Amos Laar

University of Ghana | Legon · Department of Population, Family and Reproductive Health

Nutrition-related non-communicable diseases (NR-NCDs) are a global health problem, increasingly recognised as driven by unhealthy food environments. Yet little is known about government action to implement food environment-relevant policies, particularly in low-and lower-middle income countries. This study assessed government action, implementation...

Food systems that support healthy diets in sustainable, resilient, just, and equitable ways can engender progress in eradicating poverty and malnutrition; protecting human rights; and restoring natural resources. Food system activities have contributed to great gains for humanity but have also led to significant challenges, including hunger, poor d...

Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support publ...

Health and ill health are critical concepts in public health with far reaching socio-political implications. Notwithstanding, conceptualizing health has been challenging as there appears to be no definitional consensus. A related challenge is finding a sociologically, politically, spiritually, and culturally-sound cleavage between health as defined...

The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40% of them occur intrapartum. An understanding of the contributing factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. This study identified determinants of intrapartum stillbirths in GAR. A retrospectiv...

Background and objectives Increasing the availability of healthy foods within food retail outlets can improve consumers' food environments. Such actions or inactions by food retailers may affect people's food purchasing and consumption behavior. This study explored Accra-based food retailers' perceptions and appreciation of “healthiness of food” as...

Objective: To explore communities' perspectives on the factors in the social food environment that influence dietary behaviours in African cities. Design: A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary b...

Introduction The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively affects their food acquisition and consumption. We examined the extent and nature of food and beverage advertising around p...

Grains have historically represented a major component of human diets and were predominantly consumed in whole form until the first half of the 19th century, when a combination of technological innovations and market dynamics made refined grains, hitherto a premium product, affordable and available to the masses. Grains still account for more than...

Evidence on the individual-level drivers of dietary behaviours in deprived urban contexts in Africa is limited. Understanding how to best inform the development and delivery of interventions to promote healthy dietary behaviours is needed. As noncommunicable diseases account for over 40% of deaths in Ghana, the country has reached an advanced stage...

In this chapter, I illustrate efforts by a multidisciplinary team of researchers and practitioners (public health professionals, clinicians, social workers) to engage relevant actors to adopt and integrate social public health approaches into Ghana’s national response to HIV/AIDS. The chapter shares the implementation approaches and lessons from th...

This introductory chapter presents relevant concepts and principles in public health. It highlights relevant historical, extant, and emerging approaches in public health – emphasizing their application (in subsequent chapters) to the human immunodeficiency virus (HIV). Concepts covered range from prevention, control, elimination, eradication, surve...

Beginning from the early days of AIDS, the chapter discusses the conceptualization of HIV (including AIDS) as a public health emergency of international concern. The chapter describes the global response to HIV – examining the application of cardinal public health principles to curbing AIDS in different contexts. The achievements of traditional pub...

Responding to AIDS at the global or local levels can give rise to a multitude of tensions. To facilitate sustainable attainment of AIDS response goals, these tensions need to be deliberately balanced. This chapter discusses data from an exercise that examined how responsive Ghana’s National AIDS policy documents/guidelines are to social, cultural,...

The right to the highest attainable standard of health is acknowledged universally as a fundamental human right. Unfortunately, this right seems to elude some populations referred to as key populations within the context HIV service rendition and access. They are key because they are deemed to be at higher risk of acquiring or transmitting the huma...

Assuring equitable access to life-saving public health commodities (including AIDS medications and optimal nutrition) remains a challenge globally. This chapter examines medical but also cultural constructions of access and the evolving discourses on access to life-saving AIDS medications. It traces the discourses from the era of frank absence to A...

This chapter identifies and discusses HIV/AIDS countermeasures. Such measures include traditional HIV prevention efforts of abstinence, fidelity, use of condoms, AIDS prevention measures such as treatment with antiretroviral medications (ARVs), nutrition interventions, as well as social care and psychosocial support. Donning a social public health...

There is widespread agreement among experts that a fundamental reorientation of global, regional, national and local food systems is needed to achieve the UN Sustainable Development Goals Agenda and address the linked challenges of undernutrition, obesity and climate change described as the Global Syndemic. Recognising the urgency of this imperativ...

The prevalence of obesity and diet related non-communicable diseases (NCDs) are rapidly increasing in Africa. Consumption of pre-packaged foods is one of the main drivers of these NCDs. Pre-packaged foods tend to contain high levels of energy, fat, sugar, and salt, which are known risk factors for NCDs. Food labels can guide consumers to make infor...

Over the last two decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization and development. These changes have altered African food environments and subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transitio...

Over the last two decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization and development. These changes have altered African food environments and subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transitio...

Both food safety and dietary behaviors are major contributors to the global burden of disease, especially in rapidly urbanising environments. The impact that food safety concerns have on dietary behaviors in low- and middle-income countries (LMICs) is insufficiently documented. Therefore, we examined whether food safety concerns influence consumer...

Background Ghana had significant reductions in neonatal mortality during the Millennium Development Goal (MDG) era. Few studies have attempted to identify the interventions, programs and policies that contributed to this progress. To understand the underlying factors which contributed to the reduction in neonatal mortality and to inform strategies...

Background The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40 % of them occur intrapartum. An understanding of the contributing factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. This study identified determinants of intrapartum stillbirths in GAR. Me...

The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40 % of them occur intrapartum. An understanding of the contributing factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. This study identified determinants of intrapartum stillbirths in GAR. A retrospecti...

Background: The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40 % of them occur intrapartum. An understanding of the contributing factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. This study identified determinants of intrapartum stillbirths in GAR. M...

Multiple recent global nutrition initiatives have recommended actions to transform food systems to improve food environments and food choice. This study aimed to identify actions recommended by these initiatives and understand their similarities and differences. Twelve global nutrition initiatives were reviewed, collectively spanning 13 action them...

There were eighteen Research Ethics Committees (RECs) operating in Ghana as of December 2019 but no empirical assessment of their operational characteristics had been conducted. We assessed the characteristics of Ghanaian RECs using an existing Self-Assessment Tool for RECs in Developing Countries. We present results from nine RECs that participate...

Objective: To undertake a cost-effectiveness analysis of a Community-based Hypertension Improvement Project (ComHIP) compared with standard hypertension care in Ghana. Design: Cost-effectiveness analysis using a Markov model. Setting: Lower Manya Krobo, Eastern Region, Ghana. Intervention: We evaluated ComHIP, an intervention with multiple c...

We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Econo...

Objectives Adolescents are vulnerable to diet-related health risks as they experience major life changes alongside food environment changes. In Ghana, non-communicable diseases (NCDs) are rising, and there is a need to understand what, how and why adolescents eat the way they do. This study explored perspectives of adolescents about healthy and unh...

Introduction: In 2016, cardiovascular diseases (CVDs) led to 17.9 million deaths worldwide, representing 31% of all global deaths. CVDs are the leading cause of mortality worldwide and significant barriers to achieving the sustainable development goals. Modern medicines have been significant in improving health outcomes. However, non-adherence to...

Introduction The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers. But few studies have empirically examined the factors driving these outcomes in Africa. Our study examined associations between perceived preparedness to respond to the COVID-19 pandemic and healthcare worker stress and burnout and id...

This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and intervention development in Africa. A multi-component methodology, drawing on concept mapping, was employed to construct a framework of factors influencing dietary behaviours...

Objective To investigate the perceived effects of the coronavirus disease (COVID-19) pandemic lockdown measures on food availability, accessibility, dietary practices, and strategies used by participants to cope with these measures. Design We conducted a cross-sectional multi-country online survey between May and July 2020. We used a study-specifi...

Background The exercise of power is central to understanding global health and its policy and governance processes, including how food systems operate and shape population nutrition. However, the issue of power in food systems has been little explored empirically or theoretically to date. In this article, we review previous work on understanding po...

Background: There is strong evidence that anti-platelet therapy, ACE inhibitors, beta-blockers and statins are cost-effective in reducing subsequent cardiovascular disease (CVD) events in patients with atherosclerotic cardiovascular disease (ACVD). In some settings, only a low proportion of people have access to these medications, and even lower a...

Background: Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa, driven by urbanisation and changing food environments. Policy action has been limited - and influenced by high income countries. Socio-economic/political environments of African food systems must be considered in order to understand what...

Research misconduct (RM) remains an important problem in health research despite decades of local, national, regional, and international efforts to eliminate it. The ultimate goal of every health research project, irrespective of setting, is to produce trustworthy findings to address local as well as global health issues. To be able to lead or part...

Healthcare rationing during pandemics has been widely discussed in global bioethics literature. However, existing scenarios and analyses have focused on high income countries, except for very few disease areas such as HIV treatment where some analyses related to African countries exist. We argue that the lack of scholastic discourse, and by extensi...

Growing urbanisation in Africa is accompanied by rapid changes in food environments, with potential shifts towards unhealthy food/beverage consumption, including in socio-economically disadvantaged populations. This study investigated how unhealthy food and beverages are embedded in everyday life in deprived areas of two African countries, to ident...

Background Like most other countries, Ghana is experiencing an increase in obesity and nutrition-related non-communicable diseases (NR-NCDs). The need to adopt effective and comprehensive interventions/approaches to address this burden at global, regional, and national levels has been recognized. However, there is limited contextualized evidence on...

Background: Healthcare workers' (HCWs) preparedness to respond to pandemics is critical to containing disease spread. Low-and middle-income countries, however, experience barriers to preparedness due to limited resources. In Ghana, a country with a constrained healthcare system, we examined HCWs' perceived preparedness to respond to coronavirus dis...

Child assent is recommended in addition to parental consent when enrolling children in clinical research; however, appreciation and relevance ascribed to these concepts vary in different contexts, and information on attitudes towards storage of biological samples for future research is limited, especially in developing countries. We assessed caregi...

Introduction. Despite efforts to combat hypertension by pharmacotherapy, hypertension control rates remain low. Lifestyle modifications of individuals diagnosed with hypertension have prospects for the prevention and control of hypertension. This study assessed the effect of modifiable lifestyle factors on blood pressure control among adults in urb...

Background: Unhealthy food vending can expose children to malnutrition and other diet-related challenges such as obesity. This study sought to describe types and sources of food in basic schools in urban Accra, and to describe food purchases by pupils. Methods: This was a cross-sectional study of five basic schools (3 public; 2 private) and 644 pup...

Introduction: The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers (HCWs). But few studies have empirically examined the factors driving these outcomes. We examined the association between perceived preparedness to respond to the pandemic and HCW stress and burnout and identified potential mediating...

p> Abstract Healthcare rationing during pandemics has been widely discussed in global bioethics literature. However, existing scenarios and analyses have focused on high income countries, except for very few disease areas such as HIV treatment where some analyses related to African countries exist. We argue that the lack of scholastic discourse,...

p> Abstract Healthcare rationing during pandemics has been widely discussed in global bioethics literature. However, existing scenarios and analyses have focused on high income countries, except for very few disease areas such as HIV treatment where some analyses related to African countries exist. We argue that the lack of scholastic discourse,...

Introduction: Healthcare workers' (HCWs) preparedness to respond to pandemics is critical to containing disease spread. Low-resource countries, however, experience barriers to preparedness due to limited resources. In Ghana, a country with a constrained healthcare system and high COVID-19 cases, we examined HCWs' perceived preparedness to respond t...

Background Non-Communicable Diseases (NCDs) are a leading cause of death globally. NCD mortality attributable to unhealthy food environments (FEs) is significant. Heavy marketing of unhealthy foods is an important contributor to unhealthy FEs. Aims We examined the extent of commercial food advertising, messaging, and signage on the campus of G...

Objectives The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods. Design Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. La...

Objective To identify factors influencing dietary behaviours in urban food environments in Africa and identify areas for future research. Design We systematically reviewed published/grey literature (protocol CRD4201706893). Findings were compiled into a map using a socio-ecological model on four environmental levels: individual, social, physical a...

Background: Due to rising food insecurity, natural resource scarcity, population growth, and the cost of and demand for animal proteins, insects as food have emerged as a relevant topic. This study examines the nutrient content of the palm weevil larva (Rhynchophorus phoenicis), a traditionally consumed edible insect called akokono in Ghana, and a...

In 2014, the worst outbreak of Ebola virus disease (EVD) emerged in sub‐Saharan Africa (SSA) causing fear and panic. The outbreak which started in Guinea quickly moved across to Sierra Leone and Liberia. With an average EVD case fatality rate of around 50% (range 25‐90%), there were many casualties, and the number of recorded deaths exceeded 11,300...

Background: Effective control of blood pressure is necessary to avert the risk of cardiovascular diseases from uncontrolled hypertension. Despite evidence on the benefits of hypertension control, rates of control in Ghana remain low. This study assessed the patient-level factors that influence hypertension control among adults in Accra, Ghana. Me...

Background: Globally, hypertension is a leading cause of cardiovascular disease and mortality, with the majority of deaths occurring in low- and middle-income countries. Because the burden of hypertension is increasing in low resource settings with restricted infrastructure, it is imperative that new models for hypertension care are realised. One...

Despite the clinically proven advantages of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), utilisation has been low in many African countries. To increase uptake and achieve the desired effect, the World Health Organization revised the policy to a monthly administration. Assessing the coverage...

Background: Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComH...

Background : Effective control of blood pressure is necessary to avert the risk of cardiovascular diseases from uncontrolled hypertension. Despite evidence on the benefits of hypertension control, rates of control in Ghana remain low. This study assessed the patient-level factors that influence hypertension control among adults in Accra, Ghana. Met...

Background : Effective control of blood pressure is necessary to avert the risk of cardiovascular diseases from uncontrolled hypertension. Despite evidence on the benefits of hypertension control, rates of control in Ghana remain low. This study assessed the patient-level factors that influence hypertension control among adults in Accra, Ghana. Met...

Background Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognised as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP...

Background Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognised as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP...

Background Effective control of blood pressure is necessary to avert the risk of cardiovascular diseases from uncontrolled hypertension. Despite evidence on the benefits of hypertension control, rates of control in Ghana remain low. Objective This study assessed the patient-level factors that influence hypertension control among adults in Accra, Gh...

Background: Integrating family planning (FP) with HIV care and treatment programs is a strategy to expand FP service delivery and prevent unintended pregnancies among women living with HIV. However, little is known about the extent to which FP services are available in health facilities providing HIV services across sub-Saharan Africa. In this stu...

Background Ghana has reached an advanced stage of nutrition transition, contributing to an increase in nutrition-related non-communicable diseases, particularly amongst urban women. Community involvement is an important factor in the success of efforts to promote healthy eating. The readiness of populations to accept a range of interventions needs...

Objectives To evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control. Setting Lower Manya Krobo, Eastern Region, Ghana. Participants All adult hypertensive community members, except pregnant women, were eligible for inclusion in the study. We enrolled 1339 participants, 69% o...