Physical and mental health challenges of migrant female head porters (Kayayei) in Ghana: guidelines for health promotion interventions.

Abstract

Background: While internal migrants (Kayayei) in Ghana have been perceived as a vulnerable group faced with mental and physical health challenges, there has not been enough research on the impact of the trade on their health. Grounded on the broad bioecological framework of Bronfenbrenner and Morris, this study investigated the lived experiences, prevalence of physical and mental health challenges, risk factors for mental health challenges, protective factors that mitigate the effects of the daily lived experiences on mental health. Methods: The study adopted a sequential exploratory mixed method design whereby qualitative data were collected and analysed first to get in-depth understanding of the physical and mental health of Kayayei, followed by the quantitative survey. For the qualitative study, the study employed a purposive sampling technique to select 31 Kayayei from the Agbogbloshie market. The study utilised Interpretive Phenomenology Analysis (IPA) to analyse the transcripts from the qualitative study interviews. The quantitative aspect of the study undertook a cross-sectional survey using an interviewer-administered questionnaire to collect data from 352 participants. On the other hand, the quantitative study used exploratory factor analysis, Chi-Square test, mean test, and binary logistic regression for the analysis. Results: Results for the qualitative study showed that the main reasons for migrating to Accra are economic and cultural restrictions and oppression. The findings also revealed that the Kayayei were often maltreated, lacked decent accommodation, and were involved in accidents. To cope with the situation, they used religion, social support, and distractions such as entertainment. The quantitative results indicated that participants had low level of education. Only 6.2 per cent (n=21) had Senior High education, and the majority suffered from poor physical (59.9%) and mental health, [anxiety a94.4 per cent, followed by depression 86.6 per cent, and stress at 42.4 per cent] challenges. The difficult nature of their work context coupled with maltreatment by their clients contributed to poor mental health outcomes. The results showed participants adopted various coping strategies to deal with their situation. However, apart from humour, which helped mitigate stress (OR=0.358, 95% CI=0.169, 0.757, p= 0 007), all other coping strategies used by the Kayayei increased mental health distress. The use of denial coping strategy predicted depression (95% CI=2.428, 27.038, p=0.001), stress (95% CI=0.988, 3.323, p=0.005, p=0.005), and anxiety (95% CI= 2.37, 54.088, p= 0.002). The results also showed that participants received low to medium social support overall, while support from family and friends helped mitigate mental health distress. Conclusion: The results of the present study indicated that even though the work of Kayayei exposes them to physical and mental health challenges, the coping strategies they adopt create more rather than less mental health concerns. However, social support from family and friends helped to buffer the impact of the challenges. The findings of the present study were used to develop a multilevel prevention intervention aimed at training the Kayayei on the appropriate coping strategies to adopt to improve mental health outcomes. It is recommended that at the personal level, the Kayayei should have access to psychological counselling that will teach them how to adopt better coping strategies that could enhance their mental health outcomes. At the interpersonal level, the Kayayei should be assisted to form cooperatives that could facilitate social networks, proper integration, and social support for its members. At the structural level, relevant governmental and non-profit organisations should address the determinants of health including access to physical and mental health care services, employment opportunities, skills training, and affordable housing for the Kayayei. Finally, there should be structural change and interventions that target the mental health of the vulnerable in society, particularly women.