By documenting the behaviors and factors that contribute to the leading cause of mortality and morbidity, the researcher said his goal is to help create a comprehensive system for monitoring the health-risk behaviors among Ghana's youth.
Beginning in summer 2006, Owusu and his colleagues, working on behalf of MTSU's Department of Health and Human Performance, partnered with the World Health Organization and the United States Centers for Disease Control and Prevention to help build capacity for monitoring health behavior among youth in Ghana.
This initiative—which was undertaken in conjunction with the School Health Education Program unit, also known as SHEP— involved introducing and implementing the Global School-Based Student Health Survey in Ghana. The GSHS is part of the WHO's STEPSwise approach to monitoring health behaviors in member countries, including Ghana. For his unprecedented research endeavor Owusu administered a GSHS instrument that utilized a two-stage cluster sample designed to produce a representative sample of students, ages 13-15, from 75 schools in all 10 regions of Ghana.
As the primary investigator and country coordinator for the GSHS partnership project, Owusu oversaw the surveying of 6,236 school-aged youth ranging in age from 12 to 16 from the aforementioned regions in Ghana. The just-completed findings surround the survey's nine categories of health risk, including dietary behaviors, hygiene, sexual behaviors that contribute to HIV infection, unintended pregnancy, nutrition, and violence and unintentional injury.
A native of Ghana, Owusu is a four-time African Champion, an eight-time All-American and a three-time Olympic athlete in the triple jump, with a lifelong personal and professional interest in health and fitness behaviors. Owusu said he sincerely believes that to enact positive change in health behaviors, it is important to monitor the health of secondary-school students through the establishment of a comprehensive monitoring system. Such a system, he noted,will enhance the promotion of school-health programs in Ghana through education, teacher training and program evaluation.
"Currently, 85 percent of the world's adolescent populations live in developing countries," he observed, "yet because of lack of adequate research, there is a gap in data on the health-risk behaviors of this important population segment."
Owusu said the GSHS was first developed in 2001 through a collaborative effort of the WHO, the United Nations Children's Fund, the Joint United Nations Programme on HIV/Acquired Immune Deficiency Syndrome, and the United Nations Educational, Scientific and Cultural Organization, with technical assistance from the CDC.
Regarding Owusu's recent GSHS study of Ghanaian adolescents nationwide, the following are among his initial findings related to the youths' (ages 12-16) overall basic hygiene:
"¢ 13.7 percent of the students surveyed "usually" had not cleaned/brushed their teeth in the past 30 days at the time of the survey."¢ 9.1 percent of the students surveyed reported that they had "never or rarely" washed their hands in the past 30 days at the time of the survey."¢ 12.4 percent of the students surveyed had "never or rarely" washed their hands after using the toilet in the past 30 days at the time of the survey."¢14.7 percent of the students surveyed reported that they "never or rarely" used soap when washing their hands in the past 30 days at the time of the survey.
Among the more than 3,588 students ages 13-15 who were surveyed, Owusu said 1,466, or 40.8 percent, reported that they had never talked to a parent about HIV/AIDS. Fewer of these students—1,283, or 34 percent—reported that they were not aware of the possibility of HIV/AIDS transmission from a pregnant mother to child.
"The GSHS baseline data show that information about HIV infection is lacking in a number of areas for Ghana's youth, ages 13-15," Owusu noted. "Many of those who are sexually active are engaging in behaviors that expose them to risk of infection."
Of the 3,070 students ages 13-15 who responded to the survey's questions about sexual activity, 374 , or 12 percent, reported that they had engaged in sex. Further, of those who were sexually active, 213, or 57 percent, reported that they had done so with "two or more partners." Additionally, of this sample group, 192 reported that they had engaged in sexual intercourse in the past 12 months. Of this number, 110 respondents, or 57 percent, indicated that they did not use a condom.
In spite of the fact that comprehensive research surrounding Ghanaian youths' health behaviors had never been conducted nationally before Owusu, he said he was more excited about helping compile the existence of such data versus being surprised by any of the study's initial findings.
"Although a few of the findings standout, nothing specifically surprised me, because everything we found out, everything we learned from this, was new," he explained. "Nobody's ever seen these numbers before—they've never been complied—so this research is really the starting point on which future information about these behaviors will be compared to and added to."
One finding, however, that did cause Owusu to pause, he said, was related to the youngsters' dietary behaviors.
"One question (on the GSHS) had to do with how many of the students 'always' or 'most of the time' felt hungry in the 30 days prior to the study, and the response did cause me to blink," he shared. "On a day-to-day basis, somewhere in the area of slightly under 20 percent said they felt they were hungry, and to me, that was quite large. I didn't think that question would have that high a number.
"Another thing, too, that I found very interesting had to do with the hygiene information, given that we had a national campaign on (improving basic) hygiene, among the school children," he added. "And even though that campaign was instituted in only four of the 10 regions (in Ghana) as for the time of the survey, it was striking to see how effective this government-backed program was in those four regions. "¦"
Owusu said he hopes that the data collected will serve as the basis for meaningful interventions and help guide policies in areas such as malaria and AIDS prevention for school-age youth throughout Ghana.
"This is really huge "¦ in terms of the significance of what we are doing," he said, "and already different organizations are turning to us for national-level, baseline data. There is interest in eye screening data as well as baseline measures for malaria prevalence among secondary-school students in Ghana. The main thing for us is the issue of surveillance, or monitoring (the students' health behaviors), because without it, you really are shooting in the dark.
"With the data that we've compiled," Owusu continued, "you also have the necessary information to serve as an evaluation for ongoing programs. What we are doing here, then, is providing that starting point.
Owusu said the newly culled national-level data about the health status for this particular youth group now makes it possible for Ghana to identify potential geographic "hotspots" and prioritize resources for intervention programs. For example, he explained, "The data show that students in the south of Ghana are at a much greater risk for becoming overweight compared to students in the north. Thus, if Ghana had an ongoing national campaign to address obesity among this population, resources could be shifted from north to south."
In short, a monitoring system such as the GSHS allows Ghana to refine interventions and policies, he observed. And overall, the study's new findings not only provide a baseline of information to help Ghana determine how to prioritize its current health-related programs and where resources are best allocated, but also aids planners in evaluating the programs that are in place and weigh their effectiveness, Owusu said.
With continuing support from MTSU, SHEP, WHO and CDC, Owusu said he and his colleagues will return to Ghana in September 2008 to expand the surveillance system to cover health-risk behaviors of youth who are ages 16-19. The researcher said he expects to oversee the survey of about 5,000 high-schoolers regarding their health habits and related risk behaviors; thus, making Ghana the first country in Africa to have a comprehensive health-risk behavior monitoring system for school youth ages 13-19.
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