Social factors influencing child health in Ghana

Type Journal Article - PloS one
Title Social factors influencing child health in Ghana
Volume 11
Issue 1
Publication (Day/Month/Year) 2016
Page numbers e0145401
Social determinants of health include the conditions in which people are born, live, work and grow, as well as measures that are put in place to curb illness [1]. The distribution of money, social resources, economies and political power shape these conditions at the national, regional and local levels [2]. Although earlier studies focused mainly on investigating social class and family income, recent studies have broadened the boundaries of what constitutes social determinants of health [1,3]. Social class encompasses factors influencing health and extends beyond simple measures of occupation and income; it includes family wealth, health literacy, education, employment, degree of autonomy in one’s job and quality of housing [2]. Ethnicity is also regarded as a social determinant although emphasis is usually placed on substructures defined by race, culture, family structure and gender [4]. Additionally, social relationships influence health and are therefore included in social determinant frameworks through constructs such as social support networks, social cohesion and social exclusion [5]. Furthermore, aspects of the natural environment such as climate change and the quality of water, air and soil are sometimes classified as determinants of child health [2,3]. It has been reported, for example, that infection by helminth (a free-living organism in aquatic and terrestrial environments) during pregnancy could affect motor and cognitive development (due to poor nutrition) among one-year-old infants [6]. However, the prescription of antihelminthics and vitamins to pregnant women in such environments during antenatal care can help to reduce anaemia by increasing haemoglobin concentration through to delivery and improving motor functions among their children [7]. This approach might be a good way to fight against childhood motor neuron diseases including Werdnig-Hoffmann disease, which can impair motor development and muscle movement later in life [8].

Scientists have been unable to provide a simple biological reason why the life expectancy at birth for men in the Calton region of Glasgow, Scotland, is fifty-four years, whereas that of men in Lenzie, just a few kilometres away, is eighty-two years, and why infant mortality rate among babies born to Bolivian women with no education is more than 100 per 1000 births compared with the less than 40 per 1000 babies born to women with at least secondary school education in the same country [1,2]. Evidence suggests that disparities of this nature could be reduced by improving the social environments within which people live and work [9]. Moreover, the rapid increase in the prevalence of diseases such as obesity is widely believed to be driven primarily by changes in lifestyle patterns [1,3]. However, in spite of the global interest in equity and social justice, knowledge on the social determinants of health has not yet resulted in the expected policy changes it deserves [3].

With early life events known to exert strong influences on health status in childhood and beyond, many child health researchers now consider a wide range of early life exposures in research on social determinants: these include caregiving and quality of parenting, maternal depression, home organisation, exposure to domestic violence and neighbourhood safety [3]. Humans possess a great deal of plasticity during the early years of life, helping to ensure rapid responses to changing environmental factors. This also makes children particularly susceptible to both positive and negative exposures [3]. Thus, when exposed to adversity, some of the ensuing changes can be maladaptive, potentially leading to bigger problems in adulthood [10]. For instance, depressed mothers are less attentive and sensitive to their newborns, failing to appropriately respond to the babies’ emotional signals [11]. Some encephalography studies have shown that such infants do not only develop shorter attention spans due to decreased frontal cortex activity but they also record persistent elevated heart rates and cortisol levels, which re-programme their internal “set point” to stress, and increase their risk of developing hypertension and coronary artery disease later in life [11–13]. Consequently, seemingly harmless and avoidable risks such as maternal depression could disturb human development and exert deleterious effects on lifelong health [3]. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015 [14], it is necessary to identify social determinants that might have contributed to the non-realisation of this goal. This would help towards the achievement of current and future plans (such as the Ghana national newborn health strategy and action plan, which hopes to help reduce neonatal mortality from 3.2% in 2014 to 2.1% in 2018 [15]). Here, we examined the published literature in this area in order to identify social factors influencing child health in the country.

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