Title: Factors Associated with Mental Health of Internal Migrants (Kayayei) in Agbogbloshie-
Ghana
Version: 3 Date: 21 Jan 2023
Reviewer's report:
I have reviewed the manuscript and it focuses on one of the health issues that is rarely topical
in the discourse of health conditions. Furthermore, it also studies a segment of the population
that is unique and whose plight is mostly unnoticed by government authorities. The subject of
migration and mental health continues to be of interest among researchers because of the health
consequences migrants may experience. The manuscript is, therefore, relevant as it reinforces the
dialogue of mental distress that migrants experience when they move to a new location with the
hope of improving their livelihood. The strength of the manuscript is in exploring the experiences
of the migrant head porters (“Kayayei”) and how it impacted on their mental health (depression,
stress and anxiety) as they eke out their livelihoods. The choice of this unique study population
is novel as this is a group of people that are mostly ignored. Though it is not mentioned in
the manuscript whether the study focused on women only, previous studies show that women
constitute a higher proportion of those involved in market activities which include head porters.
I assume that the term Kayayei led to the submission of the manuscript to this journal which
focuses on women’s health. I would like to propose that, if possible, the title of the manuscript
should include “female internal migrants” if it did focus on women only. The manuscript has
a number of weaknesses: first, it is not clear how the internal migrants were identified at the
markets; was it assumed that every head porter was a migrant. Second, the methods section
requires clarity (see detailed comments). Third, though the study found associations between
maltreatment by patrons, difficult nature of work and mental health challenges (depression,
stress, and anxiety) the presentation of the results in the tables is short of the expected statistical
detail for logistic regression analysis. Fourth, the manuscript should clearly state its contribution
to scientific knowledge in terms of advancing the discourse on the subject. Fifth, the manuscript
has not adapted a theory to anchor the study.
My detailed comments are presented below section by section:
Abstract
The methods in the abstract should be clear. The use of the term “purposive sample” (line
43) may not be appropriate for a quantitative study like this one. The term is mostly used
in qualitative studies. The results section does not present the Odds Ratios for the predictor
variables, only the confidence intervals and p-values are indicated in the brackets. In the
conclusion, a recommendation on constructing affordable accommodation for the Kayayei may
not be relevant (lines 61-62).
Introduction
The introduction provides sufficient background information. The problem has been stated and
so is the rationale for the study.
Methods
This is the section that needs clarity and improvement.
Participants and procedure (lines 114-128)
The manuscript should clarify how a migrant Kayayei was identified in Agbogbloshie market.
Was it assumed that every Kayayei in the market was a migrant. Are there no non-migrants who
are kayayei? It also needs to be clear that the participants in this study are females only in this
section, since Kayayei refers to female head porters.
Sample size determination and sampling
The manuscript should clarify the source of the 3000 population size (line 136). Also, the
population composition by gender. Was this the population for Kayayei only? Care should be
exercised with the use of the term “purposively”
The computation detail (lines 140-145) can be put in the appendix or presented as supplementary
information.
Data collection instrument and procedures
Ethical clearance (line 150-151): How about ethical clearance in Ghana? Was there no ethical
clearance in Ghana, the place of the study? Normally, there should have been ethical clearance
in Ghana in a study of this nature.
Data collection (line 160): What was the language of interview? Was the questionnaire
translated?
Elaborate on how data collection was conducted in the two strata (lines 118-122). Did the two
strata yield equal numbers in terms of sample interviewed?
Also, were the interviews conducted at the same time in the two strata or at different times? How
was long was the data collection period in the two strata?
Measures
The independent variables in the manuscript are not defined and so are their categorizations.
The manuscript should clearly define and categorize all the independent variables in the study.
Also, the manuscript does not state the dependent variable (s). This should be clearly stated,
defined and categorized.
The manuscript does elaborate how depression, anxiety and stress are measured but it does
not explain how these measures are eventually converted into a binary form to facilitate the
application of logistic regression analysis. It is important that this is elaborated on.
Data analysis
The manuscript should elaborate on how data processing was data after collection before the
analysis was performed. In the analysis for logistic regression, it should be clear how the
modeling was done for depression, anxiety, and stress. The choice of the logistic regression
analysis method should be justified and its assumptions stated. The measures of association for
logistic regression analysis should also be elucidated.
In the manuscript, bivariate analysis was not done, is there any explanation?
Results
There are noticeable inconsistencies between numbers cited in-text and those presented in Table
1 (check lines 199-208). Line 203 should read “…. had been living in the city for three years
and above.”
Line 204 should read “……rated their work as difficult.” And not “very difficult”
The interpretation of the results should follow the flow of the table in the way variables are
presented.
The presentation of results in Tables 2, 3 and 4 should be revisited. First, the variables in the
tables do not have categories and reference categories are not shown for logistic regression
analysis results. The categories of the variables should be shown and their references. Second,
it is not stated whether the Odds Ratios (ORs) presented are unadjusted or adjusted. Third, the
interpretation of ORs should be revisited, especially the use of the word “higher.”
Line 249: Check “59 percent less” when OR=0.39 for parity in Table 4. This should be corrected.
Table 4 shows a standard error of 5.34 for marital status. The manuscript should check this.
Discussion
The manuscript should re-state the aim of the study prior to summarizing the key findings.
The recommendation in lines 271-273 appear to be misplaced.
Line 290-291: the recommendation of an institutionalized minimum wage and appropriate price
mechanisms for the Kayayei, is it possible?
The recommendation in lines 309-311, is it possible for affordable accommodation for the
Kayayei to be constructed?
Also, the statement in lines 317-319, elaborate on how society can reconsider the changing role
of women.
State the contribution of the study to scientific knowledge in advancing the discourse on
migration and mental health.
Limitations of the study
The manuscript should have included the lack of qualitative data. As study of this nature
should have adopted a mixed methods approach. Qualitative data would have yielded additional
insightful information about the mental health issues the Kayayei experience.
Conclusion
The conclusion should be based on the study findings.