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One of the major tenacious environmental problems is the management of various household waste components. Hence, the objective of this paper was to evaluate the attitude and behavioural intention of households towards acceptability and integration of dustbin for domestic waste collection and management in Ho Municipality, Volta Region, and Ghana in general, using appropriate standard methods. Data obtained and analyzed reveals that most respondents agreed that it is important to accept and integrate dustbin for waste management (M = 4.89; SD = 1.181) and that it is good to accept and integrate dustbin for waste management (M = 4.84; SD = 1.220). They also believed that the benefits of accepting and integrating dustbin for waste management outweigh the associated risks (M = 4.69; SD = 1.223). Overall, most respondents indicated their attitude towards the acceptability and integration of dustbin for waste management, which is positive (M = 4.80; SD = 1.217). Indeed, it was found that the households have high positive attitude and intentions towards the dustbin integration and acceptance for domestic waste collection. [ABSTRACT FROM AUTHOR]

Background: The Convention on the Rights of the Child acknowledges the fundamental rights of children. Despite the adverse effects of corporal punishment, it continues to be prevalent, especially among sub-Saharan African countries, including Ghana., Objective: This study explored whether parents ever used corporal punishment on their children at home and their motivations for doing so. It also explored whether parents perceive corporal punishment as a violation of children's rights and their views on continuing or discontinuing corporal punishment at home., Participants and Setting: This study involved (100) parents across the ten regions of Ghana., Methods: A semi-structured interview guide was used to conduct interviews with parents. Thematic analysis was used to analyse the qualitative data using the aid of QSR NVivo version 10., Results: All parents reported that they had ever punished their children. Three sub-themes emerged under the motivation of parents to punish their children. These include (a) building a sense of discipline in the child to prevent future misbehaviour, (b) releasing frustrations on children, and (c) toughening up the child to confront life challenges. Also, parents had mixed opinions on whether corporal punishment violates children's human rights and whether corporal punishment should be practiced at home., Conclusions: This study demonstrated that parents perceived corporal punishment as beneficial for their children's development. There is a need for community mobilisation programmes to change parents' and society's attitudes, norms, and beliefs regarding corporal punishment., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: This study aimed to assess Ghanaian parental attitudes toward a new malaria vaccine, R21/Matrix-M, and its associated determinants., Method: A cross-sectional survey was conducted anonymously in July and August 2023 using snowball and convenience sampling techniques, using the Parental Attitude about Children Vaccination Scale., Results: A total of 818 individuals were included, 67.2% were females, their median age was 32 years, and 29.01% were hesitant to vaccinate their children. People living in forests, with younger children, having the youngest child aged 1-3 years, skipping antenatal care or scheduled vaccinations, and not being willing to give the R21/Matrix-M vaccine to children, were vaccine-hesitant. However, healthcare workers, those having a relative who died from malaria, and those who vaccinated their child against malaria were less hesitant., Discussion: A large sector of parents expressed willingness to vaccinate their children against malaria. Addressing parental hesitancy requires intervention programs targeting the identified factors and enhancing parental knowledge., Competing Interests: Conflicts of interest Authors declared that they don't have a conflict of interest. We confirm that the work presented herein has not been previously published. The submission is not currently under consideration for publication elsewhere. All authors have consented to the submission, and any necessary approvals from the responsible authorities, where the research was conducted, have been obtained. After publication, we affirm that this work will not be published elsewhere in its current form, either in English or any other language, including electronic publication, without the express written consent of the copyright holder. We did not use AI and AI-assisted technologies in the writing process., (Copyright © 2024 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Anaemia as a critical health condition greatly upsurges the risk of pregnancy complications leading to preventable maternal mortalities and long-term morbidities. Therefore, identifying anaemia-associated factors is vital for planning relevant interventions in resource-constrained regions in Sahelian Africa. This study aimed to assess the prevalence and determinants of anaemia at 36 weeks of pregnancy among antenatal women in a peri-urban municipality of Ghana. A retrospective cross-sectional study was conducted among antenatal women from five different health facilities in Savelugu Municipality. Using antenatal register as the sampling frame, 422 participants were sampled. Data were collected via antenatal records review and a structured questionnaire. Using STATA, binary logistic regression was performed to identify significantly associated factors of anaemia at 36 weeks of pregnancy, considering a significance level of α = 0.05. Prevalence of anaemia at 36 weeks was 45.3%. Low socioeconomic status (AOR = 1.78; 95%CI:1.10-2.90; p = 0.020), pre-pregnancy body mass index ≥ 25 kg/m2 (overweight or obesity) (AOR = 1.62; 95%CI:1.01-2.58; p = 0.041), non-intake of sulphadoxine-pyrimethamine drugs (AOR = 2.22; 95%:1.40-3.51; p = 0.001), and malaria infection (AOR = 3.14; 95%CI:1.66-5.93; p<0.001) were associated with increased odds of anaemia at 36 weeks of pregnancy. Anaemia remains a burden in peri-urban Northern Ghana. Given the observed correlates of anaemia, interventions should be focused on strengthening malaria preventive measures, poverty alleviation, and peri-conception nutrition programs to avert adverse pregnancy outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Adjei-Gyamfi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Stigma is a form of injustice that contributes to the worsening course of the symptoms associated with mental health problems. The paper discusses the conceptualization and development of a contemporary theoretical model of stigma. Building on the findings of an initial scoping review, the author developed a theoretical model after thoroughly analyzing and redefining the key concepts of interest. This article proposes that stigmatized individuals are impacted by the religiocultural and structural violence perspectives embedded within social spaces, leading to stigma perception appraisal and subsequent coping mechanisms, which could be adaptive or maladaptive. Current models of mental illness stigma have gaps. It is time to relook at existing stigma frameworks and fill these gaps that have existed for many years for effective anti-stigma strategies.

Objective: Food insecurity has been associated with mobility difficulty (MD) in old age. However, there is a scarcity of research on this topic from low- and middle-income countries, while the bio-psychological factors underlying this association are largely unknown. We investigated the food insecurity-MD link in Ghana and explored how sleep, anxiety, loneliness, and physical activity (PA) mediate the association., Methods: Community-based, representative cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behavior Study were analyzed (N = 1201; M age  = 66.5; women = 63%). MD was assessed with items from the SF-36 of the Medical Outcomes Study. We assessed food insecurity with items on hunger and breakfast-skipping frequency due to lack of food and resources. Adjusted OLS and mediation models via bootstrapping technique evaluated the associations., Results: Results revealed the expected association between food insecurity and MD, such that greater food insecurity was significantly and positively associated with MD across paths (from β = 0.33 to β = 0.42, p < .001). Analyses of indirect effects showed that sleep problems (27.8%), anxiety (15.5%), loneliness (17.5%), and PA (18.0%) mediated the association between food insecurity and MD. Cross-level interactions revealed that food insecurity significantly modified the link between each mediator and MD., Conclusions: Our data provide novel evidence that bio-psychological mechanisms may underlie the food insecurity-MD link and should, therefore, be considered relevant targets for interventions to prevent/manage MD in later life., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Small for gestational age (SGA) and large for gestational age (LGA) births are topical issues due to their devastating effects on the life course and are also accountable for neonatal mortalities and long-term morbidities., Objective: We tested the hypothesis that abnormal haemoglobin levels in each trimester of pregnancy will increase the risk of SGA and LGA deliveries in Northern Ghana., Design: A retrospective cohort study was conducted from April to July 2020., Settings and Participants: 422 postpartum mothers who had delivered in the last 6-8 weeks before their interview dates were recruited through a systematic random sampling technique from five primary and public health facilities in Northern Ghana., Primary Measures: Using the INTERGROWTH-21st standard, SGA and LGA births were obtained. Haemoglobin levels from antenatal records were analysed to determine their effect on SGA and LGA births by employing multinomial logistic regression after adjusting for sociodemographic and obstetric factors at a significance level of α=0.05., Results: Prevalence of anaemia in the first, second and third trimesters of pregnancy was 63.5%, 71.3% and 45.3%, respectively, and that of polycythaemia in the corresponding trimesters of pregnancy was 5.9%, 3.6% and 1.7%. About 8.8% and 9.2% of the women delivered SGA and LGA babies, respectively. After adjusting for confounders, anaemic mothers in the third trimester of pregnancy had an increased risk of having SGA births (adjusted OR, aOR 5.56; 95% CI 1.65 to 48.1; p<0.001). Mothers with polycythaemia in the first, second and third trimesters of pregnancy were 93% (aOR 0.07; 95% CI 0.01 to 0.46; p=0.040), 85% (aOR 0.15; 95% CI 0.08 to 0.64; p<0.001) and 88% (aOR 0.12; 95% CI 0.07 to 0.15; p=0.001) protected from having SGA births, respectively. Interestingly, anaemia and polycythaemia across all trimesters of pregnancy were not statistically significant with LGA births., Conclusion: Anaemia during pregnancy increased from the first to the second trimester and subsequently decreased in the third trimester while polycythaemia consistently decreased from the first to the third trimester. LGA babies were more predominant compared with SGA babies. While anaemia in the third trimester of pregnancy increased the risk of SGA births, polycythaemia across the trimesters offered significant protection. Healthcare providers and stakeholders should target pressing interventions for anaemia reduction throughout pregnancy, especially during the third trimester to achieve healthy birth outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Loneliness affects individuals of all age groups, and mobile fishers are susceptible to loneliness due to the nature of their occupation. However, there is no study examining loneliness and risky behaviours among fishers in Ghana. Therefore, the purpose of this study was to examine fishers' mobility history, prevalence of loneliness, predictors of loneliness, effects of loneliness on fishers, coping strategies to address loneliness, and prevalence of risky behaviour among fishers in Elmina, Ghana., Methods: This is a convergent parallel mixed-method study involving 385 fishers in Elmina. A questionnaire and interview guides were used to collect data from respondents. Descriptive statistics, Pearson's chi-square and Fisher exact tests, and binary logistic regression were used to analyse the quantitative data, while the qualitative data were analysed thematically., Results: From the quantitative findings, most fishers were mobile (54.5%) and travelled alone (45.7%). Approximately 83% of the fishers experienced loneliness. Male fishers (AOR = 0.049; 95% CI = 0.003-0.741; p-value = 0.030), fishers affiliated with the African Traditionalist religion (AOR = 0.043; 95% CI = 0.002-0.846; p-value = 0.038), and fishers who travelled with their working colleagues (AOR = 0.002; 95% CI = 0.000-0.023; p-value = ≤ 0.001), were less likely to be experience loneliness. Feeling bored, isolated and worried/anxious were the main perceived effects of loneliness. Alcohol consumption and finding a companion to spend time with were the main strategies fishers used to cope with their loneliness. Most male fishers consumed alcohol (92.5%; p-value = ≤ 0.001) and spent time with companions (73.5%; p-value = ≤ 0.001) to cope with their loneliness. The quantitative and qualitative findings showed that fishers engaged in risky behaviours (excessive alcohol consumption, casual sex, and smoking marijuana and tobacco). From the quantitative findings, more male fishers engaged in excessive alcohol consumption (97.6% vs. 74.5%; p-value = ≤ 0.001), casual sex (88.2% vs. 61.7%, p-value = ≤ 0.001), smoking marijuana (43.0% vs. 13.0%, p-value = ≤ 0.001) and tobacco (49.4% vs. 19.1%; p-value = 0.001) than female fishers., Conclusions: Loneliness and risky behaviours were common among fishers. Therefore, there is an urgent need to design interventions to help reduce loneliness and risky behaviour among fishers., (© 2024. The Author(s).)

Supportive housing programs such as the Community Homes for Opportunity (CHO) that provide combined formal (off-site healthcare providers) and informal (on-site supports are effective in reducing erratic housing and homelessness. This study explored the views of the Community Mental Health Agency staff on their experiences with the CHO and related changes for further improvement of the program. We applied focused ethnographic techniques to recruit 47 agency staff from 28 group homes in Southwestern Ontario, Canada. Focus group discussions were conducted at two-time points (baseline-spring 2018 and post-implementation - winter 2019). Data analysis guided by Leininger's ethnographic qualitative analysis techniques produced three main themes and 11 subthemes themes. The main themes include facilitators of CHO, challenges to the CHO implementation, and strategies for improving the CHO program. Overall, supportive housing models have been found to constitute an effective pathway to reducing precarious housing and ending chronic homelessness for those in need while enhancing their social integration.

Ammonia is a respiratory gas that is produced during the process of protein deamination. In the unionised form (NH 3 ), it readily crosses biological membranes and is highly toxic to fish. In the present study we examined the effects of unionized ammonia (UIA), on the resting oxygen consumption (MO 2 ), ventilation frequency (f V ), heart rate (HR) and heart rate variability (HRV) in Nile tilapia (Oreochromis niloticus). Fish were either exposed to progressively increasing UIA concentrations, up to 97 µM over a 5 h period, or to a constant UIA level of 7 µM over a 24 h period. For both treatment groups resting MO 2 , HR and f V were recorded as physiological variables. Relative to the control group, the fish groups exposed to the incremental UIA levels did not exhibit significant changes in their MO 2 , HR and f V at UIA concentrations of 4, 10, 35, or 61 µM compared to control fish. Exposure to 97 µM UIA, however, elicited abrupt and significant downregulations (p < 0.05) in all three responses, as MO 2 , HR and fv decreased by 25, 54 and 76 % respectively, compared to control measurements. Heart rate became increasingly irregular with increasing UIA concentrations, and heart rate variability was significantly increased at 61 and 97 µM UIA. Prolonged exposure elicited significant changes at exposure 7 µM UIA. Standard (SMR) and maximum metabolic rate (MMR) were significantly reduced, as was the corresponding f V and HR. It is evident from this study that Nile tilapia is tolerant to short term exposure to UIA up to 61 µM but experience a significant metabolic change under conditions of prolonged UIA exposures even at low concentrations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: The newly developed malaria vaccine called "R21/Matrix-M malaria vaccine" showed a high safety and efficacy level, and Ghana is the first country to approve this new vaccine. The present study aimed to evaluate the rate of vaccine hesitancy (VH) towards the newly developed malaria vaccine among parents who currently have children who are not eligible for the vaccine but may be eligible in the near future. Additionally, the study aimed to identify the factors that could potentially influence VH., Methods: A cross-sectional survey using both online-based questionnaires and face-to-face interviews was conducted in Ghana from June to August 2023. The survey specifically targeted parents of ineligible children for vaccination, including those aged less than 5 months or between 3 and 12 years. The Parent Attitudes about Childhood Vaccination (PACV) scale was used to assess parental VH., Results: A total of 765 people participated in this study. Their median age was 36.0 years with an interquartile range of 31.0-41.0 years, 67.7% were females, 41.8% completed their tertiary education, 63.3% were married, 81.6% worked in non-healthcare sectors, and 59.7% reported that their monthly income was insufficient. About one-third (34.5%) of the parents were hesitant to give their children the R21/Matrix-M malaria vaccine. The following predictors were associated with VH: working in the healthcare sector (adjusted odds ratio (AOR) = 0.50; 95% confidence interval (CI) 0.30-0.80; p = 0.005), having the other parent working in the healthcare sector (AOR = 0.54; 95% CI 0.30-0.94; p = 0.034), and not taking scheduled routine vaccinations (AOR = 1.90; 95% CI 1.27-2.84; p = 0.002)., Conclusions: Addressing VH is crucial for optimizing R21/Matrix-M vaccine coverage in Ghana's malaria control strategy. By tackling VH issues, Ghana can effectively safeguard children's health in malaria-prone areas., (© 2024. The Author(s).)

Background: Children's initiation of early sex has several negative implications on their sexual and reproductive health, growth and development. In Ghana, few studies on early sexual debut have focused on adolescents. Therefore, this study examined the prevalence, causes, correlates and effects of early sexual debut among children aged 8 to 17 in Ghana using secondary data from the Department of Children of the Ministry of Gender, Children, and Social Protection., Methods: A convergent parallel mixed-method approach guided the study. Descriptive statistics and multivariable binary logistic regression were used to analyse the quantitative data, while thematic analysis was used to analyse the qualitative data., Results: The study found that the prevalence of early sexual debut among children was 13.2%, which is more predominant among female children. The main causes of early sexual debut include engaging in sex after watching pornography, self-desire to have sex, and being influenced by alcohol consumption. Also, age, sex, education, marital status, religion, ecological zone, living arrangements, and access to the Internet were significant correlates of early sexual debut. Early sexual debut increases children's risk of unwanted pregnancy, which leads to the termination of children's education or induced abortion. Also, early sexual debut had adverse impacts on the wellbeing of pregnant children and increased children's risk of multiple lifetime sexual partners., Conclusions: This study demonstrated that socio-demographic characteristics of children (e.g., age, sex, education, and marital status) were significant correlates of early sexual debut. Policymakers need to design appropriate interventions, considering the socio-demographic characteristics of children, to curb its occurrence in Ghana., (© 2024. The Author(s).)

Background: Mental illness-related stigma does not only emanate from the public but also within families of persons with mental illnesses. Familial mental illness stigma implies family members perpetuating stigma against their loved ones with mental illnesses., Aims: The aim of this review was to analyze the empirical literature on experiences of familial mental illness stigma in four countries., Methods: Using seven databases, we reviewed 133 empirical studies with 26 meeting the inclusion criteria. Each of the 26 studies spoke to various forms of familial mental illness stigma that potentially impact the self-esteem and self-worth of the affected person., Results: Findings from this review show the existence of familial mental illness stigma in high-income countries, highlighting the need for evidence-based policies to safeguard affected persons at the family level. Close relatives stigmatizing their loved ones due to mental illnesses have contributed to the concealment of mental illness diagnoses within families, which often results in poor prognoses., Conclusions: Family members' understanding of mental illnesses is key in confronting the stigma associated with mental disorders in our communities, but this is contingent on continuous comprehensive familial program and education. Constant social support from community services and family members is essential in the recovery of persons with mental illnesses. This underscores the need for a stigma-free environment at all levels of society to ensure all-inclusiveness which calls for a comprehensive strategy that targets policy changes, public education, and media representations of mental health-related problems.

Background: Substance use among adolescents poses significant risks to their health, wellbeing, and development, particularly in low- and middle-income countries, including Ghana. However, little is known about the outlets and reasons for substance use among Ghanaian adolescents. This study examined the prevalence, correlates, reasons for substance use, and outlets of these substances among adolescents aged 10-17 in Ghana., Methods: Data were obtained from the Department of Children, Ministry of Gender, Children, and Social Protection, Ghana, which employed a cross-sectional convergent parallel mixed-methods technique to collect quantitative and qualitative data from children aged 8-17, parents or legal guardians and officials of state institutions responsible for the promotion and protection of children's rights and wellbeing. Overall, 4144 adolescents aged 10-17 were interviewed for the quantitative data, while 92 adolescents participated in 10 focus group discussions. Descriptive statistics, Pearson's chi-square test, and multivariable binary logistic regression were used to analyse the quantitative data, while the qualitative data was analysed thematically., Results: The prevalence of substance use was 12.3%. Regarding the types of substance use, alcohol (56.9%) and cigarettes (26.4%) were the most common substances. Being a male and currently working are significant risk factors, whereas being aged 10-13, and residing in the Middle- and Northern-ecological belts of Ghana are significant protective factors of substance use. Peers, household members who use substances, drug stores, and drug peddlers are the major outlets. The reasons for substance use were fun, substance as an aphrodisiac, boosting self-confidence, dealing with anxiety, and improved social status., Conclusions: There is a relatively high substance use among adolescents in Ghana, and this calls for a multi-sectoral approach to addressing substance use by providing risk-behaviour counselling, parental control, and effective implementation of substance use laws and regulations., (© 2024. The Author(s).)

Health policy frameworks for the prevention and control of non-communicable diseases have largely been developed for application in high-income countries. Limited attention has been given to the policy exigencies in lower- and middle-income countries where the impacts of these conditions have been most severe, and further clarification of the policy requirements for effective prevention is needed. This paper presents a policy approach to prevention that, although relevant to high-income countries, recognizes the peculiar situation of low-and middle-income countries. Rather than a narrow emphasis on the implementation of piecemeal interventions, this paper encourages policymakers to utilize a framework of four embedded policy levels, namely health services, risk factors, environmental, and global policies. For a better understanding of the non-communicable disease challenge from a policy standpoint, it is proposed that a policy framework that recognizes responsible health services, addresses key risk factors, tackles underlying health determinants, and implements global non-communicable disease conventions, offers the best leverage for prevention., Competing Interests: The authors declare no competing interests., (Copyright: Mark Fordjour Owusu et al.)

This study examines the concept of demand response in household appliance use. Its primary aim is to explore the factors influencing electricity consumption behavior and employ K-means clustering to group households, estimating daily electricity consumption patterns. This understanding is essential for the development of effective demand response strategies within the Greater Accra Region, Ghana. The research leveraged metrics, such as the Silhouette Score and principal component analysis to ensure the quality of the clustering process, effectively combining qualitative and quantitative data. Insights were enhanced by incorporating consumer behavior surveys to better comprehend appliance use trends and optimize demand response strategies. The findings emphasize differences in voltage, intensity, power consumption, and smart meter data among different household clusters. Notably, clusters 1 and 3 emerge as high energy consumers, particularly in water and cold appliances. These insights offer valuable guidance for targeted energy management and optimization strategies. This study underscores the significance of using consumer behavior insights to enhance and optimize demand response programs, providing essential guidance to energy stakeholders, particularly in Ghana, for the efficient optimization of electricity consumption and the successful implementation of demand response initiatives., Competing Interests: I am writing to accompany the submission of our revised manuscript titled “Optimizing Residential Demand Response in Ghana Through Iterative Techniques and Home Appliance Trend Analysis” to Heliyon. In compliance with the journal's submission guidelines and ethical standards, I hereby provide our declaration of interest. We wish to confirm that there are no conflicts of interest to declare to this manuscript. This includes any financial, personal, or professional relationships that could be construed to influence the work reported in this paper. Our research is the product of objective analysis and is uninfluenced by any external entities. The work submitted is original, has not been published elsewhere, and is not under consideration by any other publication. All authors have contributed significantly to the research and preparation of the manuscript, and have agreed to the submission to your esteemed journal. We have adhered to all ethical research standards throughout our study, and have obtained any necessary approvals for the research where applicable. Thank you for considering our manuscript for publication in Heliyon. We trust that this declaration will satisfy the journal's requirements for a transparent and ethical review process., (© 2024 The Authors.)

The study highlights the crucial roles played by interest groups in shaping the definition and redefinition of policy issues related to the COVID-19 pandemic in Africa. The study focused on selected countries to discuss strategies that were deployed to combat the COVID quandary. The selected countries are Nigeria, Ghana, Kenya, Tanzania, South Africa, Zimbabwe, Egypt, and Tunisia. A purely qualitative research, it relied on existing literature sources to produce thematic analysis which explore the various strategies adopted by interest groups in addressing the COVID-19 pandemic in Africa. The study revealed the challenges posed by the COVID-19 pandemic to the already fragile healthcare system in Africa. Again, it revealed the innovative approaches such as herbal medicine and local production of ventilators developed by African countries to tackle COVID-19 including efforts of other interests groups like government agencies, private institutions and international organizations in the fight against COVID-19 in Africa., (© 2024. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Most of the previous research focused on the effects of public support for SMEs' innovative activities dealt with the effects of financial incentives, while non-financial support was considered a kind of "black box". This research therefore aims to fill this gap by exploring the role non-financial support systems play in triggering SMEs' collaborations and innovativeness in Europe. We show that non-financial support (framework condition) significantly facilitates collaboration and innovation of European SMEs, by using partial least squares structural equation modelling (PLS-SEM) and 216 sampled datasets of the 27 EU countries from 2012 to 2020 European Innovation Scoreboard (EIS). Our expectation was confirmed about the SMEs' collaboration significant effects on their innovative activities, which subsequently translate into innovative outputs. We also found indirect significant effect of the non-financial support on SME's innovation output. This study serves several practical implications and contributes to the ongoing debate on the effects of non-financial support for cooperation and innovation activities of European SMEs., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests., (© 2023 The Authors.)

Recently, the trend of circular economy innovation (CEI) drive SMEs to initiate more sustainable practices to attain market competitiveness but rare attention has been paid in emerging economies. Hence, this study plans to explore the impacts of CEI on the triple bottom lines (TBL) efficiencies in the light of market competitiveness among the production SMEs in emerging economies. The study complied data by using a survey-based technique in Pakistan, Malaysia, and China. With a sample of 306 for each segment, data were evaluated with PLS-SEM to clarify results. The findings reveal that CEI has positive significant effects on the market competitiveness and TBL efficiencies among the production SMEs in emerging economies. The findings also clarify that market competitiveness mediates the relationship between CEI and the TBL efficiencies. The findings elaborate the theoretical foundations for environmental-based production SMEs to formulate more sustainable strategies in the light of CEI to gain market competitiveness. It also clarifies the understandings of policy makers and environmental regulators by providing a novel precursor to frame the environment-based TBL guidelines for SMEs. It adds to the UN sustainability agenda by elevating the role of CEI as a novel domain among emerging economies grounded on the resource-based view theory., (© 2023. The Author(s).)

Background: In Ghana, it is against the law for children to smoke. Nevertheless, a portion of children in the country do smoke. However, there is a paucity of research on young smokers in Ghana and other sub-Saharan African nations. This study, therefore, investigated the prevalence of smoking, the kinds of substances children smoke, predictors of smoking, reasons for and factors that lead children to smoke, and regulation of smoking among children in Ghana., Methods: In total, 5024 children aged 8-17 were studied using a cross-sectional convergent parallel mixed method. Descriptive statistics, Person's Chi-square test, Fisher Exact test, and binary logistic regression were used to analyse the quantitative data. In contrast, thematic analysis was used to analyse the qualitative data., Results: The results showed that 3.2% of children had ever smoked. Male children smoked more often than female children. The prevalence of cigarette, marijuana, and shisha smoking was 78.3%, 18%, and 3.7%, respectively. While more male children than female children smoked cigarettes and marijuana, more female children than male children used shisha. Children mainly smoked for fun and due to group culture. In addition, children were influenced by friends; parents, family members, and neighbours who smoke; curiosity; and advertisements and videos to initiate smoking. Despite the availability of regulations and laws regulating tobacco products in public places, tobacco advertisement, promotion, and sale to persons under 18, children are still smoking., Conclusions: Children who have ever engaged in smoking reported using cigarettes, marijuana, and shisha. Policymakers urgently need to strategise and strengthen their policies, programmes, and interventions to address smoking among children., (© 2023. The Author(s).)

There is a growing concern on a global scale that the world should transition towards the utilisation of energy-efficient technologies. Hydropower plays a very significant part in the fight against climate change, and as a result, it lessens the impact that climate changewill have on our ability to achieve the Sustainable Development Goals (SDGs). Both the effectiveness of hydropower generation and the amount of streamflow are impacted by climate change as well as land use and land cover (LULC). Accordingly, the purpose of this study is to conduct a literature review on the topic of the past and future effects of climate, land use, and land cover changes on hydropower generation. This review will be based on the entries found in a number of reliable databases. A systematic literature review was carried out to analyse how LULC and climate change will affect hydropower generation and development. The research was based on 158 pieces of relevant literature that had been reviewed by experts and indexed in Scopus, Google Scholar, and ScienceDirect. The review was carried out to determine three goals in mind: the impact of climate change on hydropower generation and development; the impact of climate change on streamflow; and the combined impact of changes in climate and changes in LULC on hydropower. The findings bring to light the primary factors contributing to climate change as well as shifts in LULC which are essential to the generation of hydropower on all scales. The study identifies factors such as precipitation, temperature, floods, and droughts as examples of climate change. Deforestation, afforestation, and urbanisation are identified as the primary causes of changes in LULC over the past several decades. These changes have a negative impact on the generation and development of hydropower., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

We conducted a qualitative study to examine the enablers and barriers influencing the implementation of medical cannabis from the perspectives of practicing doctors and pharmacists within the African context. Interviews were conducted to investigate medical professionals' perceptions and concerns regarding medicinal cannabis. Three major themes were identified: beliefs about consequences, optimism, and environmental resources and context. Depending on the context of use, medical professionals described cannabis as potentially useful as an adjunct medicine and yet problematic owing to knowledge and social barriers, particularly religion. Implementation strategies tailored to address structural and social concerns to providing optimal care are needed to ensure that medical professionals are well versed in policy and clinical aspects.

Noncommunicable diseases (NCDs) are a growing public health challenge in Ghana. Health promotion can provide useful avenues to reduce the incidence of NCDs in the country. We used the Ottawa Framework to assess health promotion efforts for the prevention and control of NCDs in Ghana. Data were collected using key informant interviews and documentary sources. A content analysis approach was adopted for data analysis using Nvivo 11 Software. We found a strong policy framework for NCD prevention in Ghana with the ratification of several international protocols and resolutions and the development of national and specific NCD-related policies. Implementation of these policies, however, remains achallenge due to limited resources and the overconcentration on communicable diseases. Attempts have been made to create a supportive environment through increased access to NCD services but there are serious challenges. Respondents believe the current environment does not support healthy eating and promotes unhealthy use of alcohol. The Community-based Health Planning and Services (CHPS) program engenders community participation in health but has been affected by inadequate resources. Personal skills and education programs on NCDs are erratic and confined to a few municipalities. We also found that NCD services in Ghana continue to be clinical and less preventative. These findings have far-reaching implications for practice and require health planners in Ghana to pay equal attention in terms of budgetary allocations and other resources to both NCDs and communicable diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Owusu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Abnormal birthweights are critical public health challenges accountable for most non-communicable diseases and perinatal mortalities. Regardless of the myriad of mixed evidence on maternal factors responsible for abnormal birthweight globally, most of these findings are attained from urban and rural settings. This study serves as one of the key pieces of evidence in view of the increasing prevalence of abnormal birthweight particularly in some parts of semi-rural Ghana. The study, therefore, aims to estimate the prevalence of abnormal birthweight and identify some possible maternal risk factors for abnormal birthweight in Northern Ghana., Methods: A retrospective cross-sectional study was conducted in Savelugu municipality from February-March 2022. A total of 356 mothers aged 16-46 years, having a neonate and attending postnatal care service, were recruited as study participants. Data were collected from maternal and child health record books and through structured interviews. To identify the maternal risk factors for abnormal birthweight, chi-square/Fischer's exact test and multinomial logistic regression were employed as bivariate and multivariate analyses, respectively, at 95% confidence level., Results: Prevalence rates of low birthweight and macrosomia were 22.2% and 8.7%, respectively. Maternal anaemia in first trimester (AOR 3.226; 95% CI 1.372-7.784) and third trimester (AOR 23.94; 95% CI 7.442-70.01) of gestation was strong predictors for low birthweight. Mothers belonging to minority ethnic groups (AOR 0.104; 95% CI 0.011-0.995); mothers who had ≥ 8 antenatal care visits (AOR 0.249; 95% CI 0.103-0.602); and mothers having neonates whose birth length > 47.5 cm (AOR 0.271; 95% CI 0.113-0.651) had reduced odds for low birthweight. Alternatively, mothers with gestational weeks ≥ 42 (AOR 23.21; 95% CI 4.603-56.19) and mothers from the richest households (highest socioeconomic homes) (AOR 14.25; 95% CI 1.638-23.91) were more likely to birth to macrosomic infants., Conclusion: The prevalence rates of low birthweight and macrosomia were relatively high. Anaemia in the first and third trimesters was strong determinants of low birthweight. Being minority ethnic group, frequency of antenatal visits, and childbirth length reduced the risk of low-weight births. Advanced gestational age and socioeconomic status of mothers were also predictors of macrosomia. Hence, nutrition counselling, community health education, and promotion of lifestyle improvement coupled with strengthening of health service delivery are recommended interventions., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Although it is well known that low condom usage among fishers contributes to high HIV prevalence in fishing communities, little is known about the attitudes, beliefs, and behaviors of fishers when it comes to the use of condoms., Design and Methods: This article is a follow-up to a cross-sectional study that used a mix-method design for data collection and analysis to examine the connection between mobility and the risk of contracting HIV among 385 fishers in the Elmina fishing community of Ghana. The Health Belief Model is utilized in the discussions to analyze attitudes and actions toward condom use among the fishers in Elmina., Results: Over 40% of respondents who said they had intercourse in the previous year did not use condoms. The results show that male fishers are more likely than female fishers to use condoms during sexual activity, and younger fishers are more likely to use condoms than older fishers. More condoms were used by educated fishers than by less educated or uneducated fishers. According to the study, female fishers use less condoms than male fishers since they are unable to convince their partners to use them when they refuse to. Additionally, the findings show that slightly more than one in 10 respondents did not use condoms because they believed their sexual partner to be attractive and unlikely to carry any sexual infection., Conclusion: There is a general low perception of HIV susceptibility and severity resulting in the low condom usage among the fisherfolks according to the results. The article urges civil society organizations in the study area to investigate ways to incorporate the provision of free condoms to fishers and at the numerous fishing destination sites along the coast of Elmina. The regular use of condoms in Elmina and the nearby fishing areas should also be emphasised through this outreach or mobile HIV service outlets., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Early initiation of alcohol consumption increases the risk of alcohol dependence and adverse health outcomes. Consequently, nations have enacted laws to make alcohol unlawful to be purchased by, sold to, or used in public by children. This study examined the lifetime prevalence of alcohol use among children and their reasons for consuming alcohol. In addition, the study investigated predictors of alcohol consumption and the effects of alcohol use on children. Finally, it examined the effectiveness of measures in place for regulating the sale and use of alcohol by children in the country. A total of 5024 children between the ages of 8 and 17 were sampled across the ten regions of Ghana using a cross-sectional convergent parallel mixed method. Children were interviewed with a semi-structured questionnaire, while focus group discussions were held with children, parents, and key informants. Lifetime prevalence of alcohol consumption was measured by "have you ever taken alcohol?". The study revealed that lifetime alcohol consumption was less prevalent (6.6%) among children. Sex, age, and region of residence were significant predictors of lifetime alcohol use among children. More than half of the children who reported ever taking alcohol were first introduced to drinking by friends, and more than six in ten children claimed having been intoxicated after drinking alcohol. The findings further revealed that efforts to control the sale and consumption of alcohol by children have proven difficult despite the existence of laws, policies, and national regulatory structures. While regulations on alcohol sales and consumption have been difficult to implement in rural areas, they have been successful in urban areas because institutions there ensure rigorous adherence to the regulations. The study encourages national organizations with responsibility for child protection and development to step up their regulation, investigation, and information-sharing efforts to discourage and limit children from purchasing and consuming alcohol., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2023 Sylvester Kyei-Gyamfi et al.)

Background: Alcohol consumption is part of human social behavior and constitutes a routine part of social life in many countries. Prior studies have found over-indulgence of fishers in alcohol in fishing communities. The study uses the Alcohol Myopia Theory (AMT) to analyze and explain the phenomena of fishers engaging in sex after alcohol consumption, and condom use with sexual partner(s) after alcohol consumption. The study investigated alcohol consumption, predictors of alcohol consumption, and the reasons for drinking alcohol among fishers. It also examined fishers' engagement in sex after alcohol consumption, the use of condoms with sexual partners after drinking alcohol, and predictors of the use of condoms with sexual partners after drinking alcohol., Methods: A cross-sectional convergent parallel mixed-method design was used to study 385 fishers in Elmina. Also, two focus group discussions were conducted among male and female fishers. Descriptive statistics were used to analyze the quantitative data, while the qualitative data was analyzed thematically., Results: Generally, 59.2% of participants indulged in alcohol consumption. Most male participants (70.6%) indulged in alcohol consumption than female participants (48.5%). Also, 48.5% of participants indulged in binge alcohol consumption, while 38.1% indulged in moderate alcohol consumption. The predictors of alcohol consumption were sex, religion, and type of fishing occupation. Participants identified consuming alcohol to kill loneliness and boredom, to forget family and work-related issues, and to have fun as reasons why fishers consume alcohol. Sixty-four percent of participants have ever engaged in sexual intercourse after consuming alcohol in the past 12 months. However, 70% of participants did not use a condom the last time they had sex after drinking alcohol. Only ethnicity of participants predicted their use of a condom the last time they had sex after drinking alcohol. The primary reasons for the non-use of condoms were do not like using condoms (37.9%), forgetting to use a condom (33.0%), and had sex with a trusted regular partner (15.5%)., Conclusions: This study demonstrated that alcohol consumption was prevalent among fishers, especially among male fishers, which contributes to risky sexual behaviors among them as espoused by the AMT. It is recommended that fishers are targeted for alcohol use and risky sexual behavior programs and interventions since alcohol use is prevalent among them and most of them also engage in unprotected sexual intercourse after consuming alcohol., (© 2023. The Author(s).)

Background: The global extant literature acknowledge that housing serves as a key social determinant of health. Housing interventions that involve group homes have been found to support the recovery of persons with mental illness and those with addiction issues. The current study explored the views of homeowners in relation to a supportive housing program called Community Homes for Opportunity (CHO) that modernised a provincial group home program (Homes for Special Care [HSC]) and provided recommendations for improving the program implementation in other geographical areas of Ontario., Methods: We applied ethnographic qualitative techniques to purposefully recruit 36 homeowner participants from 28 group homes in Southwest Ontario, Ontario Canada. Focus group discussions were conducted at two time points, during CHO program implementation (Fall 2018, and post implementation phases (Winter 2019) respectively., Results: Data analysis yielded 5 major themes. These include: (1) general impressions about the modernization process, (2) perceived social, economic and health outcomes, (3) enablers of the modernization program, (4) challenges to implementation of the modernization program, and (5) suggestions for implementation of the CHO in future., Conclusions: A more effective and expanded CHO program will need the effective collaboration of all stakeholders including homeowners for successful implementation., (© 2023. The Author(s).)

Background: Recovery-oriented programs provide individuals with opportunities for well-being through community integration processes that enhance the degree to which individuals could live, work, and recreate in their community. The current evaluation assessed how tenants experience their home environment after the modernization of Homes for Special Care (HSC) to Community Homes for Opportunity (CHO) in Southwest Ontario, Canada. Our study identifies existing policies and practices that could interfere with or promote the modernization process., Methods: We applied ethnographic qualitative techniques to purposefully recruit 188 participants with severe mental illness from 28 group homes. Focus groups were conducted at three time points, i.e., at pre-implementation/Baseline/Time I - spring 2018; Transition/Time II - fall 2018, and Final/Time III - winter 2019., Results: Study findings suggest that the transition of HSC to CHO supports activities that empower tenants towards personal growth and development. Participants were largely satisfied with the support they were getting in relation to the program-related services. Tenants disclosed that their quality of life and well-being had been enhanced through participating in the program, and that their social interaction and support for each other had also improved. Most tenants demonstrated autonomy in terms of personal and financial independence. The enhanced financial support for tenants did not only improve their quality of life, but also helped to raise their purchasing power, decision making, sense of responsibility and accountability towards healthy spending of their resources. Despite tenants' good impression about the CHO, some still encountered problems and provided suggestions to further improve the program., Conclusion: It is expected that a more effective and expanded CHO will lead to tenant empowerment and successful social integration., (© 2023. The Author(s).)

Background: Gambling is illegal for children in Ghana. However, young people, including children, are increasingly engaged in gambling across the country. Gambling is harmful and poses developmental implications for the youth, including children. There are limited studies on child gambling in Ghana and other sub-Saharan African countries. This study examined the prevalence of gambling participation, predictors of gambling participation, and perceived harm of gambling on children., Methods: A cross-sectional convergent parallel mixed methodology was used to study 5024 children aged 8 to 17 in the three ecological zones of Ghana. Binary logistic regression was used to examine the predictors of gambling participation while the qualitative data was analysed thematically., Results: Overall, 3.1% of children aged 8 to 17 had ever engaged in gambling activities. Also, being a female (AOR = 0.210, Wald test = 34.413, 95% CI: 0.125-0.354), having attained primary education (AOR = 4.089, Wald test = 18.643, 95% CI: 2.158-7.749), doing paid work (AOR = 2.536, Wald test = 10.687, 95% CI: 1.452-4.430), having a friend who gambles (AOR = 1.587, Wald test = 4.343; 95% CI: 1.028-2.451), having access to radio (AOR = 1.658, Wald test = 6.694, 95% CI: 1.130-2.431) and having access to mobile phone (AOR = 0.590, Wald test = 6.737, 95% CI: 0.396-0.879) were predictors of gambling participation. Gambling is perceived as harmful by children since it is addictive, affects learning and class attendance, and makes them steal from their families to gamble., Conclusions: This study demonstrated that socio-demographic characteristics (sex, age, educational attainment, ecological zone, persons taking care of children, living arrangement, engagement in paid work, radio access, mobile phone access) and gambling-related information (having friends who gamble) make children more susceptible to gambling. Researchers and policymakers should consider these socio-demographic characteristics and gambling-related information when designing interventions to curb gambling among children aged 8 to 17 in Ghana., (© 2022. The Author(s).)