and lower perceived social support. These factors independently, strongly mediated the relationship between orphanhood, parental HIV/AIDS status and mental health. The interactive and cumulative effect of engagement in child labour and being physically abused heightened the risks for depressive symptoms from 38% to 66%. Neglect and psychological abuse increased the risks for symptoms of Reactive Attachment Disorder from 26.6% to 67.3%. The cumulative effect of stigma and either child labour or physical abuse substantially increased the likelihood of delinquency symptoms to approximately 67%. Conclusion: The findings demonstrated that both AIDS orphans and children living with HIV/AIDS-infected parents showed heightened psychosocial symptoms. The present evidence also highlighted the interactive, cumulative, co-occurrence of contextual factors and HIV/AIDS unique exposures to create heightened vulnerabilities for psychological difficulties among children. The findings call for a comprehensive intervention programme that addresses factors specific to HIV/AIDS and contextual variables.

Ghana is identified among the developing countries with high maternal mortality ratio in Africa. This study unpacked the Demographic and Health Survey data by examining the maternal health indicators at the district level using GIS methods. Understanding the geographic patterns of antenatal care, place of delivery, and skilled birth attendants at the small scale will help to formulate and plan for location-specific health interventions that can improve maternal health care behavior among Ghanaian women. Districts with high rates and low rates were identified. Place of residence, Gini-Coefficient, wealth status, internet access, and religious affiliation were used to explore the underlying factors associated with the observed patterns. Economic inequality was positively associated with increased use of maternal health care services. The ongoing free maternal health policy serves as a cushion effect for the economic inequality among the districts in the Northern areas. Home delivery is common among the rural districts and is more prominent mostly in the western part of Northern Region and southwest of Upper West. Educating women about the free maternal health policy remains the most viable strategy for positive maternal health outcomes and in reducing MMR in Ghana.

Thesis (Master of Nursing)--Cape Peninsula University of Technology, 2019
The HIV/AIDS epidemic is a public health concern worldwide. An estimated 36.9 million people are living with HIV/AIDS with about two million new infections annually. An approximate ten million people have died of AIDS-related causes since the beginning of the epidemic. Sub-Saharan Africa (SSA) is the most affected sub-region, with approximately 71% of all People Living with HIV/AIDS (PLHWA) from mid-2016. In SSA, the epidemic has become a socioeconomic burden on developing countries. The literature review established a high prevalence of HIV/STIs among mineworkers and in mining communities, despite the increase in education on HIV/AIDS prevention in the media and public fora. The aim of the study was to explore and describe the knowledge and experiences of mineworkers on the prevention of HIV/AIDS in a mining community in Ghana. An exploratory, descriptive and contextual design was applied. Data collection was done using semi-structured individual interviews. The population in this study was mineworkers who come from other districts and regions in Ghana to live in the catchment community without their families because of employment. Seventeen (17) participants were interviewed, after purposive sampling was done. Interview transcriptions and manual coding were done by the researcher using Microsoft Word. The raw data was coded and sorted into themes and sub-themes and analysed by using Braun and Clarke's six-phase framework for thematic analysis. The Health Belief Model (HBM), a theoretical framework was applied to the study to predict and explain whether a person will perform an action necessary for preventing a HIV/AIDS or not. Findings from this study revealed that although there has been an increase in education on HIV/AIDS across the country and through workplace HIV/AIDS programmes, mineworkers lacked knowledge of HIV/AIDS, as they still had misconceptions about HIV/AIDS, especially regarding the mode of transmission and preventive measures. A strong recommendation was made to embark on a continuous and intensive HIV/AIDS education programme that will be focused on the knowledge needs of mineworkers to dismiss the misconceptions and improve their knowledge level. This will empower them to know the benefits of prevention and ultimately change their behaviour.

Background: The increase in the number of people living with HIV (PLHIV), especially in sub-Saharan Africa, is a major public health concern. To date, most attention has been paid to prevention strategies and clinical trials of therapy. In comparison, there have been very few studies of care and support programmes. The ‘HOPE’ programme is a major community-based care and support programme in Ghana. ‘HOPE’ provides nutritional support, skills training for employment, health education and psychological support for PLHIV and for those orphaned through AIDS. Therefore, it was seen by policy makers in the country as desirable that it should be evaluated. A PhD scholarship was funded and the researcher presenting this thesis was appointed. Broad Aims The overall aim was to carry out an evaluation of the ‘HOPE’ programme in Ghana in order to make wider recommendations for evaluation of community-based interventions (CBIs) in Ghana and Africa generally. The timing was less than ideal as many of the major decisions about the intervention had already been made and baseline data had been collected. Therefore, the preliminary aim was to explore a range of possible evaluation methods so that the most suitable approach could be selected. Thereafter, a range of more specific aims, objectives and research questions was identified. Methods: A ‘mixed methods’ approach was adopted. The first component was a desk-based analysis of the literature on the various evaluation approaches that might, at least in theory, be applied to an HIV/AIDS intervention like ‘HOPE’. From this, a decision was made to evaluate ‘HOPE’ in terms of structure, process and outcome. The second component operationalised this decision by reviewing HOPE’s working documents and conducting two pieces of field work: a quantitative and a qualitative study. The quantitative study was a structured questionnaire administered to 200 PLHIV on the ‘HOPE’ programme. The qualitative study consisted of 14 interviews with stakeholders directly involved in the programme implementation and 8 focus group discussions with the programme beneficiaries. Results: The desk-based analysis achieved three main outcomes. First, it set out in a systematic manner the different approaches to evaluation that could in theory have been applied to ‘HOPE’. It identified strengths and weaknesses and the perspectives behind each approach. Second, it set out and then summarised a detailed description of the ‘HOPE’ programme and the national context in which it operated. Third, it set the above within the context of global literature on HIV, community-based interventions and nutritional support programmes. The analysis of the quantitative data showed that beneficiaries were being provided with soy-fortified wheat and vegetable fortified oil at the time of the evaluation. On average, beneficiaries gained weight (Mean difference in weight was 2kg with 95% CI (1.1, 2.9), p-value < 0.001) and increased Body Mass Index (BMI) (Mean difference in BMI was 0.8units with 95% CI (0.4, 1.2), P-value < 0.001). Over a third of the beneficiaries (37.5%) was currently unemployed and only one in five of the beneficiaries had been trained in a skill that might have been useful to find employment: this, despite skills training for all being a programme goal. Multivariate analysis showed that the support group to which the beneficiary belonged was the most important determinant of a positive outcome. Qualitative components demonstrated perceived successes and challenges. Beneficiaries indicated that the anti-retroviral drugs were making them hungry and the food helped to alleviate that effect. They further indicated that the food was nutritious and contributed to their weight gain. Support groups have been sustained and membership increased. Some indicated that food should be more varied and some mentioned selling food to earn money to pay for their medications. Most of the beneficiaries indicated they were unemployed having lost their jobs as a result of stigmatisation. Only a few benefited from skills training leading to employment because of inadequate budgeting. Some who had been trained could not use their newly acquired skills because of lack of capital to start a business. To compound these weaknesses, most reported that they preferred petty trading to the skills offered. The monthly education and the training workshops generated hope, and improved knowledge of HIV/AIDS, promoted drug adherence and helped to reduce stigmatisation. The training of the PLHIV as peer educators is an effective method for HIV education and counselling since PLHIV listen to their peers more than health workers. Respondees predicted dissolution of the support groups when the programme ends. This is because they were not adequately involved in the decision making. Beneficiaries identified participation and cooperation as key prerequisites for sustainability but they also identified important weaknesses in ‘HOPE’ with respect to these criteria. Discussion: Despite the challenges presented by the timing and context of this study, it has been possible to carry out an evaluation that provides important learning. A mixed methods approach was appropriate and is likely to be useful in many similar evaluations. Beneficial outcomes were identified but these cannot be attributed, without qualification, to the intervention. Nonetheless, the findings indicated that participants were highly satisfied with the food support and monthly education. They were dissatisfied with the numbers trained in new skills and in other aspects of the skills training components. Also, the sustainability of the food component when the funding stops was a concern. However, the educational component could be sustained because peer educators could continue at very low cost. Most importantly, community involvement, using locally available resources, inter-sectoral collaboration and harnessing the motivation of local people were seen as key but underutilised ingredients. So, the results of the evaluation are encouraging but not conclusive. Nonetheless, care for people living with HIV is such an important problem that the desirability of conducting a cluster randomised controlled trial among a large number of support groups to assess the programme effectiveness on health, nutrition and economic status should be seriously considered despite the practical and ethical challenges implicit in such a recommendation.

This thesis investigates the issue of side effects and how they may act as a barrier to the use of modern contraceptive methods among women in Ghana. Three papers are presented each addressing the issue using different sources of data and different methodologies. The disparate nature of the data sources and techniques used provides each paper with its own perspective on the research question and each paper gives a unique insight into the topic. The aim of the first paper is to use a qualitative focus group methodology to explore in-depth the way individuals perceive information about family planning. The study seeks to better define what is meant by the term fear of side effect in this particular social context and to determine on what information and from what sources is this fear constructed. Overall the findings of this study show that fear of side effects does act as a significant barrier to the use of temporary methods and these fears result mainly from a large amount of negative information regarding side effects being passed through the social network. However the events being recounted cannot be dismissed as myth or rumour as they are most often based in real experiences. The second paper uses monthly data on contraceptive use and the experience of side effects from the calendar section of a longitudinal survey of women in Southern Ghana. Using life tables and a multi-level logistic discrete-time hazards model this study analyses contraceptive discontinuation and how it relates to the concurrent self-reported experience of side effects. The results show that experiencing side effects is associated with a higher probability of discontinuation of the method and that counselling from health workers is extremely important in minimizing discontinuation rates. The third paper uses a sub-sample of women who are not current contraceptive users from the 2003 GDHS. The study uses multiple logistic regression to determine the association between exposure to family planning information, through mass media and interpersonal channels, and the probability that a respondent will cite fear of side effects as their main reason for not intending to use a contraceptive method in the future. The results show that the only family planning communication variable which does have a significant effect is receiving a message from a health worker which increases the odds of fear of side effects being the main reason for not intending to use a method in the future. Overall the socio-economic characteristics of those not intending to use a method in the future due to a fear of side effects is more similar to current users than to those who are not intending to use in the future for other reasons.

Adolescence is a time of great exploration and change. During this time, youth are transitioning both biologically and sexually into adults. Adolescents are also testing the boundaries of self-reliance and making choices about their personal relationships. Not surprisingly, aggressive urges are often driven by peers in pursuit of some form of identity (Masten 2004). Peers can have both positive and negative effects on the wellbeing on youth. Peer groups can provide emotional, physical, and social support to youth during a time of immense change (Parker and Asher 1987; Gest, Graham-Berman, and Hartup 2001). Peers can also model delinquent and risk-taking behaviors that have lasting health, social, and economic consequences throughout the life course. In an effort to understand the role of friendships in adolescent health, social scientists have increasingly focused on adolescent network structures within schools and the role various positions and peer group formations influence behaviors such as alcohol and cigarette use, violent and serious delinquency, and sexual risk-taking. While informative, peer networks studies have yet to adequately address how peer network structures based on immigrant generation and types of marginalized social positions influence health risk behavior engagement among adolescents. In three studies, I address the dearth of research in these areas, using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). The first study investigates the influence of generational peers on alcohol misuse among immigrant youth. Testing hypotheses derived from sociological theories of generations regarding race/ethnicity, gender, and immigrant generation, findings from this study demonstrate generational ties are inversely related to alcohol misuse for immigrants and these effects depend partly on race/ethnicity and gender. The second study investigates the effects of specific network forms of social isolation on heavy episodic drinking and cigarette use among adolescents. The central finding from this study is that different network-based forms of social isolation had varying effects on alcohol and cigarette use when compared to sociable youth. The final study examines the relationship between types of social isolation and violent delinquency when compared to sociable youth. Deriving hypotheses from general strain theory, I test whether the isolation-violence relationship varies across isolation types when compared to sociable youth. I also test whether other negative experiences and circumstances (strains) tied to adolescence moderate the relationship between isolation types and violent delinquency. Finally, studies indicate a consistent gender gap in criminality. Therefore, I test whether the isolation-violence relationship differs by gender. Findings demonstrate that socially disinterested youth show a greater capacity for violent behavior, but other types of marginalized youth showed no difference in violence when compared to sociable youth. Results also suggest that some types of strain moderate the isolation-violence relationship and that these patterns are gendered.

Accompanying materials housed with archival copy.
The purpose of this research was to describe and critically interpret girls' experiences with respect to body image, physical activity and health. The qualitative inquiry included focus group and individual interviews, document analysis and field observations. These methods were used to explore the perceptions of sixty-three girls (grades eight and eleven) and staff from an inner-city high school. Through interpretive data analysis (and constant comparison), the inter-related themes of body image, physical activity and health branched into the sub-themes of societal influences and personal attitudes including: friends, boys, family, school and media. Girls' body images ranged from minor preoccupations to major dissatisfaction with their bodies, while a few girls were happy being themselves. Weak or negative family influences gave way to influences by media, boys and friends. A few girls were very active, whereas others' low levels of participation were attributed to: disinterest in physical activity, intimidation by boys, or perceived lack of opportunity. The girls' perceptions of health incorporated fitness, weight, and eating habits. Girls often used negative qualifiers when describing their weight or body shape. Generally, girls perceived overweight individuals as not taking care of themselves. This research supports the development of gender sensitive physical education programs promoting healthier lifestyles for females.

For more than a century now, malaria has been a major public health problem in Ghana which consequently has been one of the country’s sources of underdevelopment due to economic losses, high rate of morbidity and mortality. Faced with this problem, the last ten years has seen a commitment from the Ghanaian government to address the issue by establishing a policy that would transform the way the disease is prevented and controlled. The transformation of the management of the disease by the use of intersectoral collaboration strategy (ISC) was to ensure the inclusion of the grass root community members who were hitherto excluded from participating in policymaking process of the national malaria control programme (NMCP) activities. The idea was that by allowing the communities to participate, members would be empowered to have ownership of programme activities, could accept the challenges associated with the control of the disease, and above all contribute more effectively to the success of the policy goal of minimising the persistence of malaria in Ghana. However, over ten years now, no systematic study has been done to access the extent to which this policy goal has been rhetoric or a reality. This thesis therefore seeks to examine this vision by investigating the extent to which the community members are allowed by the health authorities to participate in this policy strategy. Drawing on the case studies in the rural and urban districts in Ghana, the practical reality of the degree of community participation in ISC has been explored. In addition, the roles played by the community members in malaria control programme activities were examined with the aim of understanding the importance of communities in malaria control efforts. Finally, the barriers to participation as well as the extent of the institutional involvement in ISC and its possibility to facilitate community participation have also been examined. Overall, the evidence from the study findings demonstrated that the established strategy of ISC has not significantly promoted community participation in the NMCP activities. While the communities were consulted on malaria issues, they were often excluded from the final decision-making on issues that needed to be acted upon. Consequently, the communities have no guarantee that their views will be considered during the final deliberation in which they have little or no part to play. In spite of this, the study found that through various ways, the community members had been playing a number of significant roles in the control activities. These roles included: supporting health staff in their outreach services, contributing in managing the environment, providing assistance in the monitoring and evaluation of malaria programmes and finally assisting victims to cope with the disease. The findings also indicated that without a number of barriers, certain existing contextual factors (e.g. good level of horizontal integration and political structures and social-cultural institutions) potentially could have contributed to the community participation. From the views of health officials, these barriers were the powers of central bureaucratic structures and lack of resources whilst the community members perceived poverty, lack of support from the local health authorities, the precarious nature of their livelihood and traditional culture as those factors that have undermined participation. These barriers were structural and as such tackling any one barrier in isolation was not likely to solve the malaria problem. Besides, no one government sector, on its own, through participation, could make it possible for the community members to have a full ownership of the control programme activities as well as develop a culture of malaria prevention and control. Thus in the context of the study sites, the study concluded that although there is no evidence to suggest that ISC has enhanced full community participation, the strategy should be commended. In reality, the finding indicated that through ISC strategy many sectors including the community have become more aware of malaria problem and communicate more to solve the problem together. In the light of this, the study finds joint action in the form of ISC across many government sectors as a potential solution if these barriers are to be dealt with in a more strategic way rather than a piecemeal manner. In conclusion, it has been argued that with such a complex problem like malaria, ISC with community participation in policy making process is both a necessary and sufficient condition in reducing malaria persistence in the study sites. The health sector must work collaboratively with other related sectors and it is with such collaborative efforts that can change the attitudes of the community members. Changes in behavioural attitudes are paramount if communities’ activities that affect the environment and promote breeding of mosquitoes are to be minimised. Thus with ISC strategy, what is further needed are: proper control planning that will ensure better coordination amongst sectors, adequate resources and behavioural change by the community members themselves. Each of these factors, I believe should not work in isolation, rather must work together otherwise malaria persistence in Ghana will not go away anytime soon.