Diarrhoeal diseases remain a significant cause of morbidity and mortality, particularly in poor urban communities in the Global South. Studies on food access and safety have however not considered the sources of discrete food categories and their propensity to harbour and transmit diarrhoeal disease pathogens in poor urban settings. We sought to contribute to knowledge on urban food environment and enteric infections by interrogating the sources and categories of common foods and their tendency to transmit diarrhoea in low-income communities in Accra. We modelled the likelihood of diarrhoea transmission through specific food categories sourced from home or out of home after controlling for alternate transmission pathways and barriers. We used structured interviews where households that participated in the study were selected through a multi-stage systematic sampling approach. We utilized data on 506 households from 3 low-income settlements in Accra. These settlements have socio-economic characteristics mimicking typical low-income communities in the Global South. The results showed that the incidence of diarrhoea in a household is explained by type and source of food, source of drinking water, wealth and the presence of children below five years in the household. Rice-based staples which were consumed by 94.5% of respondents in the week preceding the survey had a higher likelihood of transmitting diarrhoeal diseases when consumed out of home than when eaten at home. Sources of hand-served dumpling-type foods categorized as “staple balls” had a nuanced relationship with incidence of diarrhoea. These findings reinforce the need for due diligence in addressing peculiar needs of people in vulnerable conditions of food environment in poor urban settlements in order to reap a co-benefit of reduced incidence of diarrhoea while striving to achieve the global development goal on ending hunger.

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BackgroundMental health disorders present significant health challenges in populations in sub Saharan Africa especially in deprived urban poor contexts. Some studies have suggested that in collectivistic societies such as most African societies people can draw on social capital to attenuate the effect of community stressors on their mental health. Global studies suggest the effect of social capital on mental disorders such as psychological distress is mixed, and emerging studies on the psychosocial characteristics of collectivistic societies suggest that mistrust and suspicion sometimes deprive people of the benefit of social capital. In this study, we argue that trust which is often measured as a component of social capital has a more direct effect on reducing community stressors in such deprived communities.MethodsData from the Urban Health and Poverty Survey (EDULINK Wave III) survey were used. The survey was conducted in 2013 in three urban poor communities in Accra: Agbogbloshie, James Town and Ussher Town. Psychological distress was measured with a symptomatic wellbeing scale. Participants’ perceptions of their neighbours’ willingness to trust, protect and assist others was used to measure community sense of trust. Participants’ willingness to ask for and receive help from neighbours was used to measure personal sense of trust. Demographic factors were controlled for. The data were analyzed using descriptive and multivariate regressions.ResultsThe mean level of psychological distress among the residents was 25.5 (SD 5.5). Personal sense of trust was 8.2 (SD 2.0), and that of community sense of trust was 7.5 (SD 2.8). While community level trust was not significant, personal sense of trust significantly reduced psychological distress (B = -.2016728, t = -2.59, p < 0.010). The other factors associated with psychological distress in this model were perceived economic standing, education and locality of residence.ConclusionThis study presents evidence that more trusting individuals are significantly less likely to be psychologically distressed within deprived urban communities in Accra. Positive intra and inter individual level variables such as personal level trust and perceived relative economic standing significantly attenuated the effect of psychological distress in communities with high level neighbourhood disorder in Accra.

Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health and potentially, maternal and infant deaths. Adolescent girls faced with an unintended pregnancy are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries (LMICs) and high-income counties (HICs) and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results. In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e., strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.

Background Maternal mortality in low- and middle-income countries (LMIC) has reduced considerably over the past three decades, but it remains high. Effective interventions are available, but uptake and coverage remain low. We reviewed and synthesised evidence from systematic reviews on interventions to increase healthcare services utilisation to reduce maternal mortality among pregnant women in LMICs. Methods and findings We searched PubMed Medline and Cochrane Library databases for systematic reviews published between January 2014 and December 2021, investigating interventions to increase healthcare services uptake among pregnant women in LMICs. We used the AMSTAR tool (A Measurement Tool to Assess Systematic Reviews) to assess the methodological quality of the included reviews. We extracted data on the interventions and their effects and grouped them into broad groups based on the outcomes reported in each systematic review. We retrieved 4,022 articles. After removing duplicates, and performing title, abstract and full-text screening, we included 14 systematic reviews. The methodology quality of the included systematic reviews was from moderate to high. Male partner involvement interventions Interventions involving male partners were effective in increasing institutional delivery (one review, six studies); skilled attendance at delivery (one review, five studies); postnatal visits (one review, four studies); and maternal antiretroviral (ART) uptake for HIV-positive pregnant women (one review, three studies). However, there was no evidence of their effectiveness on increased early ANC initiation (less than 12 weeks gestation) or adequate ANC visits (at least four visits) (one review, four studies). Mobile health interventions Mobile health interventions were effective in increasing adequate ANC visits (three reviews, six studies), skilled attendance at delivery (two reviews with four studies), facility-based service utilisation (one review with three studies), early ANC initiation (one review with one study), and adherence to nutritional supplements (one review with five studies). Interventions involving giving incentives Only one systematic review reported interventions involving financial incentives and showed that incentives were effective in increasing the number of ANC visits but were ineffective in increasing postnatal visits. Health systems: facility-based interventions Facility-based health systems interventions were effective in increasing postnatal visits (one review with fourteen studies), maternal ART initiation and uptake (four interventions in one review with nine studies), immunisation uptake and follow-up ANC visits (one study each in one review). None of the reviews assessed the effect of facility-based interventions on increased facility delivery, adequate ANC visits or skilled attendance at delivery. Health systems: community-based interventions Community-based health-systems interventions were effective in increasing skilled attendance at delivery (one review with two interventions), ANC service utilisation (one review with two interventions), institutional delivery (one review with sixteen studies), ART initiation and uptake (two interventions in one review), and nutritional supplements and immunisation uptake (one review, seven and ten studies respectively). Conclusion Different interventions effectively improved healthcare service utilisation on the maternal healthcare continuum. Implementing these interventions in combination has the potential to enhance healthcare service uptake further.

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