Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication nonadherence (MNA); our study therefore aimed to determine factors associated with MNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (n = 120), Ghana; and University of Port Harcourt Teaching Hospital, (n = 73) Apapa General Hospital Lagos (n = 79) and University College Hospital Ibadan (n = 85), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (r = −0.208, P < 0.001), concern about medications (r = −0.0347, P = 0.002), and knowledge of hypertension (r = 0.14, P = 0.006). MNA was associated with formal education (P = 0.001) and use of herbal preparation (P = 0.014). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (P = 0.032). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (P = 0.006). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.
Scholars in urban political ecology, urban geography, and planning have suggested that urban greening interventions can create elite enclaves of environmental privilege and green gentrification, and exclude lower-income and minority residents from their benefits. Yet, much remains to be understood in regard to the magnitude, scope, and manifestations of green gentrification and the forms of contestation and resistance articulated against it. In this paper, we propose new questions, theoretical approaches, and research design approaches to examine the socio-spatial dynamics and ramifications of green gentrification and parse out why, how, where, and when green gentrification takes place.
While access and exposure to green spaces has been shown to be beneficial for the health of urban residents, interventions focused on augmenting such access may also catalyse gentrification processes, also known as green gentrification. Drawing from the fields of public health, urban planning and environmental justice, we argue that public health and epidemiology researchers should rely on a more dynamic model of community that accounts for the potential unintended social consequences of upstream health interventions. In our example of green gentrification, the health benefits of greening can only be fully understood relative to the social and political environments in which inequities persist. We point to two key questions regarding the health benefits of newly added green space: Who benefits in the short and long term from greening interventions in lower income or minority neighbourhoods undergoing processes of revitalisation? And, can green cities be both healthy and just? We propose the Green Gentrification and Health Equity model which provides a framework for understanding and testing whether gentrification associated with green space may modify the effect of exposure to green space on health.
Urban green space is demonstrated to benefit human health. We evaluated whether neighborhood gentrification status matters when considering the health benefits of green space, and whether the benefits are received equitably across racial and socioeconomic groups. Greater exposure to active green space was significantly associated with lower odds of reporting fair or poor health, but only for those living in gentrifying neighborhoods. In gentrifying neighborhoods, only those with high education or high incomes benefited from neighborhood active green space. Structural interventions, such as new green space, should be planned and evaluated within the context of urban social inequity and change.
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