Atiim, George A.2017-09-212018-08-312017-09-212017-09-19http://hdl.handle.net/10012/12422The epidemiologic transition demonstrates a relationship between infectious disease decline and the rise of chronic disease. In many developed countries, as rates of infectious disease fell from the 19th century, several chronic diseases including cardiovascular, cancers, and allergies evolved as critical public health problems. In developing countries, similar changes in population health and disease are occurring as chronic diseases have become an important health issue requiring urgent interventions. However, much of public health and research directions remain focused on the most common chronic diseases – heart disease, diabetes, cancers and chronic respiratory diseases. There is limited understanding of the health risk of allergic disease in developing countries. This thesis examines the emerging risk of allergic disease, with particular emphasis on food allergies, in Ghana, a lower-middle income country (LMIC) in sub-Saharan Africa experiencing rapid challenges in its population health. The broad objectives of the research were: to explore the perceptions, risk factors and coping strategies associated with food allergy and to understand how the local context shapes risk perceptions, practices and food allergy management. The thesis adopts a qualitative research approach – in-depth interviews and documentary review – to address the research objectives. The results reveal that food allergies are a growing health issue in Ghana, though often unrecognized in the community and at healthcare settings. Results also indicate that there are significant psychological (e.g. anxiety and fear), social (e.g. stigmatization, social exclusion), and economic (e.g. impact on work & household expenditures) impacts on the wellbeing of those affected by food allergy. Further, the findings reveal the importance of broader sociopolitical, and sociocultural factors such as the lack of policy, inadequate financial resources and cultural norms and how these shape risk perceptions, diagnostic practices and management of food allergy. The research makes several important contributions. First, by integrating several theoretical perspectives, this research sheds light on the epidemiology of food allergy by revealing the contextual factors influencing risk perceptions, experiences and disease management. In doing so, the research proposes a framework for understanding emerging health risks within LMIC contexts. Further, the research enhances understanding of the impacts of food allergy on the health, social and economic wellbeing of the affected population. Second, the research also makes methodological contributions by demonstrating how a qualitative research design can provide a pathway to understand the rise of food allergy in contexts where data is limited. In addition, it demonstrates the importance of inductive knowledge as a first step toward identifying allergic individuals, and key food allergens in resource-constrained settings. Third, from a policy perspective, the research highlights the need for public health policies to incorporate allergic disease in the broader chronic disease prevention agenda, as well as addressing individual, community and structural factors that act to constrain food allergy risk perception, and management.enEpidemiologic transitionFood allergySub-Saharan AfricaChronic diseaseQualitative researchDoctoral Thesis