Search

Background: The COVID-19 pandemic caused delays in care-seeking due to fears of infection and decreased healthcare access globally. These delays have been linked in some countries to COVID-19 perceptions, decreased income, and food insecurity, but little is known about patient-level factors for decreased care-seeking specifically at the beginning of COVID-19 in West Africa. Understanding these factors is important to identify those at highest risk and address healthcare-related barriers. Methods: This study used self-reported data from telephone surveys in a population-based sample in Burkina Faso (n = 1352), Ghana (n = 1621), and Sierra Leone (n = 1301) in May–June 2020. Questions assessed delays in care-seeking, sociodemographic variables, COVID-19 beliefs, and food insecurity. Bivariate analyses using chi-square and multivariate analyses using logistic regression were used to explore associations between factors and delays in care-seeking by country. Independent variables were chosen based on prior research suggesting that financial insecurity, older age, female sex, rural location, and COVID-related concerns are associated with delays. Results: Between March-June 2020, 9.9%, 10.6%, and 5.7% of participants in Burkina Faso, Ghana, and Sierra Leone, respectively, delayed care-seeking. Food insecurity was prevalent (21.8–46.1%) and in bivariate analyses was associated with delays in care-seeking in Burkina Faso and Ghana. Concern about risk of household contraction of COVID-19 was common (18.1–36.0%) and in Ghana and Sierra Leone was associated with delays in care-seeking in both bivariate and multivariate analyses. In bivariate analyses, females showed more delays in Burkina Faso, while age above 30 and urban location were associated with delays in Ghana. In multivariate analyses, food insecurity was associated with increased delayed care-seeking in Burkina Faso. Conclusions: Multiple factors were associated with delays in care-seeking early in the COVID-19 pandemic, with food insecurity and concerns about infection showing significant associations in multiple countries. These findings highlight the need to invest in clinic accessibility, community education, and financial assistance to address barriers in healthcare. While many delays have subsided since the initial phase of the COVID-19 pandemic, understanding factors associated with early disruptions of care-seeking at the patient and household level will inform strategies for maintaining healthcare access during future pandemics in West Africa. [ABSTRACT FROM AUTHOR]

Background: This paper provides an insightful quantitative ethnoecological analysis and affirms that agro-pastoralists have a multiplicity of criteria for valuating their natural forage resources. Rural households in West Africa are not only confronted with water resource scarcity but also have to cope with limited forage resources to feed livestock in both wet and dry seasons based on local knowledge. Local agro-pastoral social-ecological systems (SESs) in the study areas stem from the daily utilization of available forage resources by dominant domestic livestock (cattle, goats, and sheep) over the years. However, there is very little systematic knowledge documentation on forage-related valuation criteria in this part of the world. Hence, this study aimed at examining (1) forage resources used for different seasons and livestock types, (2) explicit forage-related valuation criteria and associated salience, and (3) effects of socio-demographic and climatic aridity on local valuation criteria. Methods: To address these aims, a total of 526 individual ethnoecological interviews (encompassing Dagbani, Gurunsi, and Mossi ethnic groups) were conducted in 16 villages coupled with vegetation sampling of 144 plots in Ghana and Burkina Faso. Rigorous model selection, generalized linear mixed-effects models, cognitive salience indices, and descriptive statistics were applied. Results: The results revealed that majority (73%) of the agro-pastoralists regarded herbaceous forage plants to be very palatable for livestock consumption in the rainy season and for cattle while woody vegetation and crop-related forage plants were rather perceived to be more important in the dry season and for goats and sheep. The findings also indicated that climatic aridity significantly influenced the number of forage-related valuation criteria cited by agro-pastoralists for different seasonal and livestock types (p < 0.001). It was also found out that agro-pastoralists did not only judge forage plants based on their availability but also on other criteria such as palatability, stimulation of milk production, and healthy growth of livestock. Conclusion: Local agro-pastoralists' knowledge on natural forage resources and their valuation criteria is geared towards sustainable domestic livestock production. This study is thus interesting and crucially important for fellow scientists, policy-makers, and other stakeholders in the agricultural production sector in local farming landscapes within West Africa and beyond. [ABSTRACT FROM AUTHOR]