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The study aimed to investigate the impact on health care seeking behaviour of the cost-sharing policies introduced in Ghana between 1985 and 1992. Qualitative research techniques were used to investigate the behaviour of patients after the introduction of these policies. Focus group discussions of cohorts of the population and in-depth interviews of health workers and selected opinion leaders were used to collect data from rural and urban health care facilities in three districts of Ghana. The study findings indicate that the cost recovery policies have led to an increase in self-medication and other behaviours aimed at cost-saving. At the same time, there is a perception of an improvement in the drug supply situation and general health delivery in government facilities. The study advocated enhanced training of drug peddlers and attendants at drug stores, especially in rural areas. User fee exemption criteria need to be worked out properly and implemented so that the very needy are not precluded from seeking health care at hospitals and clinics.

Norm enforcement may be important for resolving conflicts and promoting cooperation. However, little is known about how preferred responses to norm violations vary across cultures and across domains. In a preregistered study of 57 countries (using convenience samples of 22,863 students and non-students), we measured perceptions of the appropriateness of various responses to a violation of a cooperative norm and to atypical social behaviors. Our findings highlight both cultural universals and cultural variation. We find a universal negative relation between appropriateness ratings of norm violations and appropriateness ratings of responses in the form of confrontation, social ostracism and gossip. Moreover, we find the country variation in the appropriateness of sanctions to be consistent across different norm violations but not across different sanctions. Specifically, in those countries where use of physical confrontation and social ostracism is rated as less appropriate, gossip is rated as more appropriate.

We developed a test battery for use among children in Bangladesh, Ghana, and Tanzania, assessing general intelligence, executive functioning, and school achievement. The instruments were drawn from previously published materials and tests. The instruments were adapted and translated in a systematic way to meet the needs of the three assessment contexts. The instruments were administered by a total of 43 trained assessors to 786 children in Bangladesh, Ghana, and Tanzania with a mean age of about 13 years (range: 7-18 years). The battery provides a psychometrically solid basis for evaluating intervention studies in multiple settings. Within-group variation was adequate in each group. The expected positive correlations between test performance and age were found and reliability indices yielded adequate values. A confirmatory factor analysis (not including the literacy and numeracy tests) showed a good fit for a model, merging the intelligence and executive tests in a single factor labeled general intelligence. Measurement weights invariance was found, supporting conceptual equivalence across the three country groups, but not supporting full score comparability across the three countries.

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BackgroundStudies on healthy individuals that show minor signs of distress and depression—but that are not significant enough to be debilitating or to report to the hospital for treatment—are rare. Our primary objective was to measure the prevalence of depressive symptoms and sociodemographic correlates among healthy women 18 years and above in urban Accra, Ghana.MethodWe used secondary data from the Women’s Health Study of Accra, Wave 1 (WHSA-1), a large scale, analytic, cross-sectional study conducted in Accra, Ghana involving 3183 women. The presence or absence of depressive symptoms within the past 30 days was estimated from the average score on three common symptoms of depression: sleep, anxiety, and sadness. The explanatory variables were age-group, socioeconomic level, marital status, ethnicity, religion, education, employment, and parity. Frequencies and means were used to summarize categorical and continuous variables, respectively. Logistic regression analyses were employed to determine the predictors of depressive symptoms.ResultsThe prevalence of depressive symptoms within the previous 30 days was 26.5% (95% CI: 25.0–28.1). Women 55 years and older were more likely than women between the ages of 18 and 24 to experience depressive symptoms (AOR 2.8, 95% CI: 2.0–4.0, p < 0.001), whilst women between the ages of 35 and 54 were 1.95 times more likely than women between the ages of 18 and 24 to experience depression (AOR 1.95, 95% CI: 1.40–2.70, p < 0.001). Self-employed women were less likely to report depressive symptoms compared to the unemployed (AOR 0.70, 95% CI: 0.56–0.87, p < 0.01). Akans were less likely to experience depressive symptoms compared to Ga women (AOR 0.75, 95% CI: 0.61–0.92, p < 0.01). Non-orthodox Christians were more likely to report depressive symptoms compared to Orthodox Christians (AOR 1.32, 95% CI: 1.09–1.60, p < 0.01).ConclusionThe prevalence of symptoms of depression among healthy urban Ghanaian women is high. Older women, those with low education, and unemployed women appear to be at higher risk for depression and therefore should be targeted for interventions. Groups at risk for depression—especially older adults or individuals under economic strain—should be targeted for mood assessment as part of routine medical care.

The Christian REACH Forgiveness intervention is a 5-step psychoeducation program that focuses on promoting decisional and emotional forgiveness for an identified transgression and fostering forgivingness in general. In this study, the Christian REACH Forgiveness model was used with Ghanaian Christians (N ϭ 264; 260 are analyzed) who experienced specific interpersonal injuries and expressed a desire to forgive their transgressors. Participants were randomly assigned to a standard or Ghanaian-culture adapted REACH interventions using a waiting-list design in which participants were divided into an immediate and delayed treatment condition. Outcomes did not vary by sex, and there were no differences based on adaptations to Ghanaian culture. However, people who received either treatment benefitted by more forgiveness and conciliatory motivations, decisional and emotional forgiveness, forbearance, and dispositional forgivingness. This intervention is the first known forgiveness intervention to compare an existing and culturally adapted intervention head-tohead and the first intervention tested within an African context.

SummaryThis qualitative study aimed to assess possible changes in prescription patterns and resultant implications for the quality of care delivered in three southern districts of Ghana after the introduction of a full cost recovery scheme for drugs in 1992. While the availability of safe and effective drugs has improved especially in rural areas, not all patients are able to meet the cost for required medication. This has influenced the behaviour of most prescribers, who now take economical limitations into account. As a result, poorer patients may either take fewer drugs or smaller quantities than medically indicated, with possible ensuing consequences for public health. Overall, the cash-and-carry scheme does not appear to have changed health workers' attitudes towards patients; where such behavioural changes occurred they seemed to be due to personnel shortages. Generally, patients in rural facilities reported greater satisfaction with the care they received than urban residents; and medical assistants were perceived as friendlier than both nurses and doctors.keywords drug supply, cost-sharing, government health facility, discriminatory pricing policy, attitude,