“They Do Not Care about Us Anymore”: Understanding the Situation of Older People in Ghana

While existing research acknowledges copious challenges faced by older adults (people aged 60 and over) in Ghana and most countries in sub-Saharan Africa, they fail to situate the lived experiences of this vulnerable group within the broader context of health geography and public health. This paper draws insights from ecological systems theory and the “geographies of older people” literature to examine the lived experiences of older people in Ghana. Data for the study were gathered using interviews (42) and sharing circles (10). Our findings reveal a complex mix of experiences consistent with the different levels of the environment. Dominant themes include access to social support, functional impairment and poor health status, social status, poor access to water and sanitation services, food insecurity, economic insecurity, and caregiving burden. These findings support the wide-held notion that the experiences of older people are complex and produced by the interplay of both individual and structural factors. Our findings demonstrate that sociocultural, economic, political, and climatic factors are important consideration in promoting elderly wellbeing and quality of life in Ghana.

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Inequalities in access to water and soap matter for the COVID-19 response in sub-Saharan Africa

International Journal for Equity in Health ◽

10.1186/s12939-020-01199-z ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Safia S. Jiwani ◽

Daniel A. Antiporta

Keyword(s):

Sub Saharan Africa ◽

Access To Water ◽

Sub Saharan

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Distance from Africa, not climate, explains within-population phenotypic diversity in humans

Proceedings of The Royal Society B Biological Sciences ◽

10.1098/rspb.2008.1563 ◽

2008 ◽

Vol 276 (1658) ◽

pp. 809-814 ◽

Cited By ~ 96

Author(s):

Lia Betti ◽

François Balloux ◽

William Amos ◽

Tsunehiko Hanihara ◽

Andrea Manica

Keyword(s):

Climatic Factors ◽

Phenotypic Diversity ◽

Morphological Diversity ◽

Sub Saharan Africa ◽

Relative Role ◽

Morphometric Traits ◽

Perfect Agreement ◽

Skull Measurements ◽

Sub Saharan

The relative importance of ancient demography and climate in determining worldwide patterns of human within-population phenotypic diversity is still open to debate. Several morphometric traits have been argued to be under selection by climatic factors, but it is unclear whether climate affects the global decline in morphological diversity with increasing geographical distance from sub-Saharan Africa. Using a large database of male and female skull measurements, we apply an explicit framework to quantify the relative role of climate and distance from Africa. We show that distance from sub-Saharan Africa is the sole determinant of human within-population phenotypic diversity, while climate plays no role. By selecting the most informative set of traits, it was possible to explain over half of the worldwide variation in phenotypic diversity. These results mirror those previously obtained for genetic markers and show that ‘bones and molecules’ are in perfect agreement for humans.

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Self Supply

10.3362/9781780448190 ◽

2021 ◽

Author(s):

Sally Sutton ◽

John Butterworth

Keyword(s):

Universal Access ◽

Cost Effective ◽

Sub Saharan Africa ◽

Full Potential ◽

Public Provision ◽

Middle Income ◽

Private And Public ◽

Access To Water ◽

Sub Saharan ◽

Water Provision

While governments and development partners focus on improving community and utility-managed water supplies to ensure access for all, hundreds of millions of people are taking actions to supply their own water. In the WASH sector household investment in construction and improvement of facilities is widely employed in sanitation but in water similar efforts are ignored. Recognition of the contribution of self-supply towards universal access to water and its full potential, is hampered by a lack of data, analysis and guidance. This well-reasoned source book highlights the magnitude of the contribution of self-supply to urban and rural water provision world-wide, and the gains that are possible when governments recognise and support household-led supply development and up-grading. With limited public finances in low- (and many middle-) income countries, self-supply can fill gaps in public provision, especially amongst low-density rural populations. The book focuses on sub-Saharan Africa as the region with the greatest predicted shortfall in achieving the 2030 Sustainable Development Goal for water. Household supplies can be created, or accelerated to basic or safely managed levels, through approaches that build on the investment and actions of families, with the availability of technology options and cost-effective support from the private and public sectors. The role of self-supply needs greater recognition and a change in mindset of governments, development partners and practitioners if water services are to be extended to all and no-one is to be left behind.

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Features of Rural Communities in Latin America and Sub-Saharan Africa That Influence Well-Being of Older Persons

Innovation in Aging ◽

10.1093/geroni/igab046.1622 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 420-421

Author(s):

Andrew Banda ◽

Norah Keating ◽

Jaco Hoffman ◽

Jose Parodi ◽

Nereide Curreri

Keyword(s):

Older Adults ◽

Latin America ◽

Rural Communities ◽

Older People ◽

Scoping Review ◽

Older Persons ◽

Subjective Wellbeing ◽

Well Being ◽

Sub Saharan Africa ◽

Sub Saharan

Abstract In their recent volume, Critical Rural Gerontology, Skinner et al (2021) challenge us to set aside unidimensional notions of rural communities as bypassed vs very supportive; and to identify the elements of rurality that empower or exclude older people and how these differ across cultures and settings. Covid-19 has highlighted the need for safe and inclusive communities. Given that LMIC will be home to the majority of older adults (Gonzales et al. 2015), we undertook a scoping review of features of rural communities that influence wellbeing of older people in countries across Latin America and Sub-Saharan Africa. The review included literature in English, French, Spanish and Portuguese, using search engines MEDLINE, CINAHL Complete, PsycInfo, SocINDEX, SciELO, AJOL (Africa Journals Online), LILACS, Redalyc, LatinIndex and Clacso. Findings illustrate diversity in how community features including remoteness, infrastructure and belonging influence material, social and subjective wellbeing of older residents.

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How men who have sex with men experience HIV health services in Kampala, Uganda

BMJ Global Health ◽

10.1136/bmjgh-2019-001901 ◽

2020 ◽

Vol 5 (4) ◽

pp. e001901

Author(s):

Rachel King ◽

Zubayiri Sebyala ◽

Moses Ogwal ◽

George Aluzimbi ◽

Rose Apondi ◽

...

Keyword(s):

Hiv Prevention ◽

Health Services ◽

Healthcare Access ◽

Healthcare Services ◽

Sub Saharan Africa ◽

Health Staff ◽

Structural Factors ◽

Structural Barriers ◽

Sub Saharan ◽

Sex With Men

In sub-Saharan Africa, men who have sex with men (MSM) are socially, largely hidden and face disproportionate risk for HIV infection. Attention to HIV epidemics among MSM in Uganda and elsewhere in sub-Saharan Africa has been obscured by repressive governmental policies, criminalisation, stigma and the lack of basic epidemiological data describing these epidemics. In this paper, we aim to explore healthcare access, experiences with HIV prevention services and structural barriers to using healthcare services in order to inform the acceptability of a combination HIV prevention package of services for men who have sex with men in Uganda. We held focus group discussions (FGDs) with both MSM and healthcare providers in Kampala, Uganda, to explore access to services and to inform prevention and care. Participants were recruited through theoretical sampling with criteria based on ability to answer the research questions. Descriptive thematic coding was used to analyse the FGD data. We described MSM experiences, both negative and positive, as they engaged with health services. Our findings showed that socio-structural factors, mediated by psychological and relational factors impacted MSM engagement in care. The socio-structural factors such as stigma, homophobia and policy issues emerged strongly as did the mediating factors such as relations with specific health staff and a social support structure. A combination intervention addressing structural, social and psychological barriers could have an impact even in the precarious policy environment where this study was conducted.

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Utility-small water enterprise partnerships: serving informal urban settlements in Africa

Water Policy ◽

10.2166/wp.2004.0029 ◽

2004 ◽

Vol 6 (5) ◽

pp. 443-452 ◽

Cited By ~ 18

Author(s):

Cyrus Njiru

Keyword(s):

Water Utilities ◽

Sub Saharan Africa ◽

Water Services ◽

Water And Sanitation ◽

Sanitation Services ◽

Small Water ◽

Urban Settlements ◽

Quality Water ◽

Sub Saharan ◽

Informal Urban Settlements

Sustainable development cannot be realised when a large proportion of people do not have access to improved water services. Indeed, despite concerted international effort and publicity made in the last two decades to increase coverage of improved water and sanitation services, the number of people without improved water and sanitation services continues to increase. Water utilities are not serving a large proportion of the urban population and small water enterprises (SWEs) have moved to fill the gap. This paper looks at the growing urban water problem and outlines the role played by SWEs in providing water services to those un-served or under-served by water utilities. Typical constraints faced by SWEs are outlined and the rationale for developing utility–SWE partnerships for the benefit of water consumers (customers) is provided. Potential opportunities for developing utility-SWE partnerships are discussed. The paper argues that utility-SWE partnerships can enable SWEs to provide affordable good quality water services to customers, while providing benefit to the utility and thus also assisting the utility to meet its mandate. The paper proposes win–win utility-SWEs partnerships aimed at achieving the objectives of utilities and SWEs while improving water services to customers in informal urban settlements of developing countries, with a focus on sub-Saharan Africa.

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OC 8494 DRIVING REDUCED AIDS-ASSOCIATED MENINGO-ENCEPHALITIS MORTALITY

BMJ Global Health ◽

10.1136/bmjgh-2019-edc.24 ◽

2019 ◽

Vol 4 (Suppl 3) ◽

pp. A10.2-A10

Author(s):

Angela Loyse ◽

Godfrey S Mfinanga ◽

Cecilia Kanyama ◽

Charles Kounfack ◽

Sokoine Lesikari ◽

...

Keyword(s):

High Mortality ◽

Routine Care ◽

Sub Saharan Africa ◽

Contributing Factors ◽

Train The Trainer ◽

Csf Analysis ◽

Laboratory Capacity ◽

Poor Access ◽

Microbiological Techniques ◽

Sub Saharan

BackgroundDREAMM is an implementation study aiming to reduce meningo-encephalitis related mortality. Delays in diagnosis and treatment through poor access to diagnostics and treatments are significant contributing factors to the ongoing high mortality of HIV-associated central nervous system (CNS) infections, causing up to 25% of all HIV-related deaths in sub-Saharan Africa.MethodsA before-after design is being implemented across 3 sites in Africa; Lilongwe, Malawi, Dar Es Salaam, Tanzania and Yaoundé, Cameroon. The study is composed of 3 phases: Observation, Training and Implementation.ResultsThe observation phase (audit of practice) happened between November 2016 – May 2017 in Malawi and Tanzania. Overall, 110 patients were included. Ten-week all-cause mortality was 64% (42/66) in Tanzania and 37% (13/35) in Malawi. Approximately 75% of patients were ART experienced. Across sites, 76.6% of patients presented with abnormal mental status, with a median baseline CD4 count of 50 cells/µL. Only 2/75 patients in Tanzania had a lumbar puncture ordered compared to 27/35 in Malawi. All patients in Tanzania received empirical Fluconazole monotherapy whereas almost 1/3 patients in Malawi (11/35) were treated with Amphotericin B which is not readily available in both countries.The training phase (completed in November 2017 for Malawi and Tanzania) used the train-the-trainer approach. Interactive workshops on using rapid diagnostic tests (RDTs), performing basic microbiological techniques and safe administration of medicines were chosen as the most pertinent to reducing mortality. Patient and laboratory pathways were optimised afterwards by increasing the routine laboratory capacity, performing CSF analysis, providing infectious diseases mentorship for clinicians and procuring RDTs and reagents not locally available.Implementation is underway in Malawi and Tanzania and the audit phase is scheduled for autumn in Cameroon. Upon completion, the project is expected to create a sustainable approach to reduce the high mortality of HIV-related meningo-encephalitis with the optimised patient and laboratory pathways embedded within routine care.

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