| Mohammed K.; Batung E.; Kansanga M.M.; Luginaah I. | Alcohol misuse as a social determinant of food insecurity among smallholder farmers | 2024 | Social Science and Medicine | The availability and affordability of alcohol in smallholder communities have surged the misuse of alcohol. Misusing alcohol has dire health and nutrition consequences in smallholder communities. Alcohol misuse can divert household resources from essential household needs such as food and also hinder local food production. In the context of multiple stressors on smallholder farmers' livelihoods, it is crucial to assess the relationship between alcohol consumption and smallholder farmers' experience of hunger. Therefore, we used data from a cross-sectional survey involving 1100 smallholder farmers in the Upper West region of Ghana to examine the association between alcohol consumption and household food insecurity. Results showed that daily (OR = 3.81; p ≤ 0.001) and weekly/frequent (OR = 2.32; p ≤ 0.001) consumption of alcohol was significantly associated with higher odds of household food insecurity compared to no consumption. The relationship between alcohol and food insecurity was bidirectional. The experience of food insecurity was also significantly associated with higher odds of occasional or frequent alcohol consumption. While alcohol misuse can transition smallholder households into food insecurity, the household heads of food insecure households may resort to alcohol to cope with underlying stressors such as climate change and food insecurity. This calls for policy interventions to mitigate alcohol misuse through regulations, surveillance, economic disincentives and improving the social mechanisms of resilience to climate change and food insecurity in smallholder communities. However, policy approaches must be cautious not to disrupt the livelihoods of vulnerable smallholder farmers. © 2023 Elsevier Ltd | Open |
| Sewor C.; Obeng A.A.; Eliason S.; Agbeno E.K.; Amegah A.K. | Fruits and vegetables intake improves birth outcomes of women with gestational diabetes mellitus and hypertensive disorders of pregnancy | 2024 | BMC Nutrition | Background: Disorders of pregnancy such as hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) have been associated with adverse birth outcomes. However, the ameliorating role of maternal nutrition in the relationship between disorders of pregnancy and adverse birth outcomes has received very little attention. We investigated the relationship between HDP and GDM, and adverse birth outcomes in a Ghanaian population and evaluated the effect modifying role of fruits and vegetables consumption in the relationship. Methods: We conducted a cross-sectional study among 799 mothers who had recently delivered singletons in the Cape Coast Metropolis, Ghana. Information on HDP, GDM and birth outcomes were retrieved from the maternal health book of the mothers. A food frequency questionnaire was used to assess fruits and vegetables intake during pregnancy. Modified Poisson regression was used to investigate the association between pregnancy disorders, and preterm birth (PTB) and low birth weight (LBW). Stratified analysis was used to assess the effect modifying role of fruits and vegetables consumption in the relationship. Results: The proportion of mothers with HDP and GDM was 11.3% and 7.5%, respectively. The proportion of the mothers with both conditions was 0.9%. The prevalence of PTB and LBW in the population was 27.9 and 7.3%, respectively. These disorders of pregnancy were associated with increased risk of PTB (Adjusted Prevalence Ration [APR] = 3.02; 95% CI: 2.42, 3.77) and LBW (APR = 5.32; 95% CI: 3.19, 8.88). In the stratified analysis, risk of PTB was higher among mothers classified in tertile I compared to mothers classified in tertiles II and III. For LBW, the risk increased with increasing fruits and vegetables consumption. The interaction p values were 0.0043 and 0.1604 for PTB and LBW, respectively. Conclusions: We found mothers who were diagnosed with GDM and HDP to have increased risk of delivering a PTB and LBW baby. We also found fruits and vegetables consumption to modify the observed relationship. Mothers diagnosed with GDM and HDP should be advised during antenatal care visits to increase intake of fruits and vegetable consumption to help safeguard their health and that of the developing foetus. © 2023, The Author(s). | Open |
| Abokyi E.; Asante B.O.; Wongnaa C.A. | Women’s role of caregiving for under-five children: Implications for dietary diversity and food security in Ghana | 2023 | Cogent Food and Agriculture | This study examines the implications of women’s role of caregiving under-five children on household food security. Using two-stage least square instrumental variable estimation, we analyzed cross-sectional data from 305 smallholder farmers from rural areas in Ghana. The results indicate that household characteristics such as size, gender, and marital status also influence household dietary diversity. A government agricultural program that seeks to improve farmers’ income has the potential to improve household dietary diversity. The most important finding is that the women’s role of taking care of under-five children has negative effect on food household dietary diversity and therefore has negative implications for security of the household in rural settings. However, improved income and education mitigate the negative effects of caregiving to children under five on the household food security. A policy implication of the results is that providing nutrition knowledge to women through food security programming is vital to improving household food security and such programmes must also target family planning. © 2023 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license. | Open |
| Abraham J.D. | GENDER-BASED PLANNING OF MEALS AT THE HOUSEHOLD LEVEL IN GHANA | 2023 | African Journal of Food, Agriculture, Nutrition and Development | Planning is important for the management and sustainable use of resources. To ensure sustainable quality meals, there is the need to plan meals in the home. Planning of meals can best be achieved if gender, especially, women who are the key people responsible for meals in the home, are involved. Therefore, this study was conducted to investigate the determinants of gender-based meal planning and the frequency of meals in Ghana using structured questionnaires and a multistage sampling technique. A total of 3521 households were interviewed across fourteen regions of Ghana, to identify how males and females plan their meals at the household level, and the key players involved in the choice of meals in the home. The country is stratified into regions and the regions further stratified into urban, periurban and rural areas. Purposive sampling was used to select households for the survey considering social classes and livelihoods of the people in the communities. Data obtained were entered in Statistical Product and Service Solutions (SPSS) version 16 (IBM SPSS, Armonk, NY) for analysis using the Pearson’s chi square at a P-value of 0.05 to determine statistical differences between gender. Associations between factors that influence frequencies of meals were determined by Cramer's V. Findings showed that, women are mostly responsible for meals at the household level. The study also showed that most Ghanaian households eat three times per day, but their meals are often not planned. Furthermore, the findings of the study suggest that educational attainment and income do not have significant impact on the frequency of meals and gender-based planning of meals in the home. The study showed that 67.41% of households involved in the study were headed by men but those responsible for cooking were mostly women (63.71%). Only a few households planned their meals. Of these, women were mostly responsible for the provision of meals. Therefore, it is important to consider gender in the planning of meals to ensure good nutrition and food availability to the household throughout the year. © (2023), All Rights Reserved. | Open |
| Achaglinkame M.A.; Dari L.; Mörlein D. | A review of dairy production and utilization in Ghana and Benin | 2023 | Discover Food | High dairy production and utilization have proven very effective in improving food and nutrition security in society, especially among the rural poor. This review sought to find out the status of dairy production and utilization in Ghana and Benin, the challenges, and the way forward. The review discovered low dairy production in both countries which meets only about 19% (Ghana) and 20% (Benin) of dairy demand. This low self-sufficiency compels both countries to depend heavily on imported dairy products to meet consumers’ dairy needs. However, dairy consumption in both countries is still abysmally low (Ghana = 9 kg/person/year, Benin = 8 kg/person/year). Cow milk is the most regarded and consumed animal milk in both states and is consumed both raw and processed. Local dairy products include “wagashi” (local soft cheese), yoghurt and “brukina”/“dèguè” (fermented milk-millet beverage). Some of the challenges found include low patronage of dairy farming, low-performing breeds, safety issues, inadequate sustainable pro-dairy policies, water and pasture/forage shortages, inadequate infrastructure, poor education, unorganized local sector and climate change. However, adopting effective pro-dairy policies, effective safety and quality regulations, smart dairy farming and processing and exploring other dairy options like goat, sheep, and donkey milk is key to improving dairy production and utilization in both countries and beyond. © 2023, Springer Nature Switzerland AG. | Open |
| Adam B.; Abdulai A. | Minimum tillage as climate-smart agriculture practice and its impact on food and nutrition security | 2023 | PLoS ONE | Minimum tillage (MT) is a sustainable farming practice that limit soil disturbance only to planting stations while leaving the rest of the soil undisturbed. It is an important component of conservation agriculture, which aims to raise agricultural productivity, improve the livelihoods of farmers and build resilient farming systems. Despite the growing empirical literature on its adoption and benefits, there is a paucity of empirical evidence on the heterogeneous effect of length of MT adoption on household welfare. This study uses plot-level and household data combined with geo-referenced historical weather data to provide microeconomic evidence of the impact of MT on maize yields, food and nutrition security, and farm labor demand in Ghana. We account for potential selection bias and omitted variable problems by using an ordered probit selection model to estimate two transition-specific treatment effects: from conventional tillage systems to short-term MT adoption and from short-term to long-term MT adoption. The empirical results show that longer cropping seasons of MT adoption significantly increases maize yields and dietary diversity by about 4.33% and 14.22%, respectively, and decreases household food insecurity and labor demand by 42.31% and 11.09%, respectively. These findings highlight the necessity of developing and implementing programs that promote and help smallholder farmers to sustain its adoption for longer cropping season. Copyright: © 2023 Adam, Abdulai. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Ade D.; Salifu Yendork J.; Darkwah E. | “I always think about tomorrow what I'll eat” an exploration of the experiences of adolescents in poor urban contexts in Accra, Ghana | 2023 | Children and Society | Poverty deprives children and adolescents of good sanitation, nutrition, shelter, education, quality water, health services and negatively lead to poor physical and mental health. However, limited studies exist on the experiences of adolescents in poor urban contexts in Ghana. Using 20 adolescents from James Town, Accra, findings show adolescents look beyond money when conceptualizing poverty. They also encounter both pleasant and negative experiences in their context while remaining determined to pursue education for a better future. Implications are discussed considering the need to promote communal support because of its relevance to the well-being of the adolescents within poor urban contexts. © 2023 National Children's Bureau and John Wiley & Sons Ltd. | Open |
| Adekambi S.A.; Okello J.J.; Low J.; Abidin P.E.; Carey E. | Does vitamin A rich orange-fleshed sweetpotato adoption improve household level diet diversity? Evidence from Ghana and Nigeria | 2023 | African Journal of Science, Technology, Innovation and Development | Promoting the consumption of locally available food crops such as orange-fleshed sweetpotato (OFSP) that are rich in beta carotene, a precursor for vitamin A, has been shown to be a highly effective means of fighting against vitamin A deficiency at the community level when combined with nutrition education. After a three-year intervention promoting OFSP uptake using different market-led approaches, a structured survey was conducted among 204 participant and 422 non-participant households in Ghana and Nigeria in 2017. In this study, we test whether the adoption of OFSP has a significant effect on dietary diversity, using a counterfactual approach based on the conditional independence-based estimators of average treatment effect techniques. Results found that household, young child and woman’s dietary diversity scores increased when households adopted OFSP varieties. However, the positive effects of OFSP adoption on household dietary diversity only occurred in the Ghanaian sub-sample, not the Nigerian. Policymakers and development support partners should ensure institutional support in terms of intensive campaigns to sensitize farmers and their families about the benefits of these crops in order to create and sustain demand for biofortified foods as a means of fighting micronutrient malnutrition. © 2022 African Journal of Science, Technology, Innovation and Development. | Open |
| Adhikari P.; Marquis G.S.; Lartey A. | MATERNAL PERCEIVED STRESS, HIV STATUS, AND FEEDING STYLES ARE PREDICTORS OF INFANT DIETARY INTAKE IN GHANA | 2023 | African Journal of Food, Agriculture, Nutrition and Development | Indicators of poor maternal mental health have been associated with nonresponsive feeding styles that affect dietary intake in infants. This study examined the association between maternal mental health indicators and infant dietary intake and infant feeding behaviors within a 2003 to 2008 longitudinal observational cohort study in Ghana (the Research to Improve Infant Nutrition and Growth [RIING] project). A random sample of one third of the RIING cohort (19 HIV positive [HIV-P], 29 HIV negative [HIV-N], and 24 HIV unknown [HIV-U]) and their infants was selected for an in-home 24-hr weighed dietary study at 9 months postpartum. Maternal depressive symptoms and perceived stress scores had been measured at 6 months using the Edinburgh Postnatal Depression Scale (EPDS) and Perceived Stress Scale (PSS), respectively. All foods and liquids were weighed to determine energy and nutrient intake values. Human milk intake was weighed. Each feeding session was observed, and the feeding style was recorded. Multiple linear regression showed that maternal perceived stress was negatively associated with total food (-12.4 g, 95% CI: -21.0 to -3.8), energy (-19.5 kcal, 95% CI: -33.8 to -5.2), and fat (-0.7 g, 95% CI: -1.4 to -0.1) intake from complementary foods and liquids in infants. An HIV-P status was associated with a lower intake of fat (-6.3 g, 95% CI: -11.1 to -1.5) and vitamin A (-293.9 μg, 95% CI: -529.9 to - 57.8) compared to HIV-N. Maternal mental health indicators were not associated with feeding style. However, a positive feeding style was associated with a higher intake of fat (4.8 g, 95% CI: 0.3 to 9.2) and vitamin A (245.3 μg, 95% CI: 28.2 to 462.5) compared to a passive feeding style. This study highlights the importance of focusing on how the infants are fed during the complementary feeding period. Interventions to improve infant dietary intake should prioritize maternal mental health and promote positive feeding styles among high-risk caregivers. © 2023,African Journal of Food, Agriculture, Nutrition and Development.All Rights Reserved. | Open |
| Adjei-Gyamfi S.; Musah B.; Asirifi A.; Hammond J.; Aryee P.A.; Miho S.; Aiga H. | Maternal risk factors for low birthweight and macrosomia: a cross-sectional study in Northern Region, Ghana | 2023 | Journal of Health, Population and Nutrition | Background: Abnormal birthweights are critical public health challenges accountable for most non-communicable diseases and perinatal mortalities. Regardless of the myriad of mixed evidence on maternal factors responsible for abnormal birthweight globally, most of these findings are attained from urban and rural settings. This study serves as one of the key pieces of evidence in view of the increasing prevalence of abnormal birthweight particularly in some parts of semi-rural Ghana. The study, therefore, aims to estimate the prevalence of abnormal birthweight and identify some possible maternal risk factors for abnormal birthweight in Northern Ghana. Methods: A retrospective cross-sectional study was conducted in Savelugu municipality from February–March 2022. A total of 356 mothers aged 16–46 years, having a neonate and attending postnatal care service, were recruited as study participants. Data were collected from maternal and child health record books and through structured interviews. To identify the maternal risk factors for abnormal birthweight, chi-square/Fischer’s exact test and multinomial logistic regression were employed as bivariate and multivariate analyses, respectively, at 95% confidence level. Results: Prevalence rates of low birthweight and macrosomia were 22.2% and 8.7%, respectively. Maternal anaemia in first trimester (AOR 3.226; 95% CI 1.372–7.784) and third trimester (AOR 23.94; 95% CI 7.442–70.01) of gestation was strong predictors for low birthweight. Mothers belonging to minority ethnic groups (AOR 0.104; 95% CI 0.011–0.995); mothers who had ≥ 8 antenatal care visits (AOR 0.249; 95% CI 0.103–0.602); and mothers having neonates whose birth length > 47.5 cm (AOR 0.271; 95% CI 0.113–0.651) had reduced odds for low birthweight. Alternatively, mothers with gestational weeks ≥ 42 (AOR 23.21; 95% CI 4.603–56.19) and mothers from the richest households (highest socioeconomic homes) (AOR 14.25; 95% CI 1.638–23.91) were more likely to birth to macrosomic infants. Conclusion: The prevalence rates of low birthweight and macrosomia were relatively high. Anaemia in the first and third trimesters was strong determinants of low birthweight. Being minority ethnic group, frequency of antenatal visits, and childbirth length reduced the risk of low-weight births. Advanced gestational age and socioeconomic status of mothers were also predictors of macrosomia. Hence, nutrition counselling, community health education, and promotion of lifestyle improvement coupled with strengthening of health service delivery are recommended interventions. © 2023, BioMed Central Ltd., part of Springer Nature. | Open |
| Adokiya M.N.; Bukari M.; Ndago J.A.; Kuganab-Lem R.B.; Garti H.; Konlan M.Y.; Amoasah A.A.; Ali Z. | Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in Ghana | 2023 | PLoS ONE | Introduction Despite the gains on exclusive breastfeeding (EBF), recent nationwide surveys have consistently revealed a decline in EBF rates in Ghana. The World Food Programme implemented an intervention for Enhanced Nutrition and Value Chain (ENVAC) which was based on three pillars including pregnant women, lactating women, adolescent and children under two years old being beneficiaries of the third pillar since the first 1000 days are critical for averting malnutrition. The social behavior change communication (SBCC) interventions implemented as part of this project have a potential to increase EBF among beneficiaries but this has not been measured. Therefore, this study assessed the prevalence of EBF practice among mothers with children under two years old who were beneficiaries of the ENVAC project and its associated factors in northern Ghana. Methods This was a cross-sectional study involving 339 mother-child pairs in two districts of the northern region of Ghana. Participants were mother-child pairs who benefitted from the ENVAC project, which used SBCC strategies to promote good feeding and care practices as well as address other causes of malnutrition during antenatal care and child welfare clinic services among pregnant women, lactating mothers, and children under two years. We used WHO standard questionnaire to assess breastfeeding practices. Factors associated with EBF were modelled using multivariable logistic regression. Results Exclusive breastfeeding was 74.6% (95%CI = 69.5% -79.2%) in the ENVAC project areas, a 31.7% points higher than recent national levels. Adjusted analyses showed that EBF practice was associated with increasing maternal education: moderately educated women [aOR = 4.1 (95% CI = 2.17–7.66), P<0.001], and high [aOR = 9.15, (95% CI = 3.3–25.36), P<0.001], and access to pipe-borne water in households [aOR = 2.87, (95% CI = 1.11–7.43), P = 0.029]. Conclusion A social behaviour change communication strategy implemented by ENVAC to lactating mothers likely improved exclusive breastfeeding practice in two districts of northern Ghana. EBF practices were higher among beneficiaries with high education and households with access to pipe-borne water. A combination of SBCC strategies and maternal and household factors are likely the best way to increase EBF rates in impoverished communities and warrants further investigation through future research. Copyright: © 2023 Adokiya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Adongo E.A.; Ganle J.K. | Predictors of neonatal mortality in Ghana: evidence from 2017 Ghana maternal health survey | 2023 | BMC Pregnancy and Childbirth | Background: Neonatal mortality contributes about 47% of child mortality globally and over 50% of under-5 deaths in Ghana. There is limited population level analysis done in Ghana on predictors of neonatal mortality. Objectives: The objective of the study was to examine the predictors of neonatal mortality in Ghana. Method: This study utilizes secondary data from the 2017 Ghana Maternal Health Survey (GMHS). The GMHS survey focuses on population and household characteristics, health, nutrition, and lifestyle with particular emphasis on topics that affect the lives of newborns and women, including mortality levels, fertility preferences and family planning methods. A total of 10,624 respondents were included in the study after data cleaning. Descriptive statistical techniques were used to describe important background characteristics of the women and Pearson’s Chi-squares (χ2) test used to assess association between the outcome (neonatal death) and independent variables. Multivariate logistic regression analysis was done to estimate odd ratios and potential confounders controlled. Confidence level was held at 95%, and a p < 0.05 was considered statistically significant. Data analysis was done using STATA 15. Results: The prevalence of neonatal mortality was 18 per 1000 live births. ANC attendance, sex of baby, and skin-to-skin contact immediately after birth were predictors of neonatal mortality. Women with at least one ANC visit were less likely to experience neonatal mortality as compared to women with no ANC visit prior to delivery (AOR = 0.11; CI = 0.02–0.56, p = 0.01). Girls were less likely (AOR = 0.68; CI = 0.47–0.98; p = 0.03) to die during the neonatal period as compared to boys. Neonates who were not put skin-to-skin contact immediately after birth were 2.6 times more likely to die within the neonatal period than those who were put skin-to-skin contact immediately after birth (AOR = 2.59; CI = 1.75–3.83, p = 0.00). Conclusion: Neonatal mortality remains a public health concern in Ghana, with an estimated rate of 18 deaths per 1,000 live births. Maternal and neonatal factors such as the sex of the newborn, the number of antenatal care visits, and skin-to-skin contact between the newborn and mother immediately after birth are the predictors of neonatal mortality in Ghana. © 2023, Crown. | Open |
| Aduful A.K.; Boamah-Mensah F.; Nyarko M.Y.; Neizer M.L.; Brew Y.N.; Williams L.A.; Calys-Tagoe B.N.L.; Ackun H.K.M.; Tette E.M.A. | Family Needs Assessment of Patients with Cerebral Palsy Attending Two Hospitals in Accra, Ghana | 2023 | Children | Background: The family represents the most essential and supportive environment for children with cerebral palsy (CP). To improve children’s outcomes, it is crucial to consider the needs of families in order to offer family-centered care, which tailors services to these needs. Objective: We conducted a needs assessment to identify the family needs of patients with CP attending two hospitals in Accra. Methods: The study was a cross-sectional study involving primary caregivers of children with CP attending neurodevelopmental clinics. Structured questionnaires were used to collect data spanning an 8-month period. The data were summarized, and statistical inference was made. Results: Service needs identified were childcare, counseling, support groups, financial assistance, and recreational facilities. Information needs included adult education, job training/employment opportunities, education, health and social programs, knowledge about child development, and management of behavioral and feeding/nutrition problems. Reducing extensive travel time was desirable to improve access to healthcare. With the increasing severity of symptoms came the need for improved accessibility in the home to reduce the child’s hardship, as well as assistive devices, recreational facilities, and respite for the caregiver(s). Conclusion: Families of children with CP have information, service, and access needs related to their disease severity and family context. © 2023 by the authors. | Open |
| Agyekum P.B.; Dombrowski J.; Lutterodt H.E.; Ofosu I.W. | Consumption patterns and usage of selected underutilized legumes in a Ghanaian community | 2023 | Legume Science | Underutilized legumes are a good source of plant proteins, but they exhibit a hard-to-cook nature and poor digestibility due to the presence of anti-nutritional factors. This study focused on the factors that drive the utilization of selected underutilized legumes in the Techiman municipality of Ghana. The legumes studied were Vigna subterrenea (Bambara groundnut), Cajanus cajan (Pigeon pea), Phaseolus lunatus (Lima bean), Parkia biglobosa (African Locust bean), and Canavalia gladiata (Sword bean). The survey provided insight into the familiarity, uses, preparation methods, and the extent of knowledge of their nutritional benefits. The demographics of the participants studied were also described, and statistical analysis was done using descriptive statistics. The results showed that the legumes were well recognized despite their underutilized status and they find use primarily in domestic savory food preparation. Consumption was mostly occasional despite the knowledge of its nutritional benefits. Processing mainly referred to boiling with prior removal of foreign materials and soaking in water. Nutrition stood out as the most desired property. Strategies aiming at maximizing the use of these legumes must be considered and developed since these legumes appear to be a formidable resource for combating the prevalent food insecurity in Africa. © 2023 The Authors. Legume Science published by Wiley Periodicals LLC. | Open |
| Agyemang G.O.; Attu S.S.; Annan R.A.; Okonogi S.; Sakura T.; Asamoah-Boakye O. | Factors associated with food consumption and dietary diversity among infants aged 6–18 months in Ashanti Region, Ghana | 2023 | PLoS ONE | Background Studies have reported a poor diet quality among children in Ghana and other developing countries. Inadequate dietary diversity among children may lead to deficiencies in micronutrient intake necessary for growth and other cognitive functions. Understanding factors associated with infants’ diverse diets is a key step to promoting adequate infant and young child nutrition. This study sought to determine the factors associated with food consumption and dietary diversity (DD) among infants. Methods In this cross-sectional study among 1503 mothers-infant (aged 6–18 months) pairs from rural, urban, and peri-urban districts of Ashanti Region, factors associated with food consumption and DD were evaluated. The FAO 18-food group DD questionnaire was used to determine previous food group intake, while a structured questionnaire was used to capture data on the mother’s socio-demographic parameters and child morbidity. Data were analyzed using descriptive statistics, the Chi-square test, and binary logistic regression to compare mothers and infants who had adequate and inadequate DDS of 9 out of 18 food groups and the predictors of dietary diversity. Results About 64.7% of the infants did not meet the minimum dietary diversity. Over two-third (77.4%) of the children consumed maize porridge the previous day. Foods which were less consumed included vegetables (35%), animal milk (38.9%), and meat (organ 14%, any meat 26%). The mean food group intake from 18 food groups was 7.0, and the majority (64.7%) did not meet the recommended 9 food group intake. Significantly more younger children (6–11 months) (74%, p<0.001) compared with older children (12–18 months) (52.5%) did not meet the minimum DDS. Also compared with the older children, the younger ones had above two times increased odds of inadequate DD (OR = 2.5, p<0.001, 95% CI = 1.4–4.4). When controlled for gender, children from peri-urban areas (OR = 5.2, p = 0.260, 95% CI = 0.2–93.2) and rural areas (OR = 1.8, p = 0.650, 95% CI = 0.2–9.3) had increased odds of lower DD than urban children. Children of unemployed caregivers had an increased odds of low DD (OR = 2.3 p<0.001, 95% CI 1.7–3.2) compared with children of employed caregivers. Finally, children of caregivers with better nutrition knowledge (nine correct answers from 12 questions) had lower odds of having lower dietary diversity (adjusted OR = 0.9, p = 0.85, 95%CI = 0.5–1.6) than those with less knowledge. Conclusions Low DD was common among infants and associated with infants age, caregivers’ areas of residence, employment status, and level of nutrition education. Children who did not meet the minimum dietary diversity were not fed particular foods such as vegetables, animal milk, and organ meat. Proper maternal nutrition education and feeding practices targeting age-specific needs and community livelihood support systems are necessary to improve dietary diversity of infants. Copyright: © 2023 Opoku Agyemang et al. | Open |
| Akanbonga S.; Hasan T.; Chowdhury U.; Kaiser A.; Bonny F.A.; Lim I.E.; Mahmud I. | Infant and young child feeding practices and associated socioeconomic and demographic factors among children aged 6–23 months in Ghana: Findings from Ghana Multiple Indicator Cluster Survey, 2017–2018 | 2023 | PLoS ONE | Background Association between poor infant and young child feeding (IYCF) practices and malnutrition in infants and young children (IYC) is well established. Furthermore, appropriate IYCF practices are important during the first 1,000 days of life to ensure optimal health and development. Understanding IYCF practices and associated socioeconomic and demographic factors will inform interventions to achieve the UN 2030 Sustainable Development Goal (SDG) target to end malnutrition in all forms. Objective This study estimates the prevalence of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), and Minimum Acceptable Diet (MAD), and examines their association with socioeconomic and demographic characteristics among children aged 6–23 months in Ghana. Method We used data from the Ghana Multiple Indicator Cluster Survey 6 (GMICS6) conducted in 2017–18. Participants were recruited through multi-stage stratified cluster sampling. Information on caregiver’s self-reported breastfeeding status and 24-hour dietary recall of foods IYC were fed with were collected through face-to-face interviews. We estimated the prevalence of MDD, MMF and MAD with a 95% confidence interval (CI). We investigated the socioeconomic and demographic determinants of MDD, MMF and MAD using univariate and multivariable logistic regression analyses. Findings Among 2,585 IYC aged 6–23 months, MDD, MMF and MAD were estimated as 25.46%, 32.82% and 11.72% respectively. Age of the IYC, educational status of the mothers/primary caregivers, and resident regions were found to have positive associations with MDD, MMF and MAD. In addition, the richest household wealth index and urban area of residence were found to have significant positive associations with MDD. Conclusion We report a low prevalence of MDD, MMF and MAD. Efforts to improve IYCF practices among children aged 6–23 months in Ghana should focus on multi-sectorial approaches including increasing access to formal education, income-generating activities and addressing regional and rural-urban inequity. © 2023 Akanbonga et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Akanko I.; Abor P.A.; Tetteh C.K. | A cross-sectional study on coping strategies of frontline healthcare workers amid the COVID-19 pandemic in a developing country | 2023 | SAGE Open Medicine | Objectives: Frontline healthcare workers encountered a heightened susceptibility to negative psychological symptoms and behavioral shifts in light of the coronavirus disease 2019 pandemic. This study determined the coping strategies adopted by frontline healthcare workers in Ghana as well as assessed any differences based on demographics, job title, and ranking in four coronavirus disease 2019-designated centers in the Greater Accra region of Ghana. Methods: Using a hospital-based, mixed-method approach, the study was conducted between May 2021 and September 2021. A total of 94 frontline healthcare workers were randomly sampled and given a self-administered questionnaire, while 13 healthcare workers took in-depth interviews. Data from the survey were analyzed using both IBM SPSS and IBM AMOS and the interview data were transcribed verbatim and coded using thematic analysis. Results: The study revealed that coronavirus disease 2019 has affected the psycho-social life of frontline healthcare workers mainly in the form of depression, anxiety, and stress. The three main coping strategies adopted by frontline healthcare workers include personal preventative measures (most dominant), seeking external expert support, and obtaining institutional support. While healthcare workers within the age group 30–39 years were found most compliant with the adoption of personal preventive measures and those below 30 years were found least compliant. Conclusion: This study concludes that frontline healthcare workers have been affected by a considerable level of anxiety, stress, and depression during the coronavirus disease 2019 pandemic. The study recommends a robust psychological support system at various levels of health care and an Employee Assistance Program with access to a 24-h hotline counseling service for frontline healthcare workers, continuous personal protective equipment provision, regular evidence-based updates on the management of coronavirus disease 2019 patients, and increased commitment from the government in addressing the medical needs of infected frontline healthcare workers. © The Author(s) 2023. | Open |
| Akpalu W.; Okyere M.A. | Fish Protein Transition in a Coastal Developing Country | 2023 | Environmental and Resource Economics | In low-income food-deficit coastal countries, fish forms a critical source of animal protein. Yet, capture fisheries, which provide fish protein to the local populations, are typically overcapitalized and exhibit classical signs of biological overfishing, threatening the livelihoods of communities. With the high and increasing fishing pressure, the rate of stock depletion may continue to intensify, thereby tilting households’ preferences towards consumption of other types of animal protein depending on whether (or not) they have strong preferences for those types of protein. This, however, may have implications for the environment as the different types of protein have different environmental footprints. By employing a variant of the Suits Index (1977) and an Almost Ideal Demand Systems (AIDS) model, we found strong evidence that wealthier households in Ghana spend a lesser proportion of their protein budget on fish than their poorer counterparts. In addition, the other types of animal protein, except chicken, serves as substitutes for fish. © 2022, The Author(s), under exclusive licence to Springer Nature B.V. | Open |
| Alemu M.H.; Halloran A.; Olsen S.B.; Anankware J.P.; Nyeko P.; Ayieko M.; Nyakeri E.; Kinyuru J.; Konyole S.; Niassy S.; Egonyu J.P.; Malinga G.M.; Ng'ang'a J.; Ng'ong'a C.A.; Okeyo N.; Debrah S.K.; Kiiru S.; Acur A.; Roos N. | Promoting insect farming and household consumption through agricultural training and nutrition education in Africa: A study protocol for a multisite cluster-randomized controlled trial | 2023 | PLoS ONE | Background Edible insects are a sustainable source of high-quality animal protein. Insect farming is gaining interest globally, particularly in low-income countries, where it may provide substantial nutritional and economic benefits. To enhance insect farming practices in Africa, new farming systems are being developed. However, knowledge on how to best promote uptake of these systems is lacking. This study aims to fill this gap by investigating the effectiveness of educational interventions in promoting insect farming for household consumption in Africa. Method The study is designed as a multi-site randomized controlled trial to evaluate the impacts of agricultural training alone or in combination with nutrition education on the adoption of insect farming in Ghana, Kenya and Uganda. In each of the three countries, ninety-nine villages are randomly assigned to one of three arms: two intervention arms and a control arm with no interventions. Focusing on production (P), the first intervention arm covers agricultural training on insect farming combined with provision of insect production starter kits. Focusing on both production and consumption (PC), the second intervention arm involves the same intervention components as treatment P plus additional nutrition education. The impacts of the interventions are measured by comparing baseline and endline data collected one year apart. Primary outcomes are adoption of insect farming and consumption of the farmed insects. Discussion Understanding the drivers and impacts of novel agricultural practices is crucial for transitioning to sustainable food systems. The current project is the first to investigate how educational interventions promote insect farming for household consumption in low-income countries. The results will contribute evidence-based knowledge to support sustainable development through insect farming in Africa. Copyright: © 2023 Alemu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Amagloh F.C.; Atuna R.A.; Akabanda F.; Pobi N.O.; Donkor E.A.; Koomson G.; Amagloh F.K. | The potential of underutilised and biofortified grains, roots, and tubers in Ghana: A nutrition-sensitive approach for improved health | 2023 | CAB Reviews: Perspectives in Agriculture, Veterinary Science, Nutrition and Natural Resources | The prevalence of micronutrient deficiencies and non-communicable diseases are on the rise in Sub-Saharan Africa (SSA) despite the abundance of indigenous nutritious and biofortified crops. Rapid urbanisation and poor dietary habits have resulted in most Ghanaian households frequently consuming highly processed foods, sugar, salt, and unhealthy fats in place of complex carbohydrates such as whole grains, root and tuber crops, fruits, and vegetables. Existing postharvest and food processing practices may also not help consumers to make healthy food choices that would result in optimal nutrition. Applying a food systems approach will enable stakeholders to consider the solutions to these public health concerns through different lenses along the agricultural value chain. This review examines nutritious indigenous crops in Ghana, that include millet, sorghum, soybean, locust bean, aerial yam, taro, and cocoyam, considering how their nutrient composition could aid in disease prevention and health promotion among the populace. In addition, biofortified crops such as yellow and orange maize, high iron bean, yellow cassava, and orange-fleshed sweetpotato are discussed, highlighting the focal nutrients and their relation to health improvement. This review employs the food systems approach to critically examine how nutrition can be maximised along the various steps of the agricultural value chain. It concludes with recommendations at the individual and policy levels that could result in medium- and long-term positive impacts on nutrition and health status. © CAB International 2023. | Open |
| Amfo-Antiri A.; Agyapong N.A.F.; Cobbah L. | Dietary Habits and Nutritional Challenges of the Elderly in Ghana | 2023 | Journal of Nutrition and Metabolism | The elderly population is increasing worldwide. Dietary habits play a crucial role in prolonging life and preventing diseases. This cross-sectional study sought to investigate the dietary habits of the elderly in the Kwahu South District of the Eastern Region of Ghana and further ascertain the factors that constitute nutritional challenges among this group. A mixed method approach was used for the study. A questionnaire and focus group discussion guide were used to solicit data from study participants. A total of 97 participants made up of 59 males and 38 females participated in the study. Data on food habits reveal that staple food consumption especially those grown within the study area is common. Rice (34.1%), game meat (47.1%), banana (63.9%), and garden eggs (27.8%) were the commonly consumed foods by frequency. Mood (41.2%) and stress (24.8%) were identified as the most predominant determinants of food habits. Poly medication, toothache and loss, immobility, and financial and technological challenges were amongst the nutritional challenges mentioned by the elderly in this study. Results from the focus group discussion revealed high nutrition knowledge among the elderly through factors such as financial constraints that were mentioned as a barrier to the translation of this knowledge into practice. Strengthening of existing interventional programmes such as the Livelihood Empowerment Against Poverty and social interventions is needed to improve the dietary habits and nutritional intakes of the elderly. © 2023 Auswell Amfo-Antiri et al. | Open |
| Amoore B.Y.; Gaa P.K.; Ziblim S.-D.; Mogre V. | Preparedness of medical students to provide nutrition care following a nutrition education intervention | 2023 | BMC Research Notes | Background: Globally, 71% of deaths are due to non-communicable diseases (NCDs) of which 77% of these deaths occur in low-and-middle income countries. Nutrition is an important contributor to the occurrence, progression and management NCDs. Health care professionals’ promotion of the adoption of healthy dietary habits among individuals has been shown to reduce the occurrence of NCDs. We assessed the effects of a nutrition education intervention on medical students’ self-perceived preparedness to provide nutrition care. Methods: We administered a pre, post and four-weeks follow-up questionnaire to second year medical students who participated in a nutrition education intervention that adapted varied teaching and learning activities. Outcomes were self-perceived preparedness, relevance of nutrition education and perceived need for further training in nutrition. Repeated measures and Friedman tests were used to assess differences in mean scores across pre, post and 4-weeks follow up assessment based on p < 0.5 at 95% confidence interval. Results: The proportion of participants who felt prepared to provide nutrition care increased significantly (p = 0.001) from 38% (n = 35) at baseline to 65.2% (n = 60) immediately post-intervention and to 63.2% (n = 54) at 4-weeks follow-up. At baseline, 74.2% (n = 69) of the students perceived nutrition education to be relevant to their future career as medical doctors which increased to 85% (n = 78) immediately after the intervention (p = 0.026) and to 76% (n = 70) 4-weeks follow-up. The proportion of participants who reportedly said they will benefit from further training in nutrition increased from 63.8% (n = 58) at pre-intervention to 74.0% (n = 68) at post-intervention (p = 0.016). Conclusion: An innovative, multiple-strategy nutrition education intervention can improve medical students’ self-perceived preparedness to provide nutrition care. © 2023, The Author(s). | Open |
| Ankrah Twumasi M.; Essilfie G.; Ntiamoah E.B.; Xu H.; Jiang Y. | Assessing financial literacy and food and nutritional security relationship in an African country | 2023 | Heliyon | This study investigates the relationship between rural Ghanaian household food and nutrition security and financial literacy. We used the endogenous treatment regression (ETR) technique to address the analysis's potential selection bias problem. The findings of our study demonstrated a beneficial relationship between food and nutrition security and financial literacy. According to further studies, the relationship between food security and financial literacy is heterogeneous. Our findings may have some ramifications for promoting food and nutritional security while preserving rural development methods. © 2023 The Authors | Open |
| Ankrah Twumasi M.; Zheng H.; Asante I.O.; Ntiamoah E.B.; Amo-Ntim G. | The off-farm income and organic food expenditure nexus: Empirical evidence from rural Ghana | 2023 | Cogent Food and Agriculture | This study uses evidence gathered from survey responses from 572 rural households in Ghana to examine the link between organic expenditure and off-farm income. To solve the endogeneity problem related to off-farm income, we use the instrumental variable Tobit model. The findings showed that expenditure on organic food was strongly and favorably connected to off-farm income. According to the disaggregated findings, female off-farm income is significantly more positively correlated with organic food expenditure than male off-farm income. The results provide practical implications for facilitating organic food consumption and eliminating food and nutrition insecurity among rural dwellers. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Anku E.K.; Adu-Amoah H.G.; Ainuson-Quampah J. | Validity of STRONGkids and MUAC as nutritional screening tools for predicting acute malnutrition among hospitalized children in Accra, Ghana | 2023 | Health Sciences Investigations Journal | Background: Malnutrition is commonly reported among hospitalized paediatric patients. However, it is often not diagnosed leading to prolonged hospital stays and other medical complications. Objective: This study aimed at evaluating the validity of the Screening Tool for Risk of Nutritional Status and Growth (STRONGkids) and mid-upper arm circumference (MUAC) for assessing malnutrition in paediatric inpatients between the ages of 6 months and 5 years. The weight-for-height (WFH) z-score was used as a reference standard for the evaluation. Methods: A cross-sectional study design was used in this study. A total of 96 individuals were enrolled in the study from both the Princess Marie Louise Children’s Hospital and Korle Bu Teaching Hospital, located in Accra, Ghana. Data were collected on demographics, admission details, weight, height, MUAC, and length of hospital stay. The STRONGkids screening tool was used for nutrition risk screening. Data analysis was performed using R version 4.1.0. Descriptive statistics were used to report frequencies, averages, percentages, standard deviations, and interquartile ranges. Diagnostic values were computed for STRONGkids and MUAC using WFH z-scores. Cohen's kappa was utilized to measure inter-rater agreement, with statistical significance set at p < 0.05. Results: Males accounted for 59.3% (n = 57/96) of the study sample. The prevalence of malnutrition in this study was 30% [n = 27/96; 95% confidence interval (CI): 21-39%]. The sensitivity and specificity of STRONGkids were 70% (95% CI: 52-86%) and 43% (95% CI: 31-55%), respectively. The sensitivity and specificity of MUAC were 45% (95% CI: 27-63%) and 93% (95% CI: 86-99%), respectively. The inter-rater agreement, based on two blinded assessments, for STRONGkids, was 0.57 (p = 0.006). Conclusion: The study revealed that STRONGkids had a low overall degree of validity, while MUAC had a high validity for specificity but lower validity for other diagnostic values. As a result, it is not recommended to use STRONGkids or MUAC individually for screening pediatric malnutrition in this setting, but rather in conjunction. © 2023 University of Ghana College of Health Sciences on behalf of HSI Journal. All rights reserved. | |
| Annan R.A.; Apprey C.; Odeafo A.-B.; Benedicta T.-D.; Sakurai T.; Okonogi S. | Nutrient intakes and cognitive competence in the context of abstract reasoning of school-age children in the Tamale Metropolis of Ghana | 2023 | Nutrition and Food Science | Purpose: The association between nutrition and cognitive test performance among school children is limited in developing countries, including Ghana. This paper aims to investigate the relationship between nutrient intake and cognitive competence in the context of abstract reasoning among school-aged children in the Tamale Metropolis. Design/methodology/approach: The present cross-sectional study recruited 596 children aged 9–13 years from government-owned and private primary schools in Tamale Metropolis. Dietary intake was assessed by using three-day repeated 24-hour recall. Cognition was assessed by the Raven’s Coloured Progressive Matrices (RCPM) test, made up of 36 questions and used as a continuous variable, whereby higher scores indicated better cognition. Findings: The majority of the children did not meet the recommended dietary allowances for protein (55.5%) and fibre (94.0%) and estimated adequate requirement for energy (86.6%), folate (72.8%), vitamin E (90.6%) and zinc (74.8%). More girls (55.1%) performed poorly in the cognition test than the boys (45.7%) (p = 0.029). Between-subject effects determined using univariate and multivariate analyses indicated age (p = 0.002), dietary folate (p = 0.016), vitamin C intake (p = 0.011), combined age and dietary folate (p = 0.049) and combined age and dietary vitamin C (p = 0.022) significantly affected cognition scores. Girls had lower odds (AOR = 0.7, p = 0.021, 95%CI = 0.5–0.9) of scoring above the 50th percentile in cognition test than boys. Research limitations/implications: The current nutrient intakes of the children were inadequate. The children performed poorly in Raven’s cognition test of abstract reasoning, and this was associated with being a girl. Originality/value: To the best of the authors’ knowledge, this study is the first to investigate nutrient intakes and RCPM test performance among children in Northern Ghana. Thus, the findings of the study provide relevant information needed by stakeholders to implement nutrition programs in basic schools, aimed at ensuring optimal nutrition achievement among school children for improved cognition. © 2022, Emerald Publishing Limited. | Open |
| Anning-Dorson T. | CASSAVA-GARI VALUE CHAIN PARTICIPATION AND RURAL WOMEN’S WELLBEING: AN EXPLORATORY STUDY | 2023 | African Journal of Food, Agriculture, Nutrition and Development | Gender disparity has a severe and long-term consequence on women especially in developing African countries such as Ghana. The socio-economic effect of gender inequality is harsher on rural women dwellers in Ghana due to lack of access to business and livelihood empowering opportunities. One way to deal with the above and improve the economic wellbeing of rural women dwellers is to create economic opportunities from which they can earn a good income. In Ghana, rural women could participate in the entire value chain of food crops such as cassava as they already participate in its cultivation (upstream activities of the supply chain). The current study adopts the approach of literature review on cassava and gari production in Ghana; and conducts interviews and observations on gari processing in Ghana to share useful lessons on how to deal with socio-economic effect of gender disparity among rural women dwellers. This study interviewed women in two gari processing enclaves in the country to provide useful insight on how women wellbeing could be enhanced. A total of 17 women entrepreneurs, 33 female workers and 7 farmers from 10 communities were interviewed and observed. Firstly, this study provides an understanding of the cassava-gari (roasted fermented cassava in a form of tiny grains) value chain, and the role rural women entrepreneurs can play to enrich their livelihood. Secondly, the study highlights the key activities of gari processing by women in rural Ghana, the challenges faced, and provides valuable conclusions on how to bridge the gender gap through women’s participation in an enhanced cassava-gari value chain. Lastly, two important issues are highlighted with respect to rural women’s participation in an enhanced gari value chain: (1) the opportunity for affordable nutrition through a common local farm produce, and (2) the economic livelihood of rural women. While rural women possess enough capacity to participate meaningfully in the value chain, there are still constraints that can be dealt with by any enterprise that seeks to venture into large-scale commercial fortified gari production. Such ventures, be it a social (businesses for social good) or commercial (profit centered businesses) enterprise, will enhance access to affordable nutrition as well as economic empowerment. © 2022,Zpravy Lesnickeho Vyzkumu. All Rights Reserved. | Open |
| Ansah G.; Amoatey H.M.; Amiteye S.; Oduro V.; Amenorpe G.; Kutufam J.T.; Dzimega D.A.; Abive-Bortsi M.; Dorvlo I.K. | YELLOW MAIZE BREEDING FOR HIGHER BETA-CAROTENE: FARMERS’ PERCEPTIONS OF VITAMIN-A DEFICIENCY CONSEQUENCES AND READINESS TO GROW IMPROVED VARIETIES IN GHANA | 2023 | African Journal of Food, Agriculture, Nutrition and Development | Vitamin A deficiency poses serious health concerns among the Ghanaian populace, particularly children and pregnant women. The production and consumption of yellow maize, which contains pro-vitamin A carotenoids such as beta carotene, is therefore encouraged. Consequently, yellow maize consumption is fast gaining acceptance. However, in the near future comensurate increases in production must be achieved to ensure food security. In this regard, the aims of the study were to: evaluate farmer willingness to cultivate yellow maize varieties with enhanced beta carotene content, ascertain extent of farmers’ knowledge on production constraints and mitigation, and evaluate farmers’ perception on nutritional benefits of yellow maize and the effects of vitamin A deficiency. The survey was conducted between January and May 2018 and it covered four districts representing the forest and guinea savanna ecological zones in Ghana. In each district, five communities with 10 participants each were covered. Most yellow maize farmers (78 %) were between 15 and 55 years, 42.5 % of the farmers had no formal education, 29 % had secondary education and only 8 % had tertiary education. The main challenges facing yellow maize (YM) farmers were pest control and low yield due to erratic rainfall. Majority (70 %) of the farmers had heard about vitamin A deficiency and also noticed stunted growth, mental retardation and poor eye sight in their communities but did not link such symptoms to vitamin A deficiency. Most respondents (70 %) were not aware that yellow maize contains beta carotene. Majority (70 %) of the respondents opined that improvement in the beta carotene content of yellow maize will greatly help to drastically minimize vitamin A deficiency and enhance food security. The information elicited from farmers will guide future development of yellow maize varieties for improved production and nutrition. © 2023, African Scholarly Science Communications Trust (ASSCAT). All Rights Reserved. | Open |
| Antwi K.; Antwi-Agyei P. | Intra-gendered perceptions and adoption of climate-smart agriculture: Evidence from smallholder farmers in the Upper East Region of Ghana | 2023 | Environmental Challenges | Climate-smart agriculture (CSA) remains a key strategy for sustaining agricultural systems and achieving food security and nutrition. Despite this, uncertainty remains on how intra-gendered dynamics influence its adoption in dryland farming systems. This study implements both quantitative and qualitative approaches including household surveys, key informant interviews, and focus group discussions to explore how intra-gender dynamics shape the perceptions and adoption of climate-smart agriculture in three selected communities (Katanga, Dakio, and Zonno) in the Bolgatanga East District of the Upper East Region of Ghana. Specifically, the study answers the following research questions: (i) What is the degree of change in rainfall and temperature in the Bolgatanga East District? (ii) How does gender shape the perception of smallholder farmers on climate variability in the study communities? (iii) Which CSA interventions are employed by smallholder farming households in the study communities? (iv) Which socio-demographic factors influence intra-gendered perceptions and adoption of CSA in the study communities? Binary logistic regression was used to identify the factors influencing male and female farmers’ perceptions and adoption of climate-smart agriculture. Rainfall and temperature trends from 2010 to 2020 were analyzed using the Mann-Kendall trend test. We found that over the past ten years, smallholder farmers in the district have seen rising temperatures and erratic rainfall patterns. Less educated female smallholder farmers adopted CSA interventions relative to more educated female farmers. Married male smallholder farmers employed CSA interventions on their farms compared to single and divorced male farmers. The adoption of CSA was higher for female farmers with inherited farmland than for those with rented land. Our results indicate that the source of income and farming experience influence male smallholder farmers’ adoption of crop rotation and their decision to diversify crops on their farms. The farmland tenure system, farming experience, and income source of female farmers influence their choice to change planting dates. The study recommends the integration of intra-gendered dynamics in policy reforms to reduce the vulnerability of smallholder farmers with different socioeconomic characteristics to climate variability in Ghana. © 2023 The Author(s) | Open |
| Apprey C.; Mensah M.; Agyarko D.; Klu Y.A.K.; Acquah S. | The influence of nutrition knowledge, attitude, practices, and dietary diversity on obesity among market women in the Cape Coast Metropolis, Ghana: A cross-sectional study | 2023 | Health Science Reports | Background and Aims: Obesity and overweight are major public health threat affecting many people globally. This study aimed to examine the role of nutrition knowledge (NK), attitude, practices, and dietary diversity (DD) on the prevalence of obesity among market women in Cape Coast, Ghana. Methods: This cross-sectional study was conducted at Abura and Kotokuraba markets in the Cape Coast Metropolis of Ghana. Apparently healthy female traders (n = 402) aged ≥18 years were selected randomly from the markets. DD was assessed with dietary diversity score (DDS) using a 24h dietary recall method. NK, dietary practices, and attitudes were assessed using validated semistructured questionnaires. Body composition parameters were assessed using appropriate tools. Descriptive and binary logistic regression analysis were performed. Statistical significance was considered at p < 0.05. Results: The prevalence of overweight was 31.84% and obesity was 39.30%. Majority of respondents had poor DD as about 91% had DDS <5. About 75% of the market women had no knowledge in nutrition. About 57% eat thrice daily and 82% take supper from 7 p.m. Knowledge in nutrition was significantly associated with body fat (OR = 0.45, 95% CI = 0.26–0.78, p = 0.004), body mass index (OR = 0.40, 95% CI = 0.28–0.71, p = 0.001), and waist-to-hip ratio (OR = 0.32, 95% CI = 0.19–0.56, p < 0.001). Conclusion: The prevalence of obesity and overweight was high among the market women. Poor NK and poor DD may have influenced this. A campaign on better dietary practices and delivery of nutrition education may help to minimize the prevalence of obesity among market women. © 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC. | Open |
| Arhin S.M.; Mensah K.B.; Agbeno E.K.; Henneh I.T.; Azize D.A.; Boateng A.; Opoku-Agyeman K.; Ansah C. | Pharmacotherapy for Infertility in Ghana: A Prospective Study on Prescription Patterns and Treatment Outcomes among Women undergoing Fertility Treatment | 2023 | Current Therapeutic Research - Clinical and Experimental | Background: Pharmacotherapy remains a first-line and major treatment option for couples struggling with infertility, especially in sub-Saharan Africa, where other expensive alternatives are rarely available. Despite the reliance on pharmacotherapy for treating infertility in the subregion, especially for those diagnosed with unexplained infertility, little is known about the actual influence of drug therapies on conception. Objectives: The study aimed to prospectively assess the prescription patterns and outcomes of pharmacotherapy for women undergoing fertility treatment in Ghana. Methods: This prospective cohort study involved 482 infertile women presenting for fertility treatment in 4 fertility clinics in the Cape Coast Metropolis of Ghana between March 2019 and February 2021. A simple random sampling technique was used to recruit subjects for the study. The women were followed up for 12 months to assess the outcome of drug therapy on conception. Data analysis was done using Stata version 14. Logistic regression was used to assess the association between trends with dichotomous outcomes. Results: The study identified that approximately 45.2% of the patients received monotherapy, whereas 24.1% received a combination of 2 drugs. Patients treated with a combination of 3 drugs were more likely to conceive (adjusted odds ratio = 4.10; 95% CI, 1.29–13.02; P = 0.02) than those without treatment. Conclusions: Patients treated with combination therapies had higher chances of conception than those without medications. However, a combination of nutritional and herbal therapies were associated with improved outcomes compared with conventional and nutritional supplements. The study's outcome could provide fertility specialists and stakeholders insight into choosing appropriate treatment options for prospective couples seeking fertility care. Consequently, fertility patients can access specific treatment options to meet their desired needs. © 2023 The Author(s) | Open |
| Arnouk M.K.; Marquis G.S.; Dodoo N.D. | PREDICTORS AND CONSEQUENCES OF OVERWEIGHT AND OBESITY IN THE HOUSEHOLD: A MIXED METHODS STUDY ON RURAL GHANAIAN WOMEN AND MEN FARMERS | 2023 | African Journal of Food, Agriculture, Nutrition and Development | Overweight/obesity (OW/OB) rates are increasing in Ghana. This study aims to identify the predictors of OW/OB in women, men, and at the household level (having at least one person as OW/OB in the household) in rural Ghana and examine local perceptions of the consequences of having an OW/OB person in the household. This was a cross-sectional mixed methods study. The quantitative data was a secondary analysis of the baseline data from the LinkINg Up (LU) project; a nutrition-sensitive agriculture intervention in eight rural communities in the Eastern Region of Ghana (ClinicalTrials.gov NCT03869853). The sample included 331 women and 205 men, 19-90 years old; there were 196 households that had both a participating woman and man (spouse, son, brother, or father). Logistic regression was used to assess variables associated with OW/OB in women (n=322), men (n=205), and households (n=196). Exposure variables included age, social support, mental health, self-efficacy, food security, the other family members’ OW/OB status, and others. Qualitative data included six focus group discussions (FGDs) (three with women and three with men, aged 22-69 years and recruited from the comparison arm of the LU project) were conducted in February-March 2022 in three of the eight project communities. A structured guide and a body figure instrument were used. The FGD recordings were translated and transcribed from Krobo to English. The analysis used an inductive thematic approach. Both women and men’s OW/OB were positively associated with age and wealth. Women’s OW/OB was negatively associated with age squared, and the score for mental health symptoms. Men’s OW/OB was negatively associated with being Krobo compared to other ethnicities. Households in the highest wealth tertile were 2.5-fold more likely to have at least one person who is OW/OB as compared to households in a lower wealth tertile. Participants expressed positive social consequences of having an OW/OB person for their families (for example respect). A person’s size was concerning only when it affected one’s ability to farm or make money, which would harm the household unit (for example lead to food insecurity, children dropping out of school). Having money was seen as a modifier for the negative effects. No negative consequences were perceived for OW people. The implications of the interruption of an OB person’s work on their family are worrisome and call for interventions that address poverty and food insecurity along with nutrition. © 2022,Zpravy Lesnickeho Vyzkumu. All Rights Reserved. | Open |
| Asirifi I.; Kaetzl K.; Werner S.; Heinze S.; Abagale F.K.; Wichern M.; Lübken M.; Marschner B. | Biochar for Wastewater Treatment and Soil Improvement in Irrigated Urban Agriculture: Single and Combined Effects on Crop Yields and Soil Fertility | 2023 | Journal of Soil Science and Plant Nutrition | This work evaluated the agronomic and soil fertility effects of using municipal wastewater or anaerobically treated wastewater for irrigation and applying biochar to a soil from the Guinea savanna agroecological zone of Ghana. For this purpose, untreated municipal wastewater (WW), the effluent of an anaerobic wastewater filtration system (TWW), and clean water (CW) were used as irrigation water in a pot trial. Additionally, rice-husk biochar in the form of raw biochar (RB), water-washed biochar (WB), and biochar used as wastewater filter material (FB) were added to the soil, testing the influence on soil fertility and crop yield. Lettuce and carrot were selected for the pot study, grown on soil mixed with the biochar types at 20 t ha−1 and irrigated with either WW, TWW, or CW. Our results indicated higher crop growth morphology and yields (up to 90% increase) by WW and TWW than CW. The average yield of carrot (34.1 g pot−1) and lettuce (29.3 g pot−1) with TWW irrigation were the highest, followed by 31.2 and 27 g pot−1 with WW, then the lowest yields of 21.7 and 19.5 g pot−1 of carrot and lettuce irrigated with CW respectively. Compared to WW, TWW was more beneficial to plant development, causing an up to 10% increase in crop yields. Soils with FB and WB produced similar agronomic effects and plant nutrient concentrations but were lower than pots amended with RB. Nevertheless, combining RB with TWW showed increasing effects on pH, CEC, and P availability in the highly weathered acidic soil. The results suggest a beneficial effect of biochar-filtered wastewater on soil fertility and crop growth, offering the potential to enhance resource use efficiency in irrigated urban agroecosystems. © 2023, The Author(s). | Open |
| Aurino E.; Gelli A.; Adamba C.; Osei-Akoto I.; Alderman H. | Food for Thought? Experimental Evidence on the Learning Impacts of a Large-Scale School Feeding Program | 2023 | Journal of Human Resources | There is limited experimental evidence on the effects of large-scale, government-led interventions on human capital in resource-constrained settings. We report results from a randomized trial of the government of Ghana’s school feeding. After two years, the program led to moderate average increases in math and literacy standardized scores among pupils in treatment communities and to larger achievement gains for girls and disadvantaged children and regions. Improvements in child schooling, cognition, and nutrition constituted suggestive impact mechanisms, especially for educationally disadvantaged groups. The program combined equitable human capital accumulation with social protection, contributing to the “learning for all” sustainable development agenda. © 2023 by the Board of Regents of the University ofWisconsin System | Open |
| Awoyemi A.E.; Issahaku G.; Awuni J.A. | Drivers of household food security: Evidence from the Ghana living standards survey | 2023 | Journal of Agriculture and Food Research | The continuous increase in the population remains a challenge as the demand for food also increases at a greater pace than food production. This study sought to examine the determinants of food security in Ghana using the Ghana Living Standard Survey round seven (GLSS 7) data. Households' food security was measured using a food consumption score (FCS). A partial proportional odds model (PPO) was employed to analyse the drivers of household food security in Ghana. The results showed that being a male household head, engaging in farming, and leaving in rural areas decrease the household's chances of falling into poor and borderline food consumption poverty. The study, therefore, concluded that households in Ghana may be food-consumption-poor due to factors such as low level of education, employment status, and the location of the household, that is being in a rural area. Policies that provide employment and bridge the rural-urban divide, increasing access to education, particularly, nutrition education will enhance household food security status. © 2023 The Authors | Open |
| Ayande R.E.A.; Agordoh P.D.; Salino V.J.; Webster-Ariyan C.; Collier L.; Asante M.; Carbone E.T. | Knowledge, attitudes, and practices of registered dietitians and nutritionists regarding enteral and parenteral nutrition support in Ghana: a needs assessment study | 2023 | Frontiers in Nutrition | Background: There is a paucity of data on enteral and parenteral (EN and PN) nutrition support (NS) provided by nutrition and dietetic practitioners in adult acute care settings in Ghana. Furthermore, gray literature suggests that Ghanaian clinical nutrition professionals (CNPs) are seldom involved in advanced nutrition care teams. Objectives: To assess the knowledge, attitudes, and practices of Ghanaian CNPs regarding EN and PN. Methods: An online cross-sectional survey was administered to Ghanaian CNPs ahead of a professional development workshop on EN and PN Support. Participants were asked questions about initiation and timing of NS, and knowledge on availability of commercial formula. A 5-point Likert scale was used to assess self-efficacy in using EN and PN. To assess practical knowledge on EN and PN, participants were asked to identify whether EN or PN was indicated for seven short case scenarios. Open-ended questions were used to assess reasons for participant self-ratings. Results: A total of 76 dietitians, nutritionists, students, and interns completed the survey. For EN, self-efficacy scores were lowest for the calculation of enteral goal rate, and goal volume (mean 3.20 ± 1.27), and writing of EN prescriptions (mean 3.07 ± 1.29). Self-efficacy scores for the formulation of alternative formulas in lieu of commercial formula were the highest (3.63 ± 1.36). For PN, self-efficacy scores for all domains were lower than 3, with the lowest scores observed for writing PN prescriptions (2.19 ± 1.14) and determining micronutrient additives (2.12 ± 1.04). We identified limited training and lack of practical exposure to NS, limited ability to effectively monitor tube feeds, and prohibitive cost and limited availability of EN and PN formula among the barriers impacting self-efficacy scores. Conclusion: Given the vital role that CNPs play in the delivery of EN and PN, it is important to develop professional training programs especially focused on PN to bridge knowledge and practice gaps. Copyright © 2023 Ayande, Agordoh, Salino, Webster-Ariyan, Collier, Asante and Carbone. | Open |
| Baffour B.; Aheto J.M.K.; Das S.; Godwin P.; Richardson A. | Geostatistical modelling of child undernutrition in developing countries using remote-sensed data: evidence from Bangladesh and Ghana demographic and health surveys | 2023 | Scientific Reports | Childhood chronic undernutrition, known as stunting, remains a critical public health problem globally. Unfortunately while the global stunting prevalence has been declining over time, as a result of concerted public health efforts, there are areas (notably in sub-Saharan Africa and South Asia) where progress has stagnated. These regions are also resource-poor, and monitoring progress in the fight against chronic undernutrition can be problematic. We propose geostatistical modelling using data from existing demographic surveys supplemented by remote-sensed information to provide improved estimates of childhood stunting, accounting for spatial and non-spatial differences across regions. We use two study areas–Bangladesh and Ghana–and our results, in the form of prevalence maps, identify communities for targeted intervention. For Bangladesh, the maps show that all districts in the south-eastern region are identified to have greater risk of stunting, while in Ghana the greater northern region had the highest prevalence of stunting. In countries like Bangladesh and Ghana with limited resources, these maps can be useful diagnostic tools for health planning, decision making and implementation. © 2023, The Author(s). | Open |
| Baguune B.; Aminu D.M.; Bekyieriya E.; Adokiya M.N. | Utilization of growth monitoring and promotion services and undernutrition of children less than two years of age in Northern Ghana | 2023 | BMC Nutrition | Background: Child undernutrition is a major public health problem and an important indicator of child’s health. Adequate nutrition is critical for a child’s growth and development. Growth monitoring and promotion (GMP) services is a nutrition intervention aimed at improving the nutritional status of children. We assessed the utilization of growth monitoring and promotion services and nutritional status of children less than two years of age in northern Ghana. Methods: This was a descriptive cross-sectional study that involved face-to-face interviews among 266 mothers with children < 2 years of age attending child welfare clinics (CWC). We also collected anthropometric measurements. Descriptive statistic was performed and data presented as percentage. The nutritional status of children was classified as underweight (weight-for-age z score < -2 standard deviations), stunted (length-for-age Z score < − 2) and wasted (weight-for-length z score < -2) while utilization of GMP services was based on attendance to CWC and ability to interpret different growth curves. Chi square test was used to determine the relationship between utilization of GMP services and nutritional status of children at an alpha of 0.05. Results: The prevalence of undernutrition shows that, 18.6% of the children were underweight, 14.7% were stunted and 7.9% were wasted. About 60% of the mothers accessed GMP services regularly. Less than half of the mothers were able to interpret the children’s growth curve correctly: falling growth curve (36.8%), flattening growth curve (35.7%) and rising growth curve (27.4%). In combining children < 6 and 6–23 months of age, only one-third (33.1%) of mothers practiced appropriate infant and young child feeding. Regular GMP services was found to have a statistically significant relationship with underweight (P < 0.001), stunting (P = 0.006) and wasting (P = 0.042). Conclusion: The level of undernutrition remains high and child feeding practices is poor. Maternal utilization of GMP services is also low in the study area. Similarly, ability to interpret the child’s growth curve appropriately persist as a challenge among women. Thus, attention is needed to improve utilization of GMP services to address child undernutrition challenges. © 2023, The Author(s). | Open |
| Bentil H.J.; Adu-Afarwuah S.; Rossi J.S.; Tovar A.; Oaks B.M. | Dietary magnesium intakes among women of reproductive age in Ghana-A comparison of two dietary analysis programs | 2023 | PLoS ONE | Background Despite the importance of magnesium to health and most importantly to women of reproductive age who are entering pregnancy, very few surveys have investigated the magnesium status of women of reproductive age, particularly in Africa. Additionally, the software and programs used to analyze dietary intake vary across countries in the region. Objective To assess the dietary magnesium intake of women of reproductive age in Ghana and to compare the estimate of magnesium intake obtained from two commonly used dietary analysis programs. Methods We collected magnesium intake from 63 Ghanaian women using a semiquantitative 150-item food frequency questionnaire. Dietary data was analyzed using two different dietary analysis programs, Nutrient Data Software for Research (NDSR) and the Elizabeth Stewart Hands and Associates (ESHA) Food Processor Nutrition Analysis software. We used the Wilcoxon signed rank test to compare the mean differences between the two dietary programs. Results There were significant differences between the average dietary magnesium intake calculated by the two dietary programs, with ESHA estimating higher magnesium intake than NDSR (M±SE; ESHA: 200 ± 12 mg/day; NDSR: 168 ± 11 mg/day; p<0. 05). The ESHA database included some ethnic foods and was flexible in terms of searching for food items which we found to be more accurate in assessing the magnesium intake of women in Ghana. Using the ESHA software, 84% of the study women had intake below the recommended dietary allowances (RDA) of 320mg/day. Conclusion It is possible that the ESHA software provided an accurate estimate of magnesium in this population because it included specific ethnic foods. Concerted efforts such as magnesium supplementation and nutrition education should be considered to improve the magnesium intake of women of reproductive age in Ghana. © 2023 Bentil et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Botha N.N.; Ansah E.W.; Segbedzi C.E.; Darkwa S. | Public health concerns for food contamination in Ghana: A scoping review | 2023 | PLoS ONE | Nutrition is sturdily and rapidly becoming the foremost determinant of health in today’s Sars-Cov-2 and climate change ravaged world. While safe food sustains life, contamination obliterates its values and could result in death and short to long term morbidity. The purpose of this scoping review is to explore food contamination in Ghana, between 2001–2022. Using Arksey and O’Malley’s procedure, a systematic literature search from PubMed, JSTOR, ScienceDirect, ProQuest, Scopus, Emeralds Insight, Google Scholar, and Google was carried out. Following the inclusion criteria, 40 published and grey literature were covered in this review. The review revealed the following: Studies on food contamination involving Greater Accra, Ashanti, Central, and Eastern Regions alone account for over 50% of the total number of such studies conducted in Ghana; regulators failed in enforcing regulations, monitoring and supervision; managers failed to provide adequate infrastructure and facilities. The most common food safety risks of public health concern are: i) micro-organisms (E. coli/faecal coliforms, Staphylococcus aureus, Salmonella spp, Bacillus cereus, and Viral hepatitis); ii) drugs (Amoxicillin, Chlortetracycline, Ciprofloxacin, Danofloxacin, and Doxycycline) and; iii) chemicals (Chlorpyrifos). Salad, vegetables, sliced mango, meat pie, and snail khebab are of high public health risks. The following deductions were made from the review: Highly contaminated food results in death, short to long term morbidity, economic loss, and threatens to displace Ghana’s efforts at achieving the Sustainable Development Goals (SDG) 2. Thus, Government must resource key regulatory bodies to enhance their operational capacity, regulators must foster collaboration in monitoring and supervision of food vendors, and managers of food service outlets must provide adequate facilities to engender food safety culture. © 2023 Botha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Chamidah N.; Zaman B.; Muniroh L.; Lestari B. | MULTIRESPONSE SEMIPARAMETRIC REGRESSION MODEL APPROACH TO STANDARD GROWTH CHARTS DESIGN FOR ASSESSING NUTRITIONAL STATUS OF EAST JAVA TODDLERS | 2023 | Communications in Mathematical Biology and Neuroscience | A nutritional status of toddlers characterized by a lack of weight based on anthropometric index weight-for-age (W/A) is called underweight. In Indonesia, the anthropometric index is recorded on a Card Towards Health called KMS (Kartu Menuju Sehat) which refers to WHO–2005 Standard Growth Charts (WHO–2005 SGC). Samples used to design the WHO–2005 SGC were toddlers taken from Brazil, Ghana, India, Norway, Oman, and USA, that physically they are different from the Indonesian toddlers especially toddlers from East Java. This study aims to design Percentile Standard Growth Charts (Percentile SGC) of W/A based on samples of toddlers taken from East Java by using both least square spline ((LS-spline) and local linear estimators of a multiresponse semiparametric regression (MSR) model. Those obtained Percentile SGC would be used to assess the nutritional status of toddlers in East Java by comparing them with the WHO–2005 SGC. Results show that these Percentile SGC based on both LS-spline and local linear estimators give a lower reference than WHO–2005 SGC such that percentages of malnutrition and less-nutrition status categories provided by these Percentile SGC are also less than those provided by WHO–2005 SGC. In general, the Percentile SGC of W/A for boy and girl toddlers in East Java have the evaluator standard and have lower standard than the WHO–2005 SGC. © 2023 the author(s). | Open |
| Chamoun L.; Quinonez M.H.; Marquis G. | FACTORS INFLUENCING WOMEN’S ACCEPTANCE OF PALM WEEVIL LARVAE FOR CONSUMPTION IN PERI-URBAN COMMUNITIES IN THE ASHANTI REGION, GHANA | 2023 | African Journal of Food, Agriculture, Nutrition and Development | For Ghanaian women of reproductive age (WRA), anemia remains a pressing issue. Currently, at the global level, anemia affects 35% of this population according to the most recent “State of Food Security and Nutrition in the World” report. In Ghana, anemia is mostly associated with iron deficiency and, if left untreated, could result in several adverse outcomes including severe fatigue and exhaustion resulting in decreased work productivity, neurocognitive impairment, and complications with chronic kidney disease. Various strategies can effectively reduce iron-deficiency anemia at the population level, including food fortification, supplementation, and dietary improvement. Unfortunately, these have failed to reach Ghanaian women adequately and equitably, resulting in many not meeting their nutritional needs. As an alternative strategy to curtail iron deficiency, edible insects, such as palm weevil larvae, have been suggested for their nutritional benefits, cost-effective rearing, and yearly availability. As such, popularizing their consumption could present an opportunity to improve WRA’s iron status in Ghana. To assess the feasibility of this strategy, formative research is needed to examine local attitudes, knowledge, and beliefs associated with the consumption of palm weevil larvae. Formative research was conducted in five peri-urban communities in the Ashanti region of Ghana that were purposefully selected for the study. These communities were separated into two clusters based on their access to palm trees. The analysis was based on 12 focus group discussions conducted with 121 female respondents, at which point data saturation was reached. Thematic analysis was used to examine the facilitators and barriers to palm weevil larvae consumption as well as WRA’s general knowledge of nutrition and anemia. Women generally had favorable perceptions of palm weevil larvae as a nutritious food in its raw, frozen, and processed forms, and were eager to be involved in its value chain. The factors positively influencing the acceptance of palm weevil larvae were its perceived nutritional and health benefits, and its taste. The main barriers to its consumption in all communities were its scarcity, difficult and inconsistent access, and fear of unauthenticity and unsafety. Finally, despite women’s general awareness of the importance of iron, persistent misinformation by health-professionals undermined their perceived seriousness of iron-deficiency anemia. Women’s clear interest in palm weevil larvae is encouraging for the community-based domestication of palm weevil larvae. Future studies should examine the feasibility and logistical requirements of such a strategy and its impact on increasing the consumption of palm weevil larvae. © 2022,Zpravy Lesnickeho Vyzkumu. All Rights Reserved. | Open |
| Daba H.G.; Delele M.A.; Fanta S.W.; Satheesh N. | The extent of groundnut post-harvest loss in Africa and its implications for food and nutrition security | 2023 | Journal of Agriculture and Food Research | Reducing post-harvest loss conserves resources such as natural, human, and financial inputs that help reduce poverty, raise household incomes, and improve rural livelihoods. The plant-based protein, higher unsaturated fat content, and higher fiber value of groundnuts make them preferable for nutrition enhancement. Groundnut is also well known for its environmental significance, as it reduces the use of chemical fertilizer by fixing nitrogen from the air and enriching soil fertility. However, there are few published scientific reports on groundnut post-harvest loss assessment in African countries. Moreover, published studies of groundnut post-harvest loss focused primarily on biodeterioration during storage. Hence, this review aimed to assess the underlying causes, extent of post-harvest quality and quantity loss of groundnut in the supply chain, and post-harvest loss mitigating technologies in Africa and their implications for food and nutrition security. This review found that the higher drudgery required in the groundnut supply chain is a limiting factor for smallholder farmers in sub-Saharan African countries. Groundnut qualitative and quantitative post-harvest loss is higher during groundnut pod stripping and shelling and also during on-farm and warehouse storage of groundnut in the supply chain. Post-harvest losses of groundnut in African countries extend from 8.9% (Ghana) to 31% (Uganda). Higher-quality groundnut producers do not receive a higher market price as traders and processing factories do not test for aflatoxin content during purchase, which lets producers not follow labor- and cost-demanding good agricultural practices. In conclusion, adopting and providing improved groundnut varieties, aflatoxin control mechanisms, and post-harvest technologies of higher efficiency, lower cost, and local availability should be carried out. In addition, public awareness of aflatoxin toxicity and mitigation measures should be widely disseminated. © 2023 The Authors | Open |
| Dallmann D.; Marquis G.S.; Colecraft E.K.; Dodoo N.D. | MARITAL TRANSITION IS ASSOCIATED WITH FOOD INSECURITY, LOW DIETARY DIVERSITY, AND OVERWEIGHT IN A FEMALE POPULATION IN RURAL GHANA | 2023 | African Journal of Food, Agriculture, Nutrition and Development | Research from high-income countries shows that marital transition affects individuals’ nutrition outcomes. Yet, little is known about its effect on women’s food security status and nutrition outcomes in Sub-Saharan Africa. Moreover, most published studies merge cohabitation and marriage into one category, but these statuses might have a distinct effect on nutrition outcomes in different settings. This study examined the association between the marital transition of women living in a rural district in Ghana and their food security status, minimum dietary diversity, and overweight (body mass index (BMI) ≥ 25 kg/m2). This analysis used representative data from women with a child less than 12 months from the Upper Manya Krobo District, which was collected for the 2014 baseline of the Nutrition Links project in 137 villages (clinicaltrials.gov NCT01985243). Women’s marital transition was assessed by merging their current and previous marital status into five categories: i) continuously married; ii) remarried; iii) cohabitating with a previous union; iv) cohabitating with no previous union; v) single (majority never previously married). The adjusted logistic regression showed that, compared to women who were continuously married, those cohabitating—with or without a previous union—and those who were single were more likely to be food insecure (aOR = 2.49; 95% CI [1.31, 4.72], aOR = 2.01; 95% CI [1.13, 3.58], and aOR = 1.85; 95% CI [1.02, 3.38], respectively). Women who were cohabitating—with or without a previous union—were more likely not to meet the minimum dietary diversity than those who were continuously married (aOR = 1.82; 95% CI [0.98, 3.38] and aOR = 1.78; 95% CI [1.01, 3.12], respectively). Finally, compared to the continuously married group, cohabitating women with no previous union were less likely to be overweight (aOR = 0.40; 95% CI [0.22, 0.74]). These results are consistent with previous publications that showed married women were wealthier and more overweight. Moreover, these results indicate that cohabitation affects nutrition-related outcomes differently compared to marriage in a sub-Saharan setting. More attention must be placed on better understanding the social aspects that link women’s marital transition to diet and nutrition outcomes. © 2022,Zpravy Lesnickeho Vyzkumu. All Rights Reserved. | Open |
| Dambayi E.; Nakua E.; Aborigo R.A.; Chatio S.T.; Dalaba M.A.; Sekwo E.; Adoctor J.K.; Ofosu W.; Oduro A.R.; Nonterah E.A. | Exploring infant and young child-feeding practices among mothers of well-nourished children in northern Ghana: An INPreP substudy | 2023 | Food Science and Nutrition | This study investigated infant and young child-feeding (IYCF) practices among mothers of well-nourished children in northern Ghana. This was a qualitative study where in-depth individual interviews were conducted with participants. The interviews were audio recorded, transcribed, and QSR Nvivo software version 11 was used to organize the data before thematic analysis. It was observed that mothers of well-nourished children were likely to adhere to breastfeeding guidelines and also practice appropriate complementary feeding. Furthermore, these mothers mostly had some form of support from their husbands and mother-in-laws in feeding their infants. While adoption and adherence to appropriate IYCF practices contribute to improved nutrition outcomes in children, social support systems are needed to sustain the practice. © 2023 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC. | Open |
| Danso F.; Appiah M.A. | Prevalence and associated factors influencing stunting and wasting among children of ages 1 to 5 years in Nkwanta South Municipality, Ghana | 2023 | Nutrition | Childhood undernutrition continues to be a major public health problem and one of the most common causes of morbidity and mortality in developing countries. The risk factors of child undernutrition are diverse and change with time, place, and season.This study aimed to assess the prevalence and associated factors influencing stunting and wasting among children 1 to 5 years of age in the Nkwanta South Municipality, Ghana. This was a health facility-based descriptive cross-sectional study that used a multistage sampling technique to select 240 children 1 to 5 years of age from April to June 2019. Data were collected using a structured questionnaire and anthropometric measurements. The data were analyzed using ENA software 2011, and Stata version 15. Binary logistic regression was used to find the adjusted estimates and associations between undernutrition (stunting and wasting) and the exposure variables. P ≤ 0.05 was considered statistically significant at a 95% confidence interval. The prevalence of stunting and wasting among the children was 12.5% and 27.5%, respectively. Factors influencing stunting were parents’ working status, number of children in the household, child's age, birth interval, exclusive breastfeeding, child's vaccination status, and recurrent diarrhea. Furthermore, factors influencing wasting were parents’ educational level, parents' working status, child's age, birth interval, exclusive breastfeeding, poor appetite, child's vaccination status, and recurrent diarrhea. The results showed a high prevalence of stunting and wasting among children 1 to 5 years in the Nkwanta South Municipality. This finding indicates the degree to which nutritional screening for children is very crucial, and thus recommends government and health authorities to adapt or promote nutrition-related interventions such as educational awareness on the utilization of family planning services for birth spacing, exclusive breastfeeding practices, and vaccination to prevent undernutrition among young children. © 2023 The Author(s) | Open |
| Daum T.; Biesalski H.K.; Blaschke N.; Bosch C.; Güttler D.; Heni J.; Kariuki J.; Katusiime R.; Seidel A.; Senon Z.-N.; Woode G.; Birner R. | Nutrition-sensitive lockdowns: Conceptual framework and empirical insights from Africa during COVID-19 | 2023 | Development Policy Review | Motivation: Countries facing challenges of nutrition security confront a trade-off when dealing with pandemics such as COVID-19. Implementing lockdown measures, widely used worldwide, can help “flatten the curve” (of disease), but such measures may worsen nutrition security. Purpose: We aim to identify and justify nutrition-sensitive lockdown measures to reduce trade-offs with nutrition security. Methods and approach: We propose a conceptual framework which distinguishes eight lockdown measures and six pathways to nutrition security. To demonstrate the relevance of the pathways, we reviewed emerging literature on COVID-19 and nutrition security. We analysed the content of 1188 newspaper articles on lockdown effects in five African countries: Benin, Ghana, Kenya, Uganda and Zambia. Findings: Some lockdown measures, such as closing workplaces and restricting movement, potentially worsen nutrition far more than others. Banning events and public gatherings have far less impact on nutrition. This can be seen from the framework, the academic literature, and is supported by the analysis of newspaper reports in the five countries. Policy implications: It is better, when possible, to test and trace disease than to lock down. But when lockdowns are needed, the first recourse should be to measures that have few nutritional consequences, such as banning public events. When more drastic measures are necessary, nutritional harm should be mitigated by, for example, exempting farm labour from restrictions on movement, by replacing school meals with take-home rations, and, above all, providing income support to the most affected and most vulnerable households. © 2022 The Authors. Development Policy Review published by John Wiley & Sons Ltd on behalf of ODI. | Open |
| Davis S.L.M.; Pham T.; Kpodo I.; Imalingat T.; Muthui A.K.; Mjwana N.; Sandset T.; Ayeh E.; Dong D.D.; Large K.; Nininahazwe C.; Wafula T.; Were N.; Podmore M.; Maleche A.; Caswell G. | Digital health and human rights of young adults in Ghana, Kenya and Vietnam: A qualitative participatory action research study | 2023 | BMJ Global Health | Introduction Digital health offers the potential to strengthen health systems in low- and middle-income countries. However, experts have warned about threats to human rights. Methods We used qualitative methods to investigate how young adults in Ghana, Kenya and Vietnam use their mobile phones to access online health information and peer support, and what they see as the effect on their human rights. We applied a transnational participatory action research approach. Global and national networks of people living with HIV, AIDS activists, young adults and human rights lawyers participated in study design, desk review, digital ethnography, focus group discussions, key informant interviews and qualitative analysis. Results We interviewed 174 young adults ages 18-30 in 24 focus groups in 7 cities in Ghana, Kenya and Vietnam, and held 36 key informant interviews with national and international stakeholders. Young adults reported predominantly using Google, social media and social chat groups for health information. They emphasised reliance on trusted peer networks, and the role of social media health champions. However, gender inequalities, class, education and geography create barriers to online access. Young adults also disclosed harms linked to seeking health information online. Some described anxiety about phone dependence and risk of surveillance. They called for a greater voice in digital governance. Conclusion National health officials should invest in young adults' digital empowerment, and engage them in policy to address benefits and risks of digital health. Governments should cooperate to demand regulation of social media and web platforms to uphold the right to health. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | Open |
| de Jager I.; van de Ven G.W.J.; Giller K.E.; Brouwer I.D. | Seasonality and nutrition-sensitive farming in rural Northern Ghana | 2023 | Food Security | In rural sub-Saharan Africa, where malnutrition in all its forms is rife, the greatest gap between the availability of foods and the foods needed for a nutritious diet are faced during the ‘hunger season’. We investigated what rural households in Northern Ghana would need to grow to ensure year-round availability of a nutrient adequate diet or the income required to fulfil their dietary needs. We applied linear programming to model different scenarios and interventions. Our results provide three major insights. First, considering seasonality is crucial in nutrition-sensitive farming. Ensuring a nutritious diet year-round requires enhanced availability of vegetables and fruits throughout the year. Second, although staple crops do not provide the full range of essential nutrients, increasing their yields allows for a reduction of field size, freeing up space for the production of other foods belonging to a nutritious diet, such as vegetables. Third, small farms are unable to produce sufficient food to cover their needs. They depend on income both from agriculture and other sources, and the availability of types of foods on markets to meet their dietary needs. Our study shows the value of modelling the range of dietary effects from agricultural interventions in a specific context, using a local feasible nutritious diet as a starting point and taking seasonality into account. © 2022, The Author(s). | Open |
| Donkoh E.T.; Berkoh D.; Fosu-Gyasi S.; Boadu W.I.O.; Raji A.S.; Asamoah S.; Otabil K.B.; Otoo J.E.; Yeboah M.T.; Aganbire B.A.; Adobasom-Anane A.G.; Adams S.K.; Debrah O. | Evidence of reduced academic performance among schoolchildren with helminth infection | 2023 | International Health | Background: Soil-transmitted helminths (STHs) pose a formidable health risk to school-age children in resource-limited settings. Unfortunately, mass deworming campaigns have been derailed since the onset of the coronavirus disease 2019 pandemic. The present study assessed the cross-sectional associations between STHs, nutritional status and academic performance of schoolchildren in the Banda District of Ghana. Methods: Schoolchildren (5-16 y of age; n=275) were recruited through both school and household visits by community health workers using a multistage cluster sampling technique. In addition to school microscopy, anthropometric records were also taken. Results: The prevalence of geohelminthiasis was 40.4% (95% confidence interval 34.6 to 46.2). STHs targeted for elimination by the World Health Organization and national programmes were detected among schoolchildren. Children with intestinal parasite infection (53.7 [standard deviation {SD} 11.5]) had lower mean academic scores compared with uninfected children (59.6 [SD 16.9]) (p=0.034). In multiple regression analysis, intestinal parasite infection status and z-scores for weight-for-age showed a collective significant effect on the academic score (F1117=8.169, p<0.001, R2=0.125). Conclusions: Schoolchildren with STHs had poorer academic performance compared with uninfected children, despite their nutritional status. In addition to school feeding programmes, school-based mass drug administration campaigns may be critical for improving learning outcomes in young schoolchildren. © 2022 The Author(s). Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. | Open |
| Druye A.A.; Nelson K.; Robinson B. | Self-management for sickle cell disease among patients and parents: A qualitative study | 2023 | Chronic Illness | Objective: This study aimed to explore self-management practices among patients and parents of children with sickle cell disease (SCD). Methods: The qualitative descriptive design was employed. The study involved 19 participants comprising adult SCD patients ≥16 years, and nine parents of SCD children ≤ 15 years. Purposive sampling was conducted to select participants from a teaching hospital and SCD association. Data was collected using one-on-one interviews, transcribed verbatim, and analysed using qualitative content analysis. Results: Self-management was reported through four categories including preventive health, self-monitoring, self-diagnosis, and self-treatment. Hydration, nutrition, activity limitation, avoidance of cold temperatures, and supportive medications were the most common preventive health actions. Regarding self-monitoring and self-diagnosis, the parents emphasized objective indicators such as changes in urine and eye colour compared to the adults who utilize subjective indicators such as feeling unwell and easy fatigue. Pharmacological and non-pharmacological measures were reported by both groups for treating painful episodes, fever, leg ulcers, priapism, and unspecified symptoms. Discussion: The participants in this study practice several self-management actions with some differences in application between adults and children. Tailored self-management services may be helpful for adults and children when developing services for SCD patients. © The Author(s) 2023. | Open |
| Dugle G.; Antwi J.; Quentin W. | Peer support interventions in maternal and child healthcare delivery in sub-Saharan Africa: protocol for a realist review | 2023 | Systematic Reviews | Background: Peer support has been proposed as a promising policy intervention for addressing adverse maternal and child healthcare (MCH) outcomes in sub-Saharan Africa (SSA). Existing reviews on peer support largely draw on evidence from high-income countries or focus on single services like breastfeeding, nutrition or postnatal care. In contrast, this review aims to provide a comprehensive overview of the empirical literature on peer support interventions across various MCH services in sub-Saharan Africa. Specifically, we aim to understand how, why, for whom, and in what circumstances different forms of MCH peer support interventions contribute to improving healthcare outcomes in sub-Saharan Africa. Methods: This review follows five iterative steps for undertaking realist reviews (1) defining the review scope; (2) developing initial programme theories; (3) searching for evidence; (4) selecting and appraising evidence; and (5) extracting, analysing and synthesising evidence. Four databases–Cochrane Library, PubMed, CINAHL, and EMBASE–were repeatedly searched between March and June 2021. From a large volume of records retrieved from the database and citation search, 61 papers have been selected for review. We will conduct a second search of the same database covering June 2021 to the present before the final extraction and synthesis. The final list of selected papers will be imported into NVivo 12 software and organised, extracted, analysed and synthesised iteratively to examine and illustrate the causal links between contexts, mechanisms and outcomes of MCH peer support interventions in SSA. We have drawn on the existing literature on peer support in healthcare generally to develop initial programme theories. We will then use the empirical literature on MCH peer support interventions in SSA, inputs from a stakeholders’ workshop in Ghana and a conference presentation to refine the initial programme theory. Discussion: The review will develop an explicit theory of peer support intervention in healthcare delivery and provide insights for developing evidence-informed policy on the intervention. Drawing lessons from the different national contexts and diverse areas of MCH in SSA, the review will provide an analytically generalizable programme theory that can guide intervention design and implementation. While focusing on MCH peer support interventions in SSA, the review contributes to evolving conversations on the use of theory for health policy planning and complex intervention design and implementation globally. Trial registration: PROSPERO registration ID: CRD42023427751 . © 2023, BioMed Central Ltd., part of Springer Nature. | Open |
| Egyir I.S.; O'Brien C.; Bandanaa J.; Opit G.P. | Feeding the future in Ghana: Gender inequality, poverty, and food insecurity | 2023 | World Medical and Health Policy | As women's empowerment is critical for the adoption of agricultural technologies by farmers, some governments have over the last three decades adopted a gender equality approach to food security. In Ghana, women play a vital role as farmers and food processors, which means they impact household nutrition in important ways. In this article, we explore women's empowerment in maize-producing sites in Ghana by drawing on original data collected from over 400 farmers and service providers as part of a United States Agency for International Development-funded Feed the Future project. We employ a quasi-“women's empowerment in agriculture index” to measure the extent to which men and women maize producers are either empowered or disempowered in the domains of production, access to resources, control over income, leadership, and time allocation. Our study reveals that cost and time poverty are the main factors that influence the adoption of technologies to reduce postharvest losses. We also find that women are disproportionately disempowered in the areas of control over the use of income and time poverty. Importantly, we further find that researchers need to account for perceived versus actual empowerment when examining gender inequality in agriculture. Our study findings and policy recommendations will be of interest to policymakers, scholars, and development practitioners. © 2023 The Authors. World Medical & Health Policy published by Wiley Periodicals LLC on behalf of Policy Studies Organization. | Open |
| Ellahi B.; Dikmen D.; Seyhan-Erdoğan B.; Karabulut O.F.; Aitken A.; Agbozo F.; Zotor F.B. | Prevalence, risk factors, and self-awareness for hypertension and diabetes: rural–urban and male–female dimensions from a cross-sectional study in Ghana | 2023 | International Journal of Diabetes in Developing Countries | Background: Hypertension and diabetes remain the primary cause of non-communicable disease (NCD) related morbidity and mortality globally. Rural–urban transitions in developing countries might aggravate the risk factors and prevalence of these conditions. The study aims to determine prevalence, demographic, anthropometric, and diet-related predisposing factors for hypertension and diabetes among urban and rural dwellers and assess participants’ self-awareness of their hypertension and diabetes status. Methods: This cross-sectional survey involved 850 adult males and females age ≥ 18 years residing in urban and rural areas in the Hohoe Municipality of Ghana, randomly sampled using probability proportional to size. Data included demographic, anthropometric, physiologic (blood pressure, fasting blood glucose), and dietary information. Nutrient quantities were analysed using the Research to Improve Infant Nutrition and Growth (RIING) Nutrient Database Software. All other data was analysed in SPSS (v25). Risk factors for hypertension were estimated through ordinal logistic regression and the odds ratio (OR) with the corresponding 95% confidence level (CI) documented. Results: More females participated than males (58.4% vs 41.6%), similarly rural compared to urban inhabitants (53.5% vs 47.5%, p = 0.002) with a mean age of 47.3 ± 16.1 years. Females generally had higher adiposity, rural dwellers had higher BMI, whereas urban dwellers had higher waist and hip circumferences. Overall, 4.4% and 18.5% were diabetics and pre-diabetics, while 20.4% and 12.1% were overweight and obese respectively. Of the 36.8% hypertensives, only 18.2% were aware of their status, with significant male (40.3%) female (59.7%), and urban (43.5%) rural (56.6%) differences. Males had higher intakes of energy and nutrients of public health importance to hypertension, similar as rural inhabitants except for cholesterol. Advancing age (95% CI: 0.02.03–0.05), being male (OR: 1.56 95% CI:0.12–0.81), and increased BMI (95% CI: 0.01–0.11) were independently associated with hypertension. Conclusions: One third of the population were hypertensives but were unaware. Findings challenge the assumption of lower predisposition among rural inhabitants as we observe lifestyle habits consistent with increasing urbanisation. Efforts to mitigate rising NCD trend requires intensified community-based screening, awareness creation, and lifestyle interventions to improve diet, physical activity, and health seeking. © 2022, The Author(s), under exclusive licence to Research Society for Study of Diabetes in India. | Open |
| Folson G.K.; Bannerman B.; Atadze V.; Ador G.; Kolt B.; McCloskey P.; Gangupantulu R.; Arrieta A.; Braga B.C.; Arsenault J.; Kehs A.; Doyle F.; Tran L.M.; Hoang N.T.; Hughes D.; Nguyen P.H.; Gelli A. | Validation of Mobile Artificial Intelligence Technology–Assisted Dietary Assessment Tool Against Weighed Records and 24-Hour Recall in Adolescent Females in Ghana | 2023 | Journal of Nutrition | Background: Important gaps exist in the dietary intake of adolescents in low- and middle-income countries (LMICs), partly due to expensive assessment methods and inaccuracy in portion-size estimation. Dietary assessment tools leveraging mobile technologies exist but only a few have been validated in LMICs. Objective: We validated Food Recognition Assistance and Nudging Insights (FRANI), a mobile artificial intelligence (AI) dietary assessment application in adolescent females aged 12–18 y (n = 36) in Ghana, against weighed records (WR), and multipass 24-hour recalls (24HR). Methods: Dietary intake was assessed during 3 nonconsecutive days using FRANI, WRs, and 24HRs. Equivalence of nutrient intake was tested using mixed-effect models adjusted for repeated measures, by comparing ratios (FRANI/WR and 24HR/WR) with equivalence margins at 10%, 15%, and 20% error bounds. Agreement between methods was assessed using the concordance correlation coefficient (CCC). Results: Equivalence for FRANI and WR was determined at the 10% bound for energy intake, 15% for 5 nutrients (iron, zinc, folate, niacin, and vitamin B6), and 20% for protein, calcium, riboflavin, and thiamine intakes. Comparisons between 24HR and WR estimated equivalence at the 20% bound for energy, carbohydrate, fiber, calcium, thiamine, and vitamin A intakes. The CCCs by nutrient between FRANI and WR ranged between 0.30 and 0.68, which was similar for CCC between 24HR and WR (ranging between 0.38 and 0.67). Comparisons of food consumption episodes from FRANI and WR found 31% omission and 16% intrusion errors. Omission and intrusion errors were lower when comparing 24HR with WR (21% and 13%, respectively). Conclusions: FRANI AI–assisted dietary assessment could accurately estimate nutrient intake in adolescent females compared with WR in urban Ghana. FRANI estimates were at least as accurate as those provided through 24HR. Further improvements in food recognition and portion estimation in FRANI could reduce errors and improve overall nutrient intake estimations. © 2023 The Authors | Open |
| Fremmpong R.B.; Gross E.; Owusu V. | Crop diversity, sustainable food and nutritional security among smallholder farmers in Ghana | 2023 | British Food Journal | Purpose: The nexus between sustainable agri-food production and food security outcomes of farm households in sub-Saharan Africa is attracting policy attention. This study analyzes the effects of crop diversity on the incidence of food scarcity, dietary diversity, and the sale and consumption of own crops. Design/methodology/approach: The study uses panel data collected in 2015 and 2018 on a randomly selected sample of 2553 households from 49 villages in northern Ghana. The study employed a fixed effects modeling approach in the empirical analysis. Findings: The study finds that crop diversity is positively associated with better dietary diversity, reduced hunger, lower food expenditure, and higher consumption of own produce. The results show positive effects of crop diversity on the total harvested output and sale of agricultural production. Whilst sales improved sustainable food and nutrition security by providing purchasing power to buy nutritional inputs in the market, consumption of own produce rather improved food availability by reducing food scarcity and malnutrition. Practical implications: Crop diversity is one of the pathways for promoting sustainable agri-food production systems to ensure the food and nutritional security of vulnerable populations and promote biodiversity to achieve environmental goals in sub-Saharan Africa. Crop diversity reduces food expenditure and raises rural incomes through improved outputs and sales, which empowers farm households to diversify their dietary options to be able to overcome incidences of hunger and malnutrition in periods of food scarcity. Originality/value: The present study improves the understanding of sustainable agri-food production through crop diversity and its implications on food and nutrition security outcomes. The panel data and fixed effects modelling approach address the endogeneity problem between crop diversity and household tastes and preferences. © 2023, Emerald Publishing Limited. | Open |
| Garti H.; Wemakor A.; Badu A.; Bukari M. | Magnitude of undernutrition and its associated factors in children attending Child Welfare Clinics in Techiman Municipal, Ghana | 2023 | Nutrition and Food Science | Purpose: This study aims to estimate the magnitude of undernutrition and its associated factors [especially child health interventions at Child Welfare Clinics (CWCs)] among children in Techiman Municipality, Ghana. Design/methodology/approach: A facility-based analytical cross-sectional design involving 403 mothers/caregivers with children. Simple random sampling was used to sample study sites and participants. Child health interventions were assessed by adapting items used in the Ghana Demographics and Health Survey. Weight and length of children were measured and used to calculate anthropometric z-scores based on World Health Organization guidelines. Test for associations was performed using bivariate analysis and multivariate logistic regression. Statistical significance was considered at p < 0.05. Findings: The magnitudes of stunting, wasting and underweight were 20.6% [95% confidence interval (CI): 17–25], 11.4% (95% CI: 9–15), and 9.7% (95% CI: 7–13) respectively. Children aged 12–17 months [odds ratio (OR) = 3.1; CI: 1.3–7.5], male children (OR = 5.2; CI: 2.7–10.0) and children attending CWC 19–22 times (OR = 28.8; CI: 6.6–125) had increased odds of stunting. Additionally, belonging to households with one child under 5 (OR = 2.7; CI: 1.4–5.1) and using borehole/well water (OR = 2.7; CI: 1.4–5.3) were associated with increased odds of stunting. Similarly, being a female (OR = 3.5; CI: 1.6–8.0) and using borehole/well water (OR = 2.1; CI: 1.0–4.2) were associated with increased odds of underweight. Originality/value: The magnitude of malnutrition, specifically stunting and wasting, exceeds the threshold for public health significance. CWC attendance frequency, age and sex of the child, number of children under five years old in households and water source were significantly associated with undernutrition. © 2023, Emerald Publishing Limited. | Open |
| Ghosh T.; McCrory M.A.; Marden T.; Higgins J.; Anderson A.K.; Domfe C.A.; Jia W.; Lo B.; Frost G.; Steiner-Asiedu M.; Baranowski T.; Sun M.; Sazonov E. | I2N: image to nutrients, a sensor guided semi-automated tool for annotation of images for nutrition analysis of eating episodes | 2023 | Frontiers in Nutrition | Introduction: Dietary assessment is important for understanding nutritional status. Traditional methods of monitoring food intake through self-report such as diet diaries, 24-hour dietary recall, and food frequency questionnaires may be subject to errors and can be time-consuming for the user. Methods: This paper presents a semi-automatic dietary assessment tool we developed - a desktop application called Image to Nutrients (I2N) - to process sensor-detected eating events and images captured during these eating events by a wearable sensor. I2N has the capacity to offer multiple food and nutrient databases (e.g., USDA-SR, FNDDS, USDA Global Branded Food Products Database) for annotating eating episodes and food items. I2N estimates energy intake, nutritional content, and the amount consumed. The components of I2N are three-fold: 1) sensor-guided image review, 2) annotation of food images for nutritional analysis, and 3) access to multiple food databases. Two studies were used to evaluate the feasibility and usefulness of I2N: 1) a US-based study with 30 participants and a total of 60 days of data and 2) a Ghana-based study with 41 participants and a total of 41 days of data). Results: In both studies, a total of 314 eating episodes were annotated using at least three food databases. Using I2N’s sensor-guided image review, the number of images that needed to be reviewed was reduced by 93% and 85% for the two studies, respectively, compared to reviewing all the images. Discussion: I2N is a unique tool that allows for simultaneous viewing of food images, sensor-guided image review, and access to multiple databases in one tool, making nutritional analysis of food images efficient. The tool is flexible, allowing for nutritional analysis of images if sensor signals aren’t available. Copyright © 2023 Ghosh, McCrory, Marden, Higgins, Anderson, Domfe, Jia, Lo, Frost, Steiner-Asiedu, Baranowski, Sun and Sazonov. | Open |
| Greffeuille V.; Dass M.; Fanou-Fogny N.; Nyako J.; Berger J.; Wieringa F.T. | Micronutrient intake of children in Ghana and Benin: Estimated contribution of diet and nutrition programs | 2023 | Maternal and Child Nutrition | We estimated how micronutrient needs of young children, aged 6–24 months were covered by the standard (traditional) diets in Ghana and Benin, and the contributions of partial breastfeeding and national nutrition programs aimed at improving micronutrient status to overall micronutrient intakes. Estimates of micronutrient intake from standard diets were based on previous surveys, using the food composition table of West Africa (INFOOD). Recommended micronutrient intakes were based on World Health Organization recommendations. Children were grouped in three age groups (6–8, 9–12, and 13–24 months) to capture the changing dynamics of the complementary feeding period. As expected, from 6 months of age onwards, breastmilk didn't cover the micronutrient needs. The standard diets contributed only minimal to micronutrient intakes of children ranging from 0% to 37% of recommended intakes for Ca, Fe, Zn, vitamin A, vitamin D and iodine depending on the micronutrient considered. The contribution of mass (bio)-fortification programs to the coverage of micronutrient needs varied widely, depending on the staple food considered and the country, but overall did not allow to fill the gap in micronutrient needs of children except for vitamin A in some contexts. In contrast, consumption of voluntary fortified complementary food, especially formulated for the needs in this age groups, contributed substantially to overall micronutrient intake and could fill the gap for several micronutrients. The development of young child-targeted programs including micronutrient-dense foods, associated with interventions to increase the diet diversity and meal frequency, could significantly improve micronutrients intakes of children in both Ghana and Benin. © 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd. | Open |
| Hong B.V.; Zheng J.J.; Romo E.Z.; Agus J.K.; Tang X.; Arnold C.D.; Adu-Afarwuah S.; Lartey A.; Okronipa H.; Dewey K.G.; Zivkovic A.M. | Seasonal Factors Are Associated with Activities of Enzymes Involved in High-Density Lipoprotein Metabolism among Pregnant Females in Ghana | 2023 | Current Developments in Nutrition | Background: Small-quantity lipid-based nutrient supplements (SQ-LNS) during pregnancy and postnatally were previously shown to improve high-density lipoprotein (HDL) cholesterol efflux capacity (CEC) and length in the children of supplemented mothers at 18 mo of age in the International Lipid-Based Nutrient Supplements (iLiNS) DYAD trial in Ghana. However, the effects of SQ-LNS on maternal HDL functionality during pregnancy are unknown. Objective: The goal of this cross-sectional, secondary outcome analysis was to compare HDL function in mothers supplemented with SQ-LNS vs. iron and folic acid (IFA) during gestation. Methods: HDL CEC and the activities of 3 HDL-associated enzymes were analyzed in archived plasma samples (N = 197) from a subsample of females at 36 weeks of gestation enrolled in the iLiNS-DYAD trial in Ghana. Correlations between HDL function and birth outcomes, inflammatory markers C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP), and the effects of season were explored to determine the influence of these factors on HDL function in this cohort of pregnant females. Results: There were no statistically significant differences in HDL CEC, plasma lecithin-cholesterol acyltransferase (LCAT) activity, cholesteryl ester transfer protein (CETP) activity, or phospholipid transfer protein (PLTP) activity between mothers supplemented with SQ-LNS compared with IFA control, and no statistically significant relationships between maternal HDL function and childbirth outcomes. LCAT activity was negatively correlated with plasma AGP (R = -0.19, P = 0.007) and CRP (R = -0.28, P < 0.001), CETP and LCAT activity were higher during the dry season compared to the wet season, and PLTP activity was higher in the wet season compared to the dry season. Conclusions: Mothers in Ghana supplemented with SQ-LNS compared with IFA during gestation did not have measurable differences in HDL functionality, and maternal HDL function was not associated with childbirth outcomes. However, seasonal factors and markers of inflammation were associated with HDL function, indicating that these factors had a stronger influence on HDL functionality than SQ-LNS supplementation during pregnancy. Clinical Trial Registry number: The study was registered as NCT00970866. https://clinicaltrials.gov/study/NCT00970866 © 2023 The Authors | Open |
| Iddrisu W.A.; Gyabaah O. | Identifying factors associated with child malnutrition in Ghana: a cross-sectional study using Bayesian multilevel ordinal logistic regression approach | 2023 | BMJ open | OBJECTIVE: In developing countries, malnutrition is a noteworthy concern related to the well-being of people, and this study aimed to determine the factors that affect malnutrition among children below 5 years in Ghana. DESIGN: The study used a secondary data source, specifically the Ghanaian Multiple Indicator Cluster Survey Six (MICS 6), which was conducted by the Ghana Statistical Service in 2017-2018. The MICS data are hierarchical, as children are categorised within households, and households are further grouped within a higher cluster, violating the independence assumption that must be addressed in the analyses. This study used a Bayesian multilevel ordinal logistic regression to model, identify and analyse the factors linked to child malnutrition in Ghana. SETTING: The setting of the study was the household level across the previous 10 administrative regions in Ghana. PARTICIPANTS: Data for 8875 children under 5 years were used for the study. The data were gathered from households in all 10 administrative regions of Ghana using a sampling procedure consisting of stratification and random selection to ensure national representation. RESULTS: The results showed that the Northern Region of Ghana had the highest occurrence rate of severe and moderate malnutrition, and factors such as the count of children's books or picture books, whether the child experienced fever in the last 2 weeks, age and sex of the child, and the child's household wealth index quintile were strongly linked to malnutrition among Ghanaian children. CONCLUSION: These findings underscore the intricate interplay of factors contributing to child nutrition in Ghana and suggest that addressing malnutrition necessitates a comprehensive approach that considers factors such as access to healthcare and reading materials, household wealth, and other social and environmental factors. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | Open |
| Ismail A.; Madzorera I.; Apraku E.A.; Tinkasimile A.; Dasmane D.; Zabre P.; Ourohire M.; Assefa N.; Chukwu A.; Workneh F.; Mapendo F.; Lankoande B.; Hemler E.; Wang D.; Abubakari S.W.; Asante K.P.; Baernighausen T.; Killewo J.; Oduola A.; Sie A.; Soura A.; Vuai S.; Smith E.; Berhane Y.; Fawzi W.W. | The COVID-19 pandemic and its impacts on diet quality and food prices in sub-Saharan Africa | 2023 | PLoS ONE | Background Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods and nutrition, with recovery slowed down by lagging vaccination progress. Objective This study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. Methods We conducted a repeated cross-sectional study using a mobile platform to collect data from July-December, 2021 (round 2). We assessed participants' dietary intake of 20 food groups over the previous seven days and computed the primary outcome, the Prime Diet Quality Score (PDQS), and Dietary Diversity Score (DDS), with higher scores indicating better quality diets. We used generalized estimating equation (GEE) linear regression models to assess factors associated with diet quality during COVID-19. Results Most of the respondents were male and the mean age was 42.4 (±12.5) years. Mean PDQS (±SD) was low at 19.4(±3.8), out of a maximum score of 40 in this study. Respondents (80%) reported higher than expected prices for all food groups. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81), and older age were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, -0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) were associated with lower PDQS. Conclusion Higher food prices and lower diet quality persisted during the COVID-19 pandemic. Economic and social vulnerability and reliance on markets (and lower agriculture production) were negatively associated with diet quality. Although recovery was evident, consumption of healthy diets remained low. Systematic efforts to address the underlying causes of poor diet quality through transforming food system value chains, and mitigation measures, including social protection programs and national policies are critical. © 2023 Ismail et al. | Open |
| Janananda B.; Ansong R.S.; Hatløy A.; Atter A.; Andersen P.; Aakre I.; Annan T.; Peget F.; Agyei-Mensah Y.O.; Steiner-Asiedu M.; Kjellevold M. | A cross-sectional study on the nutritional status, dietary diversity, and small fish consumption patterns in coastal fishing communities of Ghana | 2023 | Maritime Studies | Fish is readily available to fishing communities. Given the high nutritional value of fish, these communities are expected to have better nutritional status, compared to non-fishing communities. However, this assumption is not well studied across coastal fishing communities in Ghana. Hence, this cross-sectional study was conducted to investigate the nutritional status, dietary patterns, and fish consumption of children living in coastal fishing communities in Ghana. Nutritional status of 384 randomly selected children was assessed using the mid-upper arm circumference (MUAC) measurement. MUAC less than 12.5 cm was used as the cutoff to identify malnourished children. Food and fish consumption patterns were assessed using an adopted and pretested food frequency questionnaire. The findings showed a prevalence of 0.5% wasting among surveyed children. The mean dietary diversity score (DDS) of the study participants was 4.3 ± 1.2. The mean DDS of the children of fisher mothers was less than that of the children of the female caregivers who are involved in other occupations. However, no significant difference was observed in the DDS across the coastal regions. Seventy eight percent of the children who participated in the study consumed an adequately diversified diet, and more than 40 different small fish species were consumed across the four coastal regions. The average median weekly fish intake among the children in the study sample was 213 (64–468) g. Considering that one-third of the employed respondents were fisherfolk, coupled with the availability of a great diversity of small fish in the communities, the findings of our study suggest that there is great potential to incorporate small fish into strategic interventions aimed at improving nutrition, food security, and achieving economic sustainability in these communities. © 2023, The Author(s). | Open |
| Joglekar A.A.; Vyas M.; Bhojani M.K.; Kumar A. | Effect of Abhaya Ghana Vati along with Pathya Aaahara Vihara (Diet and Lifestyle Regime) on Patients of Diabesity – A Single Arm Clinical Trial | 2023 | Journal of Natural Remedies | Introduction: Ayurveda beautifully amalgamates herbal drugs and lifestyle modifications in the management of various diseases and lifestyle disorders. Diabesity is one condition representing the two most prevalent chronic non-communicable diseases, i.e., Diabetes and Obesity According to Ayurveda, both conditions are referred to as Prameha and Sthoulya, respectively. Both the conditions are Santarpanottha Vyadhi (diseases arising from excessive and improper nutrition), having the common vitiation of Kapha Dosha, Meda Dhatu and Ama and similar lines of treatment. Haritaki or Abhaya (Terminalia chebula) is a herb that has the potential to manage both diabetes and obesity. The present study focuses on the efficacy of Abhaya Ghana Vati as a single drug regime coupled with Pathya Aahara Vihara (diet and lifestyle regime) in the management of diabesity. Methods: Abhaya Ghana Vati along with Pathya Aahara Vihara (diet and lifestyle regime), was administered in 41 patients for three months, including follow-up. The patients were assessed for the effect of the intervention on the subjective and objective criteria. Results: The intervention showed significant improvement in most of the parameters of outcome measures like BMI (27% improvement, p<0.001), Waist Hip Ratio (p<0.002), Abdominal Girth Circumference (p<0.001), Chest Girth circumference (p<0.001), Waist circumference (p<0.001). The Fasting Blood Sugar (FBS) levels declined significantly from the mean (187.4 to 168.9, p<0.048), and PPBS reduced from the mean (260 to 230.4, p<0.011), which was statistically significant. However, HbA1c declined very marginally from the mean of 8.32 to 8.23 (p<0.71). Effect of treatment on subjective parameters like Apatarpana Lakshana, Dhatusamya Lakshana and Quality of Life parameters showed significant change. Conclusions: Administration of Abhaya Ghana Vati and Pathya Aahara Vihara are beneficial in patients of diabesity. © 2023, Informatics Publishing Limited and Society for Biocontrol Advancement. All rights reserved. | Open |
| Kangmennaang J.; Siiba A.; Dassah E.; Kansanga M. | The role of social support and the built environment on diabetes management among structurally exposed populations in three regions in Ghana | 2023 | BMC Public Health | Sub-Saharan Africa is undergoing an epidemiological transition driven by rapid, unprecedented demographic, socio-cultural, and economic transitions. These transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs). As NCDs rise, several attempts have been made to understand the individual level factors that increase NCDs risks, knowledge, and attitudes around specific NCDs as well as how people live and manage NCDs. While these studies are important, and enhance knowledge on chronic diseases, little attention has been given to the role of social and cultural environment in managing chronic NCDs in underserved settings. Using purposive sampling among persons living with Diabetes Mellitus (PLWD) and participating in diabetes programs from regional and municipal hospitals in the three underserved regions in Ghana (n = 522), we assessed diabetes management and supportive care needs of PLWDs using linear latent and mixed models (gllamm) with binomial and a logit(log) link function. The result indicates that PLWDs with strong perceived social support (OR = 2.27, p ≤ 0.05) were more likely to report good diabetes management compared to PLWDs with weak perceived social support. The built environment, living with other health conditions, household wealth, ethnicity and age were associated with diabetes management. Overall, the study contributes to wider discussions on the role changing built and socio-cultural environments in the rise of diet-related diseases and their management as many Low- and Middle-Income Countries (LMICs) experience rapid epidemiological and nutrition transitions. © 2023, The Author(s). | Open |
| Kanu F.A.; Jefferds M.E.D.; Williams A.M.; Addo O.Y.; Suchdev P.S.; Sharma A.J. | Association between Hemoglobin and Elevation among School-aged Children: A Verification of Proposed Adjustments | 2023 | American Journal of Clinical Nutrition | Background: Anemia is defined by a hemoglobin (Hb) concentration lower than normal based on cutoffs specific to age, sex, and pregnancy status. Hb increases with elevation as an adaptive response to lower blood oxygen saturation, thus, adjusting Hb concentrations for elevation is necessary before applying cutoffs. Objectives: Recent evidence among preschool-aged children (PSC) and nonpregnant reproductive-aged women (WRA) suggests that current World Health Organization (WHO)-recommended Hb adjustments for elevation need updating. To confirm these findings, we examined the cross-sectional association between Hb and elevation among school-aged children (SAC). Methods: Using data from 9 population-based surveys, we examined 26,518 SAC aged 5−14 y (54.5% female) with data on Hb and elevation (−6 to 3834 m). We used generalized linear models to assess the association between Hb and elevation under varying conditions, including controlling for inflammation-corrected iron and vitamin A deficiency (VAD). Hb adjustments for each 500-m increase in elevation were estimated for SAC and compared with existing adjustments and those estimated for PSC and WRA. We evaluated the impact of these adjustments on anemia prevalence. Results: Hb concentration (g/L) was positively associated with elevation (m). The SAC-elevation adjustments were consistent with those reported among PSC and WRA and suggest current recommendations may under-adjust Hb for those residing at lower elevations (<3000 m) and over-adjust Hb for those residing at higher elevations (>3000 m). Among the surveys included, the proposed elevation adjustments increased anemia prevalence among SAC by 0% (Ghana and United Kingdom) to 15% (Malawi) relative to current elevation adjustments. Conclusion: Results confirm that current recommended Hb adjustments for elevation may need updating, and anemia prevalence among SAC may be higher than currently estimated. Findings will inform the WHO's reexamination of global guidelines on the use of Hb adjustments for anemia assessment and may result in improved identification and treatment of anemia. © 2023 American Society for Nutrition | Open |
| Kawakatsu Y.; Osei I.; Debpuur C.; Ayi A.; Osei-Sarpong F.; Shetye M.; Aiga H.; Augusto O.; Wagenaar B. | Effects of the COVID-19 pandemic on essential health and nutrition service utilisations in Ghana: Interrupted time-series analyses from 2016 to 2020 | 2023 | BMJ Open | Objectives This study aimed to assess the national-level and subnational-level effects of the COVID-19 pandemic on essential health and nutrition service utilisation in Ghana. Design Interrupted time-series. Setting and participants This study used facility-level data of 7950 governmental and non-governmental health facilities in Ghana between January 2016 and November 2020. Outcome measures As the essential health and nutrition services, we selected antenatal care (ANC); institutional births, postnatal care (PNC); first and third pentavalent vaccination; measles vaccination; vitamin A supplementations (VAS); and general outpatient care. We performed segmented mixed effects linear models for each service with consideration for data clustering, seasonality and autocorrelation. Losses of patient visits for essential health and nutrition services due to the COVID-19 pandemic were estimated as outcome measures. Results In April 2020, as an immediate effect of the COVID-19 pandemic, the number of patients for all the services decreased except first pentavalent vaccine. While some services (ie, institutional birth, PNC, third pentavalent and measles vaccination) recovered by November 2020, ANC, VAS and outpatient services had not recovered to prepandemic levels. The total number of lost outpatient visits in Ghana was estimated to be 3 480 292 (95% CI: -3 510 820 to -3 449 676), followed by VAS (-180 419, 95% CI: -182 658 to -177 956) and ANC (-87 481, 95% CI: -93 644 to -81 063). The Greater Accra region was the most affected region by COVID-19, where four out of eight essential services were significantly disrupted. Conclusion COVID-19 pandemic disrupted the majority of essential healthcare services in Ghana, three of which had not recovered to prepandemic levels by November 2020. Millions of outpatient visits and essential ANC visits were lost. Furthermore, the immediate and long-term impacts of the COVID-19 pandemic on service utilisation varied by service type and region. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | Open |
| Khosravi A.; Bassetti E.; Yuen-Esco K.; Sy N.Y.; Kane R.; Sweet L.; Zehner E.; Pries A.M. | Nutrient Profiles of Commercially Produced Complementary Foods Available in Burkina Faso, Cameroon, Ghana, Nigeria and Senegal | 2023 | Nutrients | The nutritional quality of commercially produced complementary food (CPCF) varies widely, with CPCF in high-income settings often containing excessive levels of sugar and sodium. Little is known about the nutritional quality of CPCF available in the West Africa region, despite their potential to improve the nutrition of infants and young children (IYC). This study evaluated the nutritional quality of CPCF available in five West African countries using the WHO Europe nutrient profiling model (NPM) and assessed their suitability for IYC based on label information. The proportion that would necessitate a “high sugar” warning was also determined, and the micronutrient (iron, calcium, and zinc) content was assessed against IYC-recommended nutrient intakes. Of the 666 products assessed, only 15.9% were classified as nutritionally suitable for promotion for IYC. The presence of added sugar and excessive sodium levels were the most common reasons for a product to fail the nutrient profiling assessment. Dry/instant cereals contributed the highest percentage of recommended nutrient intake (RNI) per serving. This highlights the need for policies to improve the nutritional quality of CPCF in West Africa, including labeling standards and the use of front-of-pack warning signs to promote product reformulation and clearly communicate nutritional quality to caregivers. © 2023 by the authors. | Open |
| Kubuga C.K.; Bantiu C.; Low J. | Suitability and Potential Nutrient Contribution of Underutilized Foods in Community-Based Infant Foods in Northern Ghana | 2023 | Nutrients | In rural Ghana, infant feeding is largely home-based or community-based yet less is known about the kinds of community-based infant foods and the ability of families to create a range of recipes for baby feeding using context-specific ingredients particularly in northern Ghana which has a high prevalence of malnutrition. In this explorative study on mothers (15–49 years; n = 46), we investigated community-based infant foods’ food group composition, enrichment, nutrient contribution, and acceptability. The identified community-based infant foods were mainly made of either corn or millet porridges in northern Ghana and had three nutrients with % RNI ≥ 70. We developed 38 recipes of enriched community-based infant foods adding underutilized foods (orange-fleshed sweet potato, pawpaw, cowpea, moringa, groundnut, Bambara beans, and soya beans) to increase the number of nutrients from three to at least five and at most nine nutrients with % RNI ≥ 70 based on the recipe combinations. The enriched community-based infant food recipes provided adequate caloric amounts and modest improvements in micronutrient content for infants (6–12 months). All recipes tested were deemed appropriate and acceptable for infants by mothers. Moringa and pawpaw emerged as the lowest-cost ingredients to add among the underutilized foods. Future research is necessary to assess the effectiveness of the new recipes at promoting linear growth and improving micronutrient status during the complementary feeding period. © 2023 by the authors. | Open |
| Kubuga C.K.; Song W.O.; Shin D. | Determinants of dietary patterns of Ghanaian mother-child dyads: A Demographic and Health Survey | 2023 | PLoS ONE | Having a comprehensive understanding of a population’s dietary patterns is a key component of any effective strategy for preventing malnutrition, planning, and putting nutrition interventions and policies into place. It’s interesting to note that information on dietary patterns of Ghana’s vulnerable subpopulations of women and children is lacking. The purpose of this study is to characterize the dietary patterns of women (15–49 years old) and their young children (0–3 years old), as well as to investigate into the socioeconomic and demographic factors influencing the characterized dietary patterns. The sociodemographic information and food consumption of mother-child dyads (n = 1,548) were collected for this nationally representative cross-sectional study. Principal component analysis and multiple variable logistic regression were used, respectively, to determine the dietary patterns of dyads and the determinants of the identified dietary patterns. For women and children, respectively, four dietary patterns (‘Beverage & sugary based’, ‘Meat based’, ‘Indigenous-tuber based’ and ‘Indigenous- grain based’) and two (‘Indigenous’ and ‘Milk, Meat, & cereal based’) emerged. Ethnicity, wealth quintiles, parity, seasonality, dyad’s age, body mass index, education, residency, marital status, and household size were the socioeconomic / demographic determinants of the dietary patterns. To sum up for women and children, meat based and indigenous staple based dietary patterns were identified, with several important socioeconomic and demographic variables acting as predictors of the dietary patterns. The identified dietary patterns and their determinants may serve as a basis for nutrition intervention and policies for women and children in Ghana. Copyright: This is an open access article, free of all copyright. | Open |
| Kushitor S.B.; Alangea D.O.; Aryeetey R.; de-Graft Aikins A. | Dietary patterns among adults in three lowincome urban communities in Accra, Ghana | 2023 | PLoS ONE | Objective Dietary patterns describe the dietary behaviour and habits of individuals. Unhealthy dietary patterns provide individuals with limited nutrients while increasing the risk of nutrition-related diseases. Unhealthy dietary patterns are high in urban areas, especially among low-income urban residents. This study examined dietary patterns in three low-income urban communities in Accra, Ghana, between 2011 and 2013. Methods This study used Wave 2 and 3 data from the Urban Health and Poverty Survey (EDULINK 2011 and 2013). The sample size was 960 in 2011 and 782 in 2013. Dietary pattern was examined using factor analysis and the NOVA food classification system. Summary statistics were computed for sociodemographic characteristics and diet frequency and pattern. Differences in dietary behaviours between 2011 and 2013 were also estimated. Three logistic regression models were computed to determine the predictors of dietary patterns. Results The frequency of consumption of animal-source foods (ASF) and fruits was higher in 2013 compared with 2011. The intake of processed culinary ingredients (NOVA Group 2), processed foods (NOVA Group 3) and ultra-processed foods (NOVA Group 4) was higher in 2013 versus 2011. In 2013, 29% consumed ultra-processed foods compared to 21% in 2011. Three dietary patterns (rice-based, snack-based, and staple and stew/soup) were identified. About two out of every five participants consumed the food items in the rice (43%) and staple and sauce patterns (40%). The proportion of participants who consumed the food items in the snack pattern was 35% in 2011 but 41% in 2013. Respondents aged 25- 34 and those with higher education often consumed the snack-based and rice-based dietary patterns. In 2013, participants in Ussher Town had a higher probability of consuming food items in the snack pattern than those living in Agbogbloshie. Conclusions This study found that between 2011 and 2013, more participants consumed ASFs, fruits, and processed foods. A complex interplay of personal and socio-cultural factors influenced dietary intake. The findings of this study mirror global changes in diet and food systems, with important implications for the primary and secondary prevention of NCDs. Health promotion programs at the community level are needed to address the increasing levels of processed food consumption. © 2023 Kushitor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Kushitor S.B.; Colecraft E.K. | DEVELOPMENT OF A FACILITATOR GUIDE FOR NUTRITION EDUCATION ON OVERWEIGHT AND OBESITY IN THE EASTERN REGION OF GHANA | 2023 | African Journal of Food, Agriculture, Nutrition and Development | Overweight and obesity are global public health problems. Although overweight and obesity are high in urban areas, the prevalence of overweight and obesity is increasing steadily in rural areas. However, interventions to address overweight and obesity in rural areas are limited. This study reports on the process of developing a facilitator guide for a nutrition education program on overweight and obesity in rural Ghana. The transtheoretical model guided this study. The study was conducted in three districts in the Eastern Region of Ghana. The facilitator guide was developed according to the Food and Agriculture Organisation’s (FAO) guidelines for planning community nutrition education. This study engaged nutrition and agricultural officers working in the study area and academics through an iterative process to draft, revise, and design the facilitator guide. The procedures included a desk literature review, analysis of secondary data, telephone interviews, a seminar and two workshops. The guide consists of five lessons. Lesson 1 creates an awareness of overweight and obesity by providing a definition and the Stunkard Figure Rating Scale. It also includes data on the prevalence of overweight and obesity and abdominal obesity of women in the study area. Lesson 2 discusses body image perceptions and their association with overweight and obesity. Lesson 3 highlights the economic, social and health consequences of overweight and obesity. Lesson 4 explains the four-star diet and how to achieve it. The lesson includes a description of each star of the four-star diet with local examples. Lesson 5 discusses physical activity and steps to increase physical activity. Each lesson ends with a key message. Songs were developed for Lessons 3, 4 and 5. This study describes the process of developing a facilitator guide for overweight and obesity education at the community level. The guide can be used to raise awareness of overweight and obesity and weight management © 2023, African Journal of Food, Agriculture, Nutrition and Development.All Rights Reserved. | Open |
| Laar A.; Amoah J.M.; Massawudu L.M.; Pereko K.K.A.; Yeboah-Nkrumah A.; Amevinya G.S.; Nanema S.; Odame E.A.; Agyekum P.A.; Mpereh M.; Sandaare S. | Making food-related health taxes palatable in sub-Saharan Africa: Lessons from Ghana | 2023 | BMJ Global Health | Amidst high burden of infectious diseases, undernutrition and micronutrient deficiencies, non-communicable diseases (NCDs) are predicted to become the leading cause of death in Ghana by 2030. NCDs are driven, to a large extent, by unhealthy food environments. Concerned, the Ghana Ministry of Health (MOH) has since 2012 sought to garner the support of all to address this challenge. We aimed to support the MOH to address the challenge through public health policy measures, but would soon be reminded that longstanding challenges to policy development such as data poverty, and policy inertia needed to be addressed. To do this, the we generated the needed evidence, curated the evidence, and availed the evidence to Ghanaian policymakers, researchers and civil society actors. Thus, we addressed the problem of data poverty using context-relevant research, and policy inertia through advocacy and scholar activism. In this paper, we share how a public interest coalition used context-relevant research, evidence-informed advocacy and scholar activism to valorise and increase demand for healthy food policy (including food-related health taxes) in Ghana. © 2023 BMJ Publishing Group. All rights reserved. | Open |
| Lamptey M.; Adu-Dapaah H.; Amoako-Andoh F.O.; Butare L.; Bediako K.A.; Amoah R.A.; Tawiah I.; Yeboah S.; Asibuo J.Y. | Genetic studies on iron and zinc concentrations in common bean (Phaseolus vulgaris L.) in Ghana | 2023 | Heliyon | Iron and zinc deficiencies cause high health risk to young children and expectant mothers in sub Saharan Africa. The development of biofortified common bean (Phaseolus vulgaris L.) varieties could address the acute micronutrient deficiencies with associated improvement in the nutrition and health of women, children and adults. The objective of this study was to determine the mode of gene action and genetic advance in iron and zinc levels in common bean. Field experiment was carried out using six generations of two populations made of crosses between pairs of low iron, low zinc and high iron, moderate zinc genotypes (Cal 96 ˣ RWR 2154; MCR-ISD-672 ˣ RWR 2154). Each generation (P1, P2, F1, F2, BC1P1 and BC1P2) was evaluated on the field in a randomized complete block design with three replications. Generation mean analysis were performed for each trait measured in each of the crosses while iron and zinc levels were quantified by x-ray fluorescence. The study showed that both additive and non-additive gene effects were important in determining the expression of high iron and zinc levels. Iron concentration in the common bean seeds ranged from 60.68 to 101.66 ppm while zinc levels ranged from 25.87 to 34.04 ppm. Broad sense heritability estimates of iron and zinc were high in the two crosses (62–82% for Fe and 60–74% for Zn) while narrow sense heritability ranged from low to high (53–75% for Fe and 21–46% for Zn). Heritability and genetic gain were used as selection criteria for iron and zinc, and it was concluded that doing so would be beneficial for future improvement. © 2023 The Author(s) | Open |
| Mikhail S.; Chattopadhyay L.; DiBona M.; Steppling C.; Kwadjo D.; Ramamonjisoa A.; Gallardo W.; Almendarez F.; Sylvester B.; Rosales S.; Nthalika I.; Collier Z.J.; Magee W., III; Auslander A. | The effect of short-term preoperative nutritional intervention for cleft surgery eligibility | 2023 | BMC Nutrition | Background: Children with orofacial clefts are highly susceptible to malnutrition, with severe malnutrition restricting their eligibility to receive safe surgery. Ready-to-use therapeutic foods (RUTF) are an effective treatment for malnutrition; however, the effectiveness has not been demonstrated in this patient population prior to surgery. We studied the effectiveness of short-term RUTF use in transitioning children with malnutrition, who were initially ineligible for surgery, into surgical candidates. Methods: A cohort of patients from Ghana, Honduras, Malawi, Madagascar, Nicaragua, and Venezuela enrolled in a nutrition program were followed by Operation Smile from June 2017 to January 2020. Age, weight, and length/height were tracked at each visit. Patients were included until they were sufficiently nourished (Z > = -1) with a secondary outcome of receiving surgery. The study was part of a collaborative program between Operation Smile (NGO), Birdsong Peanuts (peanut shellers and distributors), and MANA Nutrition (RUTF producer). Results: A total of 556 patients were recruited between June 2017 and January 2020. At baseline 28.2% (n = 157) of patients were diagnosed with severe, 21.0% (n = 117) moderate, and 50.7% (n = 282) mild malnutrition. 324 (58.3%) presented for at least one return visit. Of those, 207 (63.7%) reached optimal nutrition status. By visit two, the mean z-score increased from -2.5 (moderate) to -1.7 (mild) (p < 0·001). The mean time to attain optimal nutrition was 6 weeks. There was a significant difference in the proportion of patients who improved by country(p < 0.001). Conclusion: Malnutrition prevents many children with orofacial clefts in low- and middle-income countries from receiving surgical care even when provided for free. This creates an even larger disparity in access to surgery. In an average of 6 weeks with an approximate cost of $25 USD per patient, RUTF transitioned over 60% of patients into nutritionally eligible surgical candidates, making it an effective, short-term preoperative nutritional intervention. Through unique partnerships, the expansion of cost-effective, large-scale nutrition programs can play a pivotal role in ensuring those at the highest risk of living with unrepaired orofacial clefts receive timely and safe surgical care. © 2023, The Author(s). | Open |
| Miller J.D.; Young S.L.; Bryan E.; Ringler C. | Water insecurity is associated with greater food insecurity and lower dietary diversity: panel data from sub-Saharan Africa during the COVID-19 pandemic | 2023 | Food Security | There is growing recognition that water insecurity – the inability to reliably access sufficient water for all household uses – is commonly experienced globally and has myriad adverse consequences for human well-being. The role of water insecurity in food insecurity and diet quality, however, has received minimal attention. Data are from panel surveys conducted during 2020–21 among adults involved in smallholder agriculture in Niger (n = 364, 3 rounds), Nigeria (n = 501, 5 rounds), Senegal (n = 501, 5 rounds), and Ghana (n = 543, 5 rounds). We hypothesized that household water insecurity (measured using the brief Household Water Insecurity Experiences Scale) would be associated with greater individual food insecurity (using 5 of the 8 Food Insecurity Experiences Scale items) and lower dietary diversity (using the Minimum Dietary Diversity Score for Women). At baseline, 37.1% of individuals were living in water-insecure households and of these, 90.6% had some experience of food insecurity. In multilevel mixed-effects regressions, individuals living in water-insecure households had 1.67 (95% CI: 1.47, 1.89) times higher odds of reporting any food insecurity experience and were estimated to consume 0.38-fewer food groups (95% CI: -0.50, -0.27) than those living in water-secure households. Experiences with suboptimal water access and use are associated with poor nutrition. The pathways by which water insecurity impacts nutrition should be identified. Global and national food and nutrition security policies could be strengthened by monitoring and developing strategies to address household water insecurity. © 2023, The Author(s). | Open |
| Mohammed S.; Yakubu I.; Fuseini A.-G.; Abdulai A.-M.; Yakubu Y.H. | Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana | 2023 | BMC Public Health | Background: Exclusive breastfeeding is a public health priority in sub-Saharan Africa. However, systematic reviews on its determinants in Ghana remain scarce. Therefore, we systematically reviewed the prevalence and determinants of exclusive breastfeeding in children 0–6 months in Ghana. Methods: We conducted systematic searches in Embase, Medline, and Africa-Wide Information from the databases’ inception until February 2021 for studies that assessed the prevalence and determinants of exclusive breastfeeding in children 0–6 months in Ghana. Random-effects meta-analysis was used to estimate the pooled prevalence of exclusive breastfeeding and narrative synthesis to summarise the determinants. We calculated the proportion of total variability that was due to between study heterogeneity using I² statistics, and Egger’s test assessed publication bias. The review is registered with PROSPERO, CRD42021278019. Results: Out of the 258 articles identified, 24 met the inclusion criteria. Most of the included studies were cross-sectional and were published between 2005 and 2021. The pooled prevalence of exclusive breastfeeding (EBF) among children 0–6 months in Ghana was 50% (95%CI 41.0–60.0%). The prevalence was higher in rural areas (54%) than in urban areas (44%). Several factors were identified as facilitators of EBF, including older maternal age, self-employment, unemployment, living in a large house, being a house owner, giving birth in a health facility, non-caesarean delivery, adequate antenatal attendance, counselling services, participation in support groups, adequate knowledge about EBF, positive attitude towards EBF, and higher maternal education among rural dwellers. Additionally, having an average birthweight facilitated EBF. Barriers to EBF were also identified, including higher maternal education among urban dwellers, less than three months of maternity leave, maternal HIV-positive status, the experience of partner violence, lack of access to radio, inadequate breastmilk production, lack of family support, having a partner who wants more children, counselling on complementary feeding, healthcare worker recommendation of complementary feed, single marital status, and infant admission to neonatal intensive care units. Conclusion: In Ghana, EBF rates are low, with only about half of all children aged 0–6 months breastfed exclusively. A multi-dimensional approach is required to tackle the diverse sociodemographic, obstetric, and infant-related issues that hinder EBF practice in Ghana. © 2023, The Author(s). | Open |
| Nchanji E.B.; Chagomoka T.; Bellwood-Howard I.; Drescher A.; Schareika N.; Schlesinger J. | Land tenure, food security, gender and urbanization in Northern Ghana | 2023 | Land Use Policy | Links between land tenure and food and nutritional insecurity are receiving increased attention. Nevertheless, urban and periurban dwellers face challenges in accessing land to produce food for subsistence and sale. An ethnographic study and food and nutrition insecurity survey were conducted between October 2013 and November 2014 in Tamale, Northern Region of Ghana, to explore the dynamic and recursive links between land access, food access and the ability to maintain resources to meet long-term needs. Results showed that infrastructural development and agriculture compete for land. The shortage of land for agricultural purposes was pronounced in urban areas (20%) than in periurban areas (1.3%) and rural areas (0%). Food insecure households were more likely to name a lack of land than anything else as the primary reason for their inability to grow crops (Fisher's exact probability = 0.040). Urban and periurban dwellers cope with the constraints posed in the communal tenure system by using strategies such as urban–periurban-rural migrant farming and buffer zone cultivation. The role of women in providing nutritious soups is especially important, and they use various mechanisms to circumvent their lack of access to land and provide food for the household. Political, economic and cultural elements thus interact to constitute the link between land and food. © 2023 The Authors | Open |
| Nimoh F.; Prah S.; Yamoah F.; Agyei D. | Consumer perception and willingness to pay for packaged asaana: a traditional drink in Ghana | 2023 | British Food Journal | Purpose: In view of the increasing trend in food policies targeting the promotion of consumer interest in locally produced foods and growing developments in willingness-to-pay (WTP) methodologies, the authors investigate consumer preference for packaged traditional drink asaana. Design/methodology/approach: The study used a simple random sample of 336 consumers to draw on perception index and contingent valuation methods to evaluate consumers' perceptions of the attributes of packaged asaana – a traditional maize-based beverage produced in Ghana (also known as Ghana Coca-Cola). A tobit regression model was employed to analyze consumers’ WTP for the product. Findings: Analyzing the factors that influence consumers' WTP for packaged asaana using the tobit regression model, the study established the existence of positive health and nutrition, economic benefits and purchasing decision-making perceptions for asaana. While the results further showed that consumers are willing to pay a premium for well-packaged asaana, demographics such as age, income level, labeling, price of the product and savings were found to exert significant influence on consumers’ WTP for packaged asaana. Salient recommendations for food processors and relevant government agencies and food policy implications are identified. Research limitations/implications: Comprehending WTP provides valuable understanding regarding consumer qualms, actions and WTP for more secure traditional drinks and an examination of how the different factors that influence WTP for local beverages help boost local beverage production and guarantee employment. Practical implications: Analyzing WTP data for traditional drinks reveals important implications for production, marketing and public health policies. Certification systems for traditional beverages may be beneficial, and the findings can be used to create public awareness campaigns about the safety of local drinks. Originality/value: Assessing the WTP among Ghanaian consumers for traditional drinks, specifically asaana, is a ground-breaking study. The contingent evaluation (CE) and tobit regression approaches utilized in this research are strong, and the results obtained can guide decisions related to traditional drink production, marketing and the development of public health policies. © 2023, Emerald Publishing Limited. | Open |
| Nyantakyi-Frimpong H.; Christian A.K.; Ganle J.; Aryeetey R. | “NOW WE’VE ALL TURNED TO EATING PROCESSED FOODS”: A PHOTOVOICE STUDY OF THE FOOD AND NUTRITION SECURITY IMPLICATIONS OF ‘GALAMSEY’ IN GHANA | 2023 | African Journal of Food, Agriculture, Nutrition and Development | Galamsey, a popular name for small-scale mining in Ghana, is an important livelihood for many rural Ghanaians. Although concerns have been raised in the popular media about the adverse effects of galamsey on the environment, human health, and livelihoods, there is a representational paucity of evidence regarding its links with local food systems, particularly, from the perspective of affected mining communities. The current study explored community perceptions and experiences of galamsey and its perceived effects on food security and livelihoods in the East Akim Municipality in the Eastern region of Ghana. Primary data was collected in the East Akim Municipality of Ghana, using a photovoice method. Thirty-six male and female adults were purposively selected with the help of a community focal persons and advertisements in the study communities. Respondents participated in a one-day photography training and thereafter, were deployed to take at least fifteen photos that portray the effect of galamsey on food security and health. Subsequently, each participant was asked to select five of the photographs they have taken and explain why they captured that image. A photo exhibition was held to facilitate community conversation and perspectives on the effects of galamsey on food and nutrition security. Galamsey has resulted in degradation of, otherwise, fertile agricultural land, and contamination of freshwater sources. As a consequence, there is reduced cultivable land, reduced crop production, shortage of essential staple foods, increase in food price, and increased consumption of ultra-processed foods. There is also perception of increased exposure to heavy metals like mercury in locally-produced food. Given the adverse health consequences of both food and nutrition insecurity, and increased consumption of processed foods, it is important that public and policy discussions to minimize the effects of galamsey in Ghana should include considerations about food and nutrition insecurity in mining communities. © 2022,Zpravy Lesnickeho Vyzkumu. All Rights Reserved. | Open |
| Obeng C.; Jackson F.; Amissah-Essel S.; Nsiah-Asamoah C.; Perry C.A.; Gonzalez Casanova I.; Obeng-Gyasi E. | Women's perspectives on human milk banking in Ghana: results from a cross-sectional study | 2023 | Frontiers in Public Health | Background: Although political and academic interest exists in Ghana to include human milk banks (HMB) into current maternal and child health programs, efforts to establish a HMB have not yet been subjected to any real empirical inspection with the view toward implementation. Furthermore, views toward the establishment of a HMB in Ghana have not been assessed among Ghanaian women. The aims of the current study were to examine Ghanaian women's views about HMB, and to investigate women's willingness to donate to a HMB. Methods: Quantitative and qualitative responses were received from Ghanaian females (n = 1,270) aged 18+ years. Excluding outliers and missing data (n = 321), a final sample of 949 was retained for final analysis. Chi-square tests and logistic regression analysis were computed on quantitative data; Thematic analysis was performed on the qualitative responses. Results: In our sample, 64.7% of respondents indicated that Ghana is ready for a HMB. The majority (77.2%) were willing to donate milk, and 69.4% believed that donating to the HMB would favor their child. The main concerns for the unwillingness to donate excess milk included: (i) the idea of HMBs as strange/bizarre (n = 47), (ii) fear of infections (n = 15), (iii) religious beliefs (n = 9), and (iv) insufficient information (n = 24). This study serves as the first step toward the development of a HMB in Ghana. Conclusions: Overall, Ghanaian women support the building of a HMB to enhance infant nutrition and reduce childhood morbidity and mortality. Copyright © 2023 Obeng, Jackson, Amissah-Essel, Nsiah-Asamoah, Perry, Gonzalez Casanova and Obeng-Gyasi. | Open |
| Odoom D.; Mensah E.O.; Dick-Sagoe C.; Lee K.Y.; Opoku E.; Obeng-Baah J. | Examining the level of public awareness on the Sustainable Development Goals in Africa: An empirical evidence from Ghana | 2023 | Environment, Development and Sustainability | Nations which are part of the United Nations are required to institute appropriate measures to fulfil the vision of the Sustainable Development Goals (SDGs). However, for this to be possible, all stakeholders including the general public need to be fully aware of the SDGs. This research examined the level of public awareness about the SDGs among Ghanaians based on the views of 431 respondents. Means, standard deviation, Mann–Whitney U test, Kruskal Wallis and Pearson Product-Moment Correlations were used for data analysis. The study found that awareness level on SDG 1 (ending poverty), SDG 2 (zero hunger, food security, nutrition and sustainable agriculture), SDG 3 (health and well-being), SDG 5 (gender equality), and SDG 6 (clean water and sanitation) was high among Ghanaians. However, awareness level on SDG 9 (industry, innovation and infrastructure), SDG 14 (conservation of life below water), and SDG 16 (peace, justice and strong institutions) was very low among Ghanaians. No significant difference manifested in the level of awareness among male and female Ghanaians. There were statistically significant differences in educational levels of respondents and their overall level of awareness of the SDGs. Also, there was a low, negative correlation between overall level of awareness and the effectiveness of the communication strategies used in creating awareness about the SDGs. Government should re-examine its communication strategies on the SDGs and put in place a more effective communication policy framework which involves grassroots populations and local communities. © 2023, The Author(s), under exclusive licence to Springer Nature B.V. | Open |
| Ohemeng A.; Nartey E.B.; Quaidoo E.; Ansong R.S.; Asiedu M.S. | Knowledge and nutrition-related practices among caregivers of adolescents with sickle cell disease in the Greater Accra region of Ghana | 2023 | BMC Public Health | Background: Due to its severe adverse effect on child mortality, sickle cell disease (SCD) has been identified as a set of diseases of public health concern. The high mortality rate among children with SCD in Africa has been attributed to several factors including sub-optimal management and care. This study documented the nutrition-related knowledge and practices of caregivers of teenagers who suffer from sickle cell disease (SCD) to inform decisions on integrated management of the disease. Methods: The study included caregivers (n = 225) of adolescents with SCD who attended clinic at selected hospitals in Accra, Ghana. Pre-tested semi-structured questionnaire was employed in the gathering of information related to general and nutrition-related knowledge about SCD, as well as data on their nutrition-related practices with regards to their children who suffer from SCD. Pearson’s Chi-square test and binary logistic regression analyses were applied to explore the relationship between caregivers’ nutrition-related knowledge and practice. Results: Nutrition-related knowledge among the caregivers studied was low, with less than a third of them (29.3%) of the sample being classified as having good knowledge. Caregivers who considered nutrition care when the child experienced crises were few (21.8%), and those with low nutrition-related knowledge were less likely to do this compared with caregivers having high knowledge (OR = 0.37, 95% CI = 0.18, 0.78). The common nutrition actions reported were the provision of more fruits/fruit juices (36.5%) and warm fluids such as soups and teas (31.7%). More than a third of the caregivers (38.7%) admitted that they faced challenges in caring for their adolescents with SCD, particularly in the area of finance for the needed health care. Conclusion: Our study findings indicate that it is important to incorporate appropriate nutrition education messages for caregivers as part of a holistic management of SCD. © 2023, The Author(s). | Open |
| Owusu B.A.; Ofori-Boateng P.; Forbes A.; Doku D.T. | Knowledge of young people living with type 1 diabetes and their caregivers about its management | 2023 | Nursing Open | Aims and Objective: We sought to investigate knowledge and skills of type 1 diabetes (T1D) management among young people living with the disease and their caregivers. Our aim is to provide baseline evidence to inform T1D self-management education for young people living with the disease and their caregivers. Background: Both local and international guidelines recommend ongoing T1D self-management education for people living with the disease. This is because T1D often develops among young people who rarely have the competencies to adequately manage their condition. However, the extent to which young people living with T1D and their caregivers can self-manage this chronic disease in a low-resource country like Ghana is unknown. Methods: Using a phenomenological study design, semi-structured interviews were conducted with 28 young people living with type 1 diabetes, 12 caregivers and 6 healthcare providers in southern Ghana. Data were collected at homes, hospitals and support group centres of participants via face-to-face interviews, photovoice and video-conferencing. The data were analysed thematically using QSR NVivo 11. Results: The young people living with T1D and their caregivers demonstrated knowledge and skills in the self-monitoring of blood glucose, and the treatment of hyperglycaemia. Areas of more marginal or lack of knowledge were concerning carbohydrate counting, severe hypoglycaemia and the management of intercurrent illnesses. Young persons living with T1D and their caregivers received their management information from healthcare and non-healthcare providers. Access to diabetes self-management education influenced T1D management knowledge and practices. Conclusion: Young people living with type 1 diabetes and their caregivers possessed limited scope of knowledge on type 1 diabetes self-management. Multiple sources of T1D knowledge were found, some of which may not be helpful to patients. The knowledge gaps identified compromises transitional independence and self-management capacity. Relevance to Clinical Practice: It is important for clinicians and organizations that provide T1D education to provide diabetes self-management education also on managing hypoglycaemia, carbohydrate counting and managing T1D during intercurrent life events among young people living with T1D. No Patient or Public Contribution: Patients and their caregivers were interviewed as research participants. They did not conceptualize, analyse, interpret or prepare the manuscript. © 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd. | Open |
| Peprah C.; Peprah V.; Ocloo K.A. | Improving the socio-economic welfare of women through informal sector activities in Ghana | 2023 | Environment, Development and Sustainability | The importance of informal sector activities (ISA) in reducing poverty among women in low-and middle-income countries (LMICs) cannot be over emphasised. However, in LMICs including Ghana, little mixed-methods evidence exists about the prospects of ISA in improving the wellbeing of women across different spatial dimensions. Drawing on the feminist theory with mixed-methods evidence, this study explores the role of ISA in improving the welfare of women who are engaged in informal activities in the Kumasi Metropolis of Ghana. This knowledge-base is critical in contributing partly to the realisation of the UN poverty-related sustainable development goals. This study involved 356 spatially diverse women recruited from six communities in the Kumasi Metropolis using diverse sampling techniques. We found that the socio-economic welfare of the participants has significantly improved after entering into ISA. These improvements manifested in areas such as income, contribution to household expenditure, decision making at home, community participation, nutrition of family, access to education of wards, acquisition of assets and quality housing. The nature of the urban space had a weak influence on the manifestation of improvements. Findings of this study have, thus, demonstrated the potential of ISA in improving the socio-economic wellbeing of women in the informal sector in Ghana. Policy recommendations that aimed at strengthening ISA among women in Ghana have been offered for the attention of policy actors. © 2022, The Author(s), under exclusive licence to Springer Nature B.V. | Open |
| Pérez-Escamilla R.; Dykes F.C.; Kendall S. | Gearing to success with national breastfeeding programmes: The Becoming Breastfeeding Friendly (BBF) initiative experience | 2023 | Maternal and Child Nutrition | Evidence-based policy toolboxes are essential for decision makers to effectively invest in and scale up maternal-child health and nutrition programs, and breastfeeding is no exception. This special issue focuses on the experiences implementing the Becoming Breastfeeding Friendly (BBF) toolbox in England, Scotland, and Wales. BBF is an initiative that includes a toolbox for decision making based on the Complex Adaptive System-based Breastfeeding Gear Model. The BBF initiative experience in Great Britain presented in this special issue illustrates how versatile BBF is as it can be readily adapted to the specific application context. In this instance one country, England was trained by the Yale School of Public Health team that developed BBF. England, in turn, trained and assisted Scotland and Wales with the implementation and oversight of BBF in those countries. The positive experience implementing BBF in Great Britain is fully consistent with findings related to this initiative in other countries with contrasting economic, social, political and health care systems; including Germany, Ghana, Mexico, Myanmar, and Samoa. In all instances BBF has led to breastfeeding policy improvements with strong implications for enabling breastfeeding environments including maternity benefits, workforce development, the Baby Friendly Hospital Initiative and behavior change communication campaigns. In conclusion, BBF is a powerful tool to help guide the effective scaling up of evidence-based programmes to advance breastfeeding protection, promotion and support globally. © 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd. | Open |
| Prado E.L.; Adu-Afarwuah S.; Arnold C.D.; Adjetey E.; Amponsah B.; Bentil H.; Dewey K.G.; Guyer A.E.; Manu A.; Mensah M.; Oaks B.M.; Ocansey M.; Tan X.; Hastings P.D. | Prenatal and postnatal small-quantity lipid-based nutrient supplements and children's social–emotional difficulties at ages 9–11 y in Ghana: follow-up of a randomized controlled trial | 2023 | American Journal of Clinical Nutrition | Background: Provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) during early life improves growth and development. In the International Lipid-Based Nutrient Supplements DYAD–Ghana trial, prenatal and postnatal SQ-LNS reduced social–emotional difficulties at age 5 y, with greater effects among children in less-enriched home environments. Objectives: We aimed to investigate the effect of prenatal and postnatal SQ-LNS on children's social–emotional problems at age 9–11 y. Methods: In 2009–2011, 1320 pregnant women ≤20 wk gestation were randomly assigned to receive the following daily until 6 mo postpartum: 1) iron and folic acid until delivery, then placebo, 2) multiple micronutrients (MMNs), or 3) SQ-LNS (20 g/d). Children in group 3 received SQ-LNS from 6 to 18 mo. In 2021, we evaluated children's social–emotional outcomes with 6 assessment tools that used caregiver, teacher, and/or self-report to measure socioemotional difficulties, conduct problems, temperament, mood, anxiety, and emotion management. Results: We assessed outcomes in 966 children, comprising 79.4% of 1217 participants eligible for re-enrolment. No significant differences were found between the SQ-LNS and control (non-LNS groups combined) groups. Few children (<2%) experienced high parent-reported social–emotional difficulties at 9–11 y, in contrast to the high prevalence at age 5 in this cohort (25%). Among children in less-enriched early childhood home environments, the SQ-LNS group had 0.37 SD (−0.04 to 0.82) lower self-reported conduct problems than the control group (P-interaction = 0.047). Conclusions: Overall positive effects of SQ-LNS on social–emotional development previously found at age 5 y are not sustained to age 9–11 y; however, there is some evidence of positive effects among children in less-enriched environments. The lack of effects may be owing to low prevalence of social–emotional problems at preadolescence, resulting in little potential to benefit from early nutritional intervention at this age in this outcome domain. Follow-up during adolescence, when social-emotional problems more typically onset, may yield further insights. This trial was registered at clinicaltrials.gov as NCT00970866. https://clinicaltrials.gov/ct2/show/record/NCT00970866 © 2023 The Author(s) | Open |
| Qiu J.; Lo F.P.; Gu X.; Jobarteh M.L.; Jia W.; Baranowski T.; Steiner-Asiedu M.; Anderson A.K.; Mccrory M.A.; Sazonov E.; Sun M.; Frost G.; Lo B. | Egocentric Image Captioning for Privacy-Preserved Passive Dietary Intake Monitoring | 2023 | IEEE Transactions on Cybernetics | Camera-based passive dietary intake monitoring is able to continuously capture the eating episodes of a subject, recording rich visual information, such as the type and volume of food being consumed, as well as the eating behaviors of the subject. However, there currently is no method that is able to incorporate these visual clues and provide a comprehensive context of dietary intake from passive recording (e.g., is the subject sharing food with others, what food the subject is eating, and how much food is left in the bowl). On the other hand, privacy is a major concern while egocentric wearable cameras are used for capturing. In this article, we propose a privacy-preserved secure solution (i.e., egocentric image captioning) for dietary assessment with passive monitoring, which unifies food recognition, volume estimation, and scene understanding. By converting images into rich text descriptions, nutritionists can assess individual dietary intake based on the captions instead of the original images, reducing the risk of privacy leakage from images. To this end, an egocentric dietary image captioning dataset has been built, which consists of in-the-wild images captured by head-worn and chest-worn cameras in field studies in Ghana. A novel transformer-based architecture is designed to caption egocentric dietary images. Comprehensive experiments have been conducted to evaluate the effectiveness and to justify the design of the proposed architecture for egocentric dietary image captioning. To the best of our knowledge, this is the first work that applies image captioning for dietary intake assessment in real-life settings. Author | Open |
| Quinones S.; Lin S.; Tian L.; Mendola P.; Novignon J.; Adamba C.; Palermo T. | The dose-response association between LEAP 1000 and birthweight – no clear mechanisms: a structural equation modeling approach | 2023 | BMC Pregnancy and Childbirth | Background: Birthweight is an important indicator of maternal and fetal health globally. The multifactorial origins of birthweight suggest holistic programs that target biological and social risk factors have great potential to improve birthweight. In this study, we examine the dose-response association of exposure to an unconditional cash transfer program before delivery with birthweight and explore the potential mediators of the association. Methods: Data for this study come from the Livelihood Empowerment Against Poverty (LEAP) 1000 impact evaluation conducted between 2015 and 2017 among a panel sample of 2,331 pregnant and lactating women living in rural households of Northern Ghana. The LEAP 1000 program provided bi-monthly cash transfers and premium fee waivers to enroll in the National Health Insurance Scheme (NHIS). We used adjusted and unadjusted linear and logistic regression models to estimate the associations of months of LEAP 1000 exposure before delivery with birthweight and low birthweight, respectively. We used covariate-adjusted structural equation models (SEM) to examine mediation of the LEAP 1000 dose-response association with birthweight by household food insecurity and maternal-level (agency, NHIS enrollment, and antenatal care) factors. Results: Our study included a sample of 1,439 infants with complete information on birthweight and date of birth. Nine percent of infants (N = 129) were exposed to LEAP 1000 before delivery. A 1-month increase in exposure to LEAP 1000 before delivery was associated with a 9-gram increase in birthweight and 7% reduced odds of low birthweight, on average, in adjusted models. We found no mediation effect by household food insecurity, NHIS enrollment, women’s agency, or antenatal care visits. Conclusions: LEAP 1000 cash transfer exposure before delivery was positively associated with birthweight, though we did not find any mediation by household- or maternal-level factors. The results of our mediation analyses may serve to inform program operations and improve targeting and programming to optimize health and well-being among this population. Trial Registration: The evaluation is registered in the International Initiative for Impact Evaluation’s (3ie) Registry for International Development Impact Evaluations (RIDIESTUDY- ID-55942496d53af) and in the Pan African Clinical Trial Registry (PACTR202110669615387). © 2023, The Author(s). | Open |
| Rent S.; Bakari A.; Deribessa S.; Abayneh M.; Shayo A.; Bockarie Y.; Moyer C.; Kukora S. | Provider Perceptions on Bereavement Following Newborn Death: A Qualitative Study from Ethiopia and Ghana | 2023 | Journal of Pediatrics | Objective: The objective of this study was to explore how clinicians in low- and middle-income countries engage and support parents following newborn death. Study design: Qualitative interviews of 40 neonatal clinicians with diverse training were conducted in Addis Ababa, Ethiopia, and Kumasi, Ghana. Transcribed interviews were analyzed and coded through the constant comparative method. Results: Three discrete themes around bereavement communication emerged. (1) Concern for the degree of grief experienced by mothers and apprehension to further contribute to it. This led to modified communication to shield her from emotional trauma. (2) Acknowledgment of cultural factors impacting neonatal loss. Clinicians reported that loss of a newborn is viewed differently than loss of an older child and is associated with a diminished degree of public grief; however, despite cultural expectations dictating private grief, interview subjects noted that mothers do suffer emotional pain when a newborn dies. (3) Barriers impeding communication and psychosocial support for families, often relating to language differences and resource limitations. Conclusions: Neonatal mortality remains the leading global cause of mortality under age 5, with the majority of these deaths occurring in low- and middle-income countries, yet scant literature exists on approaches to communication around end-of-life and bereavement care for neonates in these settings. We found that medical providers in Ghana and Ethiopia described structural and cultural challenges that they navigate following the death of a newborn when communicating and supporting bereaved parents. © 2022 Elsevier Inc. | Open |
| Saaka M.; Awini S.; Kizito F.; Hoeschle-Zeledon I. | Fathers' level of involvement in childcare activities and its association with the diet quality of children in Northern Ghana | 2023 | Public Health Nutrition | Objective: This study assessed the level of fathers' involvement in childcare activities and its association with the diet quality of their children in Northern Ghana. Setting: The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation. Design: A community-based comparative analytical cross-sectional study. Participants: A sample of 422 rural mother-father pairs who had at least one child aged 6-36 months. Results: The overall level of fathers' involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father's involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)). Conclusions: The findings confirm earlier studies that show that fathers' involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana. © The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society. | Open |
| Sackey L.N.A.; Markin K.; Kwarteng A.; Ayitey I.M.; Kayoung P. | Presence and levels of potential trace elements in lettuce and spring onion grown in Kumasi, Ghana | 2023 | Kuwait Journal of Science | Vegetables are essential for human nutrition and health, and their consumption is increasing dramatically in every part of the world. However, irrigated water used in cultivation is usually not portable. The aim of the study was to determine the presence and level of potential trace elements in lettuce and spring onions grown and sold at Kwame Nkrumah University of Science and Technology (KNUST) and its environs. The Thermo Scientific Niton XL3t XRF Analyzer measured the heavy metal concentrations in the lettuce and spring onions. The samples were taken from three farms on the KNUST campus. The heavy metals determined in the samples were arsenic, cadmium, chromium, mercury, manganese, nickel, and lead. Most heavy metal concentrations determined in the vegetables were above the permissible limit of WHO/RML standards, except for Mn and Ni. However, Ni (88.22 mg/l) in Farm A was above the permissible limit (67.9 mg/l). The contamination of these metals showed a low degree of contamination of heavy metals in lettuce and spring onions from the various farms, except Nickel, which showed moderate contamination from Farm A (3.01 and 2.12 mg/) for lettuce and spring onion, respectively. The estimated daily intake (EDI), health quotient (HQ) and health index (HI) calculated generally indicated that most of the vegetables had low risk to human health, apart from those grown in Farm A, which had values above the permissible limit. However, long-term intake of these vegetables can be harmful due to accumulated effects. © 2023 The Authors | Open |
| Saka R.; Domfeh E.A.; Hayford F.E.A.; Asante M.; Amoah A.G.B.; Asare G.A.; Wiredu E.K. | Nutritional status and effect of highly active anti-retroviral therapy (HAART) on selected trace elements in people living with HIV in Ghana | 2023 | Scientific African | Background and objectives: Essential trace elements obtained from our diet are crucial for the initiation and development of host defence by the immune system. Trace elements such as selenium (Se), zinc (Zn) and copper (Cu) are important for immune competence, particularly in vulnerable population. Poor nutrition status including deficiencies of these vital elements is associated with immune abnormalities and increased susceptibility to infectious diseases. Methods: A comparative study involving a cohort of three hundred and twenty-five (325) participants comprising: 166 persons living with HIV (PLWH) (consisting of 100 on HAART and 66 HAART-treatment naive) and one hundred and fifty-nine (159) non-HIV controls were recruited. Waist to hip ratio and dietary habits were assessed to determine respondents’ nutritional status. Serum Zn, Se and Cu concentrations were estimated by neutron activation method. Results: Mean body mass index (BMI) of respondents was 24.7±4.8 kg/m2. Dietary recommended intakes (DRIs) of macronutrient [energy (69%), carbohydrates (86%) and fats (76%)] and micronutrient [(vitamin B2 (63%), vitamin D (15%), folate (47%) and calcium (63%)] were not adequately met by all groups. PLWH on HAART had a significantly higher total body fat (p=0.004) and visceral fat (p<0.001). Dietary intake of Se, Zn and Cu were highest among the controls (47.0±5.4 µg, 12.4±2.9 mg and 843±15.2 mg respectively) and least, among the HAART treatment naïve group (10.1±5.6 µg, 2.1±0.9mg and 438±16.3 mg respectively), although serum concentrations were significantly lower (0.63±0.21 µmol/L, 1.33±0.92 µmol/L and 1.12±0.14 µmol/L; p<0.001, respectively). Dietary intake of Se and Cu were not associated with their serum concentrations, but treatment status was significantly associated with their serum concentrations (p-value<0.001). Respondents on Zidovudine (AZT) + Lamivudine (3TC) + Nevirapine (NVP) had higher serum Se and Cu concentrations but lower Zn concentrations compared to those on other medications. Conclusion: Multiple nutrient intakes among PLWH were not adequate; thus, dietary counseling and micronutrient supplementation are strongly recommended, as food security strategies by stakeholders involved in the nutrition management of PLWH in Ghana are also needed. Intake of AZT + 3TC + NVP may improve serum concentrations of Se, and Cu, but could negatively affect serum Zn concentration. © 2023 | Open |
| Sambu W.C.; Picchioni F.; Stevano S.; Codjoe E.A.; Nkegbe P.K.; Turner C. | Food systems thinking unpacked: a scoping review on industrial diets among adolescents in Ghana | 2023 | Food Security | Unhealthy diets are among the main risk factors associated with non-communicable diseases (NCDs). In Sub Saharan Africa, NCDs were responsible for 37% of deaths in 2019, rising from 24% in 2000. There is an increasing emphasis on health-harming industrial foods, such as ultra-processed foods (UPFs), in driving the incidence of diet-related NCDs. However, there is a methodological gap in food systems research to adequately account for the processes and actors that shape UPFs consumption across the different domains of the food systems framework and macro-meso-micro levels of analysis. This paper interrogates how the Food Systems Framework for Improved Nutrition (HLPE in Nutrition and food systems. A report by the high level panel of experts on food security and nutrition of the committee on world food security, 2017), considered the dominant framework to analyse nutrition, and language of interdisciplinarity are practised in research with regards to consumption of UPFs among adolescents in Ghana, a population group that is often at the forefront of dramatic shifts in diets and lifestyles. We conducted a scoping review of studies published between 2010 and February 2022, retrieved 25 studies, and mapped the findings against the domains and analysis levels of the Food Systems Framework for Improved Nutrition (HLPE in Nutrition and food systems. A report by the high level panel of experts on food security and nutrition of the committee on world food security, 2017). Our study illustrates that there is a tendency to address unhealthy diets among adolescents in a siloed manner, and as a behavioural and nutritional issue. In most cases, the analyses fail to show how domains of the food systems framework are connected and do not account for linkages across different levels of analysis. Methodologically, there is a quantitative bias. From the policy point of view, there is a disconnect between national food policies and food governance (i.e., trade and regulations) and initiatives and measures specifically targeted at adolescent’s food environments and the drivers of UPFs consumption. © 2023, The Author(s). | Open |
| Seidu A.-A.; Hagan Jnr J.E.; Budu E.; Aboagye R.G.; Okyere J.; Sakyi B.; Adu C.; Ahinkorah B.O. | High-risk fertility behaviour and undernutrition among children under-five in sub-Saharan Africa: A cross-sectional study | 2023 | BMJ Open | Objective The study examined high-risk fertility behaviour and its association with under-five undernutrition in sub-Saharan Africa (SSA). Design We conducted a cross-sectional analysis of data from 32 sub-Saharan African countries' Demographic and Health Surveys. A weighted sample of 110 522 mother-child pairs was included in final analysis. Multilevel binary logistic regression was used to examine the association between high-risk fertility behaviour and undernutrition. The results were presented using adjusted odds ratio (aOR) with their respective 95% confidence intervals (CIs). Setting Thirty-two countries in SSA. Outcome measure Stunting, wasting, and underweight. Results The pooled prevalence of stunting was 31.3%, ranging from 15.0% in Gabon to 51.7% in Burundi. Wasting was highest among children from Burkina Faso (19.1%) and lowest among those from South Africa (1.6%). The overall prevalence of wasting was 8.1%. The prevalence of underweight was 17.0%, with the highest among children in Niger (37.1%) and lowest in South Africa (4.8%). Mothers who gave birth at the age less than 18 years and those with short birth interval were more likely to have their children being stunted, wasted, and underweight. The odds of stunting and wasting were high among children born to women with high parity. However, maternal age at birth more than 34 was associated with lower odds of childhood underweight as against those with age at birth less than 34. Conclusion Countries in SSA are encouraged to address the issue of maternal age at birth less than 18, high parity, and shorter birth intervals in order to meet the Global Nutrition targets, which aim to achieve a 40% reduction in the number of stunted children under the age of 5 and to reduce and maintain childhood wasting to less than 5% by 2025. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | Open |
| Sekyi E.; Agyapong N.A.F.; Eshun G. | Food consumption by NOVA food classification, metabolic outcomes, and barriers to healthy food consumption among university students | 2023 | Food Science and Nutrition | The NOVA food classification system is a simple tool that can be used to assess the consumption levels of different categories of foods based on their level of processing. The degree to which food is processed has a sigsnificant impact on health outcomes. In Ghana, no study exists on the consumption of the different NOVA food groups among tertiary students and how it relates to their metabolic outcomes. This study assessed the frequency of food intake according to the NOVA classification and how they relate to body mass index, waist circumference, and blood pressure. The barriers to the consumption of healthy foods among students were also assessed. This was a cross-sectional study conducted among 352 students of the Takoradi Technical University. Questionnaire was used to obtain sociodemographic information as well as data on perceived barriers to healthy food consumption. Food frequency questionnaire was used to obtain data on dietary intake. The weight, height, waist circumference, waist-to-hip ratio, and blood pressure of all participants were measured. Chi-square was used to compare categorical variables between males and females and to determine the association between the frequency of food intake according to the NOVA classification and metabolic indicators. The prevalence of overweight and obesity was 23.8%. More than half (51.1%) of the students had elevated blood pressure. The majority of study participants (54.2%) had a high frequency of consumption of both unprocessed and ultra-processed foods. Male students who frequently consumed ultra-processed foods (1–6 times/day) had significantly high blood pressure. High consumption of both ultra-processed and unprocessed foods was also associated with elevated blood pressure among male students. Limited time to prepare healthy meals and the high cost of unprocessed foods were among barriers to which most students strongly agreed to. Establishment of canteens that provide affordable healthy foods, teaching students time management, and nutrition education can mitigate barriers to healthy food consumption. © 2023 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC. | Open |
| Sibanda S.; Munjoma-Muchinguri P.; Ohene-Agyei P.; Murage A.W. | Policies for optimal nutrition-sensitive options: a study of food and nutrition security policies, strategies and programs in Ghana, Kenya and South Africa | 2023 | Frontiers in Sustainable Food Systems | Sub-Saharan Africa is experiencing the coexistence of overnutrition, undernutrition and micronutrient deficiencies. Comprehensive programs and coherent public policies are required to address this problem. A study of food and nutrition security policies, strategies and programs in Ghana, Kenya and South Africa was conducted between February and July 2022 through desk reviews and key informant interviews. The aim was to generate evidence on the extent to which the policies, strategies and programs were nutrition-sensitive and add value to the scaling up of nutrition and food security. The assessment of the documents was based on the four dimensions of food security, and the Food and the Food and Agriculture Organization of the United Nations guidelines on nutrition-sensitive agriculture. A total of 48 policies, strategies and programs were reviewed. To ensure food availability, most reviewed documents tend to focus on food production and income generation, with limited attention on production and supply of diverse and nutrient-dense foods. Access to inputs, credit and land is targeted at smallholder farmers, without little sensitivity to women and youth engagement. Food access is promoted through improved market access by upgrading infrastructure and promoting social safety nets for vulnerable populations. However, information systems for agricultural marketing as well as labor- and time-saving technologies are lacking. Although nutrition education is widely promoted, especially for mothers and children, there is a gap in addressing the nutrition needs of adolescent girls. Regarding food stability, inadequate funding, poor leadership and governance and inadequate monitoring and evaluation systems are the main barriers to successful implementation of policies, strategies and programs. While efforts have been made to promote nutrition-sensitive options in the agriculture and food system value chains, the study identified several gaps that need to be addressed to ensure adequate food and nutrition security. Copyright © 2023 Sibanda, Munjoma-Muchinguri, Ohene-Agyei and Murage. | Open |
| Snider A.; Adraki P.K.; Lolig V.; McNamara P.E. | Assessing gendered impacts of post-harvest technologies in Northern Ghana: gender equity and food security | 2023 | Gender, Technology and Development | Post-harvest loss of grains contributes to food insecurity, high food prices, and climate change. Several post-harvest technologies are used in Northern Ghana to reduce post-harvest loss, yet research on the subject rarely considers the gendered impacts of the introduction of technologies. The social and cultural context must be considered when introducing agricultural technologies into a community to avoid exacerbating inequality. The authors used a gender technology assessment tool to analyze the impacts of an introduction of three common post-harvest technologies to communities through farmer-based organizations (FBOs) in the Northern Region of Ghana. We found that, while both men and women had access to the technologies, the technologies were controlled by literate/numerate men. Although the technologies were controlled by men, their effects overall benefited men and women. When used in combination, the technologies reduced women’s time burden and had a positive impact on household food and nutrition security. We recommend that gender equity be integrated throughout a project’s lifecycle through recruitment of a gender specialist. Furthermore, extension workers and FBO leaders need training and support in gender equity. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Tabe-Ojong M.P.J., Jr.; Aihounton G.B.D.; Lokossou J.C. | “Climate-smart agriculture and food security: Cross-country evidence from West Africa” | 2023 | Global Environmental Change | In the face of climate change and extreme weather events which continue to have significant impacts on agricultural production, climate-smart agriculture (CSA) has emerged as one important entry point in reducing the emission of greenhouse gases and building climate resilience while ensuring increases in agricultural productivity with ensuing implications on food and nutrition security. We examine the relationship between CSA, land productivity (yields), and food security using a survey of farm households in Ghana, Mali, and Nigeria. To understand the correlates of the adoption of these CSA practices as well as the association between CSA, yields, and food security, we use switching regressions that account for multiple endogenous treatments. We find a positive association between the adoption of CSA practices and yields. This increase in yields translate to food security as we observe a positive association between CSA and food consumption scores. Although we show modest associations between the independent use of CSA practices such as adopting climate-smart groundnut varieties, cereal-groundnut intercropping, and the use of organic fertilizers, we find that bundling these practices may lead to greater yield and food security gains. Under the different combinations, the use of climate-smart groundnut varieties exhibit the strongest association with yields and food security. We also estimate actual-counterfactual relationships where we show that the adoption of CSA practices is not only beneficial to CSA adopters but could potentially be beneficial to non-CSA adopters should they adopt. These results have implications for reaching some of the sustainable development targets, especially the twin goals of increasing agricultural productivity and maintaining environmental sustainability. © 2023 The Author(s) | Open |
| Tandoh A.; Laar A.; Pradeilles R.; Le Port A.; Osei-Kwasi H.; Amevinya G.S.; Aryeetey R.N.O.; Agyemang C.; Holdsworth M. | Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: A community readiness appraisal | 2023 | BMJ Open | Objective This study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4-15 years) in Greater Accra Region, the highly urbanised administrative capital of Ghana. Design The community readiness model was used to conduct in-depth mixed methods interviews with stakeholders. Using predefined anchored rating statements, quantitative readiness scores ranging from 1 to 9 were generated. Thematic qualitative analysis was undertaken to understand barriers and facilitators that could influence the implementation of interventions. Setting Greater Accra Region, Ghana. Participants 18 key informants from various school/education/citizen sectors, which together represented the 'school community' of Greater Accra Region. Results The mean readiness scores indicated that the 'school community' was at the 'preplanning' stage of readiness (4.44±0.98) to address the marketing and availability of unhealthy food and beverages in and around schools. The mean readiness score for 'leadership' was the highest of all dimensions (5.36±1.60), corresponding to the 'preparation' stage. The lowest scores were found for 'community knowledge of efforts' (3.19±2.45) and 'resources for efforts' (3.64±0.87), both of which were at a 'vague awareness' stage. Conclusions The 'school community' recognised that the marketing and availability of unhealthy food and beverages was a problem. Additionally, current leadership was actively supportive of continuing/improving efforts that create healthier children's food environments. However, actions that aim to increase the 'school community's' knowledge of existing interventions and securing resources to sustain those interventions are needed before introducing readiness appropriate strategies. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | Open |
| Tandoh M.A.; Mills-Robertson F.C.; Annan R.A.; Wilson M.D.; Anderson A.K. | A comparison of intervention strategies to improve helminthiasis, nutrition and cognitive status among school-age children in helminth endemic farming and fishing areas in Ghana | 2023 | Cogent Food and Agriculture | To evaluate the impact of intervention strategies on helminthiasis, the nutritional and cognitive status of School-Age Children (SAC), we conducted a community trial with 4 intervention arms; “Nutrition Education Only” (NutEd), “Supplementation Only” (Suppl), “Nutrition Education+Supplementation” (NutEd+Suppl) versus a ‘Non-intervention‘(Control) group. The intervention was conducted on 358 SAC from 8 randomly selected schools (4 schools from fishing and 4 schools from farming communities) in the Kwahu Afram Plains South District of Ghana. Data were collected at baseline, third, and sixth-month post-intervention. Data were obtained through questionnaire, anthropometry, parasitology (faecal and urine analysis), hemoglobin levels (Hb) and whole blood zinc levels. The Ravens Colored Progressive Matrices (RCPM) were used for the cognitive assessment. At baseline, the overall helminthiasis prevalence was 29.6%, which decreased to 6.3% at the 6th-month post-intervention. About 7.5% of all the children were underweight, 11.2% were stunted, 21.5% were acutely malnourished, 46.1% were anemic and 31.4% were zinc deficient. These decreased to 5.3% (underweight), 8.5% (stunting), 9.8% (acute malnutrition), 16.1% (anemia) and 9.3% (zinc deficiency), respectively, at the 6th-month post-intervention. At baseline, 15.6% of the children passed the cognitive test which increased to 32.4% at the 6th-month post-intervention. The “NutEd” treatment recorded the most significantly improved of bmi-for-age z-score (0.27 ± 0.88, p = 0.002), height-for-age z-score (0.16 ± 0.38, p < 0.0001) and anemia (Hb levels; 1.22 ± 1.13 g/dL, p < 0.0001), The “NutEd+Suppl” group recorded the highest improvement in zinc levels (46.39 ± 22.30 µmol/L, p < 0.0001) and the “Suppl” group the highest improvement in cognitive performance (3.08 ± 6.07, p < 0.0001) between the baseline and the 6th-month post-intervention. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Tchum S.K.; Sakyi S.A.; Arthur F.; Adu B.; Abubakar L.A.; Oppong F.B.; Dzabeng F.; Amoani B.; Gyan T.; Asante K.P. | Effect of iron fortification on anaemia and risk of malaria among Ghanaian pre-school children with haemoglobinopathies and different ABO blood groups | 2023 | BMC Nutrition | Background: Haemoglobinopathies such as sickle cell disorder and glucose-6-phosphate dehydrogenase (G6PD) deficiency as well as differences in ABO blood groups have been shown to influence the risk of malaria and/or anaemia in malaria-endemic areas. This study assessed the effect of adding MNP containing iron to home-made weaning meals on anaemia and the risk of malaria in Ghanaian pre-school children with haemoglobinopathies and different ABO blood groups. Methods: This study was a double-blind, randomly clustered trial conducted within six months among infants and young children aged 6 to 35 months in rural Ghana (775 clusters, n = 860). Participants were randomly selected into clusters to receive daily semiliquid home-prepared meals mixed with either micronutrient powder without iron (noniron group) or with iron (iron group; 12.5 mg of iron daily) for 5 months. Malaria infection was detected by microscopy, blood haemoglobin (Hb) levels were measured with a HemoCue Hb analyzer, the reversed ABO blood grouping microtube assay was performed, and genotyping was performed by PCR–RFLP analysis. Results: The prevalence of G6PD deficiency among the study participants was 11.2%. However, the prevalence of G6PD deficiency in hemizygous males (8.5%) was significantly higher than that in homozygous females (2.7%) (p = 0.005). The prevalence rates of sickle cell traits (HbAS and HbSC) and sickle cell disorder (HbSS) were 17.5% and 0.5%, respectively. Blood group O was dominant (41.4%), followed by blood group A (29.6%) and blood group B (23.3%), while blood group AB (5.7%) had the least frequency among the study participants. We observed that children on an iron supplement with HbAS had significantly moderate anaemia at the endline (EL) compared to the baseline level (BL) (p = 0.004). However, subjects with HbAS and HbAC and blood groups A and O in the iron group had a significantly increased number of malaria episodes at EL than at BL (p < 0.05). Furthermore, children in the iron group with HbSS (p < 0.001) and the noniron group with HbCC (p = 0.010) were significantly less likely to develop malaria. Conclusions: Iron supplementation increased anaemia in children with HbAS genotypes and provided less protection against malaria in children with HbAC and AS and blood groups A and O. Trial registration: clinicaltrials.gov Identifier: NCT01001871. Registered 27/10/2009. Registration number: https://clinicaltrials.gov/ct2/show/record/NCT01001871. © 2023, The Author(s). | Open |
| Tetteh A.; Adanu R.M.K.; Folson G.; Agyabeng K.; Dwomoh D.; Aryeetey R. | DRIVERS OF ANAEMIA REDUCTION AMONG WOMEN OF REPRODUCTIVE AGE IN THE EASTERN AND UPPER WEST REGIONS OF GHANA: A SECONDARY DATA ANALYSIS OF THE GHANA DEMOGRAPHIC AND HEALTH SURVEYS | 2023 | African Journal of Food, Agriculture, Nutrition and Development | Anaemia among women of reproductive age (WRA) increases the risk of pregnancy-related morbidity, mortality, and poor pregnancy outcomes. Globally, there is growing interest to reduce anaemia among WRA. In Ghana, anaemia among WRA declined at the national level between 2008 (59%) and 2014 (42%). There were also important declines at the sub-national level. The Eastern region (in the south) and Upper West region (in the north) provide an interesting opportunity to understand the decline. Identifying the drivers of anaemia reduction among WRA in Ghana provides important implementation science evidence for designing effective interventions. This current study examined the drivers of reduced anaemia prevalence in women of reproductive age using data from the Ghana Demographic and Health Surveys for 2008 and 2014. Anaemia was diagnosed as haemoglobin<12.0g/dl. Data were summarized using proportions and 95% confidence intervals. A weighted binary logistic-based multivariate decomposition technique was used to identify the potential drivers of anaemia across surveys for 2003, 2008 and 2014. Sensitivity analysis was carried out to test the robustness of the results of the decomposition analysis using haemoglobin concentration. The results of the decomposition analysis were presented as endowment and coefficient effects. Statistical analysis was carried out using Stata version 15. There was an improvement in access to water and sanitation, health services, family planning, and health insurance across surveys. Drivers of anaemia reduction over time at the national level included wealth index and maternal age, education, use of hormonal contraception and body mass index (BMI). In the Eastern region, the drivers of change were household wealth index, maternal age, hormonal contraceptive use and BMI. The drivers of change in the Upper West region, were household access to water, maternal education and BMI. The findings suggest that multi-level interventions are needed across sectors to further reduce anaemia among WRA. © 2023,African Journal of Food, Agriculture, Nutrition and Development.All Rights Reserved. | Open |
| Vercillo S.; Rao S.; Ragetlie R.; Vansteenkiste J. | Nourishing the Nexus: A Feminist Analysis of Gender, Nutrition and Agri-food Development Policies and Practices | 2023 | European Journal of Development Research | This article applies feminist critiques to investigate how agri-food and nutritional development policy and interventions address gender inequality. Based on the analysis presented of global policies and examples of project experiences from Haiti, Benin, Ghana, and Tanzania, we find that the widespread emphasis on gender equality in policy and practice generally ascribes to a gender narrative that includes static, homogenized conceptualizations of food provisioning and marketing. These narratives tend to translate to interventions that instrumentalize women’s labor by funding their income generating activities and care responsibilities for other benefits like household food and nutrition security without addressing underlying structures that cause their vulnerability, such as disproportionate work burdens, land access challenges, among many others. We argue that policy and interventions must prioritize locally contextualized social norms and environmental conditions, and consider further the way wider policies and development assistance shape social dynamics to address the structural causes of gender and intersecting inequalities. © 2023, European Association of Development Research and Training Institutes (EADI). | Open |
| Wanjohi M.N.; Pradeilles R.; Asiki G.; Holdsworth M.; Kimani-Murage E.W.; Muthuri S.K.; Irache A.; Laar A.; Zotor F.; Tandoh A.; Klomegah S.; Graham F.; Osei-Kwasi H.A.; Green M.A.; Coleman N.; Mensah K.; Akparibo R.; Aryeteey R.; Rousham E.K.; Bricas N.; Bohr M.; Griffiths P. | Community perceptions on the factors in the social food environment that influence dietary behaviour in cities of Kenya and Ghana: A Photovoice study | 2023 | Public Health Nutrition | Objective: To explore communities' perspectives on the factors in the social food environment that influence dietary behaviours in African cities. Design: A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary behaviours. Follow-up in-depth interviews allowed participants to tell the 'stories' of their photographs. Thematic analysis was conducted, using data-driven and theory-driven (based on the socio-ecological model) approaches. Setting: Three low-income areas of Nairobi (n 48) in Kenya and Accra (n 62) and Ho (n 32) in Ghana. Participants: Adolescents and adults, male and female aged ≥13 years. Results: The 'people' who were most commonly reported as influencers of dietary behaviours within the social food environment included family members, friends, health workers and food vendors. They mainly influenced food purchase, preparation and consumption, through (1) considerations for family members' food preferences, (2) considerations for family members' health and nutrition needs, (3) social support by family and friends, (4) provision of nutritional advice and modelling food behaviour by parents and health professionals, (5) food vendors' services and social qualities. Conclusions: The family presents an opportunity for promoting healthy dietary behaviours among family members. Peer groups could be harnessed to promote healthy dietary behaviours among adolescents and youth. Empowering food vendors to provide healthier and safer food options could enhance healthier food sourcing, purchasing and consumption in African low-income urban communities. © The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society. | Open |
| Watson D.; Barker M.; Boua P.R.; Chatio S.; Compaoré A.; Danis M.; Dalaba M.; Erzse A.; Hardy-Johnson P.; Kehoe S.H.; Hofman K.J.; Lawrence W.T.; Nonterah E.A.; Sorgho H.; Rwafa-Ponela T.; Ward K.A.; Oduro A.; Adoctor J.; Welaga P.; Beeri P.; Dambayi E.; Nonterah E.W.; Ofosu W.; Ayibisah D.; Ouedraogo K.; Rouamba T.; Derra K.; Welgo A.; Tinto H.; Goldstein S.; Mdewa W.; Edoka I.; Hanson M.; Fall C.; Cohen E.; Wrottesley S. | What works in engaging communities? Prioritising nutrition interventions in Burkina Faso, Ghana and South Africa | 2023 | PLoS ONE | Background “Choosing All Together” (CHAT), is a community engagement tool designed to give the public a voice in how best to allocate limited resources to improve population health. This process evaluation explored the mechanisms through which CHAT generates community engagement. Method The CHAT tool was adapted and implemented for use in two rural communities (Nanoro, Burkina Faso, and Navrongo, Ghana) and one urban township (Soweto, South Africa) to prioritize maternal and child nutrition interventions. Community discussions were audio-recorded, transcribed, and translated into English. Twenty-two transcripts, including six each from Navrongo and Soweto and 10 from Nanoro, were analysed thematically to generate data driven codes and themes to explain mechanisms underlying the CHAT process. The process evaluation was based on the UK MRC process evaluation guidance. Results Seven themes describing the functions and outcomes of CHAT were identified. Themes described participants deliberating trade-offs, working together, agreeing on priorities, having a shared vision, and increasing their knowledge, also the skills of the facilitator, and a process of power sharing between participants and researchers. Participants came to an agreement of priorities when they had a shared vision. Trained facilitators are important to facilitate meaningful discussion between participants and those with lower levels of literacy to participate fully. Conclusion CHAT has been shown to be adaptable and useful in prioritising maternal and child nutrition interventions in communities in Burkina Faso, Ghana, and South Africa. Conducting CHAT in communities over a longer period and involving policy-makers would increase trust, mutual respect and develop partnerships. © 2023 Watson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Watson D.; Chatio S.; Barker M.; Boua P.R.; Compaoré A.; Dalaba M.; Erzse A.; Godfrey K.; Hofman K.; Kehoe S.; Mcgrath N.; Mukoma G.; Nonterah E.A.; Norris S.A.; Sorgho H.; Ward K.A.; Hardy-Johnson P. | Men's motivations, barriers to and aspirations for their families' health in the first 1000 days in sub-Saharan Africa: a secondary qualitative analysis | 2023 | BMJ Nutrition, Prevention and Health | Introduction The first 1000 days of life are a critical period of growth and development that have lasting implications for health, cognitive, educational and economic outcomes. In sub-Saharan Africa, gender and social norms are such that many men have little engagement with maternal and child health and nutrition during pregnancy and early childhood. This study explores how men perceive their role in three sites in sub-Saharan Africa. Methods Secondary qualitative analysis of 10 focus group discussions with 76 men in Burkina Faso, Ghana and South Africa. Data were thematically analysed to explore men's perceptions of maternal and child health and nutrition. Results Men considered themselves 'providers' and 'advisors' within their families, particularly of finances, food and medicines. They also indicated that this advice was out of care and concern for their families' health. There were similarities in how the men perceive their role. Differences between men living in rural and urban settings included health priorities, the advice and the manner in which it was provided. Across all settings, men wanted to be more involved with maternal and child health and nutrition. Challenges to doing so included stigma and proscribed social gender roles. Conclusion Men want a greater engagement in improving maternal and child health and nutrition but felt that their ability to do so was limited by culture-specified gender roles, which are more focused on providing for and advising their families. Involving both men and women in intervention development alongside policymakers, health professionals and researchers is needed to improve maternal and child health and nutrition. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | Open |
| Wemakor A.; Kwaako M.; Abdul-Rahman A. | Nutritional, health and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Ghana | 2023 | BMC Nutrition | Background: Anaemia is a serious health problem among adolescent girls in Ghana. The aims of this study were to measure the prevalence and identify the nutritional, health, and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Northern Region, Ghana. Method: An analytical cross-sectional study involving 370 adolescent girls residing in Kumbungu district, selected using multi-stage sampling procedure, was conducted. A semi-structured questionnaire, 24-hr dietary recall, food frequency questionnaire, Food Insecurity Experience scale, and anthropometry were used to gather information on socio-demographic characteristics, nutrition knowledge, dietary diversity score, food consumption score, food consumption frequency, household food insecurity, and waist and hip circumferences. Haemoglobin was measured using a portable HemoCue hg 301 + Analyzer. Anaemia in the adolescent girls was defined as haemoglobin concentration less than 12 g/dl. Chi-square test and binary logistic regression analysis were used to identify the determinants of anaemia. Results: The mean (± SD) age was 13.95 (± 2.94) years, and the majority of the girls were in school (79.5%) and lived in a rural area (81.1%). The mean (± SD) haemoglobin was 11.27 (± 1.19) g/dl, and 74.6% of the respondents had anaemia, with 1.6% having severe anaemia. The health determinant of anaemia was frequency of feeling nervous in the past 6 months [Adjusted Odds Ratio (AOR): 2.12: 95% Confidence Interval (CI): 1.17–3.89; p: 0.014], and the socio-demographic determinants were residential community status (AOR: 0.42; 95% CI: 0.24–0.75; p: 0.003), and fathers’ educational qualification (AOR: 2.57, 95% CI: 1.17–5.65, p: 0.019). No nutritional determinants of anaemia were identified for this study population. Conclusion: The prevalence of anaemia was very high and the frequency of feeling nervous in the past 6 months, residential community status, and fathers’ educational qualification were associated with anaemia among adolescent girls in Kumbungu district, Ghana. The prevalence of anaemia measured highlights the need for intensification of anaemia prevention and management interventions in the district. © 2023, The Author(s). | Open |
| Wemakor A.; Mohammed I.A.; Awuni V. | Determinants of Household Food Insecurity and Depression in Mothers: Evidence from Ghana | 2023 | Advances in Public Health | Background. Household food insecurity (FI) and maternal depression are serious public health problems, especially in low-income countries. The aims of this study were to determine the determinants of household FI and depression in mothers and the association between these constructs in Savelugu Municipality, Ghana. Methods. An analytical, community-based, cross-sectional survey was conducted to collect data on 364 mothers of under-five children selected using the multistage method in the municipal. Household FI and maternal depression were measured using the FI Experience Scale and Patient Health Questionnaire 9-item in personal interviews. Logistic regression analysis was used to identify the factors associated with household FI and maternal depression and the association between these two constructs. Results. The mean age of mothers was 30.1(±6.5) years with almost all practising Islamic religion (96.2%) and were married (96.7%). The prevalence of household FI and maternal depression were 51.6% and 25.3%, respectively. The determinants of household FI were mother's self-health rating, social support, nutrition knowledge, and household's source of drinking water, while those of maternal depression were the mother's work, place of residence, self-health rating, and nutrition knowledge. In multivariable adjusted logistic regression analysis, women in food insecure households were about three times more likely than women in food secure households to be depressed (adjusted odds ratio = 2.49; 95% confidence interval: 1.36-4.55; and p=0.003). Conclusion. The current study shows a high prevalence of both household FI and depression in mothers in Savelugu Municipality. Both personal and household characteristics of the women are associated with household FI and maternal depression statuses, and the two constructs are highly correlated. It is recommended to include depression assessment in interventions for FI. © 2023 Anthony Wemakor et al. | Open |
| Wiafe M.A.; Apprey C.; Annan R.A. | Nutrition Education Improves Knowledge of Iron and Iron-Rich Food Intake Practices among Young Adolescents: A Nonrandomized Controlled Trial | 2023 | International Journal of Food Science | Introduction. Nutrition education targeting adolescents' health has the potential to enhance their well-being into adulthood. This study assessed the impact of nutrition education on the knowledge of iron and iron-rich food intake practices of adolescents living in rural communities in Ghana. Method. An intervention study was conducted among 137 adolescents; 69 were assigned to the intervention group and 68 to the control group. Participants and guardians in the intervention group were involved in the nutrition education programme for six months. Participants in both groups completed sociodemographic, knowledge of iron, and iron-rich food intake practice questionnaires at pre- and postintervention. Data were analyzed by chi-square and t-tests. Results. At postintervention, the mean knowledge score (p<0.05) in the intervention group and control group was 5.3±1.7 and 3.9±1.9, respectively. Interventions (76%) and controls (46%) had good knowledge status. The mean knowledge score of participants with good knowledge status in the intervention group was 6.1±0.8 (p<0.05), and the control group was 5.6±0.7 (p<0.05). Forty-two percent of participants in the interventions and 26% in the controls had good food intake status. Participants with good food intake status had mean food intake scores of 3.2±0.4 (p<0.05) and 3.8±0.7 (p<0.05) for the intervention and control groups, respectively. Both groups increased and had the same mean food intake score (1.5±1.4, p>0.05), however, relatively higher in the intervention group. Conclusion. Nutrition education improved the knowledge of iron and iron-rich food intake practices of participants in the intervention group compared to the control group. Nutrition education should be a critical component in the management and prevention of micronutrient deficiency in adolescents. © 2023 Michael Akenteng Wiafe et al. | Open |
| Wiafe M.A.; Apprey C.; Annan R.A. | Impact of nutrition education and counselling on nutritional status and anaemia among early adolescents: A randomized controlled trial | 2023 | Human Nutrition and Metabolism | Introduction: Adolescent unhealthy dietary choices are largely rooted in low nutrition knowledge. The study assessed the impact of nutrition education and counselling on nutritional status and anaemia among early adolescents. Methodology: One hundred and thirty-seven adolescents aged 10-14 years were enrolled in this randomized controlled trial conducted at Asante-Akim South Municipality of Ghana. Data on weight, height, ferritin, C-reactive protein (crp), dietary iron, and vitamin C were collected at pre- and post-intervention. BMI-for-age was computed with WHO Anthro Plus. Ferritin and crp were analysed with Human ELISA test kit. Multiple past 24h recall was used to collect data on dietary iron and vitamin C intake. Nutrition education and counselling in the intervention group lasted for six months. Data was analysed using descriptive chi-square test, binary logistics regression, and t.test. Results: One hundred participants completed the study (intervention group: 50 and control group: 50). At end of the study, no statistically significant difference (p > 0.05) was observed between the study groups in terms of underweight, haemoglobin, ferritin, and dietary iron intake except for vitamin C intake. However, underweight, haemoglobin, dietary iron, and vitamin C intake mean values increased in all groups except for ferritin. Within the study groups, nutritional parameters were statistically significant (p < 0.05) at pre-and post-intervention except for ferritin levels in the intervention group. The prevalence of anaemia, low ferritin levels, inadequate dietary iron, and vitamin C intake dropped in all groups but greatly reduced in the intervention group. Conclusion: Nutrition education improved dietary iron and vitamin C intake and reduced the prevalence of anaemia in the intervention group. © 2022 The Authors | Open |
| Wiafe M.A.; Apprey C.; Annan R.A. | Nutrition Education Improves Knowledge of Iron and Iron-Rich Food Intake Practices among Young Adolescents: A Nonrandomized Controlled Trial | 2023 | International Journal of Food Science | Introduction. Nutrition education targeting adolescents' health has the potential to enhance their well-being into adulthood. This study assessed the impact of nutrition education on the knowledge of iron and iron-rich food intake practices of adolescents living in rural communities in Ghana. Method. An intervention study was conducted among 137 adolescents; 69 were assigned to the intervention group and 68 to the control group. Participants and guardians in the intervention group were involved in the nutrition education programme for six months. Participants in both groups completed sociodemographic, knowledge of iron, and iron-rich food intake practice questionnaires at pre- and postintervention. Data were analyzed by chi-square and t-tests. Results. At postintervention, the mean knowledge score (p<0.05) in the intervention group and control group was 5.3±1.7 and 3.9±1.9, respectively. Interventions (76%) and controls (46%) had good knowledge status. The mean knowledge score of participants with good knowledge status in the intervention group was 6.1±0.8 (p<0.05), and the control group was 5.6±0.7 (p<0.05). Forty-two percent of participants in the interventions and 26% in the controls had good food intake status. Participants with good food intake status had mean food intake scores of 3.2±0.4 (p<0.05) and 3.8±0.7 (p<0.05) for the intervention and control groups, respectively. Both groups increased and had the same mean food intake score (1.5±1.4, p>0.05), however, relatively higher in the intervention group. Conclusion. Nutrition education improved the knowledge of iron and iron-rich food intake practices of participants in the intervention group compared to the control group. Nutrition education should be a critical component in the management and prevention of micronutrient deficiency in adolescents. © 2023 Michael Akenteng Wiafe et al. | Open |
| Wiafe M.A.; Ayensu J.; Yeboah G.B. | Predictors of food variety and food consumption scores of adolescents living in a rural district in Ghana | 2023 | PLoS ONE | Introduction There is a dearth of information about the food variety and consumption scores of adolescents in Ghana. This study assessed predictors of food variety and consumption scores of adolescents living in a rural district in Ghana. Method In this cross-sectional study, a multi-stage sampling method was used to select one hundred and thirty-seven (137) adolescents from the Asante-Akim South Municipality of Ghana. A structured questionnaire was used to collect data on sociodemographic, food practices and dietary intakes of study participants. Descriptive, chi-square, T-test, partial correlation and binary logistic regression were used for the data analysis. Results The mean food variety score was 25.8±6.4 (range 7–42) and food consumption score was 35±5.1 (range 18.6–49.9). Food variety score was significantly (p<0.05) associated with guardian income status. A significant and positive partial correlation existed between food variety score and calcium intake (r = 0.236, p<0.05). About 49% and 51% of adolescents were food insecure and food secure, respectively. Food consumption score had significant association (p<0.05) with gender (X2 = 6.1), residence (X2 = 7.0), frequency of meal (X2 = 6.8) and food variety score (X2 = 5.4). Adolescent male (AOR = 2.3, 95% CI (1.2–4.6), p = 0.017), peri-urban residency (AOR = 2.1, 95%CI (1.0–4.4), p = 0.036), having three or more meals per day (AOR = 4.2, 95% CI (1.3–13.6), p = 0.018), and a high food variety score (AOR = 2.1, 95%CI (1.0–4.2), p = 0.041) significantly predicted food consumption scores. Conclusion Moderate income status was associated with food variety score in our study participants. Linear relationship existed between food variety and calcium intake. Adolescent males, peri-urban residency, frequency of meals and high food variety score were the predictors of food consumption score. Nutrition-specific and nutrition sensitive programmes aimed at promoting adolescent health should involve guardians. Copyright: © 2023 Wiafe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Yar D.D.; Kwenin W.K.J.; Balali G.I.; Assoah E.; Addy R.; Francis G. | Food milling machines are hosts to pathogenic bacteria: A cross-sectional study in the Asante Mampong Municipal, Ghana | 2023 | Scientific African | Foodborne illnesses are a growing concern globally, with the food processing chain being implicated as the main culprit. However, the contribution of milling machines to these outbreaks in the Asante Mampong municipality is not well understood. This study evaluated the bacteriological quality of 55 food milling machines and assessed management practices and perceptions of operators towards microbial contamination. The study recorded a total mean count of 1.95523 × 105 (CFU/ml) and identified 82 bacteria in five genera, with Salmonella spp. and Shigella spp. being the most prevalent. The Fufu pounding machine recorded the highest total isolates, while the pepper/tomato machine had the highest Salmonella isolates. Compared to similar studies, this research offers novel findings on the extent of contamination and specific genera of bacteria found in food milling machines in the Asante Mampong municipality. The study highlights the need for regular and rigorous checks on milling machines to minimize contamination and foodborne outbreaks in the food milling industry. The study's findings offer solutions to reducing foodborne illnesses locally and nationally, including increased awareness and licensing of milling machine operators to ensure good hygiene practices and minimize contamination. This research contributes to new knowledge on management practices and perceptions of operators towards microbial contamination in milling machines. Additionally, the study's relevance to the global discourse on food safety can aid in achieving Sustainable Development Goal 3 (Good Health and Well-being) and the Africa Union's Agenda 2063 in promoting food safety and nutrition security on the continent. © 2023 The Author(s) | Open |
| Yila J.O.; Martey E.; Etwire P.M.; Adogoba D.S.; Muricho G.; Desmae H. | Exploring gender differences in trait preferences among groundnut value chain actors in northern Ghana | 2023 | Agriculture and Food Security | Assessing gender differences in trait preferences of groundnut value chain actors can influence the effectiveness of crop breeding programs, the adoption of developed technologies, and policy interventions. However, there is limited evidence to support decisions that meet end users’ demands, given that most studies do not disaggregate trait preferences by sex and age. We use a stated preference method to characterize the preferences and willingness to pay (WTP) for various attributes of improved groundnut varieties by male and female youth and older adults in the different segments of the groundnut value chain. The results indicate heterogeneity in preference and WTP for production, market, and nutrition attributes of groundnut across supply chain actors. The results showed that gender is not a unifying factor in respondents’ WTP, revealing dissimilarities among youth and older adults of the same sex group. Our findings suggest that groundnut breeding programs must prioritize production, market, and nutrition attributes based on gender needs to speed up the process of adoption, commercialization, and utilization of groundnut. © 2023, The Author(s). | Open |
| Zornu J.; Tavornpanich S.; Shimaa A.E.; Addo S.; Nyaga P.; Dverdal M.J.; Norheim K.; Brun E.; Cudjoe K.S. | Bridging knowledge gaps in fish health management through education, research, and biosecurity | 2023 | Frontiers in Sustainable Food Systems | Education, research, and biosecurity have global recognition as strong pillars of sustainable aquaculture development. In many developing countries, insufficient knowledge and awareness among stakeholders regarding the relevance of education, research, and biosecurity have influenced aquaculture sustainability negatively. To uncover the gaps in education, research, and biosecurity practices in aquatic animal health management, we conducted a questionnaire-based study in various East and West African countries. By adopting the methodology of self-reporting data, we invited a significant number of individuals to participate in the study. In the end, 88 respondents contributed, with the majority from Ghana (47) and Kenya (20), and 21 respondents from five other East and West African nations. The results revealed substantial educational gaps, including the need for practical training in aquatic animal health management, nutrition, and genetics. Respondents also emphasized the importance of creating additional national aquaculture research institutions and augmented funding to enable them to address industry needs. Governments of the represented nations should actively intervene by providing the essential logistics and capacity to support aquaculture research and development. Informed government involvement is paramount for bridging the disconnection among all stakeholders, as revealed in the results. Furthermore, the lack of biosecurity measures and the understanding of the importance of biosecurity measures in the industry addressed through awareness creation. Creating awareness on biosecurity underpinned with national aquaculture biosecurity policies can prevent disease incidences in the industry. The outcomes of this study can serve as a vital working document to enhance aquatic animal health management in East and West Africa, thereby fostering sustainable and resilient aquaculture. Copyright © 2023 Zornu, Tavornpanich, Shimaa, Addo, Nyaga, Dverdal, Norheim, Brun and Cudjoe. | Open |
| Abdu A.; Marquis G.S.; Colecraft E.K.; Dodoo N.D.; Grimard F. | The Association of Women's Participation in Farmer-Based Organizations with Female and Male Empowerment and its Implication for Nutrition-Sensitive Agriculture Interventions in Rural Ghana | 2022 | Current Developments in Nutrition | Background: Few studies have examined the influence of women's participation in farmer groups on female and male empowerment, which is considered essential to improving nutrition. Objectives: The study aimed to 1) assess the empowerment of Ghanaian women farmers, 1 adult male family decision-maker per household, and the household gender equality; and 2) investigate the relation of empowerment and household gender equality with women's participation in farmer-based organizations (FBOs), women's and men's nutritional status, and household food security. Methods: A cross-sectional study investigated secondary outcomes using baseline data from a nutrition-sensitive agriculture intervention implemented through FBOs in rural Ghana. Existing FBOs in 8 communities were selected based on 6 criteria (e.g., participation level, readiness to change). Female FBO (n = 166) and non-FBO (n = 164) members together with a male family member (n = 205) provided data on individual and household characteristics; empowerment was measured across 11 indicators with the project-level Women's Empowerment in Agriculture Index. Generalized linear mixed models tested the associations of empowerment and household gender equality with FBO membership, nutritional status, and household food security. Results: Women's FBO membership was associated with an increased likelihood of women's empowerment [adjusted odds ratio (aOR): 3.25; 95% CI: 1.97, 5.33] and household gender parity (aOR: 2.82; 95% CI: 1.39, 5.84) but not men's empowerment. Household food insecurity, but not nutritional status, was positively associated with women's FBO participation and individual empowerment indicators (financial services). Food insecurity was negatively associated with the women's empowerment indicator related to attitudes about domestic violence [adjusted β coefficient (aβ): −0.78; 95% CI: −1.35, −0.21] and men's overall empowerment (aβ: −0.79; 95% CI: −1.58, −0.01). Conclusions: Understanding the complexity in which FBO participation, empowerment, nutritional status, and food security are linked is critical in designing interventions that promote gender equality and improved nutrition. This trial was registered at http://clinicaltrials.gov as NCT03869853. © 2022 American Society for Nutrition. | Open |
| Abdul Mumin Y.; Abdulai A. | Social networks, adoption of improved variety and household welfare: Evidence from Ghana | 2022 | European Review of Agricultural Economics | In this study, we examine the effects of own and peer adoption of improved soybean variety on household yields and food and nutrient consumption, using observational data from Ghana. We employ the marginal treatment effect approach to account for treatment effect heterogeneity across households and a number of identification strategies to capture social network effects. Our empirical results show that households with higher unobserved gains are more likely to adopt because of their worse outcomes when not adopting. We also find strong peer adoption effect on own yield, only when the household is also adopting, and on food and nutrient consumption when not adopting. However, the peer adoption effect on consumption attenuates when the household adopts the improved variety. Furthermore, our findings reveal that adoption tends to equalise households in terms of observed and unobserved gains on consumption and can thus serve as a mechanism for promoting food security and nutrition in this area. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the Foundation for the European Review of Agricultural Economics. All rights reserved. | Open |
| Abdul Mumin Y.; Abdulai A. | Informing Food Security and Nutrition Strategies in Sub-Saharan African Countries: An Overview and Empirical Analysis | 2022 | Applied Economic Perspectives and Policy | This article presents a systematic review of the literature on policy options to improve food security and nutrition in developing countries, and an empirical analysis of the impact of smallholder market participation on food security and nutrition in Ghana. The review focuses on the impacts of policy strategies such as structural changes in relative prices, agricultural infrastructure, economic incentives, and agricultural technologies. To account for threats of selection bias and omitted variable problem, the empirical analysis uses an ordered probit selection model to jointly estimate households' market orientation decisions and food and nutrients consumption. The empirical results show that transitioning from one market orientation to another significantly increase households' food and nutrients consumption. © 2020 The Authors. Applied Economic Perspectives and Policy published by Wiley Periodicals LLC. on behalf of Agricultural & Applied Economics Association. | Open |
| Abdul Rahman N.; Larbi A.; Berdjour A.; Kizito F.; Hoeschle‑Zeledon I. | Correction to: Cowpea Living Mulch Effect on Soil Quality and Grain Yield in Smallholder Maize-Based Cropping System of Northern Ghana (Journal of Soil Science and Plant Nutrition, (2022), 22, 3, (3925-3940), 10.1007/s42729-022-00942-5) | 2022 | Journal of Soil Science and Plant Nutrition | Due to an error during production, Table 4 and Table 5 were incorrectly numbered in this article as originally published, with Table 4 numbered as Table 5, and Table 5 numbered as Table 4. The original article has been corrected. © The Author(s) under exclusive licence to Sociedad Chilena de la Ciencia del Suelo 2022. | Open |
| Abekah-Carter K.; Awuviry-Newton K.; Oti G.O.; Umar A.R. | The unmet needs of older people in Nsawam, Ghana | 2022 | Health and Social Care in the Community | Although healthy life expectancy is projected to be increasing among older people in Ghana, a high proportion and number of older people will live with functional disability, warranting their need for long-term care. We explored the expressions used by older people to describe their needs and preference of care and support. Using the descriptive qualitative approach, 14 older people were engaged via semi-structured interviews, and the data were analysed thematically. The study found that older people desired a decent accommodation, preferential healthcare, adequate nutrition, and an opportunity to interact with their peers at social functions. A provision of sufficient financial assistance, adequate healthcare, the periodic organisation of social and group events for older people, and the availability of home care and support could help older people address these needs. The paper reveals the need for interventional research on how a model incorporating social, health and environmental factors even during a pandemic can address older people's varying needs. © 2022 John Wiley & Sons Ltd. | Open |
| Aberman N.-L.; Gelli A.; Agandin J.; Kufoalor D.; Donovan J. | Putting consumers first in food systems analysis: identifying interventions to improve diets in rural Ghana | 2022 | Food Security | A critical, yet underexplored, dimension of food systems is how consumer food preferences and beliefs interact with the food environment. We present a consumer-centered approach to identifying options for improving diets. The Value Chains for Nutrition (VCN) mixed-methods multi-disciplinary analytical approach was applied in rural Ghana. Data from in-depth consumer interviews, structured vendor interviews, and (secondary) household consumption surveys were analyzed to assess consumer diet patterns, related norms and preferences, and supply and demand characteristics of a set of empirically defined high-potential nutritious foods. Mapping results onto a supply–demand typology, we identify promising interventions to support increased availability, access, and affordability of these foods. Consumption data suggested that diets among Ghanaians were deficient in key micronutrients and calories. Fresh nutritious fruits and vegetables tended to be grown for home consumption rather than sale due to transportation challenges and seasonality of demand, especially near rural markets. Seasonal availability (fruits and vegetables) and affordability (animal foods) severely limited consumption of many nutritious foods. A set of supply, demand, and value chain interventions to enhance availability and affordability of nutritious foods are presented. Critical to success is to consider the set of interventions along each value chain required for impact. © 2022, The Author(s). | Open |
| Aberman N.-L.; Nisbett N.; Amoafo A.; Areetey R. | Assessing the readiness of small cities in Ghana to tackle overweight and obesity | 2022 | Food Security | The rapid rise in the prevalence of overweight and obesity, and the associated health problems, is an emerging challenge in Ghana, and for women in particular. This study contributes to the understanding of this emerging phenomenon in Ghana by analyzing it from a community perspective, applying the Community Readiness Model in two small cities in Ghana. A series of Key Informant Interviews were undertaken and analyzed, using the model’s scoring structure and supplementary textual analysis. We find that communities are aware of overweight and obesity as a health issue, but that it is not prioritized or championed. Furthermore, the diet counseling and keep-fit programs put the responsibility on individuals to address, rather than considering the upstream and structural causes and solutions. © 2021, The Author(s). | Open |
| Adiiboka F.; Soni R.K.; Vuvor F.; Abobi-Kanbigs D. | The Role of Nutrition in the Prevention and Management of Neonatal Jaundice in Ghana | 2022 | Texila International Journal of Public Health | Despite the well-established importance of nutrition in health and wellness, nutrition’s involvement in the management and prevention of neonatal jaundice varies greatly from one guideline to another, to the extent that some guidelines do not include the role of nutrition in the prevention and management of neonatal jaundice. In addition, mothers typically translate their nutrition knowledge into the care of their babies. Hence, it is prudent for mothers to have the requisite knowledge needed to prevent any health condition, including neonatal jaundice. This study, therefore, sought to investigate and consolidate practices that elucidate the role nutrition plays in the prevention and management of neonatal jaundice in Ghana. The study was a multi-center nested, case-control study involving 120 cases and 120 controls of neonates in three referral hospitals in Ghana. Assessment of nutrition knowledge showed that with regards to the WHO (2004 & 2017) infant feeding recommendations, mothers of babies with neonatal jaundice had a higher nutrition score than mothers with healthy babies. During treatment of neonatal jaundice, babies were mostly fed breastmilk only, and, in a few cases, extra fluids were given if the baby is not exclusively breastfed or there is a risk of dehydration during phototherapy. No probiotic supplements were given, and micronutrient supplementation may or may not be given, depending on the prevailing health conditions of the neonate. It is recommended that further assessment should be carried out to identify the effectiveness of the nutrition education given during antenatal and postnatal education sessions at hospitals, clinics, and health centers. © 2022, Texila International Journal (TIJ). All rights reserved. | Open |
| Adiiboka F.; Soni R.K.; Vuvor F.; Abobi-Kanbigs D. | Assessment of the Nutritional Status of Babies with Neonatal Jaundice in Ghana | 2022 | Texila International Journal of Public Health | Neonatal jaundice is a public health concern responsible for a relatively high rate of infant morbidity and mortality. Therefore, it is prudent to put in place effective risk-reduction strategies and detect and treat new born jaundice effectively. Optimum nutrition has been shown to be crucial to health and well-being. This study, therefore, sought to investigate the nutritional status of babies that report to three referral hospitals in Ghana (Korle-bu Teaching Hospital, Greater Accra Regional Hospital and the Tamale Teaching hospital). It was a multi-center nested, case-control study involving 120 cases and 120 controls of neonates in the three referral hospitals in Ghana. The study revealed that babies with neonatal jaundice in Ghana mostly have a normal nutritional status, even though they lose about 5% of their birth weight. More mothers of healthy babies (88.3%) did exclusive breastfeeding, compared with mothers of babies with neonatal jaundice (76.7%). It was also revealed that the three referral hospitals implemented the Baby Friendly Hospital Initiative’s ten steps to successful breastfeeding as a measure to prevent suboptimal feeding, which could lead to an increase in bilirubin levels. Assessment and interventions to prevent weight loss should therefore be paramount for babies with neonatal jaundice. © 2022, Texila International Journal (TIJ). All rights reserved. | Open |
| Adu-Afarwuah S.; Arnold C.D.; Lartey A.; Okronipa H.; Maleta K.; Ashorn P.; Ashorn U.; Fan Y.-M.; Matchado A.; Kortekangas E.; Oaks B.M.; Jackson K.H.; Dewey K.G. | Small-Quantity Lipid-Based Nutrient Supplements Increase Infants' Plasma Essential Fatty Acid Levels in Ghana and Malawi: A Secondary Outcome Analysis of the iLiNS-DYAD Randomized Trials | 2022 | Journal of Nutrition | Introduction: Small-quantity (SQ) lipid-based nutrient supplements (LNSs) may influence infants' plasma fatty acid (FA) profiles, which could be associated with short- and long-term outcomes. Objectives: We aimed to determine the impact of SQ-LNS consumption on infants' plasma FA profiles in Ghana and Malawi. Methods: Ghanaian (n = 1320) and Malawian (n = 1391) women ≤20 weeks pregnant were assigned to consume 60 mg iron and 400 μg folic acid daily until delivery [iron and folic acid (IFA) group], multiple-micronutrient supplements (MMNs) until 6 months postpartum (MMN group), or SQ-LNSs (∼7.8 linoleic acid:α-linolenic acid ratio) until 6 months postpartum (LNS group). LNS group infants received SQ-LNS from 6 to 18 months of age. We compared infant plasma FAs by intervention group in subsamples (n = 379 in Ghana; n = 442 in Malawi) at 6 and 18 months using ANOVA and Poisson regression models. Main outcomes were mean percentage compositions (%Cs; percentage of FAs by weight) of α-linolenic acid (ALA), linoleic acid (LA), EPA, DHA, and arachidonic acid (AA). Results: At 6 months, LNS infants had greater mean ± SD ALA %Cs in Ghana (0.23 ± 0.08; IFA, 0.21 ± 0.06; MMN, 0.21 ± 0.07; P = 0.034) and Malawi (0.42 ± 0.16; IFA, 0.38 ± 0.15; MMN, 0.38 ± 0.14; P = 0.034) and greater AA values in Ghana (6.25 ± 1.24; IFA, 6.12 ± 1.13; MMN, 5.89 ± 1.24; P = 0.049). At 18 months, LNS infants had a tendency towards greater ALA (0.32 ± 0.16; IFA, 0.24 ± 0.08; MMN, 0.24 ± 0.10; P = 0.06) and LA (27.8 ± 3.6; IFA, 26.9 ± 2.9; MMN, 27.0 ± 3.1; P = 0.06) in Ghana, and greater ALA (0.45 ± 0.18; IFA, 0.39 ± 0.18; MMN, 0.39 ± 0.18; P < 0.001) and LA (29.7 ± 3.5; IFA, 28.7 ± 3.3; MMN, 28.6 ± 3.4; P = 0.011) in Malawi. The prevalence of ALA below the population-specific 10th percentile was lower in the LNS group compared to the MMN group, but not the IFA group. Groups did not differ significantly in plasma EPA or DHA levels. Conclusions: SQ-LNS increased infants' plasma essential FA levels in Ghana and Malawi, which may have implications for health and developmental outcomes. © 2021 The Author(s). | Open |
| Agaba M.; Azupogo F.; Brouwer I.D. | Maternal nutritional status, decision-making autonomy and the nutritional status of adolescent girls: a cross-sectional analysis in the Mion District of Ghana | 2022 | Journal of Nutritional Science | A mother's nutritional status and participation in household decision-making, a proxy for empowerment, are known determinants of improved nutrition and health outcomes for infants and young children; however, little is known about the association among adolescents. We examined the association between maternal nutritional status, decision-making autonomy and adolescent girls' nutritional status. We analysed data of 711 mother-adolescent girl pairs aged 10-17 years from the Mion District, Ghana. Maternal nutritional status and decision-making autonomy were the independent variables while the outcomes were adolescent girls' nutritional status as defined by anaemia, stunting and body mass index-for-age Z-score categories. Girl-level (age, menarche status and the frequency of animal-source food consumption), mother-level (age, education level, and monthly earnings) and household-level (wealth index, food security status and family size) covariates were adjusted for in the analysis. All associations were examined with hierarchical survey logistic regression. There was no association between maternal height and adolescent girls being anaemic, underweight or overweight/obese. Increasing maternal height reduced the odds of being stunted [adjusted odds ratio (OR) 0.92, 95 % CI (0.89, 0.95)] for the adolescent girl. Maternal overweight/obesity was positively associated with the girl being anaemic [OR 1.35, 95 % CI (1.06, 1.72)]. The adolescent girl was more than five times likely to be thin [OR 5.28, 95 % CI (1.64-17.04)] when the mother was underweight. Maternal decision-making autonomy was inversely associated with stunting [OR 0.88, 95 % CI (0.79, 0.99)] among the girls. Our findings suggest that intergenerational linkages of a mother's nutritional status are not limited to childhood but also during adolescence. © The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society. | Open |
| Agbozo F.; Bannerman E.; Klomegah S.; Zotor F. | Lifestyle habits and perceived wellbeing of adults presenting with metabolic syndrome at a diabetic clinic in Ghana: A case-control study: Metabolic syndrome and wellbeing in Ghana | 2022 | Human Nutrition and Metabolism | Background: Heightened by the epidemiological transition associated with excess energy intake, sedentary lifestyle and urbanisation, metabolic syndrome (MetS), previously uncommon in sub-Sahara Africa, is increasingly becoming a public health concern. Methods: We retrospectively assessed the association of diet and socio-demographic indicators as exposure factors to the development of MetS in typical peri-urban and rural settings in Ghana and examined the effect of MetS on the perceived quality of life of patients. One-on-one age- and sex-matched case-control study involving 152 adults aged 45–65 years were recruited from a diabetic clinic. Controls were recruited from communities where cases resided. Case definition was concurrent adiposity, hypertension, diabetes and dyslipidaemia. Lifestyle was assessed using a lifestyle and habits questionnaire, whereas diet history was assessed using a food frequency questionnaire. Differences were tested using McNemar and paired t-tests. To determine which exposure variables significantly predicted the development of MetS, we conducted a conditional logistic regression and reported the Mantel Haenszel crude and adjusted odds ratio (OR). Results: Markers for MetS among the cases and controls were abdominal obesity (98.7% vs 36.8%), hypertension (90.8% vs 2.6%) and diabetes (72.4% vs 1.3%). Controls (77.6%) consumed more diversified diets compared to the cases (10.5%) (p = 0.001). Lower risk for MetS was linked to secondary education (COR = 0.17) and long duration of residence (COR = 0.30) in a peri-urban setting (COR = 0.22) whereas being unemployed (COR = 9.00) increased the risk. Abdominal obesity (COR = 28.51) was a stronger predictor of MetS compared to BMI ≥30 kg/m2 (COR = 14.80). Comparatively, the controls had a better self-perception of their physical wellbeing (73.7% vs 2.6%), fitness (88.2% vs 13.2%), nutrition and weight control (14.5% vs 1.3%) and psychological health (19.7% vs 0%). Conclusion: Considering that socio-demographic indicators were key exposures to MetS, we recommend interventions that promote the holistic wellbeing of the individual and should be integrated into existing health, social and community-based support services. © 2022 | Open |
| Agordoh P.D.; Lokpo S.Y.; Owiredu W.K.B.A.; Orish V.N.; Tettey C.O.; Sah J.A.; Kuatsienu L.E.; Ameke L.S.; Osei-Yeboah J. | Nutritional aberration and related morphological disorders among patients with human immunodeficiency virus infection on combination antiretroviral therapy (cART) in Ghana: A retrospective study | 2022 | Heliyon | Background: Metabolic and nutritional abnormalities among people living with human immunodeficiency virus (PLHIV) have been reported due to either their HIV infection, primary malnutrition caused by insufficient intake or consequences of the ART regimen provided. This study investigated the prevalence and patterns of nutritional abnormalities including morphological changes among HIV patients under combination Antiretroviral Therapy (cART) in the Bia-West District of the Western North Region. Methods: We employed a hospital-based retrospective longitudinal design. Records of 180 patients with HIV infection before and after antiretroviral therapy (ART) initiation were extracted at the Essam Government Hospital. Eligibility criteria included being on treatment without change in regimen for at least one year and without defaulting in scheduled visits. Data extracted included patients' demography, nutritional parameters and medication history. We assessed patients’ nutritional characteristics with the subjective global assessment (SGA) tool which includes five components of medical history (weight change, dietary intake, gastrointestinal symptoms, functional capacity & metabolic stress) and two components of physical examination (signs of fat loss and muscle wasting, alterations in fluid balance). Results: Malnutrition, lipodystrophy and body wasting among HIV patients were 48.3% (36.5–62.4), 43.9% (32.6–57.7) and 33.3% (23.6–46.0) respectively. Incremental percentage trends of malnutrition (stage I- 7.4%, stage II -22.4%, stage III-24.7%) and lipodystrophy (Stage I - 22.2%, Stage II - 48.7%, Stage III - 51.9%) were significantly associated with worsening disease status. Patients on AZT+3TC + NVP combined regimen presented with the highest malnutrition [52.9% (28.5–76.1)], lipodystrophy [64.7% (38.6–84.7)] and loss of muscle mass [47.1% (23.9–71.5)]. Long-term ART use was significantly associated with high malnutrition rate (p= 0.02620) and increasing muscle mass loss (p = 0.0040). Conclusion: High malnutrition, lipodystrophy and muscle wasting exist in PLHIV on cART in the Bia-West District. These adverse nutritional effects may be modulated by disease severity, ARV medication and duration. © 2022 The Author(s) | Open |
| Agyemang C.; van der Linden E.L.; Antwi-Berko D.; Nkansah Darko S.; Twumasi-Ankrah S.; Meeks K.; van den Born B.-J.H.; Henneman P.; Owusu-Dabo E.; Beune E. | Cohort profile: Research on Obesity and Diabetes among African Migrants in Europe and Africa Prospective (RODAM-Pros) cohort study | 2022 | BMJ open | The Research on Obesity and Diabetes among African Migrants (RODAM) prospective (RODAM-Pros) cohort study was established to identify key changes in environmental exposures and epigenetic modifications driving the high burden of cardiovascular disease (CVD) risk among sub-Saharan African migrants. PARTICIPANTS: All the participants in the RODAM cross-sectional study that completed the baseline assessment (n=5114) were eligible for the follow-up of which 2165 participants (n=638 from rural-Ghana, n=608 from urban-Ghana, and n=919 Ghanaian migrants in Amsterdam, the Netherlands) were included in the RODAM-Pros cohort study. Additionally, we included a subsample of European-Dutch (n=2098) to enable a comparison to be made between Ghanaian migrants living in the Netherlands and the European-Dutch host population. FINDINGS TO DATE: Follow-up data have been collected on demographics, socioeconomic status, medical history, psychosocial environment, lifestyle factors, nutrition, anthropometrics, blood pressure, fasting blood, urine and stool samples. Biochemical analyses included glucose metabolism, lipid profile, electrolytes and renal function, liver metabolism and inflammation. In a subsample, we assessed DNA methylation patterns using Infinium 850K DNA Methylation BeadChip. Baseline results indicated that migrants have higher prevalence of CVD risk factors than non-migrants. Epigenome-wide association studies suggest important differences in DNA methylation between migrants and non-migrants. The follow-up study will shed further light on key-specific environmental exposures and epigenetic modifications contributing to the high burden of CVD risk among sub-Saharan African migrants. FUTURE PLANS: Follow-up is planned at 5-year intervals, baseline completed in 2015 and first follow-up completed in 2021. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | Open |
| Agyin-Birikorang S.; Tindjina I.; Fugice J.J.; Dauda H.W.; Issahaku R.A.; Iddrissu M. | Zinc application rate for optimal profitability of maize production systems in the savanna agroecological zones of Northern Ghana | 2022 | Journal of Plant Nutrition | Although the critical role of zinc (Zn) in maize nutrition and productivity is well documented, there is still a need to determine the most economically justifiable Zn application rate for maize production, particularly in the savanna agroecological zones (AEZs) of northern Ghana where such study is lacking. In a three-year study at six locations across the AEZs, we compared seven Zn application rates, ranging from 0 to 15 kg ha−1 in 2.5 kg intervals, to quantify maize yield responses and determine the economically optimal Zn rate for maize production. Across all experimental sites and for the three growing seasons, maize grain yield with each treatment followed the order 15 kg Zn ha−1 = 12.5 kg Zn ha−1 = 10 kg Zn ha−1 = 7.5 kg Zn ha−1 > 5 kg Zn ha−1 > 2.5 kg Zn ha−1 > control, suggesting that 7.5 kg Zn ha−1 is the optimal Zn application rate. However, based on agro-input prices at the local level and the farm-gate prices of maize, the potential gross profit resulting from Zn application was maximized at 5 kg Zn ha−1. From the combined results, we conclude that, when the production objective is for yield optimization only, an application rate of 7.5 kg Zn ha−1 provides the best results. However, unless premium prices are paid for Zn-enriched maize grains, then Zn application rate of 5 kg ha−1 is economically justified for sustainable and profitable maize production in the Zn-deficient soils of the savanna AEZs of northern Ghana. © 2022 Taylor & Francis Group, LLC. | Open |
| Ahmed A.; Lazo D.P.L.; Alatinga K.A.; Gasparatos A. | From Ampesie to French fries: systematising the characteristics, drivers and impacts of diet change in rapidly urbanising Accra | 2022 | Sustainability Science | Sub-Saharan Africa (SSA) is urbanising rapidly. One of the most visible outcomes of this urbanisation process is the change in the diets of urban residents. However, diet change in the context of rapid urbanisation is a complex and multi-dimensional phenomenon that encompasses multiple intersecting historical, environmental, socioeconomic, and political aspects. This study aims to unravel and systematise the characteristics, drivers and impacts of diet changes in Accra, through the interviews of multiple stakeholders and Causal Loop Diagrams. Diet change is characterised by the increased consumption of certain foodstuff such as rice, chicken, fish, vegetable oil, sugar, and ultra-processed food (UPF), and the decreased consumption of traditional foodstuff such as roots, tubers, and some cereals such as millet. These changes are driven by multiple factors, including among others, changes in income, sociocultural practices, energy access, and policy and trade regimes, as well as the proliferation of supermarkets and food vendors. Collectively, these diet changes have a series of environmental, socioeconomic, and health/nutrition-related impacts. Our results highlight the need to understand in a comprehensive manner the complex processes shaping diet change in the context of urbanisation, as a means of identifying effective interventions to promote healthy and sustainable urban diets in SSA. The development of such intervention should embrace a multi-stakeholder perspective, considering that the relevant urban actors have radically different perspectives and interests at this interface of urbanisation and diet change. © 2022, The Author(s), under exclusive licence to Springer Japan KK, part of Springer Nature. | Open |
| Akoto S.; Tandoh M.A.; Nsiah K.; Asamoah-Boakye O.; Annaful V.T. | Lifestyle habits, macronutrient intake, and obesity prevalence among adolescents in rural-periurban community senior high schools in the Ho municipality of Ghana | 2022 | Frontiers in Nutrition | Background: Adolescence is a critical stage in the life cycle that presents a window of opportunity for the formation of lifetime habits or an aversion to childhood malnutrition effects. This study assessed the lifestyle habits, macronutrient intakes, and obesity prevalence among adolescents in some selected Senior High Schools in rural communities in Ho Municipality. Materials and methods: A cross-sectional survey was conducted among 272 adolescents aged 13–19 years and attending senior high schools in the Ho Municipality of Ghana. Data on sociodemographic, physical activity levels, dietary habits, and anthropometrics were obtained. A body mass index (BMI) and waist circumference (WC) were determined, while a repeated 24-h dietary recall was used to collect the dietary intakes of the participants. Results: The majority of the adolescents did not meet the Recommended Dietary Allowances (RDA) for calories (94.5%), dietary protein (68.8%), and fibre (91.5%). Adolescent boys consumed more calories (1,969.7 ± 579.9 Kcal) on average than adolescent girls (1,658.0 ± 458.7 Kcal) (p = 0.001). Overweight and obesity prevalence were 15.8 and 8.5%, respectively. About 90.4% of the adolescents did not meet the WHO recommended 150 min per week of physical exercise. On sedentary, 97.6% of adolescents spent half an hour to 5 h per day watching television when at home. Breakfast was the most frequently skipped meal (47.9%), and 59.6% of adolescents consumed fast foods such as pizza, burgers, and ice cream one to three times per week. Adolescent girls also had higher odds of being overweight or obese compared with adolescent boys (AOR = 2.4, p = 0.094, 95% CI = 0.9–6.4). Adolescents who did not meet the RDA for calories had lower odds of being overweight or obese compared with those who did (UOR = 0.3, p = 0.045, 95% CI = 0.1–0.9). Conclusion: Poor dietary habits and intake, sedentary lifestyle, and obesity prevalence were observed among the adolescents. Being an adolescent girl was associated with obesity risk, while not meeting caloric intake showed a protective effect. Efficient and effective nutrition and lifestyle education programme should be promoted in communities to improve the dietary intake and lifestyle habits of adolescents. Copyright © 2022 Akoto, Tandoh, Nsiah, Asamoah-Boakye and Annaful. | Open |
| Amegah A.K.; Sewor C.; Obeng A.A.; Coker E.S.; Eliason S. | Vitamin D intake modifies the association of household air pollution exposure with maternal disorders of pregnancy | 2022 | Indoor Air | To date, only three studies have investigated the association of household air pollution (HAP) exposure with pregnancy disorders. The ameliorating role of diet and nutrition in the association has never been explored. We conducted a cross-sectional study among 799 mothers who had recently given singleton birth in the Cape Coast Metropolis, Ghana. Structured questionnaire and semi-quantitative food frequency questionnaire were used to assess HAP exposure (from use of biomass fuels for cooking and garbage burning at home) and vitamin D (vitD) intake, respectively. Multivariable binary logistic regression was used to investigate the association between HAP exposure and pregnancy disorders. HAP exposure due to cooking with biomass fuels and garbage burning at home was associated with two fold (AOR = 2.15; 95% confidence interval [CI]: 1.05, 4.43) and six fold (AOR = 6.35; 95% CI: 2.43, 16.58) increased odds of hypertensive disorders of pregnancy (HDP). For gestational diabetes (GDM), the increased odds were two folds for both exposures but the 95% CI included the null value. Stove stacking was also associated with two folds increased odds of GDM (AOR = 1.83; 95% CI: 0.91, 3.68). In stratified analysis, the odds of HDP and GDM associated with biomass fuels use decreased with increasing vitD intake. All the interaction p values were, however, greater than 0.05. We provide the first evidence on the ameliorating role of vitD intake on the effect of HAP exposure on pregnancy disorders. In LMICs where solid fuel use and garbage burning at home is widespread, health workers should advise mothers during antenatal care visits to increase intake of vitamin D rich foods. © 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd | Open |
| Amoako-Attah I.; Kumi-Asare E.; Bukari Y. | Influence of nutrient sources and environmental conditions on vegetative growth of fungus, Erythricium salmonicolor (Berk. & Broome) Burdsall in cocoa | 2022 | Plant Science Today | Erythricium salmonicolor is the cause of pink disease in cocoa in the humid tropics. The growth of 4 isolates (ES-WR006, ES-WR008, ES-ER009 and ESER010) of the fungus on different sources of nutrient (carbohydrate, amino acid and vitamin) and environmental conditions (temperature, pH and light) were evaluated in the laboratory. The pink disease isolates utilised the nutrients to different extent, with the best radial mycelial growth rate achieved with isolate ES-WR008 followed by ES-WR006. None of the isolates produced spores in the laboratory. The isolates utilised polysaccharides as best as disaccharides and monosaccharaides. Among 7 amino acids assayed, aspartic acid was the most promising for vegetative growth. The best radial mycelial growth on vitamins was attained on folic acid and riboflavin. The minimum, optimum and maximum temperatures for growing the fungus were 18°C, 28°C and 34°C respectively. Survival of E. salmonicolor isolates within the temperature range of 18-34°C is consistent with temperatures for growing cocoa in Ghana. The isolates also grew well within a pH range of 4-8, with the best growth at pH 6. Light quality and duration influenced the vegetative growth of the isolates. Pink disease isolates maintained in 24 hr darkness or 24 hr light performed better than in alternating 12 hr darkness and 12 hr light. There was a significant (p < 0.05) repressive effect of the alternating dark and light exposures on vegetative growth of the fungus. The implications of the results for efficient management of the cocoa disease are discussed. © The Author(s). | Open |
| Andani A.; Jatoe J.B.D.; Al-Hassan R.M. | Production of Indigenous Food Crops: Implications for Children’s Nutritional Status of Farm Households in Northern Ghana | 2022 | European Journal of Development Research | This paper examines the effect of indigenous food crops on the nutrition security outcomes of children in farm households. Using a standard treatment effect model, data on children under 5 years of age from 250 farm households in selected rural districts of northern Ghana were analysed. A multistage sampling procedure was used. Descriptive statistics show high rates of child wasting (16.7%), stunting (29.8%) and underweight (25.2%), but suggest better nutritional status for children in indigenous food crops producer households than those in non-producer households. Children in producer households have higher height-for-age; weight-for-height and weight-for-age z-scores than children in non-producer households. The findings suggest that, children in non-producer households are more at risk of being stunted, wasted and underweight than those in producer households. Exploring the empirical link between the production of indigenous food crops and the nutrition status of children in northern Ghana extends the literature on nutrition and crop production. © 2021, European Association of Development Research and Training Institutes (EADI). | Open |
| Anin S.K.; Ansong R.S.; Fischer F.; Kraemer A. | Predictive Utility of Composite Child Feeding Indices (CCFIs) for Child Nutritional Status: Comparative Analyses for the Most Suitable Formula for Constructing an Optimum CCFI | 2022 | International Journal of Environmental Research and Public Health | Composite child feeding indices (CCFIs) developed from various relevant measures of dietary intake by infants and young children have several potential applications in nutritional epidemiological studies for the development and deployment of precise public health nutrition interventions against child undernutrition. The predictive utility of some CCFIs (computed from varying formulation components) for child nutritional status (stunting, wasting, and underweight) were compared. The purpose of the study was to identify the most suitable among them for possible standardization, validation, and adoption by nutritional health researchers. Using cluster sampling, data from 581 mother–child pairs were collected. Multivariable regression analyses were applied to the data obtained through a community-based analytical cross-sectional survey design. Three of the CCFIs were found to be significantly associated with only wasting (WHZ) from the linear regression models after adjusting for potential confounders and/or correlates. None of the CCFIs (whether in the continuous nor categorical form) was consistently predictive of all three measures of child nutritional status, after controlling for potential confounders and/or correlates, irrespective of the choice of regression method. CCFI 5 was constructed using a dimension reduction technique— namely principal component analysis (PCA)—as the most optimal summary index in terms of predictiveness for child wasting status, validity, and reliability (Cronbach’s α = 0.80) that captured relevant dimensions of optimal child food intake. The dimension reduction approach that was used in constructing CCFI 5 is recommended for standardization, validation, and possible adoption for wider applicability across heterogeneous population settings as an optimum CCFI usable for nutritional epidemiological studies among children under five years. © 2022 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Annan R.A.; Agyapong N.A.F.; Apprey C.; Aryeetey R. | REVIEW OF GHANA’S FOOD ENVIRONMENT: DRIVERS OF AVAILABILITY, BARRIERS TO HEALTHY FOOD ACCESS, AND IMPACT OF INTERVENTIONS AND POLICIES | 2022 | African Journal of Food, Agriculture, Nutrition and Development | Food environments exert a significant effect on population dietary choices and health outcomes. Policies that influence the food environment, can have a significant impact on individual and population dietary choices. This rapid review assessed the nature and interaction within the Ghanaian food environment, and the impact that existing school, workplace, and national food policies have on dietary intake and nutritional outcomes. Online databases and university repositories were searched for relevant articles and documents. A total of forty articles and documents were included in the review. Majority of the reviewed papers (85%) used a cross-sectional design. The findings show that traditional outlets (open markets) constitute the main food source among the Ghanaian populace, while convenience stores serve as an important source of processed foods. Prepared local foods are often consumed outside the home and are mainly sourced from street food vendors. Street foods are perceived as less expensive, convenient, and delicious. The food environment was found to influence dietary acquisition, intake, and nutritional outcomes. Although most nutrients provided by the School Feeding Programme (SFP) are below recommended intake standards, the SFP contributes positively to improved diets and nutrition status of school-age children. Children attending SFP-implementing schools experience higher intakes of protein, iron, zinc, calcium, vitamin A, folate, and have higher haemoglobin, and lower prevalence of stunting, underweight, and thinness than children in non-SFP implementing schools. Availability of a private room for breastfeeding mothers improved breastfeeding frequency. Ghana’s fatty meat restriction policy has reduced the availability and sale of fatty meat on the Ghanaian market. Reported drivers and barriers to healthy foods consumption include socio-economic factors, media information, food storage facilities, cultural perception, fruit seasonality, knowledge on the nutrient value of fruits and vegetables, safety profile of fruits and vegetables, and contribution of household production to dietary intake. In conclusion, the food environment review reveals the drivers of availability, barriers to healthy food access, and impact of interventions and policies on the Ghanaian food environment. © 2022 | Open |
| Antwi J.; Quaidoo E.; Ohemeng A.; Bannerman B. | Household food insecurity is associated with child’s dietary diversity score among primary school children in two districts in Ghana | 2022 | Food and Nutrition Research | Background: Dietary diversity is generally considered as a good indicator of nutrient adequacy and is influenced by various factors at the national, household, and individual levels. Objective: The present study sought to determine the relationships between household food insecurity, primary caregivers’ nutrition knowledge, and dietary diversity of school-aged children in Ghana. Methods: This forms part of a longitudinal study conducted in the Ayawaso West Municipal district in Accra (urban setting) and the Upper Manya Krobo district (rural setting) in Ghana. Data were collected from a total of 116 caregiver-child dyads using 24-h dietary recall and a short version of the US 12-month Household Food Security Survey Module. Nutrition knowledge and sociodemographic data were obtained using a structured questionnaire. Multivariable logistic regression was used to check for factors associated with children’s dietary diversity. Results: Majority of households reported food insecurity, with a higher percentage of insecure households located in the rural area (88.9% vs. 46.5%, P ≤ 0.0001), compared to the urban setting. Diet diversity among the study children was low, with a mean (standard deviation [SD]) of 5.8 (2.1) out of 14 food groups. Children living in food insecure households were three times more likely to have received low diverse diet compared to those from food secure households (adjusted odds ratio [OR] =3.3, 95% confidence interval [CI]: 1.4–8.0). Caregivers’ nutrition knowledge was, however, not related to children’s dietary diversity. Discussion and conclusion: Household food insecurity was a main predictor of dietary diversity among school-age children in this study. Thus, caregiver knowledge in nutrition may not be enough, particularly in the presence of food insecurity to guarantee adequate nutrition for school-aged children. © 2022 Anet Antwi et al. | Open |
| Appiah-Twumasi M.; Asale M.A. | Crop diversification and farm household food and nutrition security in Northern Ghana | 2022 | Environment, Development and Sustainability | Farm households in Africa adopt resource allocation tools such as crop diversification to minimize risk exposure and safeguard their food and nutrition security. This study uses primary data and an ordered probit model to examine how crop diversification impacts the food security outcomes of rural farmers in northern Ghana. The findings revealed that along with other factors like access to extension services and use of soil fertility management practices, crop diversification increased food access and reduced the food insecurity experience of households. As a result, policies targeted at improving the food and nutrition security of peasant households should promote adoption of diversified crop production and use of sustainable soil management practices like composting. © 2022, The Author(s), under exclusive licence to Springer Nature B.V. | Open |
| Apprey C.; Asamoah-Boakye O.; Annaful V.T.; Annan R.A. | Comparative analysis of methyl–donor nutrient intakes and RCPM cognitive performance among school-aged children | 2022 | Clinical Nutrition ESPEN | Background: Evidence shows a link between methyl-donor nutrient intakes and a child's cognitive ability. However, this is less known among Ghanaian children who might be at higher risk of methyl–donor nutrient deficiencies. This study showed comparative analysis of methyl–donor nutrient intakes and Raven's Coloured Progressive Matrices (RCPM) test performance among 2073 Ghanaian school children aged 9–13 years across four regions of Ghana. Methods: Data for the present study were obtained from the Child Nutrition, Fitness, and Cognition project; a cross-sectional survey conducted in four regions of Ghana. Dietary methyl-donor nutrient values were based on repeated 24 h recall data collected during the study periods. Cognitive tests were performed on the 2073 children using Raven's Coloured Progressive Matrices (RCPM) test. Results: We found dietary zinc (adjusted: β = 0.21, p = 0.003) and methionine (adjusted: β = 0.60, p = 0.044) intakes to be associated with RCPM scores in the linear regression model. School children living in Northern Region (adjusted OR = 0.6, p < 0.001, 95% CI = 0.4–0.7) and Volta Region (adjusted OR = 0.7, p = 0.006, 95% CI = 0.5–0.9) had lower odds of scoring above the 50th percentile on the RCPM test compared with those living in Greater Accra Region. Children who consumed below the RDA for dietary folate (unadjusted OR = 0.8, p = 0.055, 95% CI = 0.7–1.0) and zinc (unadjusted OR = 0.8, p = 0.049, 95%CI = 0.7–1.0) had lower odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the RDA for dietary folate and zinc respectively. Children who consumed below the EAR for dietary vitamin B12 (unadjusted OR = 0.7, p = 0.004, 95% CI = 0.6–0.9) had reduced odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the EAR for dietary vitamin B12. Conclusions: Higher dietary methionine intake was strongly associated with higher RCPM scores. Regional differences, and children's dietary consumption below the EAR/RDA for dietary folate, vitamin B12, and zinc were associated with poor RCPM test performance. School children's nutrient intake should be prioritized for improved cognition. © 2022 European Society for Clinical Nutrition and Metabolism | Open |
| Aryeetey R.; Atuobi-Yeboah A.; Billings L.; Nisbett N.; van den Bold M.; Toure M. | Stories of Change in Nutrition in Ghana: a focus on stunting and anemia among children under-five years (2009 – 2018) | 2022 | Food Security | The current study aimed to understand why child stunting and anemia (CS&A) rates declined in Ghana between 2009 and 2018, and which priority policies and programs will further improve nutrition outcomes. Trends and potential drivers of stunting (height-for-age z-score < -2.0 SD) and anemia (hemoglobin < 11.0 g/dL), and decomposition analysis of DHS data (2003 to 2014) were conducted. The quantitative evidence was triangulated with Net-Map analysis of nutrition stakeholder relationships and influence, desk review of policies and programs 2009–2019, and in-depth interviews with 25 stakeholders who provided additional insights to explain CS&A trends. Declines in stunting (29.6%) and anemia (14.1%) in children were observed at the national level, but with important subgroup variations. Decomposition analyses identified changes in the household, maternal, and child characteristics (including wealth, use of antenatal services, maternal education, and immunization) as correlates of anemia reduction. Stunting reduction was linked with changes in bed-net utilization, household wealth, and pregnancy care service utilization. Additionally, multiple policies and programs initiated/implemented across multiple sectors were considered potentially relevant to CS&A reduction over time, including those focused on infant and young child feeding, water and sanitation, social protection, and health care access. Initiation/strengthening of these interventions was stimulated by awareness creation and subsequently increased prioritization of stunting. However, program delivery was limited by deficits in government funding, perceived low priority of child anemia, low implementation capacity and coverage, and weak coherence across sectors. Reduced CS&A resulted from improved access to services implemented across multiple sectors, albeit limited by implementation scale and capacity. Further reduction in CS&A requires enhanced multi-sectorally coordinated actions and capacity. © 2021, The Author(s). | Open |
| Aryeetey R.; Coomson J.B. | RAPID REVIEW OF KEY POLICIES AND PROGRAMS LINKED WITH NUTRITION AND HEALTH IN GHANA | 2022 | African Journal of Food, Agriculture, Nutrition and Development | As part of the process by the government of Ghana to develop food-based dietary guidelines, a review of policies and programs was commissioned. The review aimed to identify and describe the policy environment, with a focus on identifying the type of existing policies, priorities, and programs related to nutrition and health between 2010 and 2020. The review also tracked the evolution of changes in policies and programs over the same period. Using a systematic rapid scoping review approach, policy and program documents were identified and classified according to relevant nutritionspecific and nutrition-sensensitive sectors, including health, agriculture and food, human development, social protection, and trade. Data from included documents were extracted using an excel extraction tool. The extracted data including policies, programs, objectives, coverage of the policies/programs, intended outcomes, target groups, and agencies responsible for implementing these policies and programs. More than 70 government documents, plus other reports and literature sources describing government policy and programs with relevance for nutrition were identified. Most of these policies and programs were not designed to directly address malnutrition. This is because, the policies and programs neither referenced nutrition objectives, nor nutrition outcomes. However, the existing policies and programs had aspects that can be leveraged (either through redesign or implementation) to contribute to improved nutrition outcomes. A key challenge in the nutrition programming landscape is the nonexistence of a comprehensive and costed national nutrition strategic plan to accompany the national nutrition policy. The key nutrition priorities of the Government of Ghana and its partners, as expressed in the documents reviewed included infant and young child feeding, stunting reduction, anemia, and food security. There were key nutritionrelated issues which have not been prioritized, although current local and global evidence as well as stakeholder opinion suggests these have already become, or are rapidly becoming important priorities. These include overweight and obesity, dietrelated chronic diseases, nutrition of school-age children, and nutrition of the elderly. These nutrition issues, if not appropriately addressed, will continue to exact significant human health, economic, and social costs for Ghana. There is need for a comprehensive nutrition strategy that leverages opportunities across multiple sectors to improve nutrition for today and for the future. © 2022. African Journal of Food, Agriculture, Nutrition and Development. All Rights Reserved. | Open |
| Aryeetey R.; Ramos A.I. | PROCESS AND LESSONS LEARNED IN THE DEVELOPMENT OF FOOD-BASED DIETARY GUIDELINES IN GHANA | 2022 | African Journal of Food, Agriculture, Nutrition and Development | Food-based dietary guidelines (FBDGs) are used, globally, as a tool for promoting awareness of healthy diets and, thereby, to improve dietary behaviour. It is also used as a policy framework for creating a health-promoting food environment. In sub-Saharan Africa, only a few countries have developed FBDGs. In 2016, Ghana commenced the process for developing a national FBDG. Four years down the line, significant progress has been achieved towards developing dietary guidelines for persons living in Ghana. The process for developing Ghana's FBDGs has, generally, follow the plan proposed by the 1998 FAO/WO consultative meeting on development of FBDGs, but with minor deviations. These deviations have been occasioned by the need to adapt the process to accommodate context-relevant circumstances relating to local capacity and financial resources constraints. The first step in developing Ghana’s FBDGs was to set up a national Multisectoral Technical Task Team (MTTT) under the policy direction of the Ministry of Food and Agriculture. Thereafter, an evidence review exercise was carried out, involving systematic review of existing literature, complemented by primary data collection, all aimed at understanding the priority foods, nutrition and health issues to be addressed by recommendations in the FBDGs. The key issues identified in the evidence review were validated by the MTTT and subsequently prioritized using an online survey, as well as a prioritization workshop that convened key stakeholders in nutrition and health in Ghana. Subsequently, the priority issues served as the basis for the crafting of technical recommendations. The aim of this paper is to describe the processes, people, data, and resources that have facilitated progress towards development of Ghana’s FBDGs. The challenges, and limitations of the process, as well as the solutions that have been employed to overcome them, have also been highlighted here. For the benefit of future FBDGs development in Ghana and elsewhere, the key lessons that have been learned in the development of Ghana’s FBDGs have been presented, including lessons on political will, planning and time management, resources, capacity development, and multi-sectoral action. © 2022. African Journal of Food, Agriculture, Nutrition and Development. All Rights Reserved. | Open |
| Asalu G.A.; Axame W.K.; Manu A.; Laar A.; Aryeetey R. | NUTRITION AND HEALTH-RELATED INFORMATION DISCLOSURE ON PRE-PACKAGED FOOD PRODUCTS FROM LOCAL RETAIL SHOPS IN ACCRA | 2022 | African Journal of Food, Agriculture, Nutrition and Development | The prevalence of obesity and diet related non-communicable diseases (NCDs) are rapidly increasing in Africa. Consumption of pre-packaged foods is one of the main drivers of these NCDs. Pre-packaged foods tend to contain high levels of energy, fat, sugar, and salt, which are known risk factors for NCDs. Food labels can guide consumers to make informed healthy food choices. Therefore, it is important to analyze how healthrelated information is communicated on food labels. In Ghana, there is paucity of evidence on what health-related information is available to consumers of pre-packaged foods. This study describes health-related information on labelled pre-packaged foods sold in local retail shops in Accra. A cross-sectional survey and quantitative content analysis of food label information were employed in this study. Pre-packaged food labels photograph data were sourced from shops and content analyzed to describe their healthrelated information. Nutrition and health-related information were classified using the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support (INFORMAS) system. Three hundred and fifty-one (N=351) pre-packaged foods and non-alcoholic beverages were sampled, out of which 2.3% products were unlabelled. Out of 343 labelled products, 92% disclosed ingredient list information and 68.8% had nutrition declaration. Between the two nutrition labelling formats: Back-of-Pack (BOP) and Front of Pack (FOP), BOP was the dominant (87.3%) format. Various types of FOPs were identified however, Guidelines Daily Allowance (GDA) was the most common format. The study found that 18% of labelled pre-packaged foods carried nutrition claim and about 7% had a health claim. Most of the claims were written and the others were a combination of words, numbers, and pictures/symbols. This study has shown a high disclosure of health-related label information on pre-packaged food but information presentations on labels were not consistent. The insight gained from this study shows that the presentation of health-related label information does not meet the current recommendations of Codex and the benchmarks set out by INFORMAS in promoting a healthy food environment. © 2022. African Journal of Food, Agriculture, Nutrition and Development. All Rights Reserved. | Open |
| Asirvatham R.; Demi S.M.; Ezezika O. | Are sub-Saharan African national food and agriculture policies nutrition-sensitive? A case study of Ethiopia, Ghana, Malawi, Nigeria, and South Africa | 2022 | Agriculture and Food Security | Background: In sub-Saharan Africa (SSA), malnutrition coupled with rising rates of undernutrition and the burden of overweight/obesity remains one of the most significant public health challenges facing the region. Nutrition-sensitive agriculture can play an important role in reducing malnutrition by addressing the underlying causes of nutrition outcomes. Therefore, we aim to assess the nutrition-sensitivity of food and agriculture policies in SSA and to provide recommendations for identified policy challenges in implementing nutrition-sensitive agriculture initiatives. Methods: We assessed past and current national policies relevant to agriculture and nutrition from Ethiopia, Ghana, Malawi, Nigeria, and South Africa. Thirty policies and strategies were identified and reviewed after a literature scan that included journal articles, reports, and policy documents on food and agriculture. The policies and strategies were reviewed against FAO’s Key Recommendations for Improving Nutrition Through Agriculture and Food Systems guidelines. Results: Through the review of 30 policy documents, we found that the link between agriculture and nutrition remains weak, particularly in agriculture policies. The review of the policies highlighted insufficient attention to nutrition and the production of micronutrient-rich foods, lack of strategies to increase farmer market access, and weak multi-sectoral collaboration and capacity building. Conclusion: Nutrition-sensitive agriculture has received scant attention in previous agricultural and food policies in SSA that were riddled with implementation issues, lack of capacity, and ineffective methods for multi-sector collaboration. Recognition of these challenges are leading countries to revise and create new policies that prioritize nutrition-sensitive agriculture as a key driver in overcoming malnutrition. © 2022, The Author(s). | Open |
| Atuna R.A.; Djah J.; Achaglinkame M.A.; Bakker S.; Dari L.; Osei-Kwarteng M.; Mahunu G.K.; Koomen I.; Amagloh F.K. | Types of indigenous vegetables consumed, preparation, preferences and perceived benefits in Ghana | 2022 | Journal of Ethnic Foods | Indigenous vegetables (IVs) are rich sources of essential nutrients, particularly vitamins and minerals, and other non-nutritive phytochemicals. IVs play a critical role in the food culture of the Ghanaian people. Despite their importance, they have over the years been mostly associated with the resource-poor. In this study, the types of IVs, preparation preferences, frequency of consumption and some perceived benefits ascribed by some Ghanaian consumers (n = 1393) were investigated in a cross-sectional survey. Descriptive analysis and a chi-square test of independence were conducted to summarise and determine the relationship between gender, age and consumption frequency of the IVs. The study identified okra (Abelmoschus esculentus), cocoyam (Xanthosoma sagittifolium) leaves, jute mallow (Corchorus olitorius) and garden egg (Solanum melongena) as the popular IVs consumed by respondents. Among these, about 13.3% of women and 15.3% of men indicated they consume okra. Eight per cent of the women respondents and 6.7% of the men consumed jute mallow. Almost 57% of the respondents said the IVs were used to prepare stew and soup. More than a third (39%) of the respondents indicated that they consumed the IVs either daily or more than once a week. Women respondents’ frequency of IVs consumption was significantly different [X2 (4, n = 1393) = 30.11, p = 0.000] from the men. The frequency of consumption of IVs for the elderly was significantly higher [X2 (12, n = 1393) = 30.53, p = 0.002] as compared to the younger respondents. The main perceived benefits of IVs were nutrition- and health-related. The major barriers to the consumption of IVs were cost, non-availability, palatability and cultural. The IVs were largely wet-cooked and consumed as stews or sauces and soups. These findings form good bases for further empirical studies on the nutritional and other health-benefiting attributes of the specific IVs found in this study for sustainable promotion and utilisation in Ghana. © 2022, The Author(s). | Open |
| Avoka J.A.; Ankomah A.; Ohemeng A.; Seidu I.; Wombeogo M.; Apungu F.K. | Assessing the Relationship between Individual Level Dietary Intake and the Occurrence of Preeclampsia/Eclampsia and Haemorrhage among Pregnant Women in Eastern Region of Ghana: A Prospective Cohort Study | 2022 | Texila International Journal of Public Health | Pre-eclampsia/eclampsia (PE-E) and haemorrhage are dangerous diseases that occur in pregnancy. This study seeks to assess the relationship between individual-level dietary intake and the occurrence of pre-eclampsia/eclampsia and haemorrhage among pregnant women in the Eastern Region of Ghana. The prospective cohort study involved all pregnant women in their third trimester of pregnancy (>28 weeks gestational age) reporting for antenatal care (ANC) in seven Hospitals in the Eastern Region of Ghana. The study used a 24-hour repeated dietary recall to elicit dietary intake information from pregnant women until delivery. The majority of pregnant women in this study had adequate consumption of phosphorus far above the RDI, coupled with an inadequate intake of calcium, excess intake of sodium, and manganese. The average dietary intake for carbohydrates in this study was rather higher than the RDA. There was a statistically significant association between PE-E and the intake of vitamin C. A statistically significant association exists between the intake of calcium and vitamin A and haemorrhage. The findings show that pregnant women who consumed adequate and excess amounts of vitamin C reduced their odds of developing PE-E by 41.7% and 39.8%, respectively. The results show that pregnant women who had an excess intake of calcium were 6.128 times the odds of developing haemorrhage compared to those who had inadequate intake. Again, pregnant women who had adequate intake of vitamin A were 4.351 times the odds of developing haemorrhage compared to those who had inadequate intake. It is recommended that more nutrition specialists to be trained and posted to counsel pregnant women on nutrition in pregnancy to avert the consequences of PE-E and haemorrhage. © 2022, Texila International Journal (TIJ). All rights reserved. | Open |
| Awuni V.; Garti H.K.; Amagloh F.K. | KNOWLEDGE OF PROSTATE HEALTH AND FOOD CHOICE INFLUENCE ON THE RISK OF PROSTATE DISORDERS AMONG GHANAIAN MEN | 2022 | African Journal of Food, Agriculture, Nutrition and Development | Understanding prostate health is vital for preventing, managing, and treating prostate disorders. Prostate disorder is a significant health challenge among men, and if not detected early, could lead to complications like cancer and death. Thus, knowledge of prostate health is essential for defining critical areas of intervention among men. This was a cross-sectional survey conducted among 894 Ghanaian men aged 40 to 70+ to assess their knowledge of prostate health and its influence on their food choices. The study was conducted in Greater Accra, Bono, and Northern Regions of Ghana. A structured questionnaire was employed to collect data on socio-demographics, knowledge of prostate health and consumption of foods related to prostate health. Two categories of foods, relating to prostate health were considered for the study: protective foods (fruits and vegetables) and high-risk foods (alcohol, meat, and meat products). Knowledge level scores were computed from the marks scored by participants on prostate health risk factors, causes, signs, symptoms and treatment, and nutrition and prostate health. Food choices were assessed based on the frequency of protective foods and high-risk foods intake. Associations between socio-demographic characteristics, knowledge level of prostate health, and food choices were examined using bivariate analysis, and multivariate regression analysis was conducted for possible predictors. The mean age of participants was 51.44 ±7.98. More than half of the participants (62.5%, n=559) had a high knowledge of prostate health. Participants with a family history of prostate disorders were approximately two times [OR (odds ratio) =1.973, p=0.041] more likely to have a high knowledge level of prostate health than those with no family history. Similarly, those diagnosed with prostate disorders were three times (OR = 2.736, p<0.001) more likely to have a high knowledge level of prostate health than those who have never been diagnosed of any prostate disorder. Generally, participants consumed protective and high-risk foods related to prostate health. Participants with increased knowledge of prostate health were three times (OR=2.531, p<0.001) more likely to consume protective foods. Knowledge about prostate health through experience positively impacts the consumption of fruits and vegetables. Efforts in Ghana to improve prostate health should include education on protective food choices to promote prostate health © 2022, African Journal of Food, Agriculture, Nutrition and Development.All Rights Reserved. | Open |
| Azupogo F.; Abizari A.-R.; Aurino E.; Gelli A.; Osendarp S.J.M.; Bras H.; Feskens E.J.M.; Brouwer I.D. | Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data | 2022 | Public Health Nutrition | Objective: We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. Design: Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. Setting: Countrywide, covering rural and urban areas in Ghana. Participants: Non-pregnant adolescent girls aged 15-19 years. Results: Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. Conclusions: The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls. © | Open |
| Bannor R.K.; Amfo B.; Oppong-Kyeremeh H. | Food labelling and safety consciousness of consumers in Ghana: the case of tinned tomatoes | 2022 | Journal of Agribusiness in Developing and Emerging Economies | Purpose: With the empirical evidence on the purchase behaviour of tinned tomatoes, food labelling and the safety consciousness of consumers in Ghana were examined. Design/methodology/approach: Primary data were obtained from 130 consumers. Descriptive statistics, factor analysis and multinomial probit analysis were applied. Findings: Consumers use tinned tomatoes for cooking because of its easy accessibility in nearby shops, guaranteed constant supply, attractive package, it being affordable/cheaper, its better colour, advertisement/promotion, and longer shelf life. There is a low level of food safety consciousness among consumers since only one-fifth read labels on tinned tomatoes very often, and one-fifth do not read labels at all. Consumers frequently check on tinned tomatoes' most essential information: brand/type, manufacturing and expiry dates, and weight/volume. Age, residential status, contact information, nutritional benefits and affordability influence the choice of retail brand of tinned tomatoes. The health label consumer segment and conventional label consumer segment were identified, with the majority being the former. Research limitations/implications: The sample size used for the study could be improved in terms of number and geographical coverage. This is because the study was limited to only one main urbanised area in Ghana. Therefore, it will be worthwhile for a further study to be conducted by comparing urban and rural consumers in Ghana and other countries within Africa, to either validate or reveal a different trajectory of consumer behaviour relevant to marketing, policy and practice. Originality/value: Tomato paste (tinned tomatoes) is consumed in almost all homes in Africa, but there are food scare concerns about tinned tomatoes due to reported cases of adulteration with unhealthy materials such as starch and food colour, leading to negative health implications on consumers. This makes the reading of tinned tomato labels very crucial. Thus, it is of policy relevance to investigate consumers' reading behaviour of label information on tinned tomatoes in Ghana. However, previous studies on food labelling focussed on food and nutrition labelling and implications of food labelling on consumers' purchase behaviour, with most of them outside Africa. © 2022, Emerald Publishing Limited. | Open |
| Bannor R.K.; Oppong-Kyeremeh H.; K. M. Kuwornu J. | Examining the Link between the Theory of Planned Behavior and Bushmeat Consumption in Ghana | 2022 | Journal of Sustainable Forestry | The study explored consumer segments in the bushmeat market and examined the influence of the constructs of the Theory of Planned Behavior and demographic characteristics on the consumption of bushmeat in Ghana using data obtained from 400 respondents across the three main ecological zones of Ghana, namely, the High Forest Zone, the Transitional Zone and the Savannah Zone. The Cragg’s Double Hurdle model was used to examine the influence of the constructs of the Theory of Planned Behavior on bushmeat consumption, and cluster analysis was used to examine the consumer segments. The results revealed that various factors relating to the Theory of Planned Behavior influenced bushmeat consumption and the quantity consumed differently. Specifically, the fear of contracting diseases and poisoning, nutrition, taste, the type of job of an individual and the availability of bushmeat positively influenced the consumption of bushmeat. In contrast, religion and price influenced bushmeat consumption negatively. Whereas the fear of disease influences the quantity consumed negatively, the nutrition value of bushmeat and chop bar as the source ofbushmeat positively influenced the quantity consumed. Age negatively influenced the decision to consume bush meat, whereas household size influenced the decision positively. © 2021 Taylor & Francis. | Open |
| Benajiba N.; Bernstein J.; Aboul-Enein B.H.; Khaled M.B. | Peer-reviewed Nutrition-Affiliated Journals from Sub-Saharan Africa: A Regional Snapshot | 2022 | Journal of Health Care for the Poor and Underserved | Background. Sub-Saharan African (SSA) countries face the multipart burden of nutrition-related disease characterized by a high incidence of undernutrition, overweight, obesity, and associated non-communicable disease. Local and regional research to support a robust public health response is necessary. No evaluation of the availability and scope of nutrition-related journals within SSA has been published. Methods. An electronic search for peer-reviewed journals was conducted using seven publicly accessible databases. Results. Ten journals were identified including journals from Kenya (4 journals), Nigeria (3 journals), South Africa (2 journals), and Ghana (1 journal) with eight journals in active production. All actively publishing journals are available only as English publications. Conclusion. An increased focus on evidence-based research through local and regional journal publications is necessary to develop and maintain public health nutrition programs. Active journals related to nutrition and food sciences are very limited in this comparatively large area and require more support at local, regional, and legislative levels. © Meharry Medical College. | Open |
| Bidzakin J.K.; Yeboah O.; Sugri I.; Graves A.; Awunyo-Vitor D. | Economics of Bulk Storage Techniques: Maize and Cowpea Storage in Ghana | 2022 | Advances in Agriculture | High postharvest loss is one of the major challenges faced by farmers in many African countries in their efforts to achieve food and nutrition security. Several postharvest techniques have been developed and introduced to farmers aimed at reducing food losses. This study evaluated the economic viability of four such grain storage techniques using capital budgeting techniques. Two grain protectants were applied at recommended rates in three treatment combinations to jute sacks, PICS sacks, polytanks, and poly sacks at different treatment levels and at different discount rates. Under maize storage, the net present value of all treatments yielded positive net returns. The polytank technique proved to be the most economically viable storage technique, followed by PICS and then jute sacks. Under cowpea storage, polytank proved to be the most viable, followed by PICS. This is consistent under replacement chain method and equivalent annual annuity under the three different discount rates used. Cowpea is best stored in polytanks and PICS sacks. Polytank is recommended as the most economically viable storage technique for both maize and cowpea storage. PICS is also recommend for both maize and cowpea storage. However, jute sacks and poly sacks are not suitable for cowpea storage even under chemical treatment, especially under long-term storage (over 6 months). The choice of storage technique should consider the commodity under consideration. © 2022 John K. Bidzakin et al. | Open |
| Boadi P.; Gyimah F.T.; Aryeetey R. | DESCRIPTIVE ANALYSIS OF CHANGES IN GHANA'S FOOD AVAILABILITY AND FOOD SAFETY INFORMATION BETWEEN 2010 AND 2020 | 2022 | African Journal of Food, Agriculture, Nutrition and Development | Access to safe, nutritious, and sufficient food is essential to ensure food and nutrition security and healthy lives for all. Secure access to nutritious food ensures healthy eating habits, economic growth, and stability in an economy. However, food insecurity and malnutrition persist globally. In Ghana, more than half of food-insecure people reside in the Northern ecological zones of the country. Moreover, Ghana lacks a systematic food security monitoring system to track food insecurity among vulnerable populations. This study reviewed existing evidence on the current situation and changes related to food production, trade, safety, and consumption in Ghana, as part of the process to develop food-based dietary guidelines for the country. The literature review included peer-reviewed articles published from 2010 – 2020 in Ghana to document household-level food production, consumption, and safety issues. In addition, food disappearance data (from 2010 to 2018) from the Food and Agriculture Organization of the United Nations was analysed. Means and compound annual growth rates were calculated for each food item included. The results showed that per capita food production was higher than per capita consumption in all the food categories studied, except for vegetables, and fish and fishery products. Food consumption was centred on a few priority staple crops such as cassava, maize, rice, and yams, with less consideration given to underutilised foods such as akokono (palm weevil larvae). Food imports exceeded food exports in all food categories except 1) cocoa beans and products, 2) root crops and tubers, 3) oil-bearing crops and nuts, and 4) fruits and products. Fruit and vegetable consumption in Ghana has been declining since 2013. There was also a rise in the import and consumption of processed foods, especially tomato paste, sugars, and alcoholic and non-alcoholic beverages. Food safety issues included microbial contamination, aflatoxin contamination, polycyclic aromatic hydrocarbons in smoked fish, mercury in fish, pesticide and heavy metal residues in vegetables and fruits, and food adulteration. The evidence synthesized from this study will be useful to inform the development of food-based dietary guidelines for Ghana. © 2022. African Journal of Food, Agriculture, Nutrition and Development. All Rights Reserved. | Open |
| Bowen A.; Chen Y.M.; Kodam R.S.; Odoi J.A.; Anto-Ocrah M. | “At Least Somebody Sees You as a Hero”: Fatherhood Stress and Well-Being in Ghana | 2022 | American Journal of Men's Health | Fathers’ mental health and behaviors influence child development and partner well-being, yet paternal stress and well-being are frequently overlooked; especially in non-Western settings. The aim of this mixed-methods study was to quantitatively assess the impact of parenting stress on fathers’ overall well-being in Ghana, West Africa; while qualitatively delving into their lived experiences as fathers. We used a qual/quant mixed-methods approach in this study. The study was conducted in three distinct locations in Ghana (a) Ada, a rural community on the Southeastern coast; (b) Kumasi, an urban setting in upper Southern Ghana; and (c) Sunyani, a peri-urban setting in West-central Ghana. Paternal stress was measured with the Aggravation in Parenting Scale (APS) and well-being was assessed using the Secure Flourishing Index (SFI). Textual data from focus group interviews were sorted using inductive coding and aggregated into overarching themes. Thirty-eight Ghanaian fathers ages 21 to 74 years participated in the study, average age 43 (±12.12 SD), median 39.5. Correlation analyses showed a strong, negative association between paternal stress and well-being (R = −0.63; p <.0001), which was supported in linear regression models (β = −1.04; 95% CI: −1.62, −0.45; p<.0001). Emergent themes of fatherhood stress included financial (employment, food, education, and health care), social (norms and expectations), and psychological (mental work, discipline, relationships, and coping strategies) stressors. A fourth overarching theme of pride and joy in parenting permeated the interviews. Ghanaian fathers with higher parenting stress experience lower overall well-being. Identified stressors could guide interventions that bolster the well-being of fathers and their families. © The Author(s) 2022. | Open |
| Braga B.C.; Arrieta A.; Bannerman B.; Doyle F.; Folson G.; Gangupantulu R.; Hoang N.T.; Huynh P.N.; Koch B.; McCloskey P.; Tran L.M.; Tran T.H.T.; Truong D.T.T.; Nguyen P.H.; Hughes D.; Gelli A. | Measuring adherence, acceptability and likability of an artificial-intelligence-based, gamified phone application to improve the quality of dietary choices of adolescents in Ghana and Vietnam: Protocol of a randomized controlled pilot test | 2022 | Frontiers in Digital Health | Unhealthy diets are a critical global concern while dietary measure methods are time consuming and expensive. There is limited evidence that phone-based interventions can improve nutrition data collection and dietary quality, especially for adolescents in developing countries. We developed an artificial-intelligence-based phone application called Food Recognition Assistance and Nudging Insights (FRANI) to address these problems. FRANI can recognize foods in images, track food consumption, display statistics and use gamified nudges to give positive feedback on healthy food choice. This study protocol describes the design of new pilot studies aimed at measuring the feasibility (acceptability, adherence, and usability) of FRANI and its effects on the quality of food choice of adolescents in Ghana and Vietnam. In each country, 36 adolescents (12–18 years) will be randomly allocated into two groups: The intervention group with the full version of FRANI and the control group with the functionality limited to image recognition and dietary assessment. Participants in both groups will have their food choices tracked for four weeks. The control groups will then switch to the full version of FRANI and both groups will be tracked for a further 2 weeks to assess acceptability, adherence, and usability. Analysis of outcomes will be by intent to treat and differences in outcomes between intervention and control group will use Poisson and odds ratio regression models, accounting for repeated measures at individual levels. If deemed feasible, acceptable and usable, FRANI will address gaps in the literature and advance the nutrition field by potentially improving the quality of food choices of adolescent girls in developing countries. This pilot study will also provide insights on the design of a large randomized controlled trial. The functioning and dissemination of FRANI can be an important step towards highly scalable nutrition data collection and healthier food choices for a population at risk of malnutrition. The study protocol and the methods and materials were approved by the Institutional Review Board (IRB) of the IFPRI on April 29th, 2020 (registration number #00007490), the Thai Nguyen National Hospital on April 14th, 2020 (protocol code 274/ĐĐĐ-BVTWTN) and the University of Ghana on August 10th, 2020 (Federalwide Assurance FWA 00001824; NMIMR-IRB CPN 078–19/20). The study protocol was registered in the International Standard Randomized Controlled Trial Number (ISRCTN 10681553; https://doi.org/10.1186/ISRCTN10681553) on November 12, 2021. 2022 Braga, Arrieta, Bannerman, Doyle, Folson, Gangupantulu, Hoang, Huynh, Koch, McCloskey, Tran, Tran, Truong, Nguyen, Hughes and Gelli. | Open |
| Colecraft E.K.; Christian A.K.; Ammah G.; Aryeetey R. | RAPID REVIEW OF RESEARCH ON DIETARY ATTITUDES, BELIEFS AND PRACTICES IN GHANA 1990-2020 | 2022 | African Journal of Food, Agriculture, Nutrition and Development | Food-related beliefs and attitudes influence dietary behaviors and are important drivers of nutrition outcomes. Understanding beliefs and attitudes that drive dietary behaviors, as part of the process for developing Food-based Dietary Guidelines is critical for targeting messages to motivate healthy dietary diets. This rapid review was undertaken to summarize readily available local evidence on food-related beliefs, attitudes, and associated practices in Ghana. A rapid review of 39 peer-reviewed publications and graduate-level theses on the dietary behaviors of Ghanaians was conducted between November and December 2020. The study only included articles published between 1990 and 2020 involving apparently healthy populations living in Ghana. Documents were identified through a systematic literature search of Google Scholar and PubMed. Data on food-related knowledge, beliefs, attitudes, and practices were extracted into an excel template and analyzed using thematic content analysis. The sampled research included primarily cross-sectional studies of urban, rural, peri-urban and mixed localities throughout Ghana: one was a prospective research. A range of food-related taboos were identified and classified as taboos for the general population, pregnancyrelated, or child-related. Although awareness of food-related taboos was common, they were not extensively practiced. Energy-giving and nutrient-dense foods are commonly promoted during pregnancy. Culturally prescribed pre-lacteal feeds and other infant and young child feeding (IYCF) behaviors reported in the studies were not aligned with IYCF recommendations. A 3-meals-a-day pattern was observed, commonly, across all age groups; most adult meals, particularly supper, was prepared at home. However, ready-to-eat meals were regularly purchased by adults and adolescents. Adolescents frequently reported snacking and skipping meals; breakfast was the most frequently skipped meal. Fruits and vegetables were the least consumed food groups across all age groups. Muslim faith was associated with consuming more diverse diets and greater fruit and vegetable consumption. The findings of this review provide an overview of food-related beliefs and practices of Ghanaians and can inform decisions on areas to emphasize in food-based dietary guidelines and associated nutrition education messages to promote healthy diets in the Ghanaian population. Effective nutrition education is needed to dispel harmful food beliefs and practices and promote healthy food choices across the life cycle. Dietary patterns in Ghana are linked with cultural and religious practices that are often unique to particular subgroups, although there are common strands of beliefs across ethnic groups. These beliefs can result in either adverse or beneficial outcomes, depending on what eating patterns it determines. © 2022 | Open |
| Colecraft E.K.; Marquis G.S.; Pinto C.M. | Growing and Learning Together in Fostering Multisectoral Participation for Sustaining Interventions: Lessons from 3 Successive Integrated Multidisciplinary Interventions in Rural Ghana | 2022 | Current Developments in Nutrition | Despite the recognition of nutrition as a multisectoral development issue, institutional silos persist as barriers to addressing community nutrition challenges effectively and sustainably. Over the past 2 decades, 3 integrated agriculture, livelihood, nutrition, and health interventions have been implemented in rural communities across Ghana, aimed at nurturing multisectoral collaborations to enhance institutional capacity, women's empowerment, children's diets and nutritional status, and general household well-being. Using information from published articles on the interventions, workshop reports, informal institutional engagements, and field notes, insights are presented on the efforts to garner multisectoral participation to sustain these interventions. Challenges and opportunities encountered in the process of growing and learning together relative to overcoming institutional cultures, building trust, empathizing with partners’ institutional challenges, making collective decisions, and building common ownership and accountability are explored. Fostering effective multisectoral participation is a dynamic process of continuous learning. © 2022 American Society for Nutrition. | Open |
| Coomson J.B.; Aryeetey R. | SCOPING REVIEW OF DIET-RELATED HEALTH OUTCOMES AND ASSOCIATED RISK FACTORS IN GHANA | 2022 | African Journal of Food, Agriculture, Nutrition and Development | As part of a process to develop food-based dietary guidelines (FBDGs), the national Multi-sectoral Technical Task Team coordinating FBDGs development in Ghana has commissioned a desk review of the nutrition and health situation, and trends for all persons living in Ghana, across the entire life cycle. Using a rapid scoping review method, multiple electronic databases were systematically searched using keywords related to nutrition and health outcomes, as well as potential drivers of nutrition and health in Ghana. The review included evidence from peer-reviewed articles, unpublished manuscripts, dissertations, reports of nationally representative surveys, and other grey literature (reports of nutrition situation evaluations commissioned by international and local agencies), spanning the decade starting from 2010. A total of 48 documents were included in this review: 15 for infants and young children, 14 for adolescents, 19 for adults and women of reproductive age, and five for the elderly. Among children under five, anemia and stunting were the most prevalent nutritionrelated outcomes, 62% and 19%, respectively. Underweight prevalence of 11% was observed among young children; wasting rates have remained below 10%, but registered about 20% prevalence in northern Ghana. Different levels of micronutrient deficiencies, particularly iron deficiency were reported across all age groups. Nutrient deficiency rates were higher among adolescent girls and women of reproductive age. Vitamin A deficiency was also high (21%) among under-fives. Overweight and obesity rates were high among women of reproductive age (40%) and adolescents (11% to 18% between 2013 and 2017), and still increasing. Underweight and overweight coexists among the elderly (50 years and above), at a rate of 10% and 20%, respectively. An increasing prevalence of central adiposity has also been reported among women of reproductive age (high waist circumference of 80.6%) and persons older than 60 years (67% in 2015). Rates of hypertension and cancers have also increased within the study period. Hypertension rates have been increasing with age, particularly among urban dwellers. Majority of persons with hypertension are not receiving treatment. Incidence of breast, cervical, and liver cancers were 20%, 14%, and 12% in 2018. Ghana is experiencing a double burden of malnutrition characterized by co-existing high levels of undernutrition and overnutrition. The national FBDGs for Ghana should prioritize recommendations and actions that address the dual burden of undernutrition and overnutrition. © 2022 | Open |
| Dallmann D.; Marquis G.S.; Colecraft E.K.; Kanlisi R.; Aidam B.A. | Maternal Participation Level in a Nutrition-Sensitive Agriculture Intervention Matters for Child Diet and Growth Outcomes in Rural Ghana | 2022 | Current Developments in Nutrition | Background: Little is known about how the level of program participation affects child nutrition in rural interventions. Objectives: This study examined the association between participation level in a nutrition-sensitive agriculture intervention and children's diet and anthropometric outcomes in rural Ghana. Methods: Nutrition Links was a cluster randomized controlled trial (clinicaltrials.gov NCT01985243), which enrolled caregivers with children (aged less than 2 mo in 2014-2015 and less than 18 mo in 2016-2017). Of the 287 caregivers in 19 intervention communities who enrolled, 233 adopted the intervention and received layer poultry, garden inputs, and weekly child feeding education. The egg production and repayment of poultry were monitored, and feed was sold at the weekly meetings. After endline, the nutrition educators rated each woman who adopted the intervention on a scale [very poor (1) to excellent (5)] for: 1) meeting attendance, 2) egg productivity, 3) feed and poultry loan payment, 4) contributions during meetings, and 5) attentiveness towards group members. Participation level was classified as high, medium, and low by dividing the sum of these 5 items into tertiles; 54 women who did not adopt the intervention were classified as "no participation."Generalized mixed linear models tested the difference in changes in children's diet and anthropometric indices between the participation levels and the control category - 213 caregiver-child dyads in 20 communities who received standard-of-care health and agricultural services. Results: Compared with the control category, only high participation was associated with egg consumption [adjusted OR (aOR) = 3.03; 95% CI: 1.15, 7.94]. Both medium and high participation levels were associated with length-for-age z-scores (LAZ)/height-for-age z-scores (HAZ) [adjusted β-coefficients (aβ) = 0.44; 95% CI: 0.16, 0.72 and 0.40; 95% CI: 0.12, 0.67, respectively]. Conclusion: These results highlight the importance of promoting and monitoring the level of beneficiary participation to estimate the full potential of nutrition-sensitive agriculture interventions to improve nutritional outcomes. © 2022 The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition. | Open |
| de Groot R.; Yablonski J.; Valli E. | The impact of cash and health insurance on child nutrition during the first 1000 days: Evidence from Ghana | 2022 | Food Policy | Child malnutrition remains a major global public health issue, with 155 million children under five stunted and 52 million children wasted. Social protection, in the form of cash transfer programmes, has been identified as a potential nutrition-sensitive intervention to address malnutrition in early childhood. This study documents the impacts on young child nutrition outcomes and underlying determinants of a Ghanaian cash transfer programme paired with health insurance fee exemptions, targeted to pregnant women and infants under one year. We use data from a 24-month quasi-experimental impact evaluation which exploits the fact that households were selected into the programme based on a continuous programme eligibility index. Using a difference-in-difference approach, our study finds no main treatment effect on nutritional outcomes. Household-level food security improved, yet child meal frequency decreased, suggesting an important role for the intra-household allocation of resources. We conclude that cash alone is unlikely to yield impacts on young child nutrition outcomes and integrated programmes that aim to address multiple underlying determinants at the same time need to be further examined, including effects on the intra-household division of resources. © 2022 Elsevier Ltd | Open |
| Debela B.L.; Ruml A.; Qaim M. | Effects of contract farming on diets and nutrition in Ghana | 2022 | Applied Economic Perspectives and Policy | Contract farming gained importance in many developing countries. While effects of contracting on smallholder farmers' incomes were analyzed in previous studies, diet and nutrition effects are not yet well understood. Here, we examine the effects of contract farming on dietary diversity and child anthropometrics, using survey data from the palm oil sector in Ghana. Contracting improves smallholder nutrition, but the effects vary by contract type. We distinguish between marketing contracts and resource-providing contracts that affect household labor use and gender roles differently. For both contract types, contracting female farmers has larger positive child nutrition effects than contracting male farmers. © 2021 The Authors. Applied Economic Perspectives and Policy published by Wiley Periodicals LLC on behalf of Agricultural & Applied Economics Association. | Open |
| Denomy J.; Harley J.G. | Greater Rural Opportunities for Women (GROW): A multifaceted approach to poverty alleviation at scale | 2022 | Enterprise Development and Microfinance | How did the Greater Rural Opportunities for Women (GROW) project reach over 23,000 smallholder farmers in northern Ghana and achieve impact? This case study describes the project's multifaceted approach to poverty reduction, which combined adaptive management and a comprehensive communications strategy to work toward poverty alleviation at scale. With an initial focus primarily on improved nutrition and food security, the project evolved to include a greater emphasis on women's economic empowerment and leadership. Group formation was an important strategy for providing services at scale, including increased access to market linkages, agronomic information and practices, and financial services. © 2022 Practical Action Publishing. All rights reserved. | Open |
| Egbi G.; Larbi I.A.; Nti H.; Marquis G.S.; Lartey A.; Aryeetey R. | ANEMIA PREVALENCE AND ASSOCIATED FACTORS AMONG SCHOOLAGE CHILDREN IN ACCRA AND KUMASI METROPOLIS IN GHANA | 2022 | African Journal of Food, Agriculture, Nutrition and Development | Anemia remains a serious public health concern, globally, affecting learning ability and physical development of children. Anemic children are at a higher risk of diminished economic productivity and low earning capacity in adulthood due to impaired school performance and reduced work capacity. Anemia contributes to about a quarter of Africa’s nutrition-related Disability Adjusted Life Years. The objective of this study was to determine the prevalence of anemia and its associated risk factors among school-aged children (SAC) between ages 9 and 15 years in urban Ghana. The analysis included a randomly selected subsample of 1,634 children from a larger study on nutrition of SAC enrolled between 2009 and 2012 in private and public basic schools in the Accra and Kumasi Metropolis in Ghana. Socio-demographic and household characteristics were collected with questionnaires. Weight and height were taken to the nearest 0.1kg and 0.1cm, respectively. Dietary information was collected using a food frequency questionnaire. Data were analyzed using IBM SPSS Statistic version 23. The relationship between hemoglobin levels and socio-demographic variables, and predictors of hemoglobin levels were determined using Chi-square and binary logistic regression. The mean hemoglobin concentration of the study participants was 12.9±1.3 g/dL. In Kumasi, SAC had higher mean hemoglobin concentration (13.1±1.2 g/dL) compared to those from Accra (12.6±1.3 g/dL; p=0.001). Mean hemoglobin concentration was significantly higher among males than females (13.0±1.4 g/dL vs 12.8±1.2 g/dL; p=0.002). Prevalence of anemia was 20.4%; mild anemia was most common (13.6% of total sample). Anemia cases were higher in public schools (24.6%) compared to private (18.2%). Two-thirds of anemia cases (64.0%) were from schools in Accra. Males had significantly higher prevalence of anemia (26.5%) than females (15.9%; p <0.05). In the adjusted logistic regression model, only city of residence (OR+1.65, 95% CI: 1.44–1.83), thinness (OR=2.60, 95% CI: 1.11-5.75), stunting (OR=1.85, 95% CI: 1.99-3.10) and overweight (OR=0.60, 95% CI: 0.36-0.94) were significantly associated with anemia. In this study, anemia was significantly associated with location and nutritional status. © 2022. African Journal of Food, Agriculture, Nutrition and Development. All Rights Reserved. | Open |
| Eweh P.; Tsikata D. | Gender, changing food cultures, and food security in the context of agricultural commercialization in Ghana | 2022 | Agricultural Commercialization, Gender Equality and the Right to Food: Insights from Ghana and Cambodia | The literature on food security rarely addresses how different models of agricultural commercialization affect food cultures. Thus food security is rarely discussed in all its four dimensions of availability, accessibility, utilization, and stability. We contribute to addressing this question by drawing on qualitative research conducted in four districts of Ghana in February 2016. The study found that commercialization did not guarantee food security and was in some cases even implicated in food shortages, to which some responded by shifting from preferred local staples to other foods, or items of lower social value. Commercialization and changing food cultures played a role in the introduction of ‘new’ foods such as polished rice, soybean, and instant noodles into the diets of smallholder farmers and their households. Crucially, in both northern and southern Ghana, household food provisioning was determined by a sexual division of labour which assigned greater value to men’s roles while undervaluing the responsibilities performed by women. These aspects of food culture provided the basis for privileging men’s energy and nutrition needs while marginalizing those of women and children. Our findings highlight the interaction of gender, generation, and agro-ecology in food security outcomes. © 2023 selection and editorial matter, Joanna Bourke Martignoni, Christophe Gironde, Christophe Golay, Elisabeth Prügl and Dzodzi Tsikata; individual chapters, the contributors. | Open |
| Forh G.; Apprey C.; Frimpomaa Agyapong N.A. | Nutritional knowledge and practices of mothers/caregivers and its impact on the nutritional status of children 6–59 months in Sefwi Wiawso Municipality, Western-North Region, Ghana | 2022 | Heliyon | Background: Good maternal/caregiver nutrition knowledge protects the child from events that lead to low weight-for-age z-score (WAZ) and low height-for-age z-score (HAZ). Indicators of good child nutritional status have traditionally been low in cocoa-growing areas. This paper aimed to explore the relationship between maternal nutrition knowledge and practices and its effect on the nutritional status of children 6–59 months in the Sefwi Wiawso municipality; a predominant cocoa-growing area in Ghana. Methodology: A cross-sectional study design was used to assess nutrition knowledge, nutritional practices of mothers and dietary adequacy and nutritional status of their children using 24-hour dietary recall and anthropometric measures. Results: A total of 226 caregiver-child pairs were recruited for the study. The level of nutritional knowledge was average (61.5%) among caregivers/mothers. Most caregivers (92.3%) initiated breastfeeding within 1 hour of giving birth. A total of 66% of mothers practiced exclusive breastfeeding. Complementary feeding was initiated at 6 months in 83.6% of the cases. The prevalence of underweight, wasting, and stunting were 8.29%, 10.23%, and 16.74% respectively. There was no significant association between mother/caregiver's nutrition knowledge and child malnutrition status although the risk of wasting reduced with increasing nutritional knowledge of caregivers (p = 0.118). Conclusion: There was no association between maternal nutrition knowledge and the nutritional status of children even though wasting showed a pattern of decrease with increasing nutritional knowledge. The prevalence of malnutrition in children in the study was comparatively lower than the national average. Underweight was statistically significantly higher in children whose mothers/caregivers were farmers hence appropriate nutrition education with a focus on infant and young child feeding practices should be promoted during antennal care and child welfare clinic services within these communities. Family planning services targeted particularly at teenage girls should be instituted to prevent teenage pregnancies as malnutrition is more likely to occur in children born to teenage mothers. © 2022 | Open |
| Gbagbo F.Y.; Nkrumah J. | Breastfeeding-friendly policies and programs in three public Universities in Ghana | 2022 | International Breastfeeding Journal | Background: The United Nations through its Sustainable Development Goals (SDG) 3 and 5 has championed Women empowerment for exclusive breastfeeding through various action plans and expected the concept to be decentralized through locally mandatory implementation of various institutional policies and programs in member Countries. Using Kabeer’s empowerment concept, the authors in this paper assessed availability and implementation of breastfeeding policies and programs in three public universities in Ghana. Methods: The study design was an exploratory-descriptive-case study involving university employees and student mothers from three public universities in Ghana. The universities were selected via simple random approach whilst selection of participants was purposive. Data were collected between April and July 2018 using an unstructured interview guide developed by the authors, audio recordings, field notes and desktop review of documents. Manual thematic analysis of data was done to present results descriptively. The University of Cape-Coast Ethics Review Board approved the study. Results: Thirty-six respondents participated in the study. Three main themes (Breastfeeding policy and programs, Institutional support, and views on Breastfeeding/Childcare support) emerged. Despite being gender/child friendly, none of the universities in this study has a formal breastfeeding/childcare policy/program and there are no immediate policy plans for on-campus facilities to enhance breastfeeding. Financial cost emerged as a major challenge hindering the universities from implementing a policy/program in this regard. On the part of student mothers, lack of legal protection, lack of breastfeeding-friendly university policies, inadequate availability of breastfeeding facilities, and insufficient awareness of the importance of breastfeeding among nursing mothers has been a major setback for breastfeeding on campus, hence nursing mothers continue to make personal but challenging arrangements for breastfeeding on university campuses. Conclusions: The study findings reflect negative implications for childcare as it affects optimal child nutrition, hence impacting on achieving the SDGs 3 and 5 in Ghana. The authors recommend introducing formal breastfeeding-friendly policies/programs as one of the criteria for accreditation of universities in Ghana to enhance optimal childcare and sound maternal mind for studies and/or work once there is an assurance of child safety and proximity to breastfeed on demand. © 2022, The Author(s). | Open |
| Ghadirian M.Z.; Marquis G.S.; Dodoo N.D.; Andersson N. | Ghanaian Female Adolescents Perceived Changes in Nutritional Behaviors and Social Environment After Creating Participatory Videos: A Most Significant Change Evaluation | 2022 | Current Developments in Nutrition | Background: Understanding the influence of participatory video-making on the nutrition-related behavior of video creators may help shape nutrition education interventions. Objectives: This study assessed the perceived value and influence of a participatory video intervention among participants and stakeholders. Methods: A 2018–2019 cluster randomized controlled trial (registered at http://clinicaltrials.gov as NCT03704649) selected 20 schools (10 intervention, n = 181; 10 control, n = 170) in 1 Ghanaian rural district, enrolled adolescent girls aged 13–16 y, and provided a nutrition curriculum. Each intervention school also participated in 2 series of activities designed to help adolescents plan, film, and screen 2 nutrition-related videos. The Most Significant Change method involved intervention participants and local stakeholders to assess the value and influence of the intervention – a secondary outcome of the trial. Project staff collected 116 stories of change from the adolescents. Stories described shifts in 4 domains: participant, peer, and family behavior, and structural changes in the school. The project team used a selection rubric to identify 14 stories that reflected heightened nutrition literacy. Staff conducted interviews with the 14 adolescents whose stories were selected to elaborate on details and perceived resonance. Finally, local stakeholders assessed the stories to identify the 4 most significant changes of the intervention – 1 per domain. A separate thematic analysis identified emerging patterns of motivation and action across the 14 interviews. Results: The chosen Most Significant Change stories revealed how adolescents found creative solutions to acquire iron-rich foods, encouraged neighbors to eat iron-rich foods, taught their family new agricultural practices, and promoted change in their school canteen. Local stakeholders valued stories that addressed common community nutrition issues in a creative and sustainable way, whereas adolescents prioritized stories that showed a change in health outcomes. Conclusion: Stories of change revealed that the intervention promoted a transformative influence; participants modified their eating habits, lifestyle, and their environment. © 2022 American Society for Nutrition. | Open |
| Godha D.; Tharaney M.; Nanama S.; Sanghvi T.; Laillou A.; Diop F.T.; Cisse A.S. | The Association between Iron and Folic Acid Supplementation and Malaria Prophylaxis and Linear Growth among Children and Neonatal Mortality in Sub-Saharan Africa—A Pooled Analysis | 2022 | Nutrients | The majority of research on linear growth among children is confined to South Asia and focuses on iron and folic acid (IFA) supplementation during pregnancy, without considering malaria prophylaxis. Similarly, there is limited evidence on the association of antenatal IFA supplementation and malaria prophylaxis with neonatal mortality in sub-Saharan Africa (SSA). This study aims to address these gaps. A pooled analysis of demographic and health survey (DHS) data from 19 countries in SSA was conducted to study the association between IFA supplementation and malaria prophylaxis and linear growth and neonatal mortality. Multivariate logistic and linear regression models were used. Malaria prophylaxis was significantly associated with stunting, height-for-age Z scores (HAZ scores), and neonatal mortality, but IFA supplementation was not associated with these outcomes. When women’s height and body mass index (BMI) were introduced in the model, a significant association between combined malaria prophylaxis and IFA supplementation was found with HAZ scores only. For severe stunting, no significant association was found with either in the two models. In conclusion, this study underscores the importance of antenatal malaria prophylaxis as a potential intervention for nutrition outcomes (linear growth) and neonatal mortality, as well as the importance of coordinating efforts between malaria and the health and nutrition sectors to improve these outcomes in the countries of SSA. © 2022 by the authors. | Open |
| Goh Y.E.; Marquis G.S.; Colecraft E.K.; Aryeetey R. | Participating in a Nutrition-Sensitive Agriculture Intervention Is Not Associated with Less Maternal Time for Care in a Rural Ghanaian District | 2022 | Current Developments in Nutrition | Background: Nutrition-sensitive agriculture (NSA) interventions may increase farm-related work for mothers, with consequences for child nutrition. The Nutrition Links (NL) intervention provided mothers with poultry, gardening inputs, technical support, and education to improve livelihoods and child nutrition outcomes in rural Ghana. Objectives: Our objective was to compare time allocated to child care by a cross-section of mothers in the intervention group of the NL intervention with the control group (NCT01985243). Methods: A cross-section of NL mother-child pairs was included in a time allocation substudy [intervention (NL-I) n = 74 and control (NL-C) n = 69]. In-home observations of the mother-child pair were conducted for 1 min, every 5 min, for 6 h. Observations were categorized into 4 nonoverlapping binary variables as follows: 1) maternal direct care, 2) maternal supervisory care, 3) allocare, and 4) no direct supervision. Allocare was defined as care by another person in the presence or absence of the mother. Any care was defined as the observation of maternal direct care, maternal supervisory care, or allocare. Generalized linear mixed models with binomial data distribution were used to compare the child care categories by group, adjusting for known covariates. Results: Maternal direct care (OR = 1.07; 95% CI: 0.89, 1.28) and any care (OR = 1.56; 95% CI: 0.91, 2.67) did not differ by intervention group. However, there was a higher odds of allocare (OR = 1.36; 95% CI: 1.04, 1.79) in NL-I than in NL-C women. Conclusions: Maternal participation in an NSA intervention was not associated with a decrease in time spent directly on child care but was associated with an increase in care from other household and community members. The clinicaltrials.gov number provided is for the main NL intervention and not this current substudy. © 2022 The Author(s). Published by Oxford University Press on behalf of the American Society for Nutrition. | Open |
| Hidrobo M.; Palloni G.; Gilligan D.O.; Aker J.C.; Ledlie N. | Paying for Digital Information: Assessing Farmers’ Willingness to Pay for a Digital Agriculture and Nutrition Service in Ghana | 2022 | Economic Development and Cultural Change | With the widespread growth of mobile phone coverage and adoption over the past decade, there has been considerable enthusiasm over the potential for information and communication technologies (ICTs) to provide a low-cost approach for farmers to overcome information constraints in agricultural initiatives. The commercial viability of ICTs relies on effective demand for these services. This paper assesses farmers’ willingness to pay (WTP) for a digital platform that provides nutrition-sensitive agricultural information in Ghana. Using the Becker-DeGroot-Marschak method to elicit WTP, we randomly vary the framing of the marketing for the service as well as the gender of the person targeted. We find that farmers are highly price sensitive, but most are willing to pay a low monthly price for the service. A nutrition-focused marketing message leads to higher WTP than an agriculture-only message, and women have substantially lower WTP than men, with the latter difference driven by lower WTP for the service among women who report access to alternative sources of nutrition, health, and agriculture information. © 2022 The University of Chicago. All rights reserved. | Open |
| Hormenu T. | Dietary intake and its associated factors among in-school adolescents in Ghana | 2022 | PLoS ONE | Introduction Early-life nutrition related experiences may fuel the emergence of obesity and type 2 diabetes in adolescence. The adoption of unhealthy dietary practices early in life is an indicator of adverse cardiometabolic health in adulthood. In-school adolescents’ dietary practices in Ghana have not been explored extensively despite increasing levels of obesity in adolescents. This study sought to examine dietary practices, socio-demographic disparities and the factors influencing dietary choices among in-school adolescents in Ghana. Methods A school-based, cross-sectional study was conducted in the Central region of Ghana in 2017. Using multistage sampling procedures, a total of 1,311 in-school adolescents were selected for the study. A modified version of the generic Global School Health Survey questionnaire on dietary practices was adapted and used for data collection. Percentage and frequency counts were used to report on the dietary practices, while Chi-square was used to determine socio-demographic variations in the dietary practices. Binary logistic regression was used to compute the influence of socio-demographic characteristics of respondents on the prevalence of healthy dietary behavior among in-school adolescents. Results The study revealed the prevalence of healthy dietary practices (49.9%, n = 654) among in-school adolescents in the region. The study also found increased frequency in consumption of soft drinks (93%, n = 1220) and toffees/sweets (90%, n = 1183) among in-school adolescents. However, low intake of breakfast (57%, n = 749) was observed among the adolescents. Significant disparities were observed in relation to gender, age, parental communication, academic performance and geographical location in the dietary practices of in-school adolescents. Furthermore, gender (OR = 1.36, P = 0.007), academic performance (OR = 2.19, P = 0.001) and geographical location (OR = 1.79, P = 0.001) were found to be significantly associated with dietary practices among in-school adolescents in the region. Conclusions There was low consumption of fruits and vegetables among adolescents. Fruits and vegetables consumption was associated with gender, academic performance and geographical location, and these may be a reflection that knowledge on healthy food choices and availability are important factors influencing dietary choices among in-school adolescents. School health policy interventions aimed at improving nutritional status among adolescents and enhanced fruit and vegetable consumption in the country should take into account the potential benefit of increasing availability of fruits and vegetables in schools, while reducing access to sweets and soft drinks in the schools and communities. Copyright: © 2022 Thomas Hormenu. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Jimma F.I.; Mohammed A.; Adzaworlu E.G.; Nzeh J.; Quansah L.; Dufailu O.A. | Microbial quality and antimicrobial residue of local and industrial processed fruit juice sold in Tamale, Ghana | 2022 | Discover Food | Fruits are essential part of human nutrition that provides numerous health benefits. When processed into juice, they are either packaged and stored or consumed immediately. Some reports associate foodborne illness with consumption of natural beverages contaminated with pathogenic microbes. Also, concerns of antimicrobial resistance due to antimicrobial residues in fruit juices has been raised. Thus, this study assessed the microbial quality of fruit juice by determining the incidence and load of E. coli and Salmonella spp., and the presence of antimicrobial residues in locally processed fruit juices (n = 25) and industrially (n = 3) processed fruit juices sold in Tamale, Ghana. Spread plate technique was adopted for isolation and enumeration of bacteria whilst the Premi® test kit was employed for detecting the presence of antimicrobial residue. Neither E. coli nor Salmonella spp. is recorded in all three industrially processed fruit juice samples. However, the locally processed fresh fruit juice samples recorded a prevalence rate of 88% E. coli and 40% Salmonella spp. with microbial load of 1.3 × 104 cfu/ml—9.23 × 104 cfu/ml for E. coli which is above the acceptable limits. Antimicrobial residues were absent in all 28 samples analyzed. The incidence and high E. coli load found in the local fresh fruit juice is of concern. Future studies should elucidate the pathogenicity of the isolates. Also, to avert possible foodborne illness linked with the consumption of local fresh fruit juices within Tamale and to ensure food safety, increase public health surveillance is recommended. © 2022, The Author(s). | Open |
| Kanyiri Gaa P.; Sulley S.; Boahen S.; Bogobiri S.; Mogre V. | Reported dietary habits and lifestyle behaviors of students before and during COVID-19 lockdown: A cross-sectional survey among university students from Ghana | 2022 | Journal of Public Health Research | Background: COVID-19 lockdowns involved precautions and social rules that resulted in drastic changes to daily life activities in every setting. University students were not left out as their education was affected and they had to resort to online learning from their homes. The lockdowns did not only affect their education but also potentially affected their dietary habits and lifestyle behaviors. We evaluated the reported dietary habits and lifestyle behaviors of students from a Ghanaian University before and during the COVID-19 lockdown. Materials and Methods: Following a cross-sectional design, 220 students were recruited from the University for Development Studies in Ghana. Data was collected by means of an online questionnaire. Chi-square test (χ2) analysis was used to examine associations among variables. Results: About 59% of the students skipped meals before COVID-19 whereas 47.8% skipped meals during the COVID-19 lockdown. While 64.1% consumed homemade meals before the COVID-19, 82.3% consumed homemade meals during the COVID-19 lockdown. In addition, there was a significant increase in the consumption of homemade food (p < 0.001), level of healthy foods choices (p = 0.029), and a reduced skipping of meals (0.014) during the COVID-19 lockdown. Again, 56.4% of the students engaged in exercise before the lockdown while 45% participated in exercise during the lockdown. Conclusions: The lockdown had an impact on some of the dietary and lifestyle habits of the students. University students should be supported with appropriate nutrition education and counseling programs to help them adopt healthy dietary and lifestyle habits. © The Author(s) 2022. | Open |
| Katoch O.R. | Determinants of malnutrition among children: A systematic review | 2022 | Nutrition | Objectives: Child undernutrition is a major public health problem. Globally in 2020, 149 million children <5 y of age were estimated to be stunted (too short for age), 45 million to be wasted (too thin for height), and 38.9 million were overweight. The aim of this review was to examine previous studies to determine the factors associated with malnutrition and contribute to the existing body of evidence needed for the formulation of effective interventions. Methods: This systematic review was conducted using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The Google Scholar database was used to search the studies conducted between 2012 and 2021. The included studies were searched by using some combinations of keywords and saved in Mendeley Desktop for review and referencing. Results: Of 2150 articles retrieved from the Google Scholar databases, 37 met our inclusion criteria. Of the 37 studies reviewed; 13 were conducted in India, 5 in Ethiopia, 3 in Bangladesh, 2 in Ghana, 2 in Nepal, 2 in developing countries, and 1 each in Bolira, Benin, Netherland, Columbia, Pakistan, Malaysia, Africa, Egypt, Ecuadorian, and Indonesia. Conclusion: The most consistent factors associated with child malnutrition were maternal education, household income, maternal nutritional status, age of the child, availability of sanitation facility at home, size of family, birth order in the family, and child's birth weight. Breastfeeding and caring practices, cooking area and the fuel used, sex, and socioeconomic status of the children also contribute toward child malnutrition. © 2021 Elsevier Inc. | Open |
| Klobodu S.S.; Mensah P.A.; Willis M.; Bailey D. | Weight Bias Among Nutrition and Dietetics Students in a Ghanaian Public University | 2022 | Journal of Nutrition Education and Behavior | Objectives: To measure the internal consistency reliability of 3 weight bias scales among nutrition and dietetics students enrolled at a public university in Ghana and to use the Fat Phobia Scale (FPS) to determine the prevalence of weight bias and the differences in gender and body mass index. Design: Online survey gathered self-reported height, weight, and demographic data. Explicit weight bias was assessed using validated FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales. Participants: Sample of 172 students. Main Outcome Measures: Prevalence of weight bias. Analysis: Cronbach α reliability test was used to measure the internal consistency of scales. The prevalence of weight bias was expressed as a percentage. Independent t tests and analysis of variance were used to explore differences in gender and weight categories. Results: The reliability scores for FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales were 0.92, 0.51, and 0.38, respectively. About 53% of participants expressed weight bias. A significant difference was observed for weight bias between overweight and obese participants, with participants with obesity showing greater weight bias (P = 0.03). Conclusion and Implications: Fat Phobia Scale (most reliable) identified more than half of the students had a negative attitude toward obesity. Weight bias training within this population may improve attitudes toward obesity. © 2022 The Authors | Open |
| Kuwornu J.P.; Amoyaw J.; Manyanga T.; Cooper E.J.; Donkoh E.; Nkrumah A. | Measuring the Overall Burden of Early Childhood Malnutrition in Ghana: A Comparison of Estimates From Multiple Data Sources | 2022 | International Journal of Health Policy and Management | Background: Childhood malnutrition contributes to nearly half (45%) of all deaths among children under 5 globally. The United Nations’ Sustainable Development Goals (SDGs) aims to end all forms of malnutrition by 2030; however, measuring progress towards these goals is challenging, particularly in countries with emerging economies where nationally-representative data are limited. The primary objective of this study was to estimate the overall burden of childhood malnutrition in Ghana at national and regional levels using 3 data sources. Methods: Using data from the long-standing Ghana Demographic and Health Surveys (GDHS), Ghana Multiple Indicator Cluster Survey (GMICS), and the emerging Ghana Socioeconomic Panel Survey (GSPS), we compared the prevalence of malnutrition using the extended composite index of anthropometric failure (eCIAF) for the period 2008-2011. This study included data for children aged 6-59 months and calculated all anthropometric z-scores based on the World Health Organization (WHO) Growth Standards. We tested for differences in malnutrition subtypes using two-group configural frequency analysis (CFA). Results: Of the 10 281 children (6532 from GMICS, 2141 from GDHS and 1608 from GSPS) included in the study, the only demographic difference observed was the children included in the GSPS were slightly older than those included in the GDHS and GMICS (median age of 36 vs 30 vs 33 months, P <.001). Based on the eCIAF, the overall prevalence of malnutrition at the national level was higher among children in the GSPS (57.3%, 95% CI: 53.9%–60.6%), followed by the GDHS (39.7%, 95% CI: 37.0%–42.5%), and then those in the GMICS (31.2%, 95% CI: 29.3%–33.1%). The two-group CFA showed that the 3 data sources also estimated different prevalence rates for most of the malnutrition subtypes included in the eCIAF. Conclusion: Depending on the data source adopted, our estimates of eCIAF showed that between one-third and half of all Ghanaian children aged 6-59 months had at least one form of malnutrition over the period 2008-2011. These eCIAF estimates should complement the commonly reported measures such as stunting and wasting when interpreting the severity of malnutrition in the country to inform policy decisions. © 2022 The Author(s). | Open |
| Liguori J.; Pradeilles R.; Laar A.; Zotor F.; Tandoh A.; Klomegah S.; Osei-Kwasi H.A.; Le Port A.; Bricas N.; Aryeetey R.; Akparibo R.; Griffiths P.; Holdsworth M. | Individual-level drivers of dietary behaviour in adolescents and women through the reproductive life course in urban Ghana: A Photovoice study | 2022 | Maternal and Child Nutrition | Evidence on the individual-level drivers of dietary behaviours in deprived urban contexts in Africa is limited. Understanding how to best inform the development and delivery of interventions to promote healthy dietary behaviours is needed. As noncommunicable diseases account for over 40% of deaths in Ghana, the country has reached an advanced stage of nutrition transition. The aim of this study was to identify individual-level factors (biological, demographic, cognitive, practices) influencing dietary behaviours among adolescent girls and women at different stages of the reproductive life course in urban Ghana with the goal of building evidence to improve targeted interventions. Qualitative Photovoice interviews (n = 64) were conducted in two urban neighbourhoods in Accra and Ho with adolescent girls (13–14 years) and women of reproductive age (15–49 years). Data analysis was both theory- and data-driven to allow for emerging themes. Thirty-seven factors, across four domains within the individual-level, were identified as having an influence on dietary behaviours: biological (n = 5), demographic (n = 8), cognitions (n = 13) and practices (n = 11). Several factors emerged as facilitators or barriers to healthy eating, with income/wealth (demographic); nutrition knowledge/preferences/risk perception (cognitions); and cooking skills/eating at home/time constraints (practices) emerging most frequently. Pregnancy/lactating status (biological) influenced dietary behaviours mainly through medical advice, awareness and willingness to eat foods to support foetal/infant growth and development. Many of these factors were intertwined with the wider food environment, especially concerns about the cost of food and food safety, suggesting that interventions need to account for individual-level as well as wider environmental drivers of dietary behaviours. © 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd. | Open |
| Manger M.S.; Brown K.H.; Osendarp S.J.M.; Atkin R.A.; McDonald C.M. | Barriers to and Enablers of the Inclusion of Micronutrient Biomarkers in National Surveys and Surveillance Systems in Low- and Middle-Income Countries | 2022 | Nutrients | Including biomarkers of micronutrient status in existing or planned national surveys or surveillance systems is a critical step in improving capacity to promote, design, monitor, and evaluate micronutrient policies and programs. We aimed to identify the barriers to and enablers of the inclusion of micronutrient biomarker assessment in national surveys and surveillance systems, to identify the main challenges faced during the survey process, and to review experiences using existing platforms for micronutrient surveys. We conducted a series of key informant interviews with in-country and external representatives from six countries where national-level data on micronutrient status were collected in the past 5 years: Cambodia, Pakistan, Malawi, Uganda, Ghana, and Uzbekistan. Micronutrients associated with specific public health programs were always prioritized for inclusion in the survey. If funding, time, and/or logistics allowed, other considered micronutrients were also included. The most important and frequently reported barrier to inclusion of a more comprehensive panel of micronutrient biomarkers was inadequate funding to cover the laboratory analysis cost for all micronutrients considered at the planning stage. Government support and commitment was stressed as the most important enabling factor by all key informants. Advocacy for funding for micronutrient status assessment is needed. © 2022 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Mensah D.O.; Yeboah G.; Batame M.; Lillywhite R.; Oyebode O. | Type, density, and healthiness of food-outlets in a university foodscape: a geographical mapping and characterisation of food resources in a Ghanaian university campus | 2022 | BMC Public Health | Introduction: Food environments are viewed as the interface where individuals interact with the wider food system to procure and/or consume food. Institutional food environment characteristics have been associated with health outcomes including obesity and nutrition-related non-communicable diseases (NR-NCDs) in studies from high-income countries. The objectives of this study were (1) to map and characterise the food-outlets within a Ghanaian university campus; and (2) to assess the healthiness of the food outlets. Methods: Data collection was undertaken based on geospatial open-source technologies and the collaborative mapping platform OpenStreetMap using a systematic approach involving three phases: remote mapping, ground-truthing, and food-outlet survey. Spatial analyses were performed using Quantum Geographical Information System (QGIS) and comprised kernel density, buffer, and average nearest neighbour analyses to assess outlet distribution, density, and proximity. A classification system was developed to assess the healthiness of food-outlets within the University foodscape. Results: Food-outlets were unevenly distributed over the University foodscape, with many outlets clustered closer to student residencies. Informal food-outlets were the most frequent food-outlet type. Compared to NCD-healthy food-outlets, NCD-unhealthy food-outlets dominated the foodscape (50.7% vs 39.9%) with 9.4% being NCD-intermediate, suggesting a less-healthy university foodscape. More NCD-unhealthy food outlets than NCD-healthy food outlets clustered around student residences. This difference was statistically significant for food outlets within a 100-m buffer (p < 0.001) of student residence and those within 100 and 500 m from departmental buildings/lecture halls (at 5% level of significance). Conclusion: Further action, including research to ascertain how the features of the University’s food environment have or are influencing students’ dietary behaviours are needed to inform interventions aimed at creating healthier foodscapes in the study University and other campuses and to lead the way towards the creation of healthy food environments at the home, work, and community levels. © 2022, The Author(s). | Open |
| Mockshell J.; Ogutu S.O.; Álvarez D.; Asante-Addo C.; Asante F.A. | How healthy and food secure is the urban food environment in Ghana? | 2022 | World Development Perspectives | The importance of the food environment in influencing dietary choices of consumers has been widely acknowledged, but little attention has been paid to the urban food environment in Africa despite the rise in incidence of obesity and other nutrition-related noncommunicable diseases (NR-NCDs). We contribute to the literature on urban food environments by conducting an observational macro-scan of the food environment in three cities – Accra, Cape Coast, and Koforidua – with a view to unravelling the nature of the urban food environment in Ghana. We examine the food environment based on two dimensions of food security – availability and accessibility (affordability) – and also assess the extent to which foods are processed. The results show that all four food categories – unprocessed, processed, processed culinary, and ultra-processed – are available, accessible, and affordable. Ultra-processed foods are just as highly available, accessible, and/or affordable as unprocessed foods. The results also show that processed foods account for the larger share of all foods in Ghana's urban food environment, and ultra-processed foods account for more than 30% of all processed foods. Overall, these results suggest that physical and economic access to food are not major constraints in urban Ghana. This is certainly a welcome finding from a food policy perspective; however, the high availability and accessibility of ultra-processed foods has serious potential health implications. Regulation will be needed to prevent overconsumption of ultra-processed foods and the resulting increase in obesity and other NR-NCDs. © 2022 The Author(s) | Open |
| Mohammed A.-R. | Quietly bearing the brunt of austerity in school: A qualitative study into children's experiences of food insecurity in Ghana | 2022 | International Social Science Journal | The dominant food security literature that reports on children's experiences of food insecurity rely on adult/parent proxies. Nevertheless, studies have shown that adult narrations of children's experiences might not always accurately reflect children's experiences. Furthermore, other studies have also shown that in many cases, children are the best reporters of their experiences. Against this background, this paper sets out to explore, from school children's own perspectives, their lived experiences of food insecurity in school under the Ghana School Feeding Programme (GSFP). This research is important because the latest round of austerity programmes in Ghana has compelled the service providers of the GSFP to resort to several coping strategies (such as rationing services, compromising the quality and quantity of meals served, and occasionally skipping service delivery) which can have significant effects on children's nutrition. Findings from group discussions and one-on-one semi-structured interviews with 21 primary school children aged 8 to 15 highlight school children's experiences of food insecurity. By exploring children's experiences of food insecurity in school, this paper presents evidence that shows that research about children's experiences can and should be based on children's accounts and not adult proxies. © 2022 John Wiley & Sons Ltd | Open |
| Mohammed S.; Oakley L.L.; Marston M.; Glynn J.R.; Calvert C. | Time trends in the prevalence and determinants of age-appropriate breast feeding among children aged 0-23 months in Ghana: a pooled analysis of population-based surveys, 2003-2017 | 2022 | BMJ Open | Objective We assessed the sociodemographic and maternal-child characteristics associated with age-appropriate breast feeding among children aged 0-23 months in Ghana. Methods We pooled data on 12 743 children aged 0-23 months from three Demographic and Health Surveys (2003, 2008 and 2014) and three Multiple Indicator Cluster Surveys (2006, 2011 and 2017-2018). The outcome was age-appropriate breast feeding from birth to 23 months, with age-appropriate breast feeding defined as exclusive breast feeding at 0-5 months (ie, at less than 6 months) and breastfeeding alongside appropriate complementary feeding at 6-23 months. Potential determinants were maternal-child sociodemographic, obstetric and healthcare factors. Logistic regression was used to determine the factors associated with age-appropriate breast feeding. We accounted for the complex sampling design of the cross-sectional surveys in the analysis. Results Most children aged 0-3 months were exclusively breastfed. Among children aged 4-5 months, the most common feeding pattern was breastfeeding alongside water and/or solid foods. Exclusive breastfeeding prevalence in children less than 6 months peaked in 2008 at 62.8% and declined to 42.9% in 2017. For 6-11 month olds, the percentage experiencing age-appropriate breast feeding has been stable over the last four surveys, ranging from 79.3% in 2008 to 81.1% in 2017. Age-appropriate breast feeding in 12-23 month olds declined from 77.8% in 2003 to 61.2% in 2017. Rural residence, younger age, non-facility births and multiple births were associated with decreased odds of exclusively breast feeding. For 6-11 month olds, age-appropriate breast feeding was less likely if the woman did not receive postnatal care. Younger age, being unmarried, high income, wanting a child later and earlier birth order were associated with decreased odds of age-appropriate breast feeding in 12-23 month olds. Conclusion Ghanaian children are now less likely to be exclusively breastfed than they were a decade ago. To succeed, breastfeeding promotion programmes should adopt approaches that address the predictors of suboptimal breast feeding at each age, as identified in this study. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | Open |
| Nanema S.; Adjei A.; Amevinya G.S.; Laar A. | “Some are healthy and others not”: Characterization of vended food products by Accra-based food retailers | 2022 | Frontiers in Public Health | Background and objectives: Increasing the availability of healthy foods within food retail outlets can improve consumers' food environments. Such actions or inactions by food retailers may affect people's food purchasing and consumption behavior. This study explored Accra-based food retailers' perceptions and appreciation of “healthiness of food” as a concept. It also documented measures that food retailers adopt to encourage healthy food choices. Methods: In-person semi-structured interviews were conducted with owners and managers of Accra-based supermarkets (n = 7) and corner stores (n = 13) in March 2021. The interviews were recorded, transcribed, coded, and analyzed thematically. Results: The retailers' understanding of healthy food, or lack thereof, is exemplified by such expressions as “health, absence of disease, longevity, balanced diet, diversity, sanitation, and certification.” A handful of retailers described what they sell as “products that meet consumer needs,” “harmless,” or “generally good.” Very few retailers described the food they sell as “junk,” high in sugar, fat, and salt, or energy-dense but nutrient poor foods, or as food that could pose some health risk to consumers. However, some retailers indicated that they advise their customers against the overconsumption of some foods. Conclusion: Overall, Accra-based retailers have a fair understanding of what constitutes healthy food – exhibiting limited knowledge of the connection between very salty, very sugary, and very fatty foods and health outcomes. Retailers in Accra require interventions that improve their food, health, and nutrition literacy. Improving retailers' food and nutrition literacy may improve the availability of healthier options in food retail outlets in Accra. Copyright © 2022 Nanema, Adjei, Amevinya and Laar. | Open |
| Nkegbe P.K.; Abdul Mumin Y. | Impact of community development initiatives and access to community markets on household food security and nutrition in Ghana | 2022 | Food Policy | In this study, we investigate the impact of community development initiatives and community markets on household food security and nutrition using nationally representative dataset of 16,772 households in Ghana. We estimate a multinomial endogenous switching regression of the impacts of these interventions on food security and nutrition while accounting for unobserved heterogeneities of households and communities in the allocation of these interventions. The results show that both interventions significantly increase household food security and nutrition, although the effects are much larger when these interventions are implemented together than in isolation. Moreover, the intervention strategies come at a cost of economic inefficiency in resource allocation which ends up making some households worse off. Thus, policymakers could consider implementing specific but complementary development interventions together and improving engagement with beneficiaries of such policies to ensure interventions are indeed effective and pro-poor. © 2022 Elsevier Ltd | Open |
| Nsiah-Asamoah C.; Adjei G.; Agblorti S.; Doku D.T. | Association of maternal characteristics with child feeding indicators and nutritional status of children under-two years in Rural Ghana | 2022 | BMC Pediatrics | Background: Optimal nutrition during the first two years of a child’s life is critical for the reduction of morbidity and mortality. In Ghana, majority of children miss out on optimal nutrition and only few (13%) of children receive a Minimum Acceptable Diet (MAD). Several studies have investigated the influence of community-level factors on infants and young children feeding (IYCF) practices. However, little is known about the influence of maternal factors on IYCF practices in rural settings. Therefore, this study assessed the influence of maternal factors on the feeding indicators and nutritional status of children aged 6–23 months in two administrative districts in Ghana. Methods: Data were collected among 935 mothers who had children aged 6–23 months and accessed 21 Child Welfare Clinics within the study area. The study involved a face- to-face interview using structured questionnaires to capture maternal characteristics, dietary intake and anthropometric measurements of children. Multivariate logistic regression was used to study the association between maternal factors and child nutrition outcomes (MAD, dietary diversity score (DDS) and anthropometric indicators) using Stata 16.0 software. Results: Being employed (AOR = 3.07, 95% CI: 1.71—5.49, p < 0.001) and attaining secondary or higher education (AOR = 2.86, 95% CI: 1.42—5.78, p = 0.003) were significant predictors of children receiving MAD. Similarly, having an average decision-making autonomy increased the child’s odds of receiving MAD (AOR = 1.68, 95% CI: 1.02—2.76, p = 0.040). Children of mothers who attained secondary or a higher level of education (AOR = 0.59, 95% CI: 0.36 -0.97, p = 0.040) and those whose mothers were employed (AOR = 0.71, 95% CI: 0.47—1.07, p = 0.043) were associated with a reduced risk of underweight and stunting respectively. Children of mothers with average financial independence status were more likely to receive diversified meals (AOR = 1.55, 95% CI: 1.01–2.38, p = 0.045). Conclusions: High educational level and being employed have positive influence on MAD, stunting and underweight of children. High decision-making power and average financial independence of mothers are good predictors of children receiving MAD. Family planning, women empowerment in decision-making, providing employment opportunities for mothers and promoting girl-child education are recommended. © 2022, The Author(s). | Open |
| Nyakotey D.A.; Ananga A.S.; Apprey C. | Assessing physical activity, nutrient intake and obesity in middle-aged adults in Akuse, Lower Manya Krobo, Ghana | 2022 | Journal of Health Research | Purpose: The purpose of this paper is to assess physical activity and nutrient intake and their association with obesity in apparently healthy middle-aged adults in Akuse, a rural community in the Eastern region of Ghana. Design/methodology/approach: This cross-sectional study assessed demography and anthropometry, nutrient intakes using a 3-day repeated 24 h dietary recall and physical activity using the global physical activity questionnaire (GPAQ). Data were entered into Microsoft excel and analyzed with SPSS version 25. Findings: There were 118 respondents (55 males, 46.6% and 63 females, 53.4%) in the study with mean age of 45.62 ± 6.88 years. About 90% of respondents were physically active based on WHO physical activity recommendation. Prevalence of overweight/obesity was higher among inactive participants compared to active participants and sitting/reclining hours was significantly (p-value = 0.042) associated positively with BMI after a bivariate correlation analysis, suggesting that physical activity plays a role in obesity. About one in five respondents were obese. Mean energy intake exceeded RDA for females. Sodium intake far exceeded RDA for both males and females, putting the population at potential risk of hypertension. Practical implications: This study demonstrates the need for intensifying health education and other obesity prevention interventions to curb the rising obesity prevalence in rural communities. Originality/value: The study revealed that overweight/ obesity in this rural community is higher than previously reported for rural Ghana. © 2020, David Adjatey Nyakotey, Alberta Seyram Ananga and Charles Apprey. | Open |
| Okyere J.; Azure S.A.; Budu E.; Mensah F.; Ahinkorah B.O.; Ameyaw E.K.; Seidu A.-A. | Trends and inequalities in children aged 6–59 months who received Vitamin A supplementation: evidence from the 2003, 2008 and 2014 Ghana Demographic and Health Survey | 2022 | Tropical Medicine and Health | Background: Vitamin A deficiency is considered a public health issue, particularly among children under 5 years. Vitamin A supplementation is among the ten key essential nutrition actions put in place to tackle malnutrition in children and helps to reduce under-five mortality by almost a quarter in Vitamin A deficient areas. We, therefore, examined inequalities in Vitamin A uptake among children 6–59 months in Ghana. Methods: We used data from the 2003, 2008, and 2014 Ghana Demographic and Health Surveys. The WHO’s HEAT version 3.1 software was used for all the analyses. We adopted six equity stratifiers (maternal age, economic status, level of education, place of residence, sex of the child, and region) to disaggregate Vitamin A supplementation among children 6–59 months. Four measures were used to compute inequality, namely, Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R). Results: Over the 11-year period, the proportion of children who received Vitamin A supplementation declined from 78.6% to 65.2%. There were inequalities by maternal age, particularly in 2003 (D = 13.1, CI: 2.3, 23.9; PAF = 0.5, CI: − 12.3, 13.2). The widest inequality in Vitamin A supplementation by economic status was noted in 2003 (D = 8.8, CI: 3.3–14.2; PAF = 8.3, CI: 5, 11.5). In terms of sex, the indices revealed mild inequality in Vitamin A supplementation throughout the period studied. For education, the highest inequality was observed in 2014 (D = 11.6, CI: 6.0, 17.1), while the highest inequality in terms of place of residence was observed in 2003 (D = 4.0, CI: − 0.1–8.4). In the case of region, substantial inequality was noted in 2014 (D = 34.7, CI: 22.6, 46.8; PAF = 21.1, CI: 15.3, 27). Conclusions: We conclude that there is a need for the government of Ghana to deploy targeted interventions to enhance the uptake of Vitamin A supplementation among the most disadvantaged subpopulations. Interventions targeted at these disadvantaged populations should be pro-poor in nature. In addition, the inequalities in the dimension of place of residence were mixed, favoring both rural and urban children at different points. This calls for a comprehensive and all-inclusive approach that enhances Vitamin A supplementation uptake in an equitable manner in both areas of residence. Empowerment of women through formal education could be an important step toward improving Vitamin A supplementation among children in Ghana. © 2022, The Author(s). | Open |
| Opoku-Addai K.; Korsah K.A.; Mensah G.P. | Nutritional self-care practices and skills of patients with diabetes mellitus: A study at a tertiary hospital in Ghana | 2022 | PLoS ONE | Introduction Nutritional management decreases and/or prevents the complications and deaths associated with diabetes mellitus. However, the majority of patients living with diabetes do not engage in optimal nutritional management of diabetes because they see it as the most difficult aspect of managing the condition. This study aimed to explore and describe the practices and skills on nutritional management of diabetes mellitus among patients living with diabetes attending a Ghanaian hospital. Materials and methods This study employed an exploratory, descriptive qualitative research design. Fifteen participants were recruited using purposive sampling, and interviewed with a semi-structured interview guide. Content analysis was performed on the data gathered, following which three main themes emerged. Results More than two-thirds of the participants of this study had adequate meal planning skills, ate the right quantity of foods, engaged in healthy eating habits, and consumed healthy sources of carbohydrates, fats and protein when eating. However, more than half of the participants had insufficient knowledge and skills in the reading and usage of food labels. Conclusions The participants of this study largely engaged in optimal nutritional management of diabetes due to their healthy dietary practices and preferences. It is recommended that health care professionals in Ghana find practical and robust ways to factor the reading and usage of food labels into the care and management of patients with diabetes. © 2022 Opoku-Addai et al. | Open |
| Osei K.B.; Turkson D. | Cash transfer and multidimensional child poverty: evidence from Ghana | 2022 | International Journal of Social Economics | Purpose: The impact of cash transfers on improving the living conditions of children and reducing early-life deprivations and vulnerabilities are crucial to safeguarding equality of opportunities and achieving sustainable, equitable and inclusive growth within the Sustainable Development Goals. The study aims to examine the change in deprivation rate among children aged 0–17 years between 2010 and 2012, as well as the impact of cash transfer on multidimensional child poverty in Ghana using the global Multidimensional Poverty Index (MPI). Design/methodology/approach: The study used the Ghana Livelihood Empowerment Against Poverty Impact Evaluation Survey data, which has the baseline data collected in 2010, and the follow-up was collected in 2012. The authors used the difference-in-difference estimation technique to assess the impact of the cash transfer program on the MPI of pre-school (0–5 years) and school-aged (5–17 years) children, and compared the results with that of Propensity Score Matching. Findings: The deprivation trend reveals that deprivation among pre-school children increased for nutrition, water and sanitation. The estimated result shows that cash transfer significantly reduces MPI of pre-school and school-aged in beneficiary households by 10.5 and 1.3% relative to non-beneficiary children, respectively. Originality/value: For cash transfer programs to efficiently alleviate child poverty in Ghana, the paper recommends that the conditionality aspect of the program that has been neglected by managers of the program should be enforced. Also, the program should be supplemented with food nutrients for children to reduce the deprivation of nutrition. © 2022, Emerald Publishing Limited. | Open |
| Osei R.D.; Lambon-Quayefio M.P. | Effects of Long-Term Malnutrition on Education Outcomes in Ghana: Evidence from a Panel Study | 2022 | European Journal of Development Research | Aside the direct effect on GDP at the macro level, the microeconomic impacts of undernutrition are also manifested in lower educational outcomes, reduced productivity and reduced lifetime earnings. This study sought to examine the effect of child malnutrition on learning outcomes by exploiting a nationally representative panel data which allow us to control for child-level unobserved heterogeneity in Ghana. Using a random-effects and Poisson estimations, this study shows that while current malnutrition affects children’s learning outcomes negatively, its effect may disappear in the future, especially with the implementation of appropriate interventions. The study concludes that while nutrition matters for learning outcomes, so do other educational inputs. Results are, however, differentiated by individual and household characteristics, including gender and locality. The evidence from this study serves as a useful tool for improving policies and programmes that focus on early feeding practices among pre-schoolers and improved nutrition of children of school-going age. © 2021, European Association of Development Research and Training Institutes (EADI). | Open |
| Overå R.; Atter A.; Amponsah S.; Kjellevold M. | Market women’s skills, constraints, and agency in supplying affordable, safe, and high-quality fish in Ghana | 2022 | Maritime Studies | In Ghana, the role of female informal traders (“market women”) in making low-cost smoked and dried fish available in urban and rural marketplaces is the key to explaining the high consumption of fish in the country. However, market women’s contribution to food security and nutrition (FSN), as well as to fish quality and safety is underrated and poorly understood. Fish marketing requires proficient distribution and preservation skills, economic and sociocultural competence, and a high degree of mobility. Fish traders face numerous constraints related to fish supplies, credit access, hygiene, storage facilities, transport, and market governance, all of which affect their incomes and may affect the quality and safety of fish. The article, which is based on semi-structured interviews with fish traders and fish consumers in coastal and inland markets in Ghana, documents how traders operate and exhibit agency to deal with constraints by activating a range of skills in their profit-making and their fish quality and safety enhancement strategies. The authors argue that policies grounded in knowledge about fish traders’ activities, skills, and working conditions, with budgets that prioritize investment in public infrastructure that caters for market women’s professional and personal needs, can further enhance their ability to supply affordable, safe, and high-quality fish to Ghana’s population. © 2022, The Author(s). | Open |
| Owoo B.; Ninnoni J.P.K.; Ampofo E.A.; Seidu A.-A. | “I always find myself very tired and exhausted”: The physical impact of caring; a descriptive phenomenological study of the experiences of prostate cancer caregivers in Cape Coast, Ghana | 2022 | PLoS ONE | Introduction Prostate cancer is a significant public health burden and a significant cause of morbidity and mortality among men worldwide. This study, therefore, explored how caring affects the physical health of family caregivers of prostate cancer patients. Method The study adopted a descriptive phenomenological method. Twelve participants were recruited using the purposive sampling technique. A semi-structured face to face, in-depth interviews were conducted with family caregivers of patients living with prostate cancer. The interviews were transcribed verbatim, and the data were analysed using Colaizzi’s phenomenological approach. Findings The family caregiver’s experience with the physical impact associated with caregiving uncovered two significant themes with six sub-themes. “Rest and Sleep” emerged as the first central theme, with sleeplessness, fatigue, pain, and worsening pre-existing conditions as the sub-themes. The second main theme was ‘Nutrition’ with altered eating patterns and weight loss emerging as sub-themes. Conclusion The study suggests that family caregivers of patients treated for prostate cancer may struggle with physical consequences associated with the caregiving role, which impacts their physical health. It is of great importance, especially for nurses, to come up with measures to minimise these adverse physical effects on the family caregivers through formal education programmes and training on how to care for these patients at home. © 2022 Owoo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Owusu B.A. | Perceived causes and diagnosis of febrile convulsion in selected rural contexts in Cape Coast Metropolis, Ghana | 2022 | BMC Pediatrics | Background: Febrile convulsion (FC) is a common seizure disorder among children aged 9 months to 5 years. It is usually benign and self-limiting with favourable prognosis. However, in Ghana, FC is commonly perceived as “not for hospital” and widely diagnosed and managed at home based on several beliefs and practices which are limited in related literature. Objective: This study explored the perceived causes and diagnosis of FC in selected rural communities in the Cape Coast Metropolis, Ghana. Methods: A descriptive phenomenological study design underpinned the study at five selected communities located not more than 2 Kilometres from the University of Cape Coast Hospital. Purposive and snowball sampling techniques were used to interview 42 participants made up of 27 parents, two grandmothers, seven registered traditional health practitioners, four herbalists, and two faith healers in the communities. The data was analysed using QSR NVivo 12. Results: Three perceived causes of FC were identified – biological, social/behavioural, and spiritual. Biological causes include genetic abnormalities and other underlying health conditions. The behavioural factors include poor childcare practices and nutrition. Spiritual causes include harm caused by evil spirits. The diagnosis of FC were observed prior, during and after FC attack, and these includes high body temperature, extreme body jerking, and disability outcomes respectively. Conclusion: The perceived causes of FC are interplay of complex natural, social and spiritual factors that were deep-rooted in local socio-cultural beliefs and FC experiences. Unlike the attack stage, pre-attack diagnosis were usually missed, or misconstrued to mean other health conditions. These findings indicate the need to intensify maternal and child health (MCH) education programmes on FC in the study area through improved primary healthcare. © 2022, The Author(s). | Open |
| Parbey P.; Aryeetey R. | A REVIEW OF FOOD AND NUTRITION COMMUNICATION AND PROMOTION IN GHANA | 2022 | African Journal of Food, Agriculture, Nutrition and Development | Dietary perception, behavior, and nutritional status can all be influenced by exposure to information. Behavior change communication that is appropriately designed and implemented is critical for motivating optimal dietary behavior. On the other hand, inadvertent or deliberate misinformation can drive unhealthy dietary behaviors. As part of the process to develop food-based dietary guidelines (FBDGs) for Ghana, this rapid evidence review examined the nature, extent, sources, and medium of food and nutrition information dissemination and promotion in Ghana. PubMed, Cochrane, Google Scholar, and Open Access Theses Dissertations (OATD) databases were searched systematically using keywords to identify relevant peer-reviewed and grey literature. The review included 31 documents, after excluding 1,302 documents for ineligibility (based on irrelevant title, abstract, and duplicates). Limited reporting of undernutrition was found in print and electronic media. Unhealthy foods, including sugar-sweetened beverages, snacks, yogurt, instant noodles, candy/chocolate, and ice cream were frequently advertised through various communication media. Children are highly exposed to food advertisements, which target them. Promotional characters, animation, billboards, and front-of-store displays; product-branded books, and toys are common strategies for food marketing and advertisement in Ghana. The most frequently reported sources of health and nutrition information were television, radio, social media, health professionals, families, and friends. Children and adults experienced changes in food preferences and choices as a result of exposure to food advertised on television. The commonly used traditional media were radio and television; printed newspaper use has declined tremendously in the past decade. Social media use (particularly WhatsApp, Facebook, and YouTube) is highest in urban areas, and is growing rapidly; young adults are the most active users of social media platforms. Experts recommend regulation as a mitigation for nutrition miscommunication and inaccurate promotion. The current review highlights the need for regulation of food marketing, and advertisement to safeguard a healthy food environment in Ghana. © 2022 | Open |
| Pardie P.P.; Campion B.B. | The how in fishing and fish processing: traditional artisanal fishing and fish processing practices among the Ga people of Ghana | 2022 | Maritime Studies | Ghana’s marine artisanal fisheries subsector is an important contributor to livelihoods, food security and nutrition. Despite formal institutions and laws, annual landings of small pelagic species, the most important fishery in local communities, have been declining. In Ghana, fisheries management using traditional fisheries knowledge could be crucial for food and economic security and critical towards achieving the UN Sustainable Developments Goals (SDG). This study was therefore conducted to document the fishing, fish processing and fisheries management practices of the Ga people of Ghana as a starting point for sustaining the fisheries, local fishing communities and fish value chains. Data were collected from three landing beaches using interviews and focus group discussions with fishermen, fishmongers and the respective chief fisherman. The results include findings on fishing gears and techniques, fish processing and sales and traditional fisheries management and leadership. The dominant gear used are varied forms of drift and purse seine nets on motorised canoes. Fishermen navigate using the moon, features on land, sea depth and the direction and sound of sea waves. Behavioural patterns of different fish species are used to identify fishes in the water during fishing. Catches are distributed by the canoe owner’s wife, and money from the sale is divided into three equal shares: a part to pay for fishing expenses and the other parts for the owner of the canoe and the fishing crew. The main fish processing method is smoking using the Chorkor oven. At each landing site, there is a chief fisherman who is respected as a repository of traditional knowledge on fishing practices and fisheries management. This study provides key insights into Ga traditional knowledge and highlights the need to incorporate and involve fishing communities in national fisheries policymaking. It is argued that traditional knowledge and leaders can contribute to a more sustainable management of Ghanaian fisheries and achieving SDGs 14, 1 and 2. The results of this study can also serve as a preliminary information basis and a guide for a possible adoption of the ecosystem approach to fisheries in Ghana. This could enable the country to fully fulfil her obligations under the FAO Code of Conduct for Responsible Fisheries. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. | Open |
| Quaidoo E.; Ohemeng A.; Kushitor M.K.; Antwi J. | Nutrition education incorporation into mainstream primary school curriculum in Ghana: Stakeholders’ sources of nutrition information and perceived barriers | 2022 | PLoS ONE | Introduction Nutrition literacy has been cited as a crucial life skill. Nutrition education as a primary school subject has been treated inconsequentially when compared to other subjects. We investigated an aspect of the current state of nutrition education in Ghana by engaging stakeholders about their sources of nutrition information and the perceived barriers in implementing nutrition education in mainstream primary schools. Methods Three hundred and fifty one (351) primary school children, 121 homebased caregivers, six schoolteachers, two headteachers, two Ghana Education Service (GES) officials, and six school cooks were involved in the study. Surveys were used to collect data on nutrition information acquisition behaviors and to record perceived barriers. Key Informant Interviews were conducted among GES officials, headteachers, schoolteachers and school cooks, while Focus Group Discussions were used among homebased caregivers and children to gather qualitative information. Results Only 36.3% of the primary school children had heard about nutrition, and 71% of those got nutrition information from their family members. About 70% of homebased caregivers had heard or seen nutrition messages, and their source of nutrition information was predominantly traditional media. Schoolteachers mostly received their nutrition information from non-governmental organizations and the Internet, while most of the school cooks stated their main source of nutrition information was hospital visits. Perceived barriers included schoolteachers’ knowledge insufficiency, and lack of resources to adequately deliver nutrition education. Lack of a clear policy appeared to be an additional barrier. Conclusion The barriers to the implementation of nutrition education in the mainstream curriculum at the primary school level that were identified in this study can be resolved by: providing schoolteachers with learning opportunities and adequate nutrition education resources for practical delivery, having specific national policy framework, and including family members and school cooks in the nutrition education knowledge and information dissemination process. © 2022 Quaidoo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Ragasa C.; Osei-Mensah Y.O.; Amewu S. | Impact of fish feed formulation training on feed use and farmers' income: Evidence from Ghana | 2022 | Aquaculture | Feed accounts for 60–80% of tilapia production costs, and high feed cost and limited feed access are major issues faced by fish farmers. A potential solution is for farmers to produce their own feeds using cheaper and locally available ingredients. This paper evaluates the feed formulation training implemented in Ghana as part of the Fisheries Commission's activities under the Ghana Aquaculture for Food and Jobs program. This paper analyzes baseline and follow-up survey data using difference-in-difference estimation and analysis of covariance. One year after the training, results show positive impact on the farmers' knowledge of feed formulation, quantity of feed formulated, feeding and management practices, productivity, and income. Feed formulation training encouraged more farmers to formulate their own feeds and maintained or increased total feeds used in their facilities from 2018/2019 to 2020/21. Among the farmers who did not receive training, feed formulation activities and feed quantity used reduced from 2018/19 to 2020/21. A common practice is the use of locally available quality commercial feed as starter feed for smaller fish and own-formulated feeds as a complement for or alternative to commercial growout feeds for bigger fish. Especially when constrained by lack of funds, many farmers reduce the use of commercial feeds and formulate their feeds using cheaper and locally available raw materials to maintain similar levels of feeding intensity. Feed formulation acts as an important coping strategy in the context of small-scale farmers with limited financial resources. This study recommends scaling out feed formulation training and expanding research on optimal fish nutrition using locally available and low-cost raw materials, in combination with commercial feeds, to maximize productivity and incomes for farmers. © 2022 The Authors | Open |
| Saapiire F.; Dogoli R.; Mahama S. | Adequacy of antenatal care services utilisation and its effect on anaemia in pregnancy | 2022 | Journal of Nutritional Science | Anaemia in pregnancy remains a critical public health concern in many countries including Ghana and it poses severe consequences in the short to long-term for women and their unborn babies. Although antenatal care (ANC) is largely provided for pregnant women, the extent its utilisation protects against anaemia in pregnancy remains largely understudied. The study assessed the adequacy of ANC services utilisation and its effect on anaemia among pregnant women in the Wa Municipality of Ghana. A facility-based cross-sectional survey was conducted. Probability proportionate to size sampling and systematic random sampling were used to select the facilities and 353 respondents. While 80.2% of the pregnant women reported having received a sufficient number of ANC services provided, the prevalence of the overall ANC adequacy was only 44.2 %. After adjusting for potential confounders, pregnant women who could not achieve adequate ANC attendance were 2.3 times more likely to be anaemic in the third trimester of gestation AOR = 2.26 (95 % CI 1.05, 4.89), compared to their counterparts who maintained adequate ANC attendance. Adequate ANC attendance was a consistent and significant predictor of anaemia in pregnancy in the third trimester. Health and nutrition education on the need for early initiation of ANC attendance and support for the consumption of diversified diets are two possible interventions that can help contain anaemia in pregnancy. Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society. | Open |
| Salifu N.; Segbefia C.I.; Tette E.M.A.; Alhassan Y.; Renner L.A. | Nutritional status at diagnosis of childhood cancer in Korle Bu Teaching Hospital, Accra, Ghana | 2022 | Health Sciences Investigations Journal | Background: Although most childhood cancers are curable, comorbid malnutrition can result in delayed initiation of treatment, increased treatment toxicity, and reduced overall survival. At cancer diagnosis, appropriate classification of nutritional status enhances nutritional surveillance to improve supportive care and cancer treatment outcomes. Objective: The study objective was to assess the prevalence of malnutrition at the diagnosis of childhood cancer, compare weight-based measurements with arm anthropometry in the assessment of acute malnutrition (wasting) and determine the association between malnutrition and selected cancer characteristics. Methods: The study was conducted at the Paediatric Oncology Unit (POU) at the Korle-Bu Teaching Hospital. Using consecutive recruitment, 133 participants of age ≤ 12 years with a new diagnosis of cancer were enrolled from January to December 2019. Stunting was assessed using a height-for-age z-score (HAZ). Wasting was assessed using a weight-for-height z-score (WHZ), body mass index-for-age z-score (BAZ), mid-upper arm circumference (MUAC), and upper arm muscle area (UAMA) percentile. Pearson's Chi-square and Fisher's exact tests were used to determine the association between nutritional status, cancer type and risk group. Results: The median age of participants was 4.5 years, and 64.7% (n = 86/133) were male. Of the 133 participants, 60.9% (n = 81) were diagnosed with solid tumours, 23.3% (n = 31) with leukaemia, and 15.8% (n = 21) with lymphoma. At cancer diagnosis, the prevalence of stunting was 16.8% (n = 22/131) while the prevalence of wasting was 21.8% (n = 29/133) and 40.5% (n = 53/131) using weight-based measurements (WHZ or BAZ) and arm anthropometry (MUAC or UAMA), respectively. No participant was obese. Lymphomas were significantly associated with wasting (p = 0.022). Participants with high-risk cancers were more likely to be stunted and wasted. Conclusion: Mid-upper arm circumference and UAMA detected more children with wasting than WHZ and BAZ at cancer diagnosis. Advanced-stage disease and lymphoma were associated with wasting. Establishing a nutritional rehabilitation programme at the POU, KBTH would ensure early and appropriate nutritional interventions to correct or prevent further nutritional deficits. © 2022 University of Ghana College of Health Sciences on behalf of HSI Journal. | Open |
| Sandow A.; Tice M.; Pérez-Escamilla R.; Aryeetey R.; Hromi-Fiedler A.J. | Strengthening Maternal, Infant, and Young Child Nutrition Training and Counseling in Ghana: A Community-Based Approach | 2022 | Current Developments in Nutrition | Background: Evidence-based maternal, infant, and young child nutrition (MIYCN) counseling provides caregivers essential nutrition education to optimize infant and young child feeding practices and subsequently improve child growth and development. Effective integration of responsive feeding (RF) into current MIYCN training requires working with priority communities. Objectives: Study objectives were to 1) assess MIYCN knowledge and practices among Ghanaian caregivers, 2) identify factors influencing RF/responsive parenting (RP) among Ghanaian caregivers, 3) identify barriers and facilitators influencing MIYCN training and counseling among Ghanaian health care providers, and 4) document recommendations for integrating an RF curriculum into the existing MIYCN training. Methods: This was a qualitative study, conducted within the Central Region of Ghana, based on 1) 6 focus groups with caregivers of young children (<36 mo; n = 44) and 2) in-depth interviews with health care providers (n = 14). Focus group transcripts were coded independently, consensus was reached, and a final codebook developed. The same coding process and thematic analysis were applied to the in-depth interviews. Results: Caregivers identified 3 domains influencing the primary outcome of RF/RP knowledge and practices and the secondary outcome of MIYCN: 1) health care provider counseling; 2) support from family, friends, and community members; and 3) food safety knowledge and practice. Providers identified barriers to MIYCN provider training as well as caregiver counseling which included limited access to financial and counseling resources and limited qualified staff to deliver infant and young child feeding counseling. Identified facilitators included availability of funding and counseling staff with adequate resources. Health care providers strongly endorsed integrating an RF curriculum into MIYCN training and counseling along with providing RF training and distribution of RF materials/tools to facilities. Conclusions: Health care providers directly influenced RF/RP practices through MIYCN counseling. Strengthening MIYCN counseling through the integration of an RF curriculum into MIYCN training is desired by the community. © 2022 American Society for Nutrition. | Open |
| Sawadogo P.M.; Sia D.; Nguemeleu E.T.; Kobiane J.-F.; Onadja Y.; Robins S. | Factors associated with childhood chronic malnutrition in West and Central Africa: a scoping review | 2022 | Pan African Medical Journal | Chronic malnutrition is a major public health concern that is the focus of a large body of scientific research. However, there is no synthesis of knowledge about the factors associated with this disease in West and Central Africa, where its prevalence is particularly high. We conducted a systematic search for scientific articles published between January 1st, 2000, and October 15th, 2020, that focus on chronic malnutrition in children in West and Central Africa. We queried CAIRN, PubMed, CINAHL, MEDLINE, Scopus, and Google Scholar databases for this purpose. The search process followed the recommendations of Arksey and O'Malley. Items reported in this review follow the PRISMA-ScR guidelines. Sixty articles involving children from a total of twenty (20) countries, mainly Ghana and Nigeria, were included in the final analysis. The data used were predominantly cross-sectional and were mainly drawn from demographic and health surveys. The analysis revealed that chronic malnutrition in children is associated with sociocultural, economic, and healthcare factors related to the characteristics of children, mothers, households, and communities. The association with children's vulnerability to disease, maternal education, purchasing power, and autonomy need to be further investigated in West and Central Africa. Further analysis using longitudinal data is also needed to better understand the factors associated with chronic malnutrition in West and Central Africa. Introduction. © 2022, African Field Epidemiology Network. All rights reserved. | Open |
| Scott N.; Batchelor S.; Jones T.; Barnett I.; Gordon J.; Faith B. | Mobiles for Development–A Comparative Analysis of Business Decisions | 2022 | Journal of African Business | Much research on ‘mobiles for development’ focuses on outcomes and impact of services. This paper focuses on the underlying business models. It draws on two case studies as part of a UK Aid funded evaluation of the GSM Association led mNutrition programme. Vodafone Farmers Club in Ghana provides agricultural and nutrition information via SMS and Wazazi Nipendeni in Tanzania is a maternal and child health SMS service. The paper presents the salient points of the two contrasting business models, highlighting the strengths and weaknesses of both. The merits of the different approaches depend on the principle motivation, but when it comes to delivering positive outcomes among the poorest, the weight of evidence appears to be in favor of an independent, third party driven model. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Sienso G.; Lyford C.; Oldewage-Theron W. | USING INSTRUMENTAL VARIABLES TO ESTABLISH THE RELATIONSHIP BETWEEN HOUSEHOLD PRODUCTION DIVERSITY AND HOUSEHOLD DIETARY DIVERSITY IN NORTHERN GHANA | 2022 | African Journal of Food, Agriculture, Nutrition and Development | Despite the potential for agricultural diversification to improve nutrition, little scientific evidence exists in low and middle-income countries on how the linkages between agriculture and nutrition work. In order to develop effective policies to address the nutrition-agricultural linkages in Ghana, it is important to understand and analyze the relationship between these variables. Agricultural production influences dietary quality because many rural households primarily depend on the food they produce. Households’ access to a diverse diet could enhance nutrition security as well as reduce mortality related to malnutrition. Thus, if households adopt a nutrition-sensitive approach in their production process, this may provide the necessary ingredients for diverse diets. However, over the years agricultural interventions in many developing countries have focused mainly on selected crops, particularly cereals, which may not meet household nutritional requirements. While these efforts have contributed to the reduction in hunger, over 800 million people in developing countries still suffer from hunger and micronutrient deficiencies. These effects show that eradicating hunger alone is not enough to ensure nutrition security. However, a potential solution comes from the agricultural sector through farm production diversity. A survey of rural farm households in Northern Ghana was conducted in the major and minor production seasons. Data were collected from six districts using a semi-structured questionnaire. The head of household (main decision maker) (n=505) and a woman mainly in charge of food preparation in the house were the main respondents in the surveys. Household dietary diversity score (HDDS) was measured as the number of counts of 12 food groups eaten by households within 24 hours prior to the interview and household production diversity score (HPDS) was measured as the total number of counts of crops and animals produced by the household in the last twelve months based on the same twelve food groups used in HDDS. A two stage least square with instrumental variables model was developed and estimated. After correcting for endogeneity, increased HPDS increased HDDS while increased distance to the nearest market, household size, proportion of produce sold, income, and price of maize decreased HDDS. Households are encouraged to diversify production but with caution because diversifying production may be unreliable due to the heavy reliance on rainfall in the area which is often unpredictable © 2022, African Journal of Food, Agriculture, Nutrition and Development.All Rights Reserved. | Open |
| Sowerbutts A.M.; Knight S.R.; Lapitan M.C.M.; Qureshi A.U.; Maimbo M.; Yenli E.M.T.-A.; Tabiri S.; Ghosh D.; Kingsley P.A.; Sundar S.; Shaw C.A.; Valparaiso A.; Alviz C.A.; Bhangu A.; Theodoratou E.; Weiser T.G.; Harrison E.M.; Burden S.T. | A Qualitative Exploration of Nutrition Screening, Assessment and Oral Support Used in Patients Undergoing Cancer Surgery in Low-and Middle-Income Countries | 2022 | Nutrients | Preoperative undernutrition is a prognostic indicator for postoperative mortality and morbidity. Evidence suggests that treating undernutrition can improve surgical outcomes. This study explored the provision of nutritional screening, assessment and support on surgical cancer wards in low-and middle-income countries (LMICs). This was a qualitative study and participants took part in one focus group or one individual interview. Data were analysed thematically. There were 34 participants from Ghana, India, the Philippines and Zambia: 24 healthcare professionals (HCPs) and 10 patients. Results showed that knowledge levels and enthusiasm were high in HCPs. Barriers to adequate nutritional support were a lack of provision of ward and kitchen equipment, food and sustainable nutritional supplements. There was variation across countries towards nutritional screening and assessment which seemed to be driven by resources. Many hospitals where resources were scarce focused on the care of individual patients in favour of an integrated systems approach to identify and manage undernutrition. In conclusion, there is scope to improve the efficiency of nutritional management of surgical cancer patients in LMICs through the integration of nutrition assessment and support into routine hospital policies and procedures, moving from case management undertaken by interested personnel to a system-based approach including the whole multidisciplinary team. © 2022 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Sproesser G.; Ruby M.B.; Arbit N.; Akotia C.S.; Alvarenga M.D.S.; Bhangaokar R.; Furumitsu I.; Hu X.; Imada S.; Kaptan G.; Kaufer-Horwitz M.; Menon U.; Fischler C.; Rozin P.; Schupp H.T.; Renner B. | Similar or different? Comparing food cultures with regard to traditional and modern eating across ten countries | 2022 | Food Research International | Food cultures can play a role in health and well-being. This raises the questions of whether nation boundaries unite the food cultures of different regions and ethnic groups, what characterises food cultures from very different parts of the world, and what similarities and differences exist. The present study aimed to investigate these questions with regard to eating traditions and modern eating practices. In this cross-sectional study, we recruited 3722 participants from ten countries – Brazil, China, France, Germany, Ghana, India, Japan, Mexico, Turkey, and the USA. Participants represented 25 regional and ethnic groups. They were queried about 86 traditional and modern facets of their food cultures in interviews, paper–pencil and online questionnaires. First, hierarchical cluster analysis suggested nine distinct clusters of food cultures – the food cultures of the Brazilian, Chinese, Ghanaian, Indian, Japanese, Mexican, Turkish, African and Latin US American samples, and of European descendants. Interestingly, for seven of the ten investigated countries, nation boundaries united food cultures. Second, each of the nine food culture clusters was characterised by a unique pattern of traditional and modern eating practices. Third, the nine food culture clusters varied more in their traditional eating practices than their modern eating practices. These results might promote a better understanding of the link between food cultures and health and well-being that goes beyond nutrients. For instance, food cultures might be linked to well-being via strengthening people's sense of cultural identity. Moreover, the present results contribute to a better understanding of the complex interplay between food and culture, and could help in developing culturally competent interventions to improve diet and reduce the risk of eating-related diseases. © 2022 Elsevier Ltd | Open |
| Sulley I.; Saaka M. | Relationship between caesarean section delivery and risk of overweight/obesity among children aged 6-23 months in the Tamale Metropolis of Ghana | 2022 | Journal of Nutritional Science | The recent exponential increase in caesarean section (CS) rates in many countries including Ghana requires an understanding of the potential long-term consequences on child health. The present study investigated the relationship between CS delivery and risk of childhood overweight/obesity. A retrospective cohort study was conducted from October 2019 to March 2020 in Ghana. Using multi-stage sampling, 553 mother-child pairs aged 6-23 months were selected from ten health facilities during child welfare clinic (CWC) services. We assessed the association between delivery mode (caesarean v. vaginal) and subsequent body mass index for age (BMI/age Z-score) using hierarchical multivariable linear regression analysis. The prevalence of overweight/obesity (BMI/age Z-score > +2 sd) in children was 3⋅6 %. After adjusting for maternal gestational weight gain, macrosomia and child feeding practices, children who were born through CS had mean BAZ which was 0⋅105 standard units significantly higher than their colleagues who were delivered through normal vaginal [beta coefficient (β) 0⋅105, (95 % CI 0⋅03, 0⋅55)]. CS birth was also associated with 3⋅2 times higher odds of overweight/obesity than vaginal delivery (AOR 3⋅23; 95 % CI 1⋅14, 9⋅13). Consequently, CS delivery was associated positively with increased body mass (adiposity) in the study sample. The association between CS delivery and risk of childhood obesity was attenuated after adjusting for macrosomia. These results would be important for informing clinicians and expectant mothers in considering CS delivery. Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society. | Open |
| Tadesse S.E.; Zerga A.A.; Mekonnen T.C.; Tadesse A.W.; Hussien F.M.; Feleke Y.W.; Anagaw M.Y.; Ayele F.Y. | Burden and Determinants of Anemia among Under-Five Children in Africa: Systematic Review and Meta-Analysis | 2022 | Anemia | Introduction. Globally, anemia among under-five children is a serious public health problem. Even if there are pocket studies here and there, there is limited evidence on the pooled prevalence of anemia among under-five children in Africa. Therefore, the aim of this study was to determine the pooled prevalence and determinants of anemia. Methods and Analysis. This systematic review and meta-analysis was done following the PRISMA guidelines. A comprehensive search was made in PubMed/MEDLINE, Cochrane Library, HINARI, and Ethiopian Journal of Health Development for studies published since 2009. It was supplemented with Google Scholar search. Study selection, data extraction, and quality of studies were assessed by eight reviewers. The Cochrane Q test and I2 test statistic were used to test the heterogeneity of studies. A random-effects model of DerSimonian-Laird method was used. Result. A total of 37 articles were included in this systematic review and meta-analysis. The pooled prevalence of anemia among under-five children in Africa was 59% (95% CI: 55, 63). Being female (AOR = 0.71; 95% CI: 0.57, 0.87), maternal education (AOR = 1.47; 95% CI: 1.31, 1.66), residence (AOR = 0.80; 95% CI: 0.67, 0.95), and family size (AOR = 0.93; 95% CI: 0.89, 0.98) were the determinants of anemia among African under-five children. Conclusion and Recommendation. This pooled study revealed that anemia was a severe public health problem. Sex, maternal education, residence, and family size were the determinants of anemia. Therefore, anemia prevention strategy should include sex consideration, educating mothers through youth education, area specific intervention, and encouraging birth spacing. © 2022 Sisay Eshete Tadesse et al. | Open |
| Tandoh A.; Amevinya G.S.; Addo P.; Laar A. | NUTRITION-SENSITIVE EDUCATION AND SOCIAL PROTECTION POLICIES HAVE IMPLICATIONS FOR FOOD-BASED DIETARY GUIDELINES FOR GHANA | 2022 | African Journal of Food, Agriculture, Nutrition and Development | Ghana continues to address persistent malnutrition through political action and programme development. Government-led efforts have included the formulation of multi-sectoral policies and programmes to improve the diet and nutritional status of various at-risk population groups. Globally, an important tool for promoting healthy diets are Food-Based Dietary Guidelines (FDBGs). To achieve and sustain the desired goal of promoting healthy eating habits and lifestyles, FBDGs require, among many factors, supportive national policies and programmes. When coherently incorporated in relevant nutrition-related policies and programmes, FBDGs enhance their impact on shaping and sustaining healthier dietary habits. In this context, it is essential to understand the national policy and programme environment and its potential contribution during the formulation of FBDGs. The present review aimed to identify existing nutrition-related education and social protection policies and programmes in Ghana and their relevance to the development and implementation of FBDGs. Previously conducted scoping reviews, gap analyses, and a benchmarking report of Ghana’s public health nutrition policies were used as information sources to identify relevant policies and programmes. Additionally, websites of relevant government ministries, departments and agencies were searched to retrieve applicable policies or actions that were not included in previous reviews. Nutrition-related education policies that were identified primarily support school health services, whereas social protection policies broadly target social assistance, social welfare, social equity and insurancebased policies and programmes. Specific ways these policies and programmes could support the development and implementation of Ghana’s dietary guidelines include embedding FBDGs in the school nutrition curriculum to motivate healthier food choices by schoolchildren and using FBDGs to plan meals provided as part of the country’s school feeding programme. Regarding social protection, existing instruments such as food transfers, social pensions and conditional cash transfers could be aligned with FBDGs to ensure vulnerable households can access foods and follow recommended guidelines. Although some nutrition actions are incorporated in existing policies and programmes, there are opportunities to improve their nutrition sensitivity. © 2022. African Journal of Food, Agriculture, Nutrition and Development. All Rights Reserved. | Open |
| Van Der Werf T.S.; Phillips R.O.; Johnson R.C.; Barogui Y.T. | Treatment of Buruli Ulcer | 2022 | Leprosy and Buruli Ulcer: a Practical Guide | BU has long been treated by surgical resection. During the last two decades, it has become increasingly clear that antimicrobial treatment, first, using a combination of streptomycin 15 mg/kg i.m. and rifampin 10 mg/kg p.o. for 8 weeks, results in relapse-free cure in lesions <10 cm cross-sectional diameter. Recently, a large clinical trial from Ghana and Benin showed that fully oral treatment—rifampin 10 mg/kg combined with clarithromycin—extended release, 15 mg/kg, also for 8 weeks, was equally effective but less toxic; none of the close to 300 study participants needed surgical resection, and only four had split skin grafts; sequelae were negligible. The use of other antimicrobials including fluoroquinolones has been shown to be effective in cohort studies from Australia. The role of resection surgery was studied in Benin in patients with larger lesions. Compared to patients that were operated on at week 8, a delayed decision on surgery at week 14 appeared beneficial; delay resulted in significantly less patients being operated, with reduced in-hospital treatment, and no difference in healing rate or sequelae. Sequelae such as contractures due to scar formation around joints may need specialized care in dedicated centers. General medical care with adequate nutrition and proper wound care are critical; wound saline rinsing and cleaning, dressings with non-adhesive cover, and absorptive material with short-stretch compression are all important for speedy healing. Other topical treatments (nitric oxide crème; traditional herbal remedies; clay; phenytoin) have been little studied; heat treatment might be an option for those that cannot tolerate antimicrobial treatment, such as during pregnancy. Active, early case finding has been shown to be highly efficacious. © Springer Nature Switzerland AG 2012, 2022. | Open |
| Wemakor A.; Awuni V.; Issah S. | Maternal autonomy but not social support is a predictor of child feeding indicators in the Northern Region, Ghana | 2022 | BMC Nutrition | Background: Child malnutrition may be mediated by poor infant and young child feeding (IYCF) practices. This study sought to explore if maternal social support or autonomy was related to IYCF indicators in Northern Region, Ghana. Methods: An analytical cross-sectional study was conducted with 395 randomly sampled mother–child pairs from 8 health facilities. Data were collected on socio-demographic characteristics, social support and autonomy statuses of mothers, and dietary intake and anthropometry of children. Maternal social support and autonomy statuses were derived and classified into tertiles and IYCF and child growth indicators were derived based on WHO protocol. Logistic regression analysis was used to explore the association of maternal social support and autonomy statuses to IYCF indicators and child nutritional status. Results: The mean age of the women was 27 (± 5.10) years and most belonged to the lowest tertile of social support (52.4%), and autonomy (44.1%). About half of the children, 53.2% and 44.6%, received Minimum Dietary Diversity (MDD) and Minimum Acceptable Diet (MAD) respectively but the majority (72.9%) received Minimum Meal Frequency (MMF). About a fifth of the children, 21.0%, 24.1%, and 20.5%, were wasted, stunted, and underweight respectively. Maternal autonomy was associated with IYCF but not growth indicators of young children. Compared to children of mothers of richest autonomy tertile, children of women of middle autonomy tertile were 67% less likely to receive MDD [Adjusted Odds Ratio (AOR): 0.33; 95% Confidence Interval (CI): 0.18–0.59], and 56% less likely to receive MAD (AOR: 0.44; 95% CI: 0.24–0.77). Also, children belonging to mothers of poorest autonomy tertile were 56% less likely to receive MMF compared to children of richest maternal autonomy tertile (AOR: 0.44; 95% CI: 0.23–0.84). Conclusion: Maternal autonomy and not social support is associated with IYCF indicators of children in Northern Ghana; child survival programmes should incorporate or strengthen women empowerment interventions to improve child nutrition. © 2022, The Author(s). | Open |
| Wemakor A.; Ziyaaba A.; Yiripuo F. | Risk factors of anaemia among postpartum women in Bolgatanga Municipality, Ghana | 2022 | BMC Nutrition | Introduction: Anaemia is a major public health problem affecting women of reproductive age globally. This study was conducted to assess the prevalence and determinants of anaemia among postpartum women in Bolgatanga Municipality, Ghana. Methods: The study employed an analytical cross-sectional study design to recruit 405 women who delivered in the last 6 weeks from 9 health facilities in the Municipality. Data were collected on socio-demographic characteristics, obstetric characteristics, dietary diversity, knowledge on iron-folic acid (IFA), iron and anaemia, and haemoglobin level of the women. Postpartum anaemia (PPA) was defined as hemoglobin < 12 g/dl. Chi-square and logistic regression analysis were used to identify the determinants of PPA. Results: The mean age of the participants was 27.4 ± 5.3 years and 46.70% of them had PPA. The risk factors of PPA were not meeting dietary diversity [Adjusted Odds Ratio (AOR) = 2.96; 95% Confidence Interval (CI): 1.67–5.25], low knowledge on IFA, iron and anaemia (AOR = 3.03; 95% CI: 1.67–5.25), and first trimester pregnancy anaemia (AOR = 10.39; 95% CI: 1.32–6.95). Kusasi ethnicity was protective of PPA (AOR = 0.35; CI: 0.16–0.75). Conclusion: Anaemia is prevalent in postpartum women in Bolgatanga Municipality and its risk factors are dietary diversity, knowledge on IFA, iron and anaemia, pregnancy anaemia and ethnicity. Nutrition counselling and intervention in pregnancy and after delivery are warranted to reduce the burden of anaemia in this population. © 2022, The Author(s). | Open |
| Weobong B.; Ae-Ngibise K.; Mwangi G.; Sakyi L.; Lund C. | Mental health and disability research priorities and capacity needs in Ghana: findings from a rapid review and research priority ranking survey | 2022 | Global Health Action | Background: Identification of national research agendas for mental health and disability can be supported by well-designed research priority-setting studies. Few low- and middle-income countries (LMICs) have undertaken such studies. Objective: To identify mental health and disability research priorities in Ghana. Methods: A mixed methods study comprising a rapid review, research priority ranking survey, and research capacity needs assessment survey was employed. Participants in the surveys included five expert pools identified from online search and existing database on mental health civil society organisations/non-governmental organisations. The research priority ranking was completed in two stages, using the Child and Nutrition Research Initiative (CHNRI) method to identify priority questions for immediate and short term (0 to 5 years) and medium to long term (>5 years) in stage two. Both surveys were deployed online using google forms. Analysis for the ranking survey involved computing total scores from the CHNRI criteria and generating ranks for the research questions. Results: A total of 68 experts (97% response rate), generated 94 and 92 questions for the short and long term, respectively. Forty experts (58% response rate) completed the ranking stage. The top 10 ranked research questions included: 4 questions addressing health systems; 2 questions on epidemiology; and 4 questions on interventions. All research questions were considered urgent and should be conducted in the immediate to short term (0–5 years). The methodological capacity of researchers to conduct disability and mental health research is weak. Conclusion: Our approach has generated an agenda for mental health and disability research priorities for Ghana and demonstrated that it is feasible to employ a systematic methodology for research priority setting that includes key parameters of context and research capacity. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Wiafe M.A.; Apprey C.; Annan R.A. | Effectiveness of nutrition education and counselling programme on iron deficiency anaemia among adolescents: A study protocol of a randomized trial | 2022 | Nutrition and Health | Background: [GQ4]Adolescents tend to explore their dietary environment without prior consideration of their nutritional needs. This attitude is due to low nutrition knowledge and it contributes to micronutrient deficiency such as anaemia. The study aims to investigate the effect of nutrition education and counselling on dietary iron intake and iron status of early adolescents. Methods/Design: One hundred and twenty-six early adolescents will be recruited and randomized to receive nutrition education (intervention group) and no nutrition education (control group) in the Asante-Akim South Municipality of Ghana. Data on socio-demographics, dietary factors, dietary intake, knowledge of iron and anaemia will be collected at baseline and post-intervention. Blood samples will be collected for haemoglobin, ferritin and c-reactive protein analyses. The primary outcome measures include haemoglobin and ferritin levels, secondary outcomes such as dietary iron intake, dietary vitamin C intake and knowledge level of iron will be assessed at pre-and post-intervention (6 months). The study will comply with the Consolidated Standards of Reporting Trials (CONSORT) for randomized trials. Discussion: The effectiveness of iron dietary guidelines developed will serve as a manual to aid, prevent and manage iron deficiency anaemia as well as reduce the prevalence of anaemia in the long term in Ghana. © The Author(s) 2022. | Open |
| Yaya S.; Oladimeji O.; Odusina E.K.; Bishwajit G. | Household structure, maternal characteristics and children's stunting in sub-Saharan Africa: Evidence from 35 countries | 2022 | International Health | Background: Adequate nutrition in early childhood is a necessity to achieve healthy growth and development, as well as a strong immune system and good cognitive development. The period from conception to infancy is especially vital for optimal physical growth, health and development. In this study we examined the influence of household structure on stunting in children <5 yrs of age in sub-Saharan Africa (SSA) countries. Methods: Demographic and Health Survey data from birth histories in 35 SSA countries were used in this study. The total sample of children born within the 5 yrs before the surveys (2008 and 2018) was 384 928. Children whose height-for-age z-score throughout was <-2 SDs from the median of the WHO reference population were considered stunted. Percentages and χ2 tests were used to explore prevalence and bivariate associations of stunting. In addition, a multivariable logistic regression model was fitted to stunted children. All statistical tests were conducted at a p<0.05 level of significance. Results: More than one-third of children in SSA countries were reportedly stunted. The leading countries include Burundi (55.9%), Madagascar (50.1%), Niger (43.9%) and the Democratic Republic of the Congo (42.7%). The percentage of stunted children was higher among males than females and among rural children than their urban counterparts in SSA countries. Children from polygamous families and from mothers who had been in multiple unions had a 5% increase in stunting compared with children from monogamous families and mothers who had only one union (AOR 1.05 [95% CI 1.02 to 1.09]). Furthermore, rural children were 1.23 times as likely to be stunted compared with urban children (AOR 1.23 [95% CI 1.16 to 1.29]). Children having a <24-mo preceding birth interval were 1.32 times as likely to be stunted compared with first births (AOR 1.32 [95% CI 1.26 to 1.38]). In addition, there was a 2% increase in stunted children for every unit increase in the age (mo) of children (AOR 1.02 [95% CI 1.01 to 1.02]). Multiple-birth children were 2.09 times as likely to be stunted compared with a singleton (AOR 2.09 [95% CI 1.91 to 2.28]). Conclusions: The study revealed that more than one-third of children were stunted in SSA countries. Risk factors for childhood stunting were also identified. Effective interventions targeting factors associated with childhood stunting, such as maternal education, advanced maternal age, male sex, child's age, longer birth interval, multiple-birth polygamy, improved household wealth and history of mothers' involvement in multiple unions, are required to reduce childhood stunting in the region. © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. | Open |
| A K.-D.; RS A.; J S.; Steiner-Asiedu M. | Food And Nutrition Security Situation In Ghana: Nutrition Implications For National Development | 2021 | African Journal of Food, Agriculture, Nutrition and Development | Achieving food and nutrition security is fundamental to the Sustainable Development Goals (SDGs) due to its strong interdependence with economic growth and development. Eradicating hunger and all forms of malnutrition (SDG 2) remain high on the global agenda and is at the forefront of high panel deliberations because poor dietary intake has long term negative consequences on individuals and economic advancement. The goal to end hunger and malnutrition can be achieved when food and nutrition insecurity is properly tackled through investment in agriculture parallel to economic and social protection programmes. In Ghana, about 1.5 million of the population are estimated to be food insecure while undernutrition, overnutrition and micronutrient deficiencies persist across the life stages. Challenges to food and nutrition security in Ghana have been identified as: poverty, climate change, rapid urbanization and population growth, gender inequalities and poor infrastructure. Poor economic growth, health, education, hygiene and environmental exploitation are implications of these challenges. Addressing these implications sets long-term foundation for the development of the nation by prioritising policies that are nutrition sensitive which directly address the complexity of malnutrition. The level of food and nutrition insecurity in Ghana can be reduced through a national commitment towards addressing the four pillars of food security coupled with programmes that bring about resilience through sustainable systems. To this end, intervention programmes have been introduced by government to reduce the poverty burden on households. These programmes are in the form of social interventions, governmental flagship projects, and research-driven agricultural interventions to improve yield that withstand the effect of climate change. This review is aimed to present the food and nutrition security situation in Ghana and emphasise the challenges that exacerbate the problem while bringing to light the nutritional implications to national development. It is hoped that the recommendations from this review will help the government in achieving food and nutrition security in Ghana. © 2021,African Journal of Food, Agriculture, Nutrition and Development. All Rights Reserved. | Open |
| Aboagye R.G.; Seidu A.-A.; Ahinkorah B.O.; Arthur-Holmes F.; Cadri A.; Dadzie L.K.; Hagan J.E., Jr.; Eyawo O.; Yaya S. | Dietary diversity and undernutrition in children aged 6–23 months in sub-saharan africa | 2021 | Nutrients | Dietary diversity plays a major role in the health status of children. However, evidence on its crucial role on children’s health status remains inconclusive in sub-Saharan Africa (SSA). In this study, we examined the association between dietary diversity and undernutrition among children aged 6–23 months in SSA. We pooled data from the most recent Demographic and Health Surveys of 32 countries in SSA from 2010 to 2020. A sample of 48,968 mother-child pairs of children within the ages of 6–23 months and mothers aged 15–49 years were included in this study. Multilevel logistic regression analysis was carried out to examine the association between dietary diversity and stunting, wasting, and underweight. The results were presented as crude odds ratios (cOR) and adjusted odds ratios (aOR) with their 95% confidence intervals. Statistical significance was set at p < 0.05. The overall prevalence of minimum dietary diversity was 25.1%, with South Africa recording the highest prevalence (43.9%) and Burkina Faso recording the lowest prevalence (5.6%). The highest prevalence of stunting was recorded by Burundi (51.8%) while the lowest prevalence was found in Ghana (13.6%), with an overall regional prevalence of 28.6%. For wasting, prevalence from all countries was found to be 9.4%. South Africa recorded the lowest prevalence of wasting (2.1%) while Niger recorded the highest prevalence (27.3%). Lastly, the prevalence of underweight ranged from 5.3% in South Africa to 41.8% in Niger, with an all-country prevalence of 16.4%. Children who had adequate minimum dietary diversity had 12% less likelihood of being stunted (aOR = 0.88, 95% CI = 0.83, 0.94), compared to those who had inadequate minimum dietary diversity. Having an adequate minimum dietary diversity significantly lowered the risk of underweight among children by 17% (aOR = 0.83, 95% CI = 0.77, 0.91). Having an adequate minimum dietary diversity was associated with 13% reduced odds of wasting among children (aOR = 0.87, 95% CI = 0.78, 0.97), compared to those who had inadequate minimum dietary diversity. This study highlights the significant association between minimum dietary diversity and stunting, wasting, and underweight among 6–23 month-old children in SSA. There is an urgent need for additional nutrition-specific interventions and strengthening of existing interventions aimed at improving infant and young child feeding practices, including complementary feeding practices among children aged 6–23 months in the 32 countries in SSA. Such interventions should focus more on countries where the prevalence of adequate minimum dietary diversity was low and undernutrition was high. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Abreu A.M.; Young R.R.; Buchanan A.; Lofgren I.E.; Okronipa H.E.T.; Lartey A.; Ashorn P.; Adu-Afarwuah S.; Dewey K.G.; Oaks B.M. | Maternal Blood Pressure in Relation to Prenatal Lipid-Based Nutrient Supplementation and Adverse Birth Outcomes in a Ghanaian Cohort: A Randomized Controlled Trial and Cohort Analysis | 2021 | Journal of Nutrition | Background: It is unknown whether prenatal lipid-based nutrient supplements (LNSs) affect blood pressure (BP). Associations between hypertension and birth outcomes using recently updated BP cutoffs are undetermined. Objectives: We aimed to assess the impact of LNSs on maternal hypertension and associations between hypertension and birth outcomes. Methods: Pregnant Ghanaian women at ≤20 weeks of gestation (n = 1320) were randomly assigned to receive daily 1) iron and folic acid (IFA), 2) multiple micronutrients (MMN), or 3) LNSs until delivery. BP was measured at enrollment and 36 weeks of gestation. We analyzed the effect of LNSs on BP using ANOVA and associations between hypertension [systolic BP (SBP) ≥130 mm Hg or diastolic BP (DBP) ≥80 mm Hg] and birth outcomes by linear and logistic regressions. Results: Mean ± SD SBP and DBP were 110 ± 11 and 63 ± 8 mm Hg at 36 weeks of gestation and did not differ by supplementation group (SBP, P > 0.05; DBP, P > 0.05). At enrollment, higher DBP was associated with lower birth weight and shorter gestation; women with high DBP had greater risk of low birth weight (LBW) [risk ratio (RR): 2.58; 95% CI: 1.09, 6.08] and preterm birth (PTB) (RR: 3.30; 95% CI: 1.47, 7.40). At 36 weeks of gestation, higher SBP was associated with lower birth weight, length, and head circumference and shorter gestation; higher DBP was associated with lower birth weight and length; and women with high DBP had greater risk of LBW (RR: 3.39; 95% CI: 1.32, 8.69). Neither high SBP nor hypertension were associated with birth outcomes at either time point. Conclusions: Daily provision of LNSs does not affect maternal hypertension, compared with IFA and MMN. Higher SBP and DBP are associated with a shorter gestation and smaller birth size; however, only high DBP is associated with LBW and PTB. The new BP cutoffs may help identify pregnancies at risk of adverse birth outcomes. © 2021 The Author(s). Published by Oxford University Press on behalf of the American Society for Nutrition. | Open |
| Abu B.A.Z.; Buttner N.; Garror O.D.; Stefanic R.; Sandow A.; Pereko K.A. | Qualitative assessments of anemia-related programs in Ghana reveal gaps and implementation challenges | 2021 | Annals of the New York Academy of Sciences | In spite of multiple program efforts in Ghana, progress in reducing the burden of anemia is slow. The objective was to conduct multilevel assessments of existing childhood (<5 years) anemia prevention and treatment programs according to UNICEF's conceptual framework of malnutrition, and to elucidate implementation gaps in Ghana. Purposive and snowball sampling strategies recruited 25 program personnel from 20 organizations to participate in audiorecorded interviews conducted through in-person, telephone, or email correspondence in August 2018. Interview guides constructed around UNICEF's conceptual framework of malnutrition identified context-specific immediate, underlying, and basic causes of anemia, and corresponding programs. Interviews were transcribed, coded, and analyzed using the Dedoose software version 8.1.8. Few programs addressed identified basic causes of anemia, such as inadequate human resources, housing/water/toilet facilities, and poverty/poor access to financial resources. Organizations implemented programs addressing ≥1 underlying cause. Five organizations provided food rations and/or supplements to address immediate causes. A key food-based gap identified was minimal education on fruit intake or antinutritive factors in foods; however, no interventions included vitamin C supplements. Food manufacturers mainly used cereals and grains in commercial food products. Multiple organizations worked in the same region on anemia with instances of an overlapping program focus. Food sources of vitamin C or supplements could be promoted in food-based interventions to increase the absorption of nonheme iron consumed. © 2020 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of New York Academy of Sciences | Open |
| Abukari A.S.; Acheampong A.K. | Feeding the critically ill child in intensive care units: a descriptive qualitative study in two tertiary hospitals in Ghana | 2021 | BMC Pediatrics | Background: Critically ill children require optimum feeding in the intensive care units for speedy recovery. Several factors determine their feeding and the feeding method to adopt to address this phenomenon. The aim of this study was to explore and describe the feeding criteria of critically ill children at the neonatal and paediatric intensive care units. Methods: A descriptive qualitative design was used to conduct the study. Six focus group discussions were conducted, and each group had five members. In addition, twelve one-on-one interviews were conducted in two public tertiary teaching hospitals in Ghana and analyzed by content analysis using MAXQDA Plus version 2020 qualitative software. Participants were selected purposively (N = 42). Results: The decision to feed a critically ill child in the ICU was largely determined by the child’s medical condition as well as the experts’ knowledge and skills to feed. It emerged from the data that cup feeding, enteral, parenteral, and breastfeeding were the feeding processes employed by the clinicians to feed the critically ill children. Conclusions: Regular in-service training of clinicians on feeding critically ill children, provision of logistics and specialized personnel in the ICU are recommended to reduce possible infant and child mortality resulting from suboptimal feeding. © 2021, The Author(s). | Open |
| Adams F.; Aidoo R.; Mensah J.O.; Mensah A.; Amankwah K.; Kyei B.K.; Gbadago J.E.; Konadu K.A.; Boateng G.; Oduro A.B.; Attobrah C.K. | Commercialisation of African palm weevil larvae for employment creation and nutritional security in rural Ghana: a financial feasibility approach | 2021 | Journal of Insects as Food and Feed | Edible insects are increasingly recognised as a source of nutritional security, poverty reduction and overall household wellbeing, particularly in rural sub-Saharan Africa. In Ghana, for instance, edible insects such as the African palm weevil larvae are integral part of traditional dishes, which are widely consumed among different strata of the Ghanaian society. Following the limited supply of these larvae from the traditional source, deliberate efforts at domestication are being promoted as an investment option in Ghana. This paper uses the case study approach based on data from a modern weevil larvae (akokono) micro-farm in the Ashanti region to analyse the financial viability of an insect-based business to guide future investment decisions. Standard capital budgeting tools such as net present value (NPV), benefit-cost ratio (BCR), internal rate of return (IRR) and payback period were employed to assess the financial viability of an akokono micro-farm of 5.47x7.62 m dimension. The results show that a capital expenditure of GhC 5,333.17 (US$ 935.61) is required to establish the akokono micro-farm. With a five-year project life and cost of capital of 33.5%, the investment appraisal generates a positive NPV (GhC 6,065.89 = US$ 1,164.3), BCR that is greater than unity (1.34), and an IRR (37%) which is above the current lending rate on the financial market in Ghana. The paper concludes that domestication of palm weevil larvae is financially viable at the micro-scale even in the face of pessimistic assumptions. These findings have practical implications for small-scale enterprise development in addressing problems of malnutrition and unemployment among vulnerable groups like women and youth in the rural economy of Ghana. © 2021 Wageningen Academic Publishers. All Rights Reserved. | Open |
| Adjei-Banuah N.Y.; Aduah V.A.; Ziblim S.-D.; Ayanore M.A.; Amalba A.; Mogre V. | Nutrition Knowledge is Associated With the Consumption of Iron Rich Foods: A Survey Among Pregnant Women From a Rural District in Northern Ghana | 2021 | Nutrition and Metabolic Insights | Introduction: Iron deficiency anaemia is an international public health concern and pregnant women are at an increased risk. We investigated the consumption of iron rich foods and associated factors among pregnant women in a rural district from Ghana. Methods: Following a cross-sectional design, dietary intake of iron rich foods was obtained from 252 pregnant women using a 24-hour recall food check list. Nutrition knowledge, attitudes and socio-demographic characteristics were also assessed. Findings: Participants had a mean (SD) knowledge score of 54.66 (22.74)%. About 73% of the participants had heard about iron-deficiency anaemia. Only 16.3% of the participants knew foods that help the body to absorb and use iron while 9.1% knew beverages that decrease iron absorption. About 71% of the participants ate fish and/or seafood while 67.1% of them ate green leafy vegetables. Only 4.4% of the participants ate organ meat, and 29% took flesh meat. Only 22.4% of the study participants usually drank coffee or tea while 78.2% ate vitamin C-rich foods. With regards to attitudes, 88.5% of the participants perceived anaemia to be a serious disease. Nutrition knowledge was significantly associated with the consumption of iron rich foods (β =.02; 95% CI = 0.01-0.02). Conclusion: Nutrition knowledge may be an important determinant of the consumption of iron rich foods among pregnant women making it necessary for healthcare providers to continue to provide nutrition education to pregnant women during routine antenatal care. © The Author(s) 2021. | Open |
| Agyei E.A.; Afrifa S.K.; Munkaila A.; Gaa P.K.; Kuugbee E.D.; Mogre V. | Income Level but Not Nutrition Knowledge Is Associated with Dietary Diversity of Rural Pregnant Women from Northern Ghana | 2021 | Journal of Nutrition and Metabolism | Essential nutrients are necessary for reducing the risk of maternal mortality, prenatal mortality, and low-birthweight infants. Dietary diversity can play an important role in supplying essential nutrients to both the mother and the foetus. We evaluated nutrition knowledge, attitudes, and dietary diversity of pregnant women. In addition, we investigated the sociodemographic determinants of dietary diversity among pregnant women from a rural district in Ghana. Participants were pregnant women receiving antenatal care from a rural district hospital in Ghana. Dietary diversity was measured using a 24-hour dietary recall questionnaire. Multiple linear regression was used to determine the sociodemographic characteristics of dietary diversity. About 85% of the pregnant women knew that they should eat more in comparison to nonpregnant women, and only 16.9% knew the importance of folic acid supplementation during pregnancy. Mean (SD) dietary diversity score of the participants was 5.27 (1.35), 85.4% did not consume any fruits, and 82.3% did not take milk and milk products. Almost all participants took at least one food item in the starchy staples and green leafy vegetables food groups. Moreover, 53% consumed vitamin A-rich fruits, vegetables, and tubers; 7.7% organ meats; and 30.8% eggs. Those who earned a monthly income of ≥GHC 500 or US$ 87 (B = 1.82; 0.90-2.73; p<0.001) significantly had higher dietary diversity scores compared to those who earned less. Dietary diversity of the pregnant women was suboptimal. The consumption of vitamin A- and iron-rich foods was inadequate. Income was an important determinant of the dietary diversity of pregnant women from Northern rural Ghana. © 2021 Emmanuel Amoako Agyei et al. | Open |
| Amoakoah Twum L.; Ocloo F.C.K.; Duah-Bisiw D.; Odai B.T. | Determining the effect of heat treatment on iron fortified soybean gari blend and its bioavailability | 2021 | Scientific African | Gari is a cassava based food product which lacks most essential nutrients needed to promote good health and growth. An easy-to-adopt strategy widely accepted and used by most low-income household to improve nutritional intake is to blend nutrient dense and nutrient-poor agricultureal produce in a meal. Soybean is used in food blends, as it contributes to caloric source especially supplementary protein. Micronutrient deficiency has been a major challenge in middle and low income countries. The most prominent of micronutrient deficiencies is iron deficiency, which has a potential harmful developmental effect especially on infants, adolescent girls, pregnant women and the elderly. Gari is widely consumed in Ghana and along the West African coast, therefore can be a good medium for food fortification to improve nutrition. The objective of the study was to fortify defatted soybean gari blend with iron and evaluate the effect of heat treatment on anti-nutrient content, estimated iron bioavailability and colour of the products. A known quantity of commercial food grade ferric sodium (FeNa) EDTA was added to cassava mash (with or without commercial food grade defatted soybean flour) before and after processing into gari. The elemental composition, anti-nutritional properties, estimated iron bioavaliability and colour of the product were determined using appropriate analytical methods. Results showed that fortification with iron improved the iron content of the gari samples (with or without defatted soybean flour). Addition of iron to defatted soybean gari blend before heat treatment significantly (p<0.05) decreased the lightness (L*) and yellowness (b*) of the end product. Blending gari with soybean flour elevated its anti-nutrient content; however the estimated molar ratios of anti-nutrients to iron and zinc contents were within acceptable levels as stipulated by USAID and FAO guidelines. Iron fortification of soybean gari blend has huge potential to reduce iron deficiency anaemia and protein-energy malnutrition among gari consumers in Africa. © 2021 | Open |
| Anane I.; Nie F.; Huang J. | Socioeconomic and geographic pattern of food consumption and dietary diversity among children aged 6–23 months old in Ghana | 2021 | Nutrients | Dietary inadequacy is a major challenge among young children in Ghana. Nutritional policies are required for optimum child nutrition and development. This study explored food consumption and dietary diversity by socioeconomic status and geographical location among children aged 6–23 months in Ghana. We used the latest national representative, cross‐sectional data from the Ghana Demographic and Health Survey (GDHS‐2014). A total of 887 children aged 6–23 months were used in the final analysis. The survey collected data on children’s food consumption through their mothers in the 24 h recall method. Multiple logistic regression models were used to assess the relationship between socioeconomic status and geographical location with food consumption and adequate dietary diversity after adjusting for control variables. The study revealed an association between specific food item consumption, food groups, and dietary diversity by socioeconomic and geographic characteristics. However, dairy consumption increased faster than other nutritional foods when socioeconomic status increased. Furthermore, the study revealed that children’s chances of consuming particular food items and food groups differed across Ghana’s 10 regions. The average probabilities of consuming adequate dietary diversity between the Greater Accra region and Ashanti region were 43% vs. 8% (p < 0.001). Consumption of grains, root, and tubers were relatively higher but low for Vitamin A‐rich fruits and vegetables and legumes and nuts for children aged 6–23 months in Ghana. Overall, the mean dietary diversity score was low (3.39; 95% CI: 3.30–3.49) out of eight food groups, and the prevalence of adequate dietary diversity was 22% only. There is a need for policy interventions to ensure appropriate dietary practices to promote healthy growth of children. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Ankrah D.A.; Agyei-Holmes A.; Boakye A.A. | Ghana's rice value chain resilience in the context of COVID-19 | 2021 | Social Sciences and Humanities Open | The 2020 State of the Food Security and Nutrition World report suggests that the COVID-19 pandemic may render 83 to 132 million people food insecure. The global south has been projected to be adversely affected by COVID-19 in terms of food and nutritional security. This potentially renders Africa off track in achieving SDG -2 of zero hunger by 2030. Ghana is a net importer of rice and how the sector responded to the global pandemic has received less traction in the agri-food system literature. There is skewed literature that concentrates on the global north. The paper employed a qualitative approach involving key informant interviews across 6 regions in Ghana. The study covered 48 Agricultural Extension Agents (AEAs) and Monitoring and Evaluation (M&E) officers, 80 farmers, and 48 market leaders. We use one of the country's main food staple - rice to show the food (in)-security situation during the pandemic. We articulate that using the right food security conceptual and theoretical framing remains imperative in understanding food (in)-security. The findings showed price hikes during the imposition of lockdown affected access (physical and effective demand). Rice however remained available during and after the lockdown imposition. Ghana's rice production output was affected during the COVID-19 pandemic in 2020. The ramification of COVID-19 on Ghana's rice sector was not dire but points to the vulnerability of the rice value chain to future pandemics. Important policy actions are needed to consolidate particular gains made in Ghana's planting for food and jobs to minimize rice imports. © 2021 The Authors | Open |
| Ankrah Twumasi M.; Jiang Y.; Asante D.; Addai B.; Akuamoah-Boateng S.; Fosu P. | Internet use and farm households food and nutrition security nexus: The case of rural Ghana | 2021 | Technology in Society | The impact of internet use on food and nutrition security of rural households in Ghana is investigated in this study. To offset the potential challenge of selection bias, an endogenous treatment regression (ETR) technique is utilized for the analysis. The results reveal that Internet use can improve smallholder farmers’ food and nutrition security. Internet usage has a profound positive effect on the food security of households with off-farm work and larger size of landholding. Our results suggest the intensification of efforts to enhance Internet connectivity across the nation by the government and policymakers is essential since it can go a long way to affect household welfare. The findings also highlight the importance of information and communication technologies (ICTs), the Internet, patronization to improve rural household welfare. © 2021 Elsevier Ltd | Open |
| Annan R.A.; Apprey C.; Agyemang G.O.; Tuekpe D.M.; Asamoah-Boakye O.; Okonogi S.; Yamauchi T.; Sakurai T. | Nutrition education improves knowledge and bmi-for-age in ghanaian school-aged children | 2021 | African Health Sciences | Background: Adequate nutrition is required for growth and development in children. This study tested the effectiveness of nutrition education on knowledge and BMI-for-age (BFA) of school-aged children in the Kumasi Metropolis. Methods: Children, aged 9-13 years old were recruited from ten randomly selected primary schools in the Metropolis. The schools were randomly allocated into 3 groups: nutrition education (3 schools), physical activity (PA) education (3 schools), both interventions (2 schools), or control (2 schools). Following a baseline nutrition and PA knowledge and status assessment in 433 children, twice-monthly nutrition and PA education and demonstrations were carried out for 6 months, followed by a post-intervention assessment. Results: PA and nutrition knowledge improved in all groups (P<0.001); the highest improvement was among those who received both interventions (31.0%), followed by the nutrition education group (29.8%), and the least, the control group (19.1%). Overall, BFA improved by +0.36, from baseline (-0.26) to end of the intervention (+0.10, P<0.001). Within the groups, the nutrition group (+0.65, P<.001) had the highest improvement, then, both the intervention group (+0.27, P<0.001), the PA group (+0.23, P<0.001) and lastly, the control group (+0.18, P=0.001). Conclusion: Nutrition education could improve knowledge and BMI-for-age in school-aged children in Ghana. © 2021 Annan RA et al. Licensee African Health Sciences. T. | Open |
| Annan R.A.; Gyimah L.A.; Apprey C.; Asamoah-Boakye O.; Esi Aduku L.N.; Azanu W.; Luterodt H.E.; Edusei A.K. | Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana | 2021 | Journal of Nutritional Science | Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13 19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 152 and 125 %, respectively. Pregnant adolescents with no formal education (AOR 90; P = 0004; 95 % CI 21, 398), those who experienced illness (AOR 30; P = 0011; 95 % CI 13, 70), those who experienced hunger (OR 29; P = 0010; 95 % CI 13, 65) and those with high LPI (OR 25; P = 0014; 95 % CI 12, 53) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-Treated net (ITN) (AOR 04; P = 0013; 95 % CI 02, 09) presented reduced odds LBW children; while those who experienced illness (AOR 27; P = 0020; 95 % CI 12, 60), poorer pregnant adolescents (OR 25; P = 0014; 95 % CI 11, 48) and those who experienced hunger (AOR 30; P = 0028; 95 % CI 11, 81) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended. © 2021 Cambridge University Press. All rights reserved. | Open |
| Appiah P.K.; Amu H.; Osei E.; Konlan K.D.; Mumuni I.H.; Verner O.N.; Maalman R.S.-E.; Kim E.; Kim S.; Bukari M.; Jung H.; Kofie P.; Ayanore M.A.; Amenuvegbe G.K.; Adjuik M.; Tarkang E.E.; Alhassan R.K.; Donkor E.S.; Zotor F.B.; Kweku M.; Amuna P.; Gyapong J.O.; Kim S.Y. | Breastfeeding and weaning practices among mothers in Ghana: A population-based cross-sectional study | 2021 | PLoS ONE | Background Children need good nutrition to develop proper immune mechanisms and psychosocial maturity, but malnutrition can affect their ability to realize this. Apart from the national demographic and health survey, which is carried out every 5 years, there have not been enough documented studies on child breastfeeding and weaning practices of caregivers in the Volta Region. We, therefore, examined child breastfeeding and weaning practices of mothers in the Volta Region of Ghana. Methods A sub-national survey method was adopted and a semi-structured questionnaire was used to collect data from 396 mothers and their children. Descriptive and inferential statistics comprising frequency, percentage, chi-square, and logistic regression were employed in analysing the data. We defined exclusive breastfeeding as given only breast milk to an infant from a mother or a wet nurse for six months of life except drops or syrups consisting of vitamins, minerals, supplements, or medicines on medical advice, and prolonged breastfeeding as breastfeeding up to 24 months of age. Results The prevalence of exclusive breastfeeding (EBF) was 43.7%. Mothers constituting 61.1% started breastfeeding within an hour of giving birth. In addition to breast milk, 5.1% gave fluids to their children on the first day of birth. About 66.4% started complementary feeding at 6 months, 22.0% breastfed for 24 months or beyond, while 40.4% fed their children on-demand. Child’s age (AOR: 0.23, 95% CI:0.12–0.43, p<0.0001), prolonged breastfeeding (AOR: 0.41, 95%CI: 0.12–0.87, p = 0.001), mother’s religion (AOR: 3.92, 95%CI: 1.23–12.61, p = 0.021), feeding practices counselled on (AOR: 1.72, 95%CI: 1.96–3.09, p = 0.023), mother ever heard about EBF (AOR: 0.43, 95%CI: 1.45–2.41, p = 0.039), child being fed from the bottle with a nipple (AOR: 1.53, 95%CI: 1.94–2.48, p = 0.003), and age at which complementary feeding was started (AOR: 17.43, 95%CI: 3.47–87.55, p = 0.008) were statistically associated with EBF. Conclusion Breastfeeding education has been ongoing for decades, yet there are still gaps in the breastfeeding practices of mothers. To accelerate progress towards attainment of the sustainable development goal 3 of ensuring healthy lives and promoting well-being for all at all ages by the year 2030, we recommend innovative policies that include extensive public education to improve upon the breastfeeding and weaning practices of mothers. © 2021 Appiah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Appiah P.K.; Naa Korklu A.R.; Bonchel D.A.; Fenu G.A.; Wadga-Mieza Yankey F. | Nutritional Knowledge and Dietary Intake Habits among Pregnant Adolescents Attending Antenatal Care Clinics in Urban Community in Ghana | 2021 | Journal of Nutrition and Metabolism | Introduction. Proper nutrition during pregnancy is important for the wellbeing of the mother and foetus and supports health during pregnancy, delivery, and breastfeeding. However, there are little data on nutritional knowledge and dietary intake among adolescents who are pregnant in Ghana. Hence, the study assessed the nutritional knowledge and eating habits of this vulnerable group in the Ledzokuku-Krowor Municipality, Ghana. Methods. The study was cross-sectional and employed a multistage sampling technique to select 423 participants. The study was conducted between October and November 2019. A statistical software was used to analyse data and employed Pearson's chi-square and logistics regression to assess associations between the outcome and predictor variables. A p value <0.05 at a 95% confidence interval was considered statistically significant. Results. Less than half (44.9%) of the pregnant adolescents have high nutritional knowledge. About 19.4% of them have good eating habits, while 23.9%, 18.2%, and 6.4% of them do not take breakfast, lunch, and supper, respectively. However, 15.6%, 13.9%, and 9.2% do take snacks after breakfast, lunch, and supper, respectively. About 55.9%, 59.8%, and 23.0% do not take their breakfast, lunch, and supper on time, respectively. Additionally, only 3.8% of them do take fruits and vegetables daily, while 9.7%, 23.2%, 30.0%, and 26.5% of them do take animal products, energy drinks, carbonated drinks, and legumes/nuts/seeds daily, respectively. The study showed that educational level p=0.014, occupation p=0.016, ethnicity p=0.017, and number of pregnancies p=0.021 were associated with good eating habits. Conclusion. Eating habit of adolescent pregnant women was not encouraging. Therefore, the municipal health authority with the concerned stakeholders should intensify efforts, including nutritional education to improve good eating habits, such as taking snacks in between meals, eating on time, and balance diet among pregnant adolescents, and to reduce adolescent pregnancy in the municipality. © 2021 Prince Kubi Appiah et al. | Open |
| Appiah P.K.; Osei B.; Amu H. | Factors associated with nutritional status, knowledge and attitudes among tuberculosis patients receiving treatment in Ghana: A cross-sectional study in the Tema Metropolis | 2021 | PLoS ONE | Background Nutritional deficiencies are generally associated with increased risk and severity of tuberculosis. This study investigated the nutritional status, knowledge, and attitudes of tuberculosis (TB) patients receiving treatment in the Tema Metropolis. Method A cross-sectional design was used to collect data on the nutritional knowledge, attitude, and status of TB patients. Nutritional status was analysed using World Health Organization's formula for body mass index. Pearson's chi-square and logistic regression models were used to assess associations between predictor and outcome variables. All statistical analyses were considered significant at p-values < 0.05. Result The prevalence of malnutrition among TB patients was 39.7%, 14.4%, and 4.8% for underweight, overweight, and obesity respectively. There was a high (61.0%) knowledge of nutrition among the patients. Also, 65.8% had good attitude towards nutrition. There were significant associations between normal nutritional status and age of the TB patients (p = 0.041), highest educational level attained (p = 0.036), employment status (p = 0.019), status of alcohol intake (p = 0.031), number of months on TB treatment (p = 0.021), and attitude towards nutrition (p = 0.028). Conclusion There was a reasonable nutrition-related knowledge and attitude towards nutrition among the TB patients. However, that did not reflect on their nutritional status. We recommend continuing education on smoking cessation, avoidance of harmful use of alcohol, and the establishment of food aid and other livelihood intervention programs for TB patients. © 2021 Appiah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Asante M.; Frimpong B.; Intiful F.; Nkumsah-Riverson P.; Nkansah S.A.; Ofori-Amanfo B.; Dogbe Y.Y.; Asare G.A. | Food consumption pattern and dietary diversity of a vegetarian population in Ghana | 2021 | Ghana Medical Journal | Objective: This study examined the food consumption pattern and dietary diversity of a vegetarian population in the Greater Accra Region of Ghana. Methods: A cross-sectional study was employed to examine the nutritional status of four (4) vegetarian groups in the Greater Accra Region of Ghana. One hundred and twenty-two (122) vegetarians were recruited using the total enumeration technique. Food consumption pattern and dietary diversity were assessed using a validated qualitative food frequency questionnaire and a 24-hour dietary recall, respectively. Dietary diversity was calculated using the FAO guidelines. Results: Sixty eight percent (68%) of the vegetarians reported daily intakes of vegetable protein. Majority of the vegetarians (80.6%) reported daily intakes of cereals and grains while 54% reported daily intakes of tubers. Eighty two percent (82%) and 72% of the vegetarians consumed vegetables and fruits on daily basis respectively. A few of the vegetarians (29%) reported daily intakes of fruit juices. Soft drinks, deep fried foods and fast foods were occasionally consumed. About 40.3% of the vegetarians obtained a dietary diversity score of four (4). Majority of them (68.9%) had low dietary diversity. Conclusion: The vegetarians had low dietary diversity which may lead to inadequate nutrient intakes. Thus, there is the need for nutrition-related professionals to give appropriate information on a vegetarian diet and educate vegetarians to include a variety of foods in their diet. © The Author(s), 2021. | Open |
| Asare H.; Carboo J.; Nel E.D.; Dolman R.C.; Conradie C.; Lombard M.J.; Ricci C. | Mortality in relation to profiles of clinical features in Ghanaian severely undernourished children aged 0-59 months: An observational study | 2021 | British Journal of Nutrition | Severe acute malnutrition (SAM) is associated with a complex pattern of various clinical conditions. We investigated how risk factors cluster in children with SAM, the relationship between clusters of risk factors and mortality as well as length of stay in children with SAM. A prospective observational study design was used. Data were extracted from medical records of 601 infants and children aged 0-59 months admitted and treated for SAM in three Ghanaian referral hospital between June 2013 and June 2018. Among the 601 medical records extracted, ninety-nine died. Three clusters of medical features clearly emerged from data analyses. Firstly, an association was defined by eye signs, pallor, diarrhoea and vomiting with gastrointestinal infections and malaria. In this cluster, pallor and eye signs were related to 2- to 5-fold increased mortality risk. Secondly, HIV, oedema, fast pulse, respiratory infections and tuberculosis; among those features, HIV increased child mortality risk by 2-fold. Thirdly, shock, convulsions, dermatitis, cold hands and feet, weak pulse, urinary tract infections and irritability were clustered. Among those features, cold hands and feet, dermatitis, convulsions and shock increased child mortality risk in a range of 2- to 9-fold. Medical conditions and clinical signs in children diagnosed with SAM associate in patterns and are related to clinical outcomes. © The Author(s), 2020. | Open |
| Assmus F.; Galbete C.; Knueppel S.; Schulze M.B.; Beune E.; Meeks K.; Nicolaou M.; Amoah S.; Agyemang C.; Klipsteingrobusch K.; Bahendeka S.; Spranger J.; Mockenhaupt F.P.; Smeeth L.; Stronks K.; Danquah I. | Carbohydrate-dense snacks are a key feature of the nutrition transition among ghanaian adults – findings from the rodam study | 2021 | Food and Nutrition Research | Background: African populations in sub-Saharan Africa and African migrants in Europe are facing a rapid upsurge in obesity. This trend has been related to urbanization, migration and associated shifts in lifestyle, including dietary habits. Whether changes in eating patterns contribute to the rising burden of obesity among African populations is currently unknown. Objective: Our aims in conducting this study were to characterize eating patterns among Ghanaian adults living in their country of origin and in Europe and to explore associations of meal patterns with body mass index (BMI). Design: Within the cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study, data of single 24-h dietary recalls from Ghanaian adults in rural Ghana (n = 20), urban Ghana (n = 42), and Europe (n = 172) were recorded. Eating frequencies, energy intake, and macronutrient composition of eating occasions (EOs, i.e. meals or snacks) were compared between study sites based on descriptive statistics and χ2-/Kruskal–Wallis tests. Results: A rising gradient of EO frequencies from rural Ghana through urban Ghana to Europe was observed, mainly reflecting the differences in snacking frequencies (≥1 snack per day: 20 vs. 48 vs. 52%, P = 0.008). Meal frequencies were similar across study sites (≥3 meals per day: 30 vs. 33 vs. 38%, P = 0.80). Meals were rich in carbohydrates (median 54.5, interquartile range (IQR): 43.2–64.0 energy%) and total fats (median: 27.0, IQR: 19.9–34.4 energy %); their protein content was lowest in rural Ghana, followed by urban Ghana and Europe (P = 0.0005). Snacks mainly contained carbohydrates (median: 75.7, IQR: 61.0–89.2 energy%). In linear regression analyses, there was a non-significant trend for an inverse association between snacking frequencies and BMI. Discussion and conclusions: The observed integration of carbohydrate-dense snacks into the diet supports the growing evidence for a nutrition transition among African populations undergoing socioeconomic development. This analysis constitutes a starting point to further investigate the nutritional implications of increased snacking frequencies on obesity and metabolic health in these African populations. © 2021 Frauke Assmus et al. | Open |
| Atorkey P.; Owiredua C. | Clustering of multiple health risk behaviours and association with socio-demographic characteristics and psychological distress among adolescents in Ghana: A latent class analysis | 2021 | SSM - Population Health | This study examined the prevalence of multiple health risk behaviours, the clustering patterns of health risk behaviours, the association between socio-demographic characteristics, psychological distress and clusters and the relationship between number of health risk behaviours and psychological distress among adolescents in Ghana. Participants were senior high school (SHS) students aged 11–19 years who participated in the 2012 Global School-based Students Health Survey (n = 1763). Five health risk behaviours (smoking tobacco, inadequate fruit intake, inadequate vegetable intake, alcohol intake and physical inactivity) were measured. Participants were classified to be at risk if they indicated they smoked tobacco, did not eat fruit ≥ 2 times a day and vegetables ≥ 5 a day, drank alcohol during the past 30 days and did not engage in physical activity for ≥ 60 min per day during the past 7 days. Latent class analysis and latent regression were used to identify the clusters and factors associated with the clusters respectively. Multiple logistic regression was used to determine the relationship between number of health risk behaviours and psychological distress. The prevalence of multiple health risk behaviours (2 or more) was 94.8%. Two clusters emerged: Cluster 1 (“Poor nutrition, inactive, low substance use cluster”; 91%); Cluster 2 (“High Risk Cluster”; 9%). Using cluster 1 as a reference group, adolescents in the 11–15 years category had lower odds of belonging to cluster 2 (OR = 0.21 CI 0.05–0.91, ρ = 0.036) while those experiencing symptoms of depression had higher odds of belonging to cluster 2 (OR = 2.45 CI 1.45–4.14, ρ = 0.001). No significant relationship was found between number of health risk behaviour and psychological distress. Health risk behaviours cluster among adolescents with age and depression associated with the identified clusters. Early interventions that target these clusters are needed at the individual, school and community level to mitigate the burden of non-communicable diseases. © 2020 The Authors | Open |
| Awuah R.B.; Colecraft E.K.; Wilson M.L.; Adjorlolo L.K.; Lambrecht N.J.; Nyantakyi-Frimpong H.; Jones A.D. | Perceptions and beliefs about anaemia: A qualitative study in three agroecological regions of Ghana | 2021 | Maternal and Child Nutrition | Little evidence exists concerning perceptions of anaemia in Ghanaian communities, which limits understanding of how to potentially improve health in settings with high anaemia prevalence. We explored lay perceptions of anaemia to understand local knowledge and beliefs and to provide an opportunity to inform interventions. A cross-sectional, qualitative study was conducted in selected communities in three regions of Ghana with high prevalence of anaemia. Forty-eight focus group discussions (FGDs) were conducted with adolescent girls, adult women of reproductive age and adult men (16 FGDs for each demographic group). Participants across the three demographic groups generally described anaemia as inadequate blood in the body and reported that poor diet, heat, alcohol intake, physiological factors and diseases such as malaria were the main causes of anaemia. Consequences of anaemia mentioned in the FGDs included dizziness, weight loss, loss of appetite and weakness. Prevention of anaemia was perceived to result from improved diet, avoidance of exposure to heat and improved sanitation to avoid diseases. The findings suggest that despite areas of convergence between lay and biomedical knowledge on the causes, consequences and prevention of anaemia, the burden of anaemia remains high in the study regions. This highlights a disconnect between local knowledge of anaemia and the health and nutrition behaviours needed to reduce its incidence. Effective interventions can be developed with and for communities that build upon existing knowledge while filling remaining knowledge gaps or misconceptions. © 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd. | Open |
| Azupogo F.; Abizari A.-R.; Osendarp S.J.M.; Feskens E.J.; Brouwer I.D. | Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient-Fortified Biscuits among Adolescent Girls in Northeastern Ghana | 2021 | Current Developments in Nutrition | Investing in adolescent girls' nutrition is vital for health and for breaking the intergenerational cycle of malnutrition and deprivation, but limited knowledge on the type, timing, and efficacy of interventions delays progress. We describe the design of a 26-wk randomized placebo-controlled trial with multiple-micronutrient-fortified biscuits (MMBs) among adolescent girls in northeastern Ghana. Apparently healthy, premenarche (n = 312) and postmenarche (n = 309) girls (10-17 y) were randomly assigned to receive the following for 5 d/wk: 1) MMBs (fortified with 11 vitamins and 7 minerals) or 2) unfortified biscuits. Data included plasma micronutrient status, anthropometry, body composition, cognitive function, psychosocial health, fertility, dietary intake, and sociodemographic and socioeconomic covariates, complemented with in-depth interviews (n = 30) and 4 focus group discussions. We hypothesized an increase in plasma ferritin and retinol-binding protein with a resultant increase in hemoglobin, cognition, vertical height, and psychosocial health. Our study seeks to investigate the efficacy and optimal timing of a multiple-micronutrient food intervention program for adolescent girls. The RCT was registered prospectively with the Netherlands Clinical Trials Register (NL7487). © 2020 The Author(s). | Open |
| Bamezor B.L.A.; Quaicoe T.; Forkuor J.B.; Azumah F.D. | Exploring Stakeholder Perceptions of Quality Early Childhood Education in Private Day Care Centers in Ghana: A Qualitative Approach | 2021 | Education Research International | In Ghana, despite increasing enrolment, majority of children do not have access to quality early childhood education. The lack of a context-specific and culturally relevant definition of quality in early childhood education is one of the challenges stakeholders face in promoting quality standards in Ghana. In this paper, we use data collected through qualitative semistructured interviews to explore stakeholder definition of quality in early childhood education, the implications of quality, and the key characteristics emphasized in recruiting teachers into quality early childhood education. For the participants, quality early childhood education embodies three key components: safety, nutrition, and teaching. Cognitive development, social skills, and leadership abilities were emphasized as some of the benefits of quality early childhood education for children. Regarding the recruitment of teachers, participants emphasized tertiary education rather than attitudinal and behavioral qualities as relevant for teachers in early childhood education. In view of the emphasis placed on nutrition in defining quality, we recommend that advocacy groups must ensure that the government's school feeding program extends to day care centers. This will go a long way to ensure that children from poor households are not excluded from the benefits of quality early childhood education. © 2021 Belinda Lebene Ami Bamezor et al. | Open |
| Bannor R.K.; Sharma M.; Oppong-Kyeremeh H. | Extent of urban agriculture and food security: evidence from Ghana and India | 2021 | International Journal of Social Economics | Purpose: The study attempted to assess the food security status of urban agriculture households in Ghana and India. Also, the extent of urban agriculture participation and its effect on food security in Ghana and India were examined. Design/methodology/approach: A total of 650 urban agriculture farmers were interviewed for this study in Ghana and India. Food security status of urban households was assessed by the use of the Household Food Insecurity Access Scale, whereas the determinants of the extent of urban agriculture and its effect on food security were analysed by the use of the heteroskedastic linear regression and the Seemingly Unrelated Regression models, respectively. Findings: From the study on average, households in Ghana were mildly food insecure, but that of India was moderately food insecure. The results further revealed that various demographic, economic, institutional and health and nutrition factors differently influenced urban food security and urban agriculture. Also, the extent of urban agriculture participation positively influenced food security. Originality/value: Several studies in Asia (India) and Africa (Ghana) on urban food security have been geographically limited to New Delhi, Mumbai and Greater Accra, with few studies in the Middle Belt of Ghana, and Bihar in India. Besides, there is a limited, rigorous, empirical study on the effect of the extent of UA on food security in Asia (India) and Africa (Ghana) individually and together. Moreover, we extend the frontiers of the methodological approach by applying the Seemingly Unrelated Regression (SUR) model to understand if the factors that affect food-security accessibility based on two food security accessibility tools are correlated. © 2020, Emerald Publishing Limited. | Open |
| Bentil H.J.; Abreu A.M.; Adu-Afarwuah S.; Rossi J.S.; Tovar A.; Oaks B.M. | Association between dietary magnesium intake and glycemic markers in ghanaian women of reproductive age: A pilot cross-sectional study | 2021 | Nutrients | Low magnesium intake has been shown to be associated with an increased risk of type 2 diabetes mellitus (T2DM) in several studies conducted in high-income countries. However, very few studies have been performed in Africa, where many countries have a growing rate of T2DM. We conducted a pilot cross-sectional study among 63 women in Ghana to investigate the association between magnesium intake and glycemic markers. We assessed dietary magnesium using a food frequency questionnaire and glycemic markers using fasting blood glucose and glycated hemoglobin A1c (HbA1c). Our findings showed that the mean magnesium intake was 200 ± 116 mg/day. The prevalence of T2DM was 5% by measuring fasting blood glucose and 8% by measuring HbA1c. Unadjusted linear regression models revealed that higher magnesium intake significantly predicted higher fasting blood glucose levels (β = 0.31; 95% CI: 0.07, 0.55; p = 0.01) and HbA1c levels (β = 0.26; 95% CI: 0.01, 0.51; p = 0.04). In adjusted analyses, magnesium intake was no longer significantly associated with either fasting blood glucose levels (β = 0.22; 95% CI: −0.03, 0.46; p = 0.08) or HbA1c levels (β = 0.15; 95% CI: −0.08, 0.39; p = 0.20). In conclusion, our study did not show a significant association between magnesium intake and glycemic markers in women of reproductive age in Ghana. The results of this study need to be further substantiated because this was the first study to examine magnesium intake and glycemic markers in this population in Africa. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Boadi‐kusi S.B.; Asiamah E.; Ocansey S.; Abu S.L. | Nutrition knowledge and dietary patterns in ophthalmic patients | 2021 | Clinical and Experimental Optometry | Clinical significance: Ophthalmic nutrition education programs and good dietary patterns are of considerable significance to ocular health outcomes. Background: The study aimed at assessing the level of ophthalmic nutrition knowledge and to compare the dietary patterns between different ophthalmic patients. Methods: Four hundred and ninety‐two adults (mean age 54.7 ± 19.4-years) receiving care at three eye‐care facilities in Ghana were surveyed: 171 had senile cataract, 162 had open‐angle glaucoma, and 159 had healthy eyes. A modified food frequency questionnaire was administered to elicit ophthalmic nutrition knowledge and dietary intake information of participants over the last 30-days. The results were compared between the three groups. Results: More than half of the participants (n = 267; 54.3 per cent) had received some form of education on food sources that are good for the eyes and vision, with healthy participants accounting for 50.6 per cent of this proportion. Television (55.1 per cent; 147/267), radio (49.1 per cent; 131/267) and the eye doctor (34.1 per cent; 91/267) were the most frequent sources of ophthalmic nutritional knowledge. Overall, less than one‐quarter of the participants (n = 108; 22.2 per cent) were able to correctly identify one food source for at least four out of seven selected ophthalmic nutrients. Vitamin C was the most frequently consumed ophthalmic nutrient, whereas lycopene was the least taken across all groups. The average ophthalmic nutrients intake score for those with healthy eyes (59.16 [53.39–64.93]) was significantly greater than for both glaucoma patients (37.73 [32.01–43.44]) and cataract patients (34.81 [29.24–40.37]). Conclusion: In addition to poor ophthalmic nutrition awareness and knowledge, both cataract and glaucoma patients, compared to those with healthy eyes, consumed a lesser amount of nutrients considered vital for eye health and vision. Ophthalmic nutrition education is needed to improve eye‐health outcomes. © 2021 Optometry Australia. | Open |
| Booth A.; Barnes A.; Laar A.; Akparibo R.; Graham F.; Bash K.; Asiki G.; Holdsworth M. | Policy Action Within Urban African Food Systems to Promote Healthy Food Consumption: A Realist Synthesis in Ghana and Kenya | 2021 | International journal of health policy and management | BACKGROUND: Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa, driven by urbanisation and changing food environments. Policy action has been limited - and influenced by high income countries. Socio-economic/political environments of African food systems must be considered in order to understand what policy might work to prevent NR-NCDs, for whom, and under what circumstances. METHODS: A realist synthesis of five policy areas to support healthier food consumption in urban Africa: regulating trade/foreign investment; regulating health/nutrition claims/labels; setting composition standards for processed foods; restricting unhealthy food marketing; and school food policy. We drew upon Ghana and Kenya to contextualise the evidence base. Programme theories were generated by stakeholders in Ghana/Kenya. A two-stage search interrogated MEDLINE, Web of Science and Scopus. Programme theories were tested and refined to produce a synthesised model. RESULTS: The five policies operate through complex, inter-connected pathways moderated by global-, national- and local contexts. Consumers and the food environment interact to enable/disable food accessibility, affordability and availability. Consumer relationships with each other and retailers are important contextual influences, along with political/ economic interests, stakeholder alliances and globalized trade. Coherent laws/regulatory frameworks and government capacities are fundamental across all policies. The increasing importance of convenience is shaped by demographic and sociocultural drivers. Awareness of healthy diets mediates food consumption through comprehension, education, literacy and beliefs. Contextualised data (especially food composition data) and inter-sectoral collaboration are critical to policy implementation. CONCLUSION: Evidence indicates that coherent action across the five policy areas could positively influence the healthiness of food environments and consumption in urban Africa. However, drivers of (un)healthy food environments and consumption reflect the complex interplay of socio-economic and political drivers acting at diverse geographical levels. Stakeholders at local, national, and global levels have important, yet differing, roles to play in ensuring healthy food environments and consumption in urban Africa. © 2021 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. | Open |
| Chamidah N.; Lestari B.; Wulandari A.Y.; Muniroh L. | Z-Score standard growth chart design of toddler weight using least square spline semiparametric regression | 2021 | AIP Conference Proceedings | Underweight is a nutritional status of toddlers characterized by a lack of weight based on anthropometric index weight-for-age. In Indonesia, the anthropometric index is recorded on a KMS (Card Towards Health) which refers to WHO-2005 Standard Growth Chart (WHO-2005 SGC). The toddler samples used by WHO-2005 SGC, i.e., from Ghana, Oman, Norway, the USA, Brazil, and India, are physically different from the Indonesian toddlers. This research aims to design Z-Score Standard Growth Chart (Z-Score SGC) of weight-for-age based on sample toddlers from East Java by using least square spline estimator in semiparametric regression model. The obtained Z-Score SGC would be used to assess the nutritional status of toddlers in East Java. Results showed that the highest average weight gain was achieved at interval of age 0 ≤ t < 6 for about 0.7045 kg, and growth of toddler boys was higher than girls with a difference of 0.4 kg. Also, Z-Score SGC gave a lower reference than WHO-2005 SGC such that percentage of malnutrition and less-nutrition status categories provided by Z-Score SGC was also lower than those by WHO-2005 SGC. © 2021 American Institute of Physics Inc.. All rights reserved. | Open |
| Chen G.; Jia W.; Zhao Y.; Mao Z.-H.; Lo B.; Anderson A.K.; Frost G.; Jobarteh M.L.; McCrory M.A.; Sazonov E.; Steiner-Asiedu M.; Ansong R.S.; Baranowski T.; Burke L.; Sun M. | Food/Non-Food Classification of Real-Life Egocentric Images in Low- and Middle-Income Countries Based on Image Tagging Features | 2021 | Frontiers in Artificial Intelligence | Malnutrition, including both undernutrition and obesity, is a significant problem in low- and middle-income countries (LMICs). In order to study malnutrition and develop effective intervention strategies, it is crucial to evaluate nutritional status in LMICs at the individual, household, and community levels. In a multinational research project supported by the Bill & Melinda Gates Foundation, we have been using a wearable technology to conduct objective dietary assessment in sub-Saharan Africa. Our assessment includes multiple diet-related activities in urban and rural families, including food sources (e.g., shopping, harvesting, and gathering), preservation/storage, preparation, cooking, and consumption (e.g., portion size and nutrition analysis). Our wearable device (“eButton” worn on the chest) acquires real-life images automatically during wake hours at preset time intervals. The recorded images, in amounts of tens of thousands per day, are post-processed to obtain the information of interest. Although we expect future Artificial Intelligence (AI) technology to extract the information automatically, at present we utilize AI to separate the acquired images into two binary classes: images with (Class 1) and without (Class 0) edible items. As a result, researchers need only to study Class-1 images, reducing their workload significantly. In this paper, we present a composite machine learning method to perform this classification, meeting the specific challenges of high complexity and diversity in the real-world LMIC data. Our method consists of a deep neural network (DNN) and a shallow learning network (SLN) connected by a novel probabilistic network interface layer. After presenting the details of our method, an image dataset acquired from Ghana is utilized to train and evaluate the machine learning system. Our comparative experiment indicates that the new composite method performs better than the conventional deep learning method assessed by integrated measures of sensitivity, specificity, and burden index, as indicated by the Receiver Operating Characteristic (ROC) curve. © Copyright © 2021 Chen, Jia, Zhao, Mao, Lo, Anderson, Frost, Jobarteh, McCrory, Sazonov, Steiner-Asiedu, Ansong, Baranowski, Burke and Sun. | Open |
| Cummings J.; Bergquist E.; Boateng L.; Phoxay C.; Stadler D. | Innovative Partnerships: Education That Bridges Cultures to Develop Globally Fluent Dietitians and Nutritionists | 2021 | Topics in Clinical Nutrition | Nearly every country in the world faces a dual burden of nutrition-related diseases. Increased prevalence of these conditions is especially concerning in least developed countries. Training local health care professionals to administer medical nutrition therapy and apply behavior change counseling in hospital and community settings will reduce nutrition-related disease burden. We describe strategies used by Iowa State University and Oregon Health & Science University and their partners in Ghana, Africa, and Lao People's Democratic Republic, Southeast Asia, to build professional capacity in clinical and community nutrition interventions and provide US-based dietetic interns and graduate students experience in the international nutrition sector. © 2021 Lippincott Williams and Wilkins. All rights reserved. | Open |
| Dadzie L.K.; Amo-Adjei J.; Esia-Donkoh K. | Women empowerment and minimum daily meal frequency among infants and young children in Ghana: analysis of Ghana demographic and health survey | 2021 | BMC Public Health | Background: The nutritional quality of food has an important impact on the health and well-being of families, especially children whose bodies need to grow, develop and reach their full physical and mental potential. Traditionally, women in Ghana provide care and nourishment for their children and families if they have the means to do so or if they are financially, legally and socially empowered. Women’s empowerment is not only important for women’s human rights, but also improves nutrition and health outcomes of both mothers and their children. Women’s empowerment is concerned with increasing ability to make strategic life choices in situations where the ability was hitherto denied. This study sought to investigate the association between women’s empowerment and minimum daily meal frequency (minimum number of meals to be consumed in a day) in Ghana. Methods: The study used data from the 2014 Ghana Demographic and Health Survey (GDHS). A sample of 1640 mother-child dyad was used. Mothers ages ranged from 15 to 49 while children’s ages ranged from 6 to 23 months. Univariate and multiple linear regression techniques were applied to identify women empowerment (economic, socio-familial and legal) and sociodemographic factors associated with minimum daily meal frequency scores. Data was analyzed by the STATA statistical package software version 13.0. Statistical significance level was set at P < 0.10. Results: Data from decisions on large household purchases (β = 0.351, p < 0.01) family visits (β = 0.743, p < 0.01), home ownership (β = − 0.245, p < 0.10), age of child (β = 1.387, p < 0.01), mother’s educational attainment (β = 0.496, p < 0.10) and place of residence (β = − 0.298, p < 0.10) showed significant positive association with minimum daily meal frequency in Ghana. Conclusion: Minimum daily meal frequency was largely influenced by economic and socio-familial factors that contribute to empowerment of women. as decisions on large household purchases and family visits showed significant positive association with minimum daily meal frequency. Interventional programs should target households and mothers with lower socio-demographic characteristics such as lower educational levels and low economic status to improve minimal daily meal frequency in their children thereby ensuring better child health and well-being. © 2021, The Author(s). | Open |
| Dalaba M.A.; Nonterah E.A.; Chatio S.T.; Adoctor J.K.; Watson D.; Barker M.; Ward K.A.; Debpuur C. | Culture and community perceptions on diet for maternal and child health: a qualitative study in rural northern Ghana | 2021 | BMC Nutrition | Background: This study explored cultural and community perceptions of optimal diet for maternal and child health in northern Ghana. Methods: This was an exploratory cross-sectional study using qualitative methods for data collection. Data were collected between March and April 2019 consisting of 10 focus group discussions with men and women community members between 18 and 50 years in the Kassena-Nankana districts of Ghana. Data were organised using QSR NVivo 12 qualitative software to facilitate thematic analysis. Results: All study participants recognised the importance of an optimal diet for mother, child and better pregnancy and breastfeeding outcomes. However, there were different cultural beliefs and taboos about what foods are healthy and non-healthy for women at different stages of the reproductive period. Foods perceived to be unhealthy for pregnant women were fatty foods and fresh meat (uncooked or unprocessed meat) due to the belief that they can lead to delivery complications, which many women feared. In addition, some participants relayed the cultural belief that pregnant woman should not eat eggs because it would make the child a thief. Lactating mothers are not to eat foods such as vigna subterranean known locally as bambara bean and “gari” (local meal made from cassava) because it is believed to inhibit breastmilk production. Participants emphasised that food insecurity and economic constraints meant women could not achieve optimal diet and could not afford to be selective in food choices. Conclusion: Community members recognized the importance of optimal nutrition but were constrained by poverty and cultural barriers. A dual approach which targets improvements of local food production and economic empowerment in combination with community-based discussion and education of the impacts of food taboos on health, should facilitate improvement in the diets of women and future generations. © 2021, The Author(s). | Open |
| Dass M.; Nyako J.; Tortoe C.; Fanou-Fogny N.; Nago E.; Hounhouigan J.; Berger J.; Wieringa F.; Greffeuille V. | Comparison of micronutrient intervention strategies in Ghana and Benin to cover micronutrient needs: Simulation of benefits and risks in women of reproductive age | 2021 | Nutrients | Overlapping micronutrient interventions might increase the risk of excessive micronutrient intake, with potentially adverse health effects. To evaluate how strategies currently implemented in Benin and Ghana contribute to micronutrient intake in women of reproductive age (WRA), and to assess the risk for excess intakes, scenarios of basic rural and urban diets were built, and different on-going interventions were added. We estimated micronutrient intakes for all different scenarios. Four types of intervention were included in the scenarios: fortification, biofortification, supplementation and use of locally available nutrient-rich foods. Basic diets contributed poorly to daily micronutrient intake in WRA. Fortification of oil and salt were essential to reach daily requirements for vitamin A and iodine, while fortified flour contributed less. Biofortified products could make an important contribution to the coverage of vitamin A needs, while they were not sufficient to cover the needs of WRA. Iron and folic acid supplementation was a major contributor in the intake of iron and folate, but only in pregnant and lactating women. Risk of excess were found for three micronutrients (vitamin A, folic acid and niacin) in specific contexts, with excess only coming from voluntary fortified food, supplementation and the simultaneous overlap of several interventions. Better regulation and control of fortification and targeting of supplementation could avoid excess intakes. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Drescher A.W.; Isendahl C.; Cruz M.C.; Karg H.; Menakanit A. | Urban and Peri-Urban Agriculture in the Global South | 2021 | Cities and Nature | In the contemporary world, modernist Western thought supports stereotypical perceptions of cities (innovative, dynamic, progressive) as fundamentally different from the countryside (traditional, static, conservative). This leads to the effect of making near-residential agriculture obsolete; made redundant by transport technologies and an agricultural industry that rapidly moves large quantities of foodstuff from one region to another. However, the reality of urban food production in most countries of the Global South tells another story. This chapter uses recent and Pre-Columbian Maya case studies from four different regions of the world (Africa, South-East Asia, Middle America, and the Caribbean) to illustrate the importance of urban and peri-urban agriculture and food and nutrition security as fundamental aspects of the social-ecological resilience of cities. The chapter elaborates the differences of urban and peri-urban agriculture in the Global South and the Global North, including institutional support and regulations, gender roles, the importance for food and nutrition security (case studies on Cuba and Thailand), livelihoods, ecosystem services, urban ecology (case studies on Burkina Faso and Ghana), and the role of urban food commons (case study on Cuba). This demonstrates that food production is not “the antithesis of the city”, but an urban activity that contributes to the resilience of cities. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG. | Open |
| Dubik S.D.; Amegah K.E. | Prevalence and determinants of early initiation of breastfeeding (EIBF) and prelacteal feeding in Northern Ghana: A cross-sectional survey | 2021 | PLoS ONE | Background There is suboptimal early initiation of breastfeeding (EIBF) with widespread prelacteal feeding in Ghana. However, studies exploring the determinants of EIBF and prelacteal feeding are limited in Ghana. The study was conducted to assess the prevalence and determinants of EIBF and prelacteal feeding in Northern Ghana. Methods This cross-sectional study was conducted among 508 mothers with infants aged 0–24 months in the Sagnarigu Municipality of Northern Ghana. The quantitative data were collected using a structured questionnaire adapted from Ghana’s demographic and health survey. Multivariate logistic regression was used to identify the independent determinants of EIBF and prelacteal feeding. Results The prevalence of EIBF and prelacteal feeding was 72% and 21%, respectively. The independent positive determinants of EIBF were partner support to breastfeed [adjusted Odds ratio (AOR): 1.86, 95% Confidence interval (CI): 1.09–3.17] and exposure to breastfeeding information during pregnancy (AOR = 1.63 (95% CI: 1.01–2.64). Lower odds of EIBF were observed among mothers from extended family (AOR = 0.62, 95% CI: 0.41–0.95). Regarding prelacteal feeding, negative determinants were having a normal weight baby (AOR: 0.50, 95% CI: 0.27–0.90), exposure to breastfeeding information during pregnancy (AOR: 0.54, 95% CI: 0.31–0.92), while experiencing delayed onset of lactation was a risk factor for prelacteal feeding practice (AOR: 2.35, 95% CI: 1.41–3.94). Conclusion In this study, EIBF was slightly higher than the 2030 global target on EIBF with widespread prelacteal feeding practice. Health programs aimed at improving EIBF should focus on the women partners, nutrition counselling, and support to mothers from the extended family. In the same vein, programs aimed at discouraging prelacteal feeding practice should also target women at risk, such as those with low birthweight babies and women experiencing delayed lactation onset. Copyright: © 2021 Dubik, Amegah. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Engels T.; Trotignon G.; Agyemang D.; Khan I.; Puthy K.; Roolvink L.; Schmidt E. | Cost and budget impact analysis of a school-based vision screening programme in Cambodia and Ghana: Implications for policy and programme scale-up | 2021 | Health Policy OPEN | Poor vision due to unaddressed refractive error in children is considered to be a public health problem in many low- and middle-income countries. Research shows that correcting refractive error with spectacles could have a positive impact on school attendance and academic performance for children. The aim of this study was to estimate the cost of integrating vision screening and provision of spectacles in existing school health programmes in Cambodia and Ghana. Budget impact analysis of the intervention scale up is also reported, including univariate and multivariate sensitivity analyses. This study suggests that the scale up of school-based vision screening programmes is affordable in resource limited settings, such as Cambodia and Ghana, considering the current education budgets, and providing there is sufficient in-country capacity to deliver such interventions at scale. The study highlights several policy and programme implications and provides suggestions for minimising costs and maximising efficiencies of vision screening in a school setting. Findings from this analysis can help education planners and international partners to improve their planning and budgeting processes for school-based interventions to improve health and learning outcomes for children in low- and middle-income countries. © 2021 The Author(s) | Open |
| Fructuoso I.; Romão B.; Han H.; Raposo A.; Ariza-Montes A.; Araya-Castillo L.; Zandonadi R.P. | An overview on nutritional aspects of plant-based beverages used as substitutes for cow’s milk | 2021 | Nutrients | The presence of milk in meals and products consumed daily is common and at the same time the adoption of a milk-free diet increases due to milk allergy, lactose intolerance, vegan diets, and others. Therefore, there is an increasing demand for plant-based beverages, which present variable and, sometimes, unknown nutritional characteristics. This study sought to com-pare the nutritional aspects of plant-based beverages used as substitutes for cow’s milk described in scientific studies. Therefore, we used a review of the scientific literature on PubMed, Google Scholar, Scopus, Web of Science, Google Patents, Embase, and ScienceDirect databases. The in-clusion criteria were scientific studies referring to plant-based beverage used as an alternative to cow’s milk; published in the English language; present data on the serving size, ingredients, and nutritional composition, containing at least data on energy and macronutrients of plant-based bev-erages. Ingredients and data on energy, macronutrients, and, if available, dietary fiber and some micronutrients of plant-based beverages were collected. Data were obtained from 122 beverages of 22 different matrices, with soy being the most used (27.87%, n = 34). The variation in the amount of nutrients found was 6–183 Kcal/100 mL for energy value; 0.00–22.29 g/100 mL for carbohydrate; 0.06–12.43 g/100 mL for protein; 0.00–19.00 g/100 mL for lipid; 0.00–4.40 g/100 mL for dietary fiber; 0.00–1252.94 mg/100 mL for calcium; 0.04–1.40 mg/100 mL for iron; 0.84–10,178.60 mg/100 mL for magnesium; 0.00–343.43 mg/100 mL for sodium. Salt was the most commonly found added ingredient in plant-based beverages. Some beverages have reached certain amounts of cow’s milk nutrients. However, studies have pointed out differences in their qualities/types. Thus, attention is needed when replacing milk with these alternatives. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Furuta C.; Sato W.; Murakami H.; Suri D.J.; Otoo G.E.; Tano-Debrah K.; Ghosh S.A. | Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial | 2021 | Frontiers in Nutrition | Stunting is reportedly associated with low circulating levels of essential amino acids (EAAs). This study examined the effect of a macronutrient- and micronutrient-fortified complementary food supplement (KOKO Plus) on specific plasma EAA levels and stunting in infants aged 6–18 months. In a single-blind cluster-randomized controlled trial conducted in Ghana, infants were enrolled at 6 months and followed until 18 months. Thirty-eight communities were randomly assigned to receive KOKO Plus (KP, fourteen communities, n = 321), multiple-micronutrient powder (MN, thirteen communities, n = 327), or only nutritional education as control group (NE, eleven communities, n = 318), and all groups received nutrition education. Plasma amino acids (AAs) were measured at 6, 12, and 18 months (end point). Mixed-effects models were used to assess the effect of the intervention on plasma AAs, and the relationship between plasma branched-chain AAs (BCAAs) and the risk of stunting was assessed. At the end point, total BCAA concentrations (±standard error) significantly exceeded baseline in the KP (284.2 ± 4.3 μM) and NE (289.1 ± 4.4 μM) groups but not the MN group (264.4 ± 4.1 μM). After adjustment for compliance at 200 sachets, plasma BCAAs exceeded in the KP group (284.5 ± 4.2 μM) compared to the MN group (264.6 ± 4 μM). Plasma BCAAs were positively correlated with changes in length-for-age Z-score from baseline (R = 0.327, p = 0.048). In conclusion, the plasma BCAA concentrations of infants that received KP and the NE group was significantly higher compared to the MN group but there were no differences between the KP and NE group at end point. Improved plasma BCAAs may be due to improved nutrient intake by infants exposed to KP or NE. Low BCAAs were associated with stunting, replicating the previous finding. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03181178?term=NCT03181178&draw=2&rank=1, identifier: NCT03181178. © Copyright © 2021 Furuta, Sato, Murakami, Suri, Otoo, Tano-Debrah and Ghosh. | Open |
| Galaurchi A.; Chatio S.T.; Beeri P.; Oduro A.R.; Ofosu W.; Hanson M.; Newell M.-L.; Norris S.A.; Ward K.A.; Nonterah E.A.; Biesma R. | Stakeholder perspectives on barriers and facilitators on the implementation of the 1000 days plus nutrition policy activities in ghana | 2021 | International Journal of Environmental Research and Public Health | Optimizing nutrition in the preconception and 1000 days periods have long-term benefits such as higher economic productivity, reduced risk of related non-communicable diseases and increased health and well-being. Despite Ghana’s recent progress in reducing malnutrition, the situation is far from optimal. This qualitative study analyzed the maternal and child health nutrition policy framework in Ghana to identify the current barriers and facilitators to the implementation of nutrition policies and programs relating to the first 1000 days plus. Data analyzed included in-depth interviews and focus group discussions conducted in Ghana between March and April 2019. Participants were composed of experts from government agencies, civil society organizations, community-based organizations and international partners at national and subnational levels. Seven critical areas were identified: planning policy implementation, resources, leadership and stakeholders’ engagement, implementation guidance and ongoing communication, organizational culture, accountability and governance and coverage. The study showed that, to eradicate malnutrition in Ghana, priorities of individual stakeholders have to be merged and aligned into a single 1000 days plus nutrition policy framework. Furthermore, this study may support stakeholders in implementing successfully the 1000 days plus nutrition policy activities in Ghana. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Giller K.E.; Delaune T.; Silva J.V.; van Wijk M.; Hammond J.; Descheemaeker K.; van de Ven G.; Schut A.G.T.; Taulya G.; Chikowo R.; Andersson J.A. | Small farms and development in sub-Saharan Africa: Farming for food, for income or for lack of better options? | 2021 | Food Security | Most food in sub-Saharan Africa is produced on small farms. Using large datasets from household surveys conducted across many countries, we find that the majority of farms are less than 1 ha, much smaller than previous estimates. Farms are larger in farming systems in drier climates. Through a detailed analysis of food self-sufficiency, food and nutrition security, and income among households from divergent farming systems in Ethiopia, Ghana, Mali, Malawi, Tanzania and Uganda, we reveal marked contrasts in food security and household incomes. In the south of Mali, where cotton is an important cash crop, almost all households are food secure, and almost half earn a living income. Yet, in a similar agroecological environment in northern Ghana, only 10% of households are food secure and none earn a living income. Surprisingly, the extent of food insecurity and poverty is almost as great in densely-populated locations in the Ethiopian and Tanzanian highlands that are characterised by much better soils and two cropping seasons a year. Where populations are less dense, such as in South-west Uganda, a larger proportion of the households are food self-sufficient and poverty is less prevalent. In densely-populated Central Malawi, a combination of a single cropping season a year and small farms results in a strong incidence of food insecurity and poverty. These examples reveal a strong interplay between population density, farm size, market access, and agroecological potential on food security and household incomes. Within each location, farm size is a major determinant of food self-sufficiency and a household’s ability to rise above the living income threshold. Closing yield gaps strongly increases the proportion of households that are food self-sufficient. Yet in four of the locations (Ethiopia, Tanzania, Ghana and Malawi), land is so constraining that only 42–53% of households achieve food self-sufficiency, and even when yield gaps are closed only a small proportion of households can achieve a living income. While farming remains of central importance to household food security and income, our results help to explain why off-farm employment is a must for many. We discuss these results in relation to sub-Saharan Africa’s increasing population, likely agricultural expansion, and agriculture’s role in future economic development. © 2021, The Author(s). | Open |
| Gosdin L.; Amoaful E.F.; Sharma D.; Sharma A.J.; Addo O.Y.; Ashigbi X.; Mumuni B.; Situma R.; Ramakrishnan U.; Martorell R.; Jefferds M.E. | A qualitative analysis of program fidelity and perspectives of educators and parents after two years of the girls' iron-folate tablet supplementation (gifts) program in ghanaian secondary schools | 2021 | Current Developments in Nutrition | Background: To address the burden of anemia in adolescent girls in Ghana, the Girls' Iron-Folate Tablet Supplementation (GIFTS) program was established in 2017. An evaluation found that although iron and folic acid (IFA) supplementation reached nearly all adolescent girls in schools during year 1, most girls received fewer than the minimum effective number of tablets over the school year. Barrier analyses highlighted schools as drivers of adherence, though information was incomplete on the reasons for the disparities among schools. Information was also lacking on the implementation of health and nutrition education. Objectives: At the start of year 3 of an integrated adolescent anemia prevention program with IFA supplementation, the present study sought to illuminate differences in program fidelity among schools and across time and potential factors that drive such differences. Methods: After stratifying by school level, size, geographic location, and intake adherence during year 1, 16 schools were purposively selected. For each school, semistructured key informant interviews were conducted with 1 coordinator at the district level, 3 educators at the school level, and 1 parent leader. Following thematic analysis methods, recorded and transcribed interviews were coded and organized into deductive and inductive themes. Results: Limited training, challenges during distribution of IFA, lack of incentives, and inconsistent health and nutrition education diminished program fidelity. Strong supply chain, widespread awareness promotion, improved acceptability, and intrinsically motivated educators improved program fidelity. After 2 y of implementation, schools had made program adaptations, and widespread changes in attitudes and beliefs about the IFA tablets had improved their acceptability. However, limitations remained related to supply chain, program ownership, communication between health and education sectors, training, motivation, and resources. Conclusions: The fidelity of Ghana's GIFTS program is strengthened by its supply chain, acceptability, and motivated stakeholders; however, training, curricula, clear communication, and incentives could improve it. © 2021 Oxford University Press. All rights reserved. | Open |
| Gosdin L.; Sharma A.J.; Tripp K.; Amoaful E.F.; Mahama A.B.; Selenje L.; Jefferds M.E.; Martorell R.; Ramakrishnan U.; Addo O.Y. | A School-Based Weekly Iron and Folic Acid Supplementation Program Effectively Reduces Anemia in a Prospective Cohort of Ghanaian Adolescent Girls | 2021 | Journal of Nutrition | Background: School-based iron and folic acid (IFA) supplementation is recommended for adolescent girls in countries with high burdens of anemia. Objectives: We aimed to evaluate the context-specific effectiveness of a school-based, integrated anemia control program with IFA supplementation in Ghana. Methods: Using data from a pre-post, longitudinal program evaluation, we evaluated the effectiveness of school-based weekly IFA supplementation in reducing the burden of anemia and increasing hemoglobin concentrations (Hb; primary outcomes) in 2 regions of Ghana. Generalized linear mixed effects models with schools (clusters) as random effects were used to quantify the change in the anemia prevalence and the mean Hb associated with cumulative IFA tablet consumption over 1 school year (30-36 weeks), controlling for participant-level potential confounders. A cut point for minimum effective cumulative IFA consumption that is reflective of adequate Hb was derived following logistic regression. This cut point was verified by a restricted cubic spline model of IFA consumption and Hb. Results: The analytical sample included 60 schools and 1387 girls ages 10-19 years. The prevalence of anemia declined during 1 school year of the intervention, from 25.1% to 19.6% (P = 0.001). Students consumed a mean of 16.4 IFA tablets (range, 0-36). IFA consumption was positively associated with Hb and negatively associated with anemia. Each additional IFA tablet consumed over the school year was associated with a 5% (95% CI, 1-10%) reduction in the adjusted odds of anemia at follow-up, though the relationship is nonlinear. The cut point for minimum effective consumption was 26.7 tablets over a 30-36-week school year, with tablets provided weekly. Conclusions: School-based weekly IFA supplementation is effective in improving Hb and reducing the anemia prevalence among schoolgirls in Ghana, though most participants consumed fewer than the minimum effective number of IFA tablets. Increasing intake adherence may further improve anemia outcomes in this population. © 2021 Published by Oxford University Press on behalf of the American Society for Nutrition 2021. | Open |
| Gyimah L.A.; Annan R.A.; Apprey C.; Asamoah-Boakye O.; Aduku L.N.E.; Azanu W.; Lutterodt H.E.; Edusei A.K. | Nutritional status and birth outcomes among pregnant adolescents in Ashanti Region, Ghana | 2021 | Human Nutrition and Metabolism | Inadequate nutrition during pregnancy can lead to adverse birth outcomes, and more importantly for pregnant adolescents as they require nutrients to meet their needs for their growth and the fetus. The study examined the relationship between nutritional status and birth outcomes among Ghanaian pregnant adolescents in selected districts of the Ashanti Region, Ghana. In this prospective cohort study, we followed 416 pregnant teenagers recruited at health centers during antenatal care until delivery. We measured weight and height to calculate Body Mass Index (BMI), and Mid-Upper Arm Circumference (MUAC), and nutrient intakes using a repeated 24 hr dietary recall were collected. Hemoglobin (Hb), serum levels of ferritin, prealbumin, vitamin A, Total Antioxidant Capacity (TAC), C-reactive protein (CRP), and Zinc Protoporphyrin (ZPP) were analyzed. Birth outcome data of interest were low birth weight (LBW) and preterm births (PTB). About 15.2 % had LBW, 12.5 % had PTB, and 3.1 % neonatal deaths. The majority of the pregnant adolescents consumed below Estimated Average Requirements (EAR) for thiamin (75.7 %), riboflavin (84.6 %), folate (82.9 %), vitamin A (87.3 %), iron (93.5 %), zinc (83.7 %), and calcium (96.9 %) intakes, while energy (96.6 %), protein (84.6 %), and dietary fiber (74.4 %) were below the Recommended Dietary Allowance (RDA). Anemia and wasting prevalences were 57.1 % and 27.8 %. The mean intakes for carbohydrates (p = 0.042) and dietary fiber (p = 0.012) were significantly higher among adolescent mothers with term birth (276.7 ± 111.2 g, 23.7 ± 11.2 g) than those with PTB (237.3 ± 83.7 g, 19.4 ± 9.0 g), respectively. Preterm birth proportions were higher in severely wasted (18.8 %) adolescents than moderately wasted (6.2 %) and normal MUAC (14.0 %) adolescents (p = 0.184). LBW proportions were higher among anemic (18.1 %) than the non-anemic (12.1 %), among low (30 %) compared with normal (14.9 %) serum ferritin, among low (15.7 %) compared with normal (0 %) serum prealbumin, and among low (16.2 %) compared with normal (11.1 %) serum vitamin A status pregnant adolescents. Pregnant adolescents with moderate wasting had lower odds (Adjusted odds ratio = 0.2, p = 0.017, 95 % confidence interval = 0.1–0.8) of having LBW infants compared with those with normal MUAC. The odds of preterm births were significantly higher among pregnant adolescents with dietary fiber intake below the RDA (Unadjusted OR = 2.8, p = 0.042, 95 % CI = 1.0–7.3). In conclusion, adverse birth outcomes were associated with poor nutritional status among pregnant adolescents studied. © 2021 The Author(s) | Open |
| Gyimah L.A.; Annan R.A.; Apprey C.; Edusei A.; Aduku L.N.E.; Asamoah-Boakye O.; Azanu W.; Lutterodt H. | Dietary diversity and its correlates among pregnant adolescent girls in Ghana | 2021 | PLoS ONE | Background Dietary diversity, a qualitative measure of dietary intake, which reflects the variety of foods consumed has been recommended to assuage nutritional problems related to insufficient micronutrients, and food insecurity. To better understand the underlying factors for poor birth outcomes in Ghana, we assessed factors associated with dietary diversity among rural and urban pregnant adolescents in the Ashanti Region of Ghana. Methods As part of a larger longitudinal cohort of 416 pregnant adolescents, the FAO minimum dietary diversity for women index was used to determine the dietary diversity score (DDS) of the participants from a previous days’ 24-hour dietary recall data. The household hunger scale (HHS) and lived poverty index (LPI) were used to determine hunger and socioeconomic status. Eating behavior and socio-demographic data were gathered using interviewer-administered questionnaires. Results The mean age of the participants was 17.5 (±1.4) years with an MDD-W of 4.4 and 56% recording inadequate MDD score. More rural (63.6%) than urban dwellers (50.6%) had inadequate DDS (p = 0.008). Among all the multiple variables tests of associations on dietary diversity, only hunger status (p = 0.028) and both food aversion and poverty status (p = 0.003) had a significant effect on the adolescents’ dietary diversity. Rural dwelling adolescents (AOR = 1.7, p = 0.035, 95% CI = 1.0–2.6) recorded higher odds for inadequate DD compared with the urban respondents. Pregnant adolescents with severe hunger had higher odds (Unadjusted OR = 1.9, p = 0.053, 95% CI 1.1–3.8) for inadequate dietary diversity compared with those with no hunger. Conclusions Inadequate DD is common among pregnant adolescents in this study and is associated with rural living, food insecurity, poverty, and food craving. Livelihood support for pregnant teenagers and nutrition education are recommended interventions to improve dietary quality and limit the consequences of poor dietary diversity. © 2021 Gyimah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Haq I.; Hossain M.I.; Zinnia M.A.; Hasan M.R.; Chowdhury I.-A.-Q. | Determinants of the Early Childhood Development Index among children aged < 5 years in Bangladesh, Costa Rica and Ghana: a comparative study; [Déterminants de l'indice de développement dans la petite enfance chez les enfants de moins de cinq ans au Bangladesh, au Costa Rica et au Ghana : étude comparative] | 2021 | Eastern Mediterranean Health Journal | Background: Early child development is a crucial factor for children that controls health and well-being in later life. Aims: To determine the influence of sociodemographic factors on the Early Child Development Index (ECDI) among children aged < 5 years. Methods: The analysis was performed using cross-sectional survey data from 2019, 2017–2018 and 2018 Multiple Indicator Cluster Surveys from Bangladesh, Ghana and Costa Rica, respectively. We used the χ2 test for bivariate analysis and binary logistic regression model for multivariate analysis for all 3 countries. All the statistical analyses were performed with IBM SPSS version 25 and R version 4.0.0. Results: Child age and sex, followed by maternal education level, economic status, child nutritional status, reading children’s books, and maternal functional difficulties had the greatest effect on ECDI. Children aged 36–47 months had lower odds of development than those aged 48–59 months, and boys had lower odds of development than girls in Bangladesh, Costa Rica and Ghana. Urban children had lower odds of development than rural children in Costa Rica but higher odds in Ghana. Conclusion: We recommend that governments should take the necessary steps to enhance children’s early development and well-being in all 3 countries by raising education, improving economic conditions and providing balanced nutrition. © World Health Organization (WHO) 2021. | Open |
| Haskell M.J.; Young R.; Adu-Afaruwah S.; Lartey A.; Okronipa H.E.T.; Maleta K.; Ashorn U.; Jorgensen J.M.; Fan Y.-M.; Arnold C.D.; Allen L.H.; Ashorn P.; Dewey K.G. | Small-Quantity Lipid-Based Nutrient Supplements Do Not Affect Plasma or Milk Retinol Concentrations among Malawian Mothers, or Plasma Retinol Concentrations among Young Malawian or Ghanaian Children in Two Randomized Trials | 2021 | Journal of Nutrition | Background: Vitamin A (VA) deficiency is prevalent in preschool-aged children in sub-Saharan Africa. Objectives: We assessed the effect of small-quantity lipid-based nutrient supplements (SQ-LNS) given to women during pregnancy and lactation and their children from 6 to 18 mo of age on women's plasma and milk retinol concentrations in Malawi, and children's plasma retinol concentration in Malawi and Ghana. Methods: Pregnant women (≤20 wk of gestation) were randomized to receive daily: 1) iron and folic acid (IFA) during pregnancy only; 2) multiple micronutrients (MMN; 800 μg retinol equivalent (RE)/capsule), or 3) SQ-LNS (800 μg RE/20g) during pregnancy and the first 6 mo postpartum. Children of mothers in the SQ-LNS group received SQ-LNS (400 μg RE/20 g) from 6 to 18 mo of age; children of mothers in the IFA and MMN groups received no supplement. Plasma retinol was measured in mothers at ≤20 and 36 wk of gestation and 6 mo postpartum, and in children at 6 and 18 mo of age. Milk retinol was measured at 6 mo postpartum. VA status indicators were compared by group. Results: Among Malawian mothers, geometric mean (95% CI) plasma retinol concentrations at 36 wk of gestation and 6 mo postpartum were 0.97 μmol/L (0.94, 1.01 μmol/L) and 1.35 μmol/L (1.31, 1.39 μmol/L), respectively; geometric mean (95% CI) milk retinol concentration at 6 mo postpartum was 1.04 μmol/L (0.97, 1.13 μmol/L); results did not differ by intervention group. Geometric mean (95% CI) plasma retinol concentrations for Malawian children at 6 and 18 mo of age were 0.78 μmol/L (0.75, 0.81 μmol/L) and 0.81 μmol/L (0.78, 0.85 μmol/L), respectively, and for Ghanaian children they were 0.85 μmol/L (0.82, 0.88 μmol/L) and 0.88 μmol/L (0.85, 0.91 μmol/L), respectively; results did not differ by intervention group in either setting. Conclusions: SQ-LNS had no effect on VA status of mothers or children, possibly because of low responsiveness of the VA status indicators. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition. | Open |
| Heemann M.; Kim R.; Vollmer S.; Subramanian S.V. | Assessment of Undernutrition among Children in 55 Low- And Middle-Income Countries Using Dietary and Anthropometric Measures | 2021 | JAMA Network Open | Importance: Evidence on the suitability of anthropometric failure (ie, stunting, underweight, and wasting) as a stand-alone measure of child undernutrition can inform global and national nutrition and health agendas. Objective: To provide a comprehensive estimate of the prevalence of child undernutrition by evaluating both dietary and anthropometric measures simultaneously across 55 low- and middle-income countries. Design, Setting, and Participants: This was a cross-sectional study that used Demographic and Health Surveys program data from July 2009 to January 2019, to allocate children into dietary and anthropometric failure categories. Nationally representative household surveys were conducted in 55 low- and middle-income countries. Participants included children aged 6 to 23 months who were born singleton and had valid anthropometric measures as well as available 24-hour food intake recollection. Data analysis was conducted from August 23 to October 22, 2020. Exposures: Two factors were considered to allocate children into the respective categories. Dietary failure was based on the World Health Organization standards for minimum dietary diversity. Anthropometric failure was constructed using the World Health Organization child growth reference standard z score for stunted growth, muscle wasting, and less than average weight for age. Main Outcomes and Measures: Dietary and anthropometric failures were cross-tabulated, which yielded 4 potential outcomes: dietary failure only, anthropometric failure only, both failures, and neither failure. Total child populations for each category were extrapolated from United Nations population estimates. Results: Of the 162589 children (median age [range], 14 months [6-23 months]; 83 467 boys [51.3%]; 78 894 Asian children [48.5%]) in our sample, 42.9% of children had dietary failure according to the standard World Health Organization definition without being identified as having anthropometric failures. In all, 34.7% had both failures, 42.9% had dietary failure only, 8.3% had anthropometric failure only, and 14.1% had neither failure. Dietary and anthropometric measures were discordant for 51.2% of children; these children had nutritional needs identified by only 1 of the 2 measures. Dietary failure doubled the proportion of children in need of dietary interventions compared with anthropometry alone (43%). A total of 45.3 million additional children who experienced undernutrition in these 55 countries were not captured through the evaluation of anthropometric failures only. These results were consistent across geographic regions. Conclusions and Relevance: The results of this cross-sectional study suggest that the current standard of measuring child undernutrition by estimating the prevalence of anthropometric failure should be complemented with dietary and food-based measures. Anthropometry alone may fail to identify many children who have insufficient dietary intake. © 2021 Georg Thieme Verlag. All rights reserved. | Open |
| Horlyck-Romanovsky M.F.; Huang T.T.-K.; Ahmed R.; Echeverria S.E.; Wyka K.; Leung M.M.; Sumner A.E.; Fuster M. | Intergenerational differences in dietary acculturation among Ghanaian immigrants living in New York City: A qualitative study | 2021 | Journal of Nutritional Science | Dietary acculturation may explain the increasing risk of diet-related diseases among African immigrants in the United States (US). We interviewed twenty-five Ghanaian immigrants (Youth n 13, Age (Mean ± sd) 20 y ± 54, Parents (n 6) and Grandparents (n 6) age 587 ± 97) living in New York City (NYC) to (a) understand how cultural practices and the acculturation experience influence dietary patterns of Ghanaian immigrants and (b) identify intergenerational differences in dietary acculturation among Ghanaian youth, parents and grandparents. Dietary acculturation began in Ghana, continued in NYC and was perceived as a positive process. At the interpersonal level, parents encouraged youth to embrace school lunch and foods outside the home. In contrast, parents preferred home-cooked Ghanaian meals, yet busy schedules limited time for cooking and shared meals. At the community level, greater purchasing power in NYC led to increased calories, and youth welcomed individual choice as schools and fast food exposed them to new foods. Global forces facilitated nutrition transition in Ghana as fast and packaged foods became omnipresent in urban settings. Adults sought to maintain cultural foodways while facilitating dietary acculturation for youth. Both traditional and global diets evolved as youth and adults adopted new food and healthy social norms in the US. Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of The Nutrition Society. | Open |
| Imdad A.; Rehman F.; Davis E.; Ranjit D.; Surin G.S.S.; Attia S.L.; Lawler S.; Smith A.A.; Bhutta Z.A. | Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review | 2021 | Campbell Systematic Reviews | Background: The last two decades have seen a significant decrease in mortality for children <5 years of age in low and middle-income countries (LMICs); however, neonatal (age, 0–28 days) mortality has not decreased at the same rate. We assessed three neonatal nutritional interventions that have the potential of reducing morbidity and mortality during infancy in LMICs. Objectives: To determine the efficacy and effectiveness of synthetic vitamin A, dextrose oral gel, and probiotic supplementation during the neonatal period. Search Methods: We conducted electronic searches for relevant studies on the following databases: PubMed, CINAHL, LILACS, SCOPUS, and CENTRAL, Cochrane Central Register for Controlled Trials, up to November 27, 2019. Selection Criteria: We aimed to include randomized and quasi-experimental studies. The target population was neonates in LMICs. The interventions included synthetic vitamin A supplementation, oral dextrose gel supplementation, and probiotic supplementation during the neonatal period. We included studies from the community and hospital settings irrespective of the gestational age or birth weight of the neonate. Data Collection and Analysis: Two authors screened the titles and extracted the data from selected studies. The risk of bias (ROB) in the included studies was assessed according to the Cochrane Handbook of Systematic Reviews. The primary outcome was all-cause mortality. The secondary outcomes were neonatal sepsis, necrotizing enterocolitis (NEC), prevention and treatment of neonatal hypoglycaemia, adverse events, and neurodevelopmental outcomes. Data were meta-analyzed by random effect models to obtain relative risk (RR) and 95% confidence interval (CI) for dichotomous outcomes and mean difference with 95% CI for continuous outcomes. The overall rating of evidence was determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Main Results: Sixteen randomized studies (total participants 169,366) assessed the effect of vitamin A supplementation during the neonatal period. All studies were conducted in low- and middle-income (LMIC) countries. Thirteen studies were conducted in the community setting and three studies were conducted in the hospital setting, specifically in neonatal intensive care units. Studies were conducted in 10 different countries including India (four studies), Guinea-Bissau (three studies), Bangladesh (two studies), and one study each in China, Ghana, Indonesia, Nepal, Pakistan, Tanzania, and Zimbabwe. The overall ROB was low in most of the included studies for neonatal vitamin A supplementation. The pooled results from the community based randomized studies showed that there was no significant difference in all-cause mortality in the vitamin A (intervention) group compared to controls at 1 month (RR, 0.99; 95% CI, 0.90–1.08; six studies with 126,548 participants, statistical heterogeneity I2 0%, funnel plot symmetrical, grade rating high), 6 months (RR, 0.98; 95% CI, 0.89–1.07; 12 studies with 154,940 participants, statistical heterogeneity I2 43%, funnel plot symmetrical, GRADE quality high) and 12 months of age (RR, 1.04; 95% CI, 0.94–1.14; eight studies with 118,376 participants, statistical heterogeneity I2 46%, funnel plot symmetrical, GRADE quality high). Neonatal vitamin A supplementation increased the incidence of bulging fontanelle by 53% compared to control (RR, 1.53; 95% CI, 1.12–2.09; six studies with 100,256 participants, statistical heterogeneity I2 65%, funnel plot symmetrical, GRADE quality high). We did not identify any experimental study that addressed the use of dextrose gel for the prevention and/or treatment of neonatal hypoglycaemia in LMIC. Thirty-three studies assessed the effect of probiotic supplementation during the neonatal period (total participants 11,595; probiotics: 5854 and controls: 5741). All of the included studies were conducted in LMIC and were randomized. Most of the studies were done in the hospital setting and included participants who were preterm (born < 37 weeks gestation) and/or low birth weight (<2500 g birth weight). Studies were conducted in 13 different countries with 10 studies conducted in India, six studies in Turkey, three studies each in China and Iran, two each in Mexico and South Africa, and one each in Bangladesh, Brazil, Colombia, Indonesia, Nepal, Pakistan, and Thailand. Three studies were at high ROB due to lack of appropriate randomization sequence or allocation concealment. Combined data from 25 studies showed that probiotic supplementation reduced all-cause mortality by 20% compared to controls (RR, 0.80; 95% CI, 0.66–0.96; total number of participants 10,998, number needed to treat 100, statistical heterogeneity I2 0%, funnel plot symmetrical, GRADE quality high). Twenty-nine studies reported the effect of probiotics on the incidence of NEC, and the combined results showed a relative reduction of 54% in the intervention group compared to controls (RR, 0.46; 95% CI, 0.35–0.59; total number of participants 5574, number needed to treat 17, statistical heterogeneity I2 24%, funnel plot symmetrical, GRADE quality high). Twenty-one studies assessed the effect of probiotic supplementation during the neonatal period on neonatal sepsis, and the combined results showed a relative reduction of 22% in the intervention group compared to controls (RR, 0.78; 95% CI, 0.70–0.86; total number of participants 9105, number needed to treat 14, statistical heterogeneity I2 23%, funnel plot symmetrical, GRADE quality high). Authors' Conclusions: Vitamin A supplementation during the neonatal period does not reduce all-cause neonatal or infant mortality in LMICs in the community setting. However, neonatal vitamin A supplementation increases the risk of Bulging Fontanelle. No experimental or quasi-experimental studies were available from LMICs to assess the effect of dextrose gel supplementation for the prevention or treatment of neonatal hypoglycaemia. Probiotic supplementation during the neonatal period seems to reduce all-cause mortality, NEC, and sepsis in babies born with low birth weight and/or preterm in the hospital setting. There was clinical heterogeneity in the use of probiotics, and we could not recommend any single strain of probiotics for wider use based on these results. There was a lack of studies on probiotic supplementation in the community setting. More research is needed to assess the effect of probiotics administered to neonates in-home/community setting in LMICs. © 2021 The Authors. Campbell Systematic Reviews published by John Wiley & Sons Ltd on behalf of The Campbell Collaboration | Open |
| Intiful F.D.; Abdulai H.; Nyarko R.; Tette E.; Asante M. | Malnutrition in HIV infected children on antiretroviral drugs in a cohort of Ghanaian children | 2021 | Heliyon | Background: HIV infected children are at increased risk of malnutrition which worsens the depressed immune system, leading to poor disease prognosis. Aim: To assess the nutritional status of children between 6-12 years on antiretroviral drugs (ARV) at two health facilities in Accra. Methods: The study design was cross sectional among children between 6 and 12 years being administered with antiretroviral drugs at two hospitals in Accra. A purposive sample of 100 children was used. Height and weight measurements were taken and used to compute z-scores for stunting, underweight and wasting. Haemoglobin status was obtained from their folders. A semi-structured questionnaire was used to obtain sociodemographic data and a 24-hour dietary intake used to assess nutrient intakes. Data was analyzed using IBM SPSS version 20.0. Nutrient analysis was done using Micro diet version 3.0. Data was summarized using means and percentages. Chi-squared test was used to test for associations and statistical significance set at p < 0.05. Results: The prevalence of stunting, underweight and wasting was reported as 28%, 16% and 13% respectively. Girls were more stunted and wasted compared to boys. Mean haemoglobin concentration was 10.12 ± 2.77 g/dl. Mild, moderate and severe anaemia were reported in 14.2%, 41.1% and 12.5% of the children respectively. Apart from carbohydrates, less than 50% of the children were able to meet their requirements for the other nutrients”. Conclusions: Our findings reveal high level of malnutrition among the children receiving ARV. There is the need for targeted nutrition interventions to improve the nutritional status of the children. © 2021 The Author(s) | Open |
| Issahaku I.; Alhassan M. | Nutrition knowledge, dietary practices and nutritional status of non-academic staff at the Tamale campus of University for Development Studies | 2021 | Heliyon | Background: The significance of nutritional status of individuals have economic effects on national development. Non-communicable diseases have shown to increase due to nutrition transition. This study aimed at determining the influence of nutrition knowledge and dietary practices on the nutritional status of non-academic staff at the Tamale campus of University for Development Studies (UDS). The question was, does poor nutrition knowledge result into poor dietary practices and nutritional status? Methods: A cross-sectional study design was used to take data on 152 non-academic staff of UDS-Tamale campus comprising adults 18–59 years. Non-probability quota sampling was used to collect data. Data processing was done using SPSS version 21. Means and standard deviations were calculated for continuous variables whiles categorical variables were analysed using frequencies and percentages. Chi-square test was used to determine associations between categorical variables. A p-value < 0.05, in all analysis, was considered statistically significant. Semi-structured questionnaires were used in collecting data. Data was taken between May and June 2017. Results: This study involved 93 males and 59 females' non-academic staff of UDS, Tamale campus. Majority (56%) had good nutrition knowledge of which most of the males had a high percentage compared to the females. Majority (81.6%) had a moderate dietary diversity. Only 15.1% had a higher dietary diversity and rest had low dietary diversity. Overweight and obesity together was 43.4%, though it was more prevalent among women. There was no statistically significant association between nutrition knowledge and overweight (p = 0.253) as well as between dietary diversity and nutritional status (p = 0.686). Conclusion: The prevalence of good nutrition knowledge was high among non-academic staff of UDS Tamale campus and most of them also had a moderate dietary diversity. The prevalence of overweight/obesity was 43% and nutrition knowledge was not associated with nutritional status. No association was established between dietary diversity and nutritional status. © 2021 The Author(s) | Open |
| Jahan I.; Muhit M.; Hardianto D.; Laryea F.; Amponsah S.K.; Chhetri A.B.; Smithers-Sheedy H.; McIntyre S.; Badawi N.; Khandaker G. | Epidemiology of malnutrition among children with cerebral palsy in low-and middle-income countries: Findings from the global LMIC CP register | 2021 | Nutrients | Background: This study aimed to describe the epidemiology of malnutrition among children with cerebral palsy (CP) in low-and middle-income countries (LMICs). Methods: Data from children with confirmed CP aged <18 years registered into the Global LMIC CP Register (GLM CPR) from Bangladesh, Indonesia, Nepal, and Ghana were included. Anthropometric measurements were collected, and nutritional status was determined following the WHO guidelines. Descriptive statistics and adjusted logistic regression were used to describe the nutritional status and identify predictors of malnutrition. Results: Between January 2015 and December 2020, 3619 children with CP were registered into the GLM CPR (median age at assessment: 7.0 years, 39% female). Overall, 72–98% of children from Bangladesh, Indonesia, Nepal, and Ghana had at least one form of under-nutrition. The adjusted analysis showed, older age, low maternal education, spastic tri/quadriple-gia, and Gross Motor Functional Classification System (GMFCS) levels III–V were significant pre-dictors of underweight and stunting among children with CP in Bangladesh. In Nepal, female chil-dren, GMFCS III–V had higher odds of underweight and stunting. In Ghana, low maternal education was significantly associated with underweight, whereas older age and the presence of associated impairments were the significant predictors of stunting among children with CP. Having a GMFCS of III–V increased the odds of being underweight among children in Indonesia; however, no predictors were identified for stunting, as nearly all children with CP registered from Indonesia were stunted. Conclusion: Most children with CP in GLM CPR had undernutrition. Maternal education and moderate-to-severe motor impairment (GMFCS III–V) were significant predictors. Practical nutrition education to mothers/caregivers and management guidelines according to the motor severity using local resources could improve the nutritional outcome of children with CP in LMICs. © 2021 by the author. Licensee MDPI, Basel, Switzerland. | Open |
| Kozicka M.; Elsey J.; Ekesa B.; Ajambo S.; Kikulwe E.; Gotor E. | Reassessing the Cost-Effectiveness of High-Provitamin A Bananas to Reduce Vitamin A Deficiency in Uganda | 2021 | Frontiers in Sustainable Food Systems | There are two high-provitamin A (pVA) banana-based interventions potentially available in Uganda—biofortified genetically modified (GM) banana and fast-tracked banana landraces from outside Uganda that are naturally high in provitamin A (nHpVA). Based on the newest country statistics and using adoption scenarios obtained through focus group discussions and expert interviews, we assess obstacles and opportunities for adoption as well as cost-effectiveness of these interventions. In two alternative scenarios for the GM banana (M9 matooke), we assume 40% and 64% adoption rates, which would result in US$29,374,151 and US$63,259,415 in income saved, respectively. As an alternative, for the symmetrical scenarios, we calculate that if the nHpVA banana (Apantu plantain, native of Ghana) were to be adopted, US$46,100,148 and US$76,364,988 in income would be saved. Taking into account the full cost of R&D, we estimate that the M9 matooke could save one disability-adjusted life year (DALY) at a cost of US$67.37 at best and US$145.09 at worst. We estimate that the Apantu plantain could save one DALY at a cost of US$50.54 at best and US$83.72 at worst. Our DALY analysis estimates that all assessed HpVA banana interventions are extremely cost-effective in all scenarios, following both the World Bank's and the WHO criteria. Nevertheless, successful interventions would require extensive promotion campaigns and shifts in agricultural value chains. © Copyright © 2021 Kozicka, Elsey, Ekesa, Ajambo, Kikulwe and Gotor. | Open |
| Kukeba M.W.; Callery P.; Fallon D. | Factors impacting on childhood nutrition: The experience of mothers in a rural Ghanaian community | 2021 | Appetite | Despite globally recommended infant and young child feeding (IYCF) practices, inadequate Child feeding remains a global challenge and the root cause of undernutrition. Most mothers who primarily feed children in most developing settings appear to have received information on the IYCF practices. We explored mothers' limitations to provide children optimally in a rural Ghanaian community. We interviewed 42 family members, including parents and grandparents of thirty-two children under five years, from fifteen households using an ethnographic fieldwork approach. We observed and participated in food preparation and child feeding and interviewed religious leader, diviners. Households' decision-making arrangements, mothers, emerging roles and inconsistency of fathers' roles, competing sources of knowledge poverty, food insecurity and the nature of the community's social interactions and policing of women's child feeding practices are issues mothers have to navigate to feed children in the study community. Cultural custodians should be given child nutrition and providing information. Mothers should be empowered to manage child feeding and emerging roles. © 2021 Elsevier Ltd | Open |
| Kukeba M.W.; Fallon D.; Callery P. | Child feeding in rural northern Ghana: Carer's perceptions of food and their children's diets | 2021 | Maternal and Child Nutrition | A child's diet should be composed of appropriate nutrients to achieve optimal nutritional status, and though there is a substantial evidence base for child feeding recommendations, developing countries continue to face challenges regarding optimal child feeding. This paper describes an ethnographic study undertaken in rural northern Ghana to explore community perceptions of what ‘counts’ as food for children and the impact this had on the nutrients they received. Fifteen households with children under 5 years were purposively selected. In-depth interviews were held with 25 mothers, 7 fathers and 8 grandparents within these households as well as 2 diviners. Participant observations were also undertaken. Findings show that satiety rather than nutrition was the key consideration in adult choices about a child's diet. The community regarded carbohydrate-based meals as food, but considered protein, vitamins and mineral-based foods as nonessential elements of a child's diet, and important sources of these nutrients were regarded as treats. © 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd | Open |
| Kumbiley J.; Amalba A.; Aryee P.A.; Azure S.A.; Mogre V. | Determinants of Nutrition Care Practice by Midwives and Nurses in the Antenatal and Postnatal Care Settings: A Multi-Site Cross-Sectional Survey From Ghana | 2021 | Global Pediatric Health | Aim. Midwives and nurses are critical in nutrition care for pregnant women and lactating mothers. Ghanaian nurses and midwives’ perception of the adequacy and their satisfaction with nutrition education received during training in school, level of nutrition care competencies, and nutrition practice behavior is unknown. We evaluated the adequacy of nutrition education received in nursing and midwifery school; nutrition care competencies; self-efficacy and the nutrition care practice of midwives and nurses. We also evaluated determinants of nutrition care practice during routine antenatal and postnatal care. Methods. Cross-sectional study conducted among midwives and nurses working at antenatal and postnatal clinics in Ghana. Data was collected using a self-administered questionnaire. Data analysis was done using descriptive statistics, correlation, and linear regression. Findings. Almost 90% (n = 267) of the participants received nutrition education during training, 77.5% were unsatisfied with the amount of time allocated for nutrition education and 40% felt inadequately prepared from school to provide nutrition care. Self-efficacy ranged from moderate to low. Determinants of nutrition care practice were age of respondents (B = 0.04; P =.002), nutrition-related knowledge (B = 0.05; P =.016), adequacy of nutrition education (B = 0.14; P =.006), nutrition training after school (B = 0.38; P =.010) and nutrition care self-efficacy (B = 0.03; P =.048). Conclusion. Notable knowledge gaps in basic nutrition, inadequate preparedness, and poor confidence to provide nutrition care was common. There is a need to improve the nutrition education experiences of midwives and nurses through curricula revision and refresher training courses. © The Author(s) 2021. | Open |
| Kyereh D.; Maňourová A.; Hendre P.S.; Muchugi A.; Kalousová M.; Choungo Nguekeng P.B.; Jawo T.O.; Ofori D.A.; Lojka B. | Diversity, chemical composition, and domestication potential of allanblackia parviflora a. Chev. in West Africa | 2021 | Forests | Allanblackia parviflora A. Chev. is an indigenous tree species which is found in West African rainforest zones. It is an underutilized fruit tree species that has been targeted for improvement as part of efforts to domesticate high-value indigenous multi-purpose trees for fruit and seed production in Africa. Allanblackia has several benefits, such as providing shade, timber, and medicine; however, the production of edible oil from its seeds is the economically most important use. There is evidence that the Allanblackia seed oil, which is used for cooking, the production of margarine and the manufacturing of ointments and soap, is being developed as a new agri-business in Ghana, Nigeria, Cameroon, and Tanzania. Despite the nutritional and socio-economic importance of A. parviflora, it is still at the early stages of its domestication process. Even though several researchers have explored the biology of this species, there is very limited scientific information available on its morphological and genetic diversity and silvicultural management in West Africa. Therefore, this systematic review presents an up-to-date overview on the uses, seed chemical composition, and morphological and genetic diversity of this fruit tree species, and proposes a way forward for future research towards improvement and domestication. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Kyomuhendo C.; Adeola R. | Green and grey: Nutritional lifestyle and healthful ageing in rural and urban areas of three sub-Saharan African countries | 2021 | Business Strategy and Development | Increased lifespan has resulted in a growing ageing population with non-communicable diseases (NCDs) like cardiovascular disease, diabetes, cancer, among others that are chronic in nature. Thus, causing dependency, disability, poor quality of life, and increased medical costs. This paper uses South Africa, Ghana, and Uganda to understand how improved medical interventions and social-economic conditions have increased life expectancy while changing dietary and disease patterns. The countries are chosen due to their variations in urbanization and ageing levels. South Africa is more urbanized (66%) with an 8% aged population, followed by Ghana (56.06%) with a 5.3% aged population and Uganda (23.77%) with a 4.5% aged population. Lately, healthy dietary patterns are encouraged to promote healthy ageing and prevent, slow and reverse NCDs, through consumption of organic foods (higher in wholegrain foods, vegetables, fruits, with low meat consumption). Organic products are considered healthier, nutritious, fresher, and environmentally friendly because their production excludes pesticides, chemical fertilizers, and chemical food additives. Through literature reviews, we identified how older persons' nutritional patterns in South Africa, Ghana, and Uganda have evolved and their impacts on ageing. Findings indicated rising incomes and urbanization leading to nutrition transition, with traditional foods being substituted with foods high in meat, fats, refined sugars, and oils. Consequently, a double burden of diseases that are communicable and non-communicable is emerging. Changes in diets of older persons have promoted overweight/obesity and under nutrition/underweight. It is, therefore, necessary to use strategies that improve levels of organic food intake through educational programs to the aged and their families on how to control diets and lifestyles. Also, household organic food production can be promoted by encouraging growing vegetables and fruits. This will help boost older persons' nutritional wellbeing, as well as promote the production of local organic foods that are environmental friendly and socially sustainable. © 2020 ERP Environment and John Wiley & Sons Ltd | Open |
| Laar A.; Kelly B.; Holdsworth M.; Quarpong W.; Aryeetey R.; Amevinya G.S.; Tandoh A.; Agyemang C.; Zotor F.; Laar M.E.; Mensah K.; Laryea D.; Asiki G.; Pradeilles R.; Sellen D.; L'Abbe M.R.; Vandevijvere S. | Providing Measurement, Evaluation, Accountability, and Leadership Support (MEALS) for Non-communicable Diseases Prevention in Ghana: Project Implementation Protocol | 2021 | Frontiers in Nutrition | Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support public sector actions that create healthy food marketing, retail, and provisioning environments for Ghanaian children using adapted methods from the International Network for Food and Obesity/NCDs Research Monitoring and Action Support (INFORMAS). Methods: The protocol for this observational study draws substantially from the INFORMAS' Food Promotion and Food Provision Modules. However, to appraise the readiness of local communities to implement interventions with strong potential to improve food environments of Ghanaian children, the MEALS4NCDs protocol has innovatively integrated a local community participatory approach based on the community readiness model (CRM) into the INFORMAS approaches. The setting is Ghana, and the participants include health and nutrition policy-makers, nutrition and food service providers, consumers, school authorities, and pupils of Ghanaian basic schools. Results: The study establishes a standardized approach to providing implementation science evidence for the prevention of non-communicable diseases (NCDs) in Ghana. It demonstrates feasibility and the innovative application of the INFORMAS expanded food promotion and food provision modules, together with the integration of the CRM in a lower-middle income setting. Conclusion: The research will facilitate the understanding of the processes through which the INFORMAS approach is contextualized to a lower-middle income African context. The protocol could be adapted for similar country settings to monitor relevant aspects of food environments of children. © Copyright © 2021 Laar, Kelly, Holdsworth, Quarpong, Aryeetey, Amevinya, Tandoh, Agyemang, Zotor, Laar, Mensah, Laryea, Asiki, Pradeilles, Sellen, L'Abbe and Vandevijvere. | Open |
| Ma Y.; Stubbings W.A.; Cline-Cole R.; Harrad S. | Human exposure to halogenated and organophosphate flame retardants through informal e-waste handling activities - A critical review | 2021 | Environmental Pollution | Informal electrical and electronic waste (e-waste) handling activities constitute a potentially important source of halogenated (HFRs) and organophosphate flame retardants (OPFRs) to the environment and humans. In this review, two electronic databases (ScienceDirect and Web of Science Core Collection) were searched for papers that addressed this topic. A total of 82 relevant studies (including 72 studies selected from the two databases and 10 studies located from the references of the first 72 selected studies) were identified that reported on human external and internal exposure to HFRs and OPFRs arising as a result of informal e-waste handling activities. Compared to the general population, higher levels of external exposure (i.e., inhalation, ingestion, and dermal absorption) and internal exposure (i.e., blood serum, hair, breast milk, urine, and other human matrices) to HFRs and OPFRs were identified for e-waste recyclers and residents inhabiting e-waste dismantling and recycling zones, especially for younger adults and children. Food intake and dust ingestion were the dominant exposure pathways for the majority of brominated flame retardants (BFRs) and dechlorane plus (DP); while inhalation was identified as the most significant pathway of human exposure to OPFRs in informal e-waste sites. The majority of research to date has focused on China and thus future studies should be conducted in other regions such as Africa and South Asia. Other suggested foci of future research are: examination of exposure via dermal contact with e-waste, dietary exposure of local populations to OPFRs, confirmation of the existence of and cause(s) of the higher body burdens of females compared with males amongst populations impacted by informal e-waste handling, and characterisation of exposure of such populations to chlorinated paraffins. © 2020 Elsevier Ltd; Main findings: Inhalation contributes most to human exposure to OPFRs, and dietary intake contributes most to human exposure to BFRs and DPs. Children and females are more exposed. © 2020 Elsevier Ltd | Open |
| Nanewortor B.M.; Saah F.I.; Appiah P.K.; Amu H.; Kissah-Korsah K. | Nutritional status and associated factors among people living with HIV/AIDS in Ghana: cross-sectional study of highly active antiretroviral therapy clients | 2021 | BMC Nutrition | Background: Nutrition among people living with HIV/AIDS (PLWHA) is essential in their care and management as it has implication for their immune function. We examined the nutritional status and associated factors among HIV positive clients accessing Highly Active Anti-Retroviral Therapy (HAART) at a public hospital in Ghana. Methods: This was a descriptive cross-sectional study of 152 clients. Anthropometric measurements for weight and height were carried out in 2019. Data were analysed using SPSS 22.0. Descriptive and analytical statistics comprising frequency, percentage, and binary logistic regression were adopted in presenting the results. Results: Seventy-nine percent and 74% of the clients had good nutrition knowledge and attitude, respectively. Also, 42% were malnourished (underweight = 13.8%, and overweight = 28.3%). Clients with primary (AOR = 0.36, 95% CI = 0.07–1.84), JSS/JHS (AOR = 0.26, 95% CI = 0.08–0.84), SSS/SHS (AOR = 0.22, 95% CI = 0.05–1.02) and tertiary (AOR = 0.26, 95% CI = 0.08–0.88) were less likely to be malnourished compared with those with no formal education. Those with good nutrition-related knowledge were 56% (AOR = 0.44, 95% CI = 0.18–1.09) less likely to be malnourished than those with poor knowledge; this was however, not statistically significant. Conclusion: We found a high prevalence of malnutrition among the clients which militates against progress towards achieving the Sustainable Development Goal targets 3.3 and 3.4 of stopping AIDS epidemic and preventing premature deaths from malnutrition. Our findings justify the need for the implementation of innovative interventions by stakeholders in Ghana’s health industry to improve the nutritional status of people living with the disease. © 2021, The Author(s). | Open |
| Nyantakyi-Frimpong H. | Climate change, women's workload in smallholder agriculture, and embodied political ecologies of undernutrition in northern Ghana | 2021 | Health and Place | The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women's workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers' time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana's Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women's productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature. © 2021 Elsevier Ltd | Open |
| Okyere C.Y.; Usman M.A. | The impact of irrigated agriculture on child nutrition outcomes in southern Ghana | 2021 | Water Resources and Economics | In this study, we investigated whether irrigated agriculture results in improved child nutrition outcomes among farm households in southern Ghana. Using panel data collected between 2014 and 2015, this study seeks to add to the growing body of literature on the determinants of irrigated agriculture adoption, its effects on child nutrition, and the potential pathways through which irrigation can affect child nutrition outcomes. The results from the inverse probability weighted regression adjustment (IPWRA) estimator suggest that children living in irrigating households have, on average, 0.23 standard deviations of weight-for-age and 0.27 standard deviations of weight-for-height higher than their counterparts; with males and under-five children gaining substantial improvements. Disaggregating irrigation by types, the results indicate that households planting on riverbeds or riverbanks had improved child nutrition. In contrast, children living with households lifting water from water sources had higher height-for-age and weight-for-age. Further analysis of the underlying pathways suggests that an increase in health care financing and improvement in environmental quality rather than decreases in illness incidence may be the crucial channels. Altogether, the findings show the importance of investments in agricultural development, particularly in small-scale irrigated agriculture technologies, to reduce childhood undernutrition. © 2020 | Open |
| Olson R.; Gavin-Smith B.; Ferraboschi C.; Kraemer K. | Food fortification: The advantages, disadvantages and lessons from sight and life programs | 2021 | Nutrients | Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low-and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social benefits. Despite ongoing debates globally and in some countries regarding the performance and safety of food fortification, the practice offers significant benefits across each of the main vehicles for food fortification (large-scale food fortification, biofortification and point-of-use or home fortifi-cation) ranging from reducing the prevalence of nutritional deficiencies and economic benefits to societies and economies. Using Sight and Life’s global and national experiences in implementing food fortification efforts, we demonstrate how different programs in LMICs have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Osei-Kwasi H.A.; Laar A.; Zotor F.; Pradeilles R.; Aryeetey R.; Green M.; Griffiths P.; Akparibo R.; Wanjohi M.N.; Rousham E.; Barnes A.; Booth A.; Mensah K.; Asiki G.; Kimani-Murage E.; Bricas N.; Holdsworth M. | The African urban food environment framework for creating healthy nutrition policy and interventions in urban Africa | 2021 | PLoS ONE | This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and intervention development in Africa. A multi-component methodology, drawing on concept mapping, was employed to construct a framework of factors influencing dietary behaviours in urban Africa. The framework adapted a widely used socio-ecological model (developed in a high-income country context) and was developed using a mixed-methods research approach that comprised: i. Evidence synthesis consisting of a systematic review of 39 papers covering 14 African countries; ii. Qualitative interview data collected for adolescents and adults (n = 144) using photovoice in urban Ghana and Kenya; and iii. Consultation with interdisciplinary African experts (n = 71) from 27 countries, who contributed to at least one step of the framework (creation, validation/evaluation, finalisation). The final framework included 103 factors influencing dietary behaviours. Experts identified the factors influencing dietary behaviours across all the four levels of the food environment i.e. the individual, social, physical and macro levels. Nearly half (n = 48) were individual-level factors and just under a quarter (n = 26) were at the macro environmental level. Fewer factors associated with social (n = 15) and physical (14) environments were identified. At the macro level, the factors ranked as most important were food prices, cultural beliefs and seasonality. Factors ranked as important at the social level were household composition, family food habits and dietary practices. The type of food available in the neighbourhood and convenience were seen as important at the physical level, while individual food habits, food preferences and socioeconomic status were ranked highly at the individual level. About half of the factors (n = 54) overlap with those reported in an existing socio-ecological food environment funded by a Global Challenges Research Fund Foundation Award (project code: MR/P025153/1) led by the MRC, and supported by AHRC, BBSRC, ESRC and NERC, with the aim of improving the health and prosperity of low and middle-income countries. Awards received by MH (PI). The funders had no role in study design, data collection and analysis, the decision to the public, or preparation of the manuscript. © 2021 Osei-Kwasi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Saaka M.; Saapiire F.N.; Dogoli R.N. | Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth | 2021 | Journal of Nutritional Science | The causes of undernutrition are often linked to inappropriate complementary feeding practices and poor households' access to water, sanitation and hygiene (WASH), but limited evidence exists on the combined effect of poor WASH and inappropriate complementary feeding practices on stunted child growth. We assessed the independent and joint contribution of inappropriate complementary feeding and poor WASH practices to stunted growth among children aged 6-23 months in the Jirapa Municipality of Ghana. A community-based cross-sectional analytical study design was used with a sample of 301 mothers/caregivers having children aged 6-23 months. The results indicate that in a multivariable logistic regression model that adjusted for confounders, children receiving both unimproved water and inappropriate complementary feeding had a higher and significant odd of becoming stunted (adjusted odds ratio = 33. 92; 95 % confidence interval 3 04, 37 17; P = 0 004) compared to households having both improved water sources and appropriate complementary feeding practices. Except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6-23 months. The combined effect of unimproved water and inappropriate complementary feeding on stunting was greater than either unimproved water only or inappropriate complementary feeding only. Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of The Nutrition Society. | Open |
| Sarpong S.A.; Sarpong A.K.; Lee Y. | A model for determining predictors of the muac in acute malnutrition in ghana | 2021 | International Journal of Environmental Research and Public Health | The issue of malnutrition is perhaps the most important public health determinant of global wellbeing. It is one of the main causes of improper mental and physical development as well as death of many children. The Mid Upper Arm Circumference (MUAC) rapid text setup is able to diagnose malnutrition due to the fact that the human arm contains subcutaneous fat and muscle mass. When proportional food intake increases or reduces, the corresponding increase or reduction in the subcutaneous fat and muscle mass leads to an increase or decrease in the MUAC. In this study, the researchers attempt to develop a model for determining the performance of MUAC in predicting Child malnutrition in Ghana. It focuses on the Joint Generalized Linear Model (Joint-GLM) instead of the traditional Generalized Linear Model (GLM). The analysis is based on primary data measured on children under six years, who were undergoing nutritional treatment at the Princess Marie Louise (PML) Children’s Hospital in the Ashiedu Keteke sub-metro area of Accra Metropolis. The study found that a precisely measured weight of a child, height, and albumen levels were positive determinants of the predicted MUAC value. The study also reveals that, of all the variables used in determining the MUAC outcome, the hemoglobin and total protein levels of a child would be the main causes of any variation between the exact nutritional status of a child and that suggested by the MUAC value. The final Joint-GLM suggests that, if there are occasions where the MUAC gave false results, it could be a result of an imbalance in the child’s hemoglobin and protein levels. If these two are within acceptable levels in a child, the MUAC is most likely to be consistent in predicting the child’s nutritional status accurately. This study therefore recommends the continued use of MUAC in diagnosis of child malnutrition but urges Ghana and countries in Sub-Saharan Africa to roll out an effective nutrition intervention plan targeting the poor and vulnerable suburbs so that the nutritional status of children under five years of age, who were the focus of the current study, may be improved. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Sefa-Yeboah S.M.; Osei Annor K.; Koomson V.J.; Saalia F.K.; Steiner-Asiedu M.; Mills G.A. | Development of a Mobile Application Platform for Self-Management of Obesity Using Artificial Intelligence Techniques | 2021 | International Journal of Telemedicine and Applications | Obesity is a major global health challenge and a risk factor for the leading causes of death, including heart disease, stroke, diabetes, and several types of cancer. Attempts to manage and regulate obesity have led to the implementation of various dietary regulatory initiatives to provide information on the calorie contents of meals. Although knowledge of the calorie content is useful for meal planning, it is not sufficient as other factors, including health status (diabetes, hypertension, etc.) and level of physical activity, are essential in the decision process for obesity management. In this work, we present an artificial intelligence-(AI-) based application that is driven by a genetic algorithm (GA) as a potential tool for tracking a user's energy balance and predicting possible calorie intake required to meet daily calorie needs for obesity management. The algorithm takes the users' input information on desired foods which are selected from a database and extracted records of users on cholesterol level, diabetes status, and level of physical activity, to predict possible meals required to meet the users need. The micro-and macronutrients of food content are used for the computation and prediction of the potential foods required to meet the daily calorie needs. The functionality and performance of the model were tested using a sample of 30 volunteers from the University of Ghana. Results revealed that the model was able to predict both glycemic and non-glycemic foods based on the condition of the user as well as the macro-and micronutrients requirements. Moreover, the system is able to adequately track the progress of the user's weight loss over time, daily nutritional needs, daily calorie intake, and predictions of meals that must be taken to avoid compromising their health. The proposed system can serve as a useful resource for individuals, dieticians, and other health management personnel for managing obesity, patients, and for training students in fields of dietetics and consumer science. © 2021 Sylvester M. Sefa-Yeboah et al. | Open |
| Seidu F.; Mogre V.; Yidana A.; Ziem J.B. | Utilization of growth monitoring and promotion is highest among children aged 0–11 months: a survey among mother-child pairs from rural northern Ghana | 2021 | BMC Public Health | Background: More than half of all deaths in under 5 children is related to malnutrition. Child malnutrition could be prevented through regular monitoring of the growth and development of children and the implementation of growth promotion activities referred to as growth monitoring and promotion (GMP). Mothers’/caregivers utilization of these activities through child welfare clinics could improve the growth and development of under 5 children. We evaluated mothers’ knowledge on GMP, utilization and associated factors among mother-child pairs from a poor socio-economic district in Northern Ghana. Methods: Using an analytical cross-sectional design, participants included mothers with children aged 0–59 months, grouped into 0–11 months, 12–23 months and 24–59 months. A semi-structured questionnaire containing both closed- and open-ended questions was used to collect data. Multivariate logistic regression was used to identify determinants of GMP utilization. Results: Four hundred mother-child pairs were included in the study. Overall, 28.5% (n = 114) of the mothers utilized GMP services. Almost 60%(n = 237) of the mothers knew the recommended age to seek for GMP service for their children. Only 9% of the mothers could correctly interpret the directions of the growth curves in their children’s Health Record booklet. Mothers with children aged 0–11 months were 3.9 times more likely (p = 0.009) to utilize GMP services compared to their counterparts with children aged 12–23 months and 24–59 months. Mothers who had low level of knowledge were 2.19 times (p = 0.003) more likely to utilize GMP services compared to their counterparts with high level of knowledge. Conclusion: Utilization of GMP services was low and particularly lower in children aged 24–59 months. Mothers’ knowledge in GMP was optimal although there were notable gaps. © 2021, The Author(s). | Open |
| Smith L.; Il Shin J.; McDermott D.; Jacob L.; Barnett Y.; López-Sánchez G.F.; Veronese N.; Yang L.; Soysal P.; Oh H.; Grabovac I.; Koyanagi A. | Association between food insecurity and depression among older adults from low- and middle-income countries | 2021 | Depression and Anxiety | Background: To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa). Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations. Results: In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82–3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65–3.57) times higher odds for depression. Conclusions: In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted. © 2021 Wiley Periodicals LLC | Open |
| Sommer C.L.; Wankier A.P.; Obiri-Yeboah S.; Gyamfi S.; Frimpong B.A.; Dickerson T. | A Qualitative Analysis of Factors Impacting Comprehensive Cleft Lip and Palate Care in Ghana | 2021 | Cleft Palate-Craniofacial Journal | Objective: The objective of this study was to examine practices regarding cleft lip and palate (CLP) among medical professionals and caregivers of children with CLP and to identify barriers and facilitators to comprehensive CLP care at a hospital in West Africa. Design: Qualitative methods used consisted of individual semistructured interviews with caregivers of children with CLP and one focus group with CLP team members. Setting: A majority of the interviews took place in the hospital, with some occurring during home visits. The focus group was conducted in the same hospital. Participants: Forty-five caregivers of children with CLP and 1 adult with CLP completed an interview. Additionally, 2 of the caregivers had CLP and completed an interview from their perspective. The focus group consisted of 13 CLP team members from a comprehensive CLP team in Ghana. Interventions: Interviews consisted of semistructured, open-ended questions, and the focus group relied on a discussion guide. Line-by-line coding was used to identify common themes regarding barriers and facilitators to CLP care. Results: Barriers to CLP care that were consistent across caregiver interviews and the focus group were lack of knowledge regarding CLP, stigma and cultural beliefs surrounding CLP, transportation, financial, and feeding/nutrition issues. Barriers to care identified in the interviews and focus group were similar; however, facilitators to care varied greatly between the 2. Conclusions: Two different qualitative methods provided unique perspectives on barriers and facilitators to CLP care. However, patients and caregivers continue to face substantial barriers to obtaining care. © American Cleft Palate-Craniofacial Association. All rights reserved 2020. | Open |
| Tandoh M.A.; Appiah A.O.; Edusei A.K. | Prevalence of Anemia and Undernutrition of Adolescent Females in Selected Schools in Ghana | 2021 | Journal of Nutrition and Metabolism | Anemia among adolescent females is a major worldwide public health problem which should be given appropriate attention. Half of all anemic cases are caused by iron deficiency. In addition to anemia, poor nutrition is also a challenge in sub-Saharan Africa. This study determined the prevalence of anemia and undernutrition among adolescent females in school. A cross-sectional study was conducted among 151 adolescent females in four basic schools in the Ahafo region of Ghana. The hemoglobin level and anthropometry measures of participants were taken to determine their anemic and nutritional status. The prevalence of anemia among adolescent females in school was 50.3%. Out of the 151 participants, 6.6%, 19.9%, and 23.8% were severely anemic, moderately anemic, or mildly anemic, respectively. Only 2% of the participants were underweight, but the rate of stunting was 26.5%. The notable high prevalence of anemia that was found among adolescent females was correlated with other health and wellness concerns. Anemia and under nutrition negatively affect academic performance, productivity, and general wellbeing of adolescents; therefore, effective measures should be put in place to correct and eradicate these nutritional problems. © 2021 Marina Aferiba Tandoh et al. | Open |
| Tetteh J.; Appiah A.K.; Abaidoo C.S.; Adjei-Antwi C. | The forensic use of percutaneous femur length in height and sex estimation among Ghanaians | 2021 | Forensic Science International: Reports | Height and sex play crucial roles in the identification of an individual. Height is influenced by nutrition, genetics and, climatic conditions, among others. In most developed countries, there exist well-structured osteometric data for the determination of height and sex. However, there is little anthropometric data for the determination of height and sex in Ghana. This study aimed at determining the height and sex of participants using percutaneous femoral lengths. The height and percutaneous femur length were measured, and sex was determined as indicated on the data collection form. Regression analysis and binary logistic regression were used for height and sex determination respectively. Five hundred five individuals participated in this study with 261 males and 244 females. Males were significantly taller than females (p<0.05). Males also presented with significantly longer femoral lengths than females (p<0.05). The right femoral length was numerically longer but not statistically different from their respective lengths on the left. There were significant correlations between left and right femoral lengths and height in both sexes. The left percutaneous femur showed the highest correlation with height in males (0.727) and females (0.413). The left femoral length was the best parameter of sex determination for the male participants (62.1%). In contrast, the right femoral length was the best sex determinant for females (57%). The findings of this study can be employed in forensic cases to estimate the height and sex of victims to narrow down on the search pool in the Ghanaian population. Availability of data and material: Data and materials would be made available upon request. © 2021 The Authors | Open |
| Thow A.M.; Apprey C.; Winters J.; Stellmach D.; Alders R.; Aduku L.N.E.; Mulcahy G.; Annan R. | Understanding the Impact of Historical Policy Legacies on Nutrition Policy Space: Economic Policy Agendas and Current Food Policy Paradigms in Ghana | 2021 | International journal of health policy and management | BACKGROUND: The global food system is not delivering affordable, healthy, diverse diets, which are needed to address malnutrition in all its forms for sustainable development. This will require policy change across the economic sectors that govern food systems, including agriculture, trade, finance, commerce and industry - a goal that has been beset by political challenges. These sectors have been strongly influenced by entrenched policy agendas and paradigms supported by influential global actors such as the World Bank and International Monetary Fund (IMF). METHODS: This study draws on the concept of path dependency to examine how historical economic policy agendas and paradigms have influenced current food and nutrition policy and politics in Ghana. Qualitative data were collected through interviews with 29 relevant policy actors, and documentary data were collected from current policies, academic and grey literature, historical budget statements and World Bank Group Archives (1950-present). RESULTS: Despite increased political priority for nutrition in Ghana, its integration into food policy remains limited. Food policy agendas are strongly focused on production, employment and economic returns, and existing market-based incentives do not support a nutrition-sensitive food supply. This policy focus appears to be rooted in a liberal economic approach to food policy arising from structural adjustment in the 1980s and trade liberalization in the 1990s, combined with historical experience of 'failure' of food policy intervention and an entrenched narrowly economic conception of food security. CONCLUSION: This study suggests that attention to policy paradigms, in addition to specific points of policy change, will be essential for improving the outcomes of food systems for nutrition. An historical perspective can provide food and health policy-makers with insights to foster the revisioning of food policy to address multiple national policy objectives, including nutrition. © 2021 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. | Open |
| van der Heijden T.G.W.; Chilunga F.P.; Meeks K.A.C.; Addo J.; Danquah I.; Beune E.J.; Bahendeka S.K.; Klipstein-Grobusch K.; Mockenhaupt F.P.; Waltz M.M.; Agyemang C. | The magnitude and directions of the associations between early life factors and metabolic syndrome differ across geographical locations among migrant and non-migrant ghanaians—the rodam study | 2021 | International Journal of Environmental Research and Public Health | Background: Early-life factors (ELFs) such as childhood nutrition and childhood socioeconomic status could be the drivers of the increase in metabolic syndrome (MetSyn) among African populations, but data are lacking. This study evaluated whether markers of childhood nutritional status and childhood socio-economic status were associated with MetSyn in adulthood among migrant Ghanaians living in Europe and non-migrant Ghanaians living in Ghana. Methods: Data from the Research on Obesity and Diabetes among African Migrants (RODAM) study, involving 2008 migrants and 2320 non-migrants aged ≥25 years, were analysed for this study. We used leg-length to height ratio (LHR), which is an anthropometric marker of childhood nutritional status, and parental education, which is a marker of childhood socio-economic status, as proxies. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) were calculated by logistic regression with adjustments for demographic and lifestyle factors. Results: Parental education was higher among Ghanaians in Europe than among residents in rural and urban Ghana. The prevalence of MetSyn was 18.5%, 27.7% and 33.5% for rural, urban, and migrant residents, respectively. LHR was inversely associated with MetSyn among migrants. Compared with high paternal education, individuals with low paternal education had lower odds of MetSyn in migrants (AOR 0.71 95% CI 0.54–0.94). In contrast, compared with high maternal education, individuals with intermediate maternal education had higher odds of MetSyn in urban Ghanaians (AOR 4.53 95% CI 1.50–3.74). No associations were found among rural Ghanaians. Conclusion: The magnitude and direction of the associations between ELFs and MetSyn differ across geographical locations. Intermediate maternal education was positively associated with MetSyn among urban Ghanaians, while LHR and low paternal education were inversely associated with MetSyn among migrant Ghanaians. Further research into the interplay of genetics, environment and behaviour is needed to elucidate the underlying pathological mechanisms of MetSyn amongst migrants. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Watson D.; Kehoe S.H.; Erzse A.; Compaoré A.; Debpuur C.; Nonterah E.A.; Sorgho H.; Norris S.A.; Hofman K.J.; Lawrence W.; Newell M.-L.; Godfrey K.M.; Ward K.A.; Barker M. | Community perspectives on maternal and child health during nutrition and economic transition in sub-Saharan Africa | 2021 | Public Health Nutrition | Objective: To explore community perceptions on maternal and child nutrition issues in Sub-Saharan Africa. Design: Thirty focus groups with men and women from three communities facilitated by local researchers. Setting: One urban (Soweto, South Africa) and two rural settings (Navrongo, Ghana and Nanoro, Burkina Faso) at different stages of economic transition. Participants: Two hundred thirty-seven men and women aged 18-55 years, mostly subsistence farmers in Navrongo and Nanoro and low income in Soweto. Results: Differences in community concerns about maternal and child health and nutrition reflected the transitional stage of the country. Community priorities revolved around poor nutrition and hunger caused by poverty, lack of economic opportunity and traditional gender roles. Men and women felt they had limited control over food and other resources. Women wanted men to take more responsibility for domestic chores, including food provision, while men wanted more involvement in their families but felt unable to provide for them. Solutions suggested focusing on ways of increasing control over economic production, family life and domestic food supplies. Rural communities sought agricultural support, while the urban community wanted regulation of the food environment. Conclusions: To be acceptable and effective, interventions to improve maternal and child nutrition need to take account of communities' perceptions of their needs and address wider determinants of nutritional status and differences in access to food reflecting the stage of the country's economic transition. Findings suggest that education and knowledge are necessary but not sufficient to support improvements in women's and children's nutritional status. © 2021 Cambridge University Press. All rights reserved. | Open |
| Wright L.; Konlan M.B.; Boateng L.; Epps J.B. | Nutrition risk and validation of an HIV disease-specific nutrition screening tool in Ghana | 2021 | South African Journal of Clinical Nutrition | Objectives: The objectives of this study were to assess the nutritional status and the most commonly reported nutrition-related factors contributing to nutritional risk in people living with HIV/AIDS (PLWHA) in Ghana and the specificity and sensitivity of the Rapid Nutrition Screening for HIV disease tool (RNS-H) in this population. Design: A cross-sectional design was utilised. Patients were screened for nutritional status during a one-week period by clinic nurses using the RNS-H. Results were compared with a comprehensive nutritional assessment by a dietitian. Setting: The research was conducted in a public health clinic at the University of Ghana Hospital, Legon. Subjects: Patients receiving care at the clinic were asked to participate. Outcome measures: The nutritional screening and nutritional assessment both resulted in participants being assigned to one of three nutritional statuses: ‘low risk’, ‘at risk’ and ‘high risk’. The association between the nutritional screening and nutritional assessment was measured. Results: The results of the nutritional status assigned by the RNS-H and nutritional assessment were compared. A total of 51 patients participated. A high prevalence of nutritional risk based on the RNS-S (54.9%) was found with 33.3% of the sample being malnourished. The most common nutrition-related complications were food insecurity, poor appetite, weight loss and diarrhoea. Conclusions: The RNS-H was found to have a strong specificity and sensitivity in a sample of Ghanaian PLWHA. Because of the nutritional risk and complexity of HIV in Ghana, nutritional screening using the RNS-H and nutrition care by a dietitian should be a standard of care. © 2019 The Author(s). Co-published by NISC Pty (Ltd) and Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Abu B.A.Z.; Raubenheimer J.E.; Louise van den Berg V. | Iron-focussed nutritional status of mothers with children (6–59 months) in rural northern Ghana | 2020 | Heliyon | Background: Anaemia, especially iron deficiency anemia, is an important cause of morbidity and mortality in African women and children. Aim: To assess the intake of nutrients related to iron and anaemia status among mothers in smallholder agrarian communities in Northern Ghana where anaemia is known to be endemic. Setting: Tolon Kumbumgu district and Tamale Metropolis in Ghana. Methods: A cross-sectional study was conducted among 161 mothers with children 6–59 months. Questionnaires on socio-demographics, household food security and production and food frequencies, and three 24-hour recalls were administered during structured interviews, and BMI was assessed. Dietary intakes were analysed with the Ghana Nutrient Database® (version 6.02). Nutrient intake was evaluated using the estimated average requirements and iron intakes using the probability method. Results: Most mothers (91.9%) had low literacy and were subsistence farmers. The staple diet was homemade unrefined, unfortified maize meal, homemade unfortified oil (shea butter), and seasonal green leafy vegetables (mostly amaranth), butternut, tomatoes, onions and legumes. Inadequate intakes of vitamin A (in 9.9%), folate (in 46.6%) and vitamin B12 (in 98.8%) were observed, in combination with high fibre (47.8 ± 19.0 g/day) intakes and high tea consumption. If 10% iron bio-availability was assumed, 33.1% were estimated to have inadequate iron intake; if 5% iron bio-availability was assumed, 80.8% were estimated to have inadequate iron intakes. Conclusion: In these low socio-economic agrarian communities, mothers of infants are living on home produce and rarely consumed foods (fortified salt, cooking oil and wheat flour) from the national food fortification programmes intended to address anaemia and other micronutrient deficiencies. © 2020 The Author(s); Health sciences; Public health; Hematological system; Women's health; Anthropology; Nutrition; Subsistence farming; Anaemia; Food fortification; Micronutrient intake; Women © 2020 The Author(s) | Open |
| Acheampong A.K.; Aziato L.; Marfo M.; Amevor P. | Breastfeeding and caring for children: A qualitative exploration of the experiences of mothers with physical impairments in Ghana | 2020 | BMC Pregnancy and Childbirth | Background: Breastfeeding and caring for children demand time, energy and effort. Mothers with physical impairments in Ghana require special needs to be able to achieve optimal motherhood as society demands. Globally, literature on breastfeeding and caring for children among mothers with physical disabilities is limited. Similarly, there is dearth of literature on the experiences of mothers with physical impairments in Ghana. Therefore, this study sought to add to literature by exploring the experiences of mothers with physical impairments with regards to breastfeeding and how they care for their children. Methods: Qualitative descriptive exploratory design was used. Twelve mothers with physical impairments who had been purposively sampled gave informed consent before data was collected through in-depth one-on-one interviews. Data was recorded, transcribed and analyzed inductively using the content analysis technique. Results: Mothers with physical impairments perceived breastfeeding as difficult and expensive due to issues relating to disruption of sleep, dysfunctional limbs and the need for breastfeeding mothers to eat nutritionally balanced meals. Participants felt prejudged and discriminated at different points in their daily encounters. Conclusion: Mothers with physical impairments have challenges. Therefore, attitudinal change should be advocated in the Ghanaian society with respect to issues concerning people living with disabilities. © 2020 The Author(s). | Open |
| Adams K.P.; Adu-Afarwuah S.; Mridha M.K.; Oaks B.M.; Matias S.L.; Arnold C.D.; Kumordzie S.M.; Okronipa H.; Ocansey M.E.; Dewey K.G. | The impact of maternal supplementation during pregnancy and the first 6 months postpartum on the growth status of the next child born after the intervention period: Follow-up results from Bangladesh and Ghana | 2020 | Maternal and Child Nutrition | Pregnancy and breastfeeding make demands on maternal nutrient stores. The extent of depletion and the degree to which nutrient stores are replenished between pregnancies has implications for a mother's nutritional status at conception of the subsequent child and therefore that child's birth outcomes and growth. Using follow-up data collected several years after a randomized effectiveness trial conducted in rural Bangladesh and a randomized efficacy trial conducted in semiurban Ghana, we evaluated the impact of maternal supplementation with small-quantity lipid-based nutrient supplements (LNS) or multiple micronutrients (MMN) through pregnancy (the index pregnancy) and 6 months postpartum on the growth status of the next living younger sibling conceived and born after the index pregnancy. In both Bangladesh (n = 472 younger siblings) and Ghana (n = 327 younger siblings), there were no overall differences in the growth status or the prevalence of undernutrition among younger siblings whose mothers had received LNS (or MMN, Ghana only) during and after the index pregnancy compared with the younger siblings of mothers who had received iron plus folic acid (IFA) during the index pregnancy (Ghana) or during and for 3 months after the index pregnancy (Bangladesh). These findings do not indicate that preconception nutrition interventions do not improve child growth. Rather, they suggest that any benefits of maternal LNS or MMN supplementation during one pregnancy and for 6 months postpartum are unlikely to extend to the growth of her next child beyond any effects due to IFA alone. © 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd. | Open |
| Adekambi S.A.; Okello J.J.; Rajendran S.; Acheremu K.; Carey E.E.; Low J.; Abidin P.E. | Effect of varietal attributes on the adoption of an orange-fleshed sweetpotato variety in Upper East and Northern Ghana | 2020 | Outlook on Agriculture | Despite sustained economic growth and reduction in some of forms of malnutrition, Ghana still faces a national prevalence rate of 20.8% vitamin A deficiency (VAD) among for children 6–59 months old. Orange-fleshed sweetpotato (Ipomoea batatas L.) (OFSP) can significantly improve vitamin A intake and contribute toward reducing VAD, especially in Northern Ghana where VAD is 31% among young children. Several poverty and nutrition projects in Ghana have promoted the use of OFSP for its health benefits. This study assesses the effect of three varietial attributes on adoption of the first released OFSP variety in Northern Ghana namely, Apomuden. The study concluded that sweetness, taste and dry matter have joint significant effects on adoption of an OFSP variety. The positive and negative traits highlighted will inform the on-going breeding effort. © The Author(s) 2020. | Open |
| Adu-Afarwuah S. | Impact of nutrient supplementation on maternal nutrition and child growth and development in Sub-Saharan Africa: the case of small-quantity lipid-based nutrient supplements | 2020 | Maternal and Child Nutrition | Micronutrient deficiencies remain common among women and children in Sub-Saharan Africa (SSA); in pregnant/lactating women, the intakes of essential fatty acids may also be low. Enriching home-prepared foods with small-quantity lipid-based nutrient supplements (SQ-LNSs) is a promising new strategy of delivering additional micronutrients, essential fatty acids and good quality protein to women and children. This narrative review aimed to examine the impact of SQ-LNSs supplementation among women and infants and young children in SSA, and to discuss the differential impact of SQ-LNS consumption across different settings. Papers reporting randomized trials conducted in SSA in which apparently healthy women and/or ≥6-mo-old children received SQ-LNSs were identified through electronic and manual searches. Prenatal SQ-LNS consumption reduced the prevalence of low gestational weight gain in Ghana when compared with multiple micronutrients supplementation, and was associated with poorer iron/hemoglobin status when compared with iron-plus-folic acid supplementation. SQ-LNSs received alone or as intervention package improved infant/child growth in two trials in Ghana and one trial each in Burkina Faso, Kenya, Zimbabwe and South Africa, but had no impact on growth in two trials in Malawi. SQ-LNSs supplementation improved motor development in Ghana, Burkina Faso, Malawi, Kenya, and South Africa, but had no impact on language, socio-emotional, and executive functions in Ghana and Malawi and on Griffiths’ developmental scores in Malawi. SQ-LNSs may contribute to improving child growth in SSA. More research is needed to determine the iron level in SQ-LNSs effective for improving both maternal hemoglobin/iron status and birth outcomes. © 2020 The Author. Maternal & Child Nutrition published by John Wiley & Sons Ltd | Open |
| Afriyie D.K.; Asare G.A.; Amponsah S.K.; Godman B. | COVID-19 pandemic in resource-poor countries: challenges, experiences and opportunities in Ghana | 2020 | Journal of Infection in Developing Countries | The novel coronavirus, SARS-CoV-2, which causes COVID-19, is seen world-wide. In developing countries, adequate health facilities and staff numbers are a concern. Ghana recorded its first 2 cases of COVID-19 on 12 March 2020. On 30 March 2020, a partial lockdown for 14 days was imposed and later extended along with other measures. By the end of the initial lockdown, 19 April 2020, an estimated 86,000 people had been traced and 68,591 tests performed. Of the 68,591 tests, there were 1,042 (1.5%) positive cases, 9 deaths, and 99 recoveries, with Ghana ranked number one among African countries in administering tests per million people. Ghana’s effective track and trace system, as well as lockdown and other measures, have helped limit mortality with only 85 recorded deaths by 23 June 2020. Scientists from three facilities of the University of Ghana have also successfully sequenced the genomes of COVID-19 from 15 confirmed cases, and the Food and Drugs Authority in Ghana have also helped address shortages by fast-tracking certification of hand sanitizers and local production of 3.6 million standardized personal protective equipment. There has also been the development of prototypes of locally-manufactured mechanical ventilators to meet local need at intensive care units. Most people have also resorted to changing diets and the use of supplements to boost their immune system. Although initial results are encouraging, further research is needed to understand the dynamics of COVID-19 in Ghana and provide additional guidance. Copyright © 2020 Afriyie et al. | Open |
| Agbozo F.; Abubakari A.; Der J.; Jahn A. | Maternal dietary intakes, red blood cell indices and risk for anemia in the first, second and third trimesters of pregnancy and at predelivery | 2020 | Nutrients | As anemia remains a major public health problem in Ghana, we examined the effect of dietary intakes, and antenatal care (ANC) practices on red cell indices and anemia prevalence during the pregnancy continuum for 415 women. Dietary history was taken using the Food and Agriculture Organization minimum dietary diversity indicator for women (MDD-W). Intake of ≥5 food groups was a proxy for micronutrient adequacy. Odds for anemia and meeting the MDD-W were estimated using ordinal and binary logistic regressions respectively. Intakes of 41.4% were micronutrient inadequate. At any time point in pregnancy, 54.4% were anemic (mild = 31.1%; moderate = 23.1%; severe = 0.2%) with 10%-point variation across the first (57.3%), second (56.4%) and third (53.3%) trimesters and pre-delivery (47.7%); 27.8% were anemic throughout pregnancy while 17.1% were never anemic. Morphologically, microcytic (79.4%) and hypochromic (29.3%) anemia were most prevalent, indicating nutritional deficiencies. Planning the pregnancy was a significant determinant for meeting the MDD-W. Overall, adolescence, poor diet, suboptimum ANC and underweight were associated with moderate and severe anemia. In specific time-points, dietary counselling, malaria, iron-folic acid supplementation, sickle cell disease and preeclampsia were observed. Decline of anemia during pregnancy suggests the positive impact of ANC services and supports strengthening education on dietary diversification during ANC. © 2020 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Aheto J.M.K. | Simultaneous quantile regression and determinants of under-five severe chronic malnutrition in Ghana | 2020 | BMC Public Health | Background: Under-five malnutrition is a major public health issue contributing to mortality and morbidity, especially in developing countries like Ghana where the rates remain unacceptably high. Identification of critical risk factors of under-five malnutrition using appropriate and advanced statistical methods can help formulate appropriate health programmes and policies aimed at achieving the United Nations SDG Goal 2 target 2. This study attempts to develop a simultaneous quantile regression, an in-depth statistical model to identify critical risk factors of under-five severe chronic malnutrition (severe stunting). Methods: Based on the nationally representative data from the 2014 Ghana Demographic and Health Survey, height-for-age z-score (HAZ) was estimated. Multivariable simultaneous quantile regression modelling was employed to identify critical risk factors for severe stunting based on HAZ (a measure of chronic malnutrition in populations). Quantiles of HAZ with focus on severe stunting were modelled and the impact of the risk factors determined. Significant test of the difference between slopes at different selected quantiles of severe stunting and other quantiles were performed. A quantile regression plots of slopes were developed to visually examine the impact of the risk factors across these quantiles. Results: Data on a total of 2716 children were analysed out of which 144 (5.3%) were severely stunted. The models identified child level factors such as type of birth, sex, age, place of delivery and size at birth as significant risk factors of under-five severe stunting. Maternal and household level factors identified as significant predictors of under-five severe stunting were maternal age and education, maternal national health insurance status, household wealth status, and number of children under-five in households. Highly significant differences exist in the slopes between 0.1 and 0.9 quantiles. The quantile regression plots for the selected quantiles from 0.1 to 0.9 showed substantial differences in the impact of the covariates across the quantiles of HAZ considered. Conclusion: Critical risk factors that can aid formulation of child nutrition and health policies and interventions that will improve child nutritional outcomes and survival were identified. Modelling under-five severe stunting using multivariable simultaneous quantile regression models could be beneficial to addressing the under-five severe stunting. © 2020 The Author(s). | Open |
| Akuffo A.S.; Quagrainie K.K.; Obirikorang K.A. | Analysis of the determinants of fish consumption by households in Ghana | 2020 | Aquaculture Economics and Management | A sample of 2,185 Ghanaian households from the GLSS6 was examined using a latent class model of structural heterogeneity in a linear regression framework to assess their fish consumption patterns. The results suggest that Ghanaian households fall into two consumption categories, namely “traditional” and “non-traditional” households, though there is some overlap between the two household groups. Demand for fish is price inelastic in traditional households and approximately unitary elastic in non-traditional households. In traditional households, fish is complementary to poultry but a substitute for red meat. Among non-traditional consumers, fish is complementary to poultry but a substitute for red meat and pork. While price is a major concern for traditional consumers, taste, diversity, health and nutrition are more important to non-traditional consumers. Traditional consumers are in the forest region while the non-traditional consumers are in the Savannah areas. © 2020, © 2020 Taylor & Francis Group, LLC. | Open |
| Alatinga K.A.; Daniel M.; Bayor I. | Community Experiences with Cash Transfers in Relation to Five SDGs: Exploring Evidence from Ghana’s Livelihood Empowerment Against Poverty (LEAP) Programme | 2020 | Forum for Development Studies | Social protection, which includes cash transfers, is a policy response addressing poverty and vulnerability. This paper examines the effects of cash transfers, in particular Ghana’s LEAP Programme, on the Sustainable Development Goals (SDGs). The paper examines the transformative potential of cash transfers by focusing on subjective, relational and psychosocial effects in addition to the reduction in poverty and vulnerability. The paper argues that giving the LEAP cash alone is not sufficient to address long-term poverty, but it is a necessary condition to serve as an instrument for social and economic transformation. Using a qualitative exploratory research design involving 20 in-depth interviews and seven focus group discussions, participants reported that LEAP cash had made them better off in both material and psychological dimensions of poverty, increased food security and nutrition and removed financial barriers to access health care. The cash capacitated women in decision-making, and strengthened peaceful co-existence both at family and community level. However, the LEAP may engender intra-community tensions emanating from sentiments of jealousy and perceived unfairness in the selection of beneficiaries. © 2019, © 2019 Norwegian Institute of International Affairs (NUPI). | Open |
| Amakye W.K.; Bozovic S.; Faraque A.; Yao M.; Ren J. | Nutrition education in medical school: The case of international medical students in China | 2020 | BMJ Nutrition, Prevention and Health | Objective To assess the knowledge on country-specific nutrition situation, perceptions of the nutrition curricula and factors influencing capacity to offer nutrition guidance among medical students studying internationally in China compared with their home-country counterparts. Design Cross-sectional study. Settings China, Ghana, India and Montenegro. Participants International medical students in China and medical students studying in their home countries of Ghana, India and Montenegro. Main measure An online semistructured questionnaire was administered using WeChat for international students and Microsoft Forms for home-country medical students to assess students' perceived knowledge and significance of nutrition, knowledge of country-specific nutrition situation, perceptions of the nutrition curricula and perceived capacity to offer nutrition counselling. Result In all, 190 medical students responded to the survey: 110 international students studying in China and 80 home-country students from Ghana (40), India (20) and Montenegro (20). Home-country students rated the importance of nutrition in health and disease development higher than international students (p<0.05). International students reported not having any specific nutrition courses while home-country students had nutrition courses as part of their curriculum. Only 8.2% of international students and 13.8% of home-country students were able to correctly mention any specific national nutrition guidelines of their home countries. Home-country students were more likely to provide correct nutrition recommendations for infants (χ2(3)=26.349; p=0.001), pregnancy (χ2(3)=9.793; p=0.007), lactating mothers (χ2(3)=9.112; p=0.011), diabetes (χ2(3)=13.619; p=0.001), hypertension (χ2(3)=12.022; p=0.002), overweight/obesity (χ2(3)=8.896; p=0.012) and undernutrition (χ2(3)=7.670; p=0.022) compared with international students. Practical nutrition courses, hours of nutrition education and how often students were asked nutrition-related questions tended to affect and predict the adequacy of nutrition education received and the perceived confidence for nutrition counselling. Conclusion International medical students in China are less familiar with the nutrition context in their respective home countries compared with their home-country counterparts. Medical schools in China that train significant numbers of international students need to support these students to become familiar with their respective countries' nutrition contexts. © 2020 BMJ Publishing Group. All rights reserved. | Open |
| Amponsah S.B.; Osei E.; Aikins M. | Process Evaluation of Maternal, Child Health and Nutrition Improvement Project (MCHNP) in the Eastern Region of Ghana: A Case Study of Selected Districts | 2020 | BioMed Research International | Background. Maternal, Child Health and Nutrition improvement Project is a World Bank-funded project implemented in all then ten regions of Ghana, which aims at improving access and utilization of community-based maternal, child health, and nutrition services in order to accelerate progress. This study is aimed at determining the implementation status of the project in the Eastern region by evaluating the processes involved and identifying implementation barriers from the perspective of implementors. Methods. The study was a cross-sectional in design and employed a quantitative data collection approach in ten Community-based Health Planning and Services (CHPS) centres in five districts in the region. The project coordinators and Community Health Officers were interviewed using a structured questionnaire. The project implementation reports at the facility level were reviewed using a checklist. Tertile statistic was used to describe the status of the project implementation. Result. The finding from this study indicated "complete implementation status"for maternal, child health, and nutrition activities of the project. However, none of the facilities evaluated had satisfactorily implemented all the governance processes and were therefore rated as "partially complete."The main implementation barriers emerged from the study were related to restrictions placed on the use of project funds and delays in the fund disbursement to CHPS facilities. Conclusion. The evidence gathered from the study showed very good implementation status for community-led maternal and child health service delivery, indicative of a positive response to the guidelines by service providers at the periphery and can have positive impact on the project's objectives and goals. Governance component of the project, however, revealed inadequate alignment with guidelines which might have been influenced by the lack of knowledge as a result of lack of training for implementers. This therefore calls for in-service training and improved supportive supervision at both administrative and service delivery levels. © 2020 Solomon Boamah Amponsah et al. | Open |
| Anin S.K.; Saaka M.; Fischer F.; Kraemer A. | Association between infant and young child feeding (Iycf) indicators and the nutritional status of children (6–23 months) in Northern Ghana | 2020 | Nutrients | Although recommended infant and young child feeding (IYCF) practices have been found to be protective against undernutrition in some settings, there is no finality yet due to inconsistencies in the literature. A cross-sectional survey of 581 mother-child pairs was conducted in northern Ghana in June 2018. The association between IYCF indicators and child undernutrition (stunting and wasting) were assessed. The descriptive analysis showed that 66.4% of the children (6–23 months) were introduced to complementary feeding in a timely manner, 69.4% met the minimum meal frequency, and 38.9% met the minimum acceptable diet daily. The prevalence of stunting, wasting, underweight and overweight was 33.2%, 14.1%, 27% and 2.6%, respectively. From the multivariable binary logistic regression, child gender, child age group and source of power for lighting the household were significantly associated with wasting. Intake of iron-rich foods, child age group, and maternal height were significantly associated with stunting after adjusting for confounders. The prevalence of the compliance with IYCF indicators was relatively high. None of the individual IYCF indicators showed significant association with undernutrition, except intake of iron-rich foods for stunting. Nutrition-specific interventions targeted at improving IYCF practices, dietary diversification and intake of nutrient-rich meals, should be adopted and scaled up to address undernutrition in northern Ghana. © 2020 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Annan R.A.; Sowah S.A.; Apprey C.; Agyapong N.A.F.; Okonogi S.; Yamauchi T.; Sakurai T. | Relationship between breakfast consumption, BMI status and physical fitness of Ghanaian school-aged children | 2020 | BMC Nutrition | Background: Good nutrition and physical activity of school-aged children are important for ensuring optimum growth and reducing obesity. This present study assessed associations between breakfast consumption, BMI-for-Age (BMI) and physical fitness in a cross-section of school-aged children attending government-owned primary schools in Kumasi, Ghana. Method: The sample consisted of 438 pupils (boys = 213; girls = 225; mean age 11.1 ± 1.1), attending 10 randomly selected schools. Weight (kg), height (cm) and Mid Upper Arm Circumference (MUAC) were measured for each participant, and BMI-for-age z-scores determined using the World Health Organisation (WHO) anthroplus software. Participants were stratified into thinness, normal weight, overweight/obese using WHO cut offs. Physical fitness was assessed using forward jump, left and right handgrips, flexibility, sit-ups and 50 metre run following standard procedures and converted to scores of 1 to 10 following Japanese standards, based on which percentiles were derived. Total fitness score for each pupil was computed by adding all scores. A questionnaire was used to assess meal intake patterns. Results: The mean BMI-for-age z-score for participants was - 0.24 ± 0.99. Thinness, normal weight and overweight/obesity were 2.7, 86.5, and 10.5% respectively among the pupils. Overweight was higher in girls (14.2%) compared to boys (4.2%), p = 0.003. Similarly, mean MUAC was significantly (p = 0.021) higher in the girls (22.0 ± 3.2 cm) than the boys (20.7 ± 7.3 cm). For physical fitness, the girls scored higher in forward jump (p < 0.0001), 50-m run (p = 0.002) and overall fitness score than the boys (21.0 ± 6.2 versus 19.2 ± 8.3, p = 0.012). However, a larger proportion of boys performed excellently and poorly than girls (p = 0.019). A positive correlation was observed between BMI z-score and hand grip (r = 0.21, p < 0.001), while sit up (r = - 0.11, p = 0.018) showed a negative correlation with BMI z-score. No other fitness test varied by BMI. Overweight children performed best in handgrip. Majority of children said they engaged in exercise (89.9%) and consumed breakfast (78.9%). Breakfast consumption was not associated with BMI z-score (x2 0.0359, p = 0.549) but non-breakfast consumers performed better in 50 m run compared to consumers (7.0 seconds ± 2.3 vrs 6.3 seconds ± 2.5, p = 0.022). Children who reported to exercise were physically fitter than those who did not. Conclusion: Underweight levels were low while overweight was over 10% in these children. Girls were more than 3 times affected by overweight than boys, and were also physically fitter than boys. Breakfast consumption was not related to weight or fitness. © 2020 The Author(s). | Open |
| Antwi J.; Ohemeng A.; Boateng L.; Quaidoo E.; Bannerman B. | Primary school-based nutrition education intervention on nutrition knowledge, attitude and practices among school-age children in Ghana | 2020 | Global Health Promotion | This study was performed to evaluate the effect of a six-week nutrition education intervention on the nutrition knowledge, attitude, practices, and nutrition status of school-age children (aged 6–12 years) in basic schools in Ghana. Short-term effects of nutrition education training sessions on teachers and caregivers were also assessed. Pre-post controlled design was used to evaluate the program. Intervention groups had significantly higher nutrition knowledge scores (8.8 ± 2.0 vs. 5.9 ± 2.1, P < 0.0001) compared to controls in the lower primary level. A higher proportion of children in the intervention group strongly agreed they enjoyed learning about food and nutrition issues compared to the control group (88% vs. 77%, P = 0.031). There was no significant difference in dietary diversity scores (4.8 ± 2.0 vs. 5.1 ± 1.4, P = 0.184) or in measured anthropometric indices (3.6% vs. 8.2%, P = 0.08). A marginally lower proportion of stunted schoolchildren was observed among the intervention group compared to the control group (3.6% vs. 8.2%, P = 0.080). Nutrition knowledge of teachers and caregivers significantly improved (12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.031) and (5.86 ± 0.73 to 6.24 ± 1.02, P = 0.009), respectively. Nutrition education intervention could have positive impacts on knowledge and attitudes of school children, and may be crucial in the development of healthy behaviors for improved nutrition status. © The Author(s) 2020. | Open |
| Appiah P.K.; Nkuah D.; Bonchel D.A. | Knowledge of and Adherence to Anaemia Prevention Strategies among Pregnant Women Attending Antenatal Care Facilities in Juaboso District in Western-North Region, Ghana | 2020 | Journal of Pregnancy | Background. Anaemia in pregnancy is a major problem in both developed and developing countries. The commonest source of anaemia is nutritional deficiency of iron with evidence suggesting that up to 90% of maternal anaemia may be due to inadequate consumption of dietary iron; however, there are other causes which include worm infestation, HIV infection, and genetic disorders. There are some implemented approaches in Ghana including education and awareness creation, nutritional supplements, and control and prevention of parasitic infections among others to prevent and control anaemia in pregnancy. This study assessed pregnant women adherence to Ghana's anaemia prevention strategies being implemented in the Juaboso District. Method. A descriptive cross-sectional data on knowledge of and adherence to anaemia prevention strategies among pregnant women was collected. Pearson's chi-square and logistic regression models were used to assessed associations between predictor and outcome variables. A p value <0.05 was considered as statistically significant. Findings. About 13.5% of the pregnant women had high knowledge on anaemia, while 58.4% and 28.1% had moderate and low knowledge, respectively. Less than half (39.1%) of the women adhered to anaemia prevention strategies. There were significant associations between knowledge of anaemia and where pregnant woman resides in the district (AOR: 2.04, 95% CI: 2.16-9.83, p=0.003), woman's educational (AOR: 10.43, 95% CI: 6.14-51.63, p=0.002), and occupational status (AOR: 15.14, 95% CI: 13.57-18.43, p<0.001). Again, there were significant associations between adherence to anaemia prevention strategies and the woman's ethnicity (AOR: 0.61, 95% CI: 0.04-0.92, p=0.001) and her knowledge of anaemia (AOR: 3.88, 95% CI: 1.32-7.93, p=0.001). Conclusions. Pregnant women's knowledge of anaemia and adherence to anaemia prevention strategies are not encouraging. However, anaemia in pregnancy and its consequences could be devastating to all stakeholders if actions are not taken to reduce the phenomenon. Therefore, we recommend that more education and sensitisation programs including good nutritional practices in the diet of pregnant women be promoted to increase awareness and adherence to anaemia prevention strategies among pregnant women in the Juaboso District. © 2020 Prince Kubi Appiah et al. | Open |
| Apungu F.K.; Apprey C.; Amewu E.K.A.; Ahuno S.T.; Kwarteng A. | Nutritional and health status of people living with HIV/AIDS in the eastern region of Ghana | 2020 | Nutrition and Food Science | Purpose: The purpose of the study is to assess the nutritional and health status of people living with HIV/AIDS (18-60 years) in selected health facilities in the eastern region of Ghana and to determine the influence nutrition support programmes (NSP) have on the nutritional and health status of people living with HIV/AIDS. Design/methodology/approach: A retrospective study design was used. Purposive and convenience sampling was used to select four hospitals and 200 beneficiaries and non-beneficiaries of the NSP. A structured questionnaire was used to collect the sociodemographic, anthropometric, biochemical and clinical history of the participants. Dietary intake was assessed with food frequency and 24-h dietary intake questionnaires. Previous data from the medical record within three to six months before the research was collected and compared with current data. Findings: The prevalence of underweight (using body mass index) was 17 per cent and overweight/obesity was 37 per cent. Most respondents had adequate consumption of phosphorus (70.5 per cent); inadequate intake of calcium (95 per cent), vitamin E (77.5 per cent) and vitamin A (94 per cent); and excess intakes of sodium (93 per cent), selenium (77 per cent), copper (83.5 per cent) and manganese (76 per cent). There was no significant difference in nutrient intake of beneficiaries and non-beneficiaries of the NSP, although there were significant differences in the frequency of consumption of fruits (p < 0.001), vegetables (p < 0.001), legumes (p = 0.002), animal foods (p < 0.001) and cereals, grains and starch (p < 0.001) between beneficiaries and non-beneficiaries of NSP. About 38 and 20 per cent of respondents, respectively, had low haemoglobin (Hb < 11 g/dL) and high viral load (1,000 cp/mL). Comparing the current and previous (three to six months before the study) health and nutritional status of beneficiaries and non-beneficiaries of NSP, among the beneficiaries of NSP, monocytes increased by 40.6 per cent (p = 0.028) and mean weight decreased by 2.4 per cent (p = 0.007), Hb decreased by 7.1 per cent (p = 0.27) and viral load decreased by 4.2 per cent (p = 0.49), whereas among the non-beneficiaries, mean weight decreased by 0.05 per cent (p = 0.95) and Hb increased by 9.6 per cent (p = 0.06) and monocytes increased (p = 0.28) and viral load increased by 98.2 per cent (p = 0.34). Research limitations/implications: A significant proportion of people living with HIV/AIDS had a high prevalence of underweight and overweight/obesity, inadequate nutrients intake and high viral load. The NSP for people living with HIV/AIDS in the eastern region of Ghana did not significantly influence the nutritional and health status of these people. Practical implications: Knowing the nutritional status will help health institutions plan activities towards improving the health and nutritional status of people living with HIV/AIDS. This research is aimed at not only contributing to the existing body of knowledge but also making recommendations of action towards improving NSPs of people living with HIV/AIDS. Social implications: Improvement in nutritional and health status of people living with HIV/AIDS will help reduce morbidity and mortality and its related cost to families, communities and the nation. Originality/value: This study is first to determine the influence of NSPs on nutritional and health status of people living with HIV/AIDS in the eastern region of Ghana. © 2019, Emerald Publishing Limited. | Open |
| Aryeetey R.; Harding K.; Hromi-Fiedler A.; Pérez-Escamilla R. | Analysis of stakeholder networks for breastfeeding policies and programs in Ghana | 2020 | International Breastfeeding Journal | Background: Suboptimal breastfeeding practices are driven by multiple factors. Thus, a multi-sectoral approach is necessary to design and implement appropriate policies and programs that protect, promote, and support breastfeeding. Methods: This study used Net-Map, an interactive social network interviewing and mapping technique, to: a) identify key institutional actors involved in breastfeeding policy/programs in Ghana, b) identify and describe links between actors (i.e., command, dissemination, funding, and technical assistance (TA)), and c) document actors influence to initiate or modify breastfeeding policy/programs. Ten experts were purposively selected from relevant institutions and were individually interviewed. Interview data was analysed using social networking mapping software, Gephi (version 0.9.2). Results: Forty-six unique actors were identified across six actor categories (government, United Nations agencies, civil society, academia, media, others), with one-third being from government agencies. Dissemination and TA links accounted for two-thirds of the identified links between actors (85/261 links for dissemination; 85/261 for TA). Command links were mainly limited to government agencies, while other link types were observed across all actor groups. Ghana Health Service (GHS) had the greatest in-degree centrality for TA and funding links, primarily from United Nations Children's Fund (UNICEF) and development partners. The World Health Organization, UNICEF, Ministry of Health, and GHS had the highest weighted average relative influence scores. Conclusions: Although diverse actors are involved in breastfeeding policy and programming in Ghana, GHS plays a central role. United Nations and donor agencies are crucial supporters of GHS providing breastfeeding technical and financial assistance in Ghana. © 2020 The Author(s). | Open |
| Asimeng E.; Zhang S. | Exploring the Differences, Similarities and the Effect Between Chinese and Ghanaian Traditional Cuisines Towards a Better Appreciation and Consumption | 2020 | Advances in Intelligent Systems and Computing | With the growing trend of Ghanaians frequent travel to China and Chinese traveling to Ghana and their desire to still consume their indigenous foods, there raises the question of which similar food can be substituted which contains similar health benefits and nutrition. To solve this problem, a data base and a programming language are designed for one to strategized the difference, similarities, the health benefit and ingredients to be use in preparing some foods. A lot of people find it very difficult to get a healthier food when they travel outside their country but as human pursues ways to eat healthier food and improve quality of life, there is a need to create tables with a programing for the two country foods. A descriptive model of data mining was used during the survey. Secondary sources of data were employed as part of the data collection method. By reading different books and papers and visiting different websites, it was determined that most ingredient use in preparing Ghanaian traditional cuisine is the same as that of Chinese traditional cuisine and there is some bad effect when two foods are been eating together at the same time. The results show that the traditional ingredients of the Chinese are the same as that of the Ghanaians. In the promotion of traditional cuisine in Ghana and China with their health effect, and nutritional richness, tables are created using MySQL together with Node.js in Cloud9.io to know the number of users who make enquiry for the ingredients and health benefit of some traditional cuisines. © 2020, Springer Nature Switzerland AG. | Open |
| Asuman D.; Ackah C.G.; Fenny A.P.; Agyire-Tettey F. | Assessing socioeconomic inequalities in the reduction of child stunting in sub-Saharan Africa | 2020 | Journal of Public Health (Germany) | Aim: Health and nutrition in early childhood are essential for survival, growth and adult life outcomes. As such, a number of global and national interventions have been pursued to improve early childhood health and nutrition. However, child malnutrition is pervasive and endemic across the sub Saharan Africa. This paper therefore assesses the nature and trends of socioeconomic inequalities in child stunting. The paper proceeds to decompose the causes of such socioeconomic-related inequalities over the period covered. Subjects and methods: We used data from Demographic and Health Surveys (DHSs) for ten sub-Saharan African countries conducted between 2000 and 2016. The study employs an extension to the concentration index for binary health outcomes to measure socioeconomic inequalities in stunting and decompose the causes of inequalities in stunting using a generalized decomposition technique based on recentered influence function regressions. Results: The results show substantial pro-rich inequalities in child stunting across sub-Saharan Africa. The incidence of stunting are concentrated among children living in households with low socioeconomic status. In spite of persistent declines in the prevalence of stunting among children under 5 years across the study countries since 2000, trends in socioeconomic inequalities in stunting are mixed. We find significant contributions of child, maternal, and household characteristics to inequalities in child stunting. Conclusion: The results suggest that there is the need to design and target nutrition-based interventions at children in low socioeconomic households. In addition, promoting female education and improving access to health and nutrition information will be key to improving child nutrition across the region. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature. | Open |
| Aurino E.; Wolf S.; Tsinigo E. | Household food insecurity and early childhood development: Longitudinal evidence from Ghana | 2020 | PLoS ONE | The burden of food insecurity is large in Sub-Saharan Africa, yet the evidence-base on the relation between household food insecurity and early child development is extremely limited. Furthermore, available research mostly relies on cross-sectional data, limiting the quality of existing evidence. We use longitudinal data on preschool-aged children and their households in Ghana to investigate how being in a food insecure household was associated with early child development outcomes across three years. Household food insecurity was measured over three years using the Household Hunger Score. Households were first classified as “ever food insecure” if they were food insecure at any round. We also assessed persistence of household food insecurity by classifying households into three categories: (i) never food insecure; (ii) transitory food insecurity, if the household was food insecure only in one wave; and (iii) persistent food insecurity, if the household was food insecure in two or all waves. Child development was assessed across literacy, numeracy, social-emotional, short-term memory, and self-regulation domains. Controlling for baseline values of each respective outcome and child and household characteristics, children from ever food insecure households had lower literacy, numeracy and short-term memory. When we distinguished between transitory and persistent food insecurity, transitory spells of food insecurity predicted decreased numeracy (β = -0.176, 95% CI: -0.317; -0.035), short-term memory (β = -0.237, 95% CI: -0.382; -0.092), and self-regulation (β = -0.154, 95% CI: -0.326; 0.017) compared with children from never food insecure households. By contrast, children residing in persistently food insecure households had lower literacy scores (β = -0.243, 95% CI: -0.496; 0.009). No gender differences were detected. Results were broadly robust to the inclusion of additional controls. This novel evidence from a Sub-Saharan African country highlights the need for multi-sectoral approaches including social protection and nutrition to support early child development. © 2020 Aurino et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Awuni G.A.; Reynolds D.B.; Goldsmith P.D.; Tamimie C.A.; Denwar N.N. | Agronomic and economic assessment of input bundle of soybean in moderately acidic Savanna soils of Ghana | 2020 | Agrosystems, Geosciences and Environment | Integrated input for crop productivity can increase food security among smallholder farming systems. The study evaluated agronomic and economic response of four input bundle treatments on five soybean [Glycine max (L.) Merr.] cultivars conducted under rain-fed conditions over a 4-yr period in Ghana. Experiments were a randomized complete block in factorial arrangement with four replications. Input bundles were NoduMax inoculant (I), phosphorus application (P), inoculated seed followed by phosphorus application (I+P), and certified seed as control treatment. Cultivars were Afayak, Jenguma, Quarshie, Songda, and Suong-Pungun. Soils were moderately acidic (5.7 pH) with macro- and micronutrient deficiencies. Grain yield, mean gross margin (MGM), and benefit–cost ratio (BCR) for input bundles were in descending order I+P bundle > P bundle > I bundle > control. Yield was greater in I+P bundle over I bundle, P bundle, and control by 27, 16, and 65%, respectively. Grain yield, MGM, and BCR in descending cultivar order were Afayak > Jenguma > Suong–Pungun > Quarshie > Songda. Grain yield was greater in Afayak over Jenguma, Suong-Pungun, Quarshie, and Songda by 3, 11, 13, and 21%, respectively. Cultivar yield differences may be genetically driven. This study suggests smallholders can benefit from increased returns from inoculation + phosphorus synergy. The results indicate that low soybean yields in smallholder farms are not the result of high input cost or low prices but rather are due to the inability of farmers to shift from low input productivity to innovative production technologies. Integrating soybean as a commercial crop within staple crops of smallholder farmers can provide additional income and nutrition for households. © 2020 The Authors. Agrosystems, Geosciences & Environment published by Wiley Periodicals LLC on behalf of Crop Science Society of America and American Society of Agronomy | Open |
| Ayensu J.; Annan R.; Lutterodt H.; Edusei A.; Peng L.S. | Prevalence of anaemia and low intake of dietary nutrients in pregnant women living in rural and urban areas in the Ashanti region of Ghana | 2020 | PLoS ONE | Background Anaemia remains a major cause of morbidity and mortality among women and children worldwide. Because deficiencies in essential micronutrients such as iron, folate and vitamin B12 prior to and during gestation increase a woman's risk of being anaemic, adequate dietary intake of such nutrients is vital during this important phase in life. However, information on the dietary micronutrient intakes of pregnant women in Ghana, particularly of those resident in rural areas is scanty. Thus, this study aimed to assess anaemia prevalence and dietary micronutrient intakes in pregnant women in urban and rural areas in Ghana. Methods A comparative cross sectional study design involving 379 pregnant women was used to assess the prevalence of anaemia and low intake of dietary nutrients in pregnant women living in rural and urban areas in the Ashanti region of Ghana. Anaemia status and mid upper arm circumference (MUAC) were used as proxy for maternal nutritional status. Haemoglobin measurements were used to determine anaemia prevalence and the dietary diversity of the women were determined with a 24-hour dietary recall and a food frequency questionnaire. Results Overall, anaemia was present in 56.5% of the study population. Anaemia prevalence was higher among rural residents than urban dwellers. Majority of the respondents had inadequate intakes of iron, zinc, folate, calcium and vitamin A. The mean dietary diversity score (DDS) of the study population from the first 24-hour recall was 3.81 ± 0.7. Of the 379 women, 28.8% met the minimum dietary diversity for women (MDD-W). The independent predictors of haemoglobin concentration were, gestational age, maternal age and dietary diversity score. Such that respondents with low DDS were more likely to be anaemic than those with high DDS (OR = 1.795, p = 0.022, 95% CI: 1.086 to 2.967). Conclusions A large percentage of pregnant women still have insufficient dietary intakes of essential nutrients required to support the nutritional demands during pregnancy. Particularly, pregnant women resident in rural areas require interventions such as nutrition education on the selection and preparation of diversified meals to mitigate the effects of undernutrition. © 2020 Ayensu et al. | Open |
| Azupogo F.; Abizari A.-R.; Aurino E.; Gelli A.; Osendarp S.J.M.; Bras H.; Feskens E.J.M.; Brouwer I.D. | Malnutrition, hypertension risk, and correlates: An analysis of the 2014 ghana demographic and health survey data for 15–19 years adolescent boys and girls | 2020 | Nutrients | The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our indings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes. © 2020 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Badu D.B.; Lee Y. | Government agricultural subsidy programmes impact on rice production in Ghana from 2005 to 2018 | 2020 | African Journal of Food, Agriculture, Nutrition and Development | Agricultural subsidies are considered an essential tool of policy to improve food production (or productivity), farmers' income and welfare in developing countries. There is no doubt that the role of subsidies programmes is important for farmers or rural areas, but impacts of subsidies are different from crops, inputs, government programmes and so on. Over the past years, Ghana's agricultural sector has experienced policies changes such as Ghana Shared Growth and Development Agenda (GSGDA I and II), Food and Agricultural Sector Development Policy (FASDEP I and II) and Medium Term Agricultural Sector Investment Plan (METASIP I and II) that support improving agricultural productivity, creating jobs and increasing income. The government of Ghana recognizes that food and nutrition are high priorities and conducts various subsidy programmes of agricultural inputs and outputs. Rice is the second most consumed crop in Ghana. Rice consumption in Ghana would keep increasing due to the growing population, urbanization and change in consumer lifestyles or food preference. This study analyzed the impacts of different subsidy programmes on rice production across the 10 regions in Ghana. The data used in the study starts from 2005 to 2018. The first estimation model evaluated the impacts of before-subsidies and after-subsidies on rice production in Ghana. The results from the first model showed that rice production increased after subsidies. Specifically, fertilizer after subsidies had a positive impact on rice production. However, labor after subsidies did not have statistically significant effects on rice production. The second estimation model compared two different subsidy programmes: Fertilizer Subsidy Programme (FSP) and Planting for Food and Jobs (PFJ). This study found fertilizer with FSP was more effective than with PFJ; however, labor with FSP was less effective with PFJ. The programme of FSP was intensively focused on fertilizer; however, the programme PFJ aims to cover a diverse range of fertilizer, seed, extension services, marketing and so on. © 2020 African Scholarly Science Communications Trust (ASSCAT). | Open |
| Balana B.B.; Bizimana J.-C.; Richardson J.W.; Lefore N.; Adimassu Z.; Herbst B.K. | Economic and food security effects of small-scale irrigation technologies in northern Ghana | 2020 | Water Resources and Economics | Small-scale irrigation (SSI) technologies can be useful not only to increase crop productivity and income but also as a viable adaptation practice to climate variability. A farm simulation model (FARMSIM) and data from selected SSI technologies piloted in northern Ghana under the ‘Feed the Future-Innovation Lab for Small Scale Irrigation’ (ILSSI) project were used to assess the economic feasibility of the SSI technologies and their potential to improve income and nutrition of smallholder farm households. Three dry season irrigated crops (onion, corchorus, amaranthus) grown under three agricultural water management regimes were analysed. Results show that adoption of the SSI technologies could increase the net farm profit by 154%–608% against the baseline depending on the ‘crop type - SSI technology’ combination. Nutrition levels also improved significantly as a result of the improvements in crop yields due to irrigation and use of complementary inputs. However, the results further reveal that the options that utilize capital-intensive SSI technologies such as solar-powered water pumps to grow high value cash crops are constrained by the high investment cost. Currently, farmers tend to choose low-cost SSI technologies such as a traditional watering-cans, which generate low economic returns. Improving access to credit or alternative financing schemes could mitigate the capital constraints and enable smallholders to gain more benefits from participating in market-oriented high-value irrigated production. © 2019 Elsevier B.V. | Open |
| Berhane Y.; Canavan C.R.; Darling A.M.; Sudfeld C.R.; Vuai S.; Adanu R.; Bärnighausen T.; Dessie Y.; Bukenya J.N.; Guwatudde D.; Killewo J.; Sando M.M.; Sie A.; Oduola A.M.J.; Fawzi W.W. | The age of opportunity: prevalence of key risk factors among adolescents 10–19 years of age in nine communities in sub-Saharan Africa | 2020 | Tropical Medicine and International Health | Objective: To measure health-related behaviours and risk factors among sub-Saharan African adolescents. Methods: Cross-sectional study in nine communities in Burkina Faso, Ethiopia, Eswatini, Ghana, Nigeria, Tanzania and Uganda between 2015 and 2017. Community-representative samples of males and females 10–19 years of age were selected. All communities used a uniform questionnaire that was adapted from the WHO Global School-based Student Health Survey. Weighted prevalence estimates and 95% confidence intervals were calculated for each indicator and stratified by age and sex using SAS version 9.4. All prevalence estimates were pooled across communities through random-effects meta-analyses in Stata version 14. Results: A total of 8075 adolescents participated in the study. We observed a high prevalence of inadequate fruit consumption (57–63%) and low physical activity (82–90%); a moderate prevalence of inadequate vegetable consumption (21–31%), unprotected last sex (38–45%), age at first sex <15 years (21–28%) and bullying and physical fighting (12–35%); and a low prevalence of mental health risk factors (1–11%) and alcohol and substance use risk factors (0–6%). We observed a moderate to high prevalence of daily soft drink consumption (21–31%) for all adolescents. Among sexually active adolescents 15–19 years, 37% of females reported ever being pregnant and 8% of males reported to have ever made someone pregnant. Bullying (23%) and physical fighting (35%) were more common among younger male adolescents. The prevalence of low mood was generally higher among older (15–19 years) than younger adolescents (10–14 years). The proportion of adolescents reporting alcohol, drug or cigarette use was very small, with the exception of khat use in Ethiopia. Conclusion: Overall, diet and physical activity, violence, sexual and reproductive health, and depression are important risk factors for these sub-Saharan African communities. These findings suggest that more evidence is needed including novel efforts for the collection of sensitive information, as well as a need to move towards community-tailored interventions to reach adolescent populations with varying needs. © 2019 John Wiley & Sons Ltd | Open |
| Bimpong K.A.; Cheyuo E.K.-E.; Abdul-Mumin A.; Ayanore M.A.; Kubuga C.K.; Mogre V. | Mothers’ knowledge and attitudes regarding child feeding recommendations, complementary feeding practices and determinants of adequate diet | 2020 | BMC Nutrition | Background: Complementary feeding is critical for optimal nutrition in infants and young children as it ensures their growth, health and development to attain their full potential. However, evidence shows that children from developing countries do not meet the core indicators for appropriate complementary feeding. We evaluated mothers’ knowledge and attitudes regarding child feeding recommendations and the determinants of adequate diet among children aged 6–23 months. Methods: This cross-sectional study included 200 children aged 6–23 months and their mothers/care givers recruited during child welfare clinics of two health facilities in Ghana. Data was collected using a structured questionnaire. Multivariate logistic regression was used to assess determinants of adequate diet. Results: Sixty-eight percent of the mothers knew the recommended duration of continued breastfeeding, 56.5% how to ensure dietary diversity and enrich their children’s diets and 94% (n = 188) had positive attitude towards recommended infant and young child feeding practices. Majority of the mothers (92%, n = 183) practiced continued breastfeeding, 10.5% of the children met minimum diet diversity score, 39.5% minimum meal frequency and 8.5% received minimum adequate diet. Determinants of receipt of minimum adequate diet were: having high knowledge in child feeding recommendations (100% vs. 0.0, p < 0.001) and child’s father reportedly earning adequate income to cater for the family (AOR = 12.1 (1.32–109.72, p = 0.027). Conclusion: Motherss knowledge levels regarding infant and young child feeding recommendations had notable deficiencies although they generally had a positive attitude towards child feeding recommendations. Knowledge regarding infant and young child feeding recommendations as well as the child’s father having adequate income were important determinants of adequate diet. Nutrition education should emphasize on improving mothers’ nutrition knowledge regarding infant and young child feeding recommendations and supporting mothers to overcome barriers to feed their children with adequate diets. © 2020, The Author(s). | Open |
| Boateng G.O.; Balogun M.R.; Dada F.O.; Armah F.A. | Household energy insecurity: dimensions and consequences for women, infants and children in low- and middle-income countries | 2020 | Social Science and Medicine | Energy insecurity, the lack of access to adequate, affordable, reliable, acceptable, and clean sources of energy for a healthy and sustainable livelihood, poses a challenge to several households. However, the conceptualization of its dimensions and role in the health outcomes of women, infants, and children in most sub-Saharan African countries have rarely been investigated systematically. We assessed the dimensions and adverse consequences of household energy insecurity (HEINS) in a sample of 347 Ghanaians and 420 Nigerians, with over 80% participation of women. The majority of respondents from Ghana (57%) and Nigeria (80%) had experienced of energy insecurity, at least once in the last four weeks. Following the energy insecurity framework, the experiences of participants were classified into physical, behavioral, and economic dimensions of energy insecurity. The consequences of energy insecurity grouped into psychosocial, nutritional, and disease domains. The development of a national as well as a cross-culturally validated scale that embodies these dimensions and domains will facilitate the assessment of the prevalence, causes, and consequences of HEINS. This will eventually enable the development of interventions and policies to mitigate energy insecurity and unearth modifiable factors that influence deleterious maternal, infant and child health outcomes in low-and middle-income countries. © 2020 Elsevier Ltd | Open |
| Brinkman M.; Levin-Koopman J.; Wicke B.; Shutes L.; Kuiper M.; Faaij A.; van der Hilst F. | The distribution of food security impacts of biofuels, a Ghana case study | 2020 | Biomass and Bioenergy | The demand for biofuels is expected to increase significantly in the coming years. However, there are major concerns on the impact of increased biofuel production on food security. As biofuel affects food security in various ways, it is important to assess the impacts on the four pillars of food security, availability, access, utilisation and stability. The objective of this study is to ex-ante quantify impacts of biofuel production on the four pillars of food security for urban and rural households in a developing country. We illustrate this for Ghana, which proposed a 10% biodiesel and 15% ethanol mandate for 2030 and which faces food security issues. We used the computable general equilibrium (CGE) model MAGNET in combination with a household and a nutrition module to quantify 13 food security indicators. The results show that the largest food security effects of the biofuel mandate are negative impacts on food prices and import dependency. However, the projected food security impacts of the biofuel mandate in 2030 are relatively small compared to the projected food security effects of economic development in Ghana towards 2030. Our approach enables ex-ante quantification of the effects of biofuel on the four pillars of food security and the differentiation of the effects between urban and rural households. Although improvements can be made, the approach means a big step forward compared to the state-of-the-art knowledge on food security impacts of biofuel production and it could contribute to identify options to minimise negative and optimise positive food security effects. © 2020 The Authors | Open |
| Chauwa L.; Appiah C.A.; Nsiah K.; Sarfo F.S. | Nutritional risk markers among stroke out-patients at the neurology clinic of a teaching hospital in Ghana | 2020 | Pan African Medical Journal | Introduction: stroke survivors are at risk of malnutrition due to inadequate dietary intake, as a result of neurological disorders causing dysphagia, depression and impaired ability to self-feed. There is paucity of information on nutritional status of stroke survivors after discharge from hospital care, hence, this study sought to determine the nutritional risk markers among stroke out-patients at the Neurology Clinic of Komfo Anokye Teaching Hospital, Kumasi, Ghana. Methods: a cross-sectional study was conducted among 106 stroke survivors at Komfo Anokye Teaching Hospital, Kumasi, Ghana. Nutritional status of stroke survivors was assessed, using body mass index (BMI) and mid upper arm circumference (MUAC). Biochemical and haematological nutrition indicators including total serum protein, serum albumin, total lymphocyte count, uric acid and haemoglobin were also determined. Independent t-test and ANOVA were used to test differences between mean values. Results: the mean age of study participants was 58.47±14.2 years, with 56% being females. Overall, 96 (88.7%) of the participants had malnutrition, of whom 66 (68.8%) were undernourished, while 30 (31.2%) had overnutrition. It was also found that 38.7% of the participants were anaemic, based on haemoglobin levels. Using mean BMI, stroke survivors who had been discharged over five years were significantly overweight (p = 0.010). Conclusion: there was high level of malnutrition among stroke out-patients in this study. The most common nutrition-related problem in the stroke survivors studied was anaemia. Findings from this study suggest the need for nutrition intervention strategies to address the high burden of malnutrition among the stroke survivors. © Lloyd Chauwa et al. | Open |
| Choi S.; Yuen H.M.; Annan R.; Monroy-Valle M.; Pickup T.; Aduku N.E.L.; Pulman A.; Portillo Sermeño C.E.; Jackson A.A.; Ashworth A. | Improved care and survival in severe malnutrition through eLearning | 2020 | Archives of Disease in Childhood | Background Scaling up improved management of severe acute malnutrition (SAM) has been identified as the nutrition intervention with the greatest potential to reduce child mortality but it requires improved operational capacity. Objective To investigate whether an eLearning course, which can be used at scale in resource-poor countries, leads to improved diagnosis, clinical management and survival of children with SAM. Design A 2-year preintervention and postintervention study between January 2015 and February 2017. Setting Eleven healthcare facilities: nine in Ghana, one in Guatemala, and one in El Salvador. Intervention Scenario-based eLearning course 'Caring for infants and young children with severe malnutrition'. Main outcome measures Identification of children with SAM, quality of care, case-fatality rate. Methods Medical record reviews of children aged 0-60 months attending eleven hospitals between August 2014 and July 2016, observations in paediatric wards, and interviews with senior hospital personnel. Results Postintervention there was a significant improvement in the identification of SAM: more children had the requisite anthropometric data (34.9% (1300/3723) vs 15.9% (629/3953)) and more were correctly diagnosed (58.5% (460/786) vs 47.1% (209/444)). Improvements were observed in almost all aspects of the WHO 'Ten Steps' of case-management, and case-fatality fell from 5.8% (26/449) to 1.9% (14/745) (Post-pre difference=-3.9%, 95% CI -6.6 to -1.7, p<0.001). Conclusions High quality, interactive eLearning can be an effective intervention in scaling up capacity building of health professionals to manage SAM effectively, leading to a reduction in mortality. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. | Open |
| de Groot R.; Handa S.; Ragno L.P.; Spadafora T. | Child malnutrition, consumption growth, maternal care and price shocks: new evidence from Northern Ghana | 2020 | Development Studies Research | Childhood malnutrition remains a significant global health concern. In order to implement effective policies to address the issue, it is crucial to first understand the mechanisms underlying malnutrition. This paper uses a unique dataset from Northern Ghana to explain the underlying causes of childhood malnutrition. It adopts an empirical framework to model inputs in the production of health and nutrition, as a function of child, household and community characteristics. The findings suggest that maternal agency and health contribute to improved health status. Household resources–in the form of consumption–are positively associated with food intake and nutritional outcomes. Simulations show that income growth, improving maternal care and avoiding sudden price shocks have a positive–but rather limited effect–on the reduction of malnutrition in this context. Effects are greater in children under two. Hence, policies that address underlying determinants simultaneously, and target the youngest population of children, could have the largest effect on reducing malnutrition in this population. © 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Dei-Tutu S.A.; Manful A.; Heimburger D.C.; Malechi H.; Moore D.J.; Oppong S.A.; Russell W.E.; Aliyu M.H. | Correlating maternal iodine status with neonatal thyroid function in two hospital populations in Ghana: A multicenter cross-sectional pilot study | 2020 | BMC Pediatrics | Background: Congenital hypothyroidism is a common, yet easily treatable cause of poor growth and intellectual disability. Newborn screening programs play an important role in the early detection and treatment of congenital hypothyroidism. However, an estimated 71% of children are born in countries such as Ghana, which does not have a screening program. Iodine deficiency, a common cause of congenital hypothyroidism, is present in the Ghanaian population. Mild to moderate maternal iodine deficiency may negatively impact cognitive function in children. A structured approach to examine the association between maternal iodine levels and infant thyroid function may have important ramifications on our understanding of congenital hypothyroidism in Ghana. We investigated the hypothesis that maternal iodine deficiency impacts infant thyroid function, using Thyroid Stimulating Hormone (TSH) as a marker of thyroid function. We also explored potential opportunities and barriers to newborn screening for congenital hypothyroidism in Ghana. Methods: This was a cross-sectional, multicenter pilot study of 250 women and their neonates recruited from post-natal clinics in Accra and Tamale, Ghana. We compared maternal urine iodine concentration and infant TSH, as well as maternal sociodemographic and nutrition information. Regression models were used to model the relationship between variables. Results: Median infant TSH was 4.7 μIU/ml (95% CI: 3.9-5.5) in Accra. In Tamale, the median infant TSH was 3.5 μIU/ml (95%CI: 3.3 to 3.6) (Δ: 1.3 μIU/ml, 95% CI: 0.5-2.1, p = 0.002). Median maternal urine iodine concentrations were 141.0 μg/L (95% CI: 115.7 to 166.3) and 142.5 μg/L (95% CI: 125.1 to 160.0) in Accra and Tamale, respectively (Δ:-1.5 μIU/ml, 95% CI:-32.2-29.2, p = 0.925). There was a weakly positive correlation between maternal urine iodine and infant TSH (rho 0.1, p = 0.02). Almost one-third (30%) of women in both locations had biochemical evidence of iodine deficiency. Mothers with any formal education were more likely to have higher iodine levels than their counterparts who had no formal education (coefficient 0.31, p = 0.006). Conclusions: Maternal iodine deficiency is prevalent in Ghana and is correlated to infant thyroid function. We recommend studies with larger sample sizes to assess the true scope of this relationship. © 2020 The Author(s). | Open |
| Egbi G.; Glover-Amengor M.; Tohouenou M.M.; Zotor F. | Contribution of Amaranthus cruentus and Solanum macrocarpon Leaves Flour to Nutrient Intake and Effect on Nutritional Status of Rural School Children in Volta Region, Ghana | 2020 | Journal of Nutrition and Metabolism | Background. Plant-based foods are staple diets and main micronutrient sources of most rural Ghanaian households. The objective of this study was to determine the effect of Amaranthus cruentus and Solanum macrocarpon leafy vegetable flour on micronutrient intake and nutritional status of rural Ghanaian school children. Method. This study was a randomized controlled trial that consisted of baseline data collection and a three-month nutrition intervention feeding program. Two groups of 53 children, age 4-9 years, involved in the Ghana School Feeding Program took part in the study. An experimental group consumed Amaranthus cruentus and Solanum macrocarpon leaves flour (ACSMLVF) stews and soup. The control group consumed stews and soup without ACSMLVF. Haemoglobin and serum vitamin A concentrations were determined. Dietary and anthropometric data were collected and analysed. Participants were screened for malaria parasitaemia and hookworm. Results. Anaemia was present in 41.5% and 37.3%, respectively, of the intervention and control groups at baseline. It was present in 28.3% and 53.3%, respectively, at the end of the study. This was significantly different (p=0.024). There was a low vitamin A concentration in 66.0% and 64.7% at baseline and 20.8% and 23.4% at the end of the study in the intervention and control groups, respectively. The mean iron, zinc, and provitamin A (beta-carotene) intakes of the intervention group were 14.2 ± 7.1 mg, 5.7 ± 2.1 mg, and 214.5 ± 22.6 μg, respectively, at baseline. Those of the control were 13.7 ± 6.1 mg, 5.4 ± 2.1 mg, and 210.6 ± 20.1 μg, respectively. At the end of the study, the mean intake of iron, zinc, and beta-carotene for the intervention group was 24.1 ± 10.9 mg, 13.8 ± 8.2 mg, and 694.2 ± 33.1 μg, respectively. The intake of these micronutrients for the control at the end of the study was 14.8 ± 6.2 mg, 5.9 ± 2.3 mg, and 418.4 ± 34.7 μg, respectively. Conclusion. Consumption of ACSMLVF stews and soup increased iron, zinc, and beta-carotene intakes. Anaemia prevalence was lower in the intervention group at the end of the study. © 2020 Godfred Egbi et al. | Open |
| Ekumah B.; Armah F.A.; Yawson D.O.; Quansah R.; Nyieku F.E.; Owusu S.A.; Odoi J.O.; Afitiri A.-R. | Disparate on-site access to water, sanitation, and food storage heighten the risk of COVID-19 spread in Sub-Saharan Africa | 2020 | Environmental Research | COVID-19 is an active pandemic that likely poses an existential threat to humanity. Frequent handwashing, social distancing, and partial or total lockdowns are among the suite of measures prescribed by the World Health Organization (WHO) and being implemented across the world to contain the pandemic. However, existing inequalities in access to certain basic necessities of life (water, sanitation facility, and food storage) create layered vulnerabilities to COVID-19 and can render the preventive measures ineffective or simply counterproductive. We hypothesized that individuals in households without any of the named basic necessities of life are more likely to violate the preventive (especially lockdown) measures and thereby increase the risk of infection or aid the spread of COVID-19. Based on nationally-representative data for 25 sub-Saharan African (SSA) countries, multivariate statistical and geospatial analyses were used to investigate whether, and to what extent, household family structure is associated with in-house access to basic needs which, in turn, could reflect on a higher risk of COVID-19 infection. The results indicate that approximately 46% of the sampled households in these countries (except South Africa) did not have in-house access to any of the three basic needs and about 8% had access to all the three basic needs. Five countries had less than 2% of their households with in-house access to all three basic needs. Ten countries had over 50% of their households with no in-house access to all the three basic needs. There is a social gradient in in-house access between the rich and the poor, urban and rural richest, male- and female-headed households, among others. We conclude that SSA governments would need to infuse innovative gender- and age-sensitive support services (such as water supply, portable sanitation) to augment the preventive measures prescribed by the WHO. Short-, medium- and long-term interventions within and across countries should necessarily address the upstream, midstream and downstream determinants of in-house access and the full spectrum of layers of inequalities including individual, interpersonal, institutional, and population levels. © 2020 Elsevier Inc. | Open |
| Estrada-Carmona N.; Attwood S.; Cole S.M.; Remans R.; DeClerck F. | A gendered ecosystem services approach to identify novel and locally-relevant strategies for jointly improving food security, nutrition, and conservation in the Barotse Floodplain | 2020 | International Journal of Agricultural Sustainability | Multiple lines of evidence call for the use of locally-relevant strategies to guide and support sustainable agricultural intensification while improving development and conservation outcomes. The goal of this study was to identify the ecosystem services from natural and agricultural systems to achieve this aim in the Barotse Floodplain of Zambia. Our methodology utilized a gender-sensitive ecosystem services approach, whereby local knowledge from women and men was harnessed to understand which services and their sources are important. In addition, we identified the various constraints and options people encounter for developing sustainable and nutritious agriculture while achieving conservation outcomes. The results of our study indicate that the floodplain provides a broad range of ecosystem services, which are important for securing local livelihoods and wellbeing. The forests in the uplands and the grasslands in the plains are the primary sources of the 17 provisioning and regulating ecosystem services assessed. Nonetheless, both are often converted to agriculture due to their high soil fertility. We identified opportunities and challenges for sustainable agricultural intensification and development in areas with lower conservation concerns. We discussed the constraints and limitations for promoting sustainable and inclusive agriculture in those areas. © 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Fu X.; Essegbey G.O.; Frempong G.K. | Conclusions and policy implications | 2020 | Multinationals, Local Capacity Building and Development: The Role of Chinese and European MNEs | Managerial capability is a crucial pillar in enhancing innovation and facilitating industrial development. Ghana is not only a country that bears the distinctive features of the African context, but it also models the characteristics of an emerging economy where innovation is central for further progress. In that regard, the question of how knowledge and innovation can be further stimulated to enhance growth sustainably is of keen interest to stakeholders, policy makers, development actors, innovation scholars and others alike. Finding answers to this question has become quite urgent against the background of the imperatives of sustainable development. The focus on managerial knowledge transfer to build managerial capability is a major effort to understand and address some of the crucial challenges facing emerging economies with the appropriate answers. Sustainable development is a global agenda. Invariably, nations ought to strategise for the attainment of the SDGs within their socio-economic contexts and in line with their national aspirations. For a country such as Ghana, the SDGs of poverty elimination, food and nutrition security, good health and well-being are at the core of national efforts. Ghana’s poverty incidence of 24.2 per cent of the total population may be one of the examples of relatively low poverty incidence on the continent. However, it is still not acceptable that almost a quarter of the human population in a nation should be living in poverty, especially when the aim of SDG 1 is to ‘end poverty in all its forms everywhere’. The current industrialisation drive with the flagship programme of One District One Factory (1D1F) illustrates the efforts at creating conditions for economic advancement. In the process, MNEs have the potential of being major players. © Xiaolan Fu, George Owusu Essegbey and Godfred Kwasi Frempong 2019. All rights reserved. | Open |
| Gosdin L.; Sharma A.J.; Tripp K.; Amoaful E.F.; Mahama A.B.; Selenje L.; Jefferds M.E.; Ramakrishnan U.; Martorell R.; Addo O.Y. | Barriers to and facilitators of iron and folic acid supplementation within a school-based integrated nutrition and health promotion program among ghanaian adolescent girls | 2020 | Current Developments in Nutrition | Background: Anemia is a moderate public health problem among adolescent girls in Ghana. Objectives: We aimed to evaluate the barriers to and facilitators of program fidelity to a school-based anemia reduction program with weekly iron and folic acid (IFA) supplementation. Methods: Authors analyzed directly observed weekly IFA consumption data collected longitudinally and cross-sectional data from a representative survey of 60 secondary schools and 1387 adolescent girls in the Northern and Volta regions of Ghana after 1 school year (2017-2018) of the intervention (30-36 wk). A bottleneck analysis was used to characterize the levels of IFA coverage and used adjusted generalized linear mixed-effects models to quantify the school and student drivers of IFA intake adherence. Results: Of girls, 90% had ever consumed the tablet, whereas 56% had consumed ≥15 weekly tablets (mean: 16.4, range: 0-36), indicating average intake adherence was about half of the available tablets. Among ever consumers, 88% of girls liked the tablet, and 27% reported undesirable changes (primarily heavy menstrual flow). School-level factors represented 75% of the variance in IFA consumption over the school year. Total IFA tablets consumed was associated with the ability to make up missed IFA distributions (+1.4 tablets; 95% CI: +0.8, +2.0 tablets), junior compared with senior secondary school (+5.8; 95% CI: +0.1, +11.5), educators' participating in a program-related training (+7.6; 95% CI: +2.9, 12.2), and educator perceptions that implementation was difficult (-6.9; 95% CI: -12.1, -1.7) and was an excessive time burden (-4.4; 95% CI: -8.4, -0.4). Conclusions: Although the program reached Ghanaian schoolgirls, school-level factors were barriers to adherence. Modifications such as expanded training, formalized make-up IFA distributions, sensitization (awareness promotion), and additional support to senior high schools may improve adherence. Spreading the responsibility for IFA distribution to other teachers and streamlining monitoring may reduce the burden at the school level. Strengthening the health education component and improving knowledge of IFA mong students may also be beneficial. © 2020 Oxford University Press. All rights reserved. | Open |
| Gosdin L.; Tripp K.; Mahama A.B.; Quarshie K.; Amoaful E.F.; Selenje L.; Sharma D.; Jefferds M.E.; Sharma A.J.; Whitehead R.D.; Suchdev P.S.; Ramakrishnan U.; Martorell R.; Addo O.Y. | Predictors of anaemia among adolescent schoolchildren of Ghana | 2020 | Journal of Nutritional Science | Anaemia is a public health problem in Ghana. We sought to identify factors associated with haemoglobin concentration (Hb) and anaemia among schoolattending adolescents. We analysed data from 2948 adolescent girls and 609 boys (10 19 years) selected from 115 schools from regions of Ghana as a secondary analysis of baseline surveys conducted at two time-points. We measured Hb, malaria from capillary blood, anthropometry and used a modified food frequency questionnaire to assess diet. Multivariable linear and Poisson regression models were used to identify predictors of Hb and anaemia. The prevalence of anaemia, malaria and geophagy were 24, 25, and 24 %, respectively, among girls and 13, 27 and 6 %, respectively, among boys. Girls engaging in geophagy had a 53 % higher adjusted prevalence of anaemia and 0 39 g/dl lower Hb. There were similar results among those who tested positive for malaria (+52 % anaemia; -0 42 g/dl Hb). Among girls, lower anaemia prevalence and higher Hb were associated with consumption of foods rich in haeme iron (-22 %; +0 18 g/dl), consumption of iron-fortified cereal/beverages consumed with citrus (-50 %; +0 37 g/dl) and being overweight (-22 %; +0 22 g/dl). Age was positively associated with anaemia among girls, but negatively associated among boys. Boys who tested positive for malaria had 0 31 g/dl lower Hb. Boys who were overweight or had obesity and consumed flour products were also more likely to be anaemic (119 and 56 %, respectively). Factors associated with Hb and anaemia may inform anaemia reduction interventions among school-going adolescents and suggest the need to tailor them uniquely for boys and girls. © 2020 The Author(s). | Open |
| Green M.A.; Pradeilles R.; Laar A.; Osei-Kwasi H.; Bricas N.; Coleman N.; Klomegah S.; Wanjohi M.N.; Tandoh A.; Akparibo R.; Aryeetey R.N.O.; Griffiths P.; Kimani-Murage E.W.; Mensah K.; Muthuri S.; Zotor F.; Holdsworth M. | Investigating foods and beverages sold and advertised in deprived urban neighbourhoods in Ghana and Kenya: A cross-sectional study | 2020 | BMJ Open | Objectives The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods. Design Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability. Setting Three deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya). Main outcome measure Types of foods and beverages sold and/or advertised. Results Jamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets. Conclusion Our study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action. © 2020 BMJ Publishing Group. All rights reserved. | Open |
| Grenov B.; Larnkjær A.; Lee R.; Serena A.; Mølgaard C.; Michaelsen K.F.; Manary M.J. | Circulating Insulin-Like Growth Factor-1 Is Positively Associated with Growth and Cognition in 6- to 9-Year-Old Schoolchildren from Ghana | 2020 | Journal of Nutrition | Milk intake stimulates linear growth and improves cognition in children from low-income countries. These effects may be mediated through insulin-like growth factor-1 (IGF-1). The objective was to assess the effect of milk supplement on circulating IGF-1 and to assess IGF-1 as a correlate of growth and cognition in children. Methods: Secondary data on blood spot IGF-1 from a randomized, double-blind, controlled trial in 6-9-y-old children from rural Ghana were analyzed. Intervention groups received porridge with non-energy-balanced supplements: 8.8 g milk protein/d, 100 kcal/d (Milk8); 4.4 g milk and 4.4 g rice protein/d, 100 kcal/d (Milk/rice); 4.4 g milk protein/d, 48 kcal/d (Milk4); or a control (no protein, 10 kcal/d). IGF-1, length, body composition, and Cambridge Neuropsychological Test Automated Battery (CANTAB) were measured at 3.5 or 8.5 mo. Linear regressions were used to assess the effect of milk interventions on IGF-1 and IGF-1 as a correlate of growth and cognition. Results: The increase in IGF-1 was 15.3 (95% CI: 3.3, 27.3) ng/mL higher in children receiving Milk8 compared with the control. The IGF-1 increases in the isonitrogenous, isoenergetic Milk/rice or the Milk4 groups were not different from the control (P ≥ 0.49). The increase in IGF-1 was associated with improvements in 4 out of 5 CANTAB domains. The strongest associations included reductions in "mean correct latency" from Pattern Recognition Memory and "pre-extradimensional (pre-ED) shift errors" from Intra/Extradimensional Set Shift (P ≤ 0.005). In addition, change in IGF-1 was positively associated with changes in height, weight, and fat-free mass (P ≤ 0.001). Conclusions: Intake of skimmed milk powder corresponding to one, but not half a glass of milk on school days stimulates IGF-1 in 6-9-y-old Ghanian children. IGF-1 seems to mediate the effect of milk intake on growth and cognition. The association between IGF-1 and cognition in relation to milk intake is novel and opens possibilities for dietary interventions to improve cognition. © The Author(s) 2020. | Open |
| Gyamfi D.; Wiafe Y.A.; Ofori Awuah E.; Adu E.A.; Boadi E.K. | Goitre Prevalence and Urinary Iodine Concentration in School-Aged Children in the Ashanti Region of Ghana | 2020 | International Journal of Endocrinology | Background. Iodine deficiency is a public health problem. The universal salt iodization (USI) program is the main, simple, and cost-effective intervention strategy to control iodine deficiency. The study examined the iodine status in school-aged children in Ashanti region, Ghana, using thyroid volumes along with urinary iodine concentrations, the methods recommended by the WHO/ICCIDD for monitoring the sustained impact of USI programs. Methods. This cross-sectional study was conducted among school-aged children (6-12 years) from randomly selected schools in the central and northern part of the Ashanti region, Kumasi Metropolis, and Ejura-Sekyedumase Municipality, respectively. A total of 852 children were enrolled in the study. Thyroid volume and urinary iodine concentrations of the children were determined using the standardized methods recommended by WHO/ICCIDD. Anthropometric measurements were also evaluated. Results. The mean values of thyroid volume in female and male school-aged children were 3.53 ± 0.09 and 3.32 ± 0.07, respectively. The thyroid size was significantly associated with age (P<0.0001), weight (P<0.0001), height (P<0.0001), BMI (P<0.05), and BSA (P<0.0001) by Pearson's correlation in both males and females. The P50 (median) thyroid volumes of school children investigated in this study were generally larger compared to the WHO/ICCIDD reference data by age and body surface area. The median value of urinary iodine concentration was 201.85 μg/L, which showed significant sex difference (P value <0.0001). Excessive iodine nutrition (≥300 μg/L) was observed among 34.4% of male children and 27.6% of female children. Also, 12.8% of the male and 19.5% of the female children had UIC below requirement (<100 μg/L). The criteria of thyroid volume per age yielded a goitre prevalence of 2.2%. In contrast, the criteria of thyroid volume by body surface area yielded a goitre prevalence of 0.9%. Conclusion. The study clearly indicated that adequate iodine nutrition exists generally among the school children. However, insufficient and excessive iodine intakes still persist among some of the children. The establishment of local reference values for thyroid volume that might be applicable to precisely define goitre prevalence in the Ghanaian context is highly recommended. © 2020 Daniel Gyamfi et al. | Open |
| Gyimah L.A.; Amoatey H.M.; Boatin R.; Appiah V.; Odai B.T. | The impact of gamma irradiation and storage on the physicochemical properties of tomato fruits in Ghana | 2020 | Food Quality and Safety | Objectives: Tomato is a popular fruit that makes significant contributions to human nutrition for its content of sugars, acids, vitamins, minerals, lycopene, and other constituents. The fruit, however, has a short shelf life due to its climacteric nature. In view of this, an experiment was conducted to determine the effect of postharvest treatment on the physicochemical properties of fresh tomato fruits. Materials and Methods: Freshly harvested tomato fruits were subjected to 0, 1, 2, 3, and 4 kGy gamma radiation and stored at 10 ± 1°C and 28 ± 1°C. Parameters analysed during the study include pH, total titratable acidity, weight loss, total solids, and moisture content of the sample. Results: At both storage temperatures, results of the analyses were in the range of 2.80%-38.67% for weight loss, 0.23%-0.51% for total titratable acidity, 3.5%-5.0% for total soluble solids, 94.43%- 96.53% for moisture content, and pH was generally low in the samples stored at 10 ± 1°C. Generally, gamma irradiation had an effect on the total soluble solids, total titratable acids, pH values, and moisture content and physiological weight loss at both storage temperatures. Conclusion: From the study, storing Burkina variety at a low temperature preserves the tomato fruits better than storing them at ambient temperature. © 2020 Oxford University Press. All rights reserved. | Open |
| Hasselberg A.E.; Aakre I.; Scholtens J.; Overå R.; Kolding J.; Bank M.S.; Atter A.; Kjellevold M. | Fish for food and nutrition security in Ghana: Challenges and opportunities | 2020 | Global Food Security | Fish is an important dietary source of micronutrients, particularly in low-and middle-income countries. In Ghana, effective management of fish and the fisheries is essential for food, economic and nutrition security and is critical towards achieving many of the UN Sustainable Development Goals especially those pertaining to hunger, poverty, gender equality and life under water. Ghana has experienced significant economic growth in the last few decades, but increasing inequality, uncertainties in fish availability and unsustainable management of the fisheries are challenging local food and nutrition security. This literature review examines and evaluates the role of fish and fisheries in supporting FNS in Ghana, and highlights the lack of focus on fish in the literature with regard to regional food security and fisheries governance. Our review highlights the importance of ensuring the viability of small fish populations to enhance micronutrient availability and counteract micronutrient deficiencies in Ghana. Additionally, strengthening women's role in decision making and promoting female education and empowerment in the fisheries sector is an important strategy towards enhancing FNS in the region. © 2020 The Authors | Open |
| Hermanussen M.; Scheffler C.; Pulungan A.B.; Batubara J.R.L.; Julia M.; Bogin B. | Response to the correspondence referring to our article “Stunting is not a synonym of malnutrition” (2018EJCN0997RR) by Conny Tanjung, Titis Prawitasari, Damayanti Rusli Sjarif | 2020 | European Journal of Clinical Nutrition | Not Available | Open |
| Issahaku G.; Abdulai A. | Can Farm Households Improve Food and Nutrition Security through Adoption of Climate-smart Practices? Empirical Evidence from Northern Ghana | 2020 | Applied Economic Perspectives and Policy | We examine the factors that influence farmers’ decisions to adopt climate-smart practices and how adoption affects food and nutrition security in Ghana, using an endogenous switching regression approach to account for selectivity bias. The results show that adoption positively and significantly impacts food and nutrition security. The impacts of adoption are greater in the lower quantiles of the distributions of food and nutrition security, an indication of the potential role of adoption in reducing poverty among poor households. Policy efforts that seek to improve farmers’ access to machinery and extension services may enhance the adoption of climate-smart practices. © The Author(s) 2020. Published by Oxford University Press on behalf of the Agricultural and Applied Economics Association. All rights reserved. | Open |
| Konlan K.D.; Abdulai J.A.; Konlan K.D.; Amoah R.M.; Doat A.-R. | Practices of pica among pregnant women in a tertiary healthcare facility in Ghana | 2020 | Nursing Open | Aim: This study assessed the practice of pica among pregnant women in the Ho Teaching Hospital. Design: Descriptive cross-sectional. Methods: Systematic sampling technique was used to recruit 286 pregnant women. Questionnaire was used to collect data. Data entered into Statistical Package for Social Sciences for analysis. Result: Of the 286 pregnant women, 21.2% and 17.8% considered white clay and ice respectively as nutritious. Prevalence of pica was 47.5%, while 44.9% of pregnant women who practised pica reported they feel uncomfortable when they do not eat pica as 63.3% considered intake of pica as harmful. Among women who received education against pica practice, 49.4% have ever taken pica as 50.9% of them with education on effects of pica were currently engaged in the activity (χ2 = 1.93 p =.17). Conclusion: Health professionals, especially midwives must intensify education on effects of pica among pregnant women. © 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. | Open |
| Kumordzie S.M.; Okronipa H.; Arimond M.; Adu-Afarwuah S.; Ocansey M.E.; Young R.R.; Bentil H.J.; Tamakloe S.M.; Oaks B.M.; Dewey K.G. | Maternal and child factors associated with child body fatness in a Ghanaian cohort | 2020 | Public Health Nutrition | Objective: We aimed to identify factors (child diet, physical activity; maternal BMI) associated with body composition of Ghanaian pre-school children.Design: Longitudinal analysis of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana randomized trial, which enrolled 1320 pregnant women at ≤20 weeks' gestation and followed them and their infants until 6 and 18 months postpartum, respectively. At follow-up, child age 4-6 years, we collected data on body composition (by 2H dilution), physical activity and diet, extracted dietary patterns using factor analysis, and examined the association of children's percentage body fat with maternal and child factors by regression analysis.Setting: Eastern Region, Ghana.Participants: Children 4-6 years of age.Results: The analysis included 889 children with percentage body fat and dietary data at follow-up. We identified two major dietary patterns, a snacking and a cooked foods pattern. Percentage body fat was positively associated (standardized β (se)) with maternal BMI at follow-up (0·10 (0·03); P = 0·003) and negatively associated with physical activity (-0·15 (0·05); P = 0·003, unadjusted for child gender), but not associated with the snacking (0·06 (0·03); P = 0·103) or cooked foods (-0·05 (0·07); P = 0·474) pattern. Boys were more active than girls (1470 v. 1314 mean vector magnitude counts/min; P < 0·0001) and had lower percentage body fat (13·8 v. 16·9 %; P < 0·0001).Conclusions: In this population, maternal overweight and child physical activity, especially among girls, may be key factors for addressing child overweight/obesity. We did not demonstrate a relationship between the dietary patterns and body fatness, which may be related to limitations of the dietary data available. © 2019 The Authors. | Open |
| Kushitor S.B.; Owusu L.; Kushitor M.K. | The prevalence and correlates of the double burden of malnutrition among women in Ghana | 2020 | PLoS ONE | Anaemia and underweight or overweight/obesity are major public health problems driving maternal and child mortality in low- and middle-income countries. While the burden of these conditions is recognised, the evidence for the co-occurrence of these conditions is fragmented and mixed, especially at the individual level. Further, many studies have focused on families and communities. The different pathways for the occurrence of anaemia and BMI challenges indicate that an individual can potentially live with both conditions and suffer the complications. This study examined the prevalence and factors associated with the cooccurrence of anaemia and BMI challenges among a cohort of women in Ghana. Data from the 2014 Ghana Demographic and Health Survey were used. The sample size was 4 337 women aged 15-49 years who were not pregnant during the survey. Women who suffered simultaneously from underweight or overweight/obesity and anaemia were considered as having the double burden of malnutrition. The data were analysed using descriptive statistics, Chi-square test and logistic regression in STATA. One-fifth of the participants were overweight (21%), 4% were underweight and about one-tenth were obese (12%). The prevalence of anaemia was 41%. Only one in three women had normal weight and was not anaemic (34%). About 14% of the women experienced the double burden of malnutrition. Being overweight and anaemic (57%) was the most common form of this double burden. Age, marital status, parity, and wealth were t key risk factors associated with the double burden of malnutrition. The findings from this study show that women experience multiple nutritional challenges concurrently and that only a few women had healthy nutritional status. This information is particularly important and can be introduced into health education programmes to help address misconceptions about body weight and health. © 2020 Kushitor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Laar A.; Barnes A.; Aryeetey R.; Tandoh A.; Bash K.; Mensah K.; Zotor F.; Vandevijvere S.; Holdsworth M. | Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: National experts’ assessment of government action | 2020 | Food Policy | Nutrition-related non-communicable diseases (NR-NCDs) are a global health problem, increasingly recognised as driven by unhealthy food environments. Yet little is known about government action to implement food environment-relevant policies, particularly in low-and lower-middle income countries. This study assessed government action, implementation gaps, and priorities to improve the food environment in Ghana. Using the Healthy Food-Environment Policy Index (Food-EPI), a panel comprising government and independent experts (n = 19) rated government action to improve the healthiness of food environment in Ghana against international best practices and according to steps within a policy cycle. Forty-three good practice indicators of food environment policy and infrastructure support were used, with ratings informed by systematically collected evidence of action validated by government officials. Following the rating exercise, the expert panel proposed and prioritized actions for government implementation. Three-quarters of all good practice indicators were rated at ‘low’/‘very little’ implementation. Restricting the marketing of breast milk substitutes was the only indicator rated “very high”. Of ten policy actions prioritized for implementation, restricting unhealthy food marketing in children's settings and in the media were ranked the highest priority. Providing sufficient funds for nationally-relevant research on nutrition and NCDs was the highest priority infrastructure-support action. Other priority infrastructure-support actions related to leadership, monitoring and evaluation. This study identified gaps in Ghana's implementation of internationally-recommended policies to promote healthy food environments. National stakeholders recommended actions, which will require legislation and leadership. The findings provide a baseline for measuring government progress towards implementing effective policies to prevent NR-NCDs. © 2020 The Authors | Open |
| Li Z.; Kim R.; Vollmer S.; Subramanian S.V. | Factors Associated with Child Stunting, Wasting, and Underweight in 35 Low- And Middle-Income Countries | 2020 | JAMA Network Open | Importance: Evidence on the relative importance of various factors associated with child anthropometric failures (ie, stunting, underweight, and wasting) and their heterogeneity across countries can inform global and national health agendas. Objective: To assess the relative significance of factors associated with child anthropometric failures in 35 low- and middle-income countries (LMICs). Design, Setting, and Participants: This cross-sectional study of 299353 children who were born singleton and aged 12 to 59 months with nonpregnant mothers and valid anthropometric measures assessed the strengths of associations of 26 factors with child stunting, underweight, and wasting, using Demographic and Health Surveys (2007-2018) from 35 LMICs. Data analysis was conducted from July 2019 to February 2020. Exposures: A total of 9 direct factors (ie, dietary diversity score; breastfeeding initiation; vitamin A supplements; use of iodized salt; infectious disease in past 2 weeks; oral rehydration therapy for children with diarrhea; care seeking for suspected pneumonia; full vaccination; and indoor pollution) and 17 indirect factors (household wealth; maternal and paternal education; maternal and paternal height and body mass index; maternal autonomy for health care, movement, and money; water source; sanitation facility; stool disposal; antenatal care; skilled birth attendant at delivery; family planning needs; and maternal marriage age) were assessed. Main Outcomes and Measures: Three anthropometric failure outcomes were constructed based on the 2006 World Health Organization child growth standards: stunting (height-for-age z score less than -2 standard deviations [SDs]), underweight (weight-for-age z score less than -2 SDs), and wasting (weight-for-height z score less than -2 SDs). Results: Among the 299353 children aged 12 to 59 months included in the analysis, 38.8% (95% CI, 38.6%-38.9%) had stunting, 27.5% (95% CI, 27.3%-27.6%) had underweight, and 12.9% (95% CI, 12.8%-13.0%) had wasting. In the pooled sample, short maternal height was the strongest factor associated with child stunting (odds ratio [OR], 4.7; 95% CI, 4.5-5.0; P <.001), followed by lack of maternal education (OR, 1.9; 95% CI, 1.8-2.0; P <.001), poorest household wealth (OR, 1.7; 95% CI,1.6-1.8; P <.001), and low maternal body mass index (OR, 1.6; 95% CI, 1.6-1.7; P <.001). Short paternal height was also significantly associated with higher odds of stunting (OR, 1.9; 95% CI, 1.7-2.2; P <.001). Consistent results were found for underweight (eg, short maternal height: OR, 3.5; 95% CI, 3.3-3.7; P <.001; lack of maternal education: OR, 1.8; 95% CI, 1.7-2.0; P <.001) and wasting (eg, low maternal body mass index: OR, 2.3; 95% CI, 2.1-2,4; P <.001; poorest household wealth: OR, 1.2; 95% CI, 1.1-1.3; P <.001). Parental nutritional status and household socioeconomic conditions ranked the strongest (1st to 4th) for most countries, with a few exceptions (eg, lack of maternal education ranked 18th-20th in 8 countries for child wasting). Other factors were not associated with anthropometric failures in pooled analysis and had large country-level heterogeneity; for example, unsafe water was not associated with child underweight in the pooled analysis (OR, 0.97; 95% CI, 0.95-1.00; P <.001), and it ranked from 4th to 20th across countries. Conclusions and Relevance: In this study, socioeconomic conditions and parental nutritional status were the strongest factors associated with child anthropometric failures. Poverty reduction, women's education, and nutrition programs for households could be important strategies for reducing child undernutrition; however, country-specific contexts should be considered in national policy discussions.. © 2020 American Medical Association. All rights reserved. | Open |
| Madilo F.K.; Owusu-Kwarteng J.; Parry-Hanson Kunadu A.; Tano-Debrah K. | Self-reported use and understanding of food label information among tertiary education students in Ghana | 2020 | Food Control | Food packaging labels attract consumers' attention in stores and market areas, and communicates relevant food safety and nutrition information that allows them to distinguish between food product alternatives. Therefore, the objective of this study was to assess consumers' self-reported use, knowledge and understanding of food labels among tertiary students in Ghana. A validated questionnaire was used to recruit 1478 students from fourteen (14) public tertiary institutions across the 10 regions to collect information on demographic characteristics of respondents, usage and understanding of information provided on food labels, using proportional quota and convenience sampling techniques. The majority of respondents 956 (64.7%) were between the ages of 21 and 30. A total of 463 (31.3%) students read food label ‘very often’ while 892 (60.4%) read food labels ‘sometimes’. While 963 (65.2%) of respondents indicated that information on food labels are very important, 934 (63.2%) still believe that food label information are often not credible. Respondents considered expiring date 1269 (85.9%), date of manufacture 1106 (74.8%) and health warning 1097 (74.2%) as the top three very important information on food labels whereas product value/weight, 654 (44.2%) was considered as least important in choosing particular food products. Respondents generally depend on television programs/advertisement, 1349 (91.3%); internets, 1290 (87.3%) and friends and neighbors, 1213 (82.1%) as sources of knowledge regarding food label information. When participants were provided with a sample food label to assess their understanding of food label information, 916 (62.0%) of respondents did not answer the question at all. Out of 562 (38%) who answered the question, only 243 (16.5%) correctly interpreted the information. No significant difference (P > 0.05) exist between ages, sexes, institutions, and university and training college students regarding their understanding of food label information. Eventhough tertiary education students in Ghana read and attach importance to food label information, they have limited understanding of the information provided on food labels. © 2019 Elsevier Ltd | Open |
| Mbogori T.; Kimmel K.; Zhang M.; Kandiah J.; Wang Y. | Nutrition transition and double burden of malnutrition in Africa: A case study of four selected countries with different social economic development | 2020 | AIMS Public Health | Background: Disease and lifestyle patterns have been changing rapidly especially in Africa due to transformation in economic development and urbanization. Research on the magnitude and consequences of these transformations in Africa is limited. This study investigates the shifts in nutritional status in children and adults in four selected low-, middle- and high-income countries in Africa, identifies factors associated with the shifts, and provides recommendations for future studies. Methods: Malawi, Kenya, Ghana, and South Africa were selected based on their Gross Domestic Product (GDP). Nationally representative data were obtained from the 2017 Global Nutrition Report, Demographic Health Surveys (DHSs), and the World Health Organization (WHO) database. Prevalence of underweight, overweight, and obesity were assessed and compared across the countries, gender, residence, and over time. Results: South Africa had the highest GDP and largest prevalence of overweight and obesity rates in children < 5 years old and adults > 18 (13.3% and 51.9%, respectively). Malawi, with the lowest GDP, had the highest stunting rate (37.0%). In all 4 countries, but most notably in South Africa, trends indicated that the increasing prevalence of overweight and obesity was much greater than the declining rate of underweight. Malawi, Kenya, and Ghana had a slight decline in overweight prevalence in children under 5 years. Conclusions: Nutritional shifts are occurring in Africa and seem to be heavily influenced by economic development. The double-burden of malnutrition presents prioritization challenges for policymakers. Attention needs to be shifted towards prevention of obesity, at least in the higher income countries in Africa. © 2020 the Author(s), | Open |
| Menon S.; Peñalvo J.L. | Actions targeting the double burden of malnutrition: A scoping review | 2020 | Nutrients | Background: In many developing countries, nutritional and epidemiological transitions are contributing to continuous undernutrition and escalating overnutrition, resulting in coexisting forms of malnutrition often referred as the “double burden of malnutrition” (DBM). This complex phenomenon constitutes an unprecedented challenge to global public health and has been prioritized by international health organizations, prompting governments to swift action. Specifically, five years ago the World Health Organization proposed a roadmap to tackle the DBM though so-called “double-duty actions”. The objective of this review was to synthesize the literature on interventions which address the DBM. Methods: We developed a scoping review to identify interventions addressing the DBM. We searched PUBMED for papers reporting interventions until December 2019. Articles examining interventions, government policies, or tools at the individual, household, or community level to address the double burden of malnutrition were included. Results: Seven articles met the inclusion criteria. Three were from sub-Saharan Africa, one was from Southeast Asia, and one was from Central America. Two were modelling studies, with one covering 24 low-income countries and the other focusing on Ghana. Conclusion: Notwithstanding the pressing issue of the DBM, there is a paucity of studies examining double-duty actions despite the attention that it has garnered within the global nutrition community. Whilst nutrient deficiencies may be curbed by poverty reduction measures, for obesity prevention nutrition, education and promotion of physical activity, along with the encouragement of local food production, may be instrumental. © 2019 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Ng C.D. | Stratification of BMI categories among older adults within and across countries | 2020 | Public Health Nutrition | Objective: Within- and across-country nutritional disparities were examined among older adults in six different countries at varying levels of development.Design: Cross-sectional study.Participants: Older adults (aged 50 years or over) in China, Ghana, India, Mexico, Russia and South Africa using the Study on global AGEing and adult health (SAGE).Results: While the distribution of BMI categories varied by country, development-related characteristics were generally related to BMI category in a similar way: urban-living, educated and wealthier individuals were typically more likely to be in a higher BMI category. However, there were some exceptions that corroborate findings in more developed countries. Indeed, a pooled partial proportional odds model which included gross domestic product per capita interactions made the case for intertwining processes of development and the nutrition transition.Conclusions: Population segments to be targeted by nutrition policy and programme implementation might need to change over the course of development. © The Author 2019. | Open |
| Oaks B.M.; Adu-Afarwuah S.; Kumordzie S.; Laudenslager M.L.; Smith D.L.; Lin J.; Young R.R.; Arnold C.D.; Bentil H.; Okronipa H.; Ocansey M.; Dewey K.G. | Impact of a nutritional supplement during gestation and early childhood on child salivary cortisol, hair cortisol, and telomere length at 4–6 years of age: a follow-up of a randomized controlled trial | 2020 | Stress | Dysregulation of the stress response can occur early in life and may be affected by nutrition. Our objective was to evaluate the long-term effect of nutritional supplementation during gestation and early childhood on child cortisol and buccal telomere length (a marker of cellular aging) at 4–6 years of age. We conducted a follow-up study of children born to women who participated in a nutritional supplementation trial in Ghana. In one group, a lipid-based nutrient supplement (LNS) was provided to women during gestation and the first 6 months postpartum and to their infants from age 6 to 18 months. The control groups received either iron and folic acid (IFA) during gestation or multiple micronutrients during gestation and the first 6 months postpartum, with no infant supplementation. At age 4–6 years, we measured hair cortisol, buccal telomere length, and salivary cortisol before and after a stressor. Salivary cortisol was available for 364 children across all three trial arms and hair cortisol and telomere length were available for a subset of children (n = 275 and 278, respectively) from the LNS and IFA groups. Telomere length, salivary cortisol, and hair cortisol did not differ by supplementation group. Overall, these findings suggest that nutritional supplementation given during gestation and early childhood does not have an effect on child stress response or chronic stress in children at 4–6 years. Trial registration: ClinicalTrials.gov Identifier NCT00970866.Lay Summary This study addressed a research gap about whether improved nutrition during pregnancy and early childhood impacts telomere length and cortisol in preschool children. There was no difference in child telomere length or cortisol between two trial arms of a nutritional supplementation trial that began during pregnancy. The research outcomes indicate lipid-based nutrient supplements, a relatively new form of supplementation, do not have an effect on markers of stress or cellular aging measured in later childhood. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Pelto G.H. | Applying focused ethnographic methods: Examining implications of intracultural diversity for nutrition interventions | 2020 | Nutrition Reviews | This paper examines the implications of intracultural difference for the design and implementation of nutrition interventions. It raises the question of whether small-sample, mixed-method implementation research, using a focused ethnographic approach, has sufficient power to detect meaningful differences in cultural beliefs, values, perceptions, and attitudes that are important for the design and implementation of nutrition interventions. It first presents the theoretical framework that was used to guide the research, followed by a description of the methodology of the Focused Ethnographic Study for Infant and Young Child Feeding. It then uses the findings from recent research in Ghana to address the central question. The findings document strong elements of shared cultural consensus, but intracultural differences of importance, in relation to the planning and content of behavior change communication. © The Author(s) 2020. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. | Open |
| Perumal N.; Namaste S.; Qamar H.; Aimone A.; Bassani D.G.; Roth D.E. | Anthropometric data quality assessment in multisurvey studies of child growth | 2020 | American Journal of Clinical Nutrition | Background: Population-based surveys collect crucial data on anthropometric measures to track trends in stunting [height-forage z score (HAZ) < -2SD] and wasting [weight-for-height z score (WHZ) < -2SD] prevalence among young children globally. However, the quality of the anthropometric data varies between surveys, which may affect population-based estimates of malnutrition. Objectives: We aimed to develop composite indices of anthropometric data quality for use in multisurvey analysis of child health and nutritional status. Methods: We used anthropometric data for children 0–59 mo of age from all publicly available Demographic and Health Surveys (DHS) from 2000 onwards. We derived 6 indicators of anthropometric data quality at the survey level, including 1) date of birth completeness, 2) anthropometric measure completeness, 3) digit preference for height and age, 4) difference in mean HAZ by month of birth, 5) proportion of biologically implausible values, and 6) dispersion of HAZ and WHZ distribution. Principal component factor analysis was used to generate a composite index of anthropometric data quality for HAZ and WHZ separately. Surveys were ranked from the highest (best) to the lowest (worst) index values in anthropometric quality across countries and over time. Results: Of the 145 DHS included, the majority (83 of 145; 57%) were conducted in Sub-Saharan Africa. Surveys were ranked from highest to lowest anthropometric data quality relative to other surveys using the composite index for HAZ. Although slightly higher values in recent DHS suggest potential improvements in anthropometric data quality over time, there continues to be substantial heterogeneity in the quality of anthropometric data across surveys. Results were similar for the WHZ data quality index. Conclusions: A composite index of anthropometric data quality using a parsimonious set of individual indicators can effectively discriminate among surveys with excellent and poor data quality. Such indices can be used to account for variations in anthropometric data quality in multisurvey epidemiologic analyses of child health. Am J Clin Nutr 2020;112(Suppl):806S–815S. Copyright © The Author(s) on behalf of the American Society for Nutrition 2020. | Open |
| Quansah D.Y.; Boateng D. | Maternal dietary diversity and pattern during pregnancy is associated with low infant birth weight in the Cape Coast metropolitan hospital, Ghana: A hospital based cross-sectional study | 2020 | Heliyon | Background: This study investigated the associations between mother's dietary diversity score and dietary patterns during pregnancy and the odds of low birth weight at the Cape Coast Metropolitan Hospital in Ghana. Methods: Mothers attending the postnatal clinic from January to August 2016 at the Cape Coast Metropolitan Hospital were included. Dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the women's dietary diversity score, women were categorized into low, medium or high dietary diversity score groups. The primary outcome was low birth weight and was defined as weight <2500 g at birth. Factor analysis was conducted to identify maternal dietary patterns and a multivariable logistic regression analysis was used to determine the associations between dietary diversity score and dietary patterns with low birth weight. Results: The prevalence of low birth weight in infants was 43.8% (95% CI = 39%–49%). After adjusting for covariates, the odds of low birth weight was four times higher in the low dietary diversity score group compared to the high dietary diversity score group (odds ratio [OR] = 4.29, 95% confidence interval [CI], 1.24–6.48). Three dietary patterns namely "Western", “Traditional” and "Healthy", which explained 58.23% of the total variance in food intake were identified. The subjects in the highest quartiles of “healthy” and “traditional” dietary pattern scores had significantly lower odds of low birth weight (healthy: OR = 0.23, 95% CI, 0.19–0.39, P trend <0.0001; traditional: OR = 0.14, 95% CI, 0.06–0.35, P trend <0.0001, respectively) compared to those in the lowest quartiles of dietary pattern score. Conclusion: Low dietary diversity score during pregnancy was associated with higher odds of infant low birth weight whereas dietary patterns considered as “healthy” and “traditional” during pregnancy were associated with lower odds of infant low birth weight. Findings of this study suggests that higher dietary diversity and “healthy” and “traditional” dietary patterns during pregnancy may be protective of LBW in the study area. © 2020 The Author(s); Nutrition; Diet; Public health; Epidemiology; Dietary diversity score; Dietary patterns; Postnatal care; Low birth weight; Cape Coast. © 2020 The Author(s) | Open |
| Rousham E.K.; Pradeilles R.; Akparibo R.; Aryeetey R.; Bash K.; Booth A.; Muthuri S.K.; Osei-Kwasi H.; Marr C.M.; Norris T.; Holdsworth M. | Dietary behaviours in the context of nutrition transition: A systematic review and meta-analyses in two African countries | 2020 | Public Health Nutrition | Objective: To synthesise evidence of urban dietary behaviours (macronutrients, types of foods, dietary diversity and dietary practices) in two African countries in relation to postulated changes in the context of nutrition transition.Design: Systematic review and meta-analyses, including six online databases and grey literature, 1971-2018 (Protocol CRD42017067718).Setting: Urban Ghana and Kenya.Participants: Population-based studies of healthy adolescents and adults.Results: The forty-seven included studies encompassed 20 726 individuals plus 6526 households. Macronutrients were within WHO-recommended ranges: mean energy intake was 1867 kcal/d (95 % CI 1764, 1969) and the proportions of macronutrients were carbohydrate 61·2 % (58·4, 64·0), fat 25·3 % (22·8, 28·0) and protein 13·7 % (12·3, 15·1). The proportion of population consuming fruit and vegetables was 51·6 %; unhealthy foods, 29·4 %; and sugar-sweetened beverages (SSBs), 39·9 %. Two-thirds (68·8 %) consumed animal-source proteins. Dietary diversity scores were within the mid-range. Meal patterns were structured (typically three meals per day), with evidence lacking on snacking or eating out.Conclusions: Population-level diets fell within WHO macronutrient recommendations, were relatively diverse with structured meal patterns, but some indications of nutrition transition were apparent. The proportion of population consuming fruit and vegetables was low compared to healthy-eating recommendations, and consumption of SSBs was widespread. A paucity of evidence from 1971 to 2010 precluded a longitudinal analysis of nutrition transition. Evidence from these two countries indicates which aspects of dietary behaviours may be contributing to increasing overweight/obesity, namely a low proportion of population consuming fruit and vegetables and widespread consumption of SSBs. These are potential targets for promoting healthier diets. © | Open |
| Saaka M. | Women s decision-making autonomy and its relationship with child feeding practices and postnatal growth | 2020 | Journal of Nutritional Science | Childhood stunting remains a global public health concern. Little has been documented on the effect of women s decision-making autonomy on child growth in settings where decision-making at the household and community levels is largely dominated by men. To assess the relationship between maternal autonomy and child growth, we analysed data from a cross-sectional study of 422 mothers and their youngest child aged 6 24 months in the Bawku West District of Ghana. The dimensions of women s autonomy measured were decision-making power, freedom of mobility and financial autonomy. We then compared how each dimension was associated with the likelihood of stunting and wasting. The important predictors of child growth and dietary intake as measured by the mean length-for-age Z-score (LAZ) and minimum acceptable (MAD) diet, respectively, were determined using multivariable regression models. The overall composite index of women autonomy (CIWA) showed that 52 8 % of women were of high autonomy and half of them had higher autonomy regarding their own and their children s health. After adjusting (multiple regression analysis) for potential confounders, the mean LAZ of children born to women of high autonomy was significantly higher than LAZ of children born to women of low autonomy (β = 0 132; 95 % CI 0 19, 0 95; P = 0 004). Similarly, high women s autonomy was a significant independent predictor of meeting MAD (AOR = 1 59; CI 1 09, 2 34). Of all, the dimensions of women s autonomy measured in this study, health care autonomy better predicted child growth and dietary intake. Based on the findings, nutrition policies and interventions that enhance women s decision-making autonomy could have a positive impact on child growth outcomes. © 2020 The Author(s). | Open |
| Shenton L.M.; Jones A.D.; Wilson M.L. | Factors Associated with Anemia Status Among Children Aged 6–59 months in Ghana, 2003–2014 | 2020 | Maternal and Child Health Journal | Background: In 2008, 78% of Ghanaian children under 5 years old were anemic versus 48% of children globally. In this study, we identified proximal and distal determinants of severe–moderate anemia and mild anemia related to socioeconomic status, nutrition, and health access. Methods: Using data from the 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS), the odds of severe–moderate anemia and mild anemia compared to no anemia, in relation to various hypothesized risk factors, were assessed using a multivariable, multinomial logistic regression, which accounted for survey design. Results: From among 7739 households sampled, severe–moderate anemia was found in approximately 52%, 56%, and 40% of children during 2003, 2008, and 2014, respectively. The proportion of children diagnosed as not anemic was 26% in 2003, 22% in 2008, and 33% in 2014. There are large disparities in anemia prevalence among regions and between urban and rural areas. In 2014, children who were younger (aged 6–24 months), had a recent fever, were from poorer families, and whose mothers were less educated had greater odds of being severely–moderately anemic. These results remained significant when controlling for other risk factors. Predictors of anemia in Ghana remained relatively consistent among the three time periods when the GDHS was administered. Conclusions: The prevalence of anemia in Ghana among children aged 6–59 months has remained unacceptably high. To reduce anemia in these children, the Ghanaian government should concentrate on educating women through both the traditional school system and antenatal care visits. © 2020, The Author(s). | Open |
| Somanje A.N.; Mohan G.; Lopes J.; Mensah A.; Gordon C.; Zhou X.; Moinuddin M.; Saito O.; Takeuchi K. | Challenges and potential solutions for sustainable urban-rural linkages in a ghanaian context | 2020 | Sustainability (Switzerland) | Urban-rural linkages are an integral part of fostering development in both urban and rural communities. However, the focus on development tends to have an urban bias toward Sub-Saharan Africa (SSA) with an increase in urbanization. Ghana is one of the fastest urbanizing countries in SSA. This paper sought to identify the challenges of urban-rural linkages, their corresponding solutions, and contributions to Agenda 2030 that are context-specific to Ghana through a stepwise solution scanning technique. In step 1, the study applied a scoping process to identify the urban-rural challenges. In step 2, a solution for the identified urban-rural challenges in step 1 was co-designed. In step 3, each identified solution was assessed based on its potential to contribute to all three pillars of sustainability by ranking and prioritization. In step 4, the Sustainable Development Goals (SDGs) interlinkages of the top five prioritized potential solutions were analyzed. The identified challenges were (1) inequality and gender gaps, (2) poor and lack of basic and economic infrastructures, (3) the limited effectiveness of decentralization, and (4) food and nutrition security dynamics. The prioritized potential solutions were gender inclusiveness, investment in infrastructures, sustainable agricultural systems, effective decentralization, and financial inclusion. This study recommends maximizing the synergies and minimizing the trade-offs between the SDGs of the potential solutions identified. © 2020 by the authors. | Open |
| Srinivasan C.S.; Zanello G.; Nkegbe P.; Cherukuri R.; Picchioni F.; Gowdru N.; Webb P. | Drudgery reduction, physical activity and energy requirements in rural livelihoods | 2020 | Economics and Human Biology | Low and middle-income countries in Asia and Africa have been witnessing a process of rural transformation, characterised by rising agricultural productivity, commercialisation of agriculture, improved infrastructure and access to services, over several decades. However, there is little empirical evidence on how this transformation process has affected the patterns and intensity of physical activity and time use in rural livelihoods. The lack of empirical evidence can be attributed to the constraints in accurate measurement of physical activity and energy expenditure in the context of free-living populations. Using wearable accelerometry devices, we develop robust energy expenditure profiles for men and women in rural households for two case studies in India and Ghana. An innovative feature of this study is the integration of data on energy expenditure (derived from accelerometers) with data on time-use, which has hitherto not been feasible in observational studies of rural populations. Using the data on physical activity, energy expenditure and time use from the case studies, we examine the impact of drudgery reduction- the substitution of less intense for more intense activities – on energy requirements for men and women in rural households. Our results show that drudgery reduction can have large effects on human energy (calorie) requirements, with an hour of drudgery reduction reducing energy requirements by 11–22 % for men and 13–17 % for women in Ghana and India. There are significant gender differences in energy expenditure patterns and drudgery reduction effects vary by socio-demographic characteristics and endowments of households. Our results suggest that drudgery reduction can offer rural households an important route to improved nutritional status. At the same time, drudgery reduction can lead to increased incidence of overweight and obesity for some segments of the population. The design of development interventions needs to explicitly consider the effects on nutrition and well-being through the energy expenditure dimension. © 2020 Elsevier B.V. | Open |
| Stevano S.; Johnston D.; Codjoe E. | Better decisions for food security? Critical reflections on the economics of food choice and decision-making in development economics | 2020 | Cambridge Journal of Economics | With malnutrition recognised as a key public health issue, attention has been placed on how individuals can make better decisions to attain food and nutrition security. Nevertheless, food practice entails a complex set of decisions that are not fully understood. This paper interrogates the focus on food choice by investigating how socio-economic relations shape practices of food provisioning. Given the surge of behavioural approaches in development economics and our focus on a middle-income country, we contextualise food choice in the transformations of the conceptualisations of decision-making in development economics. We draw on mixed-method evidence on food consumption practices among schoolchildren in Accra, Ghana. We find that the food decision-making process is complex in that it entails multiple moments and people, and embodies contradictory motivations. Decisions are negotiated outcomes reflecting social relations of power among the actors involved. Socio-economic inequality fragments the urban food environment and material living conditions. Furthermore, the concentration of capital gives the food industry the power to shape material and cultural relations to food in ways that extraordinarily limit the scope for individual choice. This is a critical case study to understand the contemporary dynamics of malnutrition in the urban Global South, with broader relevance for the analysis of food poverty elsewhere. © The Author(s) 2020. | Open |
| Takyi S.A.; Basu N.; Arko-Mensah J.; Botwe P.; Amoabeng Nti A.A.; Kwarteng L.; Acquah A.; Tettey P.; Dwomoh D.; Batterman S.; Robins T.; Fobil J.N. | Micronutrient-rich dietary intake is associated with a reduction in the effects of particulate matter on blood pressure among electronic waste recyclers at Agbogbloshie, Ghana | 2020 | BMC Public Health | Background: Informal recycling of electronic waste (e-waste) releases particulate matter (PM) into the ambient air. Human exposure to PM has been reported to induce adverse effects on cardiovascular health. However, the impact of PM on the cardiovascular health of e-waste recyclers in Ghana has not been studied. Although intake of micronutrient-rich diet is known to modify these PM-induced adverse health effects, no data are available on the relationship between micronutrient status of e-waste recyclers and the reported high-level exposure to PM. We therefore investigated whether the intake of micronutrient-rich diets ameliorates the adverse effects of ambient exposure to PM2.5 on blood pressure (BP). Methods: This study was conducted among e-waste and non-e-waste recyclers from March 2017 to October 2018. Dietary micronutrient (Fe, Ca, Mg, Se, Zn, and Cu) intake was assessed using a 2-day 24-h recall. Breathing zone PM2.5 was measured with a real-time monitor. Cardiovascular indices such as systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were measured using a sphygmomanometer. Ordinary least-squares regression models were used to estimate the joint effects of ambient exposure to PM2.5 and dietary micronutrient intake on cardiovascular health outcomes. Results: Fe was consumed in adequate quantities, while Ca, Se, Zn, Mg, and Cu were inadequately consumed among e-waste and non-e-waste recyclers. Dietary Ca, and Fe intake was associated with reduced SBP and PP of e-waste recyclers. Although PM2.5 levels were higher in e-waste recyclers, exposures in the control group also exceeded the WHO 24-h guideline value (25 μg/m3). Exposure to 1 μg/m3 of PM2.5 was associated with an increased heart rate (HR) among e-waste recyclers. Dietary Fe intake was associated with a reduction in systolic blood pressure levels of e-waste recyclers after PM exposure. Conclusions: Consistent adequate dietary Fe intake was associated with reduced effects of PM2.5 on SBP of e-waste recyclers overtime. Nonetheless, given that all other micronutrients are necessary in ameliorating the adverse effects of PM on cardiovascular health, nutrition-related policy dialogues are required. Such initiatives would help educate informal e-waste recyclers and the general population on specific nutrients of concern and their impact on the exposure to ambient air pollutants. © 2020 The Author(s). | Open |
| Takyi S.A.; Basu N.; Arko-Mensah J.; Dwomoh D.; Nti A.A.A.; Kwarteng L.; Acquah A.A.; Robins T.G.; Fobil J.N. | Micronutrient status of electronic waste recyclers at Agbogbloshie, Ghana | 2020 | International Journal of Environmental Research and Public Health | Growing evidence suggests that micronutrient status is adversely impacted by toxic metals (e.g., cadmium, lead, and arsenic) exposures; however, the micronutrient status of e-waste recyclers who are amongst the highest metal-exposed groups is not known. This study, therefore, assessed the micronutrient status of e-waste recyclers using dietary information (2-day 24-h recall survey) and biomarker data (whole blood and urine) among 151 participants (100 e-waste recyclers at Agbogbloshie and 51 controls at Madina Zongo from the Accra region, Ghana) in March 2017. Biomarker levels of iron (Fe), calcium (Ca), magnesium (Mg), selenium (Se), zinc (Zn) and copper (Cu) were analyzed by the ICP-MS. Linear regression models were used to assess associations ofwork-related factors and sociodemographic characteristics with micronutrient intake, blood, and urine micronutrient levels. The results showed that apart from Fe and Zn, e-waste recyclers at Agbogbloshie did not meet the day-to-day dietary requirements for Ca, Cu, Se, and Mg intake. Except for the low levels of Mg and Fe detected in blood of e-waste recyclers, all other micronutrients measured in both blood and urine of both groups fell within their reference range. Exposure to biomass burning was associated with lower blood levels of Fe, Mg, and Zn among the e-waste recyclers. Further, among e-waste recyclers, significant relationships were found between the number of years spent recycling e-waste and urinary Ca and Cu excretion. Given that, some dietary and blood levels of micronutrients were below their reference ranges, the implementation of evidence-based nutrition strategies remains necessary among e-waste recyclers to reduce their risk of becoming malnourished. © 2020 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Tandoh M.A.; Mills-Robertson F.C.; Wilson M.D.; Anderson A.K. | Nutritional and cognitive deficits of school-age children: A study in helminth-endemic fishing and farming communities in Ghana | 2020 | Nutrition and Food Science | Purpose: The purpose of this study was to elucidate the association between helminth infections, dietary parameters and cognitive performance, as well as the predictors of undernutrition among school-age children (SAC) living in helminth-endemic fishing and farming communities in Ghana. Design/methodology/approach: This was a cross sectional study involving 164 (9 to 12 years old) SAC from fishing (n = 84) and farming (n = 80) communities of the Kwahu Afram Plains South District of the Eastern Region of Ghana, using structured questionnaires and anthropometric and biochemical assessments. Findings: Overall, 51.2% of the children were males, with no significant gender difference between the communities (p = 0.88). Average age of the children was 10.5 ± 1.25 years, with no significant difference between the farming and fishing communities (p = 0.90). About 53.1% of all children were anemic, with no significant differences between farming versus fishing communities (p = 0.87). Helminth-infected children were significantly anemic (p = 0.03). Mean serum zinc level of all children was 13.1 ± 4.57 µmol/L, with zinc deficiency being significantly higher in children in the farming community (p < 0.0001). About 7.5% of all the children were underweight, whilst 13.8% were stunted with a higher proportion of stunting occurring among older children (p = 0.001) and girls (p = 0.117). There was no significant difference in the Raven’s Colored Progressive Matrices cognitive test scores between the two communities (p = 0.79). Predictors of anemia were helminthiasis and pica behavior. Originality/value: These findings are relevant and have the prospect of guiding the development of intervention programs in addressing the persistent problem of nutritional and cognitive deficits among SAC. © 2019, Emerald Publishing Limited. | Open |
| Torto N.M.; Brownell K.D. | Role of food aid and assistance in addressing the double burden of malnutrition in Ghana: A qualitative policy analysis | 2020 | BMJ Nutrition, Prevention and Health | Background and aims In many low-income and middle-income countries, the double burden of malnutrition threatens public health and economic progress, urging a re-evaluation of the roles and responsibilities of nutrition actors, both traditional and non-traditional. This study examines the food aid and assistance activities of the United Nations World Food Programme (WFP) - one non-traditional actor in the double burden conversation - and the potential for these activities to reach beyond their traditional mandate on undernutrition to also address overweight and obesity in Ghana. Methods Information on WFP activities in Ghana from 2012 up through its planning into 2023 was extracted from 11 WFP planning, operations and evaluation documents. WFP activities were then judged against the WHO's framework on the determinants of the double burden of malnutrition to determine their potential to address the double burden. Semistructured interviews were also conducted with 17 key informants in the global nutrition landscape to identify challenges that may complicate the role of WFP and other actors in addressing the double burden. Results The analysis demonstrates that WFP activities in Ghana can serve as a platform on which to address the double burden, particularly by targeting the food access, food systems and socioeconomic disadvantage determinants of the double burden. Actors' uncertainty with what role WFP should play in addressing the double burden, insufficient government attention to malnutrition and poor data on overweight and obesity were identified as potential challenges that complicate addressing the double burden. Conclusion The findings suggest that integrating WFP as a partner in the effort to address the double burden in Ghana might help amplify progress. To better address the double burden, WFP might prioritise retrofitting existing activities rather than implementing new interventions. © 2020 BMJ Publishing Group. All rights reserved. | Open |
| Verguet S.; Limasalle P.; Chakrabarti A.; Husain A.; Burbano C.; Drake L.; Bundy D.A.P. | The Broader Economic Value of School Feeding Programs in Low- and Middle-Income Countries: Estimating the Multi-Sectoral Returns to Public Health, Human Capital, Social Protection, and the Local Economy | 2020 | Frontiers in Public Health | Introduction: Globally, there are 370 million children receiving school meals every day. Coverage is least in low-income countries, where the need is greatest and where program costs are viewed as high in comparison with the benefits to public health alone. Here we explore the policy implications of including the returns of school feeding to other sectors in an economic analysis. Methods: We develop an economic evaluation methodology to estimate the costs and benefits of school feeding programs across four sectors: health and nutrition; education; social protection; and the local agricultural economy. We then apply this multi-sectoral benefit-cost analytical framework to school feeding programs in 14 countries (Botswana, Brazil, Cape Verde, Chile, Côte d'Ivoire, Ecuador, Ghana, India, Kenya, Mali, Mexico, Namibia, Nigeria, and South Africa) for which input data are readily available. Results: Across the 14 countries, we estimate that 190 million schoolchildren benefit from school feeding programs, with total program budgets reaching USD11 billion per year. Estimated annual human capital returns are USD180 billion: USD24 billion from health and nutrition gains, and USD156 billion from education. In addition, school feeding programs offer annual social protection benefits of USD7 billion and gains to local agricultural economies worth USD23 billion. Conclusions: This multi-sectoral analysis suggests that the overall benefits of school feeding are several times greater than the returns to public health alone, and that the overall benefit-cost ratio of school feeding programs could vary between 7 and 35, with particular sensitivity to the value of local wages. The scale of the findings suggests that school feeding programs are potentially much more cost-beneficial when viewed from the perspective of their multi-sectoral returns, and that it would be worthwhile following up with more detailed analyses at the national level to enhance the precision of these estimates. © Copyright © 2020 Verguet, Limasalle, Chakrabarti, Husain, Burbano, Drake and Bundy. | Open |
| Wegmüller R.; Bentil H.; Wirth J.P.; Petry N.; Tanumihardjo S.A.; Allen L.; Williams T.N.; Selenje L.; Mahama A.; Amoaful E.; Steiner-Asiedu M.; Adu-Afarwuah S.; Rohner F. | Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: Findings from a national survey | 2020 | PLoS ONE | Nationally representative data on the micronutrient status of Ghanaian women and children are very scarce. We aimed to document the current national prevalence of micronutrient deficiencies, anemia, malaria, inflammation, α-thalassemia, sickle cell disease and trait, and under- and over-nutrition in Ghana. In 2017, a two-stage cross-sectional design was applied to enroll pre-school children (6–59 months) and non-pregnant women (15–49 years) from three strata in Ghana: Northern, Middle and Southern Belt. Household and individual questionnaire data were collected along with blood samples. In total, 2123 households completed the household interviews, 1165 children and 973 women provided blood samples. Nationally, 35.6% (95%CI: 31.7,39.6) of children had anemia, 21.5% (18.4,25.0) had iron deficiency, 12.2% (10.1,14.7) had iron deficiency anemia, and 20.8% (18.1,23.9) had vitamin A deficiency; 20.3%(15.2,26.6) tested positive for malaria, 13.9% (11.1,17.3) for sickle trait plus disease, and 30.7% (27.5,34.2) for α-thalassemia. Anemia and micronutrient deficiencies were more prevalent in rural areas, poor households and in the Northern Belt. Stunting and wasting affected 21.4% (18.0,25.2) and 7.0% (5.1,9.5) of children, respectively. Stunting was more common in rural areas and in poor households. Among non-pregnant women, 21.7% (18.7,25.1) were anemic, 13.7% (11.2,16.6) iron deficient, 8.9% (6.7,11.7) had iron deficiency anemia, and 1.5% (0.8,2.9) were vitamin A deficient, 53.8% (47.6,60.0) were folate deficient, and 6.9% (4.8,9.8) were vitamin B12 deficient. Malaria parasitemia in women [8.4% (5.7,12.2)] was lower than in children, but the prevalence of sickle cell disease or trait and α-thalassemia were similar. Overweight [24.7% (21.0,28.8)] and obesity [14.3% (11.5,17.7)] were more common in wealthier, older, and urban women. Our findings demonstrate that anemia and several micronutrient deficiencies are highly present in Ghana calling for the strengthening of Ghana’s food fortification program while overweight and obesity in women are constantly increasing and need to be addressed urgently through governmental policies and programs. © 2020 Wegmüller et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Wright L.; Marrero A.; Thompson L.; Zeola S.; Boateng L.; Epps J.; Lewis S. | Culturally Adapted, Hands-on Malnutrition Workshop for Dietitians in Ghana Increases Self-efficacy, Knowledge, and Skills | 2020 | Topics in Clinical Nutrition | Malnutrition is a major public health concern in Ghana where 7.5% of women are underweight and one-third of child deaths are attributed to malnutrition. Implementation of a malnutrition diagnosis offers a potential, cost-effective solution to improve a patient's health outcome. This report describes a hands-on workshop on the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Malnutrition Guidelines designed for Ghanaian dietitians. The teaching techniques and cultural adaptation are detailed. Program evaluation demonstrated that the workshop improved knowledge, application skills, and confidence among the participants. ©2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. | Open |
| Yankah N.; Intiful F.D.; Tette E.M.A. | Comparative study of the nutritional composition of local brown rice, maize (obaatanpa), and millet—A baseline research for varietal complementary feeding | 2020 | Food Science and Nutrition | Introduction: Childhood malnutrition remains a major public health issue of concern particularly in sub-Saharan Africa, and inadequate complementary feeding is a common cause. Promoting dietary diversity is one way of tackling this problem. High dependence on maize has its limitations; modifying other local staples into complementary foods can be a feasible alternative to promote optimum nutrition. Objectives: Comparing the nutritional composition of brown rice to millet and maize to determine its beneficial value as complementary food. Methods: Experimental study was carried out at the Department of Nutrition and Food Science of University of Ghana. Samples of maize, millet, and brown rice were obtained from the Ministry of Agriculture, Accra and nutritional contents analyzed. Statistical Package for Social Sciences version 20.0 and ANOVA were used to assess differences. Results: Results showed brown rice contained the highest content of carbohydrates (77.94 ± 0.32) % and zinc (12.15 ± 0.21) mg while millet had the highest protein (10.49 ± 0E-7) mg and fat (4.99 ± 0.46) % content. Maize contained highest amount of calcium (21.24 ± 0.14) mg. Iron was only found in millet (10.72 ± 0.15) mg. The zinc content per 100 g of all three (3) cereals was above RDA. All three (3) cereals contributed significantly <10% to the RDA of calcium. Iron content of millet contributed more than 90% to RDA. Conclusions: Locally produced brown rice is rich in zinc and carbohydrates compared to millet and maize. Thus, can be used for complementary feed but, given the low protein and iron content, it may need to be fortified or diversified and used as a cereal blend. © 2020 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc. | Open |
| Zanello G.; Srinivasan C.S.; Picchioni F.; Webb P.; Nkegbe P.; Cherukuri R.; Neupane S. | Physical activity, time use, and food intakes of rural households in Ghana, India, and Nepal | 2020 | Scientific Data | With more than 820 million undernourished people living in rural areas of low- and middle-income countries (LMICs), ending hunger and ensuring access to food by all is a global priority. In the past few decades, the adoption of technological innovations in the agricultural sector and related crop yield improvements have not led to expected improvements in the nutritional status of rural households in many LMICs. The increased energy expenditure associated with the adoption of productivity-enhancing innovations may provide an important explanation of the disconnect between agricultural productivity enhancements and improved nutritional outcomes. We develop a methodology for generating reliable livelihood energy/calorie expenditure profiles for rural agricultural households using research-grade accelerometer devices. We integrate the data on physical activity and energy expenditure in rural households with data on time-use and food intakes to generate a data set that provides a unique window into rural livelihoods. This can be a valuable resource to analyse agriculture-nutrition impact pathways and improve the welfare of rural and agricultural households. © 2020, The Author(s). | Open |
| Abidin P.E.; Asare K.; Kazembe J.; Akansake D.; Dorgbetor I.K.; Suleman I.; Achibase S.; Imoro S.; Dery E.K.; Mourik T.V.; Carey E.E. | Using sand storage technology: Can we store sweetpotato roots for food and vines, thus contributing to food and nutrition security in drought-prone areas? | 2019 | Acta Horticulturae | Orange-fleshed sweetpotato (OFSP) can significantly contribute to the fight against Vitamin A deficiency in Sub-Saharan Africa. Erratic rainfalls, poor soil fertility, virus diseases, weevil incidence, and animal destruction are often experienced by farmers, particularly in drought-prone areas, and can disrupt crop production. There is a need for seed systems that supply sweetpotato planting material in-time, so that farmers can plant and harvest this crop early. Between 2011 and 2018, studies were conducted in Northern Malawi and Ghana on a technique using sand to store sweetpotato storage roots. The sprouted roots can be planted for producing vines (planting material) and unsprouted roots used for household consumption or sales. Various types of sand, and some indigenous storage techniques were investigated. Using the dry sand technique has proven to be highly effective for rural poor people living in areas with a long dry season. The studies found that vines could be readily available for planting at any time, including at the onset of the rainy season. As the onset of rains becomes more inconsistent, this technology may allow farmers to quickly respond to the early start of the rainy season with clean planting material. The trained vine producers could generate income from vine sales. Furthermore, farmers had food stock during the hunger period or sold roots when needed to buy other household items. Sand storage allowed farmers to realize good market prices, in contrast to the peak of the harvest season when prices are low due to glut. The final research findings showed the sand storage technology to be an effective approach to help reduce poverty, improve food and nutrition security and mitigate the effects of climate change. Scaling out of this technique is under way. © 2019 International Society for Horticultural Science. All rights reserved. | Open |
| Acquah E.; Darteh E.K.M.; Amu H.; Adjei D.K.A. | Predictors of underweight in children under-five years in Ghana | 2019 | Ghana Medical Journal | Background: Underweight is a key indicator of malnutrition in children and results in long term effects such as abnormalities in physical and mental health, behavioural problems, and low educational achievement. Objective: Using the conceptual framework for child malnutrition by the United Nations Children's Fund, we examined the predictors of underweight in children under five years in Ghana. Methods: This cross-sectional study made use of data from the 2014 Ghana Demographic and Health Survey. A total of 2720 children were included in the analysis. Descriptive and inferential statistics comprising frequency, percentage, chi-square, and binary logistic regression were used in analysing the data. Results: The prevalence of underweight was 11%. Age, wealth status, mother's education, region, ethnicity, household toilet facility, the source of drinking water, the incidence of diarrhoea, and subscription to health insurance significantly predicted underweight in the children. The risk of being underweight was higher in females than males (OR=1.04, 95% CI=0.81-1.34). This was, however, not statistically significant. The probability of being underweight also declined significantly with mother's level of education. Conclusion: Our findings underscore the need for the Ghana Health Service and other health sector stakeholders to apportion interventions with a focus on improving complementary feeding, poverty alleviation, and health status of children. © The Author(s). This is an Open Access article under the CC BY license. | Open |
| Adams K.P.; Adu-Afarwuah S.; Bentil H.; Oaks B.M.; Young R.R.; Vosti S.A.; Dewey K.G. | The effects of a nutrient supplementation intervention in Ghana on parents' investments in their children | 2019 | PLoS ONE | A child's endowment is a reflection of his/her genetic makeup and the conditions faced in early life. Parents build on their child's endowment by investing resources in their child, and together, a child's endowment and subsequent investments act as input into important later-life outcomes. A positive or negative shock to a child's endowment can have a direct biological effect on a child's long-term outcomes but may also affect parents' decisions about investments in the health and human capital of their children. Using follow-up data collected several years after a randomized trial in Ghana, we explored whether maternal and child supplementation with small-quantity lipid-based nutrient supplements (SQ-LNS) throughout much of the first 1,000 days influenced parental investments in the health and human capital of their children. Across the domains of family planning, breastfeeding, health, education, and paternal financial support, we found that, in general, the intervention did not affect investments in the treated child nor his/her untreated siblings. These results suggest that given production technologies, constraints, and preferences, the intervention either did not change parents' optimal investment strategies or that the effects of the intervention, namely increased birth size and attained length at 18 months of age, were too small for parents to perceive or to have any meaningful impact on parents' expectations about the returns to investments in their children. © 2019 Adams et al. | Open |
| Adhvaryu A.; Fenske J.; Nyshadham A. | Early life circumstance and adult mental health | 2019 | Journal of Political Economy | We show that psychological well-being in adulthood varies with circumstance in early life. Combining a time series of real producer prices of cocoa with a nationally representative household survey in Ghana, we find that a one standard deviation rise in the cocoa price in early life decreases the likelihood of severe mental distress in adulthood by 3 percentage points (half the mean prevalence) for cohorts born in cocoa-producing regions relative to those born in other regions. Impacts on related personality traits are consistent with this result. Maternal nutrition, reinforcing childhood investments, and adult circumstance are likely operative channels of impact. © 2019 by The University of Chicago. All rights reserved. | Open |
| Adu-Afarwuah S.; Young R.T.; Lartey A.; Okronipa H.; Ashorn P.; Ashorn U.; Oaks B.M.; Arimond M.; Dewey K.G. | Maternal and Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Increases Infants' Iron Status at 18 Months of Age in a Semiurban Setting in Ghana: A Secondary Outcome Analysis of the iLiNS-DYAD Randomized Controlled Trial | 2019 | Journal of Nutrition | Background Interventions are needed to address iron deficiency in low-income settings. Objective This secondary outcome analysis aimed to compare the hemoglobin (Hb) and iron status [zinc protoporphyrin (ZPP)] of children born to women enrolled in the iLiNS-DYAD trial in Ghana. Methods Women ≤20 wk pregnant (n = 1320) were assigned to receive 60 mg Fe/d and 400 μg folic acid/d until delivery and placebo thereafter, and no supplementation for infants (IFA group); or multiple micronutrients containing 20 mg Fe/d until 6 mo postpartum and no supplementation for infants (MMN); or small-quantity lipid-based nutrient supplements (SQ-LNSs) containing 20 mg Fe/d until 6 mo postpartum, and SQ-LNSs for infants from 6 to 18 mo of age (LNS). We compared infants' Hb (g/L) and ZPP (μmol/mol heme) at 6 and 18 mo of age. Results At 6 mo of age, groups did not differ in mean ± SD Hb (overall: 113 ± 9.9 g/L) or geometric mean (95% CI) ZPP [overall: 62.6 (60.6, 64.7)]. At 18 mo of age, mean ± SD Hb (overall: 112 ± 10.4 g/L) did not differ significantly between groups, whereas geometric mean (95% CI) ZPP was lower (P = 0.031) in the LNS group [53.9 (50.7, 57.3)] than the IFA [60.4 (56.7, 64.3)] but not the MMN [58.8 (55.6, 62.2)] group. Further, the LNS group, compared with the IFA and MMN groups combined, had a lower prevalence of elevated (>70) ZPP (27.5% compared with 35%; P = 0.02) and a marginally lower prevalence of anemia (38.7% compared with 44.9%; P = 0.06). These results generally remained unchanged when controlling for prespecified covariates or correcting for inflammation. Conclusions In this setting, providing SQ-LNSs or multiple micronutrients with 20 mg Fe/d, compared with iron (60 mg/d) and folic acid, to pregnant women does not affect their infants' Hb or iron status at 6 mo of age, but maternal and infant supplementation with SQ-LNSs increases infants' iron status at 18 mo of age. This trial was registered at clinicaltrials.gov as NCT00970866. © 2019 American Society for Nutrition. | Open |
| Agbemafle I.; Francis S.L.; Jensen H.H.; Reddy M.B. | Influence of Food Security Status and Anemia-Related Knowledge on Perceptions About 2 Nutritious Underutilized Foods Among Ghanaian Caregivers | 2019 | Food and Nutrition Bulletin | Background: Nutritious underutilized foods (NUFs) significantly contribute to sustainable dietary diversity but are often unused for many reasons. Objective: We assessed the influence of food security status (FSS) and anemia-related knowledge (ARK) on perceptions about Solanum torvum (turkey berry) and Rhynchophorus phoenicis Fabricius (palm weevil larvae) among Ghanaian caregivers. Methods: A cross-sectional survey was conducted among 891 caregivers (aged 20-49 years), who have children 6 to 59 months old, from Upper Manya Krobo district (Eastern region), Kumasi metropolitan (Ashanti region), Ho municipality (Volta region), La-Nkwantanang-Madina, and Ga West municipality (Greater-Accra region), Ghana. Food security status, ARK, and perceptions about the 2 NUFs were obtained using pretested semi-structured questionnaire. Logistic regression models were used to determine effect of FSS and ARK on perception outcomes. Results: Thirty-six percent of caregivers were food secure, while 13.9%, 28.4%, and 21.7%, respectively, were mildly, moderately, and severely food insecure. Most caregivers (62.0%) scored above 70% on ARK. High favorable perception was significantly lower for palm weevil larvae than that for turkey berry. Food secure caregivers were 4.5 times more likely to have poor favorable perceptions about palm weevil larvae than food insecure caregivers (P =.03). However, food secure caregivers were 2.9 times more likely to have high favorable perceptions about turkey berry than food insecure caregivers (P <.001). Caregivers’ knowledge about anemia was associated with high favorable perception about turkey berry by 3.3-fold (95% confidence interval: 2-5.5, P =.001). Conclusions: Nutrition education about turkey berry and palm weevil larvae is needed to encourage their use for promoting nutrient density of complementary and household foods. © The Author(s) 2019. | Open |
| Alhassan R.K.; Tsikata R.; Tizaawaw R.N.; Tannor P.A.; Quaw P.P.; Awortwi C.A.A.; Ayanore M.A.; Afaya A.; Salia S.M.; Milipaak J.; Mwini-Nyaledzigbor P.P. | Adherence to standard nursing protocols on nasogastric tube feeding in a secondary referral hospital in Ghana: Comparing self-ratings by professional and auxiliary nurses | 2019 | BMC Health Services Research | Background: Data on nurses' adherence to standard protocol on nasogastric (NG) tube feeding remain scanty in Ghana even though patients in critical medical conditions are routinely managed using this procedure. This study explored self-rated adherence to standard protocols on NG tube feeding among professional and auxiliary nurses and the perceived barriers impeding compliance to these standard protocols. Methods: This is a descriptive analytical cross-sectional study among professional (n = 89) and auxiliary (n = 24) nurses in a major referral hospital in one of the ten administrative regions in Ghana. Four-point Likert scale was used to ascertain the level of adherence to standard guidelines on nasogastric tube, ranging from 4 "Very large extent" to 1 "Very little extent". Wilcoxon Mann-Whitney test and univariate ordered logistic regression tests (proportional odds models) were performed to determine the odds of higher self-ratings among professional and auxiliary nurses. Results: Overall, the odds of higher self-ratings on adherence to standard nursing protocols on NG tube feeding was higher among auxiliary nurses than professional nurses (OR = 2.76, p = 0.031) after adjusting for age, gender, education and years of work experience. Key barriers to adherence to standard protocols on NG tube feeding were: limited opportunities for in-service trainings and insufficiency of NG tube feeding protocols on the wards. Conclusion: There is the need for more routine in-service trainings for nursing staff to update their knowledge on NG tube feeding. Hospital management should also make current nursing protocols available to nurses to guide their practice alongside routine onsite supervision of nurses. © 2019 The Author(s). | Open |
| Amugsi D.A.; Dimbuene Z.T.; Kyobutungi C. | Correlates of the double burden of malnutrition among women: An analysis of cross sectional survey data from sub-Saharan Africa | 2019 | BMJ Open | Objective: To investigate the correlates of the double burden of malnutrition (DBM) among women in five sub-Saharan African countries. Design: Secondary analysis of Demographic and Health Surveys (DHS). The outcome variable was body mass index (BMI), a measure of DBM. The BMI was classified into underweight (BMI <18.50 kg/m2), normal weight (18.50-24.99 kg/m2), overweight (25.0-29.9 kg/m2) and obesity (≥30.0 kg/m2). Settings: Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC). Subjects: Women aged 15-49 years (n=64698). Results: Compared with normal weight women, number of years of formal education was associated with the likelihood of being overweight and obese in Ghana, Mozambique and Nigeria, while associated with the likelihood of being underweight in Kenya and Nigeria. Older age was associated with the likelihood of being underweight, overweight and obese in all countries. Positive associations were also observed between living in better-off households and overweight and obesity, while a negative association was observed for underweight. Breastfeeding was associated with less likelihood of underweight in DRC and Nigeria, obesity in DRC and Ghana, overweight in Kenya and overweight and obesity in Mozambique and Nigeria relative to normal weight. Conclusions: Our analysis reveals that in all the countries, women who are breastfeeding are less likely to be underweight, overweight and obese. Education, age and household wealth index tend to associate with a higher likelihood of DBM among women. Interventions: to address DBM should take into account the variations in the effects of these correlates. © 2019 Author(s). | Open |
| Armah A.A.; Nti C.A.; Otoo G.E. | Climate change and food and nutrition security in the Bibiani-Anhwiaso Bekwai district in the Western Region of Ghana | 2019 | Cogent Environmental Science | Climate change has the potential to increase food insecurity and exacerbate malnutrition in small-scale farming households through its impacts on crop yield and income. Using a mixed-methods design, a cross-sectional study was carried out in the Bibiani-Anhwiaso Bekwai District in the Western Region of Ghana among 210 farming households with the objective of finding associations between climate change and food and nutrition security in small-scale farming households. Results from the quantitative study showed that 72% of the participants had perceived changes in weather patterns. Majority (94%) of the participants were food insecure and households that had perceived climate change were 11 times more likely to be food insecure than those that had not (p = 0.001). Results from the qualitative study showed that participants had observed less predictable weather patterns which had negative impacts on crop yield, food security and dietary diversity. The study recommended educating and encouraging farmers to adopt climate-smart agricultural practices and other modern technologies to enhance crop production and livelihood of small-scale farmers as well as food and nutrition security within the district. © 2019 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license. | Open |
| Aryee P.A.; Helegbe G.K.; Agordoh P.D.; Mohammed A.J.; Muntala J.; sKoblaji F.A.; Kumoji H.N. | Exploring consumer knowledge, understanding and use of food and nutrition label information in the tamale metropolis of Ghana | 2019 | African Journal of Food, Agriculture, Nutrition and Development | The perception that consumers in low Income Countries have poor knowledge and understanding of food or nutrition labels and, therefore, do not rely on them at the point of purchase is rife. This study was aimed at assessing consumer knowledge and understanding and its influence on food label usage in the Tamale Metropolis of Ghana. An analytical cross-sectional study design was employed and mainly literate adults aged 15 to 60 years were conveniently selected and interviewed at various points-of-purchase including supermarkets, provision shops and other trading outlets. Data were analysed using the Statistical Package for Social Sciences (SPSS) for windows (version 19.0). Percentages were calculated and reported for descriptive statistics whilst chi-square tests of significance and regression analysis were employed to measure relationships between variables. Statistically significant differences were accepted at p < 0.05. Out of the 384 consumers interviewed, 98.4% (n=378) were aware of food labels, yet, only 66.7 % (n=256) claimed they understood the labels. A large proportion (95.8%) also claimed they checked but just about 51.9% said they did so "always". Most (89.3%) claimed they are influenced by key factors on the labels with the level of influence being highest with nutrition content, followed by expiry date, health-claim, price and advertisement respectively. However, at the point-of-purchase most (79.4) revealed they looked out for expiry date. Socio-demographic characteristics including gender (p=0.009), age (p=0.017), occupation (p=0.042), educational level (p=0.022) and income (p=0.051) were significantly associated with consumers' understanding of the labels, with gender remaining the only significant predictor. Furthermore, age (p=0.054), occupation (p=0.0.007) and educational level (p < 0.001) showed significant associations with food label usage. Education level (Tertiary) emerged the only significant predictor of food label usage. The level of knowledge and use of nutrition information on food packages among predominantly literate consumers in the Tamale Metropolis of Ghana can be compared to that of consumers in other parts of the world. These results may inform the need for developing an approach towards future information and education strategies for health professionals and other stakeholders interested in consumer awareness activities. © 2019, Afr. J. Food Agric. Nutr. Dev. | Open |
| Asase A.; Kumordzie S. | Availability, Cost, and Popularity of African Leafy Vegetables in Accra Markets, Ghana | 2019 | Economic Botany | Consumption of African leafy vegetables can have a positive effect on nutrition, health, and economic well-being of both rural and urban populations. In this study, we undertook a detailed evaluation of African leafy vegetables in selected Accra markets in southern Ghana. Data were collected from 50 sellers from four markets within Accra and its environs using standard ethnobotanical methods. A total of six species of African leafy vegetables belonging to five plant families were identified. Average cost of the vegetables was about USD 0.25 per bundle (weight of bundles ranges between 0.2 and 0.6 kilograms (kg)), and prices were influenced by plant species and market location. Popularity of the leafy vegetables was high as reported by 88% of the respondents. Our findings showed that only a few of the documented African leafy vegetables were available in the markets, although popularity of these vegetables was high. © 2019, The New York Botanical Garden. | Open |
| Awuuh V.A.; Appiah C.A.; Mensah F.O. | Impact of nutrition education intervention on nutritional status of undernourished children (6-24 months) in East Mamprusi district of Ghana | 2019 | Nutrition and Food Science | Purpose: This study aims to determine the impact of nutrition education intervention on nutritional status of undernourished children aged 6-24 months in the East Mamprusi district of Ghana. Design/methodology/approach: This was a pre-post interventional study. In all, 153 undernourished children of age 6-24 months and their mothers were recruited from five communities. Underweight, stunting, wasting, mid upper arm circumference (MUAC) and haemoglobin (Hb) levels were determined at baseline and after intervention. Nutrition education was given to the mothers for three months based on the nutrition problems identified at baseline assessment. Findings: There were improvements in underweight, wasting, MUAC and Hb levels among the children after the nutrition education intervention. The level of improvement at post-intervention differed significantly for underweight (−2.4 ± 0.4, −2.2 ± 0.4; p = 0. 001), wasting (−2.2 ± 0.6, −1.9 ± 0.6; p = 0. 001), MUAC (12.3 ± 0.5, 12.9 ± 0.6; p = 0. 001) and Hb level (10.0 ± 1.4, 10.5 ± 1.4; p = 0. 001) of the children compared to pre-intervention (−1.4 ± 1.8, −1.3 ± 1.7; p = 0.314). Practical implications: There was significant improvement in the nutritional status of the undernourished children after the nutrition education intervention. Community nutritionists and stakeholders involved in nutrition and health issues concerning infants and young children should consider nutrition education, as it could be an inexpensive and effective strategy in combating childhood undernutrition in resource-poor settings. Originality/value: Findings of this study provide evidence, suggesting nutrition education as a potential strategy to curb the high rates of child undernutrition in resource-poor communities in Ghana. This study provides insight for larger studies on the effectiveness of nutrition education in curbing child malnutrition in deprived communities in Ghana. © 2018, Emerald Publishing Limited. | Open |
| Ayensu J.; Lutterodt H.; Annan R.A.; Edusei A.; Loh S.P. | Nutritional composition and acceptability of biscuits fortified with palm weevil larvae (Rhynchophorus phoenicis Fabricius) and orange-fleshed sweet potato among pregnant women | 2019 | Food Science and Nutrition | Edible insects are currently being promoted as an inexpensive alternative source of protein in underdeveloped countries due to the rising cost of conventional animal protein and the foreseen future deficit in its supply. A supplemental palm weevil larvae and orange-fleshed sweet potato biscuit was developed as part of efforts to understand the nutritional benefits of edible insects and to predict whether these benefits will contribute to better nutrition among pregnant women in Ghana. The palm weevil larvae flour and the orange-fleshed sweet potato flour were mixed with wheat flour in three formulations that had 0, 35, and 70% of palm weevil larvae flour, before being made into biscuits. The biscuits were subjected to proximate and mineral content analysis and sensory evaluation. Proximate and mineral composition of the biscuits increased with increasing levels of palm weevil larvae flour substitution. Among the blends, biscuits containing 70% palm weevil larvae had the highest energy and fat content, and protein content also increased by 45% compared with biscuits made from 100% wheat flour. Calcium, iron, and zinc levels also increased with increasing levels of palm weevil larvae flour substitution. However, carbohydrate and crude fiber concentrations of the biscuits decreased with increasing substitution. The overall acceptability of the biscuits as determined by sensory evaluation using pregnant women was high. Biscuits fortified with palm weevil larvae can be a nutritious snack for pregnant women. © 2019 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc. | Open |
| Balogun H.; Jaakkola J.J.K.; Amegah A.K. | Association of Sunlight Exposure and Consumption of Vitamin D-Rich Foods during Pregnancy with Adverse Birth Outcomes in an African Population | 2019 | Journal of Tropical Pediatrics | Background: Our objective was to assess whether dietary vitamin D (vitD) intake and sunlight exposure during pregnancy is associated with birth outcomes in a healthy Ghanaian population. Methods: A population-based cross-sectional study that included 703 mother-infant pairs accessing postnatal services at the five main health facilities in Cape Coast, Ghana was conducted in 2016. Information on sunlight exposure practices and consumption of vitD-rich foods during pregnancy was collected. Results: A 1 μg increase in vitD intake resulted in a statistically significant 0.00505 weeks increase in gestational age (95% confidence interval [CI]: 0.00005, 0.01004). Mothers classified in the first quartile of vitD intake had 37% (prevalence ratio = 1.37, 95% CI: 1.10, 1.69) increased risk of preterm birth (PTB) compared to their counterparts classified in the fourth quartile. Decreased vitD intake was also associated with low-to-moderate Apgar score. Conclusion: Nutrition education of mothers on the importance of screening for vitD deficiency during early months of pregnancy is recommended. © 2019 The Author (2019). Published by Oxford University Press. All rights reserved. | Open |
| Blaauw R.; Achar E.; Dolman R.C.; Harbron J.; Moens M.; Munyi F.; Nyatefe D.; Visser J. | The problem of hospital malnutrition in the african continent | 2019 | Nutrients | This study aims to determine the prevalence of risk of malnutrition on admission and discharge in African hospitals, and to identify the association with selected indicators. In this multi-center prospective cohort study, adult patients from hospitals in South Africa, Kenya, and Ghana were screened on admission and discharge and contacted 3 months post-discharge. Relevant morbidity and mortality outcomes were assessed. At risk of malnutrition was indicated if NRS-2002 score ≥3. Adult patients (n = 2126; 43.11 years, IQR: 31.95–55.60; 52.2% female) were screened on admission and 61% were identified as at risk of malnutrition. The proportion of at-risk patients for the three hospitals in Kenya and Ghana (66.2%) were significantly higher than that of the three South African hospitals (53.7%) (Chi2 = 31.0; p < 0.001). Discharge risk of malnutrition was 71.2% (n = 394). Mean length of stay (LOS) was 6.46 ± 5.63 days. During hospitalization, 20.6% lost ≥5% body weight, 18.8% were referred for nutrition support, and discharge BMI (23.87 ± 7.38 kg/m2) was significantly lower than admission BMI (24.3 ± 7.3 kg/m2) (p < 0.001). Admission nutrition risk was associated with lower admission and discharge BMI (p < 0.001), longer LOS (p < 0.001), increased 3-month re-admission rates (Chi2 = 1.35; p = 0.245) and increased mortality (Chi2 = 21.68; p < 0.001). Nearly two-thirds of patients were at risk of malnutrition on admission. This was associated with longer LOS and greater hospital mortality. The nutritional status of patients deteriorated during hospitalization. Routine screening practices with appropriate nutrition support action should be implemented as a matter of urgency. © 2019 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Boah M.; Azupogo F.; Amporfro D.A.; Abada L.A. | The epidemiology of undernutrition and its determinants in children under five years in Ghana | 2019 | PLoS ONE | Background Understanding the burden and contextual risk factors is critical for developing appropriate interventions to control undernutrition. Methods This study used data from the 2014 Ghana Demographic and Health Survey to estimate the prevalence of underweight, stunting, and wasting. Single multiple logistic regressions were used to identify the factors associated with underweight, wasting and stunting. The study involved 2720 children aged 0–59 months old and mother pairs. All analyses were done in STATA/IC version 15.0. Statistical significance was set at p<0.05. Results The prevalence of underweight, wasting and stunting were 10.4%, 5.3%, and 18.4% respectively. The age of the child was associated with underweight, wasting and stunting, whereas the sex was associated with wasting and stunting. Normal or overweight/obese maternal body mass index category, high woman’s autonomy and middle-class wealth index were associated with a lower odds of undernutrition. The factors that were associated with a higher odds of child undernutrition included: low birth weight (<2.5 kg), minimum dietary diversity score (MDDS), a higher (4th) birth order number of child, primary educational level of husband/partner and domicile in the northern region of Ghana. Conclusion There is still a high burden of child undernutrition in Ghana. The age, sex, birth weight, birth order and the MDDS of the child were the immediate factors associated with child undernutrition. The intermediate factors that were associated with child undernutrition were mainly maternal related factors and included maternal nutritional status and autonomy. Distal level factors which were associated with a higher odds of child undernutrition were the wealth index of the household, paternal educational status and region of residence. We recommend that interventions and policies for undernutrition should address socioeconomic inequalities at the community level while factoring in women empowerment programmes. © 2019 Boah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Carroll G.; Atuobi-Yeboah A.; Hromi-Fiedler A.; Aryeetey R.; Safon C.; Pérez-Escamilla R. | Factors influencing the implementation of the Becoming Breastfeeding Friendly initiative in Ghana | 2019 | Maternal and Child Nutrition | Becoming Breastfeeding Friendly (BBF) is an initiative designed to help countries assess their readiness to scale-up breastfeeding programs and develop key recommendations to strengthen their breastfeeding environment. In 2016, Ghana was one of two countries to first pilot BBF. In applying BBF, a committee of 15 Ghanaian nutrition, health, and breastfeeding experts implemented the BBF toolbox over 8 months. Following implementation, semistructured interviews were conducted with 12 committee members (CMs) to (a) identify facilitators and barriers to implement BBF and (b) determine factors needed to strengthen the breastfeeding environment in Ghana. Using a grounded theory approach, five domains were identified. First, a dynamic committee of key stakeholders drove the implementation of BBF. Second, CMs faced some logistical and methodological challenges, including difficulty accessing data and the need for strong in-country technical support for adhering to the BBF process. Third, CMs felt well positioned to facilitate and lead the dissemination and implementation of recommendations. Fourth, accountability would be essential to properly translate recommendations. Fifth, to move recommendations to action, advocacy would be a required first step, and BBF was proposed to facilitate this step. BBF provided an in-depth analysis of Ghana's current breastfeeding environment to help Ghana strengthen its breastfeeding governance, policies, and programs while informing CMs' government and non-governmental organizations' breastfeeding efforts. © 2019 John Wiley & Sons Ltd | Open |
| Christian A.K.; Marquis G.S.; Colecraft E.K.; Lartey A.; Soueida R. | Household food insecurity but not dietary diversity is associated with children's mean micronutrient density adequacy in rural communities across Ghana | 2019 | Nutrition | Objective: The aim of this study was to examine predictors of household food insecurity, dietary diversity, and children's mean micronutrient density adequacy and the relationship among these dietary measures. Method: Baseline analysis of a quasi-experimental 16-mo intervention study conducted in 12 rural communities in the three main agroecological zones in Ghana. The study included 608 caregivers with their 2- to 5-y-old children. Nutrient density adequacy was estimated for a subsample of 120 children. Results: Food insecurity was more severe among farming households than their non-farming counterparts (P = 0.032). Dietary diversity score was significantly higher among non-farming households than farming households (P < 0.001). Food insecurity was negatively correlated with both household dietary diversity (r = –0.385; P < 0.001) and child mean micronutrient adequacy (r = –0.305; P < 0.001). There was no significant correlation between dietary diversity and children's mean micronutrient density adequacy. Belonging to a household that is severely food insecure and household size were significant predictors of children's mean micronutrient density adequacy (ß = –0.124, P = 0.006; ß = 0.011, P = 0.006, respectively). Conclusion: Household food insecurity continues to be a good indicator of lower nutrient intake in children. © 2019 Elsevier Inc. | Open |
| Cooper M.; Brown M.E.; Azzarri C.; Meinzen-Dick R. | Hunger, nutrition, and precipitation: evidence from Ghana and Bangladesh | 2019 | Population and Environment | Changing precipitation patterns caused by climate change are expected to have major impacts on food security and nutrition in agrarian areas in developing countries. However, the linkages between the duration and severity of precipitation shocks and their effects on child nutrition and household food security metrics remain underexplored. In this study, we used Feed the Future datasets from Ghana and Bangladesh to examine the impact of precipitation extremes on nutrition, measured by children’s height-for-age and weight-for-height Z-scores, and food security, measured by the Household Hunger Scale. We used a spatial error regression to control for the effects of spatial autocorrelation, and we found an association between precipitation shocks and household hunger in both Ghana and Bangladesh, as well as an association between higher rainfall and worse child nutrition in Ghana. © 2019, The Author(s). | Open |
| Danquah I.; Addo J.; Boateng D.; Klipstein-Grobusch K.; Meeks K.; Galbete C.; Beune E.; Bahendeka S.; Spranger J.; Mockenhaupt F.P.; Stronks K.; Agyemang C.; Schulze M.B.; Smeeth L. | Early-life factors are associated with waist circumference and type 2 diabetes among Ghanaian adults: The RODAM Study | 2019 | Scientific Reports | Early-life experiences may fuel the emergence of obesity and type 2 diabetes among African populations. We evaluated childhood socio-economic status (SES) and childhood nutritional status as risk factors for increased waist circumference and type 2 diabetes among Ghanaian adults. In the multi-center, cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) Study, we calculated associations (adjusted for demographics and lifestyle) of parental education and anthropometric markers of childhood nutrition [leg length, leg length-to-height ratio (LHR)] with waist circumference and type 2 diabetes, respectively. Among 5,575 participants (mean age: 46.2 years; 62% female), lower education of either parent (vs. higher) was consistently associated with higher waist circumference (∆: 1.6–3.4 cm). Lower father’s education tended to increase the odds of type 2 diabetes by 50% in women (95% confidence interval (CI): 1.0, 2.4). Reduced leg length and LHR were associated with higher waist circumference. But only in men, leg length was inversely related to type 2 diabetes (OR per 1 standard deviation decrease: 1.1; 95% CI: 1.0, 1.3). In this study, markers of poor childhood SES and early-life nutritional status relate to abdominal obesity in men and women and to type 2 diabetes in men. Thus, prevention efforts should start in early childhood. © 2019, The Author(s). | Open |
| De Jager I.; Borgonjen-Van Den Berg K.J.; Giller K.E.; Brouwer I.D. | Current and potential role of grain legumes on protein and micronutrient adequacy of the diet of rural Ghanaian infants and young children: Using linear programming | 2019 | Nutrition Journal | Background: Grain legumes are appreciated for their contribution to dietary protein and micronutrient intake in addition to their benefits in providing income and replenishing soil fertility. They offer potential benefits in developing countries where future food demand is increasing and both undernutrition and overweight co-exist. We studied the current and potential role of grain legumes on protein, both quantity and quality, and micronutrient adequacy in the diet of rural Ghanaian infants and young children. Methods: Energy and nutrient (including amino acids) intakes of breastfed children of 6-8 months (n=97), 9-11 months (n=97), 12-23 months (n=114), and non-breastfed children of 12-23 months (n=29) from Karaga district in Northern Ghana were assessed using a repeated quantitative multi-pass 24-hour recall method. Food-based dietary guidelines that cover nutrient adequacy within the constraints of local current dietary patterns were designed using the linear programming software Optifood (version 4.0.9, Optifood). Optifood was also used to evaluate whether additional legumes would further improve nutrient adequacy. Results: We found that 60% of the children currently consumed legumes with an average portion size of 20 g per day (cooked) contributing more than 10% of their total protein, folate, iron and niacin intake. The final sets of food-based recommendations included legumes and provided adequate protein and essential amino acids but insufficient calcium, iron, niacin and/or zinc among breastfed children and insufficient calcium, vitamin C, vitamin B12 and vitamin A among non-breastfed children. The sets of food-based recommendations combined with extra legumes on top of the current dietary pattern improved adequacy of calcium, iron, niacin and zinc but only reached sufficient amounts for calcium among breastfed children of 6-8 months old. Conclusions: Although legumes are often said to be the 'meat of the poor' and current grain legume consumption among rural children contribute to protein intake, the main nutritional benefit of increased legume consumption is improvement of micronutrient adequacy. Besides food-based recommendations, other interventions are needed such as food-based approaches and/or fortification or supplementation strategies to improve micronutrient adequacy of infants and young children in rural Ghana. Trial registration: Noguchi Memorial Institute for Medical Research Institutional Review Board (NMIMR-IRB CPN 087/13-14). © 2019 The Author(s). | Open |
| Forshaw M. | Editorial | 2019 | International Journal of Health Promotion and Education | Not Available | Open |
| Gaa P.K.; Apprey C.; Annan R.; Mogre V.; Dzogbefia V.P. | The home and school environments, physical activity levels, and adiposity indices of school-age children | 2019 | International Journal of Public Health Science | The home and school environments as well as physical activity may be linked to the development of childhood obesity. We evaluated the home and school environments (HSEs), physical activity levels (PAL), television viewing (TVV) and their associations with adiposity indices of school-age children. This Cross-sectional study included children aged 6-12 years and their parents from Tamale, Ghana. HSEs and TVV were assessed using questionnaires. The physical activity questionnaire for children (PAQ-C) was used to assess children’s PALs. Weight, height and waist circumferences were measured using standard tools. About 45% of children lived within a walking distance to parks or outdoor recreation centres. Majority of the parents considered their neighbourhoods to be safe for children to engage in physical activity. Only 27% of the schools had a food and nutrition policy, and more than 70% had a field for outdoor activities. Children watched TV for an average of 1.7 hours/day. Mean physical activity scores was 2.51. The school-age children had mean (SD) BMI-for-age z-scores was-0.23(1.47). Time spent watching TV or playing video games was associated with children’s BMI-for-age z-scores (β=0.48, p=0.043), BMI (β=2.28 p=0.005), and % body fat (β=3.80, p=0.005). Child’s level of activity was negatively associated with waist circumference (β=-0.65, p<0.001). Lack of nutrition policy in schools was common. TVV hours predisposed children to excess weight whiles physical activity decreased the likelihood of being obese. © 2019 Institute of Advanced Engineering and Science. All rights reserved. | Open |
| Garcia-Casal M.N.; Mowson R.; Rogers L.; Grajeda R. | Risk of excessive intake of vitamins and minerals delivered through public health interventions: objectives, results, conclusions of the meeting, and the way forward | 2019 | Annals of the New York Academy of Sciences | The excessive consumption of certain vitamins and minerals could have deleterious consequences on health and development of individuals and populations. Simultaneous micronutrient-delivery interventions could be challenging in terms of safety as the target populations may overlap, posing a risk of excessive intake of certain micronutrients. The Evidence and Programme Guidance Unit of the Department of Nutrition for Health and Development of the World Health Organization convened a technical consultation on the risk of excessive intake of vitamins and minerals delivered through public health interventions in October 2017. The technical consultation's working groups identified important and emerging technical issues, lessons learned, and research priorities related to (1) planning, implementing, monitoring, and evaluating nutrition programs for the detection and control of the risk of excessive intakes; (2) safety, quality control, and assurance considerations; (3) coordination between public health nutrition interventions and other interventions and sectors; and (4) the legislative framework and policy coherence needed for simultaneous nutrition interventions. This paper provides the background and rationale of the technical consultation, synopsizes the presentations, and provides a summary of the main considerations proposed by the working groups. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences. | Open |
| Gehlich K.H.; Beller J.; Lange-Asschenfeldt B.; Köcher W.; Meinke M.C.; Lademann J. | Fruit and vegetable consumption is associated with improved mental and cognitive health in older adults from non-Western developing countries | 2019 | Public Health Nutrition | Objectives Consumption of fruits and vegetables has been shown to contribute to mental and cognitive health in older adults from Western industrialized countries. However, it is unclear whether this effect replicates in older adults from non-Western developing countries. Thus, the present study examined the contribution of fruit and vegetable consumption to mental and cognitive health in older persons from China, India, Mexico, Russia, South Africa and Ghana.Design Representative cross-sectional and cross-national study.Setting/Subjects We used data from the WHO Study on Global Ageing and Adult Health (SAGE), sampled in 2007 to 2010. Our final sample size included 28 078 participants.Results Fruit and vegetable consumption predicted an increased cognitive performance in older adults including improved verbal recall, improved delayed verbal recall, improved digit span test performance and improved verbal fluency; the effect of fruit consumption was much stronger than the effect of vegetable consumption. Regarding mental health, fruit consumption was significantly associated with better subjective quality of life and less depressive symptoms; vegetable consumption, however, did not significantly relate to mental health.Conclusions Consumption of fruits is associated with both improved cognitive and mental health in older adults from non-Western developing countries, and consumption of vegetables is associated with improved cognitive health only. Increasing fruit and vegetable consumption might be one easy and cost-effective way to improve the overall health and quality of life of older adults in non-Western developing countries. © The Authors 2018. | Open |
| Gelli A.; Aurino E.; Folson G.; Arhinful D.; Adamba C.; Osei-Akoto I.; Masset E.; Watkins K.; Fernandes M.; Drake L.; Alderman H. | A school meals program implemented at scale in Ghana increases height-for-age during midchildhood in girls and in children from poor households: A cluster randomized trial | 2019 | Journal of Nutrition | Background: Attention to nutrition during all phases of child and adolescent development is necessary to ensure healthy physical growth and to protect investments made earlier in life. Leveraging school meals programs as platforms to scale-up nutrition interventions is relevant as programs function in nearly every country in the world. Objective: The aim of this study was to evaluate the impact of a large-scale school meals program in Ghana on school-age children's anthropometry indicators. Methods: A longitudinal cluster randomized control trial was implemented across the 10 regions of Ghana, covering 2869 school-age children (aged 5-15 y). Communities were randomly assigned to 1) control group without intervention or 2) treatment group providing the reformed national school feeding program, providing 1 hot meal/d in public primary schools. Primary outcomes included height-for-age (HAZ) and BMI-for-age (BAZ) z scores. The analysis followed an intention-to-treat approach as per the published protocol for the study population and subgroup analysis by age (i.e., midchildhood for children 5-8 y and early adolescence for children 9-15 y), gender, poverty, and region of residence. We used single-difference ANCOVA with mixed-effect regression models to assess program impacts. Results: School meals had no effect on HAZ and BAZ in children aged 5-15 y. However, in per-protocol subgroup analysis, the school feeding intervention improved HAZ in 5- to 8-y-old children (effect size: 0.12 SDs), in girls (effect size: 0.12 SDs) - particularly girls aged 5-8 y living in the northern regions, and in children aged 5-8 y in households living below the poverty line (effect size: 0.22 SDs). There was also evidence that the intervention influenced food allocation and sharing at the household level. Conclusion: School meals can provide a platform to scale-up nutrition interventions in the early primary school years, with important benefits accruing for more disadvantaged children. This trial was registered at www.isrctn.com as ISRCTN66918874. © Copyright American Society for Nutrition 2019. | Open |
| Ghosh S.A.; Strutt N.R.; Otoo G.E.; Suri D.J.; Ankrah J.; Johnson T.; Nsiah P.; Furuta C.; Murakami H.; Perera G.; Chui K.; Bomfeh K.; Amonoo-Kuofi H.; Tano-Debrah K.; Uauy R. | A macro- and micronutrient-fortified complementary food supplement reduced acute infection, improved haemoglobin and showed a dose-response effect in improving linear growth: A 12-month cluster randomised trial | 2019 | Journal of Nutritional Science | Inadequate protein quality may be a risk factor for poor growth. To examine the effect of a macronutrient-micronutrient supplement KOKO Plus (KP), provided to infants from 6 to 18 months of age, on linear growth, a single-blind cluster-randomised study was implemented in Ghana. A total of thirty-eight communities were randomly allocated to receive KP (fourteen communities, n 322), a micronutrient powder (MN, thirteen communities, n 329) and nutrition education (NE, eleven communities, n 319). A comparison group was followed cross-sectionally (n 303). Supplement delivery and morbidity were measured weekly and anthropometry monthly. NE education was provided monthly. Baseline, midline and endline measurements at 6, 12 and 18 months included venous blood draws, diet, anthropometry, morbidity, food security and socio-economics. Length-for-age Z-score (LAZ) was the primary outcome. Analyses were intent-to-treat using mixed-effects regressions adjusted for clustering, sex, age and baseline. No differences existed in mean LAZ scores at endline (-1·219 (sd 0·06) KP, -1·211 (sd 0·03) MN, -1·266 (sd 0·03) NE). Acute infection prevalence was lower in the KP than NE group (P = 0·043). Mean serum Hb was higher in KP infants free from acute infection (114·02 (sd 1·87) g/l) than MN (107·8 (sd 2·5) g/l; P = 0·047) and NE (108·8 (sd 0·99) g/l; P = 0·051). Compliance was 84·9 % (KP) and 87·2 % (MN) but delivery 60 %. Adjusting for delivery and compliance, LAZ score at endline was significantly higher in the KP v. MN group (+0·2 LAZ; P = 0·026). A macro- and micronutrient-fortified supplement KP reduced acute infection, improved Hb and demonstrated a dose-response effect on LAZ adjusting consumption for delivery. Copyright © The Author(s) 2019 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. | Open |
| Goldsmith P.; Andrade J.; Cornelius M.; Asigbee M.; Atim P.; Tamimie C. | National School Lunch Nutrition and Cost Profile: A Case Study of the Ghana School Feeding Programme | 2019 | Food and Nutrition Bulletin | Numerous governments in developing countries institute school lunch programs or school feeding programs as a strategy to address high malnutrition and low education rates among children. In 2005, the Ghanaian government launched the Ghana School Feeding Programme (GSFP). The GSFP policy does not document (1) the actual meal and associated nutrient profile received by the student, (2) the cost of the meal ingredients to the caterer who prepares the food, nor (3) the recipe derivations that may supply an enhanced nutritional profile. We address these 3 information gaps by employing a detailed case study of 4 caterers supplying a traditional tomato stew recipe in northern Ghana within GSFP-supported school lunch programs. Specifically, we explore the following propositions: (1) GSFP caterers can deliver a school lunch for under 100 pesewas (1 GH¢ or $0.21 USD) per student; (2) the meal meets the recommended daily allowance for protein; (3) soy can serve as a cost-effective ingredient to fortify the meal in terms of protein level and protein quality; and (4) significant differences exist in the macro- and micronutrient profile due to caterer discretion. We answer the above 4 propositions, and by doing so show the importance of accurately measuring the nutritional content, costs, and quantities of the actual school lunch under study. Second, among our results, we show the economy of locally produced soy flour as an ingredient that can lower costs and raise nutrition when substituting for other locally produced proteins such as ground beef and mackerel. © The Author(s) 2019. | Open |
| Hromi-Fiedler A.J.; dos Santos Buccini G.; Gubert M.B.; Doucet K.; Pérez-Escamilla R. | Development and pretesting of “Becoming Breastfeeding Friendly”: Empowering governments for global scaling up of breastfeeding programmes | 2019 | Maternal and Child Nutrition | Scaling up breastfeeding programmes has not been highly prioritized despite overwhelming evidence that breastfeeding benefits the health of mothers and children. Lack of evidence-based tools for scaling up may deter countries from prioritizing breastfeeding. To fill this gap, Becoming Breastfeeding Friendly (BBF) was developed to guide countries in effectively scaling up programmes to protect, promote, and support breastfeeding. BBF includes an evidence-based toolbox that consists of a BBF Index, case studies, and a 5-meeting process. These three interrelated components enable countries to assess their breastfeeding scaling up environment, identify gaps, propose policy recommendations, develop a scaling up plan, and track progress. The toolbox was developed based on current evidence and expert guidance from a Technical Advisory Group, which was composed of global breastfeeding and metric experts with experience in the scaling up of health and nutrition programmes in low-, middle-, and high-income countries. The BBF toolbox required a step-by-step iterative approach to describe and systematize each component, thus an operational manual was developed. The BBF toolbox and BBF operational manual underwent intensive pretesting in two countries, Ghana and Mexico, resulting in the modification of each component plus the operational manual. Pretesting continues in six additional countries demonstrating that BBF is a robust and dynamic multi-sectoral process that, with relatively minor adaptations, can be successfully implemented in countries across world regions. © 2018 John Wiley & Sons Ltd | Open |
| Izraelov M.; Silber J. | Women’s Empowerment and Children’s Health: The Case of Ghana | 2019 | Economic Studies in Inequality, Social Exclusion and Well-Being | Women in developing countries are still the main caregivers for children. They are responsible for their nutrition and often make decisions concerning their healthcare. However, their decisions depend on their resources and on their ability to make independent choices, in short, on the degree of their empowerment. This paper takes a multidimensional approach for measuring women’s empowerment. It distinguishes between several domains of women’s empowerment (the ability to take decisions, a woman’s attitude towards violence by her husband and the resources and information available to her). Given that several variables related to women’s empowerment exist for a given domain, we use an aggregation method from literature on the fuzzy approach to multidimensional poverty measurement to derive an overall indicator for the domain. The paper assumes that children’s health is a latent variable. The indicators available on children’s health are their height and weight for age. The empirical analysis based on the 2008 Health and Demographic Survey in Ghana and on the implementation of the MIMIC approach leads to several policy relevant conclusions. First, a woman’s ability to take decisions has a significant and positive impact on children’s health. Second, variables describing a woman’s attitude towards her husband’s violence do not seem to have an impact on the children’s health and this is also the case for the extent of information available to a woman. Third, children’s health is generally higher if the educational level of the mother and her body mass index are higher. This also depends on whether the woman is married and the older she is. © Springer Nature Switzerland AG 2019. | Open |
| Kambunga S.N.; Candeias C.; Hasheela I.; Mouri H. | Review of the nature of some geophagic materials and their potential health effects on pregnant women: some examples from Africa | 2019 | Environmental Geochemistry and Health | The voluntary human consumption of soil known as geophagy is a global practice and deep-rooted in many African cultures. The nature of geophagic material varies widely from the types to the composition. Generally, clay and termite mound soils are the main materials consumed by geophagists. Several studies revealed that gestating women across the world consume more soil than other groups for numerous motives. These motivations are related to medicinal, cultural and nutrients supplementation. Although geophagy in pregnancy (GiP) is a universal dynamic habit, the highest prevalence has been reported in African countries such as Kenya, Ghana, Rwanda, Nigeria, Tanzania, and South Africa. Geophagy can be both beneficial and detrimental. Its health effects depend on the amount and composition of the ingested soils, which is subjective to the geology and soil formation processes. In most cases, the negative health effects concomitant with the practice of geophagy eclipse the positive effects. Therefore, knowledge about the nature of geophagic material and the health effects that might arise from their consumption is important. © 2019, Springer Nature B.V. | Open |
| Kohlmann K.; Callaghan-Gillespie M.; Gauglitz J.M.; Steiner-Asiedu M.; Saalia K.; Edwards C.; Manary M.J. | Alternative ready-to-use therapeutic food yields less recovery than the standard for treating acute malnutrition in children from Ghana | 2019 | Global Health Science and Practice | Background: Only 20% of children with severe acute malnutrition (SAM) have access to ready-to-use therapeutic food (RUTF), and RUTF cost limits its accessibility. Methods: This randomized, double-blind controlled study involved a clinical equivalence trial comparing the effectiveness of an alternative RUTF with standard RUTF in the home-based treatment of uncomplicated SAM and moderate malnutrition in Ghanaian children aged 6 to 59 months. The primary outcome was recovery, equivalence was defined as being within 5 percentage points of the control group, and an intention-to-treat analysis was used. Alternative RUTF was composed of whey protein, soybeans, peanuts, sorghum, milk, sugar, and vegetable oil. Standard RUTF included peanuts, milk, sugar, and vegetable oil. The cost of alternative RUTF ingredients was 14% less than standard RUTF. Untargeted metabolomics was used to characterize the bioactive metabolites in the RUTFs. Results: Of the 1,270 children treated for SAM or moderate malnutrition, 554 of 628 (88%) receiving alternative RUTF recovered (95% confidence interval [CI]=85% to 90%) and 516 of 642 (80%) receiving standard RUTF recovered (95% CI=77% to 83%). The difference in recovery was 7.7% (95% CI=3.7% to 11.7%). Among the 401 children with SAM, the recovery rate was 130 of 199 (65%) with alternative RUTF and 156 of 202 (77%) with standard RUTF (P=.01). The default rate in SAM was 60 of 199 (30%) for alternative RUTF and 41 of 202 (20%) for standard RUTF (P=.04). Children enrolled with SAM who received alternative RUTF had less daily weight gain than those fed standard RUTF (2.4 6 2.4 g/kg vs. 2.9 6 2.6 g/kg, respectively; P<.05). Among children with moderate wasting, recovery rates were lower for alternative RUTF, 386 of 443 (87%), than standard RUTF, 397 of 426 (93%) (P=.003). More isoflavone metabolites were found in alternative RUTF than in the standard. Conclusion: The lower-cost alternative RUTF was less effective than standard RUTF in the treatment of severe and moderate malnutrition in Ghana. © Kohlmann et al. | Open |
| Kpienbaareh D.; Luginaah I. | After the flames then what? exploring the linkages between wildfires and household food security in the northern Savannah of Ghana | 2019 | International Journal of Sustainable Development and World Ecology | This study deploys the livelihoods theory in political ecology together with integrated methods including remote sensing, participatory geographic information systems, interviews and focus group discussions to explore the intricate and dynamic linkages between perennial wildfires and household food insecurity among smallholder farmers in the northern savannah zone of Ghana. Our results suggest that wildfires are a major pathway to household food insecurity in two ways, as perceived by the farmers. First, in instances where wildfires destroy the major crops of smallholders, they are unable to find enough food for the lean season which results in transitory food insecurity. Secondly, in the long term, the environmental impacts of wildfires on the soil lead to lower yields and inadequate food to meet household nutritional needs. Farmers then deploy certain strategies such as early-harvesting and switching to early-maturing crops to avoid with the perennial fires and these strategies further reinforce other dimensions of food insecurity such as nutrition insecurity. Because livelihoods strategies such as crop farming, hunting, charcoal production and herding intersect in the northern savannah zone, we recommend policy options that will engage community members in finding common ways of using shared spaces sustainably. Government should also adopt policies that will encourage domestication of certain livelihood strategies such as cattle herding. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Kraak V.; Patiño S.R.-G.; Renukuntla D.; Kim E. | Progress evaluation for transnational restaurant chains to reformulate products and standardize portions to meet healthy dietary guidelines and reduce obesity and non-communicable disease risks, 2000–2018: A scoping and systematic review to inform policy | 2019 | International Journal of Environmental Research and Public Health | Transnational restaurant chains sell food and beverage products in 75 to 139 countries worldwide linked to obesity and non-communicable diseases (NCDs). This study examined whether transnational restaurant chains reformulated products and standardized portions aligned with healthy dietary guidelines and criteria. Firstly, we describe the transnational restaurant industry structure and eating trends. Secondly, we summarize results from a scoping review of healthy dietary guidelines for restaurants. Thirdly, we describe a systematic review of five electronic databases (2000–2018) to identify studies on nutrient profile and portion size changes made by transnational restaurants over 18 years. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, identified 179 records, and included 50 studies conducted in 30 countries across six regions. The scoping review found a few expert-recommended targets for restaurants to improve offerings, but no internationally accepted standard for portions or serving sizes. The systematic review results showed no standardized assessment methods or metrics to evaluate transnational chain restaurants’ practices to improve menu offerings. There was wide variation within and across countries, regions, firms, and chains to reduce energy, saturated and trans fats, sodium, and standardized portions. These results may inform future research and encourage transnational chain restaurants to offer healthy product profiles and standardized portions to reduce obesity and NCD risks worldwide. © 2019 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Kroll F.; Swart E.C.; Annan R.A.; Thow A.M.; Neves D.; Apprey C.; Aduku L.N.E.; Agyapong N.A.F.; Moubarac J.-C.; Toit A.; Aidoo R.; Sanders D. | Mappobesogenic food environments in South Africa and Ghana: Correlations and contradictions | 2019 | Sustainability (Switzerland) | In sub-Saharan Africa, urbanisation and food systems change contribute to rapid dietary transitions promoting obesity. It is unclear to what extent these changes are mediated by neighbourhood food environments or other factors. This paper correlates neighbourhood food provision with household consumption and poverty in Khayelitsha, South Africa and Ahodwo, Ghana. Georeferenced survey data of food consumption and provision were classified by obesity risk and protection. Outlets were mapped, and density and distribution correlated with risk classes. In Khayelitsha, 71% of households exceeded dietary obesity risk thresholds while 16% consumed protective diets. Obesogenic profiles were less (26%) and protective more prevalent (23%) in Ahodwo despite greater income poverty in Khayelitsha. Here, income-deprived households consumed significantly (p < 0.005) less obesogenic and protective diets. Small informal food outlets dominated numerically but supermarkets were key household food sources in Khayelitsha. Although density of food provision in Ahodwo was higher (76/km2), Khayelitsha outlets (61/km2) provided greater access to obesogenic (57% Khayelitsha; 39% Ahodwo) and protective (43% Khayelitsha; 16% Ahodwo) foods. Consumption and provision profiles correlate more strongly in Ahodwo than Khayelitsha (rKhayelitsha = 0.624; rAhodwo = 0.862). Higher obesogenic food consumption in Khayelitsha suggests that risky food environments and poverty together promote obesogenic diets. © 2019 by the authors. | Open |
| Kubuga C.K.; Hong H.G.; Song W.O. | Hibiscus sabdariffa meal improves iron status of childbearing age women and prevents stunting in their toddlers in Northern Ghana | 2019 | Nutrients | Globally, iron deficiency (ID) is the most common form of nutritional deficiency, particularly in young children and childbearing age women. ID can lead to stunting and impaired cognitive development in children, as well as adverse maternal health and birth outcomes. In this study, the efficacy of an alternative food-to-food fortification utilizing indigenous iron-rich food sources was investigated in a quasi-experimental study. Childbearing age women (15–49 years, intervention-Kassena Nankana West district: n = 60; control-Builsa North district: n = 60) and their toddlers (6–24 months) consumed Hibiscus sabdariffa leaf meals (HSM, 1.71 mg Fe/100 g meal) three times a week for 12 weeks during the dry/lean season in Northern Ghana. We found that feeding the HSM (1.9 kg/day) improved iron status of women of childbearing age with time (p = 0.011), and protected stunting among toddlers during the dry/lean season (p = 0.024), which is the period with the worst food and nutrition insecurity. Compared with the control group, the number of stunted toddlers declined in the intervention group. © 2019 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Kugbe J.X.; Kombat R.; Atakora W. | Secondary and micronutrient inclusion in fertilizer formulation impact on maize growth and yield across northern Ghana | 2019 | Cogent Food and Agriculture | Though secondary and micronutrients are known to improve crop production, their inclusion in fertilizer formulation has received minimum attention in efforts aimed at increasing maize production in northern Ghana. In this study, Sulphur, Boron, and Zinc were included in NPK formulations at different rates in northern Ghana. The experiment was a single factor, consisting of NPK 15-15-15 applied at rates (kg/ha) of 60-40-40, NPK 15-15-15 at rates of 90-60-60, NPK 15-15-15 at 100-40-40, NPK 11-22-21 + 5S+1B+1Zn at 60-40-38 + 9 + 1.8 + 1.8, NPK 11-22-21 + 5S + 1B + 1Zn at 90-60-57 + 14 + 2.7 + 2.7, NPK 11–22 21 + 5S+1B+1Zn at 100-40-38 + 9 + 1.8 + 1.8, NPS 14-31-0 + 9S + 1B + 1Zn at 60-40-0 + 11.6 + 1.3 + 1.3, NPS 14-31-0 + 9S + 1B + 1Zn at 90-60-0 + 17.4 + 1.9 + 1.9, NPS 14-31-0 + 9S + 1B + 1Zn at 100-40-0 + 11.6 + 1.3 + 1.3 and no fertilization. Treatments were randomly laid out in four farms. Urea at respective rates was applied at 6 weeks after planting. Data analyzed on growth and yield parameters at 5% probability showed that significantly higher growth and yield were recorded with the inclusion of secondary and micronutrients (P < 0.05). NPK 11-22-21 + 5S + 1B + 1Zn at 90-60-57 + 14 + 2.7 + 2.7 increased yield by 30% (mean: 3330 kg/ha) compared to the standard yield from NPK 15-15-15 at 90-60-60 (mean: 2585 kg/ha) which consisted solely of primary nutrients. Also, NPS 14-31-0 + 9S + 1B + 1Zn at 100-40-0 + 11.6 + 1.3 + 1.3 followed with yield increment of 26% (mean: 3252 kg/ha), with the zero-control treatment giving the lowest yield (mean: 356 kg/ha). While the study confirms the need for use of fertilizer in maize production across northern Ghana it demonstrates the need for secondary and micronutrient inclusion in fertilizer blends for soils of Northern Ghana. © 2019 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license. | Open |
| Kumordzie S.M.; Adu-Afarwuah S.; Arimond M.; Young R.R.; Adom T.; Boatin R.; Ocansey M.E.; Okronipa H.; Prado E.L.; Oaks B.M.; Dewey K.G. | Maternal and infant lipid-based nutritional supplementation increases height of Ghanaian children at 4–6 years only if the mother was not overweight before conception | 2019 | Journal of Nutrition | Background: Few studies have evaluated the long-term effects of nutritional supplementation during the first 1000 d of life. We previously reported that maternal and child lipid-based nutrient supplements (LNS) increased child length by 18 mo. Objective: The aim of this study was to examine the effects of LNS on later growth and body composition at 4–6 y of age. Design: This was a follow-up of children in the International Lipid-based Nutrient Supplements (iLiNS)-DYAD trial in Ghana. Women (n = 1320) at ≤20 weeks of gestation were randomly assigned to: 1) iron and folic acid during pregnancy and 200 mg calcium/d for 6 mo postpartum, 2) multiple micronutrients (1–2 RDA of 18 vitamins and minerals) during both periods, or 3) maternal LNS during both periods plus child LNS from 6 to 18 mo. At 4–6 y, we compared height, height-for-age z score (HAZ), and % body fat (deuterium dilution method) between the LNS group and the 2 non-LNS groups combined. Results: Data were available for 961 children (76.5% of live births). There were no significant differences between LNS compared with non-LNS groups in height [106.7 compared with 106.3 cm (mean difference, MD, 0.36; P = 0.226)], HAZ [−0.49 compared with −0.57 (MD = 0.08; P = 0.226)], stunting (< -2 SD) [6.5 compared with 6.3% (OR = 1.00; P = 0.993)], or % body fat [15.5 compared with 15.3% (MD = 0.16; P = 0.630)]. However, there was an interaction with maternal prepregnancy BMI (kg/m2) (P-interaction = 0.046 before correction for multiple testing): among children of women with BMI < 25, LNS children were taller than non-LNS children (+1.1 cm, P = 0.017), whereas there was no difference among children of women with BMI ≥ 25 (+0.1 cm; P = 0.874). Conclusions: There was no overall effect of LNS on height at 4–6 y in this cohort, which had a low stunting rate, but height was greater in the LNS group among children of nonoverweight/obese women. There was no adverse impact of LNS on body composition. This trial was registered at clinicaltrials.gov as NCT00970866. Copyright © American Society for Nutrition 2019. All rights reserved. | Open |
| Kuuire V.Z.; Bisung E.; Were J.M. | Examining the connection between residential histories and obesity among Ghanaians: evidence from a national survey | 2019 | Journal of Public Health (Germany) | Background: This paper examined the connection between residential histories and obesity in Ghana. In the last two decades, low- and middle-income countries (LMICs) have witnessed the fastest growth in obesity incidence. These obesity trends in many LMICs including Ghana are associated with rapid economic growth and urbanisation. Features of the urban food and built environments contribute to obesity in LMICs in many ways, including exposure to unhealthy foods, sedentary lifestyles, and passive transportation. Methods: The analytical sample consisted of 4368 adults (aged 18 and above) drawn from the World Health Organisation’s Study on Global Ageing and Health in Ghana. We employed descriptive statistics and multivariate regression models to examine the relationship between residential histories and obesity in later life using STATA 14. Results: Significant differences were observed among respondents, based on their childhood and adult residential histories. For instance, 44% of respondents who spent their childhood and adult life in the same urban area were obese, compared to 18% of those who spent their childhood and adulthood in the same rural area. Multivariable analysis revealed that cumulative exposure to urban environment was significantly associated with obesity. For example, respondents who spent their childhood and adulthood in different urban areas and childhood and adulthood in the same urban area were significantly more likely to be obese than respondents who lived in rural areas during childhood and adulthood (OR = 2.37, p < 0.001 and OR = 1.44, p < 0.001, respectively). Conclusion: Our findings show that urban residence during childhood and later in life may present cumulative risks for adult obesity. Locally appropriate public health strategies that encourage healthy lifestyles among urban dwellers will be critical in the fight against obesity. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature. | Open |
| Mandelbaum J.; Pérez-Escamilla R.; Sandow A.; Gallego-Pérez D.F.; Lartey A.; Hromi-Fiedler A. | Factors Influencing Dietary Practices Among Ghanaian Residents and Liberians Living in a Protracted Refugee Situation in Ghana | 2019 | Journal of Nutrition Education and Behavior | Objective: Examine dietary practices among Liberian refugees living in a protracted refugee situation and Ghanaians living among them. Design: Qualitative data were collected via audio-taped in-depth interviews as part of a larger mixed-methods cross-sectional study. Setting: Buduburam Refugee Settlement and neighboring villages, Ghana. Participants: Twenty-seven Liberian and Ghanaian women aged ≥16 years, who lived with ≥1 other female generation. Phenomenon of Interest: Similarities and differences in factors influencing dietary practices among Liberian refugees living in Buduburam Refugee Settlement and Ghanaians living in and around this settlement. Analysis: Domains, themes, and subthemes were confirmed through a highly iterative coding and consensus process. ATLAS.ti (version 7.5.10) was used to finalize coding and extract quotations. Results: Seven domains emerged forming direct and indirect pathways influencing dietary patterns among Liberian refugees and Ghanaians: social support, food availability, nutrition knowledge, cultural food beliefs, food access, food preparation, and national identity. Conclusions and Implications: Findings provide important insights into crucial factors driving dietary practices among refugees and local communities in and around a former protracted refugee settlement. Results strongly suggest that nutrition education, food availability, and access issues should be addressed with culturally sensitive programs targeting both the refugee and host communities. © 2018 Society for Nutrition Education and Behavior | Open |
| Mensah G.P.; van Rooyen D.R.M.; ten Ham-Baloyi W. | Nursing management of gestational diabetes mellitus in Ghana: Perspectives of nurse-midwives and women | 2019 | Midwifery | Background: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is observed in the beginning of, or first acknowledged during pregnancy. The prevalence of GDM is estimated to be approximately 15% globally and is expected to increase due to growing numbers of overweight and obesity in women in their reproductive age. The nursing management of GDM in terms of lifestyle modifications (exercise, diet and nutrition) and the taking of diabetes medication, if required, and adherence thereto is crucial to prevent maternal and neonatal-perinatal complications. This qualitative study therefore aimed to explore and describe the experiences of women regarding the nursing management they received after being diagnosed with GDM; and the perceptions of nurse-midwives on their nursing management of GDM in Ghana. Setting: This study was conducted in the military health institutions in Ghana, which includes one hospital and nine satellite clinics referred to as Medical Reception Stations providing antenatal and postnatal care to both military as well as civilian patients. Research on GDM in Ghana is extremely limited. Design: We used a descriptive phenomenological approach to conduct 15 unstructured individual interviews with women that have been diagnosed with GDM (n = 7) and nurse-midwives (n = 8) providing nursing management of GDM during a six months period (December 2014 to May 2015). Audio-recorded data was transcribed, coded and analyzed using an adapted version of Tesch's eight steps for coding. Participants: Seven (n = 7) women between 28 and 45 years of age, with 1 to 3 offspring each, participated. Most women (n = 5) did not have a family history of diabetes. The eight (n = 8) nurse-midwives that participated were between 32 and 50 years old with between 2 and 12 years of experience. Findings: Participants in this study reported similar issues that could assist in better management of GDM. The majority of participants indicated the need for education on GDM, but both women and nurse-midwives acknowledged that this education is hugely lacking. Participants generally felt that emotional support for women is critical and it was included in the nursing management of GDM. Both groups of participants acknowledged that involving women and their significant others in the nursing management of GDM is important. Cultural and socio-economic issues, such as cultural beliefs that clashed with diabetic diets, lack of financial and social grants and limited nurse-midwifery staff were mentioned by both groups to affect the nursing management of GDM. Key conclusions: The results demonstrate that, despite the reported challenges experienced by nurse-midwives and women, it was evident that the aim of nurse-midwives was to manage GDM as optimally as possible for women diagnosed with GDM, while considering the constraints established in the results. The challenges identified, specifically in terms of lack of education and cultural and socio-economic issues that affect the quality of and adherence to the nursing management of GDM, need to be addressed in order to optimize care for women diagnosed with GDM in Ghana. Implications for practice: Based on our findings, recommendations are provided that can assist nurse-midwives and other health practitioners to provide comprehensive nursing management to women that have been diagnosed with GDM. © 2019 Elsevier Ltd | Open |
| Mogre V.; Johnson N.A.; Tzelepis F.; Paul C. | Barriers to diabetic self-care: A qualitative study of patients’ and healthcare providers’ perspectives | 2019 | Journal of Clinical Nursing | Aims and objectives: To explore patient and healthcare provider (HCP) perspectives about patients’ barriers to the performance of diabetic self-care behaviours in Ghana. Background: Sub-Saharan African urban populations are increasingly affected by type 2 diabetes due to nutrition transition, sedentary lifestyles and ageing. Diabetic self-care is critical to improving clinical outcomes. However, little is known about barriers to diabetic self-care (diet, exercise, medication taking, self-monitoring of blood glucose and foot care) in sub-Saharan Africa. Design: Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Methods: Semi-structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Interviews were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used and identified themes classified according to constructs of the theory of planned behaviour (TPB): attitudes/behavioural beliefs, subjective norms and perceived behavioural control. Results: Barriers relating to attitudes included misconceptions that diabetes was caused by spiritual forces or curses, use of herbal medicines, intentional nonadherence, difficulty changing old habits, and feeling or lacking motivation to exercise. Barriers relating to subjective norms were inadequate family support, social stigma (usually by spouses and other members of the community) and cultural beliefs. Perceived behavioural control barriers were poor income levels, lack of glucometers, busy work schedules, long distance to the hospital and inadequate access to variety of foods due to erratic supply of foods or seasonality. Conclusions: Both patients and HCPs discussed similar barriers and those relating to attitude and behavioural control were commonly discussed. Relevance to Clinical Practice: Interventions to improve adherence to diabetic self-care should focus on helping persons with diabetes develop favourable attitudes and how to overcome behavioural control barriers. Such interventions should have both individualised and community-wide approaches. © 2019 John Wiley & Sons Ltd | Open |
| Mohammed H.; Aboud F. | Adaptation of a mental development assessment tool for the evaluation of the long-term effect of a successful nutrition intervention in Ghana | 2019 | Maternal and Child Nutrition | This study adapted a cognitive assessment tool to be used in evaluating nutrition interventions in developing countries and assessed its reliability and validity in Ghana. The tool was used to evaluate the long-term effect of the Enhancing Child Nutrition through Animal Source Food Management (ENAM) project. The former ENAM participants' children were contacted (now 13 to 15 years old). The items in the Wechsler Abbreviated Scale of Intelligence-II were adapted, pretested, refined, and pretested again. Cross-sectional data collection was conducted with former ENAM participants (60 interventions and 51 comparison families) in one of ENAM's three sites (the Guinea Savanna zone). Data on participants' socio-economic status and food insecurity were collected, along with their children's intellectual functioning, dietary intake, school attainment, anthropometry, and symptoms of depression. Alpha coefficient of the verbal subscale improved between the first and second pretest (from.34 to.80). After controlling for age, the intelligence scores of the children were associated with their grade (r =.35, p =.001) and academic performance (r =.26 to.33, p <.05). The verbal scale was associated with their anthropometry (r =.24 to.27, p <.05). The intervention children still recorded a better dietary diversity score than controls (6.8 vs 5.8, p =.0001); however, significance was lost after adjusting for confounders. There were no significant group differences in growth or intellectual functioning. The adapted Wechsler Abbreviated Scale of Intelligence-II tool performed well in evaluating adolescent intellectual functioning in rural Ghana, and there were no long-term effects of ENAM intervention on child growth and development. © 2019 John Wiley & Sons Ltd | Open |
| Nartey Y.A.; Asem M.; Agyei-Nkansah A.; Awuku Y.A.; Setorglo J.; Duah A.; Bampoh S.; Ayawin J.; Asibey S.O.; Ye W.; Afihene M.Y.; Roberts L.; Plymoth A. | Nutritional management of cirrhosis patients: A qualitative study exploring perceptions of patients and health workers in Ghana | 2019 | Clinical Nutrition ESPEN | Background and aims: Malnutrition is common among patients with end stage liver disease including liver cirrhosis and liver cancer. Optimal nutrition is important to reduce morbidity and mortality of these patients. There is limited qualitative data on nutritional status and management of chronic liver disease patients. We aimed to explore the knowledge, opinions and practices of cirrhosis patients and health workers in nutritional management of cirrhosis in Ghana, in order to determine whether there is a need to improve nutritional care for cirrhosis patients. Methods: We conducted a qualitative study using semi-structured interviews of cirrhotic patients (n = 16) and healthcare providers (n = 27) in three academic centers in Accra, Kumasi and Cape Coast (Ghana). Recruitment was by purposive sampling of patients attending specialist liver disease clinics. The recorded data were analyzed using NVivo 11 software, with generation of codes, themes and subthemes. Results: The major themes that emerged from the data included nutrition as part of care delivery during the hospital visit, nutritional recommendations, dietary changes and long-term practice improvement. The results showed that patients and health workers felt dietary recommendations for patients were frequently addressed, but could be significantly improved. We found that in the opinion of study participants, local guidelines are important and necessary in nutritional management of cirrhosis patients, and that participants felt it was difficult to change dietary habits following cirrhosis diagnosis. Conclusions: These results suggest that nutritional management of cirrhosis patients in Ghana requires improvement. Strategies to improve this could include a multi-disciplinary approach to nutritional management, development of local guidelines and continued nutritional assessment, monitoring and follow-up. © 2019 The Authors | Open |
| Nsiah-Asamoah C.; Pereko K.K.A.; Intiful F.D. | Nutritional counselling interactions between health workers and caregivers of children under two years: Observations at selected child welfare clinics in Ghana | 2019 | BMC Health Services Research | Background: This study evaluated the Health Works (HWs) nutritional counselling skills and information shared with caregivers. This was a cross-sectional study in which an observation checklist was used to examine Growth Monitoring and Promotion (GMP) activities and educational/counselling activities undertaken by health workers (HWs) to communicate nutrition information to caregivers, depending on the ages of the children. Methods: A total number of 528 counselling interactions between health workers and caregivers in 16 Child welfare Clinics (CWCs) in two rural districts in Ghana were observed. Frequencies were presented for the information that was obtained from each caregiver and those that were provided by the HWs during the nutritional counselling sessions. Results: About 95.1 and 61.8% of the caregiver-HW interactions involved mothers of children who were less than 6 months of age and those above 6 months respectively. HWs counselled the caregivers on appropriate nutrition for the child. Health talk messages that were shared with caregivers focused mainly on the importance of attending CWCs and vaccination of children and rarely included any teaching materials. In most of the interactions, HWs made of child's feeding practices the past 1 month; and also did not provide advice on specific issues of IYCF. Nutritional counselling information given for non-breastfeeding children was inadequate and in some cases absent. Little attention was given to the feeding of children with animal products during counselling. Conclusion: Generally nutritional information given to caregivers who had children above 6 months was inadequate. © 2019 The Author(s). | Open |
| Oaks B.M.; Jorgensen J.M.; Baldiviez L.M.; Adu-Afarwuah S.; Maleta K.; Okronipa H.; Sadalaki J.; Lartey A.; Ashorn P.; Ashorn U.; Vosti S.; Allen L.H.; Dewey K.G. | Prenatal iron deficiency and replete iron status are associated with adverse birth outcomes, but associations differ in Ghana and Malawi | 2019 | Journal of Nutrition | Background: Previous literature suggests a U-shaped relation between hemoglobin concentration and adverse birth outcomes. There is less evidence on associations between iron status and birth outcomes. Objective: Our objective was to determine the associations of maternal hemoglobin concentration and iron status with birth outcomes. Methods We conducted a secondary data analysis of data from 2 cohorts of pregnant women receiving iron-containing nutritional supplements (20-60 mg ferrous sulfate) in Ghana (n = 1137) and Malawi (n = 1243). Hemoglobin concentration and 2 markers of iron status [zinc protoporphyrin and soluble transferrin receptor (sTfR)] were measured at ≤20 weeks and 36 weeks of gestation. We used linear and Poisson regression models and birth outcomes included preterm birth (PTB), newborn stunting, low birth weight (LBW), and small-for-gestational-age. Results: Prevalence of iron deficiency (sTfR >6.0 mg/L) at enrollment was 9% in Ghana and 20% in Malawi. In early pregnancy, iron deficiency was associated with PTB (9% compared with 17%, adjusted RR: 1.63; 95% CI: 1.14, 2.33) and stunting (15% compared with 23%, adjusted RR: 1.44; 95% CI: 1.09, 1.94) in Malawi but not Ghana, and was not associated with LBW in either country; replete iron status (sTfR <10th percentile) was associated with stunting (9% compared with 15%, adjusted RR: 1.71; 95% CI: 1.06, 2.77) in Ghana, but not PTB or LBW, and was not associated with any birth outcomes in Malawi. In late pregnancy, iron deficiency was not related to birth outcomes in either country and iron-replete status was associated with higher risk of LBW (8% compared with 16%, adjusted RR: 1.90; 95% CI: 1.17, 3.09) and stunting (6% compared with 13%, adjusted RR: 2.14; 95% CI: 1.21, 3.77) in Ghana, but was not associated with birth outcomes in Malawi. Conclusions: The associations of low or replete iron status with birth outcomes are population specific. Research to replicate and extend these findings would be beneficial. © 2019 American Society for Nutrition. This is an Open Access article distributed under the terms of the Creative Commons Attribution License | Open |
| Ocansey M.E.; Adu-Afarwuah S.; Kumordzie S.M.; Okronipa H.; Young R.R.; Tamakloe S.M.; Oaks B.M.; Arimond M.; Dewey K.G.; Prado E.L. | The association of early linear growth and haemoglobin concentration with later cognitive, motor, and social–emotional development at preschool age in Ghana | 2019 | Maternal and Child Nutrition | It is important to identify the periods during childhood when exposure to environmental risk factors results in long-term neurodevelopmental deficits. Stunting and anaemia may be sensitive indicators of exposure to such risks. In a prospective cohort enrolled before birth, we investigated the association of developmental scores at 4–6 years with (a) birth length and linear growth during three postnatal periods and (2) haemoglobin (Hb) concentration at three time points. Children were participants in a follow-up study of a randomized controlled trial of nutritional supplementation in Ghana. At 4–6 years, cognitive, motor, and social–emotional developments were assessed using standard tests adapted for this population. We estimated the associations of length-for-age z-score (LAZ) at birth and postnatal linear growth (n = 710) and Hb (n = 617) with developmental scores in regression models, using multistage least squares analysis to calculate uncorrelated residuals for postnatal growth. Cognitive development at 4–6 years was significantly associated with LAZ at birth (β = 0.12, 95% CI = 0.05, 0.19), ΔLAZ from 6 to 18 months (β = 0.16, 95% CI = 0.04, 0.28), and Hb at 18 months (β = 0.13, 95% CI = 0.06, 0.20), but not with ΔLAZ during 0–6 months, ΔLAZ from 18 months to 4–6 years, Hb at 6 months, or Hb at 4–6 years. No evidence of associations with motor or social–emotional development were found. These results suggest that in similar contexts, the earlier periods prior to birth and up to 18 months are more sensitive to risk factors for long-term cognitive development associated with LAZ and Hb compared with later childhood. This may inform the optimal timing of interventions targeting improved cognitive development. © 2019 John Wiley & Sons Ltd | Open |
| Ocansey M.E.; Adu-Afarwuah S.; Kumordzie S.M.; Okronipa H.; Young R.R.; Tamakloe S.M.; Oaks B.M.; Dewey K.G.; Prado E.L. | Prenatal and postnatal lipid-based nutrient supplementation and cognitive, social-emotional, and motor function in preschool-Aged children in Ghana: A follow-up of a randomized controlled trial | 2019 | American Journal of Clinical Nutrition | Background Adequate nutrition is necessary for brain development during pregnancy and infancy. Few randomized controlled trials of supplementation during these periods have measured later developmental outcomes. Objective Our objective was to investigate the effects of provision of prenatal and postnatal lipid-based nutrient supplements (LNS) on child development at preschool age. Methods We conducted a follow-up study of 966 children aged 4-6 y in 2016, born to women who participated in the International Lipid-Based Nutrient Supplements-DYAD trial conducted in Ghana in 2009-2014, representing 79% of eligible children. Women ≤20 weeks of gestation were randomized to daily LNS or multiple micronutrient (MMN) capsules during pregnancy through 6 mo postpartum or iron and folic acid (IFA) capsules during pregnancy and calcium placebo capsules during 6 mo postpartum. Children in the LNS group received LNS from 6 to 18 mo. Primary outcomes of this follow-up study were (1) a cognitive factor score based on a test battery adapted from several standard tests, 2) fine motor score (9-hole pegboard test), and (3) social-emotional difficulties (Strengths and Difficulties Questionnaire; SDQ). Eight secondary outcomes were calculated in specific domains (e.g., language, SDQ prosocial). Analysis was by a complete case intention to treat in a 2-group comparison: LNS compared with non-LNS (MMN + IFA). Results Children in the LNS group had significantly lower social-emotional difficulties z-scores than children in the non-LNS group (adjusted for child age β = â '0.12, 95% CI: â '0.25, 0.02, P = 0.087; fully adjusted β = â '0.16, 95% CI: â '0.29, â '0.03, P = 0.013). The effect of LNS on social-emotional difficulties score was larger among children living in households with lower home environment scores (P-interaction = 0.081). No other outcomes differed between the 2 intervention groups. Conclusions Provision of LNS during the first 1000 d of development improved behavioral function, particularly for children from low nurturing and stimulation households, but did not affect cognition at preschool age in this setting. Trial Registration: clinicaltrials.gov, Identifier NCT00970866. © 2019 American Society for Nutrition. | Open |
| Ocansey M.E.; Pulakka A.; Adu-Afarwuah S.; Young R.R.; Kumordzie S.M.; Okronipa H.; Oaks B.M.; Dewey K.G.; Prado E.L. | The effects of supplementing maternal and infant diets with lipid-based nutrient supplements on physical activity and sedentary behaviour at preschool age in Ghana | 2019 | British Journal of Nutrition | Evidence on whether nutritional supplementation affects physical activity (PA) during early childhood is limited. We examined the long-term effects of lipid-based nutrient supplements (LNS) on total PA, moderate-to-vigorous PA (MVPA) and sedentary behaviour (SB) of children at 4-6 years using an accelerometer for 1 week. Their mothers were enrolled in the International Lipid-based Nutrient Supplement-DYAD randomised controlled trial in Ghana, assigned to daily LNS or multiple micronutrients (MMN) during pregnancy through 6 months postpartum or Fe and folic acid (IFA) during pregnancy and placebo for 6 months postpartum. From 6 to 18 months, children in the LNS group received LNS; the other two groups received no supplements. Analysis was done with intention to treat comparing two groups: LNS v. non-LNS (MMN+ IFA). Of the sub-sample of 375 children fitted with accelerometers, 353 provided sufficient data. Median vector magnitude (VM) count was 1374 (interquartile range (IQR) 309), and percentages of time in MVPA and SB were 4·8 (IQR 2) and 31 (IQR 8) %, respectively. The LNS group (n 129) had lower VM (difference in mean -73 (95 % CI -20, -126), P = 0·007) and spent more time in SB (LNS v. non-LNS: 32·3 v. 30·5 %, P = 0·020) than the non-LNS group (n 224) but did not differ in MVPA (4·4 v. 4·7 %, P = 0·198). Contrary to expectations, provision of LNS in early life slightly reduced the total PA and increased the time in SB but did not affect time in MVPA. Given reduced social-emotional difficulties in the LNS group previously reported, including hyperactivity, one possible explanation is less restless movement in the LNS group. © The Authors 2019 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. | Open |
| Okronipa H.; Arimond M.; Young R.R.; Arnold C.D.; Adu-Afarwuah S.; Tamakloe S.M.; Bentil H.J.; Ocansey M.E.; Kumordzie S.M.; Oaks B.M.; Dewey K.G. | Exposure to a slightly sweet lipid-based nutrient supplement during early life does not increase the preference for or consumption of sweet foods and beverages by 4-6-y-old Ghanaian preschool children: Follow-up of a randomized controlled trial | 2019 | Journal of Nutrition | Background: Whether consuming sweet foods early in life affects sweet food preferences and consumption later in childhood is unknown. Objective: We tested the hypothesis that exposure to a slightly sweet lipid-based nutrient supplement (LNS) early in life would not increase preference for or consumption of sweet items at preschool age. Methods: We followed up children who had participated in a randomized trial in Ghana in which LNS was provided to 1 group of women during pregnancy and 6 mo postpartum and to their infants from ages 6-18 mo (LNS group). The control group (non-LNS group) received iron and folic acid during pregnancy or multiple micronutrients during pregnancy and 6 mo postpartum, with no infant supplementation. At 4-6 y, we obtained data from caregivers on children's food and beverage preferences and consumption (n = 985). For a randomly selected subsample (n = 624), we assessed preference for sweet items using a photo game (range in potential scores, 0-15). For the photo game and reported consumption of sweet items, we examined group differences using predetermined noninferiority margins equivalent to an effect size of 0.2. Results: Median (quartile 1, quartile 3) reported consumption of sweet items (times in previous week) was 14 (8, 23) in the LNS group and 16 (9, 22) in the non-LNS group; in the photo game, the number of sweet items selected was 15 (11, 15) and 15 (11, 15), respectively. The upper level of the 95% CI of the mean difference between LNS and non-LNS groups did not exceed the noninferiority margins for these outcomes. Caregiver-reported preferences for sweet items also did not differ between groups (P = 0.9). Conclusion: In this setting, where child consumption of sweet foods was common, exposure to a slightly sweet LNS early in life did not increase preference for or consumption of sweet foods and beverages at preschool age. © 2019 American Society for Nutrition. This is an Open Access article distributed under the terms of the Creative Commons Attribution License | Open |
| Okyere C.Y.; Pangaribowo E.H.; Gerber N. | Household Water Quality Testing and Information: Identifying Impacts on Health Outcomes and Sanitation- and Hygiene-Related Risk-Mitigating Behaviors | 2019 | Evaluation Review | Background: In 2014, a group of 512 households in multipurpose water systems and also relying on unimproved water, sanitation, and hygiene practices in the Greater Accra region of Ghana were randomly selected to participate in water quality self-testing and also receipt of information in the form of handouts on how to improve water quality. Objectives and Research Design: Using a cluster-randomized controlled design, we study the health, sanitation, and hygiene behavior impacts of the household water quality testing and information experiment. Subjects: The study has three arms: (1) adult household members, (2) schoolgoing children, and (3) control group. Measures: The study measures the effects on handwashing with soap, cleanliness of households, and prevalence of diarrhea and self-reported fever. We also address impacts on child health and nutrition outcomes, particularly diarrhea and anthropometric outcomes. Results: We show that there is high household willingness to participate in this intervention on water quality self-testing. About 7 months after households took part in the intervention, the study finds little impacts on health outcomes and on sanitation- and hygiene-related risk-mitigating behaviors, regardless of the intervention group, either schoolchildren or adult household members. Impacts (direction and extent) are rather homogeneous for most of the outcomes across treatment groups. Conclusions: The study discusses the implications of the findings and also offers several explanations for the lack of transmission of impacts from the household water quality testing and information intervention on health outcomes and on sanitation and hygiene behaviors. © The Author(s) 2019. | Open |
| Oppong C. | Under fives in globalizing Ghana: From entitlements to deprivations | 2019 | Africa Today | This article highlights the dwindling entitlements and access of Ghanaian infants, toddlers, and nursing mothers to familial care and support and the potential effects on the feeding of infants and their levels of development as indicated by their nutritional status. These processes have been occurring within a context of increasing global pronouncements about the importance of breast milk and optimal breastfeeding, weaning, and care for infant growth and development and mounting concern regarding inadequate support given to nursing mothers. Ethnographic evidence spanning seven decades indicates how some Ghanaian infants, once regarded as supremely entitled beings, darlings of their families, have been suffering deprivation, revealed by high levels of wasting, stunting, and being underweight, recorded in several rounds of the Ghana Demographic and Health Surveys. Major expert analyses of nutrition make surprisingly little mention of the effects of family change, and gender-focused research and training appear in some cases to have supplanted earlier studies of changing familial institutions. Meanwhile, underdevelopment of under fives continues to be recognized as a national challenge. © The Trustees of Indiana University. | Open |
| Osei T.B.; Apprey C.; Mills-Robertson F.C.; Ohemeng A.N. | Nutritional status of children with sickle cell disease: A study at the Komfo Anokye Teaching Hospital of Ghana | 2019 | Nutrition and Food Science | Purpose: This study aims to assess the nutritional status of children with sickle cell diseases using anthropometric measurements, biochemical markers and dietary intakes. Design/methodology/approach: The study was conducted in 100 children of 3-12 years of age with sickle cell diseases (SCDs) at the Komfo Anokye Teaching Hospital in the Kumasi Metropolis of Ghana. Weight, height and age of participants were used to calculate body mass index-for-age. The mid-upper-arm-circumference-for-age, weight-for-age (percentiles) and height-for-age (percentiles) were compared with standards growth charts for children. Biochemical measures such as serum albumin and ferritin, as well as full blood count, were assessed. Dietary intake was assessed using 24-h dietary recall and food frequency questionnaire. Findings: From the study, 73 and 37 per cent of the children with SCD recorded inadequate intake of iron and vitamin E, respectively, when compared to the recommended daily allowance. Out of the 100 participants, 37 per cent were underweight and 22 per cent were stunted. There was significant difference (p < 0.05) in underweight (weight-for-age) prevalence by gender. A multiple variate regression showed a significant association between zinc (r2 = 0.763, p < 0.05) and haemoglobin levels. Originality/value: The evidence in this paper is relevant for treatment, health education and nutritional counselling of parents with children who have SCD. © 2018, Emerald Publishing Limited. | Open |
| Owusu M.F.; Basu A.; Barnett P. | Hypertension and diabetes management: a policy perspective from Ghana | 2019 | Journal of Health Organization and Management | Purpose: The purpose of this paper is to assess policy and management of hypertension and diabetes in Ghana. Design/methodology/approach: The authors conducted 26 key informant interviews with policy makers, payers, providers and participants from advocacy groups associated with the management of hypertension and diabetes both at national and district levels in Ghana; conducted focus group discussions with a total of 18 hypertensive and diabetic patients; and analyzed documentation detailing activities that have been undertaken in response to the management of hypertension and diabetes in Ghana. The authors then conducted a content analysis after combining the three sources of information. Findings: Using a stepwise policy process, the Ghanaian health sector has developed overarching policies and strategies on management of diabetes, hypertension, other non-communicable diseases, tobacco, alcohol and nutrition-related issues. Availability of funds and over-concentration on communicable diseases are the main barriers to the implementation of policies. Besides, response of the health sector to address the problems of hypertension and diabetes is focused more on clinical management than prevention; while the structures and processes to manage diabetes and hypertension is available at all levels of service delivery, more needs to be done on preventive aspects. Originality/value: This is the first study in Ghana to combine individual interviews, focus groups and document analysis to review policy development, implementation and response activities on the management of hypertension and diabetes. The authors believe that the evidence from this research will inform future policy initiatives on hypertension and diabetes management in Ghana. © 2018, Emerald Publishing Limited. | Open |
| Pradeilles R.; Marr C.; Laar A.; Holdsworth M.; Zotor F.; Tandoh A.; Klomegah S.; Coleman N.; Bash K.; Green M.; Griffiths P.L. | How ready are communities to implement actions to improve diets of adolescent girls and women in urban Ghana? | 2019 | BMC Public Health | Background: Ghana has reached an advanced stage of nutrition transition, contributing to an increase in nutrition-related non-communicable diseases, particularly amongst urban women. Community involvement is an important factor in the success of efforts to promote healthy eating. The readiness of populations to accept a range of interventions needs to be understood before appropriate interventions can be implemented. Therefore, this study assessed how ready urban communities are to improve diets of women of reproductive age in Ghana. Methods: Using the Community Readiness Model (CRM), in-depth interviews were conducted with 24 key informants from various sectors in low income communities across two cities in Ghana: Accra and Ho. The CRM consists of 36 open questions addressing five readiness dimensions (community knowledge of efforts, leadership, community climate, knowledge of the issue and resources). Interviews were scored using the CRM protocol with a maximum of 9 points per dimension (from 1 = no awareness to 9 = high level of community ownership). Thematic analysis was undertaken to gain insights of community factors that could affect the implementation of interventions to improve diets. Results: The mean community readiness scores indicated that both communities were in the "vague awareness stage" (3.35 ± 0.54 (Accra) and 3.94 ± 0.41 (Ho)). CRM scores across the five dimensions ranged from 2.65-4.38/9, ranging from denial/resistance to pre-planning. In both communities, the mean readiness score for 'knowledge of the issue' was the highest of all dimensions (4.10 ± 1.61 (Accra); 4.38 ± 1.81 (Ho)), but was still only at the pre-planning phase. The lowest scores were found for community knowledge of efforts (denial/resistance; 2.65 ± 2.49 (Accra)) and resources (vague awareness; 3.35 ± 1.03 (Ho)). The lack of knowledge of the consequences of unhealthy diets, misconceptions of the issue partly from low education, as well as challenges faced from a lack of resources to initiate/sustain programmes explained the low readiness. Conclusions: Despite recognising that unhealthy diets are a public health issue in these urban Ghanaian communities, it is not seen as a priority. The low community readiness ratings highlight the need to increase awareness of the issue prior to intervening to improve diets. © 2019 The Author(s). | Open |
| Prado E.L.; Yakes Jimenez E.; Vosti S.; Stewart R.; Stewart C.P.; Somé J.; Pulakka A.; Ouédraogo J.B.; Okronipa H.; Ocansey E.; Oaks B.; Maleta K.; Lartey A.; Kortekangas E.; Hess S.Y.; Brown K.; Bendabenda J.; Ashorn U.; Ashorn P.; Arimond M.; Adu-Afarwuah S.; Abbeddou S.; Dewey K. | Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso | 2019 | BMJ Global Health | Stunting prevalence is an indicator of a country's progress towards United Nations' Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-Age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%-62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress. © Author(s) (or their employer(s)) 2019. | Open |
| Ramadan W.; Chamidah N.; Zaman B.; Muniroh L.; Lestari B. | Standard Growth Chart of Weight for Height to Determine Wasting Nutritional Status in East Java Based on Semiparametric Least Square Spline Estimator | 2019 | IOP Conference Series: Materials Science and Engineering | Wasting is a condition of a children characterized by a lack of weight by measuring weight for height. Currently, to monitor the growth conditions for childrens in Indonesia, we use the Towards Healthy Card called as Kartu Menuju Sehat (KMS) which is guided by WHO 2005. The samples used to design WHO-2005 standard charts are children from Brazil, Ghana, India, USA, Norway, and Oman that have different physical conditions from children in Indonesia. Therefore, the using of standards growth charts from other countries cause incompatibility with Indonesian's children growth. To illustrate the growth patterns of children in East Java, we use the semiparametric least square spline estimator that gives more flexible pattern. In this study we used weight (kg) as a response variable, height (cm) as a predictor variable for nonparametric component, and gender as a predictor variable for parametric component. The results show the semiparametric least square spline estimator can explain the growth patterns of children well because it has determination coefficient (R2) of 99.78% and mean square error (MSE) of 0.0353. The standard chart of weight for height of boy is higher than that of girl and percentage of wasting nutritional status of girl greater than that of boy. © Published under licence by IOP Publishing Ltd. | Open |
| Squire S.A.; Robertson I.D.; Yang R.; Ayi I.; Ryan U. | Prevalence and risk factors associated with gastrointestinal parasites in ruminant livestock in the Coastal Savannah zone of Ghana | 2019 | Acta Tropica | Gastrointestinal (GIT) parasite infections result in significant economic losses to ruminant livestock production. To determine the prevalence and risk factors associated with GIT parasite infections in livestock from Ghana, a cross-sectional survey was conducted in cattle and small ruminants kept under different management systems in the Coastal Savannah zone from October 2014 to February 2015. Faecal samples were collected from 328 cattle and 502 small ruminants (sheep and goats) and examined by formal ether concentration microscopy. The management systems and environmental conditions of the farm or household were observed, and a questionnaire administered to the livestock owners. Overall, 90.8% (754/830) of livestock were infected with at least one of ten different parasites (Eimeria, Strongylid nematodes, Toxocara, Trichuris, Schistosoma, Dicrocoelium, Paramphistomum, Fasciola, Moniezia and Thysaniezia), with Eimeria the most prevalent (78.4%). Most (64.5%) livestock had coinfections with two to five parasites with parasite intensity mostly light and at least one parasite was found in 98.6% (140/142) of the herds. Binary logistic regression models were generated to assess the risk factors associated with infection. Earthen floor was positively associated with strongylid infection, multiple ruminant species with Paramphistomum infection and flock size (>25 animal) with Thysaniezia, Dicrocoelium and Fasciola infections. Separating young animals from older animals was negatively associated with Strongylid infection, feed supplementation with Thysaniezia infection and small ruminant species with Paramphistomum and Toxocara infections. The findings from this study suggests that good sanitation, proper husbandry practices and improved nutrition can improve livestock health and production in Ghana. © 2019 Elsevier B.V. | Open |
| Stewart F. | Redressing inequalities in societies growth with equity | 2019 | From Divided Pasts to Cohesive Futures: Reflections on Africa | This chapter considers whether there is a trade-off between growth and equality, as economists sometimes assert, differentiating between vertical inequality (among individuals) and horizontal inequality (among groups). Most evidence challenges the supposed trade-off, suggesting greater equality increases growth, especially sustained growth. Inequality among individuals tends to limit human resources, while inequality among groups can lead to violent conflict, and both constrain growth. Greater equality also supports other desirable objectives, including better nutrition, less crime, and better health. The impact of growth on equality is analysed. This depends on how far earnings are spread via employment; and the redistributionary effects of tax and government expenditure. Labour-intensive activities tend to improve distribution, while capital-intensive ones, heavy reliance on minerals for exports and rising skill requirements tend to worsen it. For horizontal inequality, the impact of growth varies according to group location, economic specialization and policies, illustrated by the experience of Ghana, Peru, Malaysia and Northern Ireland. The chapter surveys policies likely to improve vertical and horizontal distribution, with examples drawn from many countries. Finally, the chapter considers the political conditions needed to support equalising policies. © Cambridge University Press 2019. | Open |
| Tampah-Naah A.M.; Kumi-Kyereme A.; Amo-Adjei J. | Maternal challenges of exclusive breastfeeding and complementary feeding in Ghana | 2019 | PLoS ONE | Mothers are recommended to exclusively breastfeed their infants for the first six months of their lives. Also, after the sixth month, breastfeeding should continue with added complementary foods to the diets of children. Studies designed to sought the views of mothers on breastfeeding practices are limited. The aim of this study was to explore challenges to breastfeeding practices by considering spatial, societal and maternal characteristics in Ghana. Twenty mothers aged 15–49 years were interviewed purposively in selected communities within two regions of the country. Thematic content analytical procedures were applied to interpret and present findings. Challenges (to both exclusive breastfeeding and complementary feeding) spanned across spatial (home and work places), societal, and maternal characteristics. Key themes identified were in relation to household chores, work schedules, family influence, low breast milk production, swollen breasts or sore nipples, access to food items and preparation or giving foods. Addressing these challenges would require co-creation of supportive environments between couples and significant others as well as tackling institutional barriers that obstruct adequate breastfeeding among mothers. On complementary feeding, there is the need to form community health volunteers help educate mothers more on how to appropriately use local foods to feed their children. © 2019 Tampah-Naah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Tano-Debrah K.; Saalia F.K.; Ghosh S.; Hara M. | Development and Sensory Shelf-Life Testing of KOKO Plus: A Food Supplement for Improving the Nutritional Profiles of Traditional Complementary Foods | 2019 | Food and Nutrition Bulletin | Background: Providing nutritionally adequate complementary foods is essential in preventing malnutrition in young infants. Koko made from fermented corn dough constitutes the most common complementary food in Ghana. However, these do not meet the nutrient requirements. Objective: To develop and test the acceptability and shelf-life of an energy-dense complementary food supplement for improving the nutritional profile of traditional complementary foods. Methods: Surveys of families in urban and rural communities and stakeholder engagements with health professionals were done to identify the most predominant traditional complementary foods and young infants’ feeding practices. A food supplement, KOKO Plus, that would improve the nutritional profile of koko and other complementary foods needed to be developed. Linear programming was used in ingredient formulations for the food supplement based on locally available foods. The acceptability of the food supplement, KOKO Plus, in koko and soup was assessed using 14 trained assessors in a 2 × 2 crossover design. Shelf-life of the product was estimated using the difference in control sensory test method at different storage temperatures (24°C, 34°C, and 44°C). Results: Koko was the most predominant complementary food in many homes. The KOKO Plus food supplement improved the nutritional profile of koko to satisfy the nutrient intake requirements of young infants as recommended by World Health Organization. KOKO Plus was microbiologically safe, with estimated shelf-life of more than 12 months. Conclusion: The development of KOKO Plus as a food supplement provides a practical solution to improve the nutritional status of weaning children in Ghana. © The Author(s) 2019. | Open |
| Tohouenou M.M.; Egbi G.; Ohemeng A.; Steiner-Asiedu M. | Anaemia, vitamin-a deficiency, anthropometric nutritional status and associated factors among young school children in Kodzobi, Ghana, a peri-urban community | 2019 | Informal Logic | Anaemia, vitamin-A deficiency and under nutrition are prevalent among children at levels of public health significance in developing countries of which Ghana is no exception. The objective of this study was to assess the anaemia, low vitamin-A level and anthropometric nutritional status of 162 randomly selected young Ghanaian school children 4 - 8 years in Kodzobi, a peri-urban community and establish associated factors. Questionnaires were used to collect background data from parents of study participants. Vitamin-A and haemoglobin concentrations were determined using High Performance Liquid Chromatography and Haemocue hemoglobinometer, respectively. Malaria parasitaemia was examined by the Giemsa staining technique. Weight and height measurements were taken according to WHO's standard procedures to assess participants' nutritional status. The mean haemoglobin and serum retinol concentrations were 11.6 ± 1.1 g/dl and 22.8 ± 6.5 μg/dl, respectively. Prevalence of anaemia and vitamin-A deficiency among study participants were 38.3 % and 24.0 %, respectively. The prevalence of underweight, stunting, thinness and overweight were 9.3 %, 9.9 %, 4.3 % and 3.7 %, respectively. Haemoglobin correlated positively and significantly with weight, weight-for-age and body mass index-for-age z scores. Child's sex, vitamin-A status and parental monthly income associated with anaemia status. Females had a higher risk of being anaemic compared to males (OR = 2.519; 95 % CI: 0.965 - 6.580; p = 0.049). Participants with normal vitamin-A concentration were at lower risk of being anaemic (OR = 0.302; 95 % CI: 0.109 - 0.840; p = 0.022) than those with low vitamin- A concentration. Anaemia and young child age negatively associated with vitamin-A status, at p = 0.039 and p = 0.037, respectively. Anaemia and vitamin-A deficiency are issues of public health importance among school-aged children in Ghana. There is, therefore, the need to invest in actions that prevent their occurrence and management especially among children of school going age. © Afr. J. Food Agric. Nutr. Dev. 2019. | Open |
| Verwaart T.; Dijkxhoorn Y.; Plaisier C.; van Wagenberg C. | Agent-Based Simulation of Local Soy Value Chains in Ghana | 2019 | Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) | The assessment of changes in the relationships between supply chain agents is considered fundamental for market transformation. This paper reports on the application of a Value Chain Lab that supports the measurement of behavioral change in vertically structured supply-chain relationships. A participative gaming approach is used that enables to identify changes in mutual trust, transaction costs and risk behavior that result from value chain support and co-operation. The Value Chain Lab comprises value chain analysis, value chain games and multi-agent simulation. The paper describes the multi-agent simulation of a soy value chain in northern Ghana. The research was conducted in the context of the 2SCALE program, aiming to improve rural livelihoods and food and nutrition security in a number of African countries by developing agricultural supply chains including local smallholder farmers. The study confirms the positive effects of trust and loyalty in value chain relationships. Furthermore, it demonstrates the usefulness of agent-based simulations for exploring potential consequences of alternative interventions. © 2019, Springer Nature Switzerland AG. | Open |
| Adams K.P.; Lybbert T.J.; Vosti S.A.; Ayifah E.; Arimond M.; Adu-Afarwuah S.; Dewey K.G. | Unintended effects of a targeted maternal and child nutrition intervention on household expenditures, labor income, and the nutritional status of non-targeted siblings in Ghana | 2018 | World Development | It is common for health and nutrition interventions to target specific household members and for evaluations of their effects to focus exclusively on those members. However, if a targeted intervention changes a household's utility maximization problem or influences decision-making, households might respond to the intervention in unintended ways with the potential to affect the wellbeing of non-targeted members. Using panel data from a randomized controlled nutrition trial in Ghana, we evaluate household behavioral responses to the provision of small-quantity lipid-based nutrient supplements (SQ-LNS) to mothers and their infants to prevent undernutrition. We find that targeted supplementation with SQ-LNS had a positive effect on household expenditures on food, including some nutrient-rich food groups, as well as on non-food goods and services. We also find a positive impact on labor income, particularly among fathers. We then explore intrahousehold spillover effects on the nutritional status of non-targeted young children in the household. We find evidence that the targeted provision of SQ-LNS led to higher height-for-age z-scores among non-targeted children in the LNS group compared to the non-LNS group, though only among those with relatively taller mothers, which is an indicator of a child's growth potential. These findings support existing evidence and suggest that unintended behavioral responses and spillover are a real possibility in the context of nutrition interventions targeting nutritionally-vulnerable household members. Thoughtfully considering this possibility in the design, analyses, and evaluation of targeted nutrition interventions may provide a more complete picture of overall effects. © 2018 The Author(s) | Open |
| Adams K.P.; Okronipa H.; Adu-Afarwuah S.; Arimond M.; Kumordzie S.; Oaks B.M.; Ocansey M.E.; Young R.R.; Vosti S.A.; Dewey K.G. | Ghanaian parents' perceptions of pre and postnatal nutrient supplements and their effects | 2018 | Maternal and Child Nutrition | Small-quantity lipid-based nutrient supplements (SQ-LNS) have been studied in efficacy and effectiveness trials, but little is known about how parents perceive the products and their effects. In a randomised trial in Ghana, efficacy of SQ-LNS provided to women during pregnancy and the first 6 months postpartum and to their children from 6 to 18 months of age was assessed by comparison with iron-folic acid (IFA) capsules and multiple micronutrient (MMN) capsules provided to women. In a follow-up study conducted when the index children from the original trial were between 4 and 6 years of age, we used survey-based methods to assess retrospective and current parental perceptions of nutrient supplements generally and of SQ-LNS and their effects compared with perceptions IFA and MMN capsules. Most parents perceived that the assigned supplements (SQ-LNS, IFA, or MMN) positively impacted the mother during pregnancy (approximately 89% of both mothers and fathers) and during lactation (84% of mothers and 86% of fathers). Almost all (≥90%) of mothers and fathers perceived that the assigned supplement positively impacted the index child and expected continued positive impacts on the child's health and human capital into the future. A smaller percentage of parents perceived negative impacts of the supplements (7%–17% of mothers and 4%–12% of fathers). Perceptions of positive impacts and of negative impacts did not differ by intervention group. The results suggest that similar populations would likely be receptive to programs to deliver SQ-LNS or micronutrient capsules. © 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd. | Open |
| Adams K.P.; Vosti S.A.; Ayifah E.; Phiri T.E.; Adu-Afarwuah S.; Maleta K.; Ashorn U.; Arimond M.; Dewey K.G. | Willingness to pay for small-quantity lipid-based nutrient supplements for women and children: Evidence from Ghana and Malawi | 2018 | Maternal and Child Nutrition | Small-quantity lipid-based nutrient supplements (SQ-LNS) are designed to enrich maternal and child diets with the objective of preventing undernutrition during the first 1,000 days. Scaling up the delivery of supplements such as SQ-LNS hinges on understanding private demand and creatively leveraging policy-relevant factors that might influence demand. We used longitudinal stated willingness-to-pay (WTP) data from contingent valuation studies that were integrated into randomized controlled nutrition trials in Ghana and Malawi to estimate private valuation of SQ-LNS during pregnancy, postpartum, and early childhood. We found that average stated WTP for a day's supply of SQ-LNS was more than twice as high in Ghana than Malawi, indicating that demand for SQ-LNS (and by extension, the options for effective delivery of SQ-LNS) may be very context specific. We also examined factors associated with WTP, including intervention group, household socioeconomic status, birth outcomes, child growth, and maternal and child morbidity. In both sites, WTP was consistently negatively associated with household food insecurity, indicating that subsidization might be needed to permit food insecure households to acquire SQ-LNS if it is made available for purchase. In Ghana, WTP was higher among heads of household than among mothers, which may be related to control over household resources. Personal experience using SQ-LNS was not associated with WTP in either site. © 2017 The Authors. Maternal and Child Nutrition published by John Wiley & Sons, Ltd. | Open |
| Adjepong M.; Yakah W.; Harris W.S.; Colecraft E.; Marquis G.S.; Fenton J.I. | Association of whole blood fatty acids and growth in southern ghanaian children 2–6 years of age | 2018 | Nutrients | In Ghana, stunting rates in children below 5 years of age vary regionally. Dietary fatty acids (FAs) are crucial for linear growth. The objective of this study was to determine the association between blood FAs and growth parameters in southern Ghanaian children 2–6 years of age. A drop of blood was collected on an antioxidant treated card and analyzed for FA composition. Weight and height were measured and z-scores calculated. Relationships between FAs and growth were analyzed by linear regressions and factor analysis. Of the 209 subjects, 22% were stunted and 10.6% were essential FA deficient (triene/tetraene ratio > 0.02). Essential FA did not differ between stunted and non-stunted children and was not associated with height-for-age z-score or weight-for-age z-score. Similarly, no relationships between other blood fatty acids and growth parameters were observed in this population. However, when blood fatty acid levels in these children were compared to previously reported values from northern Ghana, the analysis showed that blood omega-3 FA levels were significantly higher and omega-6 FA levels lower in the southern Ghanaian children (p < 0.001). Fish and seafood consumption in this southern cohort was high and could account for the lower stunting rates observed in these children compared to other regions. © 2018 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Adu-Afarwuah S.; Young R.T.; Lartey A.; Okronipa H.; Ashorn P.; Ashorn U.; Zeilani M.; Dewey K.G. | Supplementation during pregnancy with small-quantity lipid-based nutrient supplements or multiple micronutrients, compared with iron and folic acid, increases women's urinary iodine concentration in semiurban Ghana: A randomized controlled trial | 2018 | Maternal and Child Nutrition | There is little information on whether prenatal multiple micronutrient (MMN) supplements containing iodine affect women's iodine status. In the International Lipid-based Nutrient Supplements DYAD-Ghana trial, we aimed to assess women's urinary iodine concentration (UIC, μg/L) during pregnancy, as one of the planned secondary outcomes. Women (n = 1,320) <20 weeks of gestation were randomized to consume 60 mg iron and 400 μg folic acid per day (iron and folic acid [IFA]); 18 vitamins and minerals including 250 μg iodine per day (MMN); or 20 g/day of small-quantity lipid-based nutrient supplements (LNS) with the same and additional 4 vitamins and minerals as the MMN (LNS). In a subsample (n = 295), we tested differences in groups' geometric mean UICs at 36 weeks of gestation controlling for baseline UIC and compared the geometric means (approximately median UICs) with the World Health Organization (WHO) cut-offs: median UIC <150, 150–249, and ≥500 reflecting low, adequate, and excessive iodine intakes, respectively. At baseline, overall median UIC was 137. At 36 weeks of gestation, controlling for baseline UIC, geometric mean (95% confidence interval) UICs of the MMN (161 [133, 184]) and LNS (158 [132, 185]) groups did not differ; both values were significantly greater (overall p =.004) than that of the IFA group (116 [101, 135]). The median UICs of the MMN and LNS groups were within the WHO “adequate” range, whereas that of the IFA group was below the WHO adequate range. In this setting, supplementation during pregnancy with small-quantity LNS or MMN providing iodine at the WHO-recommended dose, compared with IFA, increases the likelihood of adequate iodine status. © 2017 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd. | Open |
| Agbozo F.; Amardi-Mfoafo J.; Dwase H.; Ellahi B. | Nutrition knowledge, dietary patterns and anthropometric indices of older persons in four peri-urban communities in Ga West municipality, ghana | 2018 | African Health Sciences | Background: Older adults are vulnerable to malnutrition due to sociologic, physiologic and anatomical effects of ageing. Objective: To investigate the influence of nutrition knowledge and dietary patterns on nutritional status of community-dwelling ambulatory older adults. Methods: This cross-sectional survey involved 120 elderly aged 60-70 years purposively selected from four peri-urban communities in Ga West municipality, Ghana. Nutrition knowledge was assessed using a structured questionnaire and dietary intakes obtained using a standardized food frequency questionnaire. BMI from weight/height measurements was proxy for nutritional status. Data was analyzed descriptively in SPSS. Associations were tested using correlation analyses (-1| Open |
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| Agbozo F.; Atitto P.; Jahn A.; Abubakari A. | Nutrient composition and dietary diversity of on-site lunch meals, and anthropometry of beneficiary children in private and public primary schools in Ghana | 2018 | Nutrition and Health | Background: On-site lunch provided through the Ghana School Feeding Programme is expected to be nutritionally adequate thereby contributing to reducing hunger and malnutrition. Aim: The aim of this study was to assess the dietary diversity and nutrient composition of on-site school lunch and estimate the extent to which it met the Food and Agriculture Organization Reference Nutrient Intakes for children aged 3-12 years. Methods: In this cross-sectional food consumption survey, on-site lunch menus were reviewed, dietary diversity assessed and meal preparation/serving observed during a typical school week. Three randomly selected portion sizes were weighed and the average weight (grams) entered into the RIING nutrient software to estimate the nutrient composition. Anthropometry of participants enrolled in seven public (n = 113) and six private (n = 216) primary schools in Hohoe municipality, Ghana was analysed using World Health Organization Anthroplus software. Results: The menu consisted largely of energy-dense staples, some vegetables and fish. Eggs, dairy and fruits were never served. Meals served in the public and private schools were statistically similar. Fat (23.8 vs. 27.7 g), iron (3.0 vs. 2.8 mg), vitamins A (417.3 vs. 280.8 mg retinol equivalent) and C (25.1 vs. 16.5 mg) requirements were fully met. Energy (420.6 vs. 462.2 kcal), protein (6.8 vs. 6.8 g), thiamin (0.18 vs. 0.17 mg) and zinc (1.3 vs. 1.2 mg) were 50-75% met. Calcium (62.6 vs. 61.4 mg), riboflavin (0.09 vs. 0.07 mg) and niacin (1.6 vs. 1.3 mg) were 26-37% met. Concerning nutritional status, prevalence of stunting (8.9% vs. 7.9%), underweight (3.6% vs. 5.7%), thinness (1.8% vs. 3.7%) and overweight/obesity (3.5% vs. 4.2%) were also statistically similar. Conclusion: Enhancing dietary diversity is crucial to achieving nutrient-dense school meals. © The Author(s) 2018. | Open |
| Agbozo F.; Colecraft E.; Jahn A.; Guetterman T. | Understanding why child welfare clinic attendance and growth of children in the nutrition surveillance programme is below target: Lessons learnt from a mixed methods study in Ghana | 2018 | BMC Nursing | Background: Growth monitoring and promotion (GMP) programmes promote not only child health but serve as a service delivery strategy to enhance coverage for other crucial nutrition-specific interventions. This study compared community-based and facility-based GMP programme with respect to attendance rates, children's nutritional status, caregivers' satisfaction with services received and perceptions of service providers and users on factors influencing utilization. Methods: Explanatory sequential mixed methods study conducted in Ga West municipality, Ghana. It comprised 12-month secondary data analysis using growth monitoring registers of 220 infants aged 0-3 months enrolled in two community-based (CB = 104) and two facility-based (FB = 116) child welfare clinics; cross-sectional survey (exit interview) of 232 caregiver-child pairs accessing CB (n = 104) and FB services (n = 116); and in-depth interviews with 10 health workers and 15 mothers. Quantitative data were analyzed through Fisher's exact, unpaired t-tests, and logistic regression at 95% confidence interval (CI) using SPSS version 20. Qualitative data were analyzed by thematic content analysis using ATLAS.ti 7.0. Results: Mean annual attendance to both programmes was similar with an average of six visits per year. Only 13.6% of caregiver-child pairs attained more than nine visits in the 12-months period. At least 60% of children in both programs had improved weight-for-age z-scores (WAZ) scores during participation. Predictors for improved WAZ were being underweight at baseline (AOR:11.1, 95%CI:4.0-31.0), annual attendance of at least six visits (AOR:2.2, 95%CI:1.1-4.1) and meeting the Ghana Health Service target of nine visits (AOR:4.65, 95%CI:1.4-15.1). Compared to 31.5% CB users, significant proportion of FB caregivers (57.4%) were visited at home. Half were dissatisfied with services received (CB:55.6% vs. FB:62.0%, p = 0.437) citing long waiting times, negative staff attitude and extortions of money. Regarding perceptions on factors hindering service utilization, emerged themes included extremes of maternal age, high parity, postpartum socio-cultural beliefs and practices, financial commitments, undue delays, unprofessional staff behaviours, high premium on vaccination and general misconceptions about the programme. Conclusion: The association of increased attendance with improved growth reaffirms the need to strengthen primary healthcare systems to improve service delivery; sensitize caregivers on contribution of growth monitoring and promotion to early child development; and increase contacts through home visits. © 2018 The Author(s). | Open |
| Akuamoah F.; Odamtten G.T.; Kortei N.K. | Impact of gamma radiation on the microbiological quality of smoke dry shrimp (Penaeus notialis) from three different water sources in Ghana | 2018 | Cogent Food and Agriculture | Shrimps are one of the most important commodities of the global fishery trade, are consumed by humans and also used in formulation of feed for animals to enhance nutrition. Enumeration and identification of fungi and bacteria present on shrimp was checked. Gamma radiation doses of 0, 4, 8 and 10 kGy at a dose rate of 1.7 kGy/h from a Cobalt-60 source (SLL-515, Hungary) was evaluated. Mycological analysis was done by direct plating method on Oxytetracycline Glucose Yeast Extract and Dichloran Rose Bengal Chloramphenicol (DRBC) media. Bacteriological analysis was done by decimal reduction method on Plate Count Agar. Some toxigenic species of the genus Aspergillus (A. alutaceus, A. flavus, A. candidus and A. fumigatus), Fusarium (F. verticillioides) and Penicillium (P. expansum, P. citrinum and P. cyclopium) were isolated from the shrimp. Comparatively higher initial fungal and bacterial counts of 5.0–5.4 log 10 CFU/g and 4.3–4.7 log 10 CFU/g, respectively, were recorded for non-pretreated while lower counts of 1.7–2 and 1.6–2.1 log 10 CFU/g were recorded for pretreated smoked dry shrimp. Gamma radiation significantly (P < 0.05) reduced initial total fungal and bacterial populations by an average of 3 and 2.5 log cycles, respectively. © 2018 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license. | Open |
| Amegah A.K.; Nsoh M.; Ashley-Amegah G.; Anaman-Togbor J. | What factors influences dietary and non-dietary vitamin D intake among pregnant women in an African population? | 2018 | Nutrition | Objective: Data on dietary vitamin D (vitD) intake, sunlight exposure, and the associated determinants are lacking in Africa. The aim of this study was to establish the factors influencing vitD intake and sunlight exposure among pregnant women in an African population with the goal of improving maternal vitD nutrition. Methods: A population-based cross-sectional study was conducted among 703 mother–infant pairs accessing postnatal care at the five main health facilities in Cape Coast, Ghana in 2016. Information on sociodemographic characteristics and sunlight exposure practices during pregnancy were collected using a structured questionnaire. A semiquantitative food frequency questionnaire was used to estimate vitD intake during pregnancy. Results: VitD nutrition awareness during pregnancy was low in the study area. Education, occupation, ethnicity, and marital status influenced vitD intake in this population. In a multivariable linear regression adjusting for potential confounders, lack of information on essential nutrients needed in pregnancy, and infrequent consumption of recommended foods resulted in 10.51 µg (95% confidence interval [CI], −19.59 to −1.42) and 26.18 µg (95% CI, −47.18 to −5.17) reduction in vitD intake, respectively. Lack of information on the importance of vitD in pregnancy, and on their dietary and non-dietary sources resulted in 11.76 µg (95% CI, −21.53 to −2.00) and 26.34 µg (95% CI, −52.47 to −0.21) reduction in vitD intake, respectively. Employment status of mothers was associated with statistically significant higher sunlight exposure. Conclusions: The study findings call for rolling out literacy and nutrition education programs targeted at women in sub-Saharan African countries to help improve maternal nutrition. © 2017 Elsevier Inc. | Open |
| Annan R.A.; Apprey C.; Oppong N.K.; Petty-Agamatey V.; Mensah L.; Thow A.M. | Public awareness and perception of Ghana's restrictive policy on fatty meat, as well as preference and consumption of meat products among Ghanaian adults living in the Kumasi Metropolis | 2018 | BMC Nutrition | Background: The nutrition transition, currently observed across the world is driven by trade liberalization, urbanization and more sedentary lifestyles. Ghana implemented a restrictive policy to limit the availability and access to fatty meat in the 1990s. This paper sought to determine public awareness and perception of the policy's enforcement and impact, as well as the general attitude towards fatty meat, preference and consumption of meat types. Method: A cross-sectional qualitative study was carried out among 377 adults, aged ≥18 years, living in Kumasi Metropolis in the Ashanti Region, the second largest city in Ghana. An interviewer administered structured questionnaire and a food frequency questionnaire were used for data collection. Body composition parameters were determined with OMRON body composition analyser and blood pressure was measured with a digital sphygmomanometer. Results: Majority of respondents were females (62.9%), aged 18-35 years old (72.1%) and were labourers, traders or teachers (52.5%). Mean Body Mass Index of participants was 25.4 kg/m2 and percent body fat was 30.4%. Over half (58.9%) of the participants were aware of, and most (81.2%) supported the restrictions, although majority (57%) thought there was low public awareness and less than 15% felt the restrictions were well enforced. About 59.4% believed the restriction could improve health, prevent disease and reduce deaths in the long-term. Two thirds (67.1%) of the participants considered the fat content of the meat they bought and related fat to health problems (38.5%) and obesity/stroke (7.4%). Local meat products (meat produced in Ghana) were more preferred due to taste, freshness and healthiness than imported meat, but imported meat types (meat imported from other countries) were more available (56.5%), cheaper (69.5%) and regularly consumed than the local types. Conclusion: There was a good level of public awareness, strong support and positive attitude towards Ghana's restrictive food standards on meat. Although preference for local meat type was greater, imported meat was more consumed due to cost and availability. Policies which limit access to, and availability of 'unhealthy' food should be implemented and enforced to improve the food environment in order to help address the growing obesity and non communicable disease trend. © 2018 The Author(s). | Open |
| Annim S.K.; Frempong R.B. | Effects of access to credit and income on dietary diversity in Ghana | 2018 | Food Security | While the relationship between income and food security is well established, a case for the effect of credit on food security remains rather limited. This study examined the relationship between dietary diversity and household income and access to credit. We used the Food Diversity Index and Food Consumption Score to proxy dietary diversity. The fourth and fifth rounds of the Ghana Living Standards Survey, with respective sample sizes of 5779 and 8312 households, were used for the analysis. We applied an instrumental variable estimation technique to address the endogeneity between household nutritional status and income/credit. Results from both surveys showed that access to credit contributes to the consumption of a diversified diet in Ghana. Also, the results corroborated the expected positive relationship between income and dietary diversity. We recommend that, in addition to creating ways to generate income, an effort should be made to make the environment in Ghana and elsewhere more conducive to the activities of micro-credit institutions. This could be done by encouraging microfinance institutions in rural areas through tax exemptions and financial support systems. © 2018, Springer Nature B.V. and International Society for Plant Pathology. | Open |
| Anokye R.; Acheampong E.; Edusei A.K.; Mprah W.K.; Ofori-Amoah J.; Amoah V.M.K.; Arkorful V.E. | Perception of childhood anaemia among mothers in Kumasi: A quantitative approach | 2018 | Italian Journal of Pediatrics | Background: Anaemia is the world's second cause of disability and it affects over half of pre-school children in developing countries and at least 30-40% in industrial countries. In poorer malaria-endemic countries, anemia is one of the commonest preventable causes of death in children under 5 years. This study sought to determine the perceived causes, signs and symptoms as well prevention of childhood anaemia among mothers of children under 5 years in Kumasi, Ghana. Methods: A descriptive hospital-based cross-sectional study design with a sample of 228 patients attending the University Hospital, KNUST was used. A simple random sampling technique was applied in sampling and a structured questionnaire was used to collect data which was analyzed using SPSS statistical tools. Results: The study found that anemia was mostly perceived to be caused by poor feeding practices (43%) and fever (37%). The signs and symptoms mentioned mostly were pale conjunctiva (47%) and pale palm (44%). It was suggested that it could be prevented by giving adequate nutrition (23%), regular deworming (19%) as well as exclusive breastfeeding (25%). Mothers education and the number of children were found to be associated with the perception regarding anaemia as respondents who had completed SHS/A level were 5.14 times likely to have a higher knowledge score on Anaemia (AOR = 5.14; 95% CI; 1.01-21.8). Also, mothers who had 5 to 6 children were 1.65 times likely to have higher knowledge score on Anaemia (AOR = 1.65; 95% CI; 0.02-2.32). Conclusion: Previous experience with Anaemia and higher educational level results in better understanding of Anaemia. Therefore, extensive health education on anemia should be undertaken by the hospital authorities in collaboration with the Ministry of Health to improve knowledge of Anaemia. © 2018 The Author(s). | Open |
| Armar-Klemesu M.; Osei-Menya S.; Zakariah-Akoto S.; Tumilowicz A.; Lee J.; Hotz C. | Using Ethnography to Identify Barriers and Facilitators to Optimal Infant and Young Child Feeding in Rural Ghana: Implications for Programs | 2018 | Food and Nutrition Bulletin | Background: Understanding the context of infant and young child feeding (IYCF) is recognized as essential for designing appropriate complementary feeding interventions. Objective: Our objective was to study household IYCF behaviors in 2 districts in southern and northern Ghana to identify opportunities to improve existing nutrition programs. Methods: We interviewed 80 caregivers of children aged 6 to 23 months using ethnographic methods, including free listing, guided discussions and cognitive mapping techniques, and 24-hour dietary recall. Descriptive statistics and thematic content analysis were used to analyze quantitative and qualitative data. Results: In both settings, children’s diets were predominantly maize based. Fish, the main animal source food, was consumed daily but in very small quantities. Milk was consumed by only a few children, in tea and porridge. Fruits were seldom consumed. Household food production did not meet requirements, and the markets were heavily relied on for staples and other key ingredients. Most caregivers demonstrated basic knowledge and understanding of key health and nutrition concepts. Barriers to optimal child feeding identified were lack of money to purchase the nutritious foods recommended for children, seasonal food insecurity, and some caregiver beliefs, practices, and nutrition knowledge gaps. Positive contextual features include caregiver recognition of the dietary needs of young children and commitment to provide foods to meet these needs. Conclusion: Our findings suggest that complementary feeding in these rural settings can be improved through reinforcement or modification of strategic components of local health and nutrition education in light of existing barriers and enablers to optimal IYCF. © 2018, © The Author(s) 2018. | Open |
| Bandoh D.A.; Manu A.; Kenu E. | Lacking in abundance: Undernutrition in a Peri-urban fishing community in Coastal Ghana | 2018 | BMC Nutrition | Background: Malnutrition is a major problem in the world, especially in developing countries such as Ghana. Malnutrition is directly and indirectly responsible for over a million deaths in under-fives worldwide. In spite of the abundance of protein from fish and other staples in fishing communities, they are not spared of the problem of undernutrition. The study sought to assess the prevalence undernutrition among children under-five years in a fishing community in Ghana. Methods: We conducted a community-based cross-sectional study in Ekumfi Narkwa. We assessed the nutritional status of 250 children aged 6-59 months using anthropometric methods. A structured questionnaire was also used to gather socio-demographic data on the children. We generated nutritional indices with Microsoft Excel 2010 and WHO Anthro software version 3.2.2. We generate frequencies and percentages and ran a simple logistic regression to determine factors associated with malnutrition using STATA software version 13. Results: About 80%(198/250) of the children were reported to have consumed fish products more than three times in the past week whiles 85%(214/250) consumed staples more than three times in the past week. More than one-quarter (26.4%) of the children were under-nourished. The prevalence of stunting, wasting and underweight were 17.6% (44/250), 4.4% (11/250) and 12% (30/250) respectively. Age of caregiver was found to be associated with a child being underweight. The age group of the caregiver was found to be associated with undernutrition (OR:1.53; 95%CI:1.07-219). Conclusions: These findings suggest a high prevalence of under-five undernutrition in the fishing community in spite of the abundance of fish and its presence in their diet. Malnutrition interventions should therefore be extended to these communities. These interventions in fishing communities need to be tailored towards caregiver utilization of fish and other food sources available in order to improve nutrition of the children. © 2018 The Author(s). | Open |
| Banerji A.; Chowdhury S.; De Groote H.; Meenakshi J.V.; Haleegoah J.; Ewool M. | Eliciting Willingness-to-Pay through Multiple Experimental Procedures: Evidence from Lab-in-the-Field in Rural Ghana | 2018 | Canadian Journal of Agricultural Economics | This paper has the objectives of (a) comparing estimated willingness-to-pay (WTP) across three elicitation mechanisms (a Becker-DeGroot-Marschak [BDM] auction, a kth price auction, and a choice experiment [CE]) and (b) examining how these vary by participation fee. The product under consideration is kenkey made with nutritious maize, biofortified with vitamin A, which gives it a distinct orange color, in contrast to the white and yellow varieties that are traditionally consumed. We use an experiment consisting of 14 treatment arms, conducted in rural Ghana. Our estimation strategy explicitly accounts for the censored (typically at the market price) nature of the bids in the auctions, and the apparently lexicographic choices of several individuals in the CE. We find no evidence of economically meaningful (defined by the minimum currency unit of five pesewas) differences in WTP (although they may be statistically significant) across elicitation mechanisms, or by participation fee, a result that is in contrast to that found in much of the literature. A secondary finding is that the provision of nutrition information positively and significantly affects the marginal WTP for the new maize. © 2017 Canadian Agricultural Economics Society | Open |
| Boakye A.A.; Wireko-Manu F.D.; Oduro I.; Ellis W.O.; Gudjónsdóttir M.; Chronakis I.S. | Utilizing cocoyam (Xanthosoma sagittifolium) for food and nutrition security: A review | 2018 | Food Science and Nutrition | The critical role of indigenous crops in the socioeconomic growth of developing nations has necessitated calls for accelerated exploitation of staples. Cocoyam, Xanthosoma sagittifolium, is food for over 400 million people worldwide and is the most consumed aroid in West Africa. However, it remains an underexploited food resource. This study reviews existing literature and also makes use of primary data from interviews with indigenous cocoyam farmers, processors, consumers, and cocoyam scientists in the research Institutes of Ghana, to provide insight into existing nomenclature of the species, indigenous knowledge on food uses, nutritional value, and potential novel food applications of cocoyam. Adaptable technologies in conformity to new trends in food science that could be employed for in-depth molecular studies and further exploitation of the crop are also discussed. It is envisaged that the provided information would contribute to global efforts aimed at exploiting the full potential of indigenous crops for sustainable food and nutrition security. © 2018 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc. | Open |
| Boatemaa S.; Badasu D.M.; De-Graft Aikins A. | Food beliefs and practices in urban poor communities in Accra: Implications for health interventions | 2018 | BMC Public Health | Background: Poor communities in low and middle income countries are reported to experience a higher burden of chronic non-communicable diseases (NCDs) and nutrition-related NCDs. Interventions that build on lay perspectives of risk are recommended. The objective of this study was to examine lay understanding of healthy and unhealthy food practices, factors that influence food choices and the implications for developing population health interventions in three urban poor communities in Accra, Ghana. Methods: Thirty lay adults were recruited and interviewed in two poor urban communities in Accra. The interviews were audio-taped, transcribed and analysed thematically. The analysis was guided by the socio-ecological model which focuses on the intrapersonal, interpersonal, community, structural and policy levels of social organisation. Results: Food was perceived as an edible natural resource, and healthy in its raw state. A food item retained its natural, healthy properties or became unhealthy depending on how it was prepared (e.g. frying vs boiling) and consumed (e.g. early or late in the day). These food beliefs reflected broader social food norms in the community and incorporated ideas aligned with standard expert dietary guidelines. Healthy cooking was perceived as the ability to select good ingredients, use appropriate cooking methods, and maintain food hygiene. Healthy eating was defined in three ways: 1) eating the right meals; 2) eating the right quantity; and 3) eating at the right time. Factors that influenced food choice included finances, physical and psychological state, significant others and community resources. Conclusions: The findings suggest that beliefs about healthy and unhealthy food practices are rooted in multi-level factors, including individual experience, family dynamics and community factors. The factors influencing food choices are also multilevel. The implications of the findings for the design and content of dietary and health interventions are discussed. © 2018 The Author(s). | Open |
| Boateng L.; Nyarko R.; Asante M.; Steiner-Asiedu M. | Acceptability of Complementary Foods That Incorporate Moringa oleifera Leaf Powder Among Infants and Their Caregivers | 2018 | Food and Nutrition Bulletin | Background: Moringa oleifera leaf powder (MLP) is a nutrient-rich and readily available food resource that has the potential to improve the micronutrient quality of complementary foods in developing countries. Objective: To investigate the acceptability of complementary foods fortified with MLP. Methods: Moringa oleifera leaf powder was fed to infants either as part of a cereal–legume complementary food blend (MCL-35 g) or by sprinkling as a food supplement (MS-5 g) on infant’s usual foods. Mother–infant pairs (n = 18 for the MCL-35 g group and n = 16 for the MS-5 g group) attending regular weight monitoring sessions were recruited to participate in the acceptability trial. The study consisted of an initial tasting session after which mothers were to feed the assigned foods to their infants for 14 days. Mothers rated color, odor, taste, and overall liking of the complementary foods using a 5-point hedonic scale. Primary outcome was the proportion of test porridge consumed. Results: On the tasting day, MCL-35 g group infants consumed an average of 64.27% ± 25.02 of the test porridge offered, whereas MS-5 g group infants consumed an average of 66.43% ± 29.09. During the 14-day period, median percent daily consumption for MCL-35 g was 71.5% of the daily recommended intake, whereas median percent daily consumption for MS-5 g was 86.2%. Conclusion: We conclude that complementary foods incorporating Moringa oleifera leaf powder either as part of a cereal–legume complementary food blend (MCL-35 g) or when sprinkled as a food supplement (MS-5 g) on infant’s usual foods were well accepted. © 2017, © The Author(s) 2017. | Open |
| Caleyachetty R.; Thomas G.N.; Kengne A.P.; Echouffo-Tcheugui J.B.; Schilsky S.; Khodabocus J.; Uauy R. | The double burden of malnutrition among adolescents: Analysis of data from the Global School-Based Student Health and Health Behavior in School-Aged Children surveys in 57 low- and middle-income countries | 2018 | American Journal of Clinical Nutrition | Background: Adults and young children in countries experiencing the nutrition transition are known to be affected simultaneously by undernutrition and overnutrition. Adolescence is a critical period for growth and development. Yet, it is unknown to what extent this double burden of malnutrition affects adolescents in low- and middleincome countries (LMICs) and the macrolevel contextual factors associated with the double burden of malnutrition. Objective: The aim was to quantify the magnitude of the double burden of malnutrition among adolescents and to examine the potential sources of heterogeneity in prevalence estimates across LMICs. Design:We used individual-participant data from the Global School- Based Student Health and Health Behavior in School-Aged Children surveys conducted in 57 LMICs between 2003 and 2013, comprising 129,276 adolescents aged 12-15 y. Pooled estimates of stunting, thinness, or both; overweight or obesity; and concurrent stunting and overweight or obesity were calculated overall, by regions, and stratified by sex, with random-effects meta-analysis. Guided by UNICEF's conceptual framework for child malnutrition, we used ecological linear regression models to examine the association between macrolevel contextual factors (internal conflict, lack of democracy, gross domestic product, food insecurity, urbanization, and survey year) and stunting, thinness, and overweight and obesity prevalence, respectively. Results: The prevalence of stunting was 10.2% (95% CI: 8.3%, 12.2%) and of thinness was 5.5% (95% CI: 4.3%, 6.9%). The prevalence of overweight or obesity was 21.4% (95% CI: 18.6%, 24.2%). Between 38.4% and 58.7% of the variance in adolescent malnutrition was explained by macrolevel contextual factors. The prevalence of concurrent stunting and overweight or obesity was 2.0% (95% CI: 1.7%, 2.5%). Conclusions: The double burden of malnutrition among adolescents in LMICs is common. Context-sensitive implementation and scaleup of interventions and policies for the double burden of malnutrition are needed to achieve the Sustainable Development Goal to end malnutrition in all of its forms by 2030. This trial was registered at clinicaltrials.gov as NCT03346473. © 2018 Oxford University Press. All rights reserved. | Open |
| Chagomoka T.; Drescher A.; Glaser R.; Marschner B.; Schlesinger J.; Abizari A.-R.; Karg H.; Nyandoro G. | Urban and peri-urban agriculture and its implication on food and nutrition insecurity in northern Ghana: a socio-spatial analysis along the urban–rural continuum | 2018 | Population and Environment | Food and nutrition insecurity remains a challenge in sub-Saharan Africa. Several studies have examined food and nutrition insecurity in urban or rural areas but have not captured the whole continuum. Between November and December 2013, 240 households were surveyed along the urban–rural continuum in Northern Ghana. The study objective was to understand the socio-spatial dynamics of household food and nutrition insecurity and to investigate the role played by urban, peri-urban and rural agriculture. The study found that there was more involvement in agriculture in rural areas compared to peri-urban areas and urban areas. Households from urban areas were more food insecure (HFIAS > 11) compared to their counterparts in peri-urban and the rural areas. Stunting increased by 3.4 times (p = 0.048) among households located in the peri-urban area. Wasting was reduced by 0.16 times among household that produced staple food or vegetables (p = 0.011). Overweight was reduced by 0.04 times among households that produced livestock (p = 0.031). The results reveal a socio-spatial dimension of food and nutrition insecurity that is related to agricultural activities. © 2018, Springer Nature B.V. | Open |
| Choi S.; Yuen H.M.; Annan R.; Pickup T.; Pulman A.; Monroy-Valle M.; Aduku N.E.L.; Kyei-Boateng S.; Monzón C.I.V.; Sermeño C.E.P.; Penn A.; Ashworth A.; Jackson A.A. | Effectiveness of the malnutrition eLearning course for global capacity building in the management of malnutrition: Cross-Country interrupted time-Series study | 2018 | Journal of Medical Internet Research | Background: Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization. Objective: The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care. Methods: This 2-year prospective, longitudinal, cross-country, interrupted time-series study took place in Ghana, Guatemala, El Salvador, and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 preservice trainees from 9 academic institutions, and 204 online users participated. Knowledge gained after training and retention over time was measured through pre- and postassessments comprising questions pertaining to screening, diagnosis, pathophysiology and treatment, and prevention of malnutrition. Comprehension, application, and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. Results: Before the course, awareness of the World Health Organization guidelines was 36.73% (389/1059) overall, and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course in 606 participants who had pre- and postassessment data was 11.8 (95% CI 10.8-12.9; P<.001)—a relative increase of 41.5%. The proportion of participants who achieved a score above the pass mark posttraining was 58.7% (356/606), compared with 18.2% (110/606) in pretraining. Of the in-service professionals, 85.9% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis, and management. This group demonstrated significantly increased retained knowledge 6 months after training (mean difference [SD] from preassessment of 12.1 [11.8]), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional, operational, and policy changes were also found. Conclusions: The malnutrition eLearning course improved knowledge, understanding, and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following the completion of the course. © Sunhea Choi, Ho Ming Yuen, Reginald Annan, Trevor Pickup, Andy Pulman, Michele Monroy-Valle, Nana Esi Linda Aduku, Samuel Kyei-Boateng, Carmen Isabel Vel squez Monz n, Carmen Elisa Portillo Serme o, Andrew Penn, Ann Ashworth, Alan A Jackson. | Open |
| Colecraft E.K.; Asante M.; Christian A.K.; Adu-Afarwuah S. | Sociodemographic characteristics, dietary practices, and nutritional status of adults with hypertension in a semi-rural community in the eastern region of Ghana | 2018 | International Journal of Hypertension | Introduction. Hypertension is a major contributor to the global disease burden and mortality. Evidence suggests increasing hypertension prevalence in Ghana but there is limited public awareness and information on the characteristics of those with the disease. Objective. To describe the baseline characteristics of adults with hypertension who were randomized to receive either hypertension related nutrition education plus hospital-based standard of care or only the standard of care (control group) in Asesewa, a semi-rural community in the Eastern Region of Ghana. Only baseline data were used in the present analysis. Methods. A cross-sectional baseline survey was completed for 63 adults with confirmed hypertension diagnosis. Data on sociodemographic characteristics and diet were obtained through interviews and participants' body mass index (BMI) was computed. Pearson chi-square statistic was used to assess differences between those with both elevated diastolic blood pressure (DBP) and systolic blood pressure (SBP) and those with only elevated SBP. Results. Mean ± SD age of participants was 54.5±13.8 years. Approximately 71% of participants had both elevated SBP (>140 mmHg) and DBP (>90 mmHg) while the remaining 29% had only elevated SBP. The median number of times the food groups beneficial to hypertension management were consumed in the preceding week to the interview was 1 for green leafy vegetables, 1 for dairy products, 2 for fruits, and 4 for legumes. The median number of times for consuming harmful food groups was 3 for salted fish and 7 times for fats and oils. Signifcantly more participants in the age group above 50 than the younger participants had elevated SBP (83.3 vs. 16.7:P=0.027) and those with BMI equal to or greater than 25 were more likely to have both elevated SBP and DBP (P=0.047). Conclusions. Findings from this study have implications for the prevention and management of hypertension in this semi-rural population. © 2018 Esi K. Colecraft et al. | Open |
| Danquah I.; Galbete C.; Meeks K.; Nicolaou M.; Klipstein-Grobusch K.; Addo J.; Aikins A.-G.; Amoah S.K.; Agyei-Baffour P.; Boateng D.; Bedu-Addo G.; Spranger J.; Smeeth L.; Owusu-Dabo E.; Agyemang C.; Mockenhaupt F.P.; Beune E.; Schulze M.B. | Food variety, dietary diversity, and type 2 diabetes in a multi-center cross-sectional study among Ghanaian migrants in Europe and their compatriots in Ghana: the RODAM study | 2018 | European Journal of Nutrition | Purpose: The importance of dietary diversification for type 2 diabetes (T2D) risk remains controversial. We investigated associations of between- and within-food group variety with T2D, and the role of dietary diversification for the relationships between previously identified dietary patterns (DPs) and T2D among Ghanaian adults. Methods: In the multi-center cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) Study (n = 3810; Ghanaian residence, 56%; mean age, 46.2 years; women, 63%), we constructed the Food Variety Score (FVS; 0–20 points), the Dietary Diversity Score (DDS; 0–7 points), and the Diet Quality Index-International (DQI-I) variety component (0–20 points). The associations of these scores, of a “rice, pasta, meat and fish” DP, of a “mixed” DP, and of a “roots, tubers and plantain” DP with T2D were calculated by logistic regression. Results: The FVS was inversely associated with T2D, adjusted for socio-demographic, lifestyle, and anthropometric factors [odds ratio (OR) for T2D per 1 standard deviation (SD) increase: 0.81; 95% confidence interval (CI) 0.71–0.93]. The DDS and the DQI-I variety component were not associated with T2D. There was no association of the “mixed” DP and the “roots, tubers and plantain” DP with T2D. Yet, the “rice, pasta, meat and fish” DP is inversely associated with T2D (OR for T2D per 1 SD increase: 0.82; 95% CI 0.71–0.95); this effect was slightly attenuated by the FVS. Conclusions: In this Ghanaian population, between-food group variety may exert beneficial effects on glucose metabolism and partially explains the inverse association of the “rice, pasta, meat and fish” DP with T2D. © 2017, The Author(s). | Open |
| Das J.K.; Hoodbhoy Z.; Salam R.A.; Bhutta A.Z.; Valenzuela-Rubio N.G.; Weise Prinzo Z.; Bhutta Z.A. | Lipid-based nutrient supplements for maternal, birth, and infant developmental outcomes | 2018 | Cochrane Database of Systematic Reviews | Background: Ready-to-use lipid-based nutrient supplements (LNS) are a highly nutrient-dense supplement, which could be a good source of macro- and micronutrients for pregnant women who need to supplement their nutrient intake. Objectives: To assess the effects of LNS for maternal, birth and infant outcomes in pregnant women. Secondary objectives were to explore the most appropriate composition, frequency and duration of LNS administration. Search methods: In May 2018, we searched CENTRAL, MEDLINE, Embase, 22 other databases and two trials registers for any published and ongoing studies. We also checked the reference lists of included studies and relevant reviews, and we contacted the authors of included studies and other experts in the field to identify any studies we may have missed, including any unpublished studies. Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs that compared LNS given in pregnancy to no intervention, placebo, iron folic acid (IFA), multiple micronutrients (MMN) or nutritional counselling. Data collection and analysis: We used standard Cochrane procedures. Main results: We included four studies in 8018 pregnant women. All four studies took place in stable community settings in low- and middle-income countries: Bangladesh, Burkina Faso, Ghana and Malawi. None were in emergency settings. The oldest trial was published in 2009. Of the four included studies, one compared LNS to IFA, one compared LNS to MMN, and two compared LNS to both IFA and MMN. We considered the included studies to be of medium to high quality, and we rated the quality of the evidence as moderate using the GRADE approach. LNS versus IFA Maternal outcomes: there was no difference between the LNS and IFA groups as regards maternal gestational weight gain per week (standard mean difference (SMD) 0.46, 95% confidence interval (CI) -0.44 to 1.36; 2 studies, 3539 participants). One study (536 participants) showed a two-fold increase in the prevalence of maternal anaemia in the LNS group compared to the IFA group, but no difference between the groups as regards adverse effects. There was no difference between the two groups for maternal mortality (risk ratio (RR) 0.53, 95% CI 0.12 to 2.41; 3 studies, 5628 participants). Birth and infant outcomes: there was no difference between the LNS and IFA groups for low birth weight (LBW) (RR 0.87, 95% CI 0.72 to 1.05; 3 studies, 4826 participants), though newborns in the LNS group had a slightly higher mean birth weight (mean difference (MD) 53.28 g, 95% CI 28.22 to 78.33; 3 studies, 5077 participants) and birth length (cm) (MD 0.24 cm, 95% CI 0.11 to 0.36; 3 studies, 4986 participants). There was a reduction in the proportion of infants who were small for gestational age (SGA) (RR 0.94, 95% CI 0.89 to 0.99; 3 studies, 4823 participants) and had newborn stunting (RR 0.82, 95% CI 0.71 to 0.94; 2 studies, 4166 participants) in the LNS group, but no difference between the LNS and IFA groups for preterm delivery (RR 0.94, 95% CI 0.80 to 1.11; 4 studies, 4924 participants), stillbirth (RR 1.14; 95% CI 0.52 to 2.48; 3 studies, 5575 participants) or neonatal death (RR 0.96, 95% CI 0.14 to 6.51). The current evidence for child developmental outcomes is not sufficient to draw any firm conclusions. LNS versus MMN Maternal outcomes: one study (662 participants) showed no difference between the LNS and MMN groups as regards gestational weight gain per week or adverse effects. Another study (557 participants) showed an increased risk of maternal anaemia in the LNS group compared to the MMN group. Birth and infant outcomes: there was no difference between the LNS and MMN groups for LBW (RR 0.92, 95% CI 0.74 to 1.14; 3 studies, 2404 participants), birth weight (MD 23.67 g, 95% CI -10.53 to 57.86; 3 studies, 2573 participants), birth length (MD 0.20 cm, 95% CI -0.02 to 0.42; 3 studies, 2567 participants), SGA (RR 0.95, 95% CI 0.84 to 1.07; 3 studies, 2393 participants), preterm delivery (RR 1.15, 95% CI 0.93 to 1.42; 3 studies, 2630 participants), head circumference z score (MD 0.10, 95% CI -0.01 to 0.21; 2 studies, 1549 participants) or neonatal death (RR 0.88, 95% CI 0.36 to 2.15; 1 study, 1175 participants). Authors' conclusions: Findings from this review suggest that LNS supplementation has a slight, positive effect on weight at birth, length at birth, SGA and newborn stunting compared to IFA. LNS and MMN were comparable for all maternal, birth and infant outcomes. Both IFA and MMN were better at reducing maternal anaemia when compared to LNS. We did not find any trials for LNS given to pregnant women in emergency settings. Readers should interpret the beneficial findings of the review with caution since the evidence comes from a small number of trials, with one-large scale study (conducted in community settings in Bangladesh) driving most of the impact. In addition, effect sizes are too small to propose any concrete recommendation for practice. © 2018 The Cochrane Collaboration. | Open |
| De Jager I.; Giller K.E.; Brouwer I.D. | Food and nutrient gaps in rural Northern Ghana: Does production of smallholder farming households support adoption of food-based dietary guidelines? | 2018 | PLoS ONE | Food-based dietary guidelines (FBDGs) provide guidance to policy makers, the private sector and consumers to redesign food systems and to improve diets of vulnerable populations. As appropriate FBDGs are based on the actual dietary patterns and their costs, it is assumed that the recommended foods are available, affordable and acceptable for the population under study. Using quantitative dietary intake data of young children in rural Northern Ghana, we developed local FBDGs and studied whether these are supported by the diversity and quantity of the production of a household among 329 households. We found that 40% of rural Northern Ghanaian infants and young children were stunted and their nutrient intakes were far below the recommendations: the probability of adequacy for most nutrient intakes was less than 50%. At household level, the developed FBDGs were, on average, unable to sufficiently cover the household requirements for fat (60.4% of recommended nutrient intake (RNI)), calcium (34.3% RNI), iron (60.3% RNI), vitamin A (39.1% RNI), vitamin B12 (2.3% RNI) and vitamin C (54.6% RNI). This implies that even when these FBDGs are fully adopted the requirements for these nutrients will not be met. In addition, the nutrient needs and food needs (according to the developed FBDGs) of a household were only marginally covered by their own food production. The food production of over half the households supplied insufficient calcium (75.7%), vitamin A (100%), vitamin B12 (100%) and vitamin C (77.5%) to cover their needs. The food production of about 60% of the households did not cover their required quantities of grains and legumes and none covered their required quantities of vegetables. Further analysis of the food gaps at district and national level showed that sufficient grains were available at both levels (267% and 148%, respectively) to meet requirements; availability of legumes was sufficient at district level (268%) but not at national level (52%); and vegetables were insufficient at both levels (2% and 49%, respectively). Diversifying household food production is often proposed as a means to increase the diversity of foods available and thereby increasing dietary diversity of rural populations. We found that the diversity of the production of a household was indeed positively related with their food and nutrient coverage. However, the diversity of the production of a household and their food and nutrient coverage were not related with children’s dietary diversity and nutrient adequacy. Our results show that the production of a households does not support the adoption of FBDGs in rural Northern Ghana, especially for vegetables. This suggests that the promotion of FBDGs through nutrition education or behaviour change communications activities alone is insufficient to lead to improvements in diets. Additional strategies are needed to increase the food availability and accessibility of the households, especially that of fruits and vegetables, such as diversification of the crops grown, increased production of specific crops and market-based strategies. © 2018 de Jager et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Dimaria S.A.; Schwartz H.; Icard-Vernière C.; Picq C.; Zagre N.M.; Mouquet-Rivier C. | Adequacy of some locally produced complementary foods marketed in benin, Burkina faso, Ghana, and Senegal | 2018 | Nutrients | Adequate complementary foods are needed to help reduce the high prevalence of stunting in children in many Low and Middle Income Countries (LMICs). We assessed the availability, affordability, and nutrient adequacy of imported and locally produced processed cereal-based blends (PCBBs), marketed as complementary food for young children in Benin, Burkina Faso, Ghana, and Senegal. In total, 19 local producers and 275 points of sale in the four countries were surveyed to evaluate the quantities and accessibility of PCBBs. In addition, 32 PCBBs were analysed for their nutritional composition and packaging information. The results showed that only 7 out of 32 PCBBs could be classified as nutritionally satisfactory. Access to the products was insufficient in all surveyed settings. At the points of sale, the PCBB market was dominated by imported products, even though two out of four imported PCBBs were not nutritionally satisfactory. Imported PCBBs were two to three times more expensive than locally produced PCBBs. Labelling of the PCBBs was inadequate in many aspects. Technical support should be offered to local PCBB producers to ensure the adequate formulation and supply of an appropriate vitamin and mineral premix. The development of national specific regulations on PCBB composition and labelling is strongly recommended in these countries. © 2018 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Druye A.; Robinson B.; Nelson K. | Self-management recommendations for sickle cell disease: A Ghanaian health professionals' perspective | 2018 | Health Science Reports | Objective: To describe self-management recommendations for sickle cell disease (SCD) care among health professionals who manage SCD in Ghana. Method: Nine health care professionals (nurses, doctors, and physician assistants) who work in SCD were interviewed. The semistructured interviews were recorded, transcribed, and analysed using the qualitative content analysis method. Self-management recommendations were conceptualised as preventive health, self-monitoring, self-diagnosis, self-treatment, and self-evaluation. Results: Preventive health recommendations were the commonest, where the professionals described similar topics including avoidance of cold temperature, frequent oral hydration, and healthy nutrition. Self-monitoring recommendations included regular checks for pallor, urine colour, and splenic enlargement. Self-diagnosis recommendations were captured as warning signs and included pain, fever, unusual feelings, and enlarged spleen. Pain and fever management were the focus of most self-treatment advice, and there were some self-treatment recommendations for dactylitis, anaemia, and priapism. There was considerable variation in the strategies recommended for the management of individual SCD-related problems. Conclusion: Ghanaian health professionals involved in SCD care provide limited and inconsistent self-management recommendations. There is a need for the development of SCD standards and guidelines that support effective self-management. Health professionals working in SCD require continuing education in self-management. © 2018 The Authors. Health Science Reports published by Wiley Periodicals, Inc. | Open |
| Ecker O. | Agricultural transformation and food and nutrition security in Ghana: Does farm production diversity (still) matter for household dietary diversity? | 2018 | Food Policy | Africa south of the Sahara experienced an acceleration of economic growth in recent years that was accompanied by structural changes in national economies. Some African countries, such as Ghana, managed to utilize rapid growth for poverty reduction and improving food and nutrition security. Transformation of agriculture appears to have played an important role in this context. However, the linkages between agricultural transformation and food and nutrition security at the household level are not well understood. This article examines the linkage between farm production diversity and household dietary diversity in rural Ghana and how that linkage changed between 2005–06 and 2012–13. The empirical analysis employs a regression model that controls for region- and time-fixed effects. The estimation results suggest that farm production diversification, as well as household income growth, continues to be strongly associated with increased household dietary diversity. The analysis further explores the mechanism that underlies this production-consumption linkage by systematically modifying the basic model specification. © 2018 The Author | Open |
| Garti H.; Ali Z.; Garti H.A. | Maternal daily work hours affect nutritional status of children in Northern Ghana | 2018 | Nutrire | Background: Data on the effect of maternal daily work hours on child nutritional status is scarce in Ghana. Such data may be important in defining maternal employment policies for improved child nutrition. This study therefore sought to determine the effect of maternal daily work hours on the nutritional status of farmer and public service mothers in the northern region of Ghana. Methods: An analytical cross-sectional survey was conducted among 320 mothers with children 6–59 months. Maternal daily work hours and dietary intake of children were assessed with a structured questionnaire. Anthropometric measurements of children were also taken to classify child nutritional status. The association between maternal daily work hours and child nutritional status was determined using both bivariate analysis and multivariate regression modelling. Results: Majority of the children (45.1%) were aged between their second and third birthdays. The prevalence of stunting, wasting, and underweight were 17.8, 8.1, and 10.3% respectively. Only stunting (p = 0.031) associated significantly with maternal employment and was higher among children of farmers (22.1%) compared to public servants (12.8%). Even though maternal age (p = 0.035), minimum dietary diversity (p = 0.040), non-consumption of legumes (p = 0.031) and other vegetables (p = 0.006) associated with stunting at bivariate level, multivariate logistic regression analysis revealed that only maternal daily work hours had significant effect on stunting. Compared to mothers who worked above 6 h a day, those who worked only a maximum of 4 h were 5.4 times more likely to have stunted children [AOR = 5.375; 95% CI (1.751–16.502); p = 0.003]. Conclusion: Present study results show that maternal daily work hours could be an important determinant of child stunting in northern region of Ghana. © 2018, The Author(s). | Open |
| Hambidge K.M.; Krebs N.F. | Strategies for optimizing maternal nutrition to promote infant development | 2018 | Reproductive Health | Background: The growing appreciation of the multi-faceted importance of optimal maternal nutrition to the health and development of the infant and young child is tempered by incompletely resolved strategies for combatting challenges. Objective: To review the importance of maternal nutrition and strategies being employed to optimize outcomes. Methods: Selected data from recent literature with special focus on rationale for and currently published results of maternal nutrition supplements, including lipid based nutrition supplements. Results: 1) An impelling rationale for improving the maternal and in utero environment of low resource populations has emerged to achieve improved fetal and post-natal growth and development. 2) Based partly on population increases in adult height over one-two generations, much can be achieved by reducing poverty. 3) Maternal, newborn and infant characteristics associated with low resource environments include evidence of undernutrition, manifested by underweight and impaired linear growth. 4) Apart from broad public health and educational initiatives, to date, most specific efforts to improve fetal growth and development have included maternal nutrition interventions during gestation. 5) The relatively limited but real benefits of both iron/folic acid (IFA) and multiple micronutrient (MMN) maternal supplements during gestation have now been reasonably defined. 6) Recent investigations of a maternal lipid-based primarily micronutrient supplement (LNS) have not demonstrated a consistent benefit beyond MMN alone. 7) However, effects of both MMN and LNS appear to be enhanced by commencing early in gestation. Conclusions: Poor maternal nutritional status is one of a very few specific factors in the human that not only contributes to impaired fetal and early post-natal growth but for which maternal interventions have demonstrated improved in utero development, documented primarily by both improvements in low birth weights and by partial corrections of impaired birth length. A clearer definition of the benefits achievable by interventions specifically focused on correcting maternal nutrition deficits should not be limited to improvements in the quality of maternal nutrition supplements, but on the cumulative quantity and timing of interventions (also recognizing the heterogeneity between populations). Finally, in an ideal world these steps are only a prelude to improvements in the total environment in which optimal nutrition and other health determinants can be achieved. © 2018 The Author(s). | Open |
| He Z.; Bishwajit G.; Yaya S.; Cheng Z.; Zou D.; Zhou Y. | Prevalence of low birth weight and its association with maternal body weight status in selected countries in Africa: A cross-sectional study | 2018 | BMJ Open | Objectives The present study aimed to estimate the prevalence of low birth weight (LBW), and to investigate the association between maternal body weight measured in terms of body mass index (BMI) and birth weight in selected countries in Africa. Setting Urban and rural household in Burkina Faso, Ghana, Malawi, Senegal and Uganda. Participants Mothers (n=11 418) aged between 15 and 49 years with a history of childbirth in the last 5 years. Results The prevalence of LBW in Burkina Faso, Ghana, Malawi, Senegal and Uganda was, respectively, 13.4%, 10.2%, 12.1%, 15.7% and 10%. Compared with women who are of normal weight, underweight mothers had a higher likelihood of giving birth to LBW babies in all countries except Ghana. However, the association between maternal BMI and birth weight was found to be statistically significant for Senegal only (OR=1.961 (95% CI 1.259 to 3.055)). Conclusion Underweight mothers in Senegal share a greater risk of having LBW babies compared with their normal-weight counterparts. Programmes targeting to address infant mortality should focus on promoting nutritional status among women of childbearing age. Longitudinal studies are required to better elucidate the causal nature of the relationship between maternal underweight and LBW. © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | Open |
| Hiamey S.E.; Hiamey G.A. | Street food consumption in a Ghanaian Metropolis: The concerns determining consumption and non-consumption | 2018 | Food Control | Street food is an important source of food and nutrition for most urban dwellers. However, there are many concerns associated with the street food trade. This study examined whether the concerns over street food differed among consumers and non-consumers of street food and to determine which concerns affected or played significant roles in whether one will consume or not. Consistent with the Attitude Behaviour Context Model, it was found that both consumers and non-consumers did not differ in their concerns over street food. However, on the issue of what accounts for one group consuming and the other not, it was noted that sociodemographic variables were not good predictors of street food consumption. Environmental, food safety, health and vendors concerns were good predictors of street food consumption, with the non-consumers being deterred by concerns over the environment, food safety and health while vendor concerns impacted on whether consumers will continue to patronise the services of street food vendors. © 2018 Elsevier Ltd | Open |
| Jonah C.M.P.; Sambu W.C.; May J.D. | A comparative analysis of socioeconomic inequities in stunting: A case of three middle-income African countries | 2018 | Archives of Public Health | Background: Despite increased economic growth and development, and existence of various policies and interventions aimed at improving food security and nutrition, majority of countries in sub-Saharan Africa have very high levels of child malnutrition. The prevalence of stunting, an indicator of chronic malnutrition, is especially high. Methods: In this paper, we use Demographic and Health Survey datasets from three countries in the region that obtained middle-income status over the last decade (Ghana, Kenya and Zambia), to provide a comparative quantitative assessment of stunting levels, and examine patterns in stunting inequalities between 2007 and 2014. Results: Our analyses reveal that stunting rates decreased in all three countries over the study period, but are still high. In Zambia, 40% of under 5-year olds are stunted, compared to 26% in Kenya and 19% in Ghana. In all three countries, male children and those living in the poorest households have significantly higher levels of stunting. We also observe stark inequalities across socio-economic status, and show that these inequalities have increased over time. Conclusions: Our results reveal that even with economic gains at the national level, there is need for continued focus on improving the socio-economic levels of the poorest households, if child nutritional outcomes are to improve. © 2018 The Author(s). | Open |
| Kalra N.; Pelto G.; Tawiah C.; Zobrist S.; Milani P.; Manu G.; Laar A.; Parker M. | Patterns of cultural consensus and intracultural diversity in Ghanaian complementary feeding practices | 2018 | Maternal and Child Nutrition | Designing effective interventions to improve infant and young child (IYC) feeding requires knowledge about determinants of current practices, including cultural factors. Current approaches to obtaining and using research on culture tend to assume cultural homogeneity within a population. The purpose of this study was to examine the extent of cultural consensus (homogeneity) in communities where interventions to improve IYC feeding practices are needed to address undernutrition during the period of complementary feeding. A second, related objective was to identify the nature of intracultural variation, if such variation was evident. Selected protocols from the Focused Ethnographic Study for Infant and Young Child Feeding Manual were administered to samples of key informants and caregivers in a peri-urban and a rural area in Brong-Ahafo, Ghana. Cultural domain analysis techniques (free listing, caregiver assessment of culturally significant dimensions, and food ratings on these dimensions), as well as open-ended questions with exploratory probing, were used to obtain data on beliefs and related practices. Results reveal generally high cultural consensus on the 5 dimensions that were assessed (healthiness, appeal, child acceptance, convenience, and modernity) for caregiver decisions and on their ratings of individual foods. However, thematic analysis of caregiver narratives indicates that the meanings and content of the constructs connoted by the dimensions differed widely among individual mothers. These findings suggest that research on cultural factors that affect IYC practices, particularly cultural beliefs, should consider the nature and extent of cultural consensus and intracultural diversity, rather than assuming cultural homogeneity. © 2017 John Wiley & Sons Ltd | Open |
| Knowles J.; Kupka R.; Dumble S.; Garrett G.S.; Pandav C.S.; Yadav K.; Touré N.K.; Amoaful E.F.; Gorstein J. | Regression analysis to identify factors associated with urinary iodine concentration at the sub-national level in India, Ghana, and Senegal | 2018 | Nutrients | Single and multiple variable regression analyses were conducted using data from stratified, cluster sample design, iodine surveys in India, Ghana, and Senegal to identify factors associated with urinary iodine concentration (UIC) among women of reproductive age (WRA) at the national and sub-national level. Subjects were survey household respondents, typically WRA. For all three countries, UIC was significantly different (p < 0.05) by household salt iodine category. Other significant differences were by strata and by household vulnerability to poverty in India and Ghana. In multiple variable regression analysis, UIC was significantly associated with strata and household salt iodine category in India and Ghana (p < 0.001). Estimated UIC was 1.6 (95% confidence intervals (CI) 1.3, 2.0) times higher (India) and 1.4 (95% CI 1.2, 1.6) times higher (Ghana) among WRA from households using adequately iodised salt than among WRA from households using non-iodised salt. Other significant associations with UIC were found in India, with having heard of iodine deficiency (1.2 times higher; CI 1.1, 1.3; p < 0.001) and having improved dietary diversity (1.1 times higher, CI 1.0, 1.2; p = 0.015); and in Ghana, with the level of tomato paste consumption the previous week (p = 0.029) (UIC for highest consumption level was 1.2 times lowest level; CI 1.1, 1.4). No significant associations were found in Senegal. Sub-national data on iodine status are required to assess equity of access to optimal iodine intake and to develop strategic responses as needed. © 2018 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Komatsu H.; Malapit H.J.L.; Theis S. | Does women's time in domestic work and agriculture affect women's and children's dietary diversity? Evidence from Bangladesh, Nepal, Cambodia, Ghana, and Mozambique | 2018 | Food Policy | There are concerns that increasing women's engagement in agriculture could negatively affect nutrition by limiting the time available for nutrition-improving reproductive work. However, very few empirical studies provide evidence to support these concerns. This paper examines the relationship between women's time spent in domestic work and agriculture and women's and children's dietary diversity. Using data from Bangladesh, Nepal, Cambodia, Ghana, and Mozambique, we find that women's domestic work and cooking time are positively correlated with more diverse diets. We also find differential effects depending on asset poverty status. In Mozambique, working long hours in agriculture is negatively associated with women's dietary diversity score in nonpoor women, but is positively associated with poor women's dietary diversity and poor children's minimum acceptable diet. This suggests that agriculture as a source of food and income is particularly important for the asset poor. Our results reveal that women's time allocation and nutrition responses to agricultural interventions are likely to vary by socioeconomic status and local context. © 2018 The Authors | Open |
| Kwabla M.P.; Gyan C.; Zotor F. | Nutritional status of in-school children and its associated factors in Denkyembour District, eastern region, Ghana: Comparing schools with feeding and non-school feeding policies | 2018 | Nutrition Journal | Background: Childhood malnutrition still remains a major public health problem impacting negatively on the academic aptitude of school-aged children (SAC) particularly in limited resource countries. The Government of Ghana in collaboration with the Dutch Government introduced the school feeding programme (SFP) to boost the nutritional status of SAC in the country. This study sought to compare the nutritional status of SAC enrolled in schools with the SFP and SAC enrolled in schools without the SFP in place for the purpose of identifying which group has the higher rate of malnutrition. Methods: A multi-stage sampling was used to select 359 SAC between 5 and 12 years who are enrolled in primary one to six. Twelve public schools were selected, of which 6 schools benefit from the SFP and the other six do not. Anthropometric measurements were conducted for the subjects and SPSS version 20.0 was used for data entry and analysis. Chi square test was carried out to determine the difference between the two groups of schools. Results: Of the total of 359 subjects, 55.1% were from schools that do not implement the SFP and 44.9% were from schools that implement the SFP. The prevalence of stunting among children in schools on the SFP was 16.2% compared with 17.2% among children in schools that do not implement the SFP. The prevalence of thinness was two times higher (9.3%) among children in schools on the SFP than in children in schools that do not implement the SFP (4.6%) (p = 0.028). The prevalence of overweight among children in schools on the SFP was 1.9% and 0.0% for children in schools that do not implement the SFP. Sub district, sex, age of pupil, area of residence and community type were significantly associated with stunting (p = 0.002), (p = 0.008), (p = 0.008), (p < 0.001) and (p = 0.007) respectively. Conclusion: Overweight and thinness were higher among children in schools on SFP than in children in schools without SFP. An evaluation of the implementation of the school feeding programme is recommended for future studies. © 2018 The Author(s). | Open |
| Laar A.K.; Lartey M.Y.; Ankomah A.; Okyerefo M.P.K.; Ampah E.A.; Letsa D.P.; Nortey P.A.; Kwara A. | Food elimination, food substitution, and nutrient supplementation among ARV-exposed HIV-positive persons in southern Ghana | 2018 | Journal of Health, Population and Nutrition | Background: Optimal nutrition is a determinant of health in all persons. In persons living with HIV (PLHIV), nutrition is particularly important. Various factors, including dietary practices, play a role in guaranteeing nutritional health. Objectives: We investigated multiple non-prescription drugs use among HIV-positive persons receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. This paper, however, focuses on nutrient supplement use, food elimination, and food substitution practices by the PLHIV. Methods: Using quantitative and qualitative methods, we collected data from 540 HIV-positive persons at the health facility level. This paper focuses on only the quantitative data. Individual study participants were selected using a systematic random sampling procedure. Participants were interviewed after informed consent. We used univariate analysis to generate descriptive tabulations for key variables. Multivariable logistic regression modeling identified predictors of three practices (nutrient supplementation, food elimination, and food substitution). P value less than 0.05 or 95% confidence intervals facilitated determination of statistical significance. All analyses were performed using IBM SPSS Statistics for Windows, version 20.0. Results: The use of nutrient supplements was a popular practice; 72% of the PLHIV used various kinds. The primary motive for the practice was to boost appetite and to gain weight. A little over 20% of the participants reportedly eliminated certain foods and beverages, while 17% introduced new foods since their initial HIV diagnosis. All the three practices were largely driven by the quest for improved health status. We determined predictors of nutrient supplementation to be ART clinic location and having an ART adherence monitor. Having an ART adherence monitor was significantly associated with reduced odds of nutrient supplementation (AOR = 0.34; 95% CI 0.12-0.95). The only predictor for food elimination was education level (AOR = 0.29; 95% CI 0.30-0.92); predictors of food substitution were ART clinic location (AOR = 0.11; 95% CI 0.02-0.69) and anemia (defined as hemoglobin concentration less than 11.0 g/dl) (AOR = 0.21; 95% CI 0.12-0.85). Conclusions: The practice of supplementation is popular among this group of PLHIV. Food elimination and substitution are practiced, albeit in moderation. The predictors identified may prove helpful in provider-client encounters as well as local HIV programming. © 2018 The Author(s). | Open |
| Lee R.; Singh L.; van Liefde D.; Callaghan-Gillespie M.; Steiner-Asiedu M.; Saalia K.; Edwards C.; Serena A.; Hershey T.; Manary M.J. | Milk Powder Added to a School Meal Increases Cognitive Test Scores in Ghanaian Children | 2018 | Journal of Nutrition | Background: The inclusion of milk in school feeding is accepted as good nutritional practice, but specific benefits remain uncertain. Objective: The objective was to determine whether consumption of 8.8 g milk protein/d given as milk powder with a multiple micronutrient–enriched porridge resulted in greater increases in linear growth and Cambridge Neuropsychological Test Automated Battery (CANTAB) scores in Ghanaian schoolchildren when compared with 1 of 3 control groups. Methods: A randomized, double-blind, placebo-controlled clinical trial in healthy children aged 6–9 y was conducted comparing 8.8 g milk protein/d with 4.4 g milk protein/d or 4.4 g milk protein + 4.4 g rice protein/d (isonitrogenous, half of the protein from milk and half from rice) or a non-nitrogenous placebo. Primary outcomes were changes in length after 9 mo and CANTAB scores after 4.5 mo; secondary outcomes were body-composition measures. Supplements were added to porridge each school day and consumed for 9 mo. Anthropometric and body-composition measures and CANTAB tests were completed upon enrollment and after 4.5 and 9 mo. Group results were compared by using ANCOVA for anthropometric measures and the Kruskal-Wallis test for CANTAB scores. Results: Children receiving 8.8 g milk protein/d showed greater increases on percentage correct in Pattern Recognition Memory (mean ± SD: 5.5% ± 16.8%; P < 0.05) and Intra/Extradimensional Set Shift completed stages compared with all other food groups (0.6 ± 2.3; P < 0.05). No differences were seen in linear growth between the groups. The children receiving either 4.4 or 8.8 g milk protein/d had a higher fat-free body mass index than those who received no milk, with an effect size of 0.34 kg/m2. Conclusion: Among schoolchildren, the consumption of 8.8 g milk protein/d improved executive cognitive function compared with other supplements and led to the accretion of more lean body mass, but not more linear growth. This trial was registered at www.clinicaltrials.gov">www.clinicaltrials.gov as NCT02757508. © 2018 American Society for Nutrition. | Open |
| López-Ballesteros A.; Beck J.; Bombelli A.; Grieco E.; Lorencová E.K.; Merbold L.; Brümmer C.; Hugo W.; Scholes R.; Vačkář D.; Vermeulen A.; Acosta M.; Butterbach-Bahl K.; Helmschrot J.; Kim D.-G.; Jones M.; Jorch V.; Pavelka M.; Skjelvan I.; Saunders M. | Towards a feasible and representative pan-African research infrastructure network for GHG observations | 2018 | Environmental Research Letters | There is currently a lack of representative, systematic and harmonised greenhouse gas (GHG) observations covering the variety of natural and human-altered biomes that occur in Africa. This impedes the long-term assessment of the drivers of climate change, in addition to their impacts and feedback loops at the continental scale, but also limits our understanding of the contribution of the African continent to the global carbon (C) cycle. Given the current and projected transformation of socio-economic conditions in Africa (i.e. the increasing trend of urbanisation and population growth) and the adverse impacts of climate change, the development of a GHG research infrastructure (RI) is needed to support the design of suitable mitigation and adaptation strategies required to assure food, fuel, nutrition and economic security for the African population. This paper presents the initial results of the EU-African SEACRIFOG project, which aims to design a GHG observation RI for Africa. The first stages of this project included the identification and engagement of key stakeholders, the definition of the conceptual monitoring framework and an assessment of existing infrastructural capacity. Feedback from stakeholder sectors was obtained through three Stakeholder Consultation Workshops held in Kenya, Ghana and Zambia. Main concerns identified were data quality and accessibility, the need for capacity building and networking among the scientific community, and adaptation to climate change, which was confirmed to be a priority for Africa. This feedback in addition to input from experts in the atmospheric, terrestrial and oceanic thematic areas, facilitated the selection of a set of 'essential variables' that need to be measured in the future environmental RI. An inventory of 47 existing and planned networks across the continent allowed for an assessment of the current RIs needs and gaps in Africa. Overall, the development of a harmonised and standardised pan-African RI will serve to address the continent's primary societal and scientific challenges through a potential cross-domain synergy among existing and planned networks at regional, continental and global scales. © 2018 The Author(s). Published by IOP Publishing Ltd | Open |
| Lutter C.K.; Morris S.S. | Eggs: A high potential food for improving maternal and child nutrition | 2018 | Maternal and Child Nutrition | Not Available | Open |
| Marquis G.S.; Colecraft E.K.; Kanlisi R.; Aidam B.A.; Atuobi-Yeboah A.; Pinto C.; Aryeetey R. | An agriculture–nutrition intervention improved children's diet and growth in a randomized trial in Ghana | 2018 | Maternal and Child Nutrition | Stunting in Ghana is associated with rural communities, poverty, and low education; integrated agricultural interventions can address the problem. This cluster randomized controlled trial tested the effect of a 12-month intervention (inputs and training for poultry farming and home gardening, and nutrition and health education) on child diet and nutritional status. Sixteen clusters were identified and randomly assigned to intervention or control; communities within clusters were randomly chosen, and all interested, eligible mother–child pairs were enrolled (intervention: 8 clusters, 19 communities, and 287 households; control: 8 clusters, 20 communities, and 213 households). Intention-to-treat analyses were used to estimate the effect of the intervention on endline minimum diet diversity (≥4 food groups), consumption of eggs, and length-for-age (LAZ)/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WLZ)/weight-for-height (WHZ) z-scores; standard errors were corrected for clustering. Children were 10.5 ± 5.2 months (range: 0–32) at baseline and 29.8 ± 5.4 months (range: 13–48) at endline. Compared with children in the control group, children in the intervention group met minimum diet diversity (adjusted odds ratio = 1.65, 95% CI [1.02, 2.69]) and a higher LAZ/HAZ (β = 0.22, 95% CI [0.09, 0.34]) and WAZ (β = 0.15, 95% CI [0.00, 0.30]). Sensitivity analyses with random-effects and mixed-effects models and as-treated analysis were consistent with the findings. There was no group difference in WLZ/WHZ. Integrated interventions that increase access to high-quality foods and nutrition education improve child nutrition. © 2018 John Wiley & Sons Ltd | Open |
| Mogre V.; Stevens F.; Aryee P.A.; Scherpbier A.J.J.A. | Nutrition in Medicine: Medical Students׳ Satisfaction, Perceived Relevance and Preparedness for Practice | 2018 | Health Professions Education | Purpose: Doctors play a critical role in providing nutrition care and supporting patients to adopt healthy dietary habits. Improving the quality of nutrition education in medical schools is necessary to build the capacity of doctors to deliver effective nutrition care to help reduce malnutrition especially for sub-Saharan Africa. This study investigated Ghanaian undergraduate clinical level medical students’ satisfaction with their current nutrition education, preparedness to provide nutrition care, perceived relevance of nutrition education to their future practice and their relationships. Method: A survey among 207 clinical level medical students was conducted. An 11-item questionnaire with subscales was used to assess students’ demographic characteristics, satisfaction with current nutrition education, preparedness to provide nutrition care and perceived relevance of nutrition education to their future practice. Results: Ninety-two percent (n=187) of the students considered nutrition education to be relevant to their future practice. However, the majority of the students (70%) were dissatisfied with the amount of time dedicated to nutrition education in their curriculum; integration of nutrition into organ-system based modules (62.0%); inclusion of nutrition materials to promote independent study (62.8%) and nutrition course content (59.0%). Only 22.2% felt adequately prepared by their current nutrition education to provide nutrition care in the general practice setting. Satisfaction with current education in nutrition was positively related to students’ preparedness to provide nutrition care in the general practice setting. Discussion: Students were dissatisfied with their current education in nutrition, felt inadequately prepared to provide nutrition care and considered nutrition education to be highly relevant to their future practice. The findings of this study provide additional evidence that suggests changes in the current format and content of nutrition education in medical education. © 2018 King Saud bin AbdulAziz University for Health Sciences | Open |
| Mogre V.; Stevens F.C.J.; Aryee P.A.; Amalba A.; Scherpbier A.J.J.A. | Why nutrition education is inadequate in the medical curriculum: A qualitative study of students' perspectives on barriers and strategies | 2018 | BMC Medical Education | Background: The provision of nutrition care by doctors is important in promoting healthy dietary habits, and such interventions can lead to reductions in disease morbidity, mortality, and medical costs. However, medical students and doctors report inadequate nutrition education and preparedness during their training at school. Previous studies investigating the inadequacy of nutrition education have not sufficiently evaluated the perspectives of students. In this study, students' perspectives on doctors' role in nutrition care, perceived barriers, and strategies to improve nutrition educational experiences are explored. Methods: A total of 23 undergraduate clinical level medical students at the 5th to final year in the School of Medicine and Health Sciences of the University for Development Studies in Ghana were purposefully selected to participate in semi-structured individual interviews. Students expressed their opinions and experiences regarding the inadequacy of nutrition education in the curriculum. Each interview was audio-recorded and later transcribed verbatim. Using the constant comparison method, key themes were identified from the data and analysis was done simultaneously with data collection. Results: Students opined that doctors have an important role to play in providing nutrition care to their patients. However, they felt their nutrition education was inadequate due to lack of priority for nutrition education, lack of faculty to provide nutrition education, poor application of nutrition science to clinical practice and poor collaboration with nutrition professionals. Students opined that their nutrition educational experiences will be improved if the following strategies were implemented: adoption of innovative teaching and learning strategies, early and comprehensive incorporation of nutrition as a theme throughout the curriculum, increasing awareness on the importance of nutrition education, reviewing and revision of the curriculum to incorporate nutrition, and involving nutrition/dietician specialists in medical education. Conclusion: Though students considered nutrition care as an important role for doctors they felt incapacitated by non-prioritisation of nutrition education, lack of faculty for teaching of nutrition education, poor application of nutrition science and poor collaboration with nutrition professionals. Incorporation of nutrition as a theme in medical education, improving collaboration, advocacy and creating enabling environments for nutrition education could address some of the barriers to nutrition education. © 2018 The Author(s). | Open |
| Mogre V.; Stevens F.C.J.; Aryee P.A.; Matorwmasen-Akkermans F.L.; Abubakari B.; Scherpbier A.J.J.A. | Nutrition Care Practices, Barriers, Competencies and Education in Nutrition: a Survey Among Ghanaian Medical Doctors | 2018 | Medical Science Educator | Background: We evaluated medical doctors’ nutrition care practices, competencies and barriers to providing nutrition care. Furthermore, doctors’ satisfaction and perceived adequacy of their nutrition education as well as the use and effectiveness of training and learning resources for continuing nutrition education were also investigated. Methods: This cross-sectional study included medical doctors working at various levels of care in Ghana who responded to either an online or paper-based survey. Appropriate statistical tools were used to analyse the data. Results: Majority (70%) of the 114 doctors who responded to the survey estimated that more than 60% of their patients needed nutrition care. However, only ≤ 40% received such care. More than 80% of doctors referred patients to dieticians/nutritionists. Comfort levels correlated positively (r = 0.288; p = 0.002) with attitudes about nutrition care. The most common barriers to nutrition care were lack of time (79%), inadequate knowledge (78.6%) and counselling skills (68.4%). About 66% perceived their nutrition education in medical school to be inadequate, and more than 70% were either unsatisfied or undecided with their nutrition educational experiences. Perceived adequacy (r = 0.200; p = 0.016) and satisfaction with nutrition education (r = 0.218; p = 0.002) were associated with doctors’ comfort levels. Only 30% were currently using a nutrition-related learning resource for continuing education in nutrition. Conclusion: Doctors felt their patients required more nutrition care than they could provide. Their nutrition care was hindered by lack of time, inadequate knowledge, confidence and counselling skills. Educational interventions that improve on medical doctors’ attitudes and comfort levels in providing nutrition care may be needed. © 2018, The Author(s). | Open |
| Monterrosa E.C.; Beesabathuni K.; van Zutphen K.G.; Steiger G.; Kupka R.; Fleet A.; Kraemer K. | Situation analysis of procurement and production of multiple micronutrient supplements in 12 lower and upper middle-income countries | 2018 | Maternal and Child Nutrition | Globally, there are few vitamin and mineral ingredient manufacturers. To support local, in-country or regional procurement and production of multiple micronutrient supplements (MMS), the following production scenarios are possible: (a) straight ingredients of vitamins and minerals forms imported or locally produced that are mixed, tableted, or encapsulated and packaged by a local manufacturer; (b) import or local production of a vitamin and minerals premix that is tableted or encapsulated and packaged locally; (c) import of a bulk, finished product (tablets or capsules) that is packaged and branded; and (d) or import of a branded packaged product. This paper is a situation analysis of the market, manufacturing, and policy factors that are driving the production of MMS in 12 lower and upper middle-income countries. Key informants completed a self-administered structured questionnaire, which examined the local context of products available in the market and their cost, regulations and policies, in Brazil, Colombia, Guatemala, Mexico, Peru, Bangladesh, India, Vietnam, Ghana, Kenya, Nigeria, and South Africa. Our study found that although most countries have the capacity to produce locally MMS, the major barriers observed for sustainable and affordable production include (a) poor technical capacity and policies for ensuring quality along the value chain and (b) lack of policy coherence to incentivize local production and lower the manufacture and retail price of MMS. Also, better guidelines and government oversight will be required because not one country had an MMS formulation that matched the globally recommended formulation of the United Nations Multiple Micronutrient Preparation (UNIMMAP). © 2017 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd. | Open |
| Nyantakyi-Frimpong H.; Colecraft E.K.; Awuah R.B.; Adjorlolo L.K.; Wilson M.L.; Jones A.D. | Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana | 2018 | Social Science and Medicine | Livestock production and Animal-Source Foods (ASFs) like meat, milk, and eggs are excellent sources of essential micronutrients, including iron and zinc. There is evidence that encouraging increased access to and consumption of these ASFs may either positively or negatively impact anemia, or have no nutritional effects. Drawing upon first-hand experiences in Ghana, this study sought to: (1) identify the main motivations for raising livestock in Ghana; (2) describe the major barriers to consuming ASFs, especially among women of reproductive age (WRA); and (3) explore the feasibility of different livestock-centered interventions to reduce anemia. Key informant interviews and focus group discussions were held with relevant stakeholders at different geographical scales - the national, regional, district, and community levels. The results suggest that livestock enable savings, allow resource-poor households to accumulate assets, and help finance planned and unplanned expenditures (e.g., school fees and illness). Due to these multiple and often pressing uses, direct consumption of home-reared ASFs is not a major priority, especially for poor households. Even when ASFs are consumed, intra-household allocation does not favor women and adolescent girls, demographic groups with particularly high micronutrient requirements. The study participants discussed possible interventions to address these challenges, including (1) increasing livestock ownership through in-kind credit; (2) encouraging nutrition-related behavior change; (3) improving livestock housing; and (4) hatchery management. The paper discusses these interventions based upon potential acceptance, feasibility, cost effectiveness, and sustainability in the Ghanaian context. © 2018 The Authors | Open |
| Okronipa H.; Adu-Afarwuah S.; Lartey A.; Ashorn P.; Vosti S.A.; Young R.R.; Dewey K.G. | Maternal supplementation with small-quantity lipid-based nutrient supplements during pregnancy and lactation does not reduce depressive symptoms at 6 months postpartum in Ghanaian women: a randomized controlled trial | 2018 | Archives of Women's Mental Health | We examined the impact on depression at 6 months postpartum of maternal supplementation with small-quantity lipid-based nutrient supplement (SQ-LNS) compared to supplementation with iron and folic acid (IFA) or multiple micronutrients (MMN). In this partially double-blinded randomized controlled trial, pregnant women ≤20 weeks gestation (n = 1320) were recruited from antenatal clinics and randomly assigned to receive either (1) SQ-LNS during pregnancy and for 6 months postpartum, or (2) IFA during pregnancy only, or (3) MMN during pregnancy and for 6 months postpartum. Maternal depressive symptoms were measured at 6 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Women who scored 12 or more on the EPDS were considered to show symptoms of depression. One thousand one hundred fifty-one women were included in this analysis (LNS = 382, IFA = 387 and MMN = 382). Characteristics of the three groups were similar at baseline, and there were no significant differences between women who were included in the analysis (n = 1151) and those who were not (n = 169). At 6 months postpartum, 13% of the women overall showed symptoms of depression, and this did not differ by group (LNS = 13.1%, IFA = 11.2% and MMN = 14.7%. P = 0.36). The median (25, 75 percentile) EPDS score did not differ by group (LNS 4.0 (1.0, 8.0), IFA 4.0 (1.0, 8.0), MMN 5.0 (2.0, 9.0), Ptransformed = 0.13). Adjustment for covariates did not alter these findings. Maternal supplementation with SQ-LNS compared to MMN or IFA did not affect postnatal depressive symptoms in this sample of Ghanaian women. © 2017, The Author(s). | Open |
| Owusu A.Y.; Laar A. | Managing HIV-positive sero-status in Ghana’s most HIV concentrated district: self-perceived explanations and theoretical discourse | 2018 | African Journal of AIDS Research | As of December 2015 there were 37 million persons living with HIV/AIDS (PLWHAs), 70% of whom are in sub-Saharan Africa. Ghana, which contributes a relatively small number to Africa’s HIV burden, has a generalised HIV epidemic. The current national prevalence is 1.47%. Agormanya, one of the HIV sentinel sites in the county and where this study was conducted, has current prevalence of 11.6%. This makes it critical to explore how persons infected with HIV manage their lives, especially in the midst of entrenched stigma and discrimination. However, available information on how PLWHAs in sub-Saharan Africa handle their day-to-day lives mostly dwell on food and nutrition. Thus, there is dearth of information on how PLWHAs in Ghana particularly handle the circumstances of their daily lives which are mostly coloured by their HIV-positive statuses, given their stigmatised identity. We explore how PLWHAs respond to the experiences and challenges of living with HIV/AIDS in Lower Manya Krobo, consistently most HIV-infected district in Ghana. Data were collected from 38 combined purposive and randomly selected HIV-positive persons in two leading hospitals (St Martins Depores Agormanya and Atua Government hospitals which provide specialised HIV care in the district. Using in-depth interviews, we studied how PLWHAs managed their routine livelihoods in the midst of extreme stigma. We combined the social capital and resilience theoretical frameworks to show that our respondents were mostly resilient and strategically mostly drew upon extended family social support to cope with their livelihood challenges. We recommend that community opinion leaders and other stakeholders sensitise community members in Lower Manya Krobo to better understand the mode of HIV infection and encourage/strengthen family and community cohesion and social support. © 2018 NISC (Pty) Ltd. | Open |
| Polack S.; Adams M.; O'banion D.; Baltussen M.; Asante S.; Kerac M.; Gladstone M.; Zuurmond M. | Children with cerebral palsy in Ghana: malnutrition, feeding challenges, and caregiver quality of life | 2018 | Developmental Medicine and Child Neurology | Aim: To assess feeding difficulties and nutritional status among children with cerebral palsy (CP) in Ghana, and whether severity of feeding difficulties and malnutrition are independently associated with caregiver quality of life (QoL). Method: This cross-sectional survey included 76 children with CP (18mo–12y) from four regions of Ghana. Severity of CP was classified using the Gross Motor Function Classification System and anthropometric measures were taken. Caregivers rated their QoL (using the Pediatric Quality of Life Inventory Family Impact Module) and difficulties with eight aspects of child feeding. Logistic regression analysis explored factors (socio-economic characteristics, severity of CP, and feeding difficulties) associated with being underweight. Linear regression was undertaken to assess the relationship between caregiver QoL and child malnutrition and feeding difficulties. Results: Poor nutritional status was common: 65% of children aged under 5 years were categorized as underweight, 54% as stunted, and 58% as wasted. Reported difficulties with child's feeding were common and were associated with the child being underweight (odds ratio 10.7, 95% confidence interval 2.3–49.6) and poorer caregiver QoL (p<0.001). No association between caregiver QoL and nutritional status was evident. Interpretation: Among rural, low resource populations in Ghana, there is a need for appropriate, accessible caregiver training and support around feeding practices of children with CP, to improve child nutritional status and caregiver well-being. What this paper adds: Malnutrition is very common among children with cerebral palsy in this rural population in Ghana. Feeding difficulties in this population were strongly associated with being underweight. Feeding difficulties were associated with poorer caregiver quality of life (QoL). Child nutritional status was not associated with caregiver QoL. © 2018 Mac Keith Press | Open |
| Quaidoo E.Y.; Ohemeng A.; Amankwah-Poku M. | Sources of nutrition information and level of nutrition knowledge among young adults in the Accra metropolis | 2018 | BMC Public Health | Background: Acquiring accurate and adequate nutrition information is important as it could inform nutritional choices positively and promote the maintenance of a healthy nutritional status. This study assessed a sample of young adults' nutrition knowledge and identified where they gather information from to guide nutritional choices. Method: This was a cross-sectional study involving young adults (N=192) between 18 to 25 years recruited at shopping areas in the Accra Metropolis of Ghana. A pretested questionnaire was used to collect information on demographic characteristics, sources of nutrition information and basic nutrition knowledge. Pearson chi-square test was used to identify possible differences between high and low scorers of the knowledge assessment in terms of their nutrition information acquisition behaviours and logistic regression was conducted to ascertain whether source of nutrition information was related to participants' nutrition knowledge. Results: Online resources were the most popular source (92.7%) used to seek information on nutrition among study participants, and healthcare professionals were perceived to be the most reliable source of nutrition information. Additionally, participants who used healthcare professionals as a source of nutrition information were 61% (95% CI: 0.15-0.99) more likely to have a high nutrition knowledge than participants who did not consult healthcare professionals for nutrition information. Conclusion: Online resources serve as a very common source of nutrition information for young adults. Thus, healthcare professionals may need to adopt this as a useful channel to circulate trustworthy nutrition information to this age group. © 2018 The Author(s). | Open |
| Quaidoo E.Y.; Ohemeng A.; Amankwah-Poku M. | Weight perceptions, weight management practices, and nutritional status of emerging adults living in the Accra Metropolis | 2018 | BMC Nutrition | Background: Many young people have a tendency to be concerned about their physical appearance and undertake practices in order to achieve certain body ideals. There is however limited information from developing countries on the weight perceptions of emerging adults (i.e. individuals leaving the adolescence life stage and preparing to take on adulthood) and whether these opinions influence their nutritional status and weight management practices. This study sought to assess emerging adults' nutritional status, their weight perceptions and the methods they use to manage their weight. Methods: This study was cross-sectional, involving emerging adults (N = 192) recruited at shopping areas in the Accra Metropolis of Ghana. A pretested questionnaire was used to collect information on demographic characteristics, weight perceptions, and weight management strategies. Anthropometric measurements were taken using standard procedures. Descriptive analysis was performed on the demographic data, methods used to manage weight, and weight perceptions. Logistic regression was used to assess possible relationships between weight perceptions and nutritional status as well as weight perceptions and weight management practices. Results: The mean age of participants was 21.8(2.2) years with 51.0% of participants being female. Majority of the participants perceived normal weight status as the ideal body for themselves and half of them thought that they were slimmer than they actually were in reality. Three major weight management strategies were identified: engaging in physical activity, dieting and making lifestyle modifications (i.e. changes in normal eating habits coupled with regular physical activity and behavioral changes). Emerging adults who had an inaccurate body image perception were less likely (OR = 0.30, 95% CI: 0.15-0.61) to have a healthy nutritional status than emerging adults who had an accurate body image perception. Conclusion: Weight perception was associated with nutritional status. Discussions with nutrition professionals regarding realistic weight ideals would be beneficial for this age-group since half of the study's participants had inaccurate perceptions about their current weight statuses even though their statuses were normal. © 2018 The Author(s). | Open |
| Saaka M.; Ali F.; Vuu F. | Prevalence and determinants of essential newborn care practices in the Lawra District of Ghana | 2018 | BMC Pediatrics | Background: There was less than satisfactory progress, especially in sub-Saharan Africa, towards child and maternal mortality targets of Millennium Development Goals (MDGs) 4 and 5. The main aim of this study was to describe the prevalence and determinants of essential new newborn care practices in the Lawra District of Ghana. Methods: A cross-sectional study was carried out in June 2014 on a sample of 422 lactating mothers and their children aged between 1 and 12 months. A systematic random sampling technique was used to select the study participants who attended post-natal clinic in the Lawra district hospital. Results: Of the 418 newborns, only 36.8% (154) was judged to have had safe cord care, 34.9% (146) optimal thermal care, and 73.7% (308) were considered to have had adequate neonatal feeding. The overall prevalence of adequate new born care comprising good cord care, optimal thermal care and good neonatal feeding practices was only 15.8%. Mothers who attained at least Senior High Secondary School were 20.5 times more likely to provide optimal thermal care [AOR 22.54; 95% CI (2.60-162.12)], compared to women had no formal education at all. Women who received adequate ANC services were 4.0 times (AOR = 4.04 [CI: 1.53, 10.66]) and 1.9 times (AOR = 1.90 [CI: 1.01, 3.61]) more likely to provide safe cord care and good neonatal feeding as compared to their counterparts who did not get adequate ANC. However, adequate ANC services was unrelated to optimal thermal care. Compared to women who delivered at home, women who delivered their index baby in a health facility were 5.6 times more likely of having safe cord care for their babies (AOR = 5.60, Cl: 1.19-23.30), p = 0.03. Conclusions: The coverage of essential newborn care practices was generally low. Essential newborn care practices were positively associated with high maternal educational attainment, adequate utilization of antenatal care services and high maternal knowledge of newborn danger signs. Therefore, greater improvement in essential newborn care practices could be attained through proven low-cost interventions such as effective ANC services, health and nutrition education that should span from community to health facility levels. © 2018 The Author(s). | Open |
| Sackey J.; Zhang F.F.; Rogers B.; Aryeetey R.; Wanke C. | Implementation of a nutrition assessment, counseling and support program and its association with body mass index among people living with HIV in Accra, Ghana | 2018 | AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | In spite of the important role nutrition plays in the management of HIV, access to nutrition services is inadequate, especially in resource limited settings. In addition, nutrition programs for people living with HIV (PLWH) have not been sufficiently evaluated for efficacy and this study was conducted to address this gap. This study aimed to evaluate the implementation of the nutrition assessment, counseling and support (NACS) program in Accra, Ghana, and to assess whether the level of implementation of NACS was associated with the body mass index (BMI) of PLWH. A cross-sectional study was conducted in six HIV clinics (3 NACS designated and 3 non-NACS). Study participants were 152 adult PLWH at least 6 months on antiretroviral therapy and not pregnant or breastfeeding. Using a NACS implementation scale developed for this study ranging from 0 to 8 (a higher score indicating better NACS implementation), median NACS implementation score was not different between NACS-designated, and non-NACS HIV clinics (5 vs 4, p = 0.14). Almost half (47%) of the respondents were overweight or obese. A higher score on the NACS implementation scale was not significantly associated with overweight or obesity (BMI >24.9 kg/m2) after adjusting for other covariates. It was concluded that, there was poor implementation of NACS in the NACS designated HIV clinics surveyed with no nutrition counseling offered nor food support available to those who might need it. © 2017 Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Sarma S.; Nemser B.; Cole-Lewis H.; Kaonga N.; Negin J.; Namakula P.; Ohemeng-Dapaah S.; Kanter A.S. | Effectiveness of SMS technology on timely community health worker follow-up for childhood malnutrition: A retrospective cohort study in sub-Saharan Africa | 2018 | Global Health Science and Practice | Background: The Millennium Villages Project facilitated technology-based health interventions in rural under-resourced areas of subSaharan Africa. Our study examined whether data entry using SMS compared with paper forms by community health workers (CHWs) led to higher proportion of timely follow-up visits for malnutrition screening in under-5 children in Ghana, Rwanda, Senegal, and Uganda. Methods: Children under 5 years were screened for malnutrition every 90 days by CHWs using mid-upper arm circumference (MUAC) readings. CHWs used either SMS texts or paper forms to enter MUAC data. Reminder texts were sent at 15 days before follow-up was needed. Chi-square tests assessed proportion of timely follow-up visits within 90 days between SMS and paper groups. Logistic regression analysis was conducted in a step-wise multivariate model. Post-hoc power calculations were conducted to verify strength of associations. Results: SMS data entry was associated with a higher proportion of timely malnutrition follow-up visits compared with paper forms across all sites. The association was strongest with consistent SMS use over consecutive visits. SMS use at the first of 2 consecutive visits was most effective, highlighting the importance of SMS reminder alerts. Conclusions: SMS technology with reminders increased timely CHW malnutrition screening visits for under-5 children in Ghana, Rwanda, Senegal, and Uganda, highlighting the importance of such technology for improving health worker behavior in low-resource settings. © Paul et al. | Open |
| Singh S.; Fernandes M. | Home-grown school feeding: promoting local production systems diversification through nutrition sensitive agriculture | 2018 | Food Security | The consumption of some non-staple crops such as legumes and dark, green leafy vegetables can address common deficiencies in key nutrients such as vitamin A and iron; however, limited markets and supply chain development impede their production and accessibility to consumers. This study investigates the pathways to promote agricultural production and dietary diversity for a local market intervention called Home-Grown School Feeding (HGSF). School feeding menus from 24 districts across 10 regions in Ghana during the 2014–15 school year were analysed in terms of food groups and several individual foods. The menus were then compared with food groups produced by households during the past year or consumed in the past seven days using data collected from a household survey. Greater inter-food group diversity in the menus was associated with higher production levels for tubers and dark, leafy green vegetables in the South and cereals in the North. A correspondence between the frequency in which a food group appeared in a menu and the share of households who consumed foods from the food group was also noted. Key issues, such as optimizing supply chains, enabling farm linkages and supporting diverse nutrient rich food groups, that underlie the success of Home-Grown School Feeding and other agricultural policies with similar goals of promoting production and dietary diversity are highlighted through commodity specific examples. The findings of this study may help strengthen operational linkages between agriculture production and nutrition for HGSF and other similar interventions. © 2018, The Author(s). | Open |
| Subburethina Bharathi P.; Mohamed Jasim K.; Santhanalakshmi K.; Boohene D. | WLB model and performance measurement: Evidence with private hospital women nurses in Ghana milieu | 2018 | International Journal of Business Innovation and Research | The result of the study which indicates that, women nurses of private hospitals in Ghana context are able to support their hobbies, household activities, study; care for self, however, shopping for necessaries and attending family functions is one of the key areas the respondents are missing. If attending a social function is also recognised as one of the work life balance variables, it will help better job satisfaction of nurses. The majority of the women nurses in the private hospitals in Ghana context, Ghana are satisfied with different dimensions with respect to work logistics. It has been confirmed by the researcher while discussing with the nursing staff, they did express satisfaction over work logistics provided by hospitals. Skipping food and drug abuse are likely to be major lifestyle choice issues, which may impact health of nursing staff while other dimensions are not perceived as likely problems in future. Provision of canteen facilities with adequately stopped nutrition diet is likely to health. Copyright © 2018 Inderscience Enterprises Ltd. | Open |
| Tsiboe F.; Zereyesus Y.A.; Popp J.S.; Osei E. | The Effect of Women’s Empowerment in Agriculture on Household Nutrition and Food Poverty in Northern Ghana | 2018 | Social Indicators Research | The study examines the effect of women’s empowerment in agriculture on household nutrition—i.e. the availability of carbohydrates, protein, and fat—and household food poverty measured by monetary food shortfall. The analysis is done by applying instrumental variable estimation to a sample of 2642 households from a 2012 population-based survey conducted in northern Ghana. Overall, the results indicate that women’s empowerment positively influences nutrient availability and negatively influences monetary food shortfall. By decomposing women’s empowerment into its component domains, this study identified that the domains of Income, Production, and Leadership are areas for intervention to influence households’ nutrient availability and monetary food shortfall outcomes. The effect of the Time and Resources domains reveal that some intra-household trade-offs may exist. Thus, policies aimed at empowering women to ultimately improve household nutrition and food poverty need to be based on the understanding of these specific interactions. © 2017, Springer Science+Business Media Dordrecht. | Open |
| Wemakor A.; Garti H.; Azongo T.; Garti H.; Atosona A. | Young maternal age is a risk factor for child undernutrition in Tamale Metropolis, Ghana | 2018 | BMC Research Notes | Objective: Malnutrition is a common cause of morbidity and mortality in children. The aim of this study was to compare the nutritional status of children under 5 years of teenage and adult mothers in Tamale Metropolis, Ghana. A case-control study involving 300 (150 cases, 150 controls) mother-child pairs was carried out. A questionnaire was used to collect data on socio-demographic characteristics of mothers and children and anthropometry was used to assess the nutritional status of children. Anthropometric z-scores derived based on WHO Child Growth Standards were used to determine stunting, wasting and underweight statuses of children. Logistic regression analysis was used to compare the nutritional status of children of teenage and adult mothers. Results: Children of teenage mothers, compared to those of adult mothers, were 8 times more likely to be stunted [Adjusted Odds Ratio (AOR) = 7.56; 95% confidence interval (CI) 4.20-13.63], 3 times more likely to be wasted (AOR = 2.90; 95% CI 1.04-8.04), and 13 times more likely to be underweight (AOR = 12.78; 95% CI 4.69-34.81) after adjusting for potential confounders. The risk of child malnutrition increases with young maternal age; interventions should be targeted at teenage mothers and their children to reduce the risk of malnutrition. © 2018 The Author(s). | Open |
| Wentzel-Viljoen E.; Laar A.; Umugwaneza M. | Ethics in Nutrition – An African Perspective | 2018 | Advancing Global Bioethics | The chapter provides a context of nutrition/dietetic professions in Ghana (Sect. 6.1) and Rwanda (Sect. 6.2), giving background information about the current training. Training in ethics and professional conduct, regulatory ethics guidelines and code of ethics in each of the countries are emphasised. The role of relevant stakeholders in the teaching of ethics, as well as organisations responsible for guiding and regulating same is described. Ethics decision making and ethical issues faced by practitioners in the work environment and situations in the country, and other ethical issues in relation with the food system are also described. Ethical issues in the context of personalised nutrition advice, as well as ethical dilemmas regarding the food system are covered (e.g. the policy of “one cow, one family” in Rwanda). The final section of the chapter focuses on an analysis of the various country-specific ethical issues faced and addressed by nutrition professionals in the two countries. The country-specific analyses are preceded by a synopsis of the contemporary African nutrition landscape. © 2018, Springer International Publishing AG, part of Springer Nature. | Open |
| Zuurmond M.; O’Banion D.; Gladstone M.; Carsamar S.; Kerac M.; Baltussen M.; Tann C.J.; Nyante G.G.; Polack S. | Evaluating the impact of a community-based parent training programme for children with cerebral palsy in Ghana | 2018 | PLoS ONE | Background In low and middle-income settings, where access to support and rehabilitation services for children with disabilities are often lacking, the evidence base for community initiatives is limited. This study aimed to explore the impact of a community-based training programme for caregivers of children with cerebral palsy in Ghana. Methods A pre and post evaluation of an 11-month participatory training programme (“Getting to Know Cerebral Palsy”) offered through a parent group model, was conducted. Eight community groups, consisting of a total of 75 caregivers and their children with cerebral palsy (aged 18 months-12 years), were enrolled from 8 districts across Ghana. Caregivers were interviewed at baseline, and again at 2 months after the completion of the programme, to assess: quality of life (PedsQL™ Family Impact Module); knowledge about their child’s condition; child health indicators; feeding practices. Severity of cerebral palsy, reported illness, and anthropometric measurements were also assessed. Results Of the child-caregiver pairs, 64 (84%) were included in final analysis. There were significant improvements in caregiver quality of life score (QoL) (median total QoL 12.5 at baseline to 51.4 at endline, P<0.001). Caregivers reported significant improvements in knowledge and confidence in caring for their child (p<0.001), in some aspects of child feeding practices (p<0.001) and in their child’s physical and emotional heath (p< 0.001). Actual frequency of reported serious illness over 12-months remained high (67%) among children, however, a small reduction in recent illness episodes (past 2 weeks) was seen (64% to 50% p < 0.05). Malnutrition was common at both time points; 63% and 65% of children were classified as underweight at baseline and endline respectively (p = 0.5). Conclusion Children with cerebral palsy have complex care and support needs which in low and middle-income settings need to be met by their family. This study demonstrates that a participatory training, delivered through the establishment of a local support group, with an emphasis on caregiver empowerment, resulted in improved caregiver QoL. Despite less effect on effect on child health and no clear effect on nutritional status, this alone is an important outcome. Whilst further development of these programmes would be helpful, and is underway, there is clear need for wider scale-up of an intervention which provides support to families. © 2018 Zuurmond et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Abizari A.-R.; Azupogo F.; Brouwer I.D. | Subclinical inflammation influences the association between Vitamin A-And iron status among schoolchildren in Ghana | 2017 | PLoS ONE | Background and objective In resource-poor settings, micronutrient deficiencies such as Vitamin A deficiency may coexist with iron-deficiency. In this study we assessed the iron and Vitamin A status of schoolchildren and the association between Vitamin A and iron status. Methods A cross-sectional design using the baseline data of a dietary intervention trial conducted among randomly selected 5±12 years old schoolchildren (n = 224) from 2 rural schools in northern Ghana. Hemoglobin (Hb), serum ferritin (SF) and serum transferrin receptor (sTfR) concentrations were used as measures of iron status. Retinol binding protein (RBP) was used as a measure of Vitamin A status. Subclinical inflammation (SCI) was measured using C-reactive protein (CRP) and α1-Acid glycoprotein (AGP) concentrations. We examined the cross-sectional association between Vitamin A and iron status biomarkers with multiple linear regressions. Results The proportions of schoolchildren with anemia (WHO criteria), iron-deficiency (ID, SF <15μg/l and/or sTfR >8.5mg/l) and iron-deficiency anemia (IDA, concurrent anemia and ID) were 63.8%, 68.3% and 46.4% respectively. Low or marginal Vitamin A status (0.70 μmol/l RBP < 1.05μmol/l) was present in 48.2% while 37.5% of the schoolchildren had Vitamin A deficiency (VAD, RBP <0.70 μmol/l). The prevalence of SCI as well as concurrent VAD and ID were 48.7% and 25% respectively. RBP was associated with Hb (β = 7.2, P = 0.05) but not SF (β = 20.7, P = 0.33) and sTfR concentration (β = 12.0, P = 0.63). In the presence of SCI, RBP was not associated with hemoglobin status but a significant positive association was observed among children without SCI. Conclusions The study shows that RBP is significantly associated with Hb concentration but not with SF and sTfR. The observed relationship between RBP and Hb is only significant in the absence of SCI. © 2017 Abizari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Abizari A.-R.; Azupogo F.; Nagasu M.; Creemers N.; Brouwer I.D. | Seasonality affects dietary diversity of school-age children in northern Ghana | 2017 | PLoS ONE | Background and objectives: Dietary diversity score (DDS) is relatively easy to measure and is shown to be a very useful indicator of the probability of adequate micronutrient intake. Dietary diversity, however, is usually assessed during a single period and little is known about the effect of seasonality on it. This study investigates whether dietary diversity is influenced by seasonality. Methods: Two cross-sectional surveys were conducted in two different seasons—dry season (October 2010) and rainy season (May 2011) among the same school-age children (SAC) in two rural schools in northern Ghana. The study population consisted of 228 school-age children. A qualitative 24-hour dietary recall was conducted in both seasons. Based on 13 food groups, a score of 1 was given if a child consumed a food item belonging to a particular food group, else 0. Individual scores were aggregated into DDS for each child. Differences in mean DDS between seasons were compared using linear mixed model analysis. Results: The dietary pattern of the SAC was commonly plant foods with poor consumption of animal source foods. The mean DDS was significantly higher (P < 0.001) in the rainy season (6.95 ± 0.55) compared to the dry season (6.44 ± 0.55) after adjusting for potential confounders such as age, sex, occupation (household head and mother) and education of household head. The difference in mean DDS between dry and rainy seasons was mainly due to the difference in the consumption of Vitamin A-rich fruits and vegetables between the seasons. While vitamin A-rich fruits (64.0% vs. 0.9%; P < 0.0001) and vitamin A rich dark green leafy vegetables (52.6% vs. 23.3%, P < .0001) were consumed more during the rainy season than the dry season, more children consumed vitamin A-rich deep yellow, orange and red vegetables during the dry season than during the rainy season (73.7% vs. 36.4%, P <0.001). Conclusion: Seasonality has an effect on DDS and may affect the quality of dietary intake of SAC; in such a context, it would be useful to measure DDS in different seasons. Since DDS is a proxy indicator of micronutrient intake, the difference in DDS may reflect in seasonal differences in dietary adequacy and further studies are needed to establish this. © 2017 Abizari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Abizari A.-R.; Dold S.; Kupka R.; Zimmermann M.B. | More than two-thirds of dietary iodine in children in northern Ghana is obtained from bouillon cubes containing iodized salt | 2017 | Public Health Nutrition | Objective Bouillon cubes are widely consumed by poor households in sub-Saharan Africa. Because their main ingredient is salt, bouillon cubes could be a good source of iodine if iodized salt is used in their production and if their consumption by target groups is high. Our objective was to measure the iodine content of bouillon cubes, estimate their daily intake in school-aged children and evaluate their potential contribution to iodine intakes. Design In a cross-sectional study, we measured urinary iodine concentrations (UIC) and estimated total daily iodine intakes. We administered a questionnaire on usage of bouillon cubes. We measured the iodine content of bouillon cubes, household salt, drinking-water and milk products. Setting Primary schools in northern Ghana. Subjects Schoolchildren aged 6-13 years. Results Among school-aged children (n 250), median (interquartile range) UIC and estimated iodine intake were 242 (163-365) μg/l and 129 (85-221) μg/d, indicating adequate iodine status. Median household salt iodine concentration (n 100) was only 2·0 (0·83-7·4) μg/g; 72 % of samples contained <5 μg iodine/g. Iodine concentrations in drinking-water and milk-based drinks were negligible. Median iodine content of bouillon cubes was 31·8 (26·8-43·7) μg/g, with large differences between brands. Estimated median per capita consumption of bouillon cubes was 2·4 (1·5-3·3) g/d and median iodine intake from bouillon cubes was 88 (51-110) μg/d. Conclusions Despite low household coverage with iodized salt, iodine nutrition in school-aged children is adequate and an estimated two-thirds of their dietary iodine is obtained from bouillon cubes. © 2016 The Authors. | Open |
| Abu B.A.Z.; van den Berg V.L.; Raubenheimer J.E.; Louw V.J. | Pica Practices among Apparently Healthy Women and Their Young Children in Ghana | 2017 | Physiology and Behavior | Background Pica is an increased appetite/craving for food or non-food substances like clay, and chalk, and is strongly associated with iron deficiency (ID) anemia. This study assessed pica practices among non-pregnant mothers and their children, 12-to-59 months, in an anaemia endemic population in Ghana. Subjects and methods A cross-sectional quantitative survey was conducted in two randomly selected districts in Northern Ghana. The researchers developed semi-structured questionnaires with components on pica practice, history and experiences and administered via structured face-to-face interviews with mothers (N = 161) and all their children 6-59 months. Of this population, 132 mothers had children 12-to-59 months (N = 139) in April 2012. Pica practice among children was reported by their mothers. Data was analysed using SPSS version 23.0. Results Few mothers (3%) spontaneously reported pica (for uncommon food and/or non-food substances) at the time of the interview, however, 16 (12.1%) mothers with pica were confirmed after further probing. Twelve (8.6%) children were reported to have ingested/craved clay/soil/dust (11 / 91.7 %), paper (1 / 7.1%) and chalk (1/7.1%) prior to the interview. One child had poly-pica (pica for two substance). Pica was reported to have been practised by expecting mothers during 37 (26.6%) of the pregnancies of the children involved in the study, and was mostly for clay/soil (33 / 89.1%), kola nut (5 / 3.6%), uncooked rice and bambara beans. Children's pica practices were significantly associated (χ2 = 6.33; p = 0.011) with their mothers’ pica practices during pregnancy as well as with mothers’ pica practices at the time of the study (χ2 = 5.98; p = 0.035). A logistic regression analysis seemed to show that pica of the mother during pregnancy was more strongly associated with the child's pica than later pica behaviour of the mother. Many myths and misconceptions associated with the practice of pica were also reported in these communities. Conclusions The reported pica practice among mothers and their children was lower than what has been observed in other studies. Knowledge and perceptions regarding pica were mostly inaccurate. Education on pica and associated dangers of its practices should be included in nutrition interventions in communities with known high anemia prevalence. © 2017 | Open |
| Adams K.P.; Ayifah E.; Phiri T.E.; Mridha M.K.; Adu-Afarwuah S.; Arimond M.; Arnold C.D.; Cummins J.; Hussain S.; Kumwenda C.; Matias S.L.; Ashorn U.; Lartey A.; Maleta K.M.; Vosti S.A.; Dewey K.G. | Maternal and child supplementation with lipid-based nutrient supplements, but not child supplementation alone, decreases self-reported household food insecurity in some settings | 2017 | Journal of Nutrition | Background: It is unknown whether self-reported measures of household food insecurity change in response to foodbased nutrient supplementation. Objective: We assessed the impacts of providing lipid-based nutrient supplements (LNSs) to women during pregnancy and postpartum and/or to their children on self-reported household food insecurity in Malawi [DOSE and DYAD trial in Malawi (DYAD-M)], Ghana [DYAD trial in Ghana (DYAD-G)], and Bangladesh [Rang-Din Nutrition Study (RDNS) trial]. Methods: Longitudinal household food-insecurity data were collected during 3 individually randomized trials and 1 clusterrandomized trial testing the efficacy or effectiveness of LNSs (generally 118 kcal/d). Seasonally adjusted Household Food Insecurity Access Scale (HFIAS) scores were constructed for 1127 DOSE households, 732 DYAD-M households, 1109 DYAD-G households, and 3671 RDNS households. The impact of providing LNSs to women during pregnancy and the first 6 mo postpartum and/or to their children from 6 to 18-24 mo on seasonally adjusted HFIAS scores was assessed by using negative binomial models (DOSE, DYAD-M, and DYAD-G trials) and mixed-effect negative binomial models (RDNS trial). Results: In the DOSE and DYAD-G trials, seasonally adjusted HFIAS scores were not different between the LNS and non-LNS groups. In the DYAD-M trial, the average household food-insecurity scores were 14% lower (P = 0.01) in LNS households than in non-LNS households. In the RDNS trial, compared with non-LNS households, food-insecurity scores were 17% lower (P = 0.02) during pregnancy and the first 6 mo postpartum and 15% lower (P = 0.02) at 6-24 mo postpartum in LNS households. Conclusions: The daily provision of LNSs to mothers and their children throughout much of the ''first 1000 d'' may improve household food security in some settings, which could be viewed as an additional benefit that may accrue in households should policy makers choose to invest in LNSs to promote child growth and development. © 2017 American Society for Nutrition. | Open |
| Adu-Afarwuah S.; Lartey A.; Okronipa H.; Ashorn P.; Ashorn U.; Zeilani M.; Arimond M.; Vosti S.A.; Dewey K.G. | Maternal supplementation with small-quantity lipid-based nutrient supplements compared with multiple micronutrients, but not with iron and folic acid, reduces the prevalence of low gestational weight gain in semi-urban Ghana: A randomized controlled trial | 2017 | Journal of Nutrition | Background: It is unclear whether maternal supplementation with small-quantity lipid-based nutrient supplements (SQ-LNSs; 118 kcal/d) affects maternal weight. Objective: We compared several secondary anthropometric measures between 3 groups of women in the iLiNS (International Lipid-based Nutrient Supplements)-DYAD trial in Ghana. Methods: Women (n = 1320; < 20 wk of gestation) were randomly assigned to receive 60 mg Fe + 400 mg folic acid/d (IFA), 18 vitamins and minerals/d [multiple micronutrients (MMNs)], or 20 g SQ-LNSs with 22 micronutrients/d (LNS) during pregnancy and a placebo (200 mg Ca/d), MMNs, or SQ-LNSs, respectively, for 6 mo postpartum. Weight, midupper arm circumference (MUAC), and triceps skinfold (TSF) thickness at 36wk of gestation and 6mo postpartumwere analyzed, as were changes from estimated prepregnancy values.We assessed the adequacy of estimated gestational weight gain (GWG) by using Institute of Medicine (IOM) and International Fetal and Newborn Growth Standards for the 21st Century (INTERGROWTH-21st) guidelines. Results: The estimated prepregnancy prevalence of overweight or obesity was 38.5%. By 36 wk of gestation, women (n = 1015) had a mean 6 SD weight gain of 7.4 6 3.7 kg and changes of 21.0 6 1.7 cm in MUAC and 22.8 6 4.1 mm in TSF thickness. The LNS group had a lower prevalence of inadequateGWGon the basis of IOM guidelines (57.4%) than the MMN (67.2%) but not the IFA (63.1%) groups (P = 0.030), whereas the prevalence of adequate (26.9% overall) and excessive (10.4% overall) GWG did not differ by group. The percentages of normal-weight women (in kg/m2: 18.5 < body mass index < 25.0; n = 754) whose GWG was less than the third centile of the INTERGROWTH-21st standards were 23.0%, 28.7%, and 28.5% for the LNS, MMN, and IFA groups, respectively (P = 0.36). At 6 mo postpartum, the prevalence of overweight or obesity was 45.3%, and the risk of becoming overweight or obese did not differ by group. Conclusion: SQ-LNS supplementation is one potential strategy to address the high prevalence of inadequateGWGinwomen in settings similar to Ghana, without increasing the risk of excessive GWG. © 2017 American Society for Nutrition. | Open |
| Adu-Afarwuah S.; Lartey A.; Okronipa H.; Ashorn P.; Zeilani M.; Baldiviez L.M.; Oaks B.M.; Vosti S.; Dewey K.G. | Impact of small-quantity lipid-based nutrient supplement on hemoglobin, iron status and biomarkers of inflammation in pregnant Ghanaian women | 2017 | Maternal and Child Nutrition | We examined hemoglobin (Hb, g/L), iron status (zinc protoporphyrin, ZPP, µmol/mol heme, and transferrin receptor, TfR, mg/L) and inflammation (C-reactive protein, CRP and alpha-1 glycoprotein, AGP) in pregnant Ghanaian women who participated in a randomized controlled trial. Women (n = 1320) received either 60 mg Fe + 400-µg folic acid (IFA); 18 micronutrients including 20-mg Fe (MMN) or small-quantity lipid-based nutrient supplements (SQ-LNS, 118 kcal/d) with the same micronutrient levels as in MMN, plus four additional minerals (LNS) daily during pregnancy. Intention-to-treat analysis included 349, 354 and 354 women in the IFA, MMN and LNS groups, respectively, with overall baseline mean Hb and anemia (Hb <100) prevalence of 112 and 13.3%, respectively. At 36 gestational weeks, overall Hb was 117, and anemia prevalence was 5.3%. Compared with the IFA group, the LNS and MMN groups had lower mean Hb (120 ± 11 vs. 115 ± 12 and 117 ± 12, respectively; P < 0.001), higher mean ZPP (42 ± 30 vs. 50 ± 29 and 49 ± 30; P = 0.010) and TfR (4.0 ± 1.3 vs. 4.9 ± 1.8 and 4.6 ± 1.7; P < 0.001), and greater prevalence of anemia (2.2% vs. 7.9% and 5.8%; P = 0.019), elevated ZPP (>60) [9.4% vs. 18.6% and 19.2%; P = 0.003] and elevated TfR (>6.0) [9.0% vs. 19.2% and 15.1%; P = 0.004]. CRP and AGP concentrations did not differ among groups. We conclude that among pregnant women in a semi-urban setting in Ghana, supplementation with SQ-LNS or MMN containing 20 mg iron resulted in lower Hb and iron status but had no impact on inflammation, when compared with iron (60 mg) plus folic acid (400 µg). The amount of iron in such supplements that is most effective for improving both maternal Hb/iron status and birth outcomes requires further evaluation. This trial was registered at ClinicalTrials.gov as: NCT00970866. © 2016 John Wiley & Sons Ltd | Open |
| Adu-Dapaah H.; Osei-Bonsu I.; Oduro I.; Asiedu J. | Recent advances in production, processing and utilization of Moringa oleifera in Ghana | 2017 | Acta Horticulturae | Moringa (Moringa oleifera) is cultivated for use as food, fodder and medicine. Commercial production, processing, and utilization of this 'wonder' crop have increased in many African countries, including Ghana. This is due to widespread knowledge of its varied food, nutrition, medicinal and economic benefits. Despite the increased commercial production of the tree crop, not much research has been conducted, especially on its production in Ghana. This may be because moringa grows well across all agro-ecologies; additionally, it appears recommendations on agronomic practices from other tropical ecologies work for the end-users, especially farmers. This paper discusses the recent advances in agronomic aspects of production in Ghana with respect to current practices used by stakeholders along the moringa value chain from seed production, planting, processing to marketing. For optimal leaf production, high density planting (300,000-1 million plants ha-1) using either seeds or hardwood stem cuttings (30 cm to 1 m long) has been recommended. The use of moringa in agroforestry systems (alley cropping) is also being promoted in some communities. The beneficial use of the crop has been extended to include feed for grass-cutter and as a replacement for mineral fertilizers in small-holder farms. Anecdotal evidence and casual information suggest that over 10,000 farmers use improved agronomic practices. All these are discussed along with studies conducted by researchers and their implications for improving the productivity and utilization of moringa. | Open |
| Agbadi P.; Urke H.B.; Mittelmark M.B. | Household food security and adequacy of child diet in the food insecure region north in Ghana | 2017 | PLoS ONE | Background and objectives: Adequate diet is of crucial importance for healthy child development. In food insecure areas of the world, the provision of adequate child diet is threatened in the many households that sometimes experience having no food at all to eat (household food insecurity). In the context of food insecure northern Ghana, this study investigated the relationship between level of household food security and achievement of recommended child diet as measured by WHO Infant and Young Child Feeding Indicators. Methods: Using data from households and 6-23 month old children in the 2012 Feed the Future baseline survey (n = 871), descriptive analyses assessed the prevalence of minimum meal frequency; minimum dietary diversity, and minimum acceptable diet. Logistic regression analysis was used to examine the association of minimum acceptable diet with household food security, while accounting for the effects of child sex and age, maternal -age, -dietary diversity, -literacy and -education, household size, region, and urban-rural setting. Household food security was assessed with the Household Hunger Scale developed by USAID's Food and Nutrition Technical Assistance Project. Results: Forty-nine percent of children received minimum recommended meal frequency, 31% received minimum dietary diversity, and 17% of the children received minimum acceptable diet. Sixty-four percent of the children lived in food secure households, and they were significantly more likely than children in food insecure households to receive recommended minimum acceptable diet [O.R = 0.53; 95% CI: 0.35, 0.82]. However, in 80% of food secure households, children did not receive a minimal acceptable diet by WHO standards. Conclusions: Children living in food secure households were more likely than others to receive a minimum acceptable diet. Yet living in a food secure household was no guarantee of child dietary adequacy, since eight of 10 children in food secure households received less than a minimum acceptable diet. The results call for research into factors besides household food security in the search for determinants of child diet adequacy. In this study at least, household food security was a very weak marker of child diet adequacy. This finding is of significance to public health practice, since it calls into question any assumption that having enough food in a household necessarily results in adequately fed children. © 2017 Agbadi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Aheto J.M.K.; Taylor B.M.; Keegan T.J.; Diggle P.J. | Modelling and forecasting spatio-temporal variation in the risk of chronic malnutrition among under-five children in Ghana | 2017 | Spatial and Spatio-temporal Epidemiology | Background: Spatio-temporal variation in under-5-year-old children malnutrition remains unstudied in most developing countries like Ghana. This study explores and forecasts the spatio-temporal patterns in childhood chronic malnutrition among these children. We also investigate the effect of maternal education on childhood malnutrition. Methods: We analysed data on 10,036 children residing in 1516 geographic locations. A spatio-temporal model was fitted to the data and was used to produce predictive maps of spatio-temporal variation in the probability of stunting. Results: The study found substantial spatio-temporal variation in the prevalence of stunting. Also, higher levels of mother's education were associated with decreased risk of being stunted. Conclusion: Our spatio-temporal model captured variations in childhood stunting over place and time. Our method facilitates and enriches modelling and forecasting of future stunting prevalence to identify areas at high risk. Improving maternal education could be given greater consideration within an overall strategy for addressing childhood malnutrition. © 2017 Elsevier Ltd | Open |
| Ahun M.N.; Aboud F.E.; Aryeetey R.; Colecraft E.; Marquis G.S. | Child development in rural Ghana: Associations between cognitive/language milestones and indicators of nutrition and stimulation of children under two years of age | 2017 | Canadian Journal of Public Health | OBJECTIVES: Two studies aimed to assess the provision of nutrition and psychosocial stimulation in the home and to examine associations between mental development and nutrition and stimulation using a validated measure of development milestones. METHODS: The first study consisted of secondary analyses on health and nutrition data from 1081 mother-child pairs (the children aged 0-12 months) and their households in Ghana’s Eastern Region. For the second study, the Ghana Milestones Measure, consisting of items assessing cognitive and language development, was used to assess child development in a subsample (N = 330) of Study 1 participants one year later (children 10-24 months of age). This measure was mother-reported and had been validated in a separate community in Ghana. Correlation and linear regression analyses were used to analyze the data. RESULTS: Family assets and maternal education were identified as key factors of the family context. Both variables were positively associated with preventive health practices (r = 0.08 to 0.13, p < 0.0001 to 0.01), and dietary diversity (r = 0.15, p = 0.0001 to 0.0006), and negatively associated with maternal depressive symptoms (r = -0.19 to -0.12, p < 0.0001). Taller children had higher receptive (standardized beta = 0.16; p = 0.04) and expressive (0.21; 0.003) language, but not cognitive (0.15; 0.07) milestone scores, and psychosocial stimulation was positively associated with all three milestones (receptive = 0.13, p = 0.01; expressive = 0.21, p < 0.0001; and cognitive = 0.24, p < 0.0001). CONCLUSION: Our study provides the first validated measure of children’s language and cognitive development in Ghana, finding associations with nutrition and stimulation. The Ghana Milestones Measure can be used to assess and help promote children’s mental development. © 2017 Canadian Public Health Association or its licensor. | Open |
| Aimone A.M.; Brown P.; Owusu-Agyei S.; Zlotkin S.H.; Cole D.C. | Impact of iron fortification on the geospatial patterns of malaria and non-malaria infection risk among young children: A secondary spatial analysis of clinical trial data from Ghana | 2017 | BMJ Open | Objectives: Patterns of infection among children with varying levels of iron status in a malaria endemic area may vary spatially in ways requiring integrated infection and iron deficiency control programmes. The objective of this secondary analysis was to determine the geospatial factors associated with malaria and non-malaria infection status among young Ghanaian children at the end of a 5-month iron intervention trial. Design: Cluster-randomised controlled trial. Setting: Rural Ghana Participants: 1943 children (6-35 months of age) with geocoded compounds. Interventions: Point-of-use fortification with micronutrient powders containing vitamins and minerals with or without iron. Primary and secondary outcome measures: Generalised linear geostatistical models with a Matern spatial correlation function were used to analyse four infection response variables, defined using different combinations of inflammation (C-reactive protein, CRP >5 mg/L) and malaria parasitaemia. Analyses were also stratified by treatment group to assess the independent effects of the iron intervention. Results: The by-group and combined-group analyses both showed that baseline infection status was the most consistent predictor of endline infection risk, particularly when infection was defined using parasitaemia. In the No-iron group, age above 24 months and weight-for-length z-score at baseline were associated with high CRP at endline. Higher asset score was associated with a 12% decreased odds of endline infection, defined as CRP >5 mg/L and/or parasitaemia (OR 0.88, 95% credible interval 0.78 to 0.98), regardless of group. Maps of the predicted risk and spatial random effects showed a defined low-risk area around the District centre, regardless of how infection was defined. Conclusion: In a clinical trial setting of iron fortification, where all children receive treated bed nets and access to malaria treatment, there may be geographical variation in the risk of infection with distinct high-risk and low-risk areas, particularly around municipal centres. © 2017 Article author(s). | Open |
| Akparibo R.; Harris J.; Blank L.; Campbell M.J.; Holdsworth M. | Severe acute malnutrition in children aged under 5 years can be successfully managed in a non-emergency routine community healthcare setting in Ghana | 2017 | Maternal and Child Nutrition | This study investigated the performance of community-based management of severe acute malnutrition (CMAM) within routine healthcare services in Ghana. This was a retrospective cohort study of n = 488 children (6–59 months) who had received CMAM. Data for recovery, default, and mortality rates were obtained from enrolment cards in 56 outpatient centres in Upper East region, Ghana. Satisfactory rates of recovery of 71.8% were reported. Children who were enrolled with higher mid-upper arm circumference (MUAC) ≥11.5 cm had seven times greater chance of recovery compared with children who were enrolled with lower MUAC <11.5 cm, OR = 7.35, 95% CI [2.56, 21.15], p <.001. Children who were diagnosed without malaria at baseline were 30 times, OR = 30.39, 95% CI [10.02, 92.13], p <.001, more likely to recover compared with those with malaria (p <.001). The average weight gain was 4.7 g−1·kg−1·day−1, which was influenced by MUAC status at baseline, β =.78, 95% CI [0.46, 1.00], p <.001, presence of malaria, β = −1.25, 95% CI [−1.58, 0.92], p <.001, and length of stay, β = 0.13, 95% CI [0.08, 0.18], p <.001. The default rate (28.5%) was higher than international standards recommendations by Sphere. Mortality rate (1.6%) was lower than international standards. Our findings suggest that community-based management of SAM can achieve similar success when delivered in routine non-emergency settings. However, this success can be diluted by a high default rate, and the factors contributing to this need to be explored to improve programme effectiveness within communities. © 2017 John Wiley & Sons Ltd | Open |
| Amugsi D.A.; Dimbuene Z.T.; Kimani-Murage E.W.; Mberu B.; Ezeh A.C. | Differential effects of dietary diversity and maternal characteristics on linear growth of children aged 6-59 months in sub-Saharan Africa: A multi-country analysis | 2017 | Public Health Nutrition | Objective To investigate the differential effects of dietary diversity (DD) and maternal characteristics on child linear growth at different points of the conditional distribution of height-for-age Z-score (HAZ) in sub-Saharan Africa. Design Secondary analysis of data from nationally representative cross-sectional samples of singleton children aged 0-59 months, born to mothers aged 15-49 years. The outcome variable was child HAZ. Quantile regression was used to perform the multivariate analysis. Setting The most recent Demographic and Health Surveys from Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC). Subjects The present analysis was restricted to children aged 6-59 months (n 31 604). Results DD was associated positively with HAZ in the first four quantiles (5th, 10th, 25th and 50th) and the highest quantile (90th) in Nigeria. The largest effect occurred at the very bottom (5th quantile) and the very top (90th quantile) of the conditional HAZ distribution. In DRC, DD was significantly and positively associated with HAZ in the two lower quantiles (5th, 10th). The largest effects of maternal education occurred at the lower end of the conditional HAZ distribution in Ghana, Nigeria and DRC. Maternal BMI and height also had positive effects on HAZ at different points of the conditional distribution of HAZ. Conclusions Our analysis shows that the association between DD and maternal factors and HAZ differs along the conditional HAZ distribution. Intervention measures need to take into account the heterogeneous effect of the determinants of child nutritional status along the different percentiles of the HAZ distribution. © 2016 The Authors. | Open |
| Anankware P.J.; Osekre E.A.; Obeng-Ofori D.; Khamala C.M. | Factors that affect entomophagical practices in Ghana | 2017 | Journal of Insects as Food and Feed | This study evaluated the social and ecological factors that affect entomophagy in Ghana with a view to instigate the initiation of programmes for the use of insects for human and poultry nutrition in Africa. Two thousand questionnaires were administered to randomly selected respondents in all the ten regions of Ghana. With regards to social factors, entomophagy was found to be influenced by age, gender, education and occupation. Entomophagy is practiced across all age groups and gender in Ghana. Proportionally, 90, 78 and 74% of the aged (60+), middle aged (31-50) and the youth (18-30), respectively, were observed to consume various insect species. Ecologically, entomophagy was more pronounced in rural than urban areas. Over 87% of respondents who consume edible insects acquire them through harvesting/trapping. Four insect species were identified as feed for animals. The majority (81.6%) of the respondents consume insects as a source of protein, 9.6% for cultural reasons, 5.6% for medicinal values and 3.0 and 0.2%, respectively, for recreational and religious reasons. Gender has the least influence on entomophagy. Considering the economic, ecological and nutritional importance of edible insects in traditional Ghanaian foods, attention should be given to sustainable environmental harvesting practices. © 2016 Wageningen Academic Publishers. | Open |
| Arimond M.; Abbeddou S.; Kumwenda C.; Okronipa H.; Hemsworth J.; Jimenez E.Y.; Ocansey E.; Lartey A.; Ashorn U.; Adu-Afarwuah S.; Vosti S.A.; Hess S.Y.; Dewey K.G. | Impact of small quantity lipid-based nutrient supplements on infant and young child feeding practices at 18 months of age: results from four randomized controlled trials in Africa | 2017 | Maternal and Child Nutrition | Optimal infant and young child feeding (IYCF) practices can help ensure nutrient adequacy and support healthy growth and development. Small-quantity lipid-based nutrient supplements (SQ-LNS) have been proposed to help fill nutrient gaps, but little is known about the impact of provision of SQ-LNS on breastfeeding or complementary feeding practices. In the context of four coordinated randomized controlled nutrient supplementation trials in diverse sites in Africa, we compared IYCF practices at infant age 18 months (after 9–12 months of supplementation) between those receiving and not receiving SQ-LNS. Practices were assessed by caregiver recall. Continued breastfeeding ranged from 74% (Ghana site) to 97% (Burkina Faso site) and did not differ between groups in any site; prevalence of frequent breastfeeding also did not differ. In two sites (Burkina Faso and Malawi), infants receiving SQ-LNS were more likely to meet the World Health Organization recommendations for frequency of feeding (percentage point differences of 12–14%, P < 0.0001 and P = 0.005, respectively; the remaining two sites did not have data for this indicator). Most indicators of infant dietary diversity did not differ between groups in any site, but in the same two sites where frequency of feeding differed, infants receiving SQ-LNS were less likely to have low frequency of consumption of animal-source foods in the previous week (percentage point differences of 9–19% for lowest tertile, P =.02 and P = 0.04, respectively). We conclude that provision of SQ-LNS did not negatively impact self-reported IYCF practices and may have positively impacted frequency of feeding. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd. | Open |
| Assefa T.; Jha M.; Reyes M.; Schimmel K.; Tilahun S. | Commercial home gardens under conservation agriculture and drip irrigation for small holder farming in sub-Saharan Africa | 2017 | 2017 ASABE Annual International Meeting | Commercial home gardens under conservation agriculture (CA) combined with efficient water application technology have potential to contribute towards a sustainable agriculture development in sub-Sharan Africa (SSA). A USAID funded project conducted vegetable home garden experiments in three SSA countries (Ethiopia, Tanzania and Ghana) in order to investigate the effect of CA and conventional tillage (CT) practices both under drip irrigation. A total of 43 farmers are selected for this experiment in all three countries. The experiment is laid out in a paired t design on a 100 m2 plot to investigate the effect of CA and CT on vegetable yield and irrigation water management. Various level of discussion is conducted with farmers, governmental and non-governmental organizations to locate the sites, select farmers and establish the experiment. Data collection protocol is developed based on statistical analysis and field-scale modeling requirements. The results showed significant increase in vegetable yields under CA in Ethiopia and Ghana, but the lower yield is observed under CA in Tanzania due to pests and nitrogen stress associated banana leaf mulch. Similarly, significantly lower irrigation water is used under CA in Ethiopia. Various opportunities and challenges are observed in the context of these conservation agriculture setting that could potentially transform small holder farming communities for increasing food and nutrition security. Initial modeling attempt using Agriculture Policy/Environmental extender (APEX) model for home garden studies depicted consistent decrease of runoff and evapotranspiration under CA. | Open |
| Ayerakwa H.M. | Urban households' engagement in agriculture: implications for household food security in Ghana's medium sized cities | 2017 | Geographical Research | Urban and peri-urban agriculture plays an important role in meeting the food and nutrition needs of those living in the increasingly urbanised cities in Africa. The extent and scope of the practise of urban and peri-urban agriculture differs from one city to another depending on the economic, environmental, socio-political, and contextual conditions at play. Using household data drawn from urban Techiman and Tamale in the Brong Ahafo and Northern regions of Ghana respectively, this paper descriptively analyses the contribution of households' engagement in agriculture on urban households' food security. The results show that, nearly half (43%) of urban residents are involved in the production of food either in the urban or rural areas or both, primarily for household consumption and sale of surplus produce. Households who do not engage in agriculture raise their cash incomes through engagement in informal businesses. The picture is however different for households that engage in urban and rural agriculture. For such households, income raised from agriculture (rural and urban combined) is the highest in both cities contributing nearly half (43%) and about a third (33%) of total cash incomes in Techiman and Tamale respectively. The results underscore the need to place the discussion on the contribution of urban agriculture to urban food security in the broader context of the different food production arrangements available to urban households, both in urban and rural areas. © 2017 Institute of Australian Geographers | Open |
| Bertechini A.G. | Economic and Cultural Aspects of the Table Egg as an Edible Commodity | 2017 | Egg Innovations and Strategies for Improvements | Mexico, Malaysia, and Japan lead the world with each person consuming 329 or more eggs, whereas in other countries like India and Ghana, annual consumption is 63 and 12 eggs, respectively. The availability of eggs based on a country's wealth and the technology employed by the nation's egg industry influence egg consumption. Additional interactive factors affecting egg consumption center on the consumers with respect to their cultures, traditions, lifestyles, preferences, and attitudes. Consumers are concerned about the effect of egg consumption on their health. Additional concerns of high priority to many individuals include the welfare of the hens producing the eggs and the impact of production systems on the environment. Finally, the cost of eggs can influence an individual's purchase of eggs. Educating the consumer on the nutritional value of eggs from different production systems and breeds of chickens would help purchasers make informed choices. © 2017 Elsevier Inc. All rights reserved. | Open |
| Darteh E.K.M.; Acquah E.; Darteh F. | Why are our children wasting: Determinants of wasting among under 5s in Ghana | 2017 | Nutrition and Health | Background: Wasting is one of the indicators of malnutrition known to contribute to the deaths occurring from childhood malnutrition. It is the measure of body mass in relation to body length used to explain recent nutritional status. Aim: This paper examines the determinants of wasting among under 5s in Ghana. Method: Data were drawn from the 2014 Ghana Demographic and Health Survey children’s records file to examine the determinants of wasting among children. A total of 2720 children under 5 years with valid anthropometric data were used. Data on wasting were collected by measuring the weight and height of all children under 5 years of age. Bi-variate and multi-variate statistics are used to examine the determinants of wasting. Results: The bi-variate analysis showed significant differences (p < 0.001) in the prevalence of wasting among under 5s according to age of the child, region, and wealth status. On the other hand, the multi-variate analysis revealed that the odds of wasting were lower among children aged 24–35 months (Odds ratio (OR) = 0.37; p < 0.001), those from households of the middle wealth quintile (OR = 0.49, p < 0.05) and with health insurance (OR = 0.70; p < 0.10). Conclusions: Programmes and policies aimed at ensuring the survival of children during the first 24 months of life should be strengthened to reduce the risk of wasting among under 5s. Also, efforts should be made by the relevant government agencies and other stakeholders to strengthen the socio-economic status of mothers to enable them to provide adequate nutrition and improve access to health insurance for their children in order to reduce the incidence of wasting among these children. © The Author(s) 2017. | Open |
| Davis J.N.; Brown H.; Ramsay S.A. | Gaps in international nutrition and child feeding guidelines: A look at the nutrition and young child feeding education of Ghanaian nurses | 2017 | Public Health Nutrition | Objective To examine the nutrition and young child feeding (YCF) education and training of nurses in public health clinics of Ghana's Komenda-Edina-Eguafo-Abrem region (KEEA) in relation to global health guidelines, and how nurses served as educators for caregivers with children aged 0-5 years. Design A qualitative study of semi-structured one-on-one and group interviews (n 21) following a questionnaire of closed- and open-ended questions addressing child feeding, nutrition and global health recommendations. Interviews were conducted in English, audio-recorded, transcribed and coded. Descriptive data were tabulated. Content analysis identified themes from open-ended questions. Setting KEEA public health clinics (n 12). Subjects Nurses (n 41) purposefully recruited from KEEA clinics. Results A model capturing nurses' nutrition and YCF education emerged with five major themes: (i) adequacy of nurses' basic knowledge in breast-feeding, complementary feeding, iron-deficiency anaemia, YCF and hygiene; (ii) nurses' delivery of nutrition and YCF information; (iii) nurses' evaluation of children's health status to measure education effectiveness; (iv) nurses' perceived barriers of caregivers' ability to implement nutrition and YCF education; and (v) a gap in global health recommendations on YCF practices for children aged 2-5 years. Conclusions Nurses demonstrated adequate nutrition and YCF knowledge, but reported a lack of in-depth nutrition knowledge and YCF education for children 2-5 years of age, specifically education and knowledge of YCF beyond complementary feeding. To optimize child health outcomes, a greater depth of nutrition and YCF education is needed in international health guidelines. Copyright © The Authors 2017. | Open |
| de Jager I.; Abizari A.-R.; Douma J.C.; Giller K.E.; Brouwer I.D. | Grain legume cultivation and children’s dietary diversity in smallholder farming households in rural Ghana and Kenya | 2017 | Food Security | Boosting smallholder food production can potentially improve children’s nutrition in rural Sub-Saharan Africa through a production-own consumption pathway and an income-food purchase pathway. Rigorously designed studies are needed to provide evidence for nutrition impact, but are often difficult to implement in agricultural projects. Within the framework of a large agricultural development project supporting legume production (N2Africa), we studied the potential to improve children’s dietary diversity by comparing N2Africa and non-N2Africa households in a cross-sectional quasi-experimental design, followed by structural equation modelling (SEM) and focus group discussions in rural Ghana and Kenya. Comparing N2Africa and non-N2Africa households, we found that participating in N2Africa was not associated with improved dietary diversity of children. However, for soybean, SEM indicated a relatively good fit to the posteriori model in Kenya but not in Ghana, and in Kenya only the production-own consumption pathway was fully supported, with no effect through the income-food purchase pathway. Results are possibly related to differences in the food environment between the two countries, related to attribution of positive characteristics to soybean, the variety of local soybean-based dishes, being a new crop or not, women’s involvement in soybean cultivation, the presence of markets, and being treated as a food or cash crop. These findings confirm the importance of the food environment for translation of enhanced crop production into improved human nutrition. This study also shows that in a situation where rigorous study designs cannot be implemented, SEM is a useful option to analyse whether agriculture projects have the potential to improve nutrition. © 2017, The Author(s). | Open |
| De Saint Sauveur A.; Amenglor M.G.; Kinda J.; Colomban F. | Enhancing nutrient intake from moringa leaves through adequate consumption patterns | 2017 | Acta Horticulturae | Moringa leaves are rich in proteins and micronutrients. Moringanews has promoted their production, processing and use in many African countries to fight against malnutrition and to develop new agricultural and entrepreneurial activities. Promoting the consumption of fresh leaves entails working on food habits and developing adequate recipes to preserve nutrients and to enhance their bioavailability. A short review of studies is presented on the effect of heat on nutrients, and on how to associate various food products to enhance bioavailability. Dried moringa leaf powder can be used to enrich food preparations such as baby flours, biscuits, pasta or almost any kind of cereal product. Moringanews has worked with nutritionists and food processors to develop these new products. A first study, implemented with the Food Research Institute in Ghana on the impact of various drying methods on moringa leaves' nutritional content is presented here. A second study, in collaboration with the Institut de Recherche pour le Développement, France, resulted in the design of three infant formulas made of African local products and moringa leaf powder. The third study involves the association Misola in Burkina Faso, which tested moringa leaf powder as an addition to their baby formula. Lastly, Moringanews worked with a research team at Danone to test the addition of moringa leaf powder in a pasteurized high energy paste, Lemateki, designed for school aged children in Senegal. However, the use of moringa leaf powder in processed food is limited by various factors. It is a fragile product, prone to bacterial or fungal contamination, and its production entails respecting professional food processing standards. Another limitation is the lack of shelf life studies to assess the evolution of vitamins over time. Finally, more scientific data are needed on the impact of moringa leaf consumption on the human body. | Open |
| Galbete C.; Nicolaou M.; Meeks K.A.; Aikins A.D.-G.; Addo J.; Amoah S.K.; Smeeth L.; Owusu-Dabo E.; Klipstein-Grobusch K.; Bahendeka S.; Agyemang C.; Mockenhaupt F.P.; Beune E.J.; Stronks K.; Schulze M.B.; Danquah I. | Food consumption, nutrient intake, and dietary patterns in ghanaian migrants in europe and their compatriots in Ghana | 2017 | Food and Nutrition Research | Background: West African immigrants in Europe are disproportionally affected by metabolic conditions compared to European host populations. Nutrition transition through urbanisation and migration may contribute to this observations, but remains to be characterised. Objective: We aimed to describe the dietary behaviour and its socio-demographic factors among Ghanaian migrants in Europe and their compatriots living different Ghanaian settings. Methods: The multi-centre, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study was conducted among Ghanaian adults in rural and urban Ghana, and Europe. Dietary patterns were identified by principal component analysis. Results: Contributions of macronutrient to the daily energy intake was different across the three study sites. Three dietary patterns were identified. Adherence to the ‘mixed’ pattern was associated with female sex, higher education, and European residency. The ‘rice, pasta, meat, and fish’ pattern was associated with male sex, younger age, higher education, and urban Ghanaian environment. Adherence to the ‘roots, tubers, and plantain’ pattern was mainly related to rural Ghanaian residency. Conclusion: We observed differences in food preferences across study sites: in rural Ghana, diet concentrated on starchy foods; in urban Ghana, nutrition was dominated by animal-based products; and in Europe, diet appeared to be highly diverse. © 2017 The Author(s). | Open |
| Gruber J.F.; Hille D.A.; Liu G.F.; Kaplan S.S.; Nelson M.; Goveia M.G.; Mast T.C. | Heterogeneity of Rotavirus Vaccine Efficacy among Infants in Developing Countries | 2017 | Pediatric Infectious Disease Journal | Background: Rotavirus is the leading cause of severe diarrhea worldwide in young children. Although rotavirus vaccine efficacy is high in developed countries, efficacy is lower in developing countries. Here, we investigated heterogeneity of rotavirus vaccine efficacy by infant characteristics in developing countries. Methods: An exploratory, post hoc analysis was conducted using randomized controlled trial data of the pentavalent rotavirus vaccine (RV5) conducted in Africa and Asia (NCT00362648). Infants received either 3 doses of vaccine/placebo and were followed for up to 2 years. Within subgroups, vaccine efficacies and 95% confidence intervals (CIs) against rotavirus gastroenteritis (RVGE) were estimated using Poisson regression. We assessed heterogeneity of efficacy by age at first dose, gender, breastfeeding status and nutrition status. Results: African children receiving the first dose at <8 weeks had lower efficacy (23.7%; 95% CI: -8.2%-46.3%) than those vaccinated at ≥8 weeks (59.1%; 95% CI: 34.0%-74.6%). Marginally statistically significant differences were observed by age at first dose, gender and underweight status in Ghana and gender in Asian countries. Conclusions: Heterogeneity of efficacy was observed for age at first dose in African countries. This was an exploratory analysis; additional studies are needed to validate these results. Copyright © 2016 Wolters Kluwer Health, Inc. | Open |
| Hetherington J.B.; Wiethoelter A.K.; Negin J.; Mor S.M. | Livestock ownership, animal source foods and child nutritional outcomes in seven rural village clusters in Sub-Saharan Africa | 2017 | Agriculture and Food Security | Background: Sub-Saharan Africa currently has the highest prevalence of malnutrition worldwide. In children under the age of 5years, malnutrition can have long-term effects on physical and cognitive development, with implications at the national scale. Theoretically, livestock-based interventions are well placed to overcome constraints faced by micronutrient and/or food-based interventions. However, there is limited empirical evidence to support this hypothesis. Methods: This study utilised agriculture, nutrition and anthropometry data from the Millennium Villages Project to investigate relationships between livestock ownership, animal source foods (ASF) consumption and child nutritional outcomes across seven rural village clusters in Sub-Saharan Africa. Village clusters were located in different agro-ecological zones and included: Bonsaaso, Ghana; Mayange, Rwanda; Mwandama, Malawi; Tiby, Mali; Pampaida, Nigeria; Potou, Senegal; and Ruhiira, Uganda. Data from 1624 households (including 1543 children) were included in the analysis. Results: Overall, the proportion of children with stunting, underweight or wasting across the seven village clusters was 40, 18 and 5%, respectively. Livestock ownership, ASF consumption and child nutritional outcomes varied between village clusters. Households that owned livestock were generally more likely to consume associated ASF. For example, the proportion of households that consumed milk was higher in households that owned cows compared to those that did not in Pampaida, Mayange and Ruhiira (P<0.05), while poultry meat consumption was generally higher in poultry-keeping households in Mayange and Ruhiira (P<0.05). The relationship between ASF consumption and anthropometric measurements was complex, ranging from positively to negatively associated depending on the food commodity and village cluster. For instance, in Ruhiira, the mean weight-for-age Z score(WAZ) was significantly higher (better) in children from households that consumed eggs in the last 30days, while in Potou, mean WAZ was significantly lower (worse) in children from households that consumed eggs in the last 30days (P<0.05). Conclusions: This study contributes to the growing body of research that investigates the relationships between livestock ownership, ASF consumption and nutritional outcomes in children. Our results reveal complex patterns that vary across agro-ecological zones. More research is needed to assess seasonal variations in these factors, effects of gender roles on intra-household distribution of ASF, as well as effects of zoonotic food-borne diseases on nutritional status of children in these sites. © 2017 The Author(s). | Open |
| Humphries D.; Nguyen S.; Kumar S.; Quagraine J.E.; Otchere J.; Harrison L.M.; Wilson M.; Cappello M. | Effectiveness of albendazole for hookworm varies widely by community and correlates with nutritional factors: A cross-sectional study of school-age children in Ghana | 2017 | American Journal of Tropical Medicine and Hygiene | Mass drug administration (MDA) targeting school-age children is recommended by the World Health Organization for the global control of soil-transmitted helminth (STH) infections. Although considered safe and cost-effective to deliver, benzimidazole anthelminthics are variably effective against the three most common STHs, and widespread use has raised concern about the potential for emerging resistance. To identify factors mediating response to albendazole, we conducted a cross-sectional study of hookworm infection in the Kintampo North Municipality of Ghana in 2011. Among 140 school-age children residing in five contiguous communities, the hookworm prevalence was 59% (82/140). The overall cure rate following administration of single-dose albendazole (400 mg) was 35% (27/76), with a community-wide fecal egg reduction rate (ERR) of 61% (95% confidence interval: 51.8-71.1). Significant disparities were observed in albendazole effectiveness by community, with a cure rate as low as 0% (N = 24) in Jato Akuraa and ERRs ranging from 53% to 95% across the five study sites. Individual host factors associated with response to deworming treatment included time since last meal, pretreatment blood hemoglobin level, and mid-upper arm circumference. These data demonstrate significant community-level variation in the effectiveness of albendazole, even among populations living in close proximity. Identification of host factors that influence response to albendazole, most notably the timing of drug administration and nutritional factors, creates an opportunity to enhance the effectiveness of deworming through targeted interventions. These findings also demonstrate the importance of measuring anthelminthic response as part of the monitoring and evaluation of community-based deworming programs. © 2017 by The American Society of Tropical Medicine and Hygiene. | Open |
| Jaacks L.M.; Kavle J.; Perry A.; Nyaku A. | Programming maternal and child overweight and obesity in the context of undernutrition: Current evidence and key considerations for low- and middle-income countries | 2017 | Public Health Nutrition | The goals of the present targeted review on maternal and child overweight and obesity were to: (i) understand the current situation in low- and middle-income countries (LMIC) with regard to recent trends and context-specific risk factors; and (ii) building off this, identify entry points for leveraging existing undernutrition programmes to address overweight and obesity in LMIC. Trends reveal that overweight and obesity are a growing problem among women and children in LMIC; as in Ghana, Kenya, Niger, Sierra Leone, Tanzania and Zimbabwe, where the prevalence among urban women is approaching 50 %. Four promising entry points were identified: (i) the integration of overweight and obesity into national nutrition plans; (ii) food systems (integration of food and beverage marketing regulations into existing polices on the marketing of breast-milk substitutes and adoption of policies to promote healthy diets); (iii) education systems (integration of nutrition into school curricula with provision of high-quality foods through school feeding programmes); and (iv) health systems (counselling and social and behaviour change communication to improve maternal diet, appropriate gestational weight gain, and optimal infant and young child feeding practices). We conclude by presenting a step-by-step guide for programme officers and policy makers in LMIC with actionable objectives to address overweight and obesity. Copyright © The Authors 2017 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (. | Open |
| Laar A.; Kotoh A.; Parker M.; Milani P.; Tawiah C.; Soor S.; Anankware J.P.; Kalra N.; Manu G.; Tandoh A.; Zobrist S.; Engmann C.; Pelto G. | An Exploration of Edible Palm Weevil Larvae (Akokono) as a Source of Nutrition and Livelihood: Perspectives From Ghanaian Stakeholders | 2017 | Food and Nutrition Bulletin | Background: Meeting the nutritive needs of infants and young children is a challenge in Ghana. Alternative animal source foods, including insects, could enhance infant and young child dietary quality while also improving livelihoods. Objective: To investigate the perspectives of Ghanaian stakeholders on the acceptability of the palm weevil larvae (akokono) as a food source and the feasibility of micro-farming this local edible insect as a complementary food for infants and young children. Methods: We conducted an ethnographic study in the Brong-Ahafo Region of Ghana. First, 48 caregivers were asked questions about feeding and care practices, including attitudes toward production and consumption of akokono. Then, a selection of previously interviewed respondents joined 1 of 8 focus group discussions to provide further insight on key themes that emerged from earlier interviews. Concurrently, interviews with 25 other key local stakeholders were conducted. Results: Respondents generally had favorable perceptions of akokono as a nutritious food. A small minority would not consume akokono for religious reasons. Key factors positively influencing the acceptability of akokono as a complementary food were familiarity with the consumption of akokono by the primary caregiver and health worker endorsement of akokono. Stakeholders consider the larvae farmable and were open to its domestication. Conclusions: Anticipated barriers to scaling up akokono micro-farming include a need for greater familiarity with and acceptance of the insect as food for infants and young children and creation of a sustainable market. Engagement with stakeholders, including health workers, will facilitate use of akokono as a complementary food. © 2017, © The Author(s) 2017. | Open |
| Laar A.K.; Aryeetey R.N.O.; Annan R.; Aryee P.A.; Amagloh F.K.; Akparibo R.; Laar M.E.; Amuna P.; Zotor F.B. | Contribution of scaling up nutrition Academic Platforms to nutrition capacity strengthening in Africa: Local efforts, continental prospects and challenges | 2017 | Proceedings of the Nutrition Society | Addressing contemporary nutrition problems often requires application of knowledge from multiple disciplines. The scaling up nutrition (SUN) movement harnesses multiple sectors for effective global and in-country planning and implementation. Although the role of knowledge networks (academia and research institutions) is recognised, the how of engaging knowledge networks in the current SUN architecture is only now becoming apparent. For relevant sectors to play their roles effectively, observed capacity gaps, particularly in developing country settings, need to be addressed. The present paper presents the work being undertaken by the Ghana SUN Academic Platform (AP), a local knowledge network, towards strengthening nutrition capacity in Ghana. The AP presently provides technical support, evidence and capacity towards scaling up effective nutrition interventions in Ghana and beyond. The data presented draws heavily on the observations and collective experiences of the authors in practice, complemented by a review of relevant literature. The ultimate goal of the AP is to build capacity of professionals from nutrition and cognate sectors (including planning, agriculture, health, economics, research and academia). This is an essential ingredient for effective and durable SUN efforts. The paper recognises that both disciplinary and interdisciplinary capacity is required for effective SUN efforts in Africa, and offers an approach that utilises cross-sector/inter-professional, peer-learning and experiential learning initiatives. © The Authors 2017. | Open |
| Laar A.K.; Aryeetey R.N.O.; Mpereh M.; Zotor F.B. | Improving nutrition-sensitivity of social protection programmes in Ghana | 2017 | Proceedings of the Nutrition Society | Social protection (SP) has been demonstrated as an effective tool against poverty and severe hunger. In Ghana, SP interventions have been employed to address vulnerability to poverty since 1965. Nevertheless, its potential for enhancing nutrition has hardly been explored. To harness the cross-sectoral benefits of scaling up nutrition-sensitive actions in Ghana, the national development planning commission requested an assessment of nutrition linkages across existing SP policies and programmes. The present paper presents gaps and opportunities for improving nutrition-sensitivity of existing SP programming in Ghana. The evidence draws heavily on desk review of available published and grey literature. The data show that SP provides an entry point for mainstreaming nutrition into other programmes. However, designing and coupling SP programmes with nutrition programmes remain a challenge in Ghana. Local SP interventions are predominantly designed as standalone services and therefore are implemented independent of each other. To increase synergy between SP and nutrition, including nutrition as an explicit objective of SP policies/strategies is recommended. © 2017 The Authors. | Open |
| Leyvraz M.; Aaron G.J.; Poonawala A.; van Liere M.J.; Schofield D.; Myatt M.; Neufeld L.M. | Coverage of nutrition interventions intended for infants and young children varies greatly across programs: Results from coverage surveys in 5 countries | 2017 | Journal of Nutrition | Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d'Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap. © 2017 American Society for Nutrition. | Open |
| Lo Vecchio A.; Liguoro I.; Dias J.A.; Berkley J.A.; Boey C.; Cohen M.B.; Cruchet S.; Salazar-Lindo E.; Podder S.; Sandhu B.; Sherman P.M.; Shimizu T.; Guarino A. | Rotavirus immunization: Global coverage and local barriers for implementation | 2017 | Vaccine | Background Rotavirus (RV) is a major agent of gastroenteritis and an important cause of child death worldwide. Immunization (RVI) has been available since 2006, and the Federation of International Societies of Gastroenterology Hepatology and Nutrition (FISPGHAN) identified RVI as a top priority for the control of diarrheal illness. A FISPGHAN working group on acute diarrhea aimed at estimating the current RVI coverage worldwide and identifying barriers to implementation at local level. Methods A survey was distributed to national experts in infectious diseases and health-care authorities (March 2015–April 2016), collecting information on local recommendations, costs and perception of barriers for implementation. Results Forty-nine of the 79 contacted countries (62% response rate) provided a complete analyzable data. RVI was recommended in 27/49 countries (55%). Although five countries have recommended RVI since 2006, a large number (16, 33%) included RVI in a National Immunization Schedule between 2012 and 2014. The costs of vaccination are covered by the government (39%), by the GAVI Alliance (10%) or public and private insurance (8%) in some countries. However, in most cases, immunization is paid by families (43%). Elevated cost of vaccine (49%) is the main barrier for implementation of RVI. High costs of vaccination (rs = −0.39, p = 0.02) and coverage of expenses by families (rs = 0.5, p = 0.002) significantly correlate with a lower immunization rate. Limited perception of RV illness severity by the families (47%), public-health authorities (37%) or physicians (24%) and the timing of administration (16%) are further major barriers to large- scale RVI programs. Conclusions After 10 years since its introduction, the implementation of RVI is still unacceptably low and should remain a major target for global public health. Barriers to implementation vary according to setting. Nevertheless, public health authorities should promote education for caregivers and health-care providers and interact with local health authorities in order to implement RVI. © 2017 Elsevier Ltd | Open |
| Lori J.R.; Ofosu-Darkwah H.; Boyd C.J.; Banerjee T.; Adanu R.M.K. | Improving health literacy through group antenatal care: A prospective cohort study | 2017 | BMC Pregnancy and Childbirth | Background: To examine whether exposure to group antenatal care increased women's health literacy by improving their ability to interpret and utilize health messages compared to women who received standard, individual antenatal care in Ghana. Methods: We used a prospective cohort design. The setting was a busy urban district hospital in Kumasi, the second most populous city in Ghana. Pregnant women (N = 240) presenting for their first antenatal visit between 11 and 14 weeks gestation were offered participation in the study. A 27% drop-out rate was experienced due to miscarriage, transfer or failure to return for follow-up visits, leaving 184 women in the final sample. Data were collected using an individual structured survey and medical record review. Summary statistics as well as two sample t-tests or chi-square were performed to evaluate the group effect. Results: Significant group differences were found. Women participating in group care demonstrated improved health literacy by exhibiting a greater understanding of how to operationalize health education messages. There was a significant difference between women enrolled in group antenatal care verses individual antenatal care for preventing problems before delivery, understanding when to access care, birth preparedness and complication readiness, intent to use a modern method of family planning postpartum, greater understanding of the components of breastfeeding and lactational amenorrhea for birth spacing, and intent for postpartum follow-up. Conclusion: Group antenatal care as compared to individual care offers an opportunity to increase quality of care and improve maternal and newborn outcomes. Group antenatal care holds the potential to increase healthy behaviors, promote respectful maternity care, and generate demand for services. Group ANC improves women's health literacy on how to prevent and recognize problems, prepare for delivery, and care for their newborn. © 2017 The Author(s). | Open |
| Menyanu E.; Charlton K.E.; Ware L.J.; Russell J.; Biritwum R.; Kowal P. | Salt use behaviours of ghanaians and south africans: A comparative study of knowledge, attitudes and practices | 2017 | Nutrients | Salt consumption is high in Africa and the continent also shares the greatest burden of hypertension. This study examines salt-related knowledge, attitude and self-reported behaviours (KAB) amongst adults from two African countries—Ghana and South Africa—which have distributed different public health messages related to salt. KAB was assessed in the multinational longitudinal World Health Organisation (WHO) study on global AGEing and adult health (WHO-SAGE) Wave 2 (2014–2015). Respondents were randomly selected across both countries—Ghana (n = 6746; mean age 58 years old; SD 17; 41% men; 31% hypertensive) and South Africa (n = 3776, mean age 54 years old; SD 17; 32% men; 45% hypertensive). South Africans were more likely than Ghanaians to add salt to food at the table (OR 4.80, CI 4.071–5.611, p < 0.001) but less likely to add salt to food during cooking (OR 0.16, CI 0.130–0.197, p < 0.001). South Africans were also less likely to take action to control their salt intake (OR 0.436, CI 0.379–0.488, p < 0.001). Considering the various salt reduction initiatives of South Africa that have been largely absent in Ghana, this study supports additional efforts to raise consumer awareness on discretionary salt use and behaviour change in both countries. © 2017 by the authors. Licensee MDPI, Basel, Switzerland. | Open |
| Mogre V.; Aryee P.A.; Stevens F.C.J.; Scherpbier A.J.J.A. | Future Doctors’ Nutrition-Related Knowledge, Attitudes and Self-Efficacy Regarding Nutrition Care in the General Practice Setting: A Cross-Sectional Survey | 2017 | Medical Science Educator | Background: Doctors are in a good position to provide nutrition advice to patients. However, doctors and medical students find their nutrition education to be inadequate. We evaluated nutrition-related knowledge, attitudes and self-efficacy in a sample of future doctors. Furthermore, we investigated the association between nutrition-related knowledge, attitude and self-efficacy. We also compared nutrition-related knowledge, attitudes and self-efficacy with level of clinical training. Methods: Following a cross-sectional design, the nutrition-related knowledge, attitudes and self-efficacy of 207 undergraduate clinical-level medical students (referred to as future doctors) was measured using a questionnaire. Items of the questionnaire were derived from previously validated survey instruments. Descriptive statistics of mean and standard deviation was used to describe the data. Results: Future doctors had a mean knowledge score of 64%. Their mean knowledge scores in the nutrition topics assessed were 41% for ‘malnutrition in children’, 59% for ‘diabetes and obesity’ and 73% for ‘nutrients, energy and their deficiencies’. Future doctors’ attitudes towards nutrition care were generally positive but were uncertain in the effectiveness of health education in changing the lifestyle of patients. They felt inadequate in their self-efficacy to provide nutrition care. Attitudes towards nutrition care correlated (r = 0.371, p < 0.001) positively with self-efficacy to provide nutrition care. Level of clinical training was associated to nutrition-related knowledge of the students. Conclusion: Future doctors had positive attitudes towards nutrition care but showed important knowledge gaps and also felt inadequate in their confidence to provide nutrition care. Attitudes may be important in nutrition care self-efficacy. © 2017, The Author(s). | Open |
| Mogre V.; Yakubu A.; Fuseini M.; Amalba A.; Aguree S. | Nurses' knowledge and attitudes regarding malnutrition in children and its management in Ghana | 2017 | Curationis | BACKGROUND: Malnutrition contributes significantly to child morbidity and mortality. Nurses require appropriate knowledge, skills and attitudes to prevent and treat malnutrition in children using appropriate guidelines or protocols. OBJECTIVES: The aim of this article was to assess nurses' knowledge, attitudes towards malnutrition and its management using the World Health Organization (WHO) or United Nations International Children's Fund guidelines for the treatment of severely malnourished children and to evaluate factors associated with their knowledge and attitudes. METHODS: Participants included 104 nurses working in the outpatient and paediatric units or departments of four hospitals in Tamale metropolis. An 88-item questionnaire was used to measure nurses' socio-demographic characteristics as well as their knowledge and attitudes towards malnutrition in children and its management using the WHO guidelines for the inpatient treatment of severely malnourished children. RESULTS: Nurses' knowledge in malnutrition and its management was slightly above average (54.0%), but their attitudes were highly positive. Factors that were associated with nurses' knowledge were number of nutrition courses undertaken in nursing school, number of years working as a nurse, receipt of a refresher course on nutrition after school and receipt of training on the guidelines. Nurses' attitudes were associated with report of having awareness on the guidelines, number of years a nurse has been involved in the treatment of a severely malnourished child. CONCLUSION: Nurses' knowledge levels in the inpatient treatment of severely malnourished children were not desirable. However, their attitudes were generally positive. Receipt of previous training, awareness of the WHO guidelines, practice experience and number of years as a nurse significantly affected knowledge and attitude scores in the positive direction. | Open |
| Oaks B.M.; Young R.R.; Adu-Afarwuah S.; Ashorn U.; Jackson K.H.; Lartey A.; Maleta K.; Okronipa H.; Sadalaki J.; Baldiviez L.M.; Shahab-Ferdows S.; Ashorn P.; Dewey K.G. | Effects of a lipid-based nutrient supplement during pregnancy and lactation on maternal plasma fatty acid status and lipid profile: Results of two randomized controlled trials | 2017 | Prostaglandins Leukotrienes and Essential Fatty Acids | It is unknown whether a novel small-quantity lipid-based nutrient supplement (SQ-LNS) containing alpha-linolenic (ALA) and linoleic acids impacts maternal plasma lipids and fatty acid status. We measured plasma fatty acids (wt%) and lipid concentrations at 36 wk gestation and breast milk fatty acids (wt%) at 6 months postpartum in a subsample of women enrolled in a randomized controlled trial studying the effects of SQ-LNS on birth outcomes and child growth. Women≤20 wk gestation in Ghana (n=1,320) and Malawi (n=1,391) were assigned to receive daily either: 1) iron-folic acid (pregnancy); 2) multiple micronutrients (pregnancy and lactation); or 3) SQ-LNS (pregnancy and lactation). At 36 wk, plasma ALA levels were higher in those receiving SQ-LNS. SQ-LNS increased breast milk ALA in Ghana but not Malawi. There was no effect on plasma lipids or other selected fatty acids. SQ-LNS may impact plasma and breast milk ALA levels depending on the population. © 2017 The Authors | Open |
| Ofori-Asenso R.; Agyeman A.A.; Ashiagbor G. | Anthropometric profiles of child-bearing women in Ghana - past measurements and future trends | 2017 | Open Public Health Journal | Background: Temporal changes in anthropometric indices of Ghanaian adults have not been thoroughly researched. In this study, we present results and projections of mean BMI, underweight and obesity prevalence among women (15-49 years) in Ghana. Methods: This is a secondary analysis of the mean BMI, underweight and obesity prevalence data reported in the Demographic and Health Survey (DHS) studies in Ghana between 1993 and 2014. Using a simple linear change (regression) model approach, we determine the rate of change of the anthropometric measures and project estimates for the years 2020, 2025 and 2030. Results: Between 1993 and 2014, the mean BMI among Ghanaian women increased by 3 kg/m2 and by 2030, the average Ghanaian woman will have a BMI of around 27.3 Kg/m2. Underweight prevalence has decreased by about 45% from 11.3% in 1993/1998 to 6.2% in 2014 and projected to reach 2.2% by 2030. Obesity on the other hand has seen significant increase of over 400% from 3.4% in 1993 to 15.3% in 2014. By 2030, nearly 23% of Ghanaian women are projected to be obese. Conclusions: Among Ghanaian women, obesity has now outstripped underweight in terms of public health significance. Greater emphasis and urgent measures to address the rising obesity in this country are needed. While the observed trends should inform future healthcare planning and resource allocation, this should in no way undermine undernutrition prevention efforts, as preventing undernourishment is still a good investment for this country. Rather, a broader perspective that seeks to address both undernutrition and overnutrition healthy individuals should be rigorously pursued. © 2017 Ofori-Asenso et al. | Open |
| Omari R.; Quorantsen K.E.; Omari P.K. | Nutrition knowledge and food consumption practices and barriers in rural Ghana: The case of foods for preventing vitamin A and iron deficiencies | 2017 | African Journal of Food, Agriculture, Nutrition and Development | Food-based approaches such as dietary diversification, nutrient retention and biofortification combined with nutrition education can be effective in eliminating micronutrient deficiencies. The objective of this study was to assess the nutrition knowledge and consumption practices as well as barriers to consumption with specific focus on food-based approaches to vitamin A and iron deficiencies prevention and to identify individual, community and governmental level strategies that may facilitate the adoption of these approaches. Using qualitative methods, one focus group (FG) discussion each was conducted with members of the Cocoa Farmers' Cooperatives in each of the 25 rural communities in the Amansie West and Asunafo North Districts in Ghana. Findings showed participants in only 3 FGs had knowledge of vitamin A and its deficiency diseases while only 2 FGs had knowledge of foods that could prevent vitamin A deficiency. Participants in 23 FGs were aware of the occurrence of iron deficiency anaemia especially in pregnant women; however, only 8 FGs had knowledge of the causes of anaemia. Furthermore, all the 25 FGs mentioned the use of haematinics in the treatment and prevention of anaemia but only 4 FGs knew about the use of food-based approaches. Various types of animal products, vegetables, fruits, and legumes, which are useful in preventing vitamin A and iron deficiencies, were found to be available in the communities. However, participants in all the 25 FGs indicated that the consumption of these foods particularly dark-green leafy vegetables has been dwindling with time. The FG participants mentioned a number of barriers to consumption of these foods and they include inadequate knowledge of nutritional value of the foods, lack of cooking skill, low production levels, laziness, conflicting media reports, lack of storage facilities, and contamination with agrochemicals. Findings imply that nutrition interventions should focus on education and awareness creation and implementation of strategies that can remove consumption barriers and facilitate the adoption of food-based approaches for managing micronutrient deficiencies. | Open |
| Prado E.L.; Abbeddou S.; Adu-Afarwuah S.; Arimond M.; Ashorn P.; Ashorn U.; Bendabenda J.; Brown K.H.; Hess S.Y.; Kortekangas E.; Lartey A.; Maleta K.; Oaks B.M.; Ocansey E.; Okronipa H.; Ouédraogo J.B.; Pulakka A.; Somé J.W.; Stewart C.P.; Stewart R.C.; Vosti S.A.; Yakes Jimenez E.; Dewey K.G. | Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso | 2017 | Journal of Child Psychology and Psychiatry and Allied Disciplines | Background: Previous reviews have identified 44 risk factors for poor early child development (ECD) in low- and middle-income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD. Methods: We conducted path analyses of factors associated with 18-month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD. Results: Out of 42 indicators of the 34 factors examined, 6 were associated with 18-month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts. Conclusions: Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status. © 2017 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health. | Open |
| Pudlo J. | Food, Health, and Nutrition in Ghana | 2017 | Home healthcare now | Not Available | Open |
| Ross W.L.; Gallego-Pérez D.F.; Lartey A.; Sandow A.; Pérez-Escamilla R.; Hromi-Fiedler A. | Dietary patterns in Liberian refugees in Buduburam, Ghana | 2017 | Maternal and Child Nutrition | Previous research suggests that acculturation (i.e., exposure and assimilation to local culture) is associated with changes in dietary patterns among immigrants. This study investigates this association in a refugee population using time in refugee settlement as a proxy for acculturation. A cross-sectional survey was conducted among a systematic sample to (a) identify dietary patterns in Liberian refugees and Ghanaians living in or near a refugee settlement, (b) compare adherence to these dietary patterns between groups, and (c) investigate the association between acculturation and dietary patterns in Liberian refugees. Participants were Liberian and Ghanaian women with young children living in the Buduburam refugee settlement or Awutu in Ghana (n = 480; 50% Liberian; mean age 28, SD 6.3, range 16–48 years). Time in settlement was assessed by self-report; food consumption was assessed by food frequency questionnaire. Principal component analysis was used to identify dietary patterns; a generalized linear model was used to test the association of interest. Three distinct dietary patterns emerged: Healthy, Sweets, and Fats. Ghanaians were more adherent to the Healthy pattern than Liberians (p < 0.05). Liberians were more adherent to the Sweets and Fats patterns than Ghanaians (p < 0.05). There were no significant differences in dietary pattern adherence among the Liberians based on time in settlement. Ghanaians living in Awutu were more adherent to the Healthy pattern than Ghanaians who lived in settlement (p < 0.05). Differences in dietary patterns were observed between Liberian refugees and Ghanaians. These differences were not associated with acculturation and may be related to the food environment in the settlement. © 2016 John Wiley & Sons Ltd | Open |
| Saaka M.; Galaa S.Z. | How is dietary diversity related to haematological status of preschool children in Ghana? | 2017 | Food and Nutrition Research | Background: The role of dietary diversity on blood biomarkers may be significant, but the evidence is limited. Objective: This study assessed the association between dietary diversity and haematological status of children aged 6-59 months controlling for various known confounders. Design: The analysis in this study is based on the 2014 Ghana Demographic and Health survey data.The study involved 2,388 pre-school children aged 6-59 months who constituted the sub-sample for anaemia assessment. Results: The mean haemoglobin concentration (Hb) was 10.2 g/dl ± 1.50 (95 % CI: 10.1 to 10.3), and anaemia prevalence (Hb < 11 g/dl) among children aged 6-59 months was 66.8 % (CI: 63.7 to 69.8). In multivariable logistic regression analysis,continued breastfeeding [Adjusted odds ratio (AOR) = 1.9 (95% CI: 1.19–2.91], 12–23 months of age (AOR = 2.4 (95% CI: 1.40–3.98), having fever in last two weeks (AOR = 1.7 (95% CI: 1.20–2.45, birth interval ≤ 24 months (AOR = 1.9 (1.20–2.84), and poorest wealth quintile (AOR = 2.6 (95% CI: 1.48–4.48) were positively associated with anaemia. Conclusion: The current study showed that factors other than poor dietary diversity predicted anaemia among children aged 6–59 months in Ghana. © 2017 The Author(s). | Open |
| Saaka M.; Oladele J.; Larbi A.; Hoeschle-Zeledon I. | Household food insecurity, coping strategies, and nutritional status of pregnant women in rural areas of Northern Ghana | 2017 | Food Science and Nutrition | There is limited information on the magnitude and determinants of household food insecurity (HFI) and how it relates to the nutritional status of pregnant women in Northern Ghana. The magnitude, determinants of HFI, and how it relates to the nutritional status of pregnant women were evaluated in the Africa RISING West Africa project intervention communities in Northern Ghana. The prevalence of moderate and severe household hunger was 25.9% (95% CI: 19.0, 34.3) and 6.8% (95% CI: 4.2, 10.9) respectively. The independent predictors of maternal thinness were region of residence, gestational age and maternal age. Compared to women in the first trimester, women in the third trimester were 2.2 times more likely of being underweight adjusted odds ratio (AOR = 2.19, CI: 1.02, 4.70). Women who were under 20 years of age were 11.9 times more likely of being thin compared to women aged more than 35 years (AOR = 11.97, CI: 2.55, 5. 67). Food insecurity was highly prevalent but it was not associated with maternal thinness of pregnant women. The risk of maternal thinness increased as the gestational age increased and this has a great potential of adversely influencing pregnancy outcomes and overall quality of life. © 2017 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc. | Open |
| Sugri I.; Maalekuu B.K.; Gaveh E.; Kusi F. | Sweet Potato Value Chain Analysis Reveals Opportunities for Increased Income and Food Security in Northern Ghana | 2017 | Advances in Agriculture | Sweet potato has gained prominence due to its ability to adapt to wide production ecologies and yield response to minimal external inputs. Orange-fleshed cultivars in particular have immense potential to improve household income and nutrition in sub-Saharan Africa. However, the sweet potato value chain (SPVC) is not well-developed in many producing countries. The study was conducted in two regions to characterize the production operations as well as identify opportunities to propel the SPVC in Northern Ghana. Data were collected using mixed methods including structured questionnaires via face-to-face interviews. Analysis of strengths, weaknesses, opportunities, and threats (SWOT) was conducted at multistakeholder platforms with different actors. Gross margin profit and benefit-cost ratios were determined by using six cost variables. Overall, the industry was largely a fresh produce market, targeting food vendors, processors, and direct selling to wholesalers, retailers, and household consumers. The SWOT analysis revealed wide-ranging opportunities including favourable production ecologies, processing options, and insatiable local and international markets. The institutional actors need to network the primary actors to synergistically operate with a collective profit motive. The most prioritized production constraints such as access to seed, cost of chemical fertilizer, short shelf-life, field pests and diseases, and declining soil fertility should be addressed. © 2017 Issah Sugri et al. | Open |
| Weber J.M.; Ryan K.N.; Tandon R.; Mathur M.; Girma T.; Steiner-Asiedu M.; Saalia F.; Zaidi S.; Soofi S.; Okos M.; Vosti S.A.; Manary M.J. | Acceptability of locally produced ready-to-use therapeutic foods in Ethiopia, Ghana, Pakistan and India | 2017 | Maternal and Child Nutrition | Successful treatment of severe acute malnutrition has been achieved with ready-to-use therapeutic food (RUTF), but only 15% of children with severe acute malnutrition receive RUTF. The objective of this study was to determine whether new formulations of RUTF produced using locally available ingredients were acceptable to young children in Ethiopia, Ghana, Pakistan and India. The local RUTFs were formulated using a linear programming tool that allows for inclusion of only local ingredients and minimizes cost. The study consisted of 4 two-arm, crossover, site-randomized food acceptability trials to test the acceptability of an alternative RUTF formula compared with the standard peanut-based RUTF containing powdered milk. Fifty children with moderate wasting in each country were enrolled in the 2-week study. Acceptability was measured by overall consumption, likeability and adverse effects reported by caregivers. Two of the four RUTFs did not include peanut, and all four used alternative dairy proteins rather than milk. The ingredient cost of all of the RUTFs was about 60% of standard RUTF. In Ethiopia, Ghana and India, the local RUTF was tolerated well without increased reports of rash, diarrhoea or vomiting. Children consumed similar amounts of local RUTF and standard RUTF and preferred them similarly as well. In Pakistan, local RUTF was consumed in similar quantities, but mothers perceived that children did not enjoy it as much as standard RUTF. Our results support the further investigation of these local RUTFs in Ethiopia, Ghana and India in equivalency trials and suggest that local RUTFs may be of lower cost. © 2016 John Wiley & Sons Ltd | Open |
| Wrigley-Asante C.; Agyei-Mensah S.; Obeng F.A. | It's not all about wealth and beauty: Changing perceptions of fatness among Makola market women of Accra, Ghana | 2017 | Singapore Journal of Tropical Geography | Within the African context, body shape preferences may be influenced by culture without necessarily taking into consideration health implications. Thus, fatness is culturally associated with beauty, prosperity, and prestige while thinness is perceived as a sign of ill-health or poverty. Using a cross section of Makola market women, who traditionally are perceived as fat and affluent, our findings revealed that the perception of fatness as a sign of richness and beauty is changing due to women's access to knowledge and information on the health implications of fatness. The challenge for these women however, is adhering to healthy lifestyles despite living sedentary lives in the market place which is a conducive environment for one to become fat. We recommend that qualified professionals should encourage these women through continuous programmes on regenerative health and nutrition aimed at healthy lifestyle behaviour at the market places. The social groups that women belong to should be targeted, trained and equipped with the right information on healthy living so that they can disseminate this information to other members of their networks. © 2017 Department of Geography, National University of Singapore and John Wiley & Sons Australia, Ltd | Open |
| Yawson A.E.; Amoaful E.O.; Senaya L.K.; Yawson A.O.; Aboagye P.K.; Mahama A.B.; Selenje L.; Ngongalah V. | The lancet series nutritional interventions in Ghana: A determinants analysis approach to inform nutrition strategic planning | 2017 | BMC Nutrition | Background: Malnutrition is a leading cause of mortality and morbidity among children in low- and middle-income countries. Ghana is one of 36 countries with the highest burden of stunting, globally. The aim of this work is to use data driven planning methods to conduct in-depth analysis on the Lancet series nutrition interventions in Ghana to inform nutritional strategic planning. Methods: A mixed methods approach was employed for this national nutritional assessment conducted in May 2016. Quantitative data on nutritional interventions were generated by application of the Determinants Analysis Tool and phenomenological approach was employed to explain the causes of barriers identified. Outputs from the tool were analyzed by simple descriptive statistics and data from group discussions were assessed by thematic content analysis. The base line years for this assessment were 2014 and 2015. Results: Overall in Ghana, 21.0% of frontline health workers are trained on lactation management and breastfeeding counselling and support, 56.6% of mothers of children 0-2 years initiated breastfeeding within one hour of birth, and 59.4% of mothers with children 0-5 months took iron folate supplementation for 90 or more days during pregnancy. In addition, only 19.9% of children 12-59 months received two doses of vitamin A supplementation in a calendar year, and 32.5% of children 6-59 months with severe acute malnutrition were admitted for treatment at health facilities. In all, among infants 6-8 months old, 6.9% were fed with minimum dietary diversity, 50.6% received age appropriate meal frequency and 21.6% received iron rich diet. Inadequate pre-service and in-service training for staff, low prioritization and coordination (at higher levels) and weak integration of services (at lower levels) were key barriers to nutrition coverage in Ghana. Conclusion: Data driven analysis and planning based on proven nutritional interventions in Ghana demonstrated gaps and barriers and garnered workable strategies to improve nutrition services. © 2017 The Author(s). | Open |
| Zanello G.; Srinivasan C.S.; Nkegbe P. | Piloting the use of accelerometry devices to capture energy expenditure in agricultural and rural livelihoods: Protocols and findings from northern Ghana | 2017 | Development Engineering | In this study we report on the protocols adopted and the findings from a pilot study in northern Ghana involving 40 respondents wearing accelerometry devices for a week. We show how integrating energy expenditure data from wearable accelerometry devices with data on activity and time-use can provide a window into agricultural and rural livelihoods in developing country contexts that has not been previously available for empirical research. Our findings confirm some of the stylised facts of agricultural and rural livelihoods, but the study also provides several new insights that come from the triangulation of energy expenditure, time use, and activity data. We report findings and explore the potential applications of using accelerometry devices for a better understanding of agriculture-nutrition linkages in developing countries. © 2017 The Authors | Open |
| Zereyesus Y.A.; Amanor-Boadu V.; Ross K.L.; Shanoyan A. | Does Women’s Empowerment in Agriculture Matter for Children’s Health Status? Insights from Northern Ghana | 2017 | Social Indicators Research | Given that women in rural communities in developing countries are responsible for the nutrition and health-related decisions affecting children in their care, their empowerment may influence the health status of their children. The association between women’s empowerment, measured by using a recently developed Women’s Empowerment in Agriculture Index, and children’s health status is examined for a sample of households in Northern Ghana applying a Multiple Indicators Multiple Causes (MIMIC) model. The MIMIC approach is used to link multiple indicator variables with multiple independent variables through a “single underlying” latent variable. Height-for-age and weight-for-height z-scores are used as indicators of the underlying children’s health status and women’s empowerment in agriculture and control variables are used as the multiple independent variables. Our results show that neither the composite empowerment score used to capture women’s empowerment in agriculture nor its decomposed components are statistically significant in their association with the latent children’s health status. However, the associations between children’s health status and control variables such as mother’s education, child’s age, household’s hunger scale and residence locale are statistically significant. Results also confirm the existence of the ‘single underlying’ common latent variable. Of the two health status indicators, height-for-age scores and weight-for- height scores, the former exhibited a relatively stronger association with the latent health status. While promoting women’s empowerment to enhance their ability to make strategic life choices, it is important to carefully consider how the achievement of these objectives will impact the women’s well-being and the well-being of the children in their care. © 2016, The Author(s). | Open |
| Aaron G.J.; Strutt N.; Boateng N.A.; Guevarra E.; Siling K.; Norris A.; Ghosh S.; Nyamikeh M.; Attiogbe A.; Burns R.; Foriwa E.; Toride Y.; Kitamura S.; Tano-Debrah K.; Sarpong D.; Myatt M. | Assessing program coverage of two approaches to distributing a complementary feeding supplement to infants and young children in Ghana | 2016 | PLoS ONE | The work reported here assesses the coverage achieved by two sales-based approaches to distributing a complementary food supplement (KOKO Plus™) to infants and young children in Ghana. Delivery Model 1 was conducted in the Northern Region of Ghana and used a mixture of health extension workers (delivering behavior change communications and demand creation activities at primary healthcare centers and in the community) and petty traders recruited from among beneficiaries of a local microfinance initiative (responsible for the sale of the complementary food supplement at market stalls and house to house). Delivery Model 2 was conducted in the Eastern Region of Ghana and used a market-based approach, with the product being sold through micro-retail routes (i.e., small shops and roadside stalls) in three districts supported by behavior change communications and demand creation activities led by a local social marketing company. Both delivery models were implemented sub-nationally as 1-year pilot programs, with the aim of informing the design of a scaled-up program. A series of cross-sectional coverage surveys was implemented in each program area. Results from these surveys show that Delivery Model 1 was successful in achieving and sustaining high (i.e., 86%) effective coverage (i.e., the child had been given the product at least once in the previous 7 days) during implementation. Effective coverage fell to 62% within 3 months of the behavior change communications and demand creation activities stopping. Delivery Model 2 was successful in raising awareness of the product (i.e., 90% message coverage), but effective coverage was low (i.e., 9.4%). Future programming efforts should use the health extension / microfinance / petty trader approach in rural settings and consider adapting this approach for use in urban and periurban settings. Ongoing behavior change communications and demand creation activities is likely to be essential to the continued success of such programming. © 2016 Aaron et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Abubakari A.; Jahn A. | Maternal dietary patterns and practices and birth weight in Northern Ghana | 2016 | PLoS ONE | Background: Adequate maternal nutrition is a key factor for achieving good pregnancy outcomes. Moreover, inadequate dietary intake during pregnancy is considered an important contributor to maternal malnutrition in developing countries. Although some studies have examined the effect of the entire diet on birth outcome, most studies have been very narrow because they considered the effect of single nutrient. The single nutrient approach is a major setback because usually several nutrient deficiencies are more likely to occur than single deficiencies especially in low-income settings. Objectives: The main aim of this study was to investigate the association between maternal dietary patterns, and practices and birth weight in Northern Ghana. Participant Settings: A facility-based cross-sectional survey was performed in two districts in the Northern Region of Ghana. The selected districts were the Tamale Metropolis and Savelugu-Nanton District. These districts were purposively sampled to represent a mix of urban, peri-urban and rural populations, therefore ensuring that the distribution in social groups of the study population was similar to the entire population of the region. In all, 578 mothers who were drawing antenatal and postnatal care services were interviewed using a questionnaire, which asked the mothers about their frequency of consumption of individual foods per week since they became pregnant or when they were pregnant. Statistical Analysis: We determined dietary patterns by applying a factor analysis with a varimax rotation using STATA. Multivariate analysis was used to establish association between maternal factors and dietary patterns. Logistic regression was used to assess the association between dietary practices and patterns and birth weight. Results: Women who ate outside the home twice a week (OR = 1.6 & 95% CI; 1.1-2.45, P; 0.017) and those who practiced 'pica' (OR = 1.7 & 95% CI; 1.16-2.75, P; 0.008) had increased odds for low birth. Two dietary patterns were identified - namely 'health conscious' and 'non-health conscious'. Health conscious diet (OR = 0.23 95% CI 0.12-0.45 per standard deviation change in scores, P; <0.0001) and dietarydiversity score (OR = 0.10 95% CI 0.04-0.13 per standard deviation change in scores, P; <0.0001) showed a protective effect for low birthweight respectively after adjusting for gestational age. Conclusion: Mothers who practiced good nutrition such as consuming foods across and within the various food groups were less likely to have low birthweight babies. Our findings buttress the importance of optimal nutrition during pregnancy. © 2016 Abubakari, Jahn. | Open |
| Ackatia-Armah N.M.; Addy N.A.; Ghosh S.; Dubé L. | Fostering reflective trust between mothers and community health nurses to improve the effectiveness of health and nutrition efforts: An ethnographic study in Ghana, West Africa | 2016 | Social Science and Medicine | As the global health agenda shifts from the Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs), the need for effective preventive health efforts has gained prominence, particularly in low-income regions with poor health and nutrition outcomes. To address needs in communities with limited access to health services and personnel, it is important to develop strategies that can improve the effectiveness of nurses as they interact with the populations they serve. We contribute to informing such strategies by explaining how mothers' "reflective trust" in community health nurses develops as a key influencer in their health-related decision-making and behavior. Between December 2012 and June 2013, our ethnographic study gathered data in three adjacent rural and semi-rural communities in Ghana's Eastern Region, using interviews with 39 nursing mothers, three focus groups - with mothers, health-workers, and community leaders - as well as 941 h of participant observation. We focused on interactions between mothers and nurses, highlighting tensions between communities' traditions and messages that nurses bring, which are often based on modern science. We also investigated how mothers come to exhibit reflective trust in the nurses to make sense of traditional and scientific knowledge on infant feeding, and integrate them into their own feeding decisions. Our findings have global implications for effectively sustaining and scaling health and nutrition efforts through community approaches. © 2016 Elsevier Ltd. | Open |
| Adam A. | Gender differentials and disease-specific cause of infant mortality: A case study in an urban hospital in Accra, Ghana | 2016 | African Journal of Reproductive Health | Infant mortality is a major public health problem especially in developing countries. It is an indicator of quality of and accessibility to primary healthcare as well as the overall health status of a country. Understanding the risk factors for infant mortality is the first important step to reducing its incidence/prevalence. This study examined the prevalence and disease-specific causes of infant mortality in an urban hospital in Ghana and gender differences in the burden of infant mortality. Births and deaths data at the hospital were reviewed and analyzed. Results indicated infant mortality of 32/1000 live births and highlighted malaria, severe anemia, and neonatal sepsis as the leading causes of infant deaths. Gender differences in infant mortality was not statistically significant (X2; P-value=0.73). It is critical to strengthen existing malaria control programs for infants and develop targeted interventions to improve infant nutrition for high risk infants. © 2016, Women’s Health and Action Research Centre. All rights reserved. | Open |
| Adu-Afarwuah S.; Lartey A.; Okronipa H.; Ashorn P.; Peerson J.M.; Arimond M.; Ashorn U.; Zeilani M.; Vosti S.; Dewey K.G. | Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: A randomized controlled trial | 2016 | American Journal of Clinical Nutrition | Background: Childhood stunting usually begins in utero and continues after birth; therefore, its reduction must involve actions across different stages of early life. Objective: We evaluated the efficacy of small-quantity, lipid-based nutrient supplements (SQ-LNSs) provided during pregnancy, lactation, and infancy on attained size by 18 mo of age. Design: In this partially double-blind, individually randomized trial, 1320 women at #20 wk of gestation received standard iron and folic acid (IFA group), multiple micronutrients (MMN group), or SQ-LNS (LNS group) daily until delivery, and then placebo, MMNs, or SQ-LNS, respectively, for 6 mo postpartum; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age (endline). The primary outcome was child length by 18 mo of age. Results: At endline, data were available for 85% of 1228 infants enrolled; overall mean length and length-for- Age z score (LAZ) were 79.3 cm and 20.83, respectively, and 12% of the children were stunted (LAZ ,22). In analysis based on the intended treatment, mean 6 SD length and LAZ for the LNS group (79.7 6 2.9 cm and 20.69 6 1.01, respectively) were significantly greater than for the IFA (79.1 6 2.9 cm and 20.87 6 0.99) and MMN (79.1 6 2.9 cm and 20.91 6 1.01) groups (P = 0.006 and P = 0.009, respectively). Differences were also significant for weight and weight-for- Age z score but not head or midupper arm circumference, and the prevalence of stunting in the LNS group was 8.9%, compared with 13.7% in the IFA group and 12.9% in the MMN group (P = 0.12). In analysis based on actual supplement provided at enrollment, stunting prevalences were 8.9% compared with 15.1% and 11.5%, respectively (P = 0.045). Conclusion: Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child's attained length by age 18 mo in similar settings. This trial was registered at clinicaltrials.gov as NCT00970866. Am J Clin Nutr 2016;104:797-808. © 2016 American Society for Nutrition. | Open |
| Agbozo F.; Atito P.; Abubakari A. | Malnutrition and associated factors in children: A comparative study between public and private schools in Hohoe Municipality, Ghana | 2016 | BMC Nutrition | Background: Due to vulnerabilities resulting from disparities in socio-economic status (SES), most nutrition and health interventions are targeted at children in public schools. This study was conducted to investigate the determinants of malnutrition among pupils attending public and private schools in the Hohoe municipality, Ghana. Methods: School-based cross-sectional survey, which used a multi-stage random sampling technique to select 633 pupils, aged 3-12 years enrolled in 14 public and seven private schools. Data was collected through face-to-face interviews using semi-structured questionnaire. Type of school attended was used as proxy of SES of the pupils. Weight, height and mid upper-arm circumference were measured and used to generate underweight, stunting, thinness and obesity levels using WHO Antroplus and STATA 12.1. Mutually adjusted simple and multinomial logistic regressions were performed to determine associations between explanatory and dependent variables. Results: Underweight (13 % vs. 2 %, p = <0.0001), stunting (12 % vs. 3 %, p = <0.0001) and thinness (8 % vs. 1.4 %, p < 0.0001) were higher among pupils attending public schools compared to their private schools counterparts. Public school pupils had increased likelihood for underweight (AOR = 7.5; 95 % CI = 2.4-23; p = 0.001) and an increase risk for thinness (RR = 4.7; 95 % CI = 1.5-21.2; p = 0.028) but had decrease risk for overweight (RR = 0.3; 95 % CI = 0.1-1; p = 0.043). Overweight (9 %) was higher among private schools pupils compared to public schools (3 %). Underweight (14 % vs. 6 %), stunting (14 % vs. 4 %) and thinness (8 % vs. 4 %) were higher among pupils in rural schools compared to urban dwellers. Rural schools children were twice likely to become stunted (AOR = 2.6; 95 % CI = 1.0-6.4; p = 0.043). However among pupils attending schools in urban areas, the prevalence of overweight was 7 % compare to 1 % in rural areas. Pupils who consumed only two meals per day were more likely to be underweight (AOR = 6.8; 95 % CI = 1.4-32.2; p = 0.016), stunted (AOR = 7.2; 95 % CI = 1.2-43.7; p = 0.033) and thin (RR = 9.4; 95 % CI = 2.0-47.8; p = 0.007) compared to those who had at least three square meals daily. Conclusion: Both under nutrition and over-nutrition were common among the school pupils but overweight appeared largely driven by high SES and urbanization while under nutrition was associated with low SES and rural residency. Interventions targeting school children should aim at reducing poverty and hunger as these factors remain as underlying causes of malnutrition in childhood. © 2016 The Author(s). | Open |
| Agbozo F.; Colecraft E.; Ellahi B. | Impact of type of child growth intervention program on caregivers’ child feeding knowledge and practices: a comparative study in Ga West Municipality, Ghana | 2016 | Food Science and Nutrition | Community-based growth promotion (CBGP) delivered by community volunteers aims at enhancing the traditional growth monitoring and promotion (GMP) program delivered by community health nurses through the promotion of optimum infant and young child feeding (IYCF) leading to improved child growth. This study compared IYCF knowledge and practices among caregiver–child pairs (0–24 months) receiving child welfare services from CBGP (n = 124) and GMP (n = 108) programs. Semistructured questionnaires were used to interview caregivers on IYCF knowledge/practices and validated food frequency questionnaire used to record infants’ food intakes. Group differences were determined using Chi-square and independent samples t-tests (P < 0.05; 95% confidence interval [CI]). Mean IYCF knowledge scores were similar (CBGP: 10.84 ± 1.69 vs. GMP: 10.23 ± 1.38, P = 0.062). However, more CBGP caregivers (17%) were highly knowledgeable than their GMP counterparts (5%) (P = 0.011). Early breastfeeding initiation (CBGP: 54% vs. GMP: 28%, P < 0.0001), exclusive breastfeeding (CBGP: 73% vs. GMP: 56%, P = 0.001), and timely complementary feeding (CBGP: 72% vs. GMP: 49%, P = 0.014) were reportedly higher among CBGP caregivers. Underweight was 11% (CBGP: 8% vs. GMP: 14%, P = 0.154). Mean dietary diversity scores (10 food groups) were similar (CBGP: 4.49 ± 1.89 vs. GMP: 3.87 ± 1.89, P = 0.057) but more CBGP caregivers (77%) achieved minimum dietary diversity than their GMP counterparts (61%) (P = 0.035). Few caregivers achieved minimum meal frequency (CBGP: 31% vs. GMP: 29%, P = 0.486) and minimum acceptable diet (CBGP: 23% vs. GMP: 21%, P = 0.464) indicators. Number of children under 5 years owned by caregiver (adjusted odds ratio [AOR]: 0.405; 95% CI: 1.13–78.53, P = 0.038), her educational level (AOR: 0.112; 95% CI: 0.02–0.90, P = 0.040), and IYCF knowledge (AOR: 0.140; 95% CI: 0.03–0.79, P = 0.026) significantly predicted optimum child feeding. Nutrition education on optimum complementary feeding and birth spacing strategies should intensify. © 2015 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc. | Open |
| Appiah C.A.; Otoo G.E.; Steiner-Asiedu M. | Preferred body size in urban ghanaian women: Implication on the overweight/obesity problem | 2016 | Pan African Medical Journal | Introduction: In a society where 'plumpness' is traditionally favoured, it is imperative to examine the impact of sociocultural factors on the rising overweight/obesity problem. The study was designed to assess the preferred body size among women in Kumasi metropolis, Ghana. Methods: A cross-sectional survey was conducted among 394 women, aged 20 years and above, in 6 randomly selected churches in the Kumasi metropolis. Subjects were asked to select their preferred body size from photographic silhouettes consisting of six images of women of known BMI (20, 24, 28, 30, 33 and 38kg/m2) arranged in random order. Participants were asked to associate items concerning body size preference, health, social and individual attributes to one of the six silhouettes. Participants' BMI were assessed. Independent samples t-test and analysis of variance were used to assess differences in preferred body size across categories of BMI and socio-demographic characteristics. Results: The prevalence of overweight/obesity among the women was 68.4%. The respondents preferred a large (overweight) body size. They associated silhouette of large (overweight) body size with eating well, affluence and high social value. Though the overweight/obese respondents associated normal body size with health they preferred a large (overweight) body size. Conclusion: Sociocultural ideals for body size override health reasons for the women's preferred body size. This study shows that tackling the overweight/obesity problem solely from nutrition and health perspective may not be adequate. A holistic interdisciplinary strategy involving nutrition, health, social and behavioural science is needed to develop culturally-sensitive interventions against the emerging obesity problem. © Collins Afriyie Appiah et al. | Open |
| Aryeetey R.; Oltmans S.; Owusu F. | Food retail assessment and family food purchase behavior in Ashongman Estates, Ghana | 2016 | African Journal of Food, Agriculture, Nutrition and Development | A key feature of the nutrition transition in developed countries is the rapid transformation of the food system towards increasing availability and access to cheaper, and more processed foods. These changes are associated with alterations in dietary behavior with implications for chronic disease risk. However, the process of change in the food system begins with changes in the food retail system and its subsequent effect on consumer behavior. Currently, little is known about the nature of the food marketplace in emerging economies like Ghana, and also how the changing economy and food retail situation are influencing consumer behavior. The current paper presents a case study of the food retail system and consumer food purchase behavior in suburban Accra. Between May and August 2012, an assessment of food retail outlets was carried out in Ashongman Estates, a suburb of Accra. The study involved observations, in-depth interviews with retailers, and a survey of households. Data from the study allowed classification of retail food vendors across the urban food retail system. In addition, data on food purchase preferences and purchase behavior were obtained from a household survey of 75 randomly selected households in Ashongman Estates. The data showed that traditional markets still constitute the most important source of household food purchases. A majority of households (87%) reported preference for traditional markets, and almost all households (99%) indicated traditional markets as their main source for purchasing household food. Foods available from supermarkets were mainly processed foods. However, processed foods are also commonly available through the traditional markets and minimarkets. The preference for traditional markets was attributed to greater variety of foods, lower price, and proximity of food source. Minimarket vendors, including corner stores, table top vendors, hawkers, and fuel station shops that are located within the community, served as an additional food source, complementing food purchases from the traditional markets. The study concluded that although traditional markets remain the main source of household food, interventions are needed to ensure that food markets in the community include access to a variety of fresh produce rather than promote processed foods, in order to promote consumer health. | Open |
| Ayensu J.; Annan R.A.; Edusei A.; Badu E. | Impact of maternal weight on pregnancy outcomes: a systematic review | 2016 | Nutrition and Food Science | Purpose: The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy outcome. The increasing prevalence of maternal overweight and obesity worldwide has become a problem of concern among public health professionals. The purpose of this paper is to review the evidence regarding the impact of maternal weight on pregnancy outcomes to facilitate the provision of evidence-based information to pregnant women during antenatal clinics in Ghana. Design/methodology/approach: A search was conducted in PubMed, PLOS ONE, Cochrane, Embase and bibliographies for all studies on maternal weight and pregnancy outcomes published from January 2000 to May 2013. The key words used for the search were: “pre-pregnancy BMI”, “gestational weight gain”, “maternal weight”, “pregnancy outcomes” and “birth outcomes”. Findings: The search yielded 113 papers; out of these, 35 studies were included in the review after exclusion of duplicates and irrelevant papers. Excluded papers included animal studies and human studies that did not meet inclusion criteria. Research limitations/implications: The review only considered papers published from 2000 to 2013 and might have left out other important papers published before 2000 and after 2013. Practical implications: The origins of the studies included in the review suggest paucity of studies on maternal weight and pregnancy outcomes in developing countries where there is a double burden of malnutrition. There is the need for more studies to be initiated in this area. Social implications: Results of this review have revealed that the extremes of maternal weight prior to and during pregnancy increase the risk of maternal and fetal complications. Originality/value: This paper provides evidential information on the impact of maternal weight on pregnancy outcomes for counseling during antenatal clinics. © 2016, © Emerald Group Publishing Limited. | Open |
| Bentil H.J.; Steiner-Asiedu M.; Lartey A. | Comparison of the complementary feeding practices between mothers with twins and mothers with singletons | 2016 | Pan African Medical Journal | Introduction: Several studies have been done on infant feeding practices but few have focused on twins. The aim of this study was to compare the complementary feeding practices between mothers with twins and mothers with singletons. Methods: Mother-infant pairs (50 mother-twin pairs and 50 mother-singleton pairs) with children aged 6 to 23 months were recruited from two public health clinics and communities in Tema and Ashaiman. Information was collected on the background characteristics of the mothers. Recumbent length and weight of the children were measured. Dietary information on the infants was collected using 24 hour recall. The differences between two groups were tested using independent t-student test for continuous variables and chi-square test for categorical variables. Results: The minimum dietary diversity (4+ food groups) was met by only 32% of the twins and 40% of the singletons, and 28% of the twins and 38% of the singletons met the requirement for minimum acceptable diet (minimum dietary diversity and the minimum meal frequency). Minimum meal frequency was met by 78% of the twins and 76% of the singletons. There were no significant differences between the two groups of infants. Prevalence of undernutrition was not significantly different among the two groups (twins versus singletons: underweight-26% versus 24%, stunting-20% versus 24% and wasting-14% versus 10%. Conclusion: Complementary feeding practices were suboptimal in both groups of mothers requiring interventions to improve infant feeding practices. © Helena Joycelyn Bentil et al. | Open |
| Braithwaite J.; Matsuyama Y.; Mannion R.; Johnson J.; Bates D.W.; Hughes C. | How to do better health reform: A snapshot of change and improvement initiatives in the health systems of 30 countries | 2016 | International Journal for Quality in Health Care | Health systems are continually being reformed. Why, and how? To answer these questions, we draw on a book we recently contributed, Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries. We analyse the impact that these health-reform initiatives have had on the quality and safety of care in an international context-that is, in low-, middle- and highincome countries-Argentina, Australia, Brazil, Chile, China, Denmark, England, Ghana, Germany, the Gulf states, Hong Kong, India, Indonesia, Israel, Italy, Japan, Mexico, Myanmar, New Zealand, Norway, Oman, Papua New Guinea (PNG), South Africa, the USA, Scotland and Sweden. Popular reforms in less well-off countries include boosting equity, providing infrastructure, and reducing mortality and morbidity in maternal and child health. In countries with higher GDP per capita, the focus is on new IT systems or trialling innovative funding models. Wealthy or less wealthy, countries are embracing ways to enhance quality of care and keep patients safe, via mechanisms such as accreditation, clinical guidelines and hand hygiene campaigns. Two timely reminders are that, first, a population's health is not determined solely by the acute system, but is a product of inter-sectoral effort-that is, measures to alleviate poverty and provide good housing, education, nutrition, running water and sanitation across the population. Second, all reformers and advocates of better-quality of care should include well-designed evaluation in their initiatives. Too often, improvement is assumed, not measured. That is perhaps the key message. © The Author 2016. | Open |
| Christian A.K.; Marquis G.S.; Colecraft E.K.; Lartey A.; Sakyi-Dawson O.; Ahunu B.K.; Butler L.M. | Caregivers' nutrition knowledge and attitudes are associated with household food diversity and children's animal source food intake across different agro-ecological zones in Ghana | 2016 | British Journal of Nutrition | Caregivers' nutrition knowledge and attitudes may influence the variety of foods available in the household and the quality of children's diets. To test the link, this study collected data on caregivers' (n 608) nutrition knowledge and feeding attitudes as well as the diets of their household and of their 2-5-year-old children in twelve rural communities nested in the three main agro-ecological zones of Ghana. Household foods and children's animal source foods (ASF) consumed in the past 7 d were categorised into one of fourteen and ten groups, respectively. About 28 % of caregivers believed that their children needed to be fed only 2-3 times/d. Reasons for having adult supervision during child meal times, feeding diverse foods, prioritising a child to receive ASF and the perceived child benefits of ASF differed across zones (P<0·001). Households with caregivers belonging to the highest tertile of nutrition knowledge and attitude scores consumed more diverse diets compared with those of caregivers in the lowest tertile group (11·2 (sd 2·2) v. 10·0 (sd 2·4); P<0·001). After controlling for the effect of agro-ecological zone, caregivers' nutrition knowledge and feeding attitudes positively predicted household dietary diversity and the frequency and diversity of children's ASF intakes (P<0·001). The number of years of formal education of caregivers also positively predicted household dietary diversity and children's ASF diversity (P<0·001). A key component to improving child nutrition is to understand the context-specific nutrition knowledge and feeding attitudes in order to identify relevant interventions. © The Authors 2015. | Open |
| Egyir B.K.; Ramsay S.A.; Bilderback B.; Safaii S.A. | Complementary Feeding Practices of Mothers and Their Perceived Impacts on Young Children: Findings from KEEA District of Ghana | 2016 | Maternal and Child Health Journal | Objective Appropriate and timely complementary feeding practices are fundamental to a child’s growth, health, and development during the first 2 years of life. This study aimed to understand (1) Ghanaian mother’s complementary feeding practices, and (2) their perceived and observed impacts of complementary feeding on their children. Methods Ghanaian mothers with children 4–24 months of age were recruited from four communities in the Komenda Edina Eguafo Abrem district in the Central Region of Ghana (n = 99). A qualitative methodological approach with focus group interview discussions was used. Eleven focus group interviews were conducted, and were audio recorded and transcribed. The audio transcriptions were coded and analyzed into pertinent themes, meta-themes, and theoretical concepts. Results Over 80 % (85) of mothers reported poor knowledge about the effects of complementary feeding on their children and 45 % (45) of the children were undernourished, indicating inappropriate complementary feeding practices. Some mothers held misconceptions about the effect of food on children’s health. Four overarching themes were identified: (1) mothers’ background knowledge about food, child health and growth outcomes, (2) mothers’ motivation in feeding their children, (3) barriers to feeding, (4) foods mothers offered their children. Conclusion for Practice Nutrition education on complementary feeding is needed for Ghanaian mothers. Health facilities and community outreach programs could be a venue to provide education to mothers regarding infant and young child feeding practices in Ghana. © 2016, Springer Science+Business Media New York. | Open |
| Ezui K.S.; Franke A.C.; Mando A.; Ahiabor B.D.K.; Tetteh F.M.; Sogbedji J.; Janssen B.H.; Giller K.E. | Fertiliser requirements for balanced nutrition of cassava across eight locations in West Africa | 2016 | Field Crops Research | Insufficient and unbalanced fertiliser use widens cassava yield gaps. We assessed the spatial variability of optimal fertiliser requirements of cassava for enhanced nutrient use efficiency and increased yield using the balanced nutrition approach of the QUEFTS model. Two datasets comprised of five fertiliser experiments conducted at eight locations across Southern Togo, Southern Ghana and Northern Ghana from 2007 to 2012 were used. The ratio of storage roots dry matter yield over the sum of available N, P and K expressed in crop nutrient equivalent from the soil and nutrient inputs was used as a proxy to estimate nutrient use efficiency. Nutrient use efficiencies of 20.5 and 31.7 kg storage roots dry matter per kilo crop nutrient equivalent were achieved at balanced nutrition at harvest index (HI) values of 0.50 and 0.65, respectively. N, P and K supplies of 16.2, 2.7 and 11.5 kg at an HI of 0.50, and 10.5, 1.9 and 8.4 kg at an HI of 0.65 were required to produce 1000 kg of storage roots dry matter. The corresponding optimal NPK supply ratios are 6.0-1.0-4.2 and 5.3-1.0-4.2. Nutrient use efficiencies decreased above yields of 77-93% of the maximum. Evaluation of the performance of blanket fertiliser rates recommended by national research services for cassava production resulted in average benefit:cost ratios of 2.4 ± 0.9, which will be unattractive to many farmers compared to 3.8 ± 1.1 for the balanced fertiliser rates. The indigenous soil supply of nutrients revealed that, at balanced nutrition, K was the most limiting nutrient to achieve storage roots yields up to 8 Mg dry matter ha-1 at most sites, whereas N and P were needed at greater yields. Dry weight of storage roots measured on the control plots in our researcher managed experiment ranged from 5.6 to 12.2 Mg ha-1, and were larger than the average weight in farmers' fields in West Africa of 4 Mg ha-1. Substantial yield increase could be attained in the region with improved crop management and fertiliser requirements formulation on the basis of balanced nutrition. © 2015 Elsevier B.V. | Open |
| Fernandes M.; Galloway R.; Gelli A.; Mumuni D.; Hamdani S.; Kiamba J.; Quarshie K.; Bhatia R.; Aurino E.; Peel F.; Drake L. | Enhancing Linkages between Healthy Diets, Local Agriculture, and Sustainable Food Systems: The School Meals Planner Package in Ghana | 2016 | Food and Nutrition Bulletin | Background: Interventions that enhance linkages between healthy diets and local agriculture can promote sustainable food systems. Home-grown school feeding programs present a promising entry point for such interventions, through the delivery of nutritious menus and meals. Objective: To describe the adaptation of the School Meals Planner Package to the programmatic and environmental reality in Ghana during the 2014 to 2015 school year. Methods: Guided by a conceptual framework highlighting key considerations and trade-offs in menu design, an open-source software was developed that could be easily understood by program implementers. Readily available containers from markets were calibrated into "handy measures" to support the provision of adequate quantities of food indicated by menus. Schools and communities were sensitized to the benefits of locally sourced, nutrient-rich diets. A behavior change communication campaign including posters and songs promoting healthy diets was designed and disseminated in schools and communities. Results: The School Meals Planner Package was introduced in 42 districts in Ghana, reaching more than 320 000 children. Monitoring reports and feedback on its use were positive, demonstrating how the tool can be used by planners and implementers alike to deliver nutritious, locally-sourced meals to schoolchildren. The value of the tool has been recognized at the highest levels by Ghana's government who have adopted it as official policy. Conclusions: The School Meals Planner Package supported the design of nutritious, locally sourced menus for the school feeding program in Ghana. The tool can be similarly adapted for other countries to meet context-specific needs. © The Author(s) 2016. | Open |
| Gelli A.; Masset E.; Folson G.; Kusi A.; Arhinful D.K.; Asante F.; Ayi I.; Bosompem K.M.; Watkins K.; Abdul-Rahman L.; Agble R.; Ananse-Baden G.; Mumuni D.; Aurino E.; Fernandes M.; Drake L. | Evaluation of alternative school feeding models on nutrition, education, agriculture and other social outcomes in Ghana: Rationale, randomised design and baseline data | 2016 | Trials | Background: 'Home-grown' school feeding programmes are complex interventions with the potential to link the increased demand for school feeding goods and services to community-based stakeholders, including smallholder farmers and women's groups. There is limited rigorous evidence, however, that this is the case in practice. This evaluation will examine explicitly, and from a holistic perspective, the simultaneous impact of a national school meals programme on micronutrient status, alongside outcomes in nutrition, education and agriculture domains. The 3-year study involves a cluster-randomised control trial designed around the scale-up of the national school feeding programme, including 116 primary schools in 58 districts in Ghana. The randomly assigned interventions are: 1) a school feeding programme group, including schools and communities where the standard government programme is implemented; 2) 'home-grown' school feeding, including schools and communities where the standard programme is implemented alongside an innovative pilot project aimed at enhancing nutrition and agriculture; and 3) a control group, including schools and households from communities where the intervention will be delayed by at least 3 years, preferably without informing schools and households. Primary outcomes include child health and nutritional status, school participation and learning, and smallholder farmer income. Intermediate outcomes along the agriculture and nutrition pathways will also be measured. The evaluation will follow a mixed-method approach, including child-, household-, school- and community-level surveys as well as focus group discussions with project stakeholders. The baseline survey was completed in August 2013 and the endline survey is planned for November 2015. Results: The tests of balance show significant differences in the means of a number of outcome and control variables across the intervention groups. Important differences across groups include marketed surplus, livestock income, per capita food consumption and intake, school attendance, and anthropometric status in the 2-5 and 5-15 years age groups. In addition, approximately 19 % of children in the target age group received some form of free school meals at baseline. Conclusion: Designing and implementing the evaluation of complex interventions is in itself a complex undertaking, involving a multi-disciplinary research team working in close collaboration with programme- and policy-level stakeholders. Managing the complexity from an analytical and operational perspective is an important challenge. The analysis of the baseline data indicates that the random allocation process did not achieve statistically comparable treatment groups. Differences in outcomes and control variables across groups will be controlled for when estimating treatment effects. Trial registration number:ISRCTN66918874(registered on 5 March 2015). © 2016 Gelli et al. | Open |
| Glover-Amengor M.; Agbemafle I.; Hagan L.L.; Mboom F.P.; Gamor G.; Larbi A.; Hoeschle-Zeledon I. | Nutritional status of children 0-59 months in selected intervention communities in northern Ghana from the africa RISING project in 2012 | 2016 | Archives of Public Health | Background: Poor nutritional status during childhood and its long-term impact on economic growth and wellbeing is well known. This study assessed the nutritional status of children in selected communities in northern Ghana, to serve as baseline data for the Africa Research in Sustainable Intensification for the Next Generation (Africa RISING) project that sought to improve farm-household nutrition through agriculture. Methods: A cross-sectional study was conducted among children 0-59 months in selected communities in the Northern (Tibali and Cheyohi No. 2), Upper West (Goli and Zanko) and Upper East (Bonia and Sambulgu) regions of northern Ghana. A pre-tested, semi-structured questionnaire was used to obtain information on background characteristics of caregivers and children. Weight and height were measured for children following World Health Organization (WHO) procedures and transformed into z-scores using the WHO Anthro. Results: All the caregivers (522) were females; majority (73.4%) had no formal education, 82.7% were married and 70.5% engaged in farming. In all, 533 children were recruited: Northern region (38.6%), Upper West (33.4%) and Upper East (28.0%). Majority (52.5%) of the children were males. The mean age was 32±19months. Levels of stunting, underweight and wasting were 27.2, 17.6 and 8.2% respectively. Stunting, underweight and wasting levels increased within the first two years of life. Overall, 33.8% of the children in northern Ghana were malnourished; 20.2% were from the Northern region, 7.0 and 6.8% were from Upper East and Upper West respectively. Conclusion: Different forms of malnutrition still exist as a public health problem in various communities in northern Ghana and need to be curtailed using effective agriculture-nutrition sensitive interventions. © 2016 Glover-Amengor et al. | Open |
| Haggblade S.; Duodu K.G.; Kabasa J.D.; Minnaar A.; Ojijo N.K.O.; Taylor J.R.N. | Emerging Early Actions to Bend the Curve in Sub-Saharan Africa's Nutrition Transition | 2016 | Food and Nutrition Bulletin | Background: Sub-Saharan Africa is the last region to undergo a nutrition transition and can still avoid its adverse health outcomes. Objective: The article explores emerging responses to €bend the curve€ in sub-Saharan Africa's nutrition transition to steer public health outcomes onto a healthier trajectory. Methods: Early responses in 3 countries at different stages of food system transformation are examined: South Africa - advanced, Ghana - intermediate, and Uganda - early. By comparing these with international experience, actions are proposed to influence nutrition and public health trajectories as Africa's food systems undergo rapid structural change. Results: Arising from rapid urbanization and diet change, major public health problems associated with overweight are taking place, particularly in South Africa and among adult women. However, public health responses are generally tepid in sub-Saharan Africa. Only in South Africa have policy makers instituted extensive actions to combat overweight and associated noncommunicable diseases through regulation, education, and public health programs. Elsewhere, in countries in the early and middle stages of transition, public health systems continue to focus their limited resources primarily on undernutrition. Related pressures on the supply side of Africa's food systems are emerging that also need to be addressed. Conclusions: Three types of intervention appear most feasible: maternal and child health programs to simultaneously address short-term undernutrition problems while at the same time helping to reduce future tendencies toward overweigh; regulatory and fiscal actions to limit access to unhealthy foods; and modernization of Africa's agrifood food system through job skills training, marketing reforms, and food industry entrepreneurship. © Nevin Scrimshaw International Nutrition Foundation. | Open |
| Kailembo A.; Preet R.; Stewart Williams J. | Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: Results from the WHO Study on global AGEing and adult health (SAGE) | 2016 | BMC Oral Health | Background: Edentulism (loss of all teeth) is a final marker of disease burden for oral health common among older adults and poorer populations. Yet most evidence is from high-income countries. Oral health has many of the same social and behavioural risk factors as other non-communicable diseases (NCDs) which are increasing rapidly in low- and middle-income countries with ageing populations. The "common risk factor approach" (CRFA) for oral health addresses risk factors shared with NCDs within the broader social and economic environment. Methods: The aim is to improve understanding of edentulism prevalence, and association between common risk factors and edentulism in adults aged 50 years and above using nationally representative samples from China (N = 11,692), Ghana (N = 4093), India (N = 6409) and South Africa (N = 2985). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). Multivariable logistic regression describes association between edentulism and common risk factors reported in the literature. Results: Prevalence of edentulism: in China 8.9 %, Ghana 2.9 %, India 15.3 %, and South Africa 8.7 %. Multivariable analysis: in China, rural residents were more likely to be edentulous (OR 1.36; 95 % CI 1.09-1.69) but less likely to be edentulous in Ghana (OR 0.53; 95 % CI 0.31-0.91) and South Africa (OR 0.52; 95 % CI 0.30-0.90). Respondents with university education (OR 0.31; 95 % CI 0.18-0.53) and in the highest wealth quintile (OR 0.68; 95 % CI 0.52-0.90) in China were less likely to be edentulous. In South Africa respondents with secondary education were more likely to be edentulous (OR 2.82; 95 % CI 1.52-5.21) as were those in the highest wealth quintile (OR 2.78; 95 % CI 1.16-6.70). Edentulism was associated with former smokers in China (OR 1.57; 95 % CI 1.10-2.25) non-drinkers in India (OR 1.65; 95 % CI 1.11-2.46), angina in Ghana (OR 2.86; 95 % CI 1.19-6.84) and hypertension in South Africa (OR 2.75; 95 % CI 1.72-4.38). Edentulism was less likely in respondents with adequate nutrition in China (OR 0.68; 95 % CI 0.53-0.87). Adjusting for all other factors, compared with China, respondents in India were 50 % more likely to be edentulous. Conclusions: Strengthening the CRFA should include addressing common determinants of health to reduce health inequalities and improve both oral and overall health. © 2016 The Author(s). | Open |
| Kyu H.H.; Bachman V.F.; Alexander L.T.; Mumford J.E.; Afshin A.; Estep K.; Veerman J.L.; Delwiche K.; Iannarone M.L.; Moyer M.L.; Cercy K.; Vos T.; Murray C.J.L.; Forouzanfar M.H. | Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: Systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013 | 2016 | BMJ (Online) | Objective: To quantify the dose-response associations between total physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events. Design: Systematic review and Bayesian dose-response meta-analysis. Data sources: PubMed and Embase from 1980 to 27 February 2016, and references from relevant systematic reviews. Data from the Study on Global AGEing and Adult Health conducted in China, Ghana, India, Mexico, Russia, and South Africa from 2007 to 2010 and the US National Health and Nutrition Examination Surveys from 1999 to 2011 were used to map domain specific physical activity (reported in included studies) to total activity. Eligibility criteria for selecting studies: Prospective cohort studies examining the associations between physical activity (any domain) and at least one of the five diseases studied. Results: 174 articles were identified: 35 for breast cancer, 19 for colon cancer, 55 for diabetes, 43 for ischemic heart disease, and 26 for ischemic stroke (some articles included multiple outcomes). Although higher levels of total physical activity were significantly associated with lower risk for all outcomes, major gains occurred at lower levels of activity (up to 3000-4000 metabolic equivalent (MET) minutes/week). For example, individuals with a total activity level of 600 MET minutes/week (the minimum recommended level) had a 2% lower risk of diabetes compared with those reporting no physical activity. An increase from 600 to 3600 MET minutes/week reduced the risk by an additional 19%. The same amount of increase yielded much smaller returns at higher levels of activity: an increase of total activity from 9000 to 12 000 MET minutes/week reduced the risk of diabetes by only 0.6%. Compared with insufficiently active individuals (total activity >600 MET minutes/week), the risk reduction for those in the highly active category (≥8000 MET minutes/ week) was 14% (relative risk 0.863, 95% uncertainty interval 0.829 to 0.900) for breast cancer; 21% (0.789, 0.735 to 0.850) for colon cancer; 28% (0.722, 0.678 to 0.768) for diabetes; 25% (0.754, 0.704 to 0.809) for ischemic heart disease; and 26% (0.736, 0.659 to 0.811) for ischemic stroke. Conclusions: People who achieve total physical activity levels several times higher than the current recommended minimum level have a significant reduction in the risk of the five diseases studied. More studies with detailed quantification of total physical activity will help to find more precise relative risk estimates for different levels of activity. © BMJ Publishing Group Ltd 2016. | Open |
| Lo Turco V.; Potortì A.G.; Rando R.; Ravenda P.; Dugo G.; Di Bella G. | Functional properties and fatty acids profile of different beans varieties | 2016 | Natural Product Research | Dried seeds of four varieties of Phaseolus vulgaris, three of Vigna unguiculata ssp. unguiculata and two of Vigna angularis grown and marketed in Italy, Mexico, India, Japan, Ghana and Ivory Coast were analysed for fatty acids content. In oils from seeds of P. vulgaris, the main fatty acids were linolenic (34.7–41.5%) and linoleic (30.7–40.3%), followed by palmitic (10.7–16.8%). The first three aforementioned fatty acids in the lipid fraction of V. unguiculata varieties were 28.4, 28.7 and 26.2%, respectively; while in V. angularis varieties, main fatty acids were linoleic (36.4–39.1%) and palmitic (26.9–33.3%), followed by linolenic (17.9–22.2%). Statistical analyses indicate that botanical species play a rule in bean fatty acids distribution, while the same was not verified for geographical origin. Furthermore, the atherogenic index (AI) and the thrombogenic index (TI) were investigated for health and nutritional information. The results showed that these wide spread legumes have functional features to human health. © 2016 Informa UK Limited, trading as Taylor & Francis Group. | Open |
| Marquis G.S.; Lartey A.; Perez-Escamilla R.; Mazur R.E.; Brakohiapa L.; Birks K.A. | Factors are not the same for risk of stopping exclusive breast-feeding and introducing different types of liquids and solids in HIV-affected communities in Ghana | 2016 | British Journal of Nutrition | Exclusive breast-feeding (EBF) for 6 months supports optimal infant growth, health and development. This paper examined whether maternal HIV status was associated with EBF and other infant feeding practices. Pregnant women were enrolled after HIV counselling, and their babies were followed up for up to 1 year. Data on household socio-economics and demographics, maternal characteristics and infants' daily diet were available for 482 infants and their mothers (150 HIV-positive (HIV-P), 170 HIV-negative (HIV-N) and 162 HIV-unknown (HIV-U)). Survival analyses estimated median EBF duration and time to introduction of liquids and foods; hazards ratios (HR) used data from 1-365 and 1-183 d, adjusting for covariates. Logistic regression estimated the probability of EBF for 6 months. Being HIV-P was associated with a shorter EBF duration (139 d) compared with HIV-N (163 d) and HIV-U (165 d) (P=0·004). Compared with HIV-N, being HIV-P was associated with about a 40 % higher risk of stopping EBF at any time point (HR 1·39; 95 % CI 1·06, 1·84; P=0·018) and less than half as likely to complete 6 months of EBF (adjusted OR 0·42; 95 % CI 0·22, 0·81; P=0·01). Being HIV-P tended to be or was associated with a higher risk of introducing non-milk liquids (HR 1·34; 95 % CI 0·98, 1·83; P=0·068), animal milks (HR 2·37; 95 % CI 1·32, 4·24; P=0·004) and solids (HR 1·56; 95 % CI 1·10, 2·22; P=0·011) during the first 6 months. Weight-for-age Z-score was associated with EBF and introducing formula. Different factors (ethnicity, food insecurity, HIV testing strategy) were associated with the various feeding behaviours, suggesting that diverse interventions are needed to promote optimal infant feeding. Copyright © The Authors 2016. | Open |
| Oaks B.M.; Laugero K.D.; Stewart C.P.; Adu-Afarwuah S.; Lartey A.; Ashorn P.; Vosti S.A.; Dewey K.G. | Late-pregnancy salivary cortisol concentrations of Ghanaian women participating in a randomized controlled trial of prenatal lipid-based nutrient supplements | 2016 | Journal of Nutrition | Background: High circulating cortisol is associated with miscarriage, preterm birth, and low birth weight. Research in nonpregnant individuals suggests that improved nutrition may lower cortisol concentrations. It is unknown whether nutritional supplementation during pregnancy lowers cortisol. Objective: Our objective was to determine whether women receiving a lipid-based nutrient supplement (LNS) throughout pregnancy would have lower salivary cortisol at 36 wk gestation compared with women receiving other nutrient supplements. Methods: We conducted a randomized controlled trial in 1320 pregnant Ghanaian women at ≤20 wk gestation who were assigned to receive daily throughout pregnancy: 1) 60 mg iron + 400 mg folic acid (IFA), 2) multiple micronutrients (MMNs), or 3) 20 g LNS (containing 118 kcal, 22 micronutrients, and protein). Morning salivary cortisol was collected from a subsample at baseline and at 28 and 36 wk gestation. Results: A total of 758 women had cortisol measurements at 28 or 36 wk gestation. Salivary cortisol at 36 wk gestation did not differ between groups and was (mean ± SE) 7.97 ± 0.199 in the IFA group, 7.84 ± 0.191 in theMMN group, and 7.77 ± 0.199 nmol/L in the LNS group, when adjusted for baseline cortisol, time of waking, and time between waking and saliva collection (P = 0.67). Therewas an interaction between supplementation group andwomen's age (continuous variable, P-interaction = 0.03); and when agewas dichotomized by themedian, significant differences in salivary cortisol concentrations between groups were seen in women≤26 y of age (IFA = 8.23 ± 0.284 nmol/L, MMN= 8.20 ± 0.274 nmol/L, and LNS = 7.44 ± 0.284 nmol/L; P = 0.03) but not in women > 26 y old (IFA = 7.71 ± 0.281 nmol/L, MMN = 7.50 ± 0.274 nmol/L, and LNS = 8.08 ± 0.281 nmol/L; P = 0.13). Conclusions: We conclude that supplementation with LNSs or MMNs during pregnancy did not affect the cortisol concentration in the study population as a whole, in comparison with IFA, but that LNS consumption among younger women may lead to lower cortisol at 36 wk gestation. This trial was registered at clinicaltrials.gov as NCT00970866. © 2016 American Society for Nutrition. | Open |
| Ofori-Asenso R.; Agyeman A.A.; Laar A.; Boateng D. | Overweight and obesity epidemic in Ghana - A systematic review and meta-analysis | 2016 | BMC Public Health | Background: In many low and middle income countries (LMICs), the distribution of adulthood nutritional imbalance is shifting from a predominance of undernutrition to overnutrition. This complex problem poses a huge challenge to governments, non-state actors, and individuals desirous of addressing the problem of malnutrition in LMICs. The objective of this study was to systematically review the literature towards providing an estimate of the prevalence of overweight and obesity among adult Ghanaians. Methods: This study followed the recommendations outlined in the PRISMA statement. Searches were performed in PubMed, Science Direct, google scholar, Africa Journals Online (AJOL) and the WHO African Index Medicus database. This retrieved studies (published up to 31st March 2016) that reported overweight and obesity prevalence among Ghanaians. All online searches were supplemented by reference screening of retrieved papers to identify additional studies. Results: Forty-three (43) studies involving a total population of 48,966 sampled across all the ten (10) regions of Ghana were selected for the review. Our analysis indicates that nearly 43% of Ghanaian adults are either overweight or obese. The national prevalence of overweight and obesity were estimated as 25.4% (95% CI 22.2-28.7%) and 17.1% (95% CI = 14.7-19.5%), respectively. Higher prevalence of overweight (27.2% vs 16.7%) and obesity (20.6% vs 8.0%) were estimated for urban than rural dwellers. Prevalence of overweight (27.8% vs 21.8%) and obesity (21.9% vs 6.0%) were also significantly higher in women than men. About 45.6% of adult diabetes patients in Ghana are either overweight or obese. At the regional level, about 43.4%, 36.9%, 32.4% and 55.2% of residents in Ashanti, Central, Northern and Greater Accra region, respectively are overweight or obese. These patterns generally mimic the levels of urbanization. Per studies' publication years, consistent increases in overweight and obesity prevalence were observed in Ghana in the period 1998-2016. Conclusions: There is a high and rising prevalence of overweight and obesity among Ghanaian adults. The possible implications on current and future population health, burden of chronic diseases, health care spending and broader economy could be enormous for a country still battling many infectious and parasitic diseases. Public health preventive measures that are appropriate for the Ghanaian context, culturally sensitive, cost-effective and sustainable are urgently needed to tackle this epidemic. © 2016 The Author(s). | Open |
| Omari R.; Frempong G. | Food safety concerns of fast food consumers in urban Ghana | 2016 | Appetite | In Ghana, out-of-home ready-to-eat foods including fast food generally have been associated with food safety problems. Notwithstanding, fast food production and consumption are increasing in Ghana and therefore this study sought to determine the food safety issues of importance to consumers and the extent to which they worry about them. First, through three focus group discussions on consumers' personal opinions about food safety issues, some emergent themes were obtained, which were used to construct an open-ended questionnaire administered face-to-face to 425 respondents systematically sampled from 20 fast food restaurants in Accra. Findings showed that most fast food consumers were concerned about food hazards such as pesticide residue in vegetables, excessive use of artificial flavour enhancers and colouring substances, bacterial contamination, migrated harmful substances from plastic packages, and general unhygienic conditions under which food is prepared and sold. Consumers also raised concerns about foodborne diseases such as cholera, typhoid, food poisoning, diarrhoea, bird flu and swine flu. The logistic regression model showed that being male increased the likelihood of worrying about general food safety issues and excessive use of flavour enhancers than in females while being youthful increased the likelihood of being worried about typhoid fever than in older consumers. These findings imply that consumers in urban Ghana are aware and concerned about current trends of food safety and foodborne disease challenges in the country. Therefore, efforts targeted at improving food safety and reducing incidences of foodborne diseases should not only focus on public awareness creation but should also design more comprehensive programmes to ensure the making of food safety rules and guidelines and enforcing compliance to facilitate availability and consumers' choice of safe foods. © 2015 Elsevier Ltd. | Open |
| Owusu-Addo E. | Perceived impact of Ghana's conditional cash transfer on child health | 2016 | Health Promotion International | A plethora of studies from sub-Saharan Africa indicate that orphaned and vulnerable children are exposed to adverse health, education and other social outcomes. Across diverse settings, conditional cash transfer (CCT) programmes have been successful in improving health outcomes amongst vulnerable children. This study explored the pathways of CCTs' impact on the health of orphans and vulnerable children in rural Ghana. Due to the multi-dimensional nature of CCTs, the programme impact theory was used to conceptualize CCTs' pathways of impact on child health. A qualitative descriptive exploratory approach was used for this study. This study drew on the perspectives of 18 caregivers, 4 community leaders and 3 programme implementers from two rural districts in Ghana. Semi-structured individual interviews were conducted with the participants. Thematic content analysis was conducted on the interview transcripts to pull together core themes running through the entire data set. Five organizing themes emerged from the interview transcripts: improved child nutrition, health service utilization, poverty reduction and social transformation, improved education and improved emotional health and well-being demonstrating the pathways through which CCTs work to improve child health. The results indicated that CCTs offer a valuable social protection instrument for improving the health of orphans and vulnerable children by addressing the social determinants of child health such as nutrition, access to health care, child poverty and education. © 2014 The Author. | Open |
| Owusu-Addo S.B.; Owusu-Addo E.; Morhe E.S.K. | Health information-seeking behaviours among pregnant teenagers in Ejisu-Juaben Municipality, Ghana | 2016 | Midwifery | Objective to examine health information-seeking behaviours among pregnant teenagers. Design qualitative design using semi-structured interviews and focus groups. The study followed the Consolidated Criteria for Reporting Qualitative Studies (COREQ). Settings/Participants antenatal clinic at Ejisu Government hospital, Ghana. Twenty eight pregnant teenagers aged 15–19 and one midwife participated in the study. Method the participants were interviewed in person at the antenatal clinic. The individual interviews and focus groups were digitally recorded, transcribed, and then analysed using thematic framework analysis. Findings three themes emerged from the analysis of the transcripts: information needs, sources of information and barriers to information seeking. Findings indicate unmet information needs among pregnant teenagers including proper understanding of pregnancy stages, infant feeding practices, nutrition, labour and birth and postnatal care. Pregnant teenagers largely relied on traditional sources for information on pregnancy as compared to official sources such as midwives, nurses or doctors. Conclusion/Implications for practice given that traditional sources, such as family and neighbours were the predominant sources of information, to effectively and comprehensively address the information needs of pregnant teenagers, interventions should target both the expecting teenagers and the family and/or the community at large. The findings further point to a need for a shift in maternal health care policy through the establishment of adolescent only antenatal care day to effectively meet the heath information needs of pregnant teenagers. © 2016 Elsevier Ltd | Open |
| Prado E.L.; Adu-Afarwuah S.; Lartey A.; Ocansey M.; Ashorn P.; Vosti S.A.; Dewey K.G. | Effects of pre- and post-natal lipid-based nutrient supplements on infant development in a randomized trial in Ghana | 2016 | Early Human Development | Background Maternal and infant undernutrition is negatively associated with infant development. Aims We tested the hypothesis that provision of small-quantity lipid-based nutrient supplements (SQ-LNS) to pregnant women and infants positively affects infant development. Study design In a partially double-blind randomized controlled trial, we compared the following daily maternal supplements during pregnancy and until 6 months post-partum: iron/folic acid capsule (IFA), capsule containing 18 micronutrients (MMN), or 20 g SQ-LNS. Children in the SQ-LNS group also received SQ-LNS from age 6 to 18 months. The study is registered as NCT00970866. Subjects 1320 pregnant women in Ghana enrolled in the trial; 1173 of their children participated in developmental assessment. Outcome measures We monitored the acquisition of 10 developmental milestones monthly by parental report, observed the attainment of 6 motor milestones at 6, 12, and 18 months, and conducted detailed assessment of motor, language, socio-emotional, and executive function at 18 months. Results By researcher observation, a greater percentage of children in the SQ-LNS group (53%) was able to walk alone at 12 months than in the IFA group (43%; RR = 1.23, 95% CI = 1.02–1.49; p = 0.025). We found no significant differences between groups in milestone acquisition by parent report or in any scores at 18 months. The difference in mean z-scores between groups ranged from 0.03–0.13 for motor (p = 0.84), 0.01–0.08 for language (p = 0.46), 0.01–0.02 for socio-emotional (p = 0.75), and 0.00–0.02 for executive function (p = 0.95). Conclusion While provision of maternal and child SQ-LNS in Ghana may affect walking at 12 months, it did not affect infant development at 18 months. © 2016 Elsevier Ireland Ltd | Open |
| Quansah E.; Ohene L.A.; Norman L.; Mireku M.O.; Karikari T.K. | Social factors influencing child health in Ghana | 2016 | PLoS ONE | Objectives. Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals' target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the nonrealisation of this goal. Methods. ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Results. Major social factors influencing child health in the country include maternal education, ruralurban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Conclusions. Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother's health knowledge is emphasised. © 2016 Quansah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Saaka M. | How is household food insecurity and maternal nutritional status associated in a resource-poor setting in Ghana? | 2016 | Agriculture and Food Security | Background: Population-based studies show household food insecurity is associated with increased body mass index (BMI) and an increased risk of overweight in adult women in developed countries. However, there is insufficient empirical evidence of the association between food insecurity and maternal nutritional status in resource-poor settings. This study investigated the relationship between household food insecurity (HFI) and maternal nutritional status in a resource-poor setting of Ghana, where some households suffer from some form of food insecurity during the year. Methods: A community-based cross-sectional cluster study was conducted in June 2015. The study communities were selected using probability proportionate to size. The study population comprised non-lactating and non-pregnant women who were selected using a two-stage cluster sampling procedure. HFI was quantified using the Household Hunger Scale. Multiple regression analysis was conducted to test whether HFI significantly predicts maternal nutritional status, controlling for potential confounding factors. BMI was used to assess the nutritional status. Results: The prevalence of moderate to severe household hunger was 46.9 %. In analysis of covariance, while adjusting for household size, place of residence and household wealth index, the mean BMI for women from food-secure households was 1.4 kg/m2 significantly higher than the mean BMI for women from food-insecure households (25.7 ± 5.3 vs. 24.3 ± 4.0) (95 % CI 0.54-2.35), p = 0.002. Multivariable regression analysis showed that, after adjusting for potential confounders, there was a significant negative association between moderate to severe household hunger and BMI (β = -0.16, p < 0.001). Conclusions: In conclusion, food insecurity in the study population was prevalent and was associated with low maternal BMI. Household food insecurity was negatively associated with maternal overweight and obesity. Women in food-secure households were more likely than food-insecure households to consume milk, pulses, oily and sugar-based foods. © 2016 The Author(s). | Open |
| Steiner-Asiedu M.; Harrison O.; Vuvor F.; Tano-Debrah K. | Quality evaluation of processed clay soil samples | 2016 | Pan African Medical Journal | Introduction: This study assessed the microbial quality of clay samples sold on two of the major Ghanaian markets. Methods: The study was a cross-sectional assessing the evaluation of processed clay and effects it has on the nutrition of the consumers in the political capital town of Ghana. The items for the examination was processed clay soil samples. Results: Staphylococcus spp and fecal coliforms including Klebsiella, Escherichia, and Shigella and Enterobacterspp were isolated from the clay samples. Samples from the Kaneshie market in Accra recorded the highest total viable counts 6.5 Log cfu/g and Staphylococcal count 5.8 Log cfu/g. For fecal coliforms, Madina market samples had the highest count 6.5 Log cfu/g and also recorded the highest levels of yeast and mould. For Koforidua, total viable count was highest in the samples from the Zongo market 6.3 Log cfu/g. Central market samples had the highest count of fecal coliforms 4.6 Log cfu/g and yeasts and moulds 6.5 Log cfu/g. “Small”market recorded the highest staphylococcal count 6.2 Log cfu/g. The water activity of the clay samples were low, and ranged between 0.65±0.01 and 0.66±0.00 for samples collected from Koforidua and Accra respectively. Conclusion: The clay samples were found to contain Klebsiella spp. Escherichia, Enterobacter, Shigella spp. staphylococcus spp., yeast and mould. These have health implications when consumed. © Benja Ramilitiana et al. | Open |
| Tette E.M.A.; Neizer M.; Nyarko M.Y.; Sifah E.K.; Nartey E.T.; Donkor E.S. | Changing patterns of disease and mortality at the Children's Hospital, Accra: Are infections rising? | 2016 | PLoS ONE | Background: The Millennium Development Goals (MDGs) have led to reductions in child mortality worldwide. This has, invariably, led to the changes in the epidemiology of diseases associated with child mortality. Although facility based data do not capture all deaths, they provide an opportunity to confirm diagnoses and insight into these changes which are relevant for further disease control. Objective: To identify changes in the disease pattern of children who died at the Princess Marie Louise Children's Hospital (PML) in Ghana from 2003-2013. Methods: A cross sectional review of mortality data was carried out at PML. The age, sex, duration of admission and diagnosis of consecutive patients who died at the hospital between 2003 and 2013 were reviewed. This information was entered into an Access database and analysed using Stata 11.0 software. Results: Altogether, 1314 deaths (3.6%) occurred out of a total of 37,012 admissions. The majority of the deaths, 1187 (90.3%), occurred in children under the age of 5 years. While deaths caused by malaria, malnutrition, HIV infection and diarrhoea decreased, deaths caused by pneumonia were rising. Suspected septicaemia and meningitis showed a fluctuating trend with only a modest decrease between 2012 and 2013. The ten leading causes of mortality among under-fives were malnutrition, 363 (30.6%); septicaemia, 301 (25.4%); pneumonia, 218 (18.4%); HIV infection, 183 (15.4%); malaria, 155 (13.1%); anaemia, 135 (11.4%); gastroenteritis/dehydration, 110 (9.3%); meningitis, 58 (4.9%); tuberculosis, 34 (2.9%) and hypoglycaemia, 27 (2.3%). For children aged 5-9 years, the leading causes of mortality were malaria, 42 (42.9%); HIV infection, 27 (27.6%); anaemia, 14 (14.3%); septicaemia, 12 (12.2%); meningitis, 10 (10.2%); malnutrition, 9 (9.2%); tuberculosis, 5 (5.1%); pneumonia, 4 (4.1%); encephalopathy, 3 (3.1%); typhoid fever, 3 (3.1%) and lymphoma, 3 (3.1%). In the adolescent age group, malaria, 8 (27.6%); anaemia, 6 (20.7%); HIV infection, 5 (17.2%); sickle cell disease, 3 (10.3%) and meningitis, 3 (10.3%) were most common. Conclusion: There has been a decline in the under-five mortality at PML over the years; however, deaths caused by pneumonia appear to be rising. This highlights the need for better diagnostic services, wider HIV screening and clinical audits to improve outcomes in order to achieve further reductions in child mortality and maintain the gains. © 2016 Tette et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Open |
| Tette E.M.A.; Sifah E.K.; Nartey E.T.; Nuro-Ameyaw P.; Tete-Donkor P.; Biritwum R.B. | Maternal profiles and social determinants of malnutrition and the MDGs: What have we learnt? | 2016 | BMC Public Health | Background: Maternal socio-demographic and health profiles are important determinants of malnutrition in children. In the 1990s, malnutrition was associated with low-birth-weight, young mothers and low maternal socio-economic status at Princess Marie Louise Children's Hospital (PML). It is not known how this has changed by efforts to achieve the Millennium Development Goals. We examined socio-demographic and health profiles of mothers of children with acute malnutrition and those without the condition to identify risk factors for malnutrition and focus on preventive efforts. Methods: An unmatched case-control study was conducted in 2013 at PML, the largest facility for treating malnourished children in Ghana in 2013. Mothers of children with moderate and severe acute malnutrition were compared with mothers of well-nourished children. Weight-for-height was used to classify malnutrition. Record forms and a semi-structured questionnaire were used for data collection. An analysis was done with Stata 11.0 software. Results: Altogether, 371 mothers were studied consisting of 182 mothers of malnourished children and 189 mothers of well-nourished children. Mothers of malnourished children were more likely to be unmarried or cohabiting, have lower family incomes, HIV infection and chronic disease. They were less likely to stay with or provide alternative care for their child. Awareness and use of social services, health insurance and a cash transfer programme were low. A remarkable reduction in the number of malnourished children occurred when families earned more than $250 USD a month. Over-nutrition was present in both groups of mothers. Conclusion: Low family income, unmarried status and type of child care were the main social determinants of malnutrition. There appears to be a reduction in the number of other poor socio-demographic characteristics in both the study and control groups compared to results from a previous study at the same centre, probably because of efforts toward attaining the MDGs. These findings suggest that prevention and optimum management need to involve multidisciplinary teams consisting of health professionals, social workers and/or key workers to enable families at risk to access social care and social protection interventions (MDG 1). This will make the management of malnutrition more effective, prevent relapse, protect the next child and address maternal over-nutrition. © 2016 Tette et al. | Open |
| Tette E.M.A.; Sifah E.K.; Tete-Donkor P.; Nuro-Ameyaw P.; Nartey E.T. | Feeding practices and malnutrition at the Princess Marie Louise Children's hospital, Accra: What has changed after 80 years? | 2016 | BMC Nutrition | Background: Sub-optimal feeding practices are associated with malnutrition. In 1933, Dr Cecily Williams, while working at Princess Marie Louise Children's Hospital (PML) in Accra described Kwashiorkor as the disease of children "deposed"from breast feeding who were being fed plain fermented maize diets. Presently, it is not clear how this has changed after 80 years. Methods: We conducted an unmatched case-control study at PML in 2013 in order to determine faulty feeding practices associated with malnutrition. PML is a 74 bed children's hospital and the largest centre for treating children with malnutrition in Ghana. Under-fives with Moderate or Severe Acute Malnutrition (SAM or MAM) were selected as cases while the controls were children without SAM or MAM. Results: A total of 182 malnourished and 189 well-nourished under-fives and their mothers were studied. Faulty feeding practices including early weaning, shorter duration of exclusive breastfeeding, mixed feeding, bottle feeding and limited consumption of fruits were found. Though the use of "iced kenkey"a maize-based diet was limited, over one-third of malnourished children (39.1 %) were still being weaned with plain unfortified fermented maize gruel both of which Dr Williams associated with Kwashiorkor. Well-nourished children were more likely to receive solid food (38.0 %), fortified maize gruel (29.2 %), and Cerelac® (24 %) a processed cereal-based complementary food. A child's refusal to breastfeed was the most common reason for stopping breastfeeding among malnourished children. Conclusions: More effective nutrition education and new complementary feeding diets that are wholesome yet appeal to a new generation of mothers are needed. The patho-physiology of feeding problems needs further study. © 2016 The Author(s). | Open |
| Tiwari S.; Daidone S.; Ruvalcaba M.A.; Prifti E.; Handa S.; Davis B.; Niang O.; Pellerano L.; Quarles van Ufford P.; Seidenfeld D. | Impact of cash transfer programs on food security and nutrition in sub-Saharan Africa: A cross-country analysis | 2016 | Global Food Security | This paper explores the extent to which government-run cash transfer programs in four sub-Saharan countries affect food security and nutritional outcomes. These programs include Ghana's Livelihood Empowerment Against Poverty, Kenya's Cash Transfer for Orphans and Vulnerable Children, Lesotho's Child Grants Program and Zambia's Child Grant model of the Social Cash Transfer program. Our cross-country analysis highlights the importance of robust program design and implementation to achieve the intended results. We find that a relatively generous and regular and predictable transfer increases the quantity and quality of food and reduces the prevalence of food insecurity. On the other hand, a smaller, lumpy and irregular transfer does not lead to impacts on food expenditures. We complement binary treatment analysis with continuous treatment analysis to understand not only the impact of being in the program but also the variability in impacts by the extent of treatment. © 2016 Food and Agriculture Organization of the United Nations | Open |
| Tsiboe F.; Zereyesus Y.A.; Osei E. | Non-farm work, food poverty, and nutrient availability in northern Ghana | 2016 | Journal of Rural Studies | Despite the significant economic development in Ghana, northern Ghana has made little progress. Nationally, households engaged in the non-farm work are less likely to be categorized as poor, relative to those engaged in farming only. Given the well-established positive nexus between non-farm work and food security, this study extends the literature by analyzing the nexus between different types of non-farm work (own business, wage employment, and their combination) and household food nutrient availability in northern Ghana. Results from an application of a linear regression with endogenous treatment effects model to a sample of 3488 farming households and 5770 individuals indicate that, non-farm work positively affects food nutrient availability; and that farming households that own non-farm business are superior in terms of their nutrient availability and the extent of food security. Furthermore, households participating in the labor market in search of supplemental income do not appear to have better food security status relative to those engaged in farming only. Finally, females participating in non-farm work provide the largest contribution to household food nutrient availability. The study recommends the implementation of policies and building of infrastructure that foster the creation of non-farm income generating opportunities in northern Ghana, coupled with a framework that enables women to take advantage of these opportunities. © 2016 Elsevier Ltd | Open |
| Wang N.; Chen Y.; Ning Z.; Li Q.; Han B.; Zhu C.; Chen Y.; Xia F.; Jiang B.; Wang B.; Wang X.; Jensen M.D.; Lu Y. | Exposure to famine in early life and nonalcoholic fatty liver disease in adulthood | 2016 | Journal of Clinical Endocrinology and Metabolism | Context: Epidemiologic studies have indicated that early life nutrition influences later risk of obesity, type 2 diabetes, and metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) is also considered a metabolic disease. Objective: The aim was to explore the association between adult NAFLD and fetal or childhood exposure to Great Chinese Famine between 1959 and 1962 during fetal and childhood period. Design and setting: In total, 5306 subjects from the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors study were divided into a fetal-exposed (1959-1962), childhood-exposed (1949-1958), adolescence/young adult-exposed (1921-1948), and nonexposed (1963-1974, reference) group. Main outcome measure: The degrees of steatosis of NAFLD were determined by ultrasonography. Results: The prevalences of NAFLD in the nonexposed (1963-1974), fetal-exposed, and childhood-exposed participants were 55.9%, 55.8%, and 55.4% in men and 33.0%, 46.3%, and 51.7% in women, respectively. Compared with those nonexposed, fetal- and childhood-exposed women but not men had a significantly higher prevalence of moderate-severe steatosis (P<.05). A significant association existed in women between increased alanine aminotransferase and both fetal and childhood exposure to famine, after adjusting for age, rural/urban residence, economic status, body mass index, diabetes, dyslipidemia, and hypertension (both P<.05). Famine exposure during the fetal period (odds ratio 1.77,95% confidence interval 1.22, 2.57) and childhood (odds ratio 1.82, 95% confidence interval 1.35, 2.46) was associated with an increased prevalence of moderate-severe NAFLD in women in the above fully adjusted model. Conclusions: Exposure to the Great Famine in early life had sex-specific association with moderate-severe NAFLD. This indicates that malnutrition in early life may influence the development of adult NAFLD; thus pregnant women and their infants and children may require the highest priority in obtaining nutritional relief. Copyright © 2016 by the Endocrine Society. | Open |
| Wemakor A.; Mensah K.A. | Association between maternal depression and child stunting in Northern Ghana: A cross-sectional study | 2016 | BMC Public Health | Background: Stunting indicates failure to attain genetic potential for height and is a well-documented indicator for poor growth. Depression is common in women of reproductive age and women's mental health problems may affect the growth of young children. We examined the association between maternal depression and stunting in mother-child pairs attending Child Welfare Clinic (CWC) in Northern Ghana. Methods: An analytical cross-sectional study was performed involving mothers (15-45 years) and their children (0-59 months) who attended CWC at Bilpeila Health Centre, Tamale, Ghana. Socio-demographic data were collected using a semi-structured questionnaire, maternal depression was measured using Centre for Epidemiological Studies Depression Screening Scale, and anthropometry was conducted on children following standard procedures. The association between maternal depression and child stunting was examined in logistic regression adjusting for potential confounders. Results: Prevalence rates of child stunting and maternal depression were estimated at 16.1 and 27.8 % respectively in Northern Ghana. Mothers with depression when compared with those without depression tended to be younger, be currently unmarried, belong to the poorest household wealth tertile, and were more likely to have low birth weight babies, so these characteristics were adjusted for. In an adjusted multivariate logistic regression model, children of depressed mothers were almost three times more likely to be stunted compared to children of non-depressed mothers (Adjusted OR = 2.48, 95 % CI 1.29-4.77, p = 0.0011). Conclusions: There is a high prevalence of depression among mothers in Northern Ghana which is associated with child stunting. Further studies are needed to identify the determinants of maternal depression and to examine its association with child stunting to inform nutrition programming. © 2016 The Author(s). | Open |
| Abubakari A.; Kynast-Wolf G.; Jahn A. | Prevalence of abnormal birth weight and related factors in Northern region, Ghana | 2015 | BMC Pregnancy and Childbirth | Background: Birth weight is a crucial determinant of the development potential of the newborn. Abnormal newborn weights are associated with negative effects on the health and survival of the baby and the mother. Therefore, this study was designed to determine the prevalence of abnormal birth weight and related factors in Northern region, Ghana. Methods: The study was a facility-based cross-sectional survey in five hospitals in Northern region, Ghana. These hospitals were selected based on the different socio-economic backgrounds of their clients. The data on birth weight and other factors were derived from hospital records. Results: It was observed that low birth weight is still highly prevalent (29.6 %), while macrosomia (10.5 %) is also increasingly becoming important. There were marginal differences in low birth weight observed across public hospitals but marked difference in low birth weight was observed in Cienfuegos Suglo Specialist Hospital (Private hospital) as compared to the public hospitals. The private hospital also had the highest prevalence of macrosomia (20.1 %). Parity (0-1) (p < 0.001), female gender (p < 0.001) and location (rural) (p < 0.001) were significantly associated with decreased risk of macrosomic births. On the other hand, female infant sex (p < 0.001), residential status (rural) (p < 0.001) and parity (0-1) (p < 0.001) were significantly associated with increased risk of low birth weigh. Conclusions: Our findings show that under nutrition (low birth weight) and over nutrition (macrosomia) coexist among infants at birth in Northern region reflecting the double burden of malnutrition phenomenon, which is currently being experienced by developing and transition counties. Both low birth weight and macrosomia are risk factors, which could contribute considerably to the current and future burden of diseases. This may overstretch the already fragile health system in Ghana. Therefore, it is prudent to recommend that policies aiming at reducing diet related diseases should focus on addressing malnutrition during pregnancy and early life. © 2015 Abubakari et al. | Open |
| Adu-Afarwuah S.; Lartey A.; Okronipa H.; Ashorn P.; Zeilani M.; Peerson J.M.; Arimond M.; Vosti S.; Dewey K.G. | Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana | 2015 | American Journal of Clinical Nutrition | Background: The International Lipid-Based Nutrient Supplements Project developed a small-quantity (20 g/d) lipid-based nutrient supplement (LNS) for pregnant and lactating women. Objective: We evaluated the effects of prenatal LNS supplementation on fetal growth. Design: In a community-based, partially double-blind, individually randomized controlled trial, 1320 women ≤20 wk pregnant received 60 mg Fe/400 mg folic acid (IFA), or 1-2 Recommended Dietary Allowances of 18 micronutrients, including 20 mg Fe (MMN), or LNS with the same micronutrients as the MMN group, plus 4 minerals and macronutrients contributing 118 kcal (LNS) daily until delivery. Fetal growth was compared across groups by using intention- to-treat analysis. The primary outcome was birth length. Results: This analysis included 1057 women (IFA = 349, MMN = 354, LNS = 354). Groups did not differ significantly in mean birth length, length-for-age z score (LAZ), head circumference, or percentage low birth length but differed in mean birth weight (P = 0.044), weight-for-age z score (WAZ; P = 0.046), and BMI-forage z score (BMIZ; P = 0.040), with a trend toward differences in low birth weight (P = 0.069). In pairwise comparisons, the LNS group had greater mean birth weight (+85 g; P = 0.040), WAZ (+0.19; P = 0.045), and BMIZ (+0.21; P = 0.035) and a lower risk of low birth weight (RR: 0.61, 95% CI: 0.39, 0.96; P = 0.032) than did the IFA group. The other group differences were not significant. The effect of intervention was modified by mother's parity, age, height, baseline hemoglobin, household food insecurity, and child sex, with parity being the most consistent modifier. Among primiparous women (IFA = 131; MMN = 110; LNS = 128), the LNS group had greater mean birth length (+0.91 cm; P = 0.001), LAZ (+0.47; P = 0.001), weight (+237 g; P < 0.001), WAZ (+0.56; P < 0.001), BMIZ (+0.52; P < 0.001), head circumference (0.50 cm; P = 0.017), and head circumference-for-age z score (+0.40; P = 0.022) than did the IFA group; similar differences were found when comparing the LNS and MMN groups among primiparous women, and no group differences were found among multiparous women. Conclusion: Prenatal LNS supplementation can improve fetal growth among vulnerable women in Ghana, particularly primiparous women. © 2015 American Society for Nutrition. | Open |
| Aheto J.M.K.; Keegan T.J.; Taylor B.M.; Diggle P.J. | Childhood Malnutrition and Its Determinants among Under-Five Children in Ghana | 2015 | Paediatric and Perinatal Epidemiology | Background Childhood malnutrition adversely affects short- and long-term health and economic well-being of children. Malnutrition is a global challenge and accounts for around 40% of under-five mortality in Ghana. Limited studies are available indicating determinants of malnutrition among children. This study investigates prevalence and determinants of malnutrition among children under-five with the aim of providing advice to policymakers and other stakeholders responsible for the health and nutrition of children. Methods The study used data from the 2008 Ghana Demographic and Health Survey (GDHS). Analyses were conducted on 2083 children under 5 years old nested within 1641 households with eligible anthropometric measurements, using multilevel regression analysis. Results from the multilevel models were used to compute probabilities of malnutrition. Results This study observed that 588 (28%), 276 (13%), and 176 (8%) of the children were moderately 'stunted', moderately 'underweight', and moderately 'wasted' respectively. Older ages are associated with increased risk of stunting and underweight. Longer breast-feeding duration, multiple births, experience of diarrhoeal episodes, small size at birth, absence of toilet facilities in households, poor households, and mothers who are not covered by national health insurance are associated with increased risk of malnutrition. Increase in mother's years of education and body mass index are associated with decreased malnutrition. Strong residual household-level variations in childhood nutritional outcomes were found. Conclusion Policies and intervention strategies aimed at improving childhood nutrition and health should address the risk factors identified and the need to search for additional risk factors that might account for the unexplained household-level variations. © 2015 John Wiley & Sons Ltd. | Open |
| Akachi Y.; Canning D. | Inferring the economic standard of living and health from cohort height: Evidence from modern populations in developing countries | 2015 | Economics and Human Biology | Average adult height is a physical measure of the biological standard of living of a population. While the biological and economic standards of living of a population are very different concepts, they are linked and may empirically move together. If this is so, then cohort heights can also be used to make inferences about the economic standard of living and health of a population when other data are not available. We investigate how informative this approach is in terms of inferring income, nutrition, and mortality using data on heights from developing countries over the last 50 years for female cohorts born 1951-1992. We find no evidence that the absolute differences in adult height across countries are associated with different economic living standards. Within countries, however, faster increases in adult cohort height over time are associated with more rapid growth of GDP per capita, life expectancy, and nutritional intake. Using our instrumental variable approach, each centimeter gain in height is associated with a 6% increase in income per capita, a reduction in infant mortality of 7 per thousand (or an 1.25 year increase in life expectancy), and an increase in nutrition of 64 calories and 2 grams of protein per person per day relative to the global trend. We find that increases in cohort height can predict increases in income even for countries not used in the estimation of the relationship. This suggests our approach has predictive power out of sample for countries where we lack income and health data. © 2015 The Authors. Published by Elsevier B.V. | Open |
| Amugsi D.A.; Mittelmark M.B.; Oduro A. | Association between maternal and child dietary diversity: An analysis of the Ghana Demographic and Health Survey | 2015 | PLoS ONE | Objective (s): This study examined the association between maternal and child dietary diversity in a population-based national sample in Ghana. Methods: The data for this analysis are from the 2008 Ghana Demographic and Health Survey. We used data obtained from 1187 dyads comprised of mothers' ages 15-49 and their youngest child (ages 6-36 months). Maternal and child dietary diversity scores (DDS) were created based on the mother's recall of her own and her child's consumption of 15 food groups, during the 24 hours prior to the in-home survey. The same food groups were used to compose both maternal and child DDS. Linear regression was used to assess the relationship between the predicted outcome - child DDS - and maternal DDS, taking into account child age and sex, maternal factors (age, education, occupation, literacy, empowerment, number of antenatal visits as an indicator of health care use), household Wealth Index, and urban/rural place of residence. Results: There was a statistically significant positive association between child and maternal DDS, after adjusting for all other variables. A difference of one food group in mother's consumption was associated with a difference of 0.72 food groups in the child's food consumption (95% CI: 0.63, 0.82). Also, statistically significant positive associations were observed such that higher child DDS was associated with older child age, and with greater women's empowerment. Conclusions: The results show a significant positive association between child and maternal DD, after accounting for the influence of child, maternal and household level factors. Since the likely path of influence is that maternal DDS impacts child DDS, public health efforts to improve child health may be strengthened by promoting maternal DDS due to its potential for a widened effect on the entire family. Copyright: © 2015 Amugsi et al. | Open |
| Arimond M.; Zeilani M.; Jungjohann S.; Brown K.H.; Ashorn P.; Allen L.H.; Dewey K.G. | Considerations in developing lipid-based nutrient supplements for prevention of undernutrition: Experience from the International Lipid-Based Nutrient Supplements (iLiNS) Project | 2015 | Maternal and Child Nutrition | The International Lipid-Based Nutrient Supplements (iLiNS) Project began in 2009 with the goal of contributing to the evidence base regarding the potential of lipid-based nutrient supplements (LNS) to prevent undernutrition in vulnerable populations. The first project objective was the development of acceptable LNS products for infants 6-24 months and for pregnant and lactating women, for use in studies in three countries (Burkina Faso, Ghana and Malawi). This paper shares the rationale for a series of decisions in supplement formulation and design, including those related to ration size, ingredients, nutrient content, safety and quality, and packaging. Most iLiNS supplements have a daily ration size of 20g and are intended for home fortification of local diets. For infants, this ration size is designed to avoid displacement of breast milk and to allow for dietary diversity including any locally available and accessible nutrient-dense foods. Selection of ingredients depends on acceptability of flavour, micronutrient, anti-nutrient and essential fatty acid contents. The nutrient content of LNS designed to prevent undernutrition reflects the likelihood that in many resource-poor settings, diets of the most nutritionally vulnerable individuals (infants, young children, and pregnant and lactating women) are likely to be deficient in multiple micronutrients and, possibly, in essential fatty acids. During ingredient procurement and LNS production, safety and quality control procedures are required to prevent contamination with toxins or pathogens and to ensure that the product remains stable and palatable over time. Packaging design decisions must include consideration of product protection, stability, convenience and portion control. © 2015 John Wiley & Sons, Ltd. | Open |
| Aryeetey R.N.O.; Tay M. | Compliance Audit of Processed Complementary Foods in Urban Ghana | 2015 | Frontiers in Public Health | Background and objectives: Although processed complementary foods (PCFs) can contribute to meeting dietary needs of infants and young children, it has been associated with unethical marketing practices, which undermine practice of exclusive breastfeeding for 6 months. The current study assessed PCF labeling compliance to the International Code of Marketing of Breast Milk Substitutes (CMBMS) and the National Breastfeeding Promotion Regulation (NBPR) in Ghana. Methods: A variety of PCF were purchased from child welfare clinics, fuel station shops, supermarkets, “mother/baby” care shops, and pharmacies in the La and Osu Klottey sub-metropolitan areas in Accra. The labels were evaluated against the best practice indicators proposed by the Maternal, Infant, and Young Child Nutrition Working Group based on the international CMBMS, and also indicators based on the NBPR. An overall compliance estimate was determined based on intensity of compliance to the indicators. Results: The PCF purchased included cereal-based products, fruit juices, fruit and vegetable purees, milk-based products, and combination meals; 75% of PCF were imported. One hundred of the 108 products identified were labeled in English and thus included in analysis. None of the products complied with all labeling requirements of CMBMS or NBPR; 84 and 17% of product labels complied with at least 50% of NBPR and 50% of CMBMS indicators, respectively. Only 5% of labels had content indicating importance of exclusive breastfeeding for 6 months. Additionally, only 5% of labels warned against the hazard of introducing PCF earlier than 6 months as required by the NBPR. Conclusion: Labeling of most PCF sold by selected retailers in Accra did not comply with NBPR and CMBMS labeling requirements. Enforcement of local law on labeling of PCF is urgently needed. Copyright © 2015 Aryeetey and Tay. | Open |
| Barimah J.; Laryea D.; Okine U.N.K. | Date fruit powder as sugar replacer in rock buns | 2015 | Nutrition and Food Science | Purpose – This paper aims to assess the potential of date fruit powder as a refined sugar replacer in rock buns to help promote and diversify the utilization of date fruit. Design/methodology/approach – Date fruit pulp was sun dried, milled into powder, sieved and its proximate composition determined. Refined sugar in rock buns was replaced with date fruit powder at 0, 50, 80 and 100 per cent levels. The samples were then subjected to proximate, mineral and sensory evaluation. Findings – Date fruit powder had 1.47 per cent crude fiber and was high in carbohydrate (82.15 per cent). Carbohydrate content of samples decreased (48.55-29.72 per cent), while crude protein (6.78-9.97 per cent), crude fat (22.74-33.66 per cent) and crude fiber (0-0.49 per cent) contents increased with an increasing substitution of date powder. Of all, 0 and 50 per cent substituted rock bun samples were the most preferred. Date powder significantly (p < 0.05) increased the potassium (0.55-1.57 per cent), calcium (0.08-1.08 per cent) and iron (0.53-0.625 per cent) contents of the samples. Originality/value – This research assessed the potential of date fruit powder as a replacer of refined sugar in rock buns, as it remains an underutilized commodity in Ghana. Replacing 50 per cent of refined sugar improved the nutrient composition of rock buns, thereby making date fruit powder a nutritious sugar replacer which could be used in pastry products. This when adopted would diversify the utilization of date fruits while providing good nutrition to consumers. © 2015, © Emerald Group Publishing Limited. | Open |
| Belane A.K.; Dakora F.D. | Assessing the relationship between photosynthetic C accumulation and symbiotic N nutrition in leaves of field-grown nodulated cowpea (Vigna unguiculata L. Walp.) genotypes | 2015 | Photosynthetica | This study evaluated the relationship between photosynthetic carbon accumulation and symbiotic nitrogen nutrition in young fully expanded leaves of 30 nodulated cowpea genotypes grown in the field at Manga, Ghana, in 2005 and 2006. Estimates of fixed-N in photosynthetic leaves revealed greater symbiotic N in genotypes with higher photosynthetic rates and increased leaf transpiration rate/efficiency. There was also greater C accumulation in genotypes with higher symbiotic N and/or total N. Additionally, genotypes with high contents of C per unit of leaf total N exhibited greater C per unit of leaf N-fixed. The C/N and C/Rubisco-N ratios were generally similar in their magnitude when compared to the C/N-fixed ratio due possibly to the fact that Rubisco accounts for a high proportion of photosynthetic leaf N, irrespective of whether the enzyme was formed from soil N or symbiotic N. Cowpea genotypes that relied heavily on soil N for their N nutrition exhibited much higher C/N-fixed ratios, while conversely those that depended more on symbiosis for meeting their N demands showed markedly lower C/N-fixed values. For example, genotypes Omondaw, Bensogla, IT93K-2045-29, and Sanzie, which respectively derived 83.9, 83.1, 82.9, and 76.3% N from fixation, recorded lower C/N-fixed ratios of 10.7, 12.2, 12.1, and 13.0 mg mg−1 in that order in 2005. In contrast, genotypes Botswana White, IT94D-437-1, TVu1509, and Apagbaala, which obtained 14.8, 15.0, 26.4, and 26.0% of their N nutrition from fixation, showed high C/N-fixed values of 84.0, 69.0, 35.2, and 40.6 mg.mg−1, respectively, in 2005. This clearly indicates that genotypes that obtained less N from symbiosis and more N from soil revealed very high C/N-fixed values, an argument that was reinforced by the negative correlations obtained between the three C/N ratios (i.e. C/N, C/Rubisco-N, and C/N-fixed) and leaf N concentration, percentage nitrogen derived from fixation, total N content, amount of N-fixed, and Rubisco N. These data suggest a direct link between photosynthetic C accumulation and symbiotic N assimilation in leaves of nodulated cowpea, and where genotypes derived a large proportion of their N from fixation, photosynthetic C yield substantially increased. © 2015, The Institute of Experimental Botany. | Open |
| Bosu W.K. | An overview of the nutrition transition in West Africa: Implications for non-communicable diseases | 2015 | Proceedings of the Nutrition Society | The nutrition landscape in West Africa has been dominated by the programmes to address undernutrition. However, with increasing urbanisation, technological developments and associated change in dietary patterns and physical activity, childhood and adult overweight, and obesity are becoming more prevalent. There is an evidence of increasing intake of dietary energy, fat, sugars and protein. There is low consumption of fruit and vegetables universally in West Africa. Overall, the foods consumed are predominantly traditional with the component major food groups within recommended levels. Most of the West African countries are at the early stages of nutrition transition but countries such as Cape Verde, Ghana and Senegal are at the latter stages. In the major cities of the region, children consume energy-dense foods such as candies, ice cream and sweetened beverages up to seven times as frequently as fruit and vegetables. Adult obesity rates have increased by 115 % in 15 years since 2004. In Ghana, the prevalence of overweight/obesity in women has increased from 12·8 % in 1993 to 29·9 % in 2008. In Accra, overweight/obesity in women has increased from 62·2 % in 2003 to 64·9 % in 2009. The age-standardised proportion of adults who engage in adequate levels of physical activity ranges from 46·8 % in Mali to 94·7 % in Benin. The lingering stunting in children and the rising overweight in adults have resulted to a dual burden of malnutrition affecting 16·2 % of mother-child pairs in Cotonou. The prevalence of hypertension has been increased and ranges from 17·6 % in Burkina Faso to 38·7 % in Cape Verde. The prevalence is higher in the cities: 40·2 % in Ougadougou, 46·0 % in St Louis and 54·6 % in Accra. The prevalence of diabetes ranges from 2·5 to 7·9 % but could be as high as 17·9 % in Dakar, Senegal. The consequences of nutrition transition are not only being felt by the persons in the high socioeconomic class, but also in cities such as Accra and Ouagadougou, where at least 19 % of adults from the poorest households are overweight and 19-28 % have hypertension. Concerted national action involving governments, partners, private sector and civil society is needed to re-orient health systems and build capacity to address the dual burden of malnutrition, to regulate the food and beverage industry and to encourage healthy eating throughout the life course. © The Author 2014. | Open |
| Cameron S.; Ananga E.D. | Savings Groups, Livelihoods and Education: Two Case Studies in Ghana | 2015 | Journal of International Development | Does access to better village-level facilities for saving and borrowing improve educational outcomes and expenditure? Based on a literature review and case studies in Ghana commissioned by Plan UK, this paper finds that savings groups programmes, such as village savings and loans associations, help poor rural households pay for education in some contexts but not others. Households use loans directly to pay school expenses and also invest in income-generating activities that allow them to raise educational expenditure in the longer term. There are additional indirect effects on education through health care, nutrition and household decision-making. © 2015 John Wiley & Sons, Ltd. | Open |
| Coppin J.P.; Juliani H.R.; Wu Q.; Simon J.E. | Variations in Polyphenols and Lipid Soluble Vitamins in Moringa oleifera | 2015 | Processing and Impact on Active Components in Food | Moringa oleifera is a commonly used plant and a rich source of nutrients and antioxidants. Using HPLC combined with UV and MS detection, a total of 20 moringa leaf samples field-grown from the same genetic varieties introduced into and grown in Ghana, Senegal, and Zambia were collected and analyzed to give an individual account of α- and β-carotenes, α- and γ-tocopherols, and six chlorogenic analogs. The total α- and β-carotenes and α- and γ-tocopherols ranged between 4.49 -116.79. mg/100. g dry weight (d.w.). Total chlorogenic analogs ranged from 181. mg/100. g d.w. Samples varied based on the environment, country of origin and genetic and morphological characteristics. Moringa oleifera has great potential to become a far more important food source as it is a rich source of vitamins and polyphenols. © 2015 Elsevier Inc. All rights reserved.. | Open |
| Craig L.; Lutz A.; Berry K.A.; Yang W. | Recommendations for fluoride limits in drinking water based on estimated daily fluoride intake in the Upper East Region, Ghana | 2015 | Science of the Total Environment | Both dental and skeletal fluorosis caused by high fluoride intake are serious public health concerns around the world. Fluorosis is particularly pronounced in developing countries where elevated concentrations of naturally occurring fluoride are present in the drinking water, which is the primary route of exposure. The World Health Organization recommended limit of fluoride in drinking water is 1.5mgF-L-1, which is also the upper limit for fluoride in drinking water for several other countries such as Canada, China, India, Australia, and the European Union. In the United States the enforceable limit is much higher at 4mgF-L-1, which is intended to prevent severe skeletal fluorosis but does not protect against dental fluorosis. Many countries, including the United States, also have notably lower unenforced recommended limits to protect against dental fluorosis. One consideration in determining the optimum fluoride concentration in drinking water is daily water intake, which can be high in hot climates such as in northern Ghana. The results of this study show that average water intake is about two times higher in Ghana than in more temperate climates and, as a result, the fluoride intake is higher. The results also indicate that to protect the Ghanaian population against dental fluorosis, the maximum concentration of fluoride in drinking water for children under 6-8years should be 0.6mgF-L-1 (and lower in the first two years of life), and the limit for older children and adults should be 1.0mgF-L-1. However, when considering that water treatment is not cost-free, the most widely recommended limit of 1.5mgF-L-1 - which is currently the limit in Ghana - may be appropriate for older children and adults since they are not vulnerable to dental fluorosis once the tooth enamel is formed. © 2015 Elsevier B.V. | Open |
| Danquah I.; Dobrucky C.L.; Frank L.K.; Henze A.; Amoako Y.A.; Bedu-Addo G.; Raila J.; Schulze M.B.; Mockenhaupt F.P.; Schweigert F.J. | Vitamin A: Potential misclassification of vitamin A status among patients with type 2 diabetes and hypertension in urban Ghana | 2015 | American Journal of Clinical Nutrition | Background: Sub-Saharan Africa is facing a double burden of malnutrition: vitamin A deficiency (VAD) prevails, whereas the nutrition-related chronic conditions type 2 diabetes (T2D) and hypertension are emerging. Serum retinol'a VAD marker'increases in kidney disease and decreases in inflammation, which can partly be attributed to alterations in the vitamin A-transport proteins retinolbinding protein 4 (RBP4) and prealbumin. Kidney dysfunction and inflammation commonly accompany T2D and hypertension. Objective: Among urban Ghanaians, we investigated the associations of T2D and hypertension with serum retinol as well as the importance of kidney function and inflammation in this regard. Design: A hospital-based, case-control study in individuals for risk factors of T2D, hypertension, or both was conducted in Kumasi, Ghana (328 controls, 197 with T2D, 354 with hypertension, and 340 with T2D plus hypertension). In 1219 blood samples, serum retinol, RBP4, and prealbumin were measured. Urinary albumin and estimated glomerular filtration rate (eGFR) defined kidney function. C-reactive protein (CRP) >5 mg/L indicated inflammation. We identified associations of T2D and hypertension with retinol by linear regression and calculated the contribution of RBP4, prealbumin, urinary albumin, eGFR, and CRP to these associations as the percentages of the explained variance of retinol. Results: VAD (retinol <1.05 μmol/L) was present in 10% of this predominantly female, middle-aged, overweight, and deprived population. Hypertension, but not T2D, was positively associated with retinol (β: 0.12; 95% CI: 0.08, 0.17), adjusted for age, sex, socioeconomic factors, anthropometric measurements, and lifestyle. In addition to RBP4 (72%) and prealbumin (22%), the effect of increased retinol on individuals with hypertension was mainly attributed to impaired kidney function (eGFR: 30%; urinary albumin: 5%) but not to inflammation. Conclusions: In patients with hypertension, VAD might be underestimated because of increased serum retinol in the context of kidney dysfunction. Thus, the interpretation of serum retinol in sub-Saharan Africa should account for hypertension status. © 2015 American Society for Nutrition. | Open |
| Djameh C.; Saalia F.K.; Sinayobye E.; Budu A.; Essilfie G.; Mensah-Brown H.; Sefa-Dedeh S. | Optimization of the sorghum malting process for pito production in Ghana | 2015 | Journal of the Institute of Brewing | Pito is an alcoholic beverage obtained through a yeast (Saccharomyces cerevisiae) fermentation of wort extracted from sorghum (Sorghum bicolor L. Moench) malt. The malting conditions of sorghum are thought to influence the quality characteristics of the malt, and subsequently the quality of the pito obtained from it. Studies were carried out on a local sorghum cultivar grown in Ghana - chireh, to optimize the conditions for malting conditions for pito production in Ghana. A 33 full factorial experimental design was replicated with steeping times of 12, 16 and 22h, germination times of 3, 4 and 5days, and malt drying temperatures of 30, 40 and 50°C as factors. Diastatic power, extract yield, attenuation limit and free amino nitrogen were determined. Germination duration significantly affected diastatic power and free amino nitrogen (p<0.001). Extract yield was also significantly influenced by germination duration (p=0.001). The germination time, steeping time and drying temperature had no significant effect on the attenuation limit. The optimal conditions for malting this specific cultivar grown in Ghana to obtain critical malt quality indices are 12.0-12.5h steeping, 5days of germination at 30°C and drying at 40°C. Free amino nitrogen levels in all treatments were higher than the minimum requirement for good yeast nutrition and fermentation. © 2015 The Institute of Brewing & Distilling. | Open |
| Egbi G.; Ayi I.; Saalia F.K.; Zotor F.; Adom T.; Harrison E.; Ahorlu C.K.; Steiner-Asiedu M. | Impact of cowpea-based food containing fish meal served with Vitamin C-rich drink on iron stores and hemoglobin concentrations in Ghanaian schoolchildren in a Malaria endemic area | 2015 | Food and Nutrition Bulletin | Background: Nutritional anemia is a public health problem among Ghanaian schoolchildren. There is need to employ dietary modification strategies to solve this problem through school and household feeding programs. Objective: To evaluate the effectiveness of cowpea-based food containing fish meal served with vitamin C-rich drink to improve iron stores and hemoglobin concentrations in Ghanaian schoolchildren. Methods: The study involved cross-sectional baseline and nutrition intervention phases. There were 150 participants of age 6 to 12 years. They were randomly assigned to 3 groups, fish meal-vitamin C (n = 50), vitamin C (n = 50), and control (n = 50), and given different cowpea-based diets for a 6-month period. Height and weight measurements were done according to the standard procedures, dietary data were obtained by 24-hour recall and food frequency questionnaire, hemoglobin concentrations were determined by Hemocue Hemoglobinometer, and serum ferritin and complementreactive protein (CRP) were determined by enzyme-linked immunosorbent assay. Participants' blood samples were examined for malaria parasitemia and stools for helminthes using Giemsa stain and Kato-Katz techniques, respectively. Results: Mean ferritin concentration was not significantly different among groups. End line mean or change in hemoglobin concentrations between fish meal-vitamin C group (128.4 + 7.2/8.3 + 10.6 g/L) and control (123.1 ± 6.6/4.2 ± 10.4 g/L) were different, P <.05. Change in prevalence of anemia in fish meal-vitamin C group (19.5%) was different compared to those of vitamin C group (9.3%) and the control (12.2%). Levels of malaria parasitemia and high CRP among study participants at baseline and end line were 58% and 80% then 55% and 79%, respectively. Level of hookworm infestation was 13%. Conclusion: Cowpea-based food containing 3% fish meal and served with vitamin C-richdrink improved hemoglobin concentration and minimized the prevalence of anemia among the study participants. © The Author(s) 2015. | Open |
| Entsieh A.A.; Emmelin M.; Pettersson K.O. | Learning the ABCs of pregnancy and newborn care through mobile technology | 2015 | Global Health Action | Background: The diffusion of mobile phones in low- and middle-income countries has taken place faster than any other infrastructural development. Mobile Midwife, a mobile application implemented in Ghana in 2010, sends timely messages in local languages to registered expectant mothers and new parents. The field of mobile health (mHealth) is severely underresearched, yet it can be an alternative for improving health systems and the ways in which health services are delivered. Objective: Our goal was to investigate the role that Mobile Midwife technology has played in the lives of pregnant and nursing mothers in Awutu Senya District, Ghana. Design: A total of three focus group discussions and 19 individual interviews were conducted. Discussions and interviews were recorded, transcribed verbatim from the local language to English, and analyzed by means of qualitative content analysis at the manifest and latent levels. Results: The main findings show that while oscillating between modern and traditional practices, women gradually gained trust in Mobile Midwife's counselling and attempted to balance between myths and reality regarding nutrition in pregnancy. In addition, their decisions to seek essential obstetric care were enhanced by Mobile Midwife's advice. Women also felt strengthened in their understanding of the importance of seeking professional care during pregnancy and childbirth as well as recognizing signs of ill health in the newborn. Conclusions: The findings indicate that Mobile Midwife could be an excellent tool in working towards the improvement of maternal health. Mobile Midwife will hopefully contribute to the stepwise achievement of the Sustainable Development Goals extended from the Millennium Development Goals, which expire at the end of 2015. There is a need for strong political will from key stakeholders, to embark in the field of mHealth as a complementary means to strengthen health systems. © 2015 Angela Afua Entsieh et al. | Open |
| Ghosh S.; Kurpad A.; Tano-Debrah K.; Otoo G.E.; Aaron G.A.; Toride Y.; Uauy R. | Role of protein and amino acids in infant and young child nutrition: Considerations for the development and delivery of high quality complementary food supplements | 2015 | Journal of Nutritional Science and Vitaminology | Prevention of malnutrition in infants and children is multifaceted and requires the following: access to and intake of nutritious food starting at birth with exclusive breastfeeding for the first 6 mo of life, continued breastfeeding in combination with complementary foods from 6-24 mo of age, access to clean drinking water and sanitation, and access to preventive and curative health care (including prenatal). Nutrient-dense complementary foods can improve nutritional status and have long-term benefits; however, in a review of plant-based complementary foods in developing countries, most of them failed to meet many micronutrient requirements. There is need to provide other cost-effective alternatives to increase the quality of the diet during the complementary feeding stage of the lifecycle. This paper provides an overview of the development, testing, efficacy and effectiveness of the delivery of KOKO Plus on the growth and nutritional status of infants 6-24 mo of age. © 2015, Center for Academic Publications Japan. All rights reserved. | Open |
| Issaka A.I.; Agho K.E.; Burns P.; Page A.; Dibley M.J. | Determinants of inadequate complementary feeding practices among children aged 6-23 months in Ghana | 2015 | Public Health Nutrition | Objective To explore complementary feeding practices and identify potential risk factors associated with inadequate complementary feeding practices in Ghana by using the newly developed WHO infant feeding indicators and data from the nationally representative 2008 Ghana Demographic and Health Survey. Design The source of data for the analysis was the 2008 Ghana Demographic and Health Survey. Analysis of the factors associated with inadequate complementary feeding, using individual-, household-and community-level determinants, was done by performing multiple logistic regression modelling. Setting Ghana. Subjects Children (n 822) aged 6-23 months. Results The prevalence of the introduction of solid, semi-solid or soft foods among infants aged 6-8 months was 72·6 % (95 % CI 64·6 %, 79·3 %). The proportion of children aged 6-23 months who met the minimum meal frequency and dietary diversity for breast-fed and non-breast-fed children was 46·0 % (95 % CI 42·3 %, 49·9 %) and 51·4 % (95 % CI 47·4 %, 55·3 %) respectively and the prevalence of minimum acceptable diet for breast-fed children was 29·9 % (95 % CI 26·1 %, 34·1 %). Multivariate analysis revealed that children from the other administrative regions were less likely to meet minimum dietary diversity, meal frequency and acceptable diet than those from the Volta region. Household poverty, children whose mothers perceived their size to be smaller than average and children who were delivered at home were significantly less likely to meet the minimum dietary diversity requirement; and children whose mothers did not have any postnatal check-ups were significantly less likely to meet the requirement for minimum acceptable diet. Complementary feeding was significantly lower in infants from illiterate mothers (adjusted OR=3·55; 95 % CI 1·05, 12·02). Conclusions The prevalence of complementary feeding among children in Ghana is still below the WHO-recommended standard of 90 % coverage. Non-attendance of postnatal check-up by mothers, cultural beliefs and habits, household poverty, home delivery of babies and non-Christian mothers were the most important risk factors for inadequate complementary feeding practices. Therefore, nutrition educational interventions to improve complementary feeding practices should target these factors in order to achieve the fourth Millennium Development Goal. © 2014 The Authors. | Open |
| Issaka A.I.; Agho K.E.; Page A.N.; Burns P.L.; Stevens G.J.; Dibley M.J. | Comparisons of complementary feeding indicators among children aged 6-23 months in Anglophone and Francophone West African countries | 2015 | Maternal and Child Nutrition | Stunting, a consequence of suboptimal complementary feeding practices, continues to be a significant public health problem in West Africa. This paper aimed to compare rates of complementary feeding indicators among children aged 6-23 months between four Anglophone and seven Francophone West African countries. The data used for this study were the most recent Demographic and Health Surveys of the various countries, namely Ghana, Liberia, Nigeria, Sierra Leone (Anglophone countries), Benin, Burkina Faso, Cote d'Ivoire, Guinea, Mali, Niger and Senegal (Francophone countries) conducted between 2006 and 2013. The analyses were limited to last-born children aged 6-23 months and covered 34999 children: 12623 in the Anglophone countries and 22376 children in the Francophone countries. Complementary feeding indicators were examined using the method proposed by the World Health Organization (WHO) in 2008. Introduction of solid, semi-solid or soft foods among children aged 6-23 months in the Anglophone countries ranged from 55.3% (Liberia) to 72.6% (Ghana). The corresponding rates for the Francophone countries ranged from 29.7% (Mali) to 65.9% (Senegal). The average rate of minimum dietary diversity for the Anglophone countries was 32.0% while that of the Francophone countries was only 10.6%. While the minimum meal frequency rates ranged between 42.0% (Sierra Leone) and 55.3% (Nigeria) for the Anglophone countries, the corresponding rates for the Francophone countries ranged between 25.1% (Mali) and 52.4% (Niger). Both the Anglophone and the Francophone countries reported alarmingly low rates of minimum acceptable diet, with the two groups of countries averaging rates of 19.9% (Anglophone) and 5.5% (Francophone). The rates of all four complementary feeding indicators across all the 11 countries fell short of the WHO's requirement for optimal complementary feeding practices. Intervention studies using cluster-randomised controlled trials are needed in order to improve the nutritional status of young children in West Africa. © 2015 John Wiley & Sons Ltd. | Open |
| Issaka A.I.; Agho K.E.; Page A.N.; Burns P.L.; Stevens G.J.; Dibley M.J. | Determinants of suboptimal complementary feeding practices among children aged 6-23 months in four anglophone West African countries | 2015 | Maternal and Child Nutrition | Suboptimal complementary feeding practices have a detrimental impact on a child's growth, health and development in the first two years of life. They lead to child malnutrition, which contributes to the high prevalence of stunting (38%) and underweight (28%) reported for children <5 years of age in Sub-Saharan Africa. This study analysed complementary feeding practices in four anglophone West African countries (Ghana, Liberia, Nigeria and Sierra Leone) using the most recent Demographic and Health Surveys. The study covered 12623 children aged 6-23 months from four anglophone West African countries (Ghana: 822 children: Liberia: 1458 children, Nigeria: 8786 children and Sierra Leone: 1557 children). Four complementary feeding indicators were examined against a set of individual-, household- and community-level factors, using multiple regression analysis. Multivariate analyses found that lack of post-natal contacts with health workers, maternal illiteracy and geographical region were common determinants of delayed introduction of solid, semi-solid or soft foods across all four countries. Predictors for minimum dietary diversity, minimum meal frequency and minimum acceptable diet included children aged 6-11 months, administrative/geographical region, poorer household income and limited access to media. The authors recommend that the four anglophone West African countries studied should prioritise efforts to improve complementary feeding practices in order to reduce child morbidity and mortality. Interventional studies on complementary feeding should target those from poor and illiterate households. © 2015 John Wiley & Sons Ltd. | Open |
| Koopman J.J.E.; van Bodegom D.; van Heemst D.; Westendorp R.G.J. | Handgrip strength, ageing and mortality in rural Africa | 2015 | Age and Ageing | Background: muscle strength measured as handgrip strength declines with increasing age and predicts mortality. While handgrip strength is determined by lifestyle through nutrition and physical activity, it has almost exclusively been studied in western populations with a sedentary lifestyle. This study aims to investigate the relation between handgrip strength, ageing and mortality in a population characterised by a predominance of malnutrition and manual labour.Design: a population-based longitudinal study.Setting: a traditional African rural population in Ghana.Subjects: nine hundred and twenty-three community-dwelling individuals aged 50 and older.Methods: demographic characteristics were registered. At baseline, height, body mass index (BMI) and handgrip strength were measured and compared with those in a western reference population. Survival of the participants was documented during a period of up to 2 years.Results: handgrip strength was dependent on age, sex, height and BMI. Compared with the western reference population, handgrip strength was lower due to a lower height and BMI but declined over age similarly. Risk of mortality was lower in participants having higher handgrip strength, with a hazard ratio of 0.94 per kg increase (P = 0.002). After adjustment for age, sex, tribe, socio-economic status, drinking water source, height and BMI, only handgrip strength remained predictive of mortality.Conclusion: in a traditional rural African population characterised by malnutrition and manual labour, handgrip strength declines over age and independently predicts mortality similar to western populations. Handgrip strength can be used as a universal marker of ageing. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. | Open |
| Laar A.; Aryeetey R.N.O.; Akparibo R.; Zotor F. | Nutrition sensitivity of the 2014 budget statement of Republic of Ghana | 2015 | Proceedings of the Nutrition Society | Ghana's Constitution and several international treaties she has ratified demonstrate support for fundamental human rights to nutrition and freedom from hunger. However, it is unknown how this support is being translated into investment in nutrition. National budgets are important vehicles through which governments communicate intent to address pertinent national challenges. The present paper assesses the nutrition sensitivity of Ghana's budget statement for the year ending 31 December 2014. We perused the budget in its entirety, examining allocations to various sectors with the goal of identifying support for direct nutrition interventions. We examined allocations to various sectors as per cent of gross domestic product (GDP). The review shows that the total revenue and grants for the 2014 fiscal year is Ghana Cedis (GH¢) 26 001·9 million (25 % of GDP). The total expenditure for the same period is estimated at GH¢34 956·8 million (33·1 % of GDP). The health sector is allocated GH¢3 353 707 814 (3·8 % of GDP). As of 28 October 2014, the Bank of Ghana's Official Exchange Rate was US$1 = GH¢3·20. It is one of the key sectors whose interventions directly or indirectly impact on nutrition. However, the proportion of the national budget that goes to direct nutrition interventions is not evident in the budget. Nutrition is embedded in other budget lines. Allocations to relevant nutrition-sensitive sectors are very low (<0·5 % of GDP). We conclude that Ghana's 2014 budget statement pays scant attention to nutrition. By embedding nutrition in other budget lines, Ghana runs the risk of perpetually rolling out national spending actions insensitive to nutrition. © The Authors 2015. | Open |
| Laar A.; El-Adas A.; Amenyah R.N.; Atuahene K.; Asare E.; Tenkorang E.Y.; Laar M.; Adjei A.A.; Quakyi I. | Food and nutrition assistance to HIV-infected and affected populations in Ghana: A situational analysis and stakeholder views | 2015 | African Geographical Review | Poor nutrition is a determinant of death particularly among persons living with HIV (PLHIV). This paper discusses the state of food and nutrition assistance to PLHIV in Ghana. A review of published articles and program reports was done and supported by in-depth interviews with key stakeholders. Data were qualitatively analyzed. A matrix highlighting problems that need to be addressed, possible attributable factors, strengths, and opportunities of existing actions metamorphosed from the analysis. Although stakeholders agree that adequate nutrition is critically important for PLHIV, food and nutrition interventions to PLHIV are inadequate. © 2014 The African Specialty Group of the Association of American Geographers. | Open |
| Long R.N.; Renne E.P.; Basu N. | Understanding the social context of the asgm sector in ghana: A qualitative description of the demographic, health, and nutritional characteristics of a small-scale gold mining community in Ghana | 2015 | International Journal of Environmental Research and Public Health | This descriptive paper describes factors related to demographics and health in an artisanal and small-scale gold mining (ASGM) community in Ghana’s Upper East Region. Participants (n = 114) were surveyed in 2010 and 2011, adapting questions from the established national Demographic Health Survey (DHS) on factors such as population characteristics, infrastructure, amenities, education, employment, maternal and child health, and diet. In the study community, some indicators of household wealth (e.g., radios, mobile phones, refrigerators) are more common than elsewhere in Ghana, yet basic infrastructure (e.g., cement flooring, sanitation systems) and access to safe water supplies are lacking. Risk factors for poor respiratory health, such as cooking with biomass fuel smoke and smoking tobacco, are common. Certain metrics of maternal and child health are comparable to other areas of Ghana (e.g., frequency of antenatal care), whereas others (e.g., antenatal care from a skilled provider) show deficiencies. Residents surveyed do not appear to lack key micronutrients, but report lower fruit and vegetable consumption than other rural areas. The results enable a better understanding of community demographics, health, and nutrition, and underscore the need for better demographic and health surveillance and data collection across ASGM communities to inform effective policies and programs for improving miner and community health. © 2015, by the authors, licensee MDPI, Basel, Switzerland. | Open |
| Malapit H.J.L.; Quisumbing A.R. | What dimensions of women's empowerment in agriculture matter for nutrition in Ghana? | 2015 | Food Policy | This paper investigates linkages between women's empowerment in agriculture and the nutritional status of women and children using 2012 baseline data from the Feed the Future population-based survey in northern Ghana. Using a new survey-based index, the women's Empowerment in Agriculture Index, we conduct individual-level analyses of nutrition-related indicators including exclusive breastfeeding, children's dietary diversity score, minimum dietary diversity and minimum acceptable diet, children's height-for-age, weight-for-height, and weight-for-age z-scores, and women's dietary diversity score and body mass index. Results suggest that women's empowerment is more strongly associated with the quality of infant and young child feeding practices and only weakly associated with child nutrition status. Women's empowerment in credit decisions is positively and significantly correlated with women's dietary diversity, but not body mass index. This suggests that improved nutritional status is not necessarily correlated with empowerment across all domains, and that these domains may have different impacts on nutrition. © 2015 The Authors. | Open |
| Marquis G.S.; Colecraft E.K.; Sakyi-Dawson O.; Lartey A.; Ahunu B.K.; Birks K.A.; Butler L.M.; Reddy M.B.; Jensen H.H.; Huff-Lonergan E. | An integrated microcredit, entrepreneurial training, and nutrition education intervention is associated with better growth among preschool-aged children in rural Ghana | 2015 | Journal of Nutrition | Background: Poor diet quality is a determinant of the high prevalence rates of malnutrition in Ghana. There is little evidence on the effectiveness of a multisector intervention to improve children's diets and nutritional status. Objective: The project tested whether participation in an entrepreneurial and nutrition education intervention with microcredit was associated with the nutritional status of children 2-5 y of age. Methods: A quasi-experimental 16-mo intervention was conducted with microcredit loans and weekly sessions of nutrition and entrepreneurship education for 179 women with children 2-5 y of age [intervention group (IG)]. Nonparticipating women and their children from the same villages (nonparticipant, n = 142) and from similar neighboring villages (comparison, n = 287) were enrolled. Repeated measures linear regression models were used first to examine children's weight-for-age (WAZ), height-for-age (HAZ), and body mass index-for-age (BAZ) z scores at baseline and at 4 follow-up time points ~4 mo apart. Time, intervention status, time-by-intervention interaction terms, region of residence, household wealth rank, household head occupation, number of children <5 y of age, and child sex and age were included. Results: There was a significant interaction between the IG and time for BAZ (P = 0.02) with significant Bonferronicorrected pairwise comparisons between the IG and comparison group (CG) at 8 mo (difference of 0.36±0.09 z score, P < 0.0001). The WAZ group difference was significant between 4 and 16 mo (P = 0.01 for interaction) and peaked at 8-12 mo (differences of ~0.28 z). The HAZ of children in the IG was significantly higher than that in the CG, reaching a 0.19 z difference at 16 mo (P < 0.05). When the fixed effects models were fitted in sensitivity analyses, some group anthropometric differences were of lower magnitude but remained significant. Conclusion: An integrated package of microcredit and education may improve nutritional outcomes of children living in poor, rural communities. © 2015 American Society for Nutrition. | Open |
| Novignon J.; Aboagye E.; Agyemang O.S.; Aryeetey G. | Socioeconomic-related inequalities in child malnutrition: evidence from the Ghana multiple indicator cluster survey | 2015 | Health Economics Review | Background: Malnutrition is a prevalent public health concern in Ghana. While studies have identified factors that influence child malnutrition and related inequalities in Ghana, very little efforts have been made to decompose these inequalities across various household characteristics. This study examined the influence of socioeconomic factors on inequality in child malnutrition using a decomposition approach. Methods: The study employed cross section data from the 2011 Multiple Indicator Cluster Survey (MICS). Analysis was done at three levels: First, concentration curves were constructed to explore the nature of inequality in child malnutrition. Secondly, concentration indices were computed to quantify the magnitude of inequality. Thirdly, decomposition analysis was conducted to determine the role of mother’s education and health insurance coverage in inequality of child malnutrition. Results: The concentration curves showed that there exists a pro-poor inequality in child malnutrition measured by stunting and wasting. The concentration indices of these measures indicated that the magnitude of inequality was higher and significant at 1 % for weight-for-age (WAZ) (−0.1641), relative to height-for-age (HAZ) (−0.1613). The decomposition analyses show that whilst mother’s education contributed about 13 and 11 % to inequality in HAZ, it contributed about 18.9 and 11.8 % to inequality in WAZ for primary and secondary or above education attainments, respectively. Finally, health insurance contributed about 1.91 and 1.03 % to inequality in HAZ and WAZ, respectively. Conclusion: The results suggest that there is the need to encourage critical policies directed towards improving female literacy in the country. The existence of a functional health insurance system and increasing universal coverage are recommended to mitigate child malnutrition. © 2015, Novignon et al. | Open |
| Nyadanu D.; Lowor S.T. | Promoting competitiveness of neglected and underutilized crop species: comparative analysis of nutritional composition of indigenous and exotic leafy and fruit vegetables in Ghana | 2015 | Genetic Resources and Crop Evolution | Ghana is endowed with a lot of indigenous leaf and fruit vegetables which are nutritious and are used in the treatment of many ailments. However, current changes in food habits in both rural and urban households have led to overdependence on energy-rich but nutrient poor staple crops. Most of these non-indigenous staple crops are not adapted to local conditions in Ghana as compared to indigenous vegetables making their production and consumption expensive and therefore worsening malnutrition and food insecurity issues. To promote consumption of indigenous vegetables and conservation of their genetic resources in Ghana, proximate, mineral and vitamins composition and medicinal properties of five indigenous leaf (Amaranthus cruentus, Corchorus olitorius, Solanum macrocarpon, Xanthosoma sagittifolium, Adasonia digitata) and three fruit vegetables (Solanum torvum, Solanum aethiopicum, Solanum macrocarpon) vegetables were evaluated using recommended methodologies. Proximate, mineral and vitamins composition varied significantly among the species analyzed. Nutritional composition of indigenous leaf and fruit vegetables were compared with that of exotic vegetables and significant differences were noted. In general, proteins, carbohydrates, dietary fibers, potassium, calcium, magnesium, phosphorus, Vitamin A, Vitamin C and Vitamin E were significantly higher in indigenous vegetables than their exotic counterparts. The results highlight nutritional importance of indigenous vegetables and the need to promote their consumption and safeguard their genetic resources. For further promotion, some urgent research directions are suggested. © 2014, Springer Science+Business Media Dordrecht. | Open |
| Orcholski L.; Luke A.; Plange-Rhule J.; Bovet P.; Forrester T.E.; Lambert E.V.; Dugas L.R.; Kettmann E.; Durazo-Arvizu R.A.; Cooper R.S.; Schoeller D.A. | Under-reporting of dietary energy intake in five populations of the African diaspora | 2015 | British Journal of Nutrition | Studies on the role of diet in the development of chronic diseases often rely on self-report surveys of dietary intake. Unfortunately, many validity studies have demonstrated that self-reported dietary intake is subject to systematic under-reporting, although the vast majority of such studies have been conducted in industrialised countries. The aim of the present study was to investigate whether or not systematic reporting error exists among the individuals of African ancestry (n 324) in five countries distributed across the Human Development Index (HDI) scale, a UN statistic devised to rank countries on non-income factors plus economic indicators. Using two 24 h dietary recalls to assess energy intake and the doubly labelled water method to assess total energy expenditure, we calculated the difference between these two values ((self-report - expenditure/expenditure) x 100) to identify under-reporting of habitual energy intake in selected communities in Ghana, South Africa, Seychelles, Jamaica and the USA. Under-reporting of habitual energy intake was observed in all the five countries. The South African cohort exhibited the highest mean under-reporting (-52.1% of energy) compared with the cohorts of Ghana (-22.5 %), Jamaica (-17.9 %), Seychelles (-25.0 %) and the USA (-18.5 %). BMI was the most consistent predictor of under-reporting compared with other predictors. In conclusion, there is substantial under-reporting of dietary energy intake in populations across the whole range of the HDI, and this systematic reporting error increases according to the BMI of an individual. © The Authors 2015. | Open |
| Saaka M.; Wemakor A.; Abizari A.-R.; Aryee P. | How well do WHO complementary feeding indicators relate to nutritional status of children aged 6-23 months in rural Northern Ghana? | 2015 | BMC Public Health | Background: Though the World Health Organization (WHO) recommended Infant and Young Child Feeding (IYCF) indicators have been in use, little is known about their association with child nutritional status. The objective of this study was to explore the relationship between IYCF indicators (timing of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet) and child growth indicators. Methods: A community-based cross-sectional survey was carried out in November 2013. The study population comprised mothers/primary caregivers and their children selected using a two-stage cluster sampling procedure. Results: Of the 1984 children aged 6-23 months; 58.2 % met the minimum meal frequency, 34.8 % received minimum dietary diversity (≥4 food groups), 27.8 % had received minimum acceptable diet and only 15.7 % received appropriate complementary feeding. With respect to nutritional status, 20.5 %, 11.5 % and 21.1 % of the study population were stunted, wasted and underweight respectively. Multiple logistic regression analysis revealed that compared to children who were introduced to complementary feeding either late or early, children who started complementary feeding at six months of age were 25 % protected from chronic malnutrition (AOR = 0.75, CI = 0.50 - 0.95, P = 0.02). It was found that children whose mothers attended antenatal care (ANC) at least 4 times were 34 % protected [AOR 0.66; 95 % CI (0.50 - 0.88)] against stunted growth compared to children born to mothers who attended ANC less than 4 times. Children from households with high household wealth index were 51 % protected [AOR 0.49; 95 % CI (0.26 - 0.94)] against chronic malnutrition compared to children from households with low household wealth index. After adjusting for potential confounders, there was a significant positive association between appropriate complementary feeding index and mean WLZ (β = 0.10, p = 0.005) but was not associated with mean LAZ. Conclusions: The WHO IYCF indicators better explain weight-for-length Z-scores than length-for-age Z-scores of young children in rural Northern Ghana. Furthermore, a composite indicator comprising timely introduction of solid, semi-solid or soft foods at 6 months, minimum meal frequency, and minimum dietary diversity better explains weight-for-length Z-scores than each of the single indicators. © 2015 Saaka et al. | Open |
| Sedda L.; Tatema A.J.; Morley D.W.; Atkinson P.M.; Wardrop N.A.; Pezzulo C.; Sorichetta A.; Kuleszo J.; Rogers D.J. | Poverty, health and satellite-derived vegetation indices: Their inter-spatial relationship in West Africa | 2015 | International Health | Background: Previous analyses have shown the individual correlations between poverty, health and satellitederived vegetation indices such as the normalized difference vegetation index (NDVI). However, generally these analyses did not explore the statistical interconnections between poverty, health outcomes and NDVI. Methods: In this research aspatial methods (principal component analysis) and spatial models (variography, factorial kriging and cokriging) were applied to investigate the correlations and spatial relationships between intensity of poverty, health (expressed as child mortality and undernutrition), and NDVI for a large area of West Africa. Results: This research showed that the intensity of poverty (and hence child mortality and nutrition) varies inversely with NDVI. From the spatial point-of-view, similarities in the spatial variation of intensity of poverty and NDVI were found. Conclusions: These results highlight the utility of satellite-based metrics for poverty models including health and ecological components and, in general for large scale analysis, estimation and optimisation of multidimensional poverty metrics. However, it also stresses the need for further studies on the causes of the association between NDVI, health and poverty. Once these relationships are confirmed and better understood, the presence of this ecological component in poverty metrics has the potential to facilitate the analysis of the impacts of climate change on the rural populations afflicted by poverty and child mortality. © The Author 2015. | Open |
| Shelus V.; Hernandez O.L. | The usefulness of a handwashing proxy in large household surveys | 2015 | Journal of Water Sanitation and Hygiene for Development | Handwashing with soap is a cost-effective way of reducing diarrheal disease mortality in children under 5. Tracking this practice among child caretakers is a challenge, as the gold standard method – structured observations – is cumbersome, costly, and conducive to over-performance. The water, sanitation, and hygiene (WASH) field needs a valid, reliable proxy to track handwashing with soap in large surveys. This proxy is crucial as the new 2015–2030 Sustainable Development Goals (SDGs) may track hygiene. Using data from the Multiple Indicators Cluster Survey (MICS) and the Demographic Health Survey (DHS) from five countries, we conducted multivariate analyses to explore an association between the presence of functional handwashing stations (HWSs), (together with needed supplies) and the likelihood of lower reports of child diarrheal disease. A limited to moderate association exists in three of the five countries considered, characterized by comparable rates of childhood diarrhea: Malawi, Sierra Leone, and Zimbabwe. The relationship was detected when controlling for potential confounding factors (other WASH elements, socio-demographic factors, nutrition practices, and immunization status) and when accounting for cluster effects. The likelihood of reported diarrhea among children under 5 increases when there is no HWS, just a handwashing device with no supplies, only water or only soap. The relationship is moderate in Malawi and less strong in Sierra Leone and Zimbabwe. No relationship was found in Ethiopia and Ghana. Further exploration of the usefulness of this proxy in other African and non-African contexts is warranted. © IWA Publishing 2015. | Open |
| Tette E.M.A.; Sifah E.K.; Nartey E.T. | Factors affecting malnutrition in children and the uptake of interventions to prevent the condition | 2015 | BMC Pediatrics | Background: Malnutrition is a major cause of child morbidity and mortality. There are several interventions to prevent the condition but it is unclear how well they are taken up by both malnourished and well nourished children and their mothers and the extent to which this is influenced by socio-economic factors. We examined socio-economic factors, health outcomes and the uptake of interventions to prevent malnutrition by mothers of malnourished and well-nourished in under-fives attending Princess Marie Louise Children's Hospital (PML). Methods: An unmatched case control study of malnourished and well-nourished children and their mothers was conducted at PML, the largest facility for managing malnutrition in Ghanaian children. Malnourished children with moderate and severe acute malnutrition were recruited and compared with a group of well-nourished children attending the hospital. Weight-for-height was used to classify nutritional status. Record forms and a semi-structured questionnaire were used for data collection, which was analysed with Stata 11.0 software. Results: In all, 182 malnourished and 189 well-nourished children and their mothers/carers participated in the study. Children aged 6-12 months old formed more than half of the malnourished children. The socio-demographic factors associated with malnutrition in the multivariate analysis were age ≤24 months and a monthly family income of ≤200 GH Cedis. Whereas among the health outcomes, low birth weight, an episode of diarrhoea and the presence of developmental delay were associated with malnutrition. Among the interventions, inadequate antenatal visits, faltering growth and not de-worming one's child were associated with malnutrition in the multivariate analysis. Immunisation and Vitamin A supplementation were not associated with malnutrition. Missed opportunities for intervention were encountered. Conclusion: Poverty remains an important underlying cause of malnutrition in children attending Princess Marie Louise Children's Hospital. Specific and targeted interventions are needed to address this and must include efforts to prevent low birthweight and diarrhoea, and reduce health inequalities. Regular antenatal clinic attendance, de-worming of children and growth monitoring should also be encouraged. However, further studies are needed on the timing and use of information on growth faltering to prevent severe forms of malnutrition. © 2015 Tette et al. | Open |
| Yarney L.; Mba C.; Asampong E. | Qualitative study on the socio-cultural determinants of care of children orphaned by AIDS in the Ashanti and Eastern regions of Ghana | 2015 | BMC Public Health | Background: Almost three decades after the discovery of HIV and AIDS in Ghana, the most obvious impact of the disease is the growing orphan crisis affecting most families and communities, especially in areas that the prevalence of HIV has exceeded the epidemic's threshold of 5%. Studies have indicated that these orphans usually experience a wide range of problems which include education, nutrition, physical and sexual abuse, emotional and psychological distress, stigma and discrimination, among others The aim of the study was to examine the social, cultural, and traditional norms and practices that influence the care of children orphaned by AIDS in Ghana. Methods: The study employed focus group discussions, in-depth interviews and key informant interviews to generate information on the socio-cultural factors that impact orphan care in the Ashanti and Eastern regions of Ghana. Results: The findings indicated that the cultural practices that influence how well an AIDS orphan is taken care of by their caregivers include traditional rituals, ceremonies, and norms like funeral rites, marriage and naming ceremonies, festivals, inheritance, polygyny, and puberty rites. The social factors mentioned to affect orphan care significantly were: excessive alcohol drinking, and tobacco and drug use, dressing with fashion, night club attendance, market days, stigma and discrimination, among others. Conclusion: It is recommended that though some cultural and traditional practices are deeply rooted in communities and cannot be done away completely, orphan care policies on interventions should take into account these factors to mitigate their effects on the care of orphans. © 2015 Yarney et al.; licensee BioMed Central. | Open |
| Zotor F.B.; Ellahi B.; Amuna P. | Applying the food multimix concept for sustainable and nutritious diets | 2015 | Proceedings of the Nutrition Society | Despite a rich and diverse ecosystem, and biodiversity, worldwide, more than 2 billion people suffer from micronutrient malnutrition or hidden hunger. Of major concern are a degradation of our ecosystems and agricultural systems which are thought to be unsustainable thereby posing a challenge for the future food and nutrition security. Despite these challenges, nutrition security and ensuring well balanced diets depend on sound knowledge and appropriate food choices in a complex world of plenty and want. We have previously reported on how the food multimix (FMM) concept, a food-based and dietary diversification approach can be applied to meet energy and micronutrient needs of vulnerable groups through an empirical process. Our objective in this paper is to examine how the concept can be applied to improve nutrition in a sustainable way in otherwise poor and hard-to-reach communities. We have reviewed over 100 FMM food recipes formulated from combinations of commonly consumed traditional candidate food ingredients; on average five per recipe, and packaged as per 100 g powders from different countries including Ghana, Kenya, Botswana, Zimbabawe and Southern Africa, India, Mexico, Malaysia and the UK; and for different age groups and conditions such as older infants and young children, pregnant women, HIV patients, diabetes and for nutrition rehabilitation. Candidate foods were examined for their nutrient strengths and nutrient content and nutrient density of recipes per 100 g were compared with reference nutrient intakes for the different population groups. We report on the nutrient profiles from our analysis of the pooled and age-matched data as well as sensory analysis and conclude that locally produced FMM foods can complement local diets and contribute significantly to meet nutrient needs among vulnerable groups in food-insecure environments. © The Authors 2015. | Open |
| Abizari A.-R.; Buxton C.; Kwara L.; Mensah-Homiah J.; Armar-Klemesu M.; Brouwer I.D. | School feeding contributes to micronutrient adequacy of Ghanaian schoolchildren | 2014 | British Journal of Nutrition | Without gains in nutritional outcomes, it is unlikely that school feeding programmes (SFP) could improve cognition and academic performance of schoolchildren despite the improvements in school enrolment. We compared the nutrient intake adequacy and Fe and nutritional status of SFP and non-SFP participants in a cross-sectional survey involving 383 schoolchildren (aged 5-13 years). Quantitative 24h recalls and weighed food records, repeated in 20% subsample, were used to estimate energy and nutrient intakes adjusted for day-to-day variations. The probability of adequacy (PA) was calculated for selected micronutrients and the mean of all PA (MPA) was calculated. The concentrations of Hb, serum ferritin, and soluble transferrin receptor (sTfR) and anthropometric measurements were used to determine Fe and nutritional status. Energy and nutrient intakes and their adequacies were significantly higher among SFP participants (P<0·001). The MPA of micronutrients was significantly higher among SFP participants (0·61 v. 0·18; P<0·001), and the multiple-micronutrient-fortified corn soya blend was a key contributor to micronutrient adequacy. In SFP participants, 6g/l higher Hb concentrations (P<0·001) and about 10% points lower anaemia prevalence (P=0·06) were observed. The concentration of sTfR was significantly lower among SFP participants (11·2 v. 124mg/l; P=0·04); however, there was no difference in the prevalence of Fe deficiency and Fe-deficiency anaemia between SFP and non-SFP participants. There was also no significant difference in the prevalence of thinness, underweight and stunting. In conclusion, the present results indicate that school feeding is associated with higher intakes and adequacies of energy and nutrients, but not with the prevalence of Fe and nutritional status indicators. The results also indicate an important role for micronutrient-dense foods in the achievement of micronutrient adequacy within SFP. Copyright © 2014 The Authors. | Open |
| Abubakari A.; Sadik B.B.; Keisan Y. | Impact of village savings and loans associations on the nutritional status of under-five children: A case study in the Sissala West District of Upper West Region | 2014 | Pakistan Journal of Nutrition | This study examined the impact of Village Savings and Loans Associations introduced by PLAN Ghana in the Sissala West District on the nutritional status of under-five children in the area. The study was carried out in six randomly selected communities (Silbelle, Buoti, Kandia, Zini, Nimoro and Buo), within which this Savings Programme is in operation. The focus areas of the study were; how food is accessed in the study area, contribution of women to household nutrition, nutrition situation in the VSLA households since the inception of the programme, factors that affect nutritional status and also to ascertain the knowledge, beliefs and practices of beneficiary communities on food production, preparations and consumption. Data collected was both quantitative and qualitative and was obtained using semi-structured interview and anthropometry measurement. The result suggested that the institution of Village Savings and Loans Associations has resulted in better nutrition and health of children in the beneficiaries' households. It is recommended that the NGO (PLAN GHANA) should expand the coverage of the programme to more communities in the district. The recommendations also implored policy makers to design favourable policies on microfinance programmes in general. © Asian Network for Scientific Information, 2014. | Open |
| Anderman T.L.; Remans R.; Wood S.A.; DeRosa K.; DeFries R.S. | Synergies and tradeoffs between cash crop production and food security: A case study in rural Ghana | 2014 | Food Security | Despite dramatic improvements in global crop yields over the past half-century, chronic food insecurity persists in many parts of the world. Farming crops for sale (cash cropping) has been recommended as a way to increase income that can, in turn, improve food security for smallholder farmers. Despite long-term efforts by development agencies and government to promote cash cropping, there is limited evidence documenting a relationship between these crops and the food security of households cultivating them. We used a mixed methods approach to build a case study to assess these relationships by collecting quantitative and qualitative data from cacao and oil palm farmers in the Ashanti region of Ghana. Three dimensions of food security were considered: food availability, measured by the months in a year households reported inadequate food; food access, indicated by the coping strategies they employed to secure sufficient food; and food utilization, gauged by the diversity of household diets and anthropometric measurements of child nutritional status. We found significant negative relationships between each of these pillars of food security and a household's intensity of cash crop production, measured by both quantity and area. A qualitative assessment indicated community perception of these tradeoffs and identified potential mechanisms, including increasing food prices and competing activities for land use, as underlying causes. The adverse relationship between cash crop production and household food security observed in this paper calls for caution; results suggest that positive relationships cannot be assumed, and that further empirical evidence is needed to better understand these tradeoffs. © 2014 Springer Science+Business Media Dordrecht and International Society for Plant Pathology. | Open |
| Ayokunle O.; Odusoga A.O. | Community-based management of micronutrient deficiency in malnourished children in Ghana | 2014 | Bangladesh Journal of Medical Science | The relationship between undernutrition and ill health is complex. It is complicated by growth retardation, impaired mental development, and significant morbidity from malaria, diarrhoeal diseases, pneumonia etc. and mortality. Several micronutrients are required for adequate growth and development especially in young children. They also account for three of the four most important forms of malnutrition worldwide. This review attempts to evaluate the community-based management of malnutrition in developing countries while comparing it to the in-patient management of malnourished children. Parameters evaluated include cost, coverage, choice, nosocomial infection acquisition and effect on productivity. The community-based management of severe malnutrition has many benefits that should be harnessed by healthcare givers so as to reduce the burden of malnutrition in low resource settings. © 2014, Bangladesh Journal of Medical Science. All rights reserved. | Open |
| Baidoo I.K.; Fletcher J.J.; Mensah P.K.; Quagraine R.E.; Opata N.S. | Determination of mineral element composition of Ayoyo, Baobab and Dandelion vegetable green leaves in Ghana using instrumental neutron activation analysis | 2014 | Journal of Food Measurement and Characterization | The present investigation was undertaken to determine the nutritional compositions (mineral elements) of three green leafy vegetable; Dandelion (Taraxacum Officinale), Ayoyo (Corchorus Olitorius) and Baobab (Adasonia Digitata). The ultimate goal is to improve nutrition and health by advocating for increased consumption of indigenous green leafy vegetables with an objective to increasing public acceptance, awareness and utilization. The mineral elements were determined using instrumental neutron activation analysis, over 20 elements were detected. However, 14 mineral elements were quantitatively evaluated on the basis of k0-method and relative comparator method. The leaves were characterized with high concentration of Mg, Ca, Cl and K, and substantive amount of Mn, Fe, Zn, Cu and I. The composition of the mineral elements and its respective percent contribution to Recommended Dietary Allowance/Adequate Intake (RDA/AI) for various life groups indicates that reasonable consumption of any of the three green leafy vegetable can contribute substantive amount of daily nutritional requirement for minor nutrients like; I, Cu, Zn, Mn, and Fe as well as major nutritional (Mg, Ca, Cl and K) needs for all life groups. Each of the leaves was also characterize with high K/Na ratios. Tolerable upper intake levels (UL) analysis also showed no significant abuse for the mineral elements determined. Other potential toxic elements (As, Cd and Hg) and non-nutritional minerals (Br, V, Al and Ba) were either not detected or were found in low concentrations. © 2014, Springer Science+Business Media New York. | Open |
| Darkwa S. | Knowledge of nutrition facts on food labels and their impact on food choices on consumers in Koforidua, Ghana: A case study | 2014 | South African Journal of Clinical Nutrition | Objective: The aim of this study was to investigate consumers' knowledge of food labels and how this knowledge guides their decisions when making purchasing choices with regard to food. Design: This was a descriptive research design study. Setting: The setting was the suburb of Koforidua Municipality in the Eastern region of Ghana. Subjects: One hundred and forty-three customers were observed in store from four randomly sampled supermarkets. One hundred of these customers completed a self-administered questionnaire. Outcome measures: Measurements included observation and a self-administered questionnaire that elicited information on label-reading habits, attitudes towards health awareness and the influence of food labels on food choices. Data were analysed using descriptive statistics. Results: Sixty-five of the 100 consumers (54 females and 46 males) who consented to respond to the questionnaire looked at or read food labels before selecting a food to purchase. Seventy-five per cent reported reading the food labels prior to selecting food. This study found that nutrition knowledge had a low to average impact on consumers' food choices. Half of the consumers who reported reading the food labels did not do so regularly. This could have implications on how often such information is used when purchasing food. Also, only 22% of the study respondents answered correctly when asked to explain "26% RDA (recommended dietary allowance) vitamin A per serving" on a food label, even though 45% of the respondents had a tertiary education. Conclusion: These findings indicate awareness and knowledge of food labelling which may not always adequately impact on food choices, even though study respondents indicated high awareness and low to average reading of labels prior to purchasing food. © SAJCN. | Open |
| Darteh E.K.M.; Acquah E.; Kumi-Kyereme A. | Correlates of stunting among children in Ghana | 2014 | BMC Public Health | Background: Stunting, is a linear growth retardation, which results from inadequate intake of food over a long period of time that may be worsened by chronic illness. Over a long period of time, inadequate nutrition or its effects could result in stunting. This paper examines the correlates of stunting among children in Ghana using data from the 2008 Ghana Demographic and Health Survey (GDHS). Methods. The paper uses data from the children recode file of the 2008 Demographic and Health Survey (DHS), a nationally representative cross sectional survey conducted in Ghana. A total of 2379 children under five years who had valid anthropometric data were used for the study. Data on the stunting of children were collected by measuring the height of all children under six years of age. A measuring board produced by Shorr Productions was used to obtain the height of the children. Children under 2 years of age were measured lying down on the board while those above 2 years were measured standing. In the DHS data, a z-score is given for the child's height relative to the age. Both bi-variate and multi-variate statistics are used to examine the correlates of stunting. Results: Stunting was common among males than females. Age of child was a significant determinant of stunting with the highest odd of stunting been among children aged 36-47 months. Region was significantly related to stunting. Children from the Eastern Region were more likely to be stunted than children from the Western Region which is the reference group (OR = 1.7 at p < 0.05). Number of children in household was significantly related to stunting. Children in households with 5-8 children were 1.3 times more likely to be stunted compared to those with 1-4 children (p <.05). Mother's age was a significant predictor of stunting with children whose mothers were aged 35-44 years being more likely to be stunted. Conclusion: Culturally appropriate interventions and policies should be put in place to minimise the effects of the distal, proximal and intermediate factors on stunting among under 5 children in Ghana. © 2014 Darteh et al.; licensee BioMed Central Ltd. | Open |
| de-Graft Aikins A. | Food Beliefs and Practices During Pregnancy in Ghana: Implications for Maternal Health Interventions | 2014 | Health Care for Women International | Ghanaian women's food beliefs and practices during pregnancy and the scope for developing more effective maternal health interventions were explored in this study. Thirty-five multiethnic Ghanaian women between the ages of 29 and 75 were interviewed about pregnancy food beliefs and practices. I show that, based on the data analysis, their knowledge about food was drawn from lifeworlds (family and friends), educational settings, health professionals, mass media, and body-self knowledge (unique pregnancy experiences). Core lay ideas converged with expert knowledge on maternal health nutrition. Multiple external factors (e.g., economics, cultural representations of motherhood) and internal factors (e.g., the unpredictable demands of the pregnant body) influenced pregnancy food practices. I suggest and discuss a need for culturally situated multilevel interventions. © Taylor & Francis Group, LLC. | Open |
| Durazo-Arvizu R.A.; Camacho P.; Bovet P.; Forrester T.; Lambert E.V.; Plange-Rhule J.; Hoofnagle A.N.; Aloia J.; Tayo B.; Dugas L.R.; Cooper R.S.; Luke A. | 25-Hydroxyvitamin D in African-origin populations at varying latitudes challenges the construct of a physiologic norm | 2014 | American Journal of Clinical Nutrition | Background: The vitamin D-endocrine system is thought to play a role in physiologic processes that range from mineral metabolism to immune function. Serum 25-hydroxyvitamin D [25(OH)D] is the accepted biomarker for vitamin D status. Skin color is a key determinant of circulating 25(OH)D concentrations, and genes responsible for melanin content have been shown to be under strong evolutionary selection in populations living in temperate zones. Little is known about the effect of latitude on mean concentrations of 25(OH)D in dark-skinned populations. Objective: The objective was to describe the distribution of 25(OH)D and its subcomponents in 5 population samples of African origin from the United States, Jamaica, Ghana, South Africa, and the Seychelles. Design: Participants were drawn from the Modeling of the Epidemiologic Transition Study, a cross-sectional observational study in 2500 adults, ages 25-45 y, enrolled between January 2010 and December 2011. Five hundred participants, ∼50% of whom were female, were enrolled in each of 5 study sites: Chicago, IL (latitude: 41°N); Kingston, Jamaica (17°N); Kumasi, Ghana (6°N); Victoria, Seychelles (4°S); and Cape Town, South Africa (34°S). All participants had an ancestry primarily of African origin; participants from the Seychelles trace their history to East Africa. Results: A negative correlation between 25(OH)D and distance from the equator was observed across population samples. The frequency distribution of 25(OH)D in Ghana was almost perfectly normal (Gaussian), with progressively lower means and increasing skewness observed at higher latitudes. Conclusions: It is widely assumed that lighter skin color in populations outside the tropics resulted from positive selection, driven in part by the relation between sun exposure, skin melanin content, and 25(OH)D production. Our findings show that robust compensatory mechanisms exist that create tolerance for wide variation in circulating concentrations of 25(OH)D across populations, suggesting a more complex evolutionary relation between skin color and the vitamin D pathway. This trial was registered at clinicaltrials.gov as NCT02111902. © 2014 American Society for Nutrition. | Open |
| Egbi G.; Steiner-Asiedu M.; Kwesi F.S.; Ayi I.; Ofosu W.; Setorglo J.; Klobodu S.S.; Armar-Klemesu M. | Anaemia among school children older than five years in the Volta Region of Ghana | 2014 | The Pan African medical journal | INTRODUCTION: Anaemia among children is a public health issue in Ghana. The Ghana School Feeding Programme (GSFP) was instituted on pilot basis in an effort to provide nutritious lunch to school children. Evidence on the nutritional status of pupils is needed to inform the expansion of GSFP. This study sought to assess anaemia among Ghanaian pupils.; METHODS: This cross-sectional study involved a random sample of 143 pupils aged 6 to 12 years. Blood samples were collected and analysed for serum-ferritin (SF), C-reactive protein (CRP), haemoglobin and malaria-parasitaemia (MP). Stool samples were examined for soil-transmitted helminths. Dietary data were collected using the 24 hour-recall method on three non-consecutive days and a food frequency questionnaire. The Student's t-test was used to compare mean values between sexes. Binary logistic regression was performed to identify factors associated with anaemia. Statistical significance was set at p < 0.05.; RESULTS: SF and haemoglobin concentrations were 23.9 ± 15 ng/ml and 120 ± 11 g/L respectively. The prevalence of anaemia was 30.8%. More females (41.5%) than males (21.8%) had anaemia (p < 0.005). Seventy-one percent of pupils had low SF levels. MP prevalence was 67.8%. Hookworm infestation was only observed in males (18.0%). Dietary iron and vitamin C intakes were 18.98 ± 8.8 mg and 23.7 ± 6.7 mg, respectively. Child's sex, SF and MP were associated with anaemia. Males had a lower likelihood of being anaemic (OR = 0.2, CI 0.1-0.5, p = 0.002).; CONCLUSION: The study findings underscore the need for multi-pronged approaches that address both malaria control and nutrition in order to reduce anaemia among pupils. | Open |
| Frank L.K.; Kröger J.; Schulze M.B.; Bedu-Addo G.; Mockenhaupt F.P.; Danquah I. | Dietary patterns in urban Ghana and risk of type 2 diabetes | 2014 | British Journal of Nutrition | There is epidemiological evidence for associations between dietary patterns and type 2 diabetes. However, for sub-Saharan Africa, information on dietary patterns and their contribution to diabetes is lacking. The aim of the present study was to identify dietary patterns and their associations with type 2 diabetes in an urban Ghanaian population. In a hospital-based case-control study on risk factors for type 2 diabetes in Kumasi, a FFQ was administered to 675 controls and 542 cases. Dietary patterns were identified by using factor analysis including thirty-three food items. Logistic regression was used to evaluate the associations of dietary patterns with type 2 diabetes. Overall, two dietary patterns were identified: (1) a 'purchase' dietary pattern which positively correlated with the consumption of sweets, rice, meat, fruits and vegetables and (2) a 'traditional' dietary pattern that correlated with the intake of fruits, plantain, green leafy vegetables, fish, fermented maize products and palm oil. In the highest quintile of the 'purchase' dietary pattern, participants were younger, leaner and of higher socio-economic status than those in the lower quintiles. In contrast, participants in the highest quintile of the 'traditional' dietary pattern were older, heavier and more deprived compared with those in the lower quintiles. In the multivariate model, the 'purchase' dietary pattern was inversely associated with type 2 diabetes (OR per 1 sd 0·41, 95 % CI 0·33, 0·50); the 'traditional' dietary pattern increased the odds of diabetes per 1 sd by 54 % (95 % CI 1·35, 1·81). In conclusion, two diverse dietary patterns were identified and associated with type 2 diabetes in urban Ghana. The determinants of pattern adherence require further investigation. Copyright © The Authors 2014. | Open |
| Ghosh S.; Tano-Debrah K.; Aaron G.J.; Otoo G.; Strutt N.; Bomfeh K.; Kitamura S.; Suri D.J.; Murakami H.; Furuta C.; Sarpong D.; Saalia F.; Nakao Y.; Amonoo-Kuofi H.; Uauy R.; Toride Y. | Improving complementary feeding in Ghana: Reaching the vulnerable through innovative business-the case of KOKO Plus | 2014 | Annals of the New York Academy of Sciences | Reaching vulnerable populations in low-resource settings with effective business solutions is critical, given the global nature of food and nutrition security. Over a third of deaths of children under 5 years of age are directly or indirectly caused by undernutrition. The Lancet series on malnutrition (2013) estimates that over 220,000 lives of children under 5 years of age can be saved through the implementation of an infant and young child feeding and care package. A unique project being undertaken in Ghana aims to bring in two elements of innovation in infant and young child feeding. The first involves a public-private partnership (PPP) to develop and test the efficacy and effectiveness of the delivery of a low-cost complementary food supplement in Ghana called KOKO Plus™. The second involves the testing of the concepts of social entrepreneurship and social business models in the distribution and delivery of the product. This paper shares information on the ongoing activities in the testing of concepts of PPPs, social business, social marketing, and demand creation using different delivery platforms to achieve optimal nutrition in Ghanaian infants and young children in the first 2 years of life. It also focuses on outlining the concept of using PPP and base-of-the-pyramid approaches toward achieving nutrition objectives. © 2014 New York Academy of Sciences. | Open |
| Gyampoh S.; Otoo G.E.; Aryeetey R.N.O. | Child feeding knowledge and practices among women participating in growth monitoring and promotion in Accra, Ghana | 2014 | BMC Pregnancy and Childbirth | Background: Child undernutrition and poor feeding practices remain a concern in Ghana. The Growth Monitoring and Promotion (GMP) programme seeks to empower mothers to provide appropriate child care. Although the program has been implemented in Ghana for over four decades, little is known about its impact on child feeding outcomes. The current study assessed the association between GMP exposure and mothers' child feeding knowledge and practices in the Accra Metropolitan Area (AMA), Ghana.Methods: A cross-sectional survey of 199 mother-child pairs accessing child welfare services in six public health facilities in the AMA was conducted. A structured questionnaire was used to collect data on respondent characteristics and child feeding knowledge a 24-hour dietary recall tool was used to record child feeding practices. Linear regression analysis was used to determine the association between mothers' exposure to GMP and their knowledge and practices on child feeding.Results: Seventy four percent of mothers had not missed any scheduled child welfare clinic sessions. Over 60% of mothers knew the appropriate age of introduction of foods; 86% also gave correct response regarding minimum number of times their child should be fed daily. About 81% of children less than 6 months were exclusively breastfed in the preceding 24 hours, although 36% had received water since birth. Forty two percent of children 6-23 months received dietary diverse meals while 64% were fed the required number of times in a day. Overall, only 32% of children 6-23 months received a minimum acceptable diet in the preceding 24 hours. A higher GMP exposure was positively associated with feeding knowledge scores among mothers with children below 6 months (p < 0.05).Conclusion: Although most mothers were knowledgeable about recommendations, feeding practices were suboptimal, especially complementary feeding. GMP exposure was associated with feeding knowledge only among mothers with children less than 6 months. Strengthening of feeding counselling focused on children above 6 months is recommended. © 2014 Gyampoh et al.; licensee BioMed Central Ltd. | Open |
| Issaka A.I.; Agho K.E.; Page A.N.; Burns P.; Stevens G.J.; Dibley M.J. | Determinants of early introduction of solid, semi-solid or soft foods among infants aged 3-5 months in four Anglophone West African countries | 2014 | Nutrients | This study was conducted to explore and identify factors associated with the practice of early introduction of solid, semi-solid or soft foods among infants aged 3-5 months in four Anglophone West African countries. Data sources for the analyses were the latest Demographic and Health Survey datasets of the 4 countries, namely Ghana (GDHS, 2008), Liberia (LDHS, 2007), Nigeria (NDHS, 2013) and Sierra Leone (SLDHS, 2008). Multiple logistic regression methods were used to analyze the factors associated with early introduction of solid, semi-solid or soft foods among infants aged 3-5 months, using individual-, household- and community-level determinants. The sample consisted of 2447 infants aged 3-5 months from four Anglophone West African countries: 166 in Ghana, 263 in Liberia, 1658 in Nigeria and 360 in Sierra Leone. Multivariable analyses revealed the individual factors associated with early introduction of solid, semi-solid or soft foods in these countries. These included increased infant's age, diarrhea, acute respiratory infection and newborns perceived to be small by their mothers. Other predictors of early introduction of solid, semi-solid or soft foods were: mothers with no schooling, young mothers and fathers who worked in an agricultural industry. Public health interventions to improve exclusive breastfeeding practices by discouraging early introduction of solid, semi-solid or soft foods are needed in all 4 countries, targeting especially mothers at risk of introducing solid foods to their infants early. © 2014 by the authors; licensee MDPI, Basel, Switzerland. | Open |
| Lartey A.; Marquis G.S.; Mazur R.; Perez-Escamilla R.; Brakohiapa L.; Ampofo W.; Sellen D.; Adu-Afarwuah S. | Maternal HIV is associated with reduced growth in the first year of life among infants in the Eastern region of Ghana: The research to improve infant nutrition and growth (RIING) project | 2014 | Maternal and Child Nutrition | Children of HIV-infected mothers experience poor growth, but not much is understood about the extent to which such children are affected. The Research to Improve Infant Nutrition and Growth (RIING) Project used a longitudinal study design to investigate the association between maternal HIV status and growth among Ghanaian infants in the first year of life. Pregnant women in their third trimester were enrolled into three groups: HIV-negative (HIV-N, n=185), HIV-positive (HIV-P, n=190) and HIV-unknown (HIV-U, n=177). Socioeconomic data were collected. Infant weight and length were measured at birth and every month until 12 months of age. Weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) z-scores were compared using analysis of covariance. Infant HIV status was not known as most mothers declined to test their children's status at 12 months. Adjusted mean WAZ and LAZ at birth were significantly higher for infants of HIV-N compared with infants of HIV-P mothers. The prevalence of underweight at 12 months in the HIV-N, HIV-P and HIV-U were 6.6%, 27.5% and 9.9% (P<0.05), respectively. By 12 months, the prevalence of stunting was significantly different (HIV-N=6.0%, HIV-P=26.5% and HIV-U=5.0%, P<0.05). The adjusted mean±SE LAZ (0.57±0.11 vs. -0.95±0.12; P<0.005) was significantly greater for infants of HIV-N mothers than infants of HIV-P mothers. Maternal HIV is associated with reduce infant growth in weight and length throughout the first year of life. Children of HIV-P mothers living in socioeconomically deprived communities need special support to mitigate any negative effect on growth performance. © 2012 John Wiley & Sons Ltd. | Open |
| Lloyd-sherlock P.; Ebrahim S.; Grosskurth H. | Is hypertension the new HIV epidemic? | 2014 | International Journal of Epidemiology | Not Available | Open |
| Lopez-Teros V.; Chileshe J.; Idohou-Dossou N.; Fajarwati T.; Medoua Nama G.; Newton S.; Kumar M.V.; Wang Z.; Wasantwisut E.; Hunt J.R. | International experiences in assessing vitamin A status and applying the vitamin A-labeled isotope dilution method | 2014 | International Journal for Vitamin and Nutrition Research | Inadequate vitamin A (VA) nutrition continues to be a major problem worldwide, and many interventions being implemented to improve VA status in various populations need to be evaluated. The interpretation of results after an intervention depends greatly on the method selected to assess VA status. To evaluate the effect of an intervention on VA status, researchers in Cameroon, India, Indonesia, Mexico, Senegal and Zambia have used serum retinol as an indicator, and have not always found improvement in response to supplementation. One problem is that homeostatic control of serum retinol may mask positive effects of treatment in that changes in concentration are observed only when status is either moderately to severely depleted or excessive. Because VA is stored mainly in the liver, measurements of hepatic VA stores are the "gold standard" for assessing VA status. Dose response tests such as the relative dose response (RDR) and the modified relative dose response (MRDR), allow a qualitative assessment of VA liver stores. On the other hand, the use of the vitamin A-labeled isotope dilution (VALID) technique, (using 13C or 2H-labeled retinyl acetate) serves as an indirect method to quantitatively estimate total body and liver VA stores. Countries including Cameroon, China, Ghana, Mexico, Thailand and Zambia are now applying the VALID method to sensitively assess changes in VA status during interventions, or to estimate a population's dietary requirement for VA. Transition to the use of more sensitive bio chemical indicators of VA status such as the VALID technique is needed to effectively assess interventions in populations where mild to moderate VA deficiency is more prevalent than severe deficiency. © International Atomic Energy Agency 2014. | Open |
| Maleta K.; Amadi B. | Community-based management of acute malnutrition (CMAM) in sub-Saharan Africa: Case studies from Ghana, Malawi, and Zambia | 2014 | Food and Nutrition Bulletin | Background. Recent success with community-based management of acute malnutrition (CMAM) has spurred interest on how to improve coverage while maintaining treatment outcomes. Objective. To document, as case studies, the experience of three African countries, Malawi, Ghana, and Zambia, in scaling up CMAM. Methods. Desk review using published and unpublished data and country programmatic data and key informant interviews. Results. All three countries, with different motivations for startup, have successfully integrated CMAM into their essential health packages for children under 5 years of age, at least in their policy and strategic documents. Strong leadership by the ministries of health has been instrumental, complemented by key stakeholders and donor partners. Implementation is at variable stages, depending on when the program rolled out, with Malawi having achieved the most integration, followed by Ghana and Zambia. Using CMAM, the three countries have significantly extended service coverage and improved treatment outcomes, with cure rates ranging from 73% in Ghana to 90% in Malawi, while maintaining very low death rates: 1.7% in Malawi, 2% in Ghana, and 5% in Zambia. Conclusions. CMAM is a viable option to improve service coverage and outcomes in health systems where inpatient therapeutic care alone cannot suffice. © 2014, The Nevin Scrimshaw International Nutrition Foundation. | Open |
| Marquis G.S.; Colecraft E.K. | Community interventions for dietary improvement in Ghana | 2014 | Food and nutrition bulletin | UNLABELLED: Background. Low caregiver income and poor nutrition knowledge and skills are important barriers to achieving optimal child feeding in rural Ghana.; OBJECTIVE: An integrated microcredit and nutrition education intervention was implemented to address these barriers.; METHODS: Using a quasi-experimental design, 134 caregivers of children 2 to 5 years of age in six intervention communities were enrolled into self-selected savings and loan groups. They received small individual loans over four 16-week cycles to support their income-generating activities. Nutrition and entrepreneurial education was provided during weekly loan repayment meetings. Another 261 caregivers in six comparison communities did not receive the intervention. Data on household sociodemographic and economic characteristics, perception of income-generating activity profits, and children's consumption of animal-source foods in the previous week were collected at baseline and at four additional time points. Differences according to group (intervention vs. control) and time (baseline vs. endline) were analyzed with chi-square and Student's t-tests.; RESULTS: The intervention and comparison groups did not differ by caregivers' age and formal education; few (35) had previous experience with microcredit loans. At endline, more intervention than comparison caregivers perceived that their business profits had increased (59% vs. 23%, p < .001). In contrast to comparison children, after 16 months of intervention children consumed more livestock meat (p =.001), organ meat (p = .04), eggs (p = .001), and milk and milk products (p < .0001) in the previous week in comparison with baseline.; CONCLUSIONS: Integrated food-centered strategies can improve children's diets, which will enhance their nutritional status, health, and cognitive outcomes. | Open |
| Nikoi E.; Anthamatten P. | Childhood anaemia in Ghana: An examination of associated socioeconomic and health factors | 2014 | African Geographical Review | Anaemia is a significant public health issue in many low-income countries, yet little systematic work has examined associated socioeconomic and health factors beyond clinical research. The present study examines the effects of the characteristics of individual children, their mothers and households on anaemia prevalence among Ghanaian children under age five. A generalized linear mixed regression model is applied to data derived from the 2008 MEASURE Demographic and Health Survey in Ghana to estimate fixed and random effects of associated variables on anaemia. Significantly associated factors include childs age, sex, and fever status in the two weeks preceding the survey, mothers body mass index, haemoglobin level, health insurance coverage, mothers education and household wealth status. Factors not significantly associated include whether children received iron supplements, slept under a mosquito bed net and the type of mosquito bed net utilized. Childhood anaemia is related to personal, social and environmental factors. Developing sound policy to address this health problem will require additional research to understand the ways in which these factors are related. © 2013 The African Specialty Group of the Association of American Geographers. | Open |
| Nikoi E.; Anthamatten P. | An examination of environmental correlates with childhood height-for-age in Ghana | 2014 | Public Health Nutrition | Objective The relationship between a child's environment and nutritional status is difficult to examine yet could offer an important guide to policy. The objective of the present work was to examine individual and environmental correlates with childhood height-for-age in Ghana. Design Data were derived from the 2008 MEASURE Demographic and Health Survey in Ghana, the 2000 Ghana Population and Housing Census, and the World Wide Fund for Nature's eco-regions database. A generalized linear mixed regression model was used to estimate the effects of individual and environmental correlates on height-for-age. Subjects The study examined 2225 Ghanaian children aged 0-59 months. Setting The setting was all districts in Ghana for the year 2008. Results After accounting for individual characteristics of children, mothers and households, height-for-age was significantly associated with population density. Other significantly associated variables in the final model were the age of the child, vaccination status, the size of the child at birth, months of breast-feeding, mother's BMI, whether the child's mother had health insurance and wealth quintile. Conclusions In addition to a number of characteristics of the children and their households, the social milieu is important to understanding differences in height-for-age among children in Ghana. The biophysical environment was not associated with height-for-age. © 2012 The Authors. | Open |
| Siekmans K.; Receveur O.; Haddad S. | Can an integrated approach reduce child vulnerability to anaemia? Evidence from three African countries | 2014 | PLoS ONE | Addressing the complex, multi-factorial causes of childhood anaemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a "buffering" of risk associated with known causes of anaemia would be observed among children living in areas benefiting from a community-based health and nutrition program intervention. Cross-sectional data on the nutrition and health status of children 24-59 mo (N = 2405) were obtained in 2000 and 2004 from program evaluation surveys in Ghana, Malawi and Tanzania. Linear regression models estimated the association between haemoglobin and immediate, underlying and basic causes of child anaemia and variation in this association between years. Lower haemoglobin levels were observed in children assessed in 2000 compared to 2004 (difference -3.30 g/L), children from Tanzania (-9.15 g/L) and Malawi (-2.96 g/L) compared to Ghana, and the youngest (24-35 mo) compared to oldest age group (48-59 mo; -5.43 g/L). Children who were stunted, malaria positive and recently ill also had lower haemoglobin, independent of age, sex and other underlying and basic causes of anaemia. Despite ongoing morbidity, risk of lower haemoglobin decreased for children with malaria and recent illness, suggesting decreased vulnerability to their anaemia-producing effects. Stunting remained an independent and unbuffered risk factor. Reducing chronic undernutrition is required in order to further reduce child vulnerability and ensure maximum impact of anaemia control programs. Buffering the impact of child morbidity on haemoglobin levels, including malaria, may be achieved in certain settings. © 2014 Siekmans et al. | Open |
| Sodjinou R.; Bosu W.K.; Fanou N.; Déart L.; Kupka R.; Tchibindat F.; Baker S. | A systematic assessment of the current capacity to act in nutrition in West Africa: Cross-country similarities and differences | 2014 | Global Health Action | Background: Although it is widely accepted that lack of capacity is one of the barriers to scaling up nutrition in West Africa, there is a paucity of information about what capacities exist and the capacities that need to be developed to accelerate progress toward improved nutrition outcomes in the region. Objective: To systematically assess the current capacity to act in nutrition in the West Africa region and explore cross-country similarities and differences. Design: Data were collected from 13West African countries through interviews with government officials, key development partners, tertiary-level training institutions, and health professional schools. The assessment was based on a conceptual framework of four interdependent levels (tools; skills; staff and infrastructure; and structures, systems and roles). In each of the surveyed countries, we assessed capacity assets and gaps at individual, organizational, and systemic levels. Results: Important similarities and differences in capacity assets and gaps emerged across all the surveyed countries. There was strong momentum to improve nutrition in nearly all the surveyed countries. Most of the countries had a set of policies on nutrition in place and had set up multisectoral, multi-stakeholder platforms to coordinate nutrition activities, although much remained to be done to improve the effectiveness of these platforms. Many initiatives aimed to reduce undernutrition were ongoing in the region, but there did not seem to be clear coordination between them. Insufficient financial resources to implement nutrition activities were a major problem in all countries. The bulk of financial allocations for nutrition was provided by development partners, even though some countries, such as Niger, Nigeria, and Senegal, had a national budget line for nutrition. Sporadic stock-outs of nutrition supplies were reported in most of the countries as a result of a weak logistic and supply chain system. They also had a critical shortage of skilled nutrition professionals. There was limited supervision of nutrition activities, especially at lower levels. Nigeria and Ghana emerged as the countries with the greatest capacities to support the expansion of a nutrition workforce, although a significant proportion of their trained nutritionists were not employed in the nutrition sector. None of the countries had in place a unified nutrition information system that could guide decision-making processes across the different sectors. Conclusions: There is an urgent need for a shift toward wider reforms for nutrition capacity development in the West Africa region. Addressing these unmet needs is a critical first step toward improved capacity for action in nutrition in the region. © 2014 Roger Sodjinou et al. | Open |
| Suri D.J.; Tano-Debrah K.; Ghosh S.A. | Optimization of the nutrient content and protein quality of cereal-legume blends for use as complementary foods in Ghana | 2014 | Food and Nutrition Bulletin | Background. Nutritionally adequate complementary foods made from locally available ingredients are of high priority in developing countries, including Ghana. The majority of complementary foods in these countries are cereal-based and are unable to meet the nutrient intakes recommended by the World Health Organization. Objective. To evaluate the nutrient content and protein quality of local cereal-legume blends for complementary foods against recommendations and to determine the quantities of additional ingredients required to meet needs by using linear programming. Methods. Nine cereal-legume combinations (maize, sorghum, or millet combined with cowpea, peanut, or soybean) and koko (a traditional Ghanaian maizebased complementary food) were evaluated based on the macronutrient targets for a daily ration of complementary food for the age group 12 to 24 months: 264 kcal, 6.5 g of protein, and 8.2 to 11.7 g of fat. Protein quality was assessed by the Protein Digestibility Corrected Amino Acid Score (PDCAAS). Linear programming was then used to determine the amounts of additional oil, sugar, and lysine needed to meet macronutrient requirements. Results. No traditional cereal-legume food met all complementary food macronutrient requirements on its own. Cereal-legume blends made with peanut or cowpeas were low in quality protein, while those with soybean were low in fat. Lysine was the limiting amino acid (PDCAAS 0.50 to 0.82) in all blends. Adding lysine increased utilizable protein by 1% to 10% in soybean blends, 35% to 40% in peanut blends, and 14% to 24% in cowpea blends. Peanut-maize, peanut-millet, and all soybean-cereal blends were able to meet macronutrient targets; most micronutrients remained below recommended levels. Conclusions. Traditional cereal-legume blends made from locally available ingredients do not meet energy, quality protein, and fat recommendations for complementary foods; however, such complementary food blends may be optimized to meet nutrient requirements by using linear programming as a tool to determine the exact levels of fortificants to be added (including, but not limited to, added fat, amino acids, and micronutrients). © 2014, The Nevin Scrimshaw International Nutrition Foundation. | Open |
| Abizari A.-R.; Pilime N.; Armar-Klemesu M.; Brouwer I.D. | Cowpeas in Northern Ghana and the Factors that Predict Caregivers' Intention to Give Them to Schoolchildren | 2013 | PLoS ONE | Background:Cowpeas are important staple legumes among the rural poor in northern Ghana. Our objectives were to assess the iron and zinc content of cowpea landraces and identify factors that predict the intention of mothers/caregivers to give cowpeas to their schoolchildren.Methods and Findings:We performed biochemical analysis on 14 landraces of cowpeas and assessed the opinion of 120 caregiver-child pairs on constructs based on the combined model of the Theory of Planned Behaviour and Health Belief Model. We used correlations and multiple regressions to measure simple associations between constructs and identify predictive constructs. Cowpea landraces contained iron and zinc in the range of 4.9-8.2 mg/100 g d.w and 2.7-4.1 mg/100 g d.w respectively. The landraces also contained high amounts of phytate (477-1110 mg/100 g d.w) and polyphenol (327-1055 mg/100 g d.w). Intention of mothers was strongly associated (rs = 0.72, P<0.001) with and predicted (β = 0.63, P<0.001) behaviour. The constructs, barriers (β = -0.42, P = 0.001) and attitudes towards behaviour (β = 0.25, P<0.028), significantly predicted intention albeit the predictive ability of the model was weak.Conclusions:We conclude that some cowpea landraces from northern Ghana have appreciable amounts of iron and zinc but probably with poor bioavailability. Attitudes towards giving cowpeas and perception of barriers are important predictors of caregivers' intention to give cowpeas to their schoolchildren. Finally our results suggest that increasing knowledge on nutritional benefits of cowpeas may increase health values caregivers hold for their children in support of giving cowpeas to schoolchildren. © 2013 Abizari et al. | Open |
| Amegah A.K.; Damptey O.K.; Sarpong G.A.; Duah E.; Vervoorn D.J.; Jaakkola J.J.K. | Malaria Infection, Poor Nutrition and Indoor Air Pollution Mediate Socioeconomic Differences in Adverse Pregnancy Outcomes in Cape Coast, Ghana | 2013 | PLoS ONE | Background:The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES). Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES.Methods:A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire.Results:In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145) reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87), low education (187 g; 95% CI: 355-20), studentship during pregnancy (291 g; 95% CI: 506-76) and low income (147 g; 95% CI: 277-17). In causal pathway analysis, malaria infection (6-20%), poor nutrition (2-51%) and indoor air pollution (10-62%) mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21) risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56) of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49) and 278% (RR: 3.78; 95% CI: 1.39-10.27) increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk.Conclusion:We provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition and indoor air pollution, on pregnancy outcomes in a developing country setting. © 2013 Amegah et al. | Open |
| Ampaabeng S.K.; Tan C.M. | The long-term cognitive consequences of early childhood malnutrition: The case of famine in Ghana | 2013 | Journal of Health Economics | We examine the role of early childhood health in human capital accumulation. Using a unique data set from Ghana with comprehensive information on individual, family, community, school quality characteristics and a direct measure of intelligence together with test scores, we examine the long-term cognitive effects of the 1983 famine on survivors. We show that differences in intelligence test scores can be robustly explained by the differential impact of the famine in different parts of the country and the impacts are most severe for children under two years of age during the famine. We also account for model uncertainty by using Bayesian Model Averaging. © 2013 Elsevier B.V. | Open |
| Basu S.; Millett C. | Social epidemiology of hypertension in middle-income countries: Determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study | 2013 | Hypertension | Large-scale hypertension screening campaigns have been recommended for middle-income countries. We sought to identify sociodemographic predictors of hypertension prevalence, diagnosis, treatment, and control among middle-income countries. We analyzed data from 47 443 adults in all 6 middle-income countries (China, Ghana, India, Mexico, Russia, and South Africa) sampled in nationally representative household assessments from 2007 to 2010 as part of the World Health Organization Study on Global Aging and Adult Health. We estimated regression models accounting for age, sex, urban/rural location, nutrition, and obesity, as well as hypothesized covariates of healthcare access, such as income and insurance. Hypertension prevalence varied from 23% (India) to 52% (Russia), with between 30% (Russia) and 83% (Ghana) of hypertensives undiagnosed before the survey and between 35% (Russia) and 87% (Ghana) untreated. Although the risk of hypertension significantly increased with age (odds ratio, 4.6; 95% confidence interval, 3.0-7.1; among aged, 60-79 versus <40 years), the risk of being undiagnosed or untreated fell significantly with age. Obesity was a significant correlate to hypertension (odds ratio, 3.7; 95% confidence interval, 2.1-6.8 for obese versus normal weight), and was prevalent even among the lowest income quintile (13% obesity). Insurance status and income also emerged as significant correlates to diagnosis and treatment probability, respectively. More than 90% of hypertension cases were uncontrolled, with men having 3 times the odds as women of being uncontrolled. Overall, the social epidemiology of hypertension in middle-income countries seems to be correlated to increasing obesity prevalence, and hypertension control rates are particularly low for adult men across distinct cultures. © 2013 American Heart Association, Inc. | Open |
| Beard J.H.; Oresanya L.B.; Ohene-Yeboah M.; Dicker R.A.; Harris H.W. | Characterizing the global burden of surgical disease: A method to estimate inguinal hernia epidemiology in Ghana | 2013 | World Journal of Surgery | Background: Surgical conditions represent an immense yet underrecognized source of disease burden globally. Characterizing the burden of surgical disease has been defined as a priority research agenda in global surgery. Little is known about the epidemiology of inguinal hernia, a common easily treatable surgical condition, in resource-poor settings. Methods: Using data from the National Health and Nutrition Examination Survey prospective cohort study of inguinal hernia, we created a method to estimate hernia epidemiology in Ghana. We calculated inguinal hernia incidence and prevalence using Ghanaian demographic data and projected hernia prevalence under three surgical rate and hernia incidence scenarios. Disability adjusted life-years (DALYs) associated with inguinal hernia along with costs for surgical repair were estimated. Results: According to this approach, the prevalence of inguinal hernia in the Ghanaian general population is 3.15 % (range 2.79-3.50 %). Symptomatic hernias number 530,082 (range 469,501-588,980). The annual incidence of symptomatic hernias is 210 (range 186-233) per 100,000 population. At the estimated Ghanaian hernia repair rate of 30 per 100,000, a backlog of 1 million hernias in need of repair develop over 10 years. The cost of repairing all symptomatic hernias in Ghana is estimated at US$53 million, and US$106 million would be required to eliminate hernias over a 10-year period. Nearly 5 million DALYs would be averted with the repair of prevalent cases of symptomatic hernia in Ghana. Conclusions: Data generated by our method indicate the extent to which Ghana lacks the surgical capacity to address its significant inguinal hernia disease burden. This approach provides a simple framework for calculating inguinal hernia epidemiology in resource-poor settings that may be used for advocacy and program planning in multiple country contexts. © 2012 Société Internationale de Chirurgie. | Open |
| Buxton C.; Davies A. | Nutritional knowledge levels of nursing students in a tertiary institution: Lessons for curriculum planning | 2013 | Nurse Education in Practice | This article presents findings of a study which assessed the nutritional knowledge levels of nursing students as nurses are in a better position to serve as nutrition educators and counselors by engaging their clients in discussions that would increase their knowledge about disease prevention and management through nutrition. This was a descriptive cross-sectional study, where a selfadministered questionnaire was completed by 166 undergraduate consenting third (3rd) and final (4th) year nursing students in a public university in Ghana who answered 20 multiple choice general nutrition questions. An average score of 8.95±2.01 corresponding to 44.8%, below average, was obtained by the respondents. It was determined that the nutrition knowledge of 3.6%, 62.7% and 33.7% of the study participants was good, adequate and inadequate respectively. It was found that the differences with respect to the nutrition knowledge levels between the age groups, gender, work experience and educational background of respondents were not statistically significant at p<0.05. The findings of this study support other reports that nurses need more training in nutrition and therefore have important implications for professionals planning curricula for nursing education at the undergraduate level in the university. © 2012 Elsevier Ltd. | Open |
| Debrah E. | Alleviating poverty in Ghana: The case of Livelihood Empowerment against Poverty (LEAP) | 2013 | Africa Today | In 2008, the government of Ghana implemented Livelihood Empowerment against Poverty, a plan to empower the extremely poor financially, increase basic school enrollment among children of poor households, reduce the infant mortality rate, improve child nutrition, and grow local economies. However, after four years, only a minority had witnessed an improvement in their living conditions. The rural poor, particularly in the three northern regions, continue to suffer. A multidimensional approach, focusing on free health insurance, provision of primary and secondary education to teach productive skills, the pursuit of good governance to block the diversion of funds for social services, and prioritizing women and girls will roll poverty into oblivion. | Open |
| Doku D.; Koivusilta L.; Raisamo S.; Rimpelä A. | Socio-economic differences in adolescents' breakfast eating, fruit and vegetable consumption and physical activity in Ghana | 2013 | Public Health Nutrition | Abstract Objective Few studies have investigated the association between adolescents' socio-economic status (SES) and health behaviours in developing countries. Socio-economic differences in breakfast eating, fruit and vegetable consumption and physical activity were investigated among Ghanaian adolescents. Design A school-based survey of 12-18-year-olds (n 1195, response rate 89·7 %) was conducted in 2008. Logistic regression analyses were applied to study the associations between breakfast eating, fruit and vegetable consumption and physical activity, and SES. Setting Southern Ghana, West Africa. Subjects School pupils aged 12-18 years. Results Of all adolescents, 31 % took breakfast less than 4 d/week, over half (56 %) and 48 %, respectively, rarely ate fruits and vegetables. Younger adolescents (12-15-year-olds) consumed fruits and vegetables frequently compared with older ones (16-18-year-olds). Boys were more likely to participate in physical activity than girls. The probability of frequent breakfast eating was higher in adolescents from more affluent backgrounds than in those from less affluent ones. Compared with those whose mothers were illiterate, both tertiary and primary maternal educational attainment increased the probability of frequent fruit intake. Similarly, tertiary educational attainment increased the likelihood of frequent vegetable intake. Compared with those with unemployed mothers, mothers' low employment grade was related to higher probability of frequent fruit intake. High school performance was associated with frequent fruit intake, whereas high or medium school performance increased the likelihood of vegetable intake compared with low school performance. Conclusions Interventions are needed to improve breakfast intake, fruit and vegetable consumption and physical activity in order to prevent degenerative diseases among Ghanaian adolescents. Copyright © The Authors 2011. | Open |
| Garza C.; Borghi E.; Onyango A.W.; De Onis M. | Parental height and child growth from birth to 2 years in the WHO multicentre growth reference study | 2013 | Maternal and Child Nutrition | Linear growth from birth to 2 years of children enrolled in the World Health Organization Multicentre Growth Reference Study was similar despite substantial parental height differences among the six study sites. Within-site variability in child length attributable to parental height was estimated by repeated measures analysis of variance using generalized linear models. This approach was also used to examine relationships among selected traits (e.g. breastfeeding duration and child morbidity) and linear growth between 6 and 24 months of age. Differences in intergenerational adult heights were evaluated within sites by comparing mid-parental heights (average of the mother's and father's heights) to the children's predicted adult height. Mid-parental height consistently accounted for greater proportions of observed variability in attained child length than did either paternal or maternal height alone. The proportion of variability explained by mid-parental height ranged from 11% in Ghana to 21% in India. The average proportion of between-child variability accounted for by mid-parental height was 16% and the analogous within-child estimate was 6%. In the Norwegian and US samples, no significant differences were observed between mid-parental and children's predicted adult heights. For the other sites, predicted adult heights exceeded mid-parental heights by 6.2-7.8cm. To the extent that adult height is predicted by height at age 2 years, these results support the expectation that significant community-wide advances in stature are attainable within one generation when care and nutrition approximate international recommendations, notwithstanding adverse conditions likely experienced by the previous generation. © 2013 John Wiley & Sons Ltd. | Open |
| Hiamey S.E.; Amuquandoh F.E.; Boison G.A. | Are we indeed what we eat? Street food consumption in the Market Circle area of Takoradi, Ghana | 2013 | Nutrition and Health | The paper examines street foods consumption in the Market Circle of Sekondi-Takoradi, Ghana. The data used for the study were obtained from individuals who were either purchasing or consuming street foods in the Market Circle in August of 2011. The results revealed that the average consumer makes use of street foods six times in a week and there was a penchant for carbohydrate based foods over other types of street foods. Reasons including cost saving, convenience and eating on credit were noted to underlie the consumption of street foods in the area. Based on the findings, it was concluded that the high consumption of street foods in the Market Circle was for reasons other than nutrition and health. © 2015, SAGE Publications. All rights reserved. | Open |
| Humphries D.; Simms B.T.; Davey D.; Otchere J.; Quagraine J.; Terryah S.; Newton S.; Berg .E.; Harrison L.M.; Boakye D.; Wilson M.; Cappello M. | Hookworm infection among school age children in kintampo north municipality, ghana: Nutritional risk factors and response to albendazole treatment | 2013 | American Journal of Tropical Medicine and Hygiene | Children (n = 812) 6-11 years of age attending 16 schools in the Kintampo North Municipality of Ghana were screened for participation in a study on hookworm infection, nutrition, and response to albendazole. The prevalence of Necator americanus hookworm infection (n = 286) was 39.1%, and significant predictors of infection included age, malaria parasitemia, lack of health care, school area, levels of antibodies against hookworm, and low consumption of animal foods. The cure rate after a single dose (400 mg) albendazole was 43%, and the mean fecal egg count reduction rate was 87.3%. Data for an in vitro egg hatch assay showed a trend toward reduced albendazole susceptibility in posttreatment hookworm isolates (P = 0.06). In summary, hookworm infection is prevalent among school age children in the Kintampo NorthMunicipality and animal food intake inversely correlates with infection status.Modest cure rates and fecal egg count reduction rates reinforce the need for further investigation of potential benzimidazole resistance in Ghana. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene. | Open |
| Abiba A.; Grace A.N.K.; Kubreziga K.C. | Effects of dietary patterns on the nutritional status of upper primary school children in Tamale metropolis | 2012 | Pakistan Journal of Nutrition | Unhealthy eating increases the risk of malnutrition. This study was therefore carried out to determine the effects of dietary patterns on the nutritional status of upper primary school children in the Tamale metropolis. A cross-sectional study was carried out; hundred (100) participants were randomly selected from five basic schools. Data collection tools and techniques included: anthropometry, dietary assessment, interviews and observations. Food frequency questionnaires were administered to assess dietary intake over a period of two weeks. Results from the study revealed that, the prevalence of underweight was relatively low among participants (10%) as compared to other developing countries. 7% were at a risk of becoming overweight whilst 4% were overweight. Foods consumed were basically from local staples. Variability was however lacking in the diet for most (65%). Consumption of animal protein was also low. 73% of participants did not consume eggs whereas fish and meat were consumed occasionally. Most meals were eaten at home and parents mostly determined what is eaten at each meal time. 37% snack twice a day. 56% of the participants consumed both light and heavy meals as snacks. Snacking was frequent among the overweight and those at risk of becoming overweight than the underweight. General nutrition knowledge of respondents was poor. Conclusively, snacking is more likely to influence respondent's nutritional status. Moreover, sedentary lifestyles may be implicated for the prevalence of overweight and risk of becoming overweight. The risk of pernicious anemia could also be high since animal protein consumption was low. © Asian Network for Scientific Information, 2012. | Open |
| Abizari A.-R.; Moretti D.; Zimmermann M.B.; Armar-Klemesu M.; Brouwer I.D. | Whole cowpea meal fortified with NaFeEDTA Reduces iron deficiency among ghanaian school children in a malaria endemic area | 2012 | Journal of Nutrition | Cowpeas, like other legumes, contain high amounts of native iron but are rich in phytic acid (PA) and polyphenols (PP) that inhibit iron absorption. NaFeEDTA may overcome the combined inhibitory effect of PA and PP. Our objective was to test the efficacy of NaFeEDTA-fortified cowpea meal in improving iron status of school children in a malaria endemic area. We conducted a double-blind, controlled trial with 5- to 12-y-old school children from 2 rural communities in northern Ghana (n = 241). Eligible children were randomly assigned to 2 treatment groups to receive either cowpea meal fortified with 10 mg Fe/meal as NaFeEDTA, or an identical but nonfortified cowpea meal. Meals were provided 3 d/wk for a period of ;7 mo under strict supervision. Mass deworming and malaria antigenemia screening and treatment were carried out at baseline and 3.5 mo into the trial. Consumption of cowpea flour fortified with NaFeEDTA resulted in improvement of hemoglobin (P < 0.05), serum ferritin (P < 0.001), and body iron stores (P < 0.001) and reduction of transferrin receptor (P < 0.001) compared with nonfortified flour. Fortification resulted in a 30 and 47% reduction in the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) (P < 0.05), respectively. The results indicate that fortification of cowpea flour with NaFeEDTA overcomes the combined inhibitory effect of PA and PP and, when used for targeted school-based fortification of cowpea flour, is effective in reducing the prevalence of ID and IDA among school children in malaria endemic rural northern Ghana. © 2012 American Society for Nutrition. | Open |
| Austin G.; Baten J.; van Leeuwen B. | The biological standard of living in early nineteenth-century West Africa: New anthropometric evidence for northern Ghana and Burkina Faso | 2012 | Economic History Review | West Africans are on average shorter than Europeans today. Whether this was already the case at the end of the Atlantic slave trade is an important question for the history of nutrition and physical welfare. We present the first study of changing heights for people born mostly in what are now northern Ghana and Burkina Faso during the early nineteenth century. The dataset, not used before for anthropometry, documents men born between 1800 and 1849. Mostly purchased from slave owners, they were recruited into the Dutch army to serve in the Dutch East Indies. We find that height development was stagnant between 1800 and 1830 and deteriorated strongly during the 1840s. In international comparison and after taking selectivity issues into account, these Ghanaian and Burkinabe recruits were notably shorter than north-western Europeans but not shorter than southern Europeans during this period. © Economic History Society 2011. | Open |
| Danquah I.; Bedu-Addo G.; Terpe K.-J.; Micah F.; Amoako Y.A.; Awuku Y.A.; Dietz E.; Van Der Giet M.; Spranger J.; Mockenhaupt F.P. | Diabetes mellitus type 2 in urban Ghana: Characteristics and associated factors | 2012 | BMC Public Health | Background: Sub-Saharan Africa faces a rapid spread of diabetes mellitus type 2 (DM2) but its potentially specific characteristics are inadequately defined. In this hospital-based study in Kumasi, Ghana, we aimed at characterizing clinical, anthropometric, socio-economic, nutritional and behavioural parameters of DM2 patients and at identifying associated factors. Methods. Between August 2007 and June 2008, 1466 individuals were recruited from diabetes and hypertension clinics, outpatients, community, and hospital staff. Fasting plasma glucose (FPG), serum lipids and urinary albumin were measured. Physical examination, anthropometry, and interviews on medical history, socio-economic status (SES), physical activity and nutritional behaviour were performed. Results: The majority of the 675 DM2 patients (mean FPG, 8.31 mmol/L) was female (75%) and aged 40-60 years (mean, 55 years). DM2 was known in 97% of patients, almost all were on medication. Many had hypertension (63%) and microalbuminuria (43%); diabetic complications occurred in 20%. Overweight (body mass index > 25 kg/m 2), increased body fat (> 20% (male), > 33% (female)), and central adiposity (waist-to-hip ratio > 0.90 (male), > 0.85 (female)) were frequent occurring in 53%, 56%, and 75%, respectively. Triglycerides were increased ( 1.695 mmol/L) in 31% and cholesterol ( 5.17 mmol/L) in 65%. Illiteracy (46%) was high and SES indicators generally low. Factors independently associated with DM2 included a diabetes family history (adjusted odds ratio (aOR), 3.8; 95% confidence interval (95%CI), 2.6-5.5), abdominal adiposity (aOR, 2.6; 95%CI, 1.8-3.9), increased triglycerides (aOR, 1.8; 95%CI, 1.1-3.0), and also several indicators of low SES. Conclusions: In this study from urban Ghana, DM2 affects predominantly obese patients of rather low socio-economic status and frequently is accompanied by hypertension and hyperlipidaemia. Prevention and management need to account for a specific risk profile in this population. © 2012 Danquah et al; licensee BioMed Central Ltd. | Open |
| Kramer M.S.; Moodie E.E.M.; Platt R.W. | Infant feeding and growth: Can we answer the causal question? | 2012 | Epidemiology | Not Available | Open |
| Manson J.; Ameh E.; Canvassar N.; Chen T.; Den Hoeve A.; Lever F.; Hesse A.; Millar A.; Emil S.; Ade-Ajayi N. | Gastroschisis: A multi-centre comparison of management and outcome | 2012 | African Journal of Paediatric Surgery | Background: Anecdotal evidence and a handful of literature reports suggest that the outcome for infants born with gastroschisis in many African countries is poor when compared to Western nations. We wished to evaluate current management strategies and outcomes in African and Western units that treat infants with gastroschisis. Patients and Methods: We conducted a retrospective review of case-notes for infants with gastroschisis who presented to a hospital between 1 January 2004 and 31 December 2007. There were five participating centres, divided for analysis into an African cohort (three centres) and a Western cohort (two centres). Results: Fewer infants presented to a hospital with gastroschisis in the African cohort when compared to the Western cohort, particularly when the size of catchment area of each hospital was taken into account. The physiological state of the infant on presentation and management strategy varied widely between centres. Primary closure, preformed silo and surgical silo with delayed closure were all utilised in the African cohort. Use of the preformed silo and delayed abdominal wall closure was the strategy of choice in the Western cohort. The 30-day mortality was 23% and 1% respectively. This primary outcome measure varied considerably in the African cohort but was the same in the two Western units. Conclusions: Gastroschisis in the African cohort was characterised by fewer infants presenting to a hospital and a more variable outcome when compared to the Western cohort. A detailed epidemiological study to determine the incidence of gastroschisis in African countries may provide valuable information. In addition, interventions such as prompt resuscitation, safe neonatal transfer, the use of the preformed silo and parenteral nutrition could improve outcomes in infants with gastroschisis. | Open |
| Marriott B.P.; White A.; Hadden L.; Davies J.C.; Wallingford J.C. | World Health Organization (WHO) infant and young child feeding indicators: Associations with growth measures in 14 low-income countries | 2012 | Maternal and Child Nutrition | Eight World Health Organization (WHO) feeding indicators (FIs) and Demographic and Health Survey data for children <24 months were used to assess the relationship of child feeding with stunting and underweight in 14 poor countries. Also assessed were the correlations of FI with country gross national income (GNI). Prevalence of underweight and stunting increased with age and ≥50% of 12-23-month children were stunted. About 66% of babies received solids by sixth to eighth months; 91% were still breastfeeding through months 12-15. Approximately half of the children were fed with complementary foods at the recommended daily frequency, but <25% met food diversity recommendations. GNI was negatively correlated with a breastfeeding index (P<0.01) but not with other age-appropriate FI. Regression modelling indicated a significant association between early initiation of breastfeeding and a reduction in risk of underweight (P<0.05), but a higher risk of underweight for continued breastfeeding at 12-15 months (P<0.001). For infants 6-8 months, consumption of solid foods was associated with significantly lower risk of both stunting and underweight (P<0.001), as was meeting WHO guidance for minimum acceptable diet, iron-rich foods (IRF) and dietary diversity (P<0.001); desired feeding frequency was only associated with lower risk of underweight (P<0.05). Timely solid food introduction, dietary diversity and IRF were associated with reduced probability of underweight and stunting that was further associated with maternal education (P<0.001). These results identify FI associated with growth and reinforce maternal education as a variable to reduce risk of underweight and stunting in poor countries. © 2011 Blackwell Publishing Ltd. | Open |
| Ohlhorst S.D.; Slavin M.; Bhide J.M.; Bugusu B. | Use of Iodized Salt in Processed Foods in Select Countries Around the World and the Role of Food Processors | 2012 | Comprehensive Reviews in Food Science and Food Safety | The Micronutrient Initiative (MI) issued the Institute of Food Technologists (IFT) a project to assess the extent to which iodized salt is used in processed foods, as well as food processors' level of knowledge on iodine nutrition. Iodine is an essential micronutrient required by the body that is found in a limited number of foods, thus many individuals require additional sources of iodine to meet their daily requirement. Without these additional sources, a range of disorders referred to as iodine deficiency disorders (IDD), including mental impairment, may become present, with over 2 billion people worldwide at risk due to insufficient iodine nutrition. IDD is especially damaging during the early stages of pregnancy and in early childhood. In their most severe form, IDD includes cretinism, stillbirth, and miscarriage, and increased infant mortality. Since 1994 the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have recommended universal salt iodization (USI) as a safe, cost-effective, and sustainable strategy to ensure sufficient intake of iodine by all individuals. However, USI has in practice tended to focus only on table salt and not all salt destined for human consumption. Recent trends, particularly in industrialized countries, show that individuals are consuming the majority of their salt through processed foods, in which iodized salt is generally not used, rather than through iodized table salt. Additionally, recent initiatives to encourage reduced sodium consumption have prompted many consumers to reduce their intake of iodized table salt. While these trends in sodium consumption are more frequently observed in industrialized countries, they are expanding into many developing countries where iodine deficiency is also a concern. Thus countries which focus on iodization of table salt alone may not achieve optimal iodine nutrition of their population. This report provides an overview of the 2 Phases of this project. Phase I was to conduct an environmental scan/desk review of processed food consumption patterns in 39 countries selected by MI (see Table 1). Phase II was to conduct an electronic survey of food processors and detailed telephone interviews with a small sample of select company representatives from 16 countries (see Table 2). Per the scope of work, IFT conducted a desk review to determine the types and level of processed food consumption in the 39 countries of interest, as well as to identify suppliers of the major processed foods consumed and the use of salt as an ingredient in those products. Whenever possible, IFT also gathered information on the sodium content of widely consumed processed foods and the sources of salt currently used in these products; the types of processed foods and extent to which they are consumed by different socioeconomic groups; if iodized salt was used in processed foods; and whether or not there are policies in place to influence dietary salt reduction and how these efforts are implemented. For Phase II, IFT reached out to food company representatives to determine their use of iodized salt in processed food products; their sources of salt; their awareness of iodine nutrition and salt as a fortification vehicle; and their interest in learning more about salt iodization. For the purposes of this project, processed foods are considered to be all food products that have undergone a change of character or been altered from their original form. 1- Preselected countries (from MI) for Phase I of the iodized salt in processed foods project. Countries with heavy Countries with high Countries with Latin American European burden for IDD burden for IDD opportunity to progress countries countries India Russia Senegal Chile United Kingdom Pakistan Afghanistan Ghana Argentina Ireland Ethiopia United Republic of Tanzania Ukraine Mexico Finland China Democratic Republic of Congo Kenya Bolivia Netherlands Sudan Iraq Mozambique Uruguay Australia Indonesia Bangladesh Niger New Zealand Philippines Yemen Egypt Angola Haiti Turkey South Africa Brazil Nigeria Nepal 2- Preselected countries (from MI) for Phase II of the iodized salt in process foods project. Australia Kenya Bangladesh Mexico Bolivia Nigeria China Pakistan Egypt Russia Ghana Senegal India South Africa Indonesia United Kingdom To complete the desk review, IFT conducted literature searches and Internet reviews for each of the 39 countries of interest from May to September 2010. IFT reached out to its members with expertise in the countries of interest and 3rd parties such as government agencies, food companies, salt suppliers, and nongovernmental organizations to gain contacts and information. The acquisition of literature or access to databases or other sources of information which are not freely available was limited. For Phase II, IFT sent an electronic survey to over 800 individuals from all 16 countries in October 2010. IFT reached out to its members and other contacts with expertise in the countries of interest, which included food companies and salt suppliers who were asked to complete the electronic survey, but also 3rd parties, such as academics, government agencies, nongovernmental organizations, and so on, who were asked to pass the survey along to their food industry contacts. Outreach included over 15 multinational food companies. The survey responses IFT received were limited; however, IFT made a substantial effort to obtain useful information for each country. IFT also used survey responses and personal e-mail communications to locate 10 food company representatives to participate in telephone interviews to gain more detailed information. Many of the 39 countries reviewed struggle with food insecurity, thus it was generally difficult to find food consumption data for these impoverished nations, particularly data on processed food consumption. Nationwide food consumption data were helpful to better understand processed food consumption for those countries that collected it; however, developing countries often lack the resources for such a large undertaking. Smaller, published academic studies were most useful in identifying types of foods that may be available in the different locales within a country, at times including minimally processed foods. IFT found that residents in many of the developing countries typically consume minimally processed foods such as bread and cheese, but that they do not frequently consume what are considered processed foods in "Western" society (packaged, prepared foods). Although processed foods may be available, consumption often differs based on income and region in the country. The more affluent and urban areas of countries appear more able to purchase processed foods, and therefore more likely to have a higher consumption rate. A pattern of processed food consumption or lack thereof did not present itself for the various country categories assigned to the 39 countries evaluated. Whether the country has a heavy or high IDD burden or an opportunity to progress did not correlate with the consumption of processed foods in that country. IDD is present in both developed and developing countries, and countries from each of these categories may or may not have processed foods available. Some countries with the heaviest burden for IDD may also have many processed foods available such as China, while another country with high IDD does not appear to have even minimally processed foods readily available. However, the majority of the European countries and Latin American countries identified on the list do have processed foods more readily available than some other countries identified, although not all are prepared with iodized salt. Many of the developing nations reviewed have the highest prevalence for IDD, often due to the high level of food insecurity. IDD is more closely linked to food insecure populations, which are also often low-income and rural populations, who lack access to food, including food that may have been prepared with iodized salt. Some of the developing countries have enacted legislation to combat high rates of IDD and require iodization of all salt to be consumed; however, they also often lack regulatory infrastructure and therefore lack effective methods to monitor and enforce salt iodization. For this reason, it appears that even when legislation and other efforts have been enacted, they are not comprehensively implemented. Future research needs surrounding iodine use in processed foods include the need for nationwide food consumption data and additional food science research. Nationwide food consumption data are most helpful to determine processed food consumption; however, developing countries often lack the resources for such a large undertaking. Nationwide food consumption information can also reveal sources of salt intake in the diet and help to determine vehicle(s) for iodized salt delivery. Food science research determines the amount of iodine that should be added to a product to still meet standards after food processing and time spent on a store or consumer's shelf, and to ensure that iodization does not impact the taste or other qualities of food products. Survey and telephone respondents reported potential challenges when using iodized salt in food products, including: trade barriers; increased costs; lack of resources and technical capability; lack of enforcement; instability of iodine; potential equipment and process overhauls; competing priorities; and consumer misconceptions. Salt suppliers also face challenges when iodizing salt in developing countries, as they may not have the technical capabilities, equipment, or resources to do so. The survey and telephone respondents indicate that food companies are willing to use iodized salt in food products; however, the use of iodized salt in food products may need to be mandated by law and effectively. © 2012 Institute of Food Technologists ®. | Open |
| Wallace A.S.; Ryman T.K.; Dietz V. | Experiences integrating delivery of maternal and child health services with childhood immunization programs: Systematic review update | 2012 | Journal of Infectious Diseases | Background. The World Health Organization and the United Nations Children's Fund promote integration of maternal and child health (MCH) and immunization services as a strategy to strengthen immunization programs. We updated our previous review of integrated programs and reviewed reports of integration of MCH services with immunization programs at the service delivery level. Methods. Published and unpublished reports of interventions integrating MCH and immunization service delivery were reviewed by searching journal databases and Web sites and by contacting organizations.Results.Among 27 integrated activities, interventions included hearing screening, human immunodeficiency virus services, vitamin A supplementation, deworming tablet administration, malaria treatment, bednet distribution, family planning, growth monitoring, and health education. When reported, linked intervention coverage increased, though not to the level of the corresponding immunization coverage in all cases. Logistical difficulties, time-intensive interventions ill suited for campaign delivery, concern for harming existing services, inadequate overlap of target age groups, and low immunization coverage were identified as challenges. Conclusions. Results of this review reinforce our 2005 review findings, including importance of intervention compatibility and focus on immunization program strength. Ensuring proper planning and awareness of compatibility of service delivery requirements were found to be important. The review revealed gaps in information about costs, comparison to vertical delivery, and impact on all integrated interventions that future studies should aim to address. © 2012 The Author. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. | Open |
| Abrahams Z.; McHiza Z.; Steyn N.P. | Diet and mortality rates in Sub-Saharan Africa: Stages in the nutrition transition | 2011 | BMC Public Health | Background: During the last century we have seen wide-reaching changes in diet, nutritional status and life expectancy. The change in diet and physical activity patterns has become known as the nutrition transition. At any given time, a country or region within a country may be at different stages within this transition. This paper examines a range of nutrition-related indicators for countries in Sub-Saharan Africa (SSA) and attempts to develop a typical model of a country in transition. Methods. Based on the availability of data, 40 countries in SSA were selected for analysis. Data were obtained from the World Health Organisation, Demographic and Health Surveys and the Food and Agriculture Organisation of the United Nations. Multiple linear regression analysis (MLRA) was used to explore the determinants of infant mortality. A six point score was developed to identify each country's stage in the nutrition transition. Results: MLRA showed that underweight-for-age, protein and the percentage of exclusively breastfed infants were associated with the infant mortality rate (IMR). The majority of countries (n = 26) used in the analysis had nutrition transition scores of zero and one. Most of them had a high prevalence of infant mortality, children that were stunted or underweight-for-age, small percentages of women that were overweight and obese, and low intakes of energy, protein, and fat. Countries with the highest scores include South Africa, Ghana, Gabon, Cape Verde and Senegal which had relatively low IMRs, high levels of obesity/overweight, and low levels of underweight in women, as well as high intakes of energy and fat. These countries display classic signs of a population well established in the nutrition-related non-communicable disease phase of the nutrition transition. Conclusions: Countries in SSA are clearly undergoing a nutrition transition. More than half of them are still in the early stage, while a few have reached a point where changes in dietary patterns are affecting health outcomes in a large portion of the population. Those in the early stage of the transition are especially important, since primordial prevention can still be introduced. © 2011 Abrahams et al; licensee BioMed Central Ltd. | Open |
| Addo A.A.; Marquis G.S.; Lartey A.A.; Pérez-Escamilla R.; Mazur R.E.; Harding K.B. | Food insecurity and perceived stress but not HIV infection are independently associated with lower energy intakes among lactating Ghanaian women | 2011 | Maternal and Child Nutrition | Human immunodeficiency virus (HIV) seropositive women living in low-income communities may have difficulty meeting the increased energy requirements that are associated with both lactation and HIV infection. Data on household food security and maternal socio-demographic characteristics, perceived stress, anthropometry, reported illness, dietary intakes and preferences, and exposure to nutrition education were collected from 70 lactating women [16 seropositive (HP), 27 seronegative (HN), and 27 who refused to be tested and had unknown HIV status (HU)]. Diet was assessed with three 24-h recalls (one market day, one weekend day, and one non-market weekday). Data were collected at 8.4 (SD = 4.7) months postpartum. Most women (74.3%) reported being in good health at the time of study. Three-day mean energy intakes did not differ by HIV status [HP: 12 000 kJ (SD = 3600), HN: 12 600 kJ (SD = 5100), and HU: 12 300 kJ (SD = 4800); P = 0.94]. Protein, fat, vitamin A, thiamin, riboflavin, niacin, vitamin C, calcium, iron, and zinc intakes also did not differ by group (P > 0.10). There was a higher proportion of women with high stress levels in food insecure households compared with food secure households (55.6% vs. 26.5%; P = 0.01). Energy intake was independently negatively associated with food insecurity [high: 11 300 kJ (SD = 3500) vs. low: 13 400 kJ (SD = 5400), respectively; P = 0.050] and stress [high: 10 800 kJ (SD = 2800) vs. low: 13 400 kJ (SD = 5300), P = 0.021]. These results suggest the need to integrate multi-dimensional interventions that address economic and mental health constraints which may limit some women's ability to meet their dietary needs. © 2010 Blackwell Publishing Ltd. | Open |
| Adotey D.K.; Stibilj V.; Serfor-Armah Y.; Nyarko B.J.B.; Jaćimović R. | Dietary supply of selenium for adolescents in three residential care orphanages in Southern Ghana | 2011 | Science of the Total Environment | Adolescents require optimum dietary supply of the essential trace mineral selenium (Se); however the absence of reliable and accurate data on the dietary supply of selenium for the adolescent population in Ghanaian residential care orphanages have made it difficult for public health nutritionists to assess the adequacy of the dietary supply. The dietary supply of selenium for adolescents (12-15years) in three residential care orphanages, (Osu, Tutu-Akwapim and Teshie), in Southern Ghana have been evaluated by sampling their 24-h duplicate diets (including water) for 7-consecutive days using the duplicate diet sampling technique. The mass fraction of selenium in the blended lyophilized homogenates of duplicate diets was determined by radiochemical neutron activation analysis (RNAA). The validity of the RNAA method for selenium determination was checked by analyses of NIST SRM 1548a (Typical diet). The chemical yield of the radiochemical separation was determined by spectrophotometry. The average mass fractions of selenium in the blended lyophilized 24-hour duplicate diets for Osu, Tutu-Akwapim and Teshie were; 165±61 [117.2-285.2], 203±68 [110.5-304.9] and 250±92 [128.8-408.0]ng Seg -1 lyophilized matter respectively. The average dietary supply of Se were, 57.6±17.3 [42.2-88.4], 82.0±30.7 [44.3-136.2] and 91.7±44.2 [46.0-153.4]μg Seday -1 for Osu, Tutu-Akwapim and Teshie orphanages respectively. The data generated will help public health nutritionists in the provision of dietary advice and nutritional support for the studied orphanages, as well as other orphanages. The data will also help in the planning of institutional diets. © 2011 Elsevier B.V. | Open |
| Adu-Afarwuah S.; Lartey A.; Zeilani M.; Dewey K.G. | Acceptability of lipid-based nutrient supplements (LNS) among Ghanaian infants and pregnant or lactating women | 2011 | Maternal and Child Nutrition | Inadequate micronutrient intake during pregnancy, lactation and infancy is a major problem in many developing countries. Lipid-based nutrient supplements (LNS) can improve micronutrient status, growth and development of infants, and also have potential to improve nutritional status of pregnant and lactating women. The objective of the study was to test the acceptability of LNS designed for infants (LNS-20gM) and pregnant or lactating women (LNS-P&L). Participants were infants (n=22, mean age=8 months) and pregnant or lactating women (n=24) attending routine services at a hospital in Ghana. Infants consumed 45g of a test meal consisting of one part LNS-20gM and three parts fermented maize porridge, while women consumed 50g of a similar test meal containing LNS-P&L instead. Participants also used their respective LNS at home for 14 days. Primary outcome was the proportion of the test meal consumed. On average, infants consumed 76.2% of the test meal [95% (confidence interval) CI: 65.7, 86.7], while women consumed 87.1% (95% CI: 82.6, 91.6). During the 14-day period, median daily consumption of LNS-20gM was 19.3g, very close to the recommended 20gd -1, while that of LNS-P&L was one sachet, as recommended. We conclude that LNS-20gM and LNS-P&L were well accepted. © 2010 Blackwell Publishing Ltd. | Open |
| Afoakwah A.N.; Owusu W.B. | The relationship between dietary intake, body composition and blood pressure in male adult miners in Ghana | 2011 | Asian Journal of Clinical Nutrition | Unhealthy lifestyle and eating habits have been associated with the increasing prevalence of diet-related non-communicable diseases such as cardiovascular disorders and hypertension. The study was a cross-sectional involving 320 underground male miners in the Obuasi municipality. The research was conducted to generate data on the associations between characteristics of underground miners, their nutrition and blood pressure. Cluster and simple random sampling techniques were used to select the respondents from their residential areas. Independent sample t-test and Spearman's correlation (2 tailed) were used to test the significance of associations between selected continuous variables, while Chi-square test was used to test for significance between categorical variables. Logistic regression was used to determine the extent to which significant variables predicted high blood pressure. Results indicated that apart from vehicle ownership (p = 0.02) and length of working underground (p<0.001). All other socio-economic variables did not indicate any significant association with blood pressure. About 41.6% of the respondents were hypertensive. The prevalence of obesity and overweight cases combined were 62.1%. Potassium intake correlated significantly and positively with systolic (r = 0.11, p = 0.04) and diastolic blood pressure (r = 0.13, p = 0.02). The risk of developing hypertension increased with age, with persons within the age categories of 30-39 years, 40-49 years and 50-59 years had odds ratios of 2.55 (95% CI: 1.12-5.81), 3.34 (95% CI: 1.45-7.68) and 7.56 (95% CI: 2.91-19.84), respectively. Nutrient intake and blood pressure monitoring must be part of the day-to-day programmes of the underground male miners. © 2011 Asian Network for Scientific Information. | Open |
| Ahenkan A.; Boon E. | Improving nutrition and health through non-timber forest products in Ghana | 2011 | Journal of Health, Population and Nutrition | Nutrition and health are fundamental pillars of human development across the entire life-span. The potential role of non-timber forest products (NTFPs) in improving nutrition and health and reduction of poverty has been recognized in recent years. NTFPs continue to be an important source of household food security, nutrition, and health. Despite their significant contribution to food security, nutrition, and sustainable livelihoods, these tend to be overlooked by policy-makers. NTFPs have not been accorded adequate attention in development planning and in nutrition-improvement programmes in Ghana. Using exploratory and participatory research methods, this study identified the potentials of NTFPs in improving nutrition and food security in the country. Data collected from the survey were analyzed using the SPSS software (version 16.0). Pearson's correlation (p<0.05) showed that a significant association exists between NTFPs and household food security, nutrition, and income among the populations of Bibiani-Bekwai and Sefwi Wiawso districts in the western region of Ghana. NTFPs contributed significantly to nutrition and health of the poor in the two districts, especially during the lean seasons. The results of the survey also indicated that 90% of the sampled population used plant medicine to cure various ailments, including malaria, typhoid, fever, diarrhoea, arthritis, rheumatism, and snake-bite. However, a number of factors, including policy vacuum, increased overharvesting of NTFPs, destruction of natural habitats, bushfires, poor farming practices, population growth, and market demand, are hindering the use and development of NTFPs in Ghana. The study also provides relevant information that policy-makers and development actors require for improving nutrition and health in Ghana. © International Centre for Diarrhoeal Disease Research, Bangladesh. | Open |
| Belane A.K.; Dakora F.D. | Levels of nutritionally-important trace elements and macronutrients in edible leaves and grain of 27 nodulated cowpea (Vigna unguiculata L. Walp.) genotypes grown in the Upper West Region of Ghana | 2011 | Food Chemistry | Analysis of edible leaves and grain of 27 nodulated cowpea genotypes in 2005 and 2006 revealed differences in mineral density. Cowpea genotype IT82D-889 exhibited high concentrations of P, K, Ca, Mg and S in grain relative to Brown Eye, IT84S-2246 and TVx3236. Fe concentration in cowpea grain ranged from 63. mg/kg in Ngonji to 137. mg/kg in Soronko, while Zn was 44. mg/kg in Ngonji and 65. mg/kg in Vuli-1. Leaf concentrations of Cu, Mn, B and Fe were consistently higher in the genotypes Apagbaala, IT84S-2246, Fahari and IT97K-499-39, while Fe, Cu, B and Zn were lower in TVu11424, Brown Eye, Vuli-1, Soronko and Glenda. Compared with spinach, cowpea leaves had greater levels of Fe (5-fold in magnitude), Mn, P, Ca, K and Mg. Based on these data it is likely that when and where the dietary intake of cowpea leaves is high in Africa, children would suffer less from micronutrient deficiency. © 2010 Elsevier Ltd. | Open |
| Karamba W.R.; Quiñones E.J.; Winters P. | Migration and food consumption patterns in Ghana | 2011 | Food Policy | This paper examines the link between migration and food consumption patterns in Ghana, which has a history of widespread migration and high levels of poverty. Data from 4130 households from the nationally representative 2005/2006 Ghana Living Standards Survey are used for the analysis. Since migrants self-select into migration, an instrumental variable approach is taken to analyze the relationship between migration and total food expenditures per capita, food expenditures across a range of food categories and shares of food expenditures across these categories. Overall, the results indicate that migration does not substantially affect total food expenditures per capita, and has minimal noticeable effect on food expenditure patterns. Looking at results in different settings, the analysis indicates that only in high migration regions does migration appear to increase overall food expenditures resulting in a shift towards the consumption of potentially less nutritious categories of food, such as sugar and beverages and eating out of the home. The results raise questions about the value of migration for improving the food consumption of migrant sending households. © 2010 Elsevier Ltd. | Open |
| Michaelsen K.F.; Dewey K.G.; Perez-Exposito A.B.; Nurhasan M.; Lauritzen L.; Roos N. | Food sources and intake of n-6 and n-3 fatty acids in low-income countries with emphasis on infants, young children (6-24 months), and pregnant and lactating women | 2011 | Maternal and Child Nutrition | With increasing interest in the potential effects of n-6 and n-3 fatty acids in early life, there is a need for data on the dietary intake of polyunsaturated fatty acids (PUFA) in low-income countries. This review compiles information on the content in breast milk and in foods that are important in the diets of low-income countries from the few studies available. We also estimate the availability of fat and fatty acids in 13 low-income and middle-income countries based on national food balance sheets from the United Nations' Food and Agriculture Organization Statistical Database (FOASTAT). Breast milk docosahexaenoic acid content is very low in populations living mainly on a plant-based diet, but higher in fish-eating countries. Per capita supply of fat and n-3 fatty acids increases markedly with increasing gross domestic product (GDP). In most of the 13 countries, 70-80% of the supply of PUFA comes from cereals and vegetable oils, some of which have very low α-linolenic acid (ALA) content. The total n-3 fatty acid supply is below or close to the lower end of the recommended intake range [0.4%E (percentage of energy supply)] for infants and young children, and below the minimum recommended level (0.5%E) for pregnant and lactating women in the nine countries with the lowest GDP. Fish is important as a source of long-chain n-3 fatty acids, but intake is low in many countries. The supply of n-3 fatty acids can be increased by using vegetable oils with higher ALA content (e.g. soybean or rapeseed oil) and by increasing fish production (e.g. through fish farming). © 2011 Blackwell Publishing Ltd. | Open |
| Pelto G.H.; Armar-Klemesu M. | Balancing nurturance, cost and time: Complementary feeding in Accra, Ghana | 2011 | Maternal and Child Nutrition | This paper presents a picture of the general patterns of complementary feeding behaviours in urban Ghana. A focused ethnographic study protocol for assessing complementary feeding developed for the Global Alliance for Improved Nutrition was used to collect data from caregivers of children 6-24months of age. We examined the multiple factors that influence the selection of foods for infants and young children in this urban setting, and found that economic factors, health beliefs and other nurturing-related values, access to food and issues of convenience all play important roles. We conclude that the interactions of nurturance, cost and time are vectors that affect feeding decisions. © 2011 Blackwell Publishing Ltd. | Open |
| Saaka M.; Galaa S. | Improving the utilization of health and nutrition services: experience from the Catholic Relief Services supported the Development Assistance Programme in Ghana. | 2011 | Primary health care research & development | Low utilization of health and nutrition services is a major setback to the attainment of ultimate health of many populations in developing countries including Ghana. Primary health care (PHC) forms the basis for the provision of good quality and sustainable health care and making it accessible to the majority of the population. In line with this, the Catholic Relief Services spearheaded a Development Assistance Programme for the 2004-08 financial year in the northern sector of Ghana. The primary beneficiaries were children in their early years and pregnant and lactating women. The main aim of the evaluation was to assess the extent to which the programme objectives were achieved. This paper highlights the innovative processes used to improve access to and utilization of key health and nutrition services and their impact on the health of children and women. A pre-test/post-test design involving two cross-sectional surveys at baseline and follow-up surveys were used to determine the outcome/impact of the programme. The study findings show that the programme reduced chronic malnutrition by 1.5 percentage points/year in participating communities. The programme also empowered individuals and communities to adopt positive health behaviours (empowerment defined here as the ability to act in one's own interest). Furthermore, the programme provided facilities and logistics, which increased access to health and nutrition services, improved the quality of health services and strengthened the institutional capacity of District Health Management teams to plan for and manage health activities. The programme showed improvement over time in terms of health-seeking behaviours, practices and coverage of health and nutrition services from the baseline levels. If similar programme activities are put in place, the nutrition-related millennium development goals are most likely to be met. | Open |
| Svedberg P. | How many people are malnourished? | 2011 | Annual Review of Nutrition | The present article reviews the strengths and weaknesses of the three main methods for estimating the prevalence of malnutrition in populations: self-reported hunger, estimates based on food supplies, and anthropometrics. Although far from flawless, anthropometrics is found to be the most reliable method and also the most useful for directing policy. The main form of malnutrition among adults is overweight, not only in developed countries, but also in almost all developing countries. Only in a few developing countries is adult underweight more prevalent. By the conventional anthropometric indicators, about one-quarter of all children below the age of 5 in the developing countries are stunted or underweight, and about 10% are wasted. The total burden of malnutrition among young children, as measured by the Composite Index of Anthropometric Failure, is considerably higher, about 60% in India, the country with the largest child population in the world. Copyright © 2011 by Annual Reviews. All rights reserved. | Open |
| Uduku O. | School building design for feeding programmes and community outreach: Insights from Ghana and South Africa | 2011 | International Journal of Educational Development | This article investigates how school building design can support primary school feeding programmes in low- and middle-income countries. Furthermore it argues for schools to become community "development hubs" ; incorporating both local access to education and also to programmes for nutrition, ICT, health education and other services, outside of school hours. It reviews the literature on school feeding programmes. Data from field research on schools in Ghana and South Africa is used to identify the key design issues for schools delivering feeding programmes. It considers how national education policies can affect school planning and building priorities. The article concludes by calling for the evolution of a new school design model, in which the school site becomes a "development hub", supporting children" education, associated support activities including school feeding, and importantly also, integrated community development outreach activities. © 2010 Elsevier Ltd. | Open |
| Whitty C.; Kinn S. | Foreword: Lesson learning about getting research into policy and practice | 2011 | Health Research Policy and Systems | The UK Department for International Development (DFID) is committed to investing in research to combat poverty, reduce high mortality and morbidity in resource poor contexts and support progress towards meeting the Millennium Development Goals. Research helps us to identify what works, what does not work and how to understand the local context when introducing new ways of working. There is no point doing research if the findings do not get into policy and practice. DFID strongly encourages all research programmes to consider research uptake activities as an integral part of the research.This special supplement draws on the work of the Sexual Health HIV Evidence into Practice (SHHEP) initiative. SHHEP is a collaboration across four DFID Research Programme Consortia (RPC) that undertake research and action on HIV and Sexual and Reproductive Health in resource poor contexts. Each consortium consists of 5 or more research, advocacy or service provider institutions from the south and the north working together over a five year period on critical areas of sexual and reproductive health. The essence of SHHEP is to share learning on research uptake and research engagement in Sexual and Reproductive Health, including HIV. The group has formulated a range of targeted mechanisms to communicate health research to different audiences and spearhead change, and were finalists for the British Medical Journal 2010 Getting Research into Practice (GRiP) prize.The papers in this special supplement focus on lesson learning on getting research into policy and practice. They highlight the range of methodologies and approaches researchers and communication specialists have used in different contexts to try to ensure research does not simply gather dust on library shelves but feeds into and is relevant to policy and practice in different contexts (for example South Africa, Swaziland, Tanzania, Uganda, Malawi, Ghana, Bangladesh) and on a diversity of topic areas (Gender based violence, sexualities, orphans and vulnerable children, HIV care and treatment including male circumcision, cotrimoxazole and links with nutrition)The work reported in this supplement provides examples of approaches that have been tried and from which other researchers can learn. They demonstrate that getting research into policy and practice is complex, dynamic and multi-faceted; and a wide range of context and issue specific conceptual and practical approaches have to be used. I hope that the innovative approaches and promising ways forward, presented in these papers, will inspire and motivate others.© 2011 Whitty and Kinn; licensee BioMed Central Ltd. | Open |
| Berti P.R.; Mildon A.; Siekmans K.; Main B.; MacDonald C. | An adequacy evaluation of a 10-year, four-country nutrition and health programme | 2010 | International Journal of Epidemiology | Background: Evaluations of large-scale health and nutrition programmes in developing countries are needed for determining the effectiveness of interventions. This article critically analyses a non-governmental organization (NGO)-led large-scale, multi-country, 10-year micronutrient and health (MICAH) programme with an 'adequacy evaluation', that is, a documentation of time trends in the expected direction. Methods: MICAH was implemented from 1996 to 2005 in selected areas of Ethiopia, Ghana, Malawi and Tanzania, reaching>6 million people with numerous health and nutrition interventions. Coverage and impact were monitored through surveys at baseline, midpoint and end of funding. The data were subjected to post-hoc methods of quality determination, and, if of suitable quality, included in the adequacy evaluation. Results: Most collected data were of moderate or high quality and therefore included in the adequacy evaluation. There were moderate to large improvements in vitamin A status in Ethiopian school-age children, children <5 years of age in Tanzania and Ghana and mothers in Ghana. Iodine status improved in Malawi and Tanzania. Anaemia rates and malaria prevalence decreased in women, pregnant women and pre-school children in Ghana, Malawi and Tanzania, but anaemia increased in Ethiopian women. Large increases were reported for rates of exclusive breastfeeding and immunization. Child growth improved to the maximum that would be predicted with the given interventions. Conclusions: Numerous nutrition and health impacts were observed in the intervention areas, often of a magnitude equal to or larger than observed in controlled interventions or trials. These results show the value of integrated long-term interventions. © Published by Oxford University Press on behalf of the International Epidemiological Association. The Author 2010; all rights reserved. | Open |
| Bosu W.K. | Epidemic of hypertension in Ghana: A systematic review | 2010 | BMC Public Health | Background. Hypertension is a major risk factor for many cardiovascular diseases in developing countries. A comprehensive review of the prevalence of hypertension provides crucial information for the evaluation and implementation of appropriate programmes. Methods. The PubMed and Google Scholar databases were searched for published articles on the population-based prevalence of adult hypertension in Ghana between 1970 and August 2009, supplemented by a manual search of retrieved references. Fifteen unique population-based articles in non-pregnant humans were obtained. In addition, two relevant unpublished graduate student theses from one university department were identified after a search of its 1996-2008 theses. Results. The age and sex composition of study populations, sampling strategy, measurement of blood pressure, definition of hypertension varied between studies. The prevalence of hypertension (BP 140/90 mmHg antihypertensive treatment) ranged from 19% to 48% between studies. Sex differences were generally minimal whereas urban populations tended to have higher prevalence than rural population in studies with mixed population types. Factors independently associated with hypertension included older age group, over-nutrition and alcohol consumption. Whereas there was a trend towards improved awareness, treatment and control between 1972 and 2005, less than one-third of hypertensive subjects were aware they had hypertension and less than one-tenth had their blood pressures controlled in most studies. Conclusion. Hypertension is clearly an important public health problem in Ghana, even in the poorest rural communities. Emerging opportunities such as the national health insurance scheme, a new health policy emphasising health promotion and healthier lifestyles and effective treatment should help prevent and control hypertension. © 2010 Bosu. | Open |
| Crookston B.T.; Alder S.C.; Boakye I.; Merrill R.M.; Amuasi J.H.; Porucznik C.A.; Stanford J.B.; Dickerson T.T.; Dearden K.A.; Hale D.C.; Sylverken J.; Snow B.S.; Osei-Akoto A.; Ansong D. | Exploring the relationship between chronic undernutrition and asymptomatic malaria in Ghanaian children | 2010 | Malaria Journal | Background. A moderate association has been found between asymptomatic parasitaemia and undernutrition. However, additional investigation using the gold standard for asymptomatic parasitaemia confirmation, polymerase chain reaction (PCR), is needed to validate this association. Anthropometric measurements and blood samples from children less than five years of age in a rural Ghanaian community were used to determine if an association exists between chronic undernutrition and PCR-confirmed cases of asymptomatic malaria. Methods. This was a descriptive cross-sectional study of 214 children less than five years of age from a community near Kumasi, Ghana. Blood samples and anthropometric measurements from these children were collected during physical examinations conducted in January 2007 by partners of the Barekuma Collaborative Community Development Programme. Results. Findings from the logistic model predicting the odds of asymptomatic malaria indicate that children who experienced mild, moderate or severe stunting were not more likely to have asymptomatic malaria than children who were not stunted. Children experiencing anaemia had an increased likelihood (OR = 4.15; 95% CI: 1.92, 8.98) of asymptomatic malaria. Similarly, increased spleen size, which was measured by ultrasound, was also associated with asymptomatic malaria (OR = 2.17; 95% CI: 1.44, 3.28). Fast breathing, sex of the child, and age of the child were not significantly associated with the asymptomatic malaria. Conclusions. No significant association between chronic undernutrition and presence of asymptomatic malaria was found. Children who experience anaemia and children who have splenomegaly are more likely to present asymptomatic malaria. Programmes aimed at addressing malaria should continue to include nutritional components, especially components that address anaemia. © 2010 Crookston et al; licensee BioMed Central Ltd. | Open |
| Ghosh S.; Smriga M.; Vuvor F.; Suri D.; Mohammed H.; Armah S.M.; Scrimshaw N.S. | Effect of lysine supplementation on health and morbidity in subjects belonging to poor peri-urban households in Accra, Ghana | 2010 | American Journal of Clinical Nutrition | Background: Lysine affects diarrhea and anxiety via effects on serotonin receptors, enhanced intestinal repair, and sodium chloride-dependent opioid peptide transport. Objective: The objective was to investigate the effects of lysine supplementation on morbidity, growth, and anxiety in children and adults of peri-urban areas of Accra, Ghana. Design: In a double-blind randomized trial, the effect of lysine supplementation (1 g lysine/d) compared with that of placebo was examined in 2 groups of men, women, and children (n = 271). Primary outcomes included diarrheal and respiratory morbidity, growth, and anxiety and complement C3, C-reactive protein, serum cortisol, transferrin, and ferritin values. Independent-sample t tests, odds ratios, generalized estimating equations, 4-parameter sinusoid regression, and generalized linear models were used. Results: Thirty percent of men, 50% of women, and 15% of children were at risk of lysine inadequacy. Supplementation in children reduced diarrheal episodes [19 lysine, 35 placebo; odds ratio (OR): 0.52; 95% CI: 0.29, 0.92; P = 0.046] and the total number of days ill (21 lysine, 47 placebo; OR: 0.44; 95% CI: 0.26, 0.74; P = 0.034). Mean days ill per child per week (0.058 6 0.039 lysine, 0.132 ± 0.063 placebo; P = 0.017) were negatively associated with weight gain with control for baseline weight and study group (P = 0.04). Men had fewer coryza episodes (23 lysine, 39 placebo; OR: 0.60; 95% CI: 0.36, 1.01; P = 0.05), total number of days ill (lysine: 130; placebo: 266; OR: 0.51; 95% CI: 0.28, 0.93; P = 0.03), and mean days ill per person per week (lysine: 0.21 ± 0.23; placebo: 0.41 ± 0.35; P = 0.04). Serum ferritin (P = 0.045) and C-reactive protein (P = 0.018) decreased in lysine-supplemented women but increased in placebo-supplemented women. Conclusion: Lysine supplementation reduced diarrheal morbidity in children and respiratory morbidity in men in Ghana. © 2010 American Society for Nutrition. | Open |
| Newton S.; Filteau S.; Owusu-Agyei S.; Ampofo W.; Kirkwood B.R. | Seroprotection associated with infant vitamin A supplementation given with vaccines is not related to antibody affinity to Hepatitis B and Haemophilus influenzae type b vaccines | 2010 | Vaccine | Vaccines are usually assessed by analyses of their safety and immunogenicity to determine the effectiveness of eliciting antibody responses against target organisms. However, it is equally important to establish antibody affinity because of its specific role in protection from infection. Antibody affinity can be determined by comparisons of various antibody concentrations in dose-response curves. During a study on the immunogenicity of a pentavalent vaccine in 888 infants, antibody affinity analyses of the hepatitis B and Haemophilus influenzae type b components were investigated in infants given 15. mg RE vitamin A with their vaccination and those who were not given vitamin A. In this paper we present the results of 222 infants; a 25% sub-sample of the original study. Analyses were carried out using dilutions of serum samples from fitted values corresponding to optical densities from antibody detection assays. These were obtained from the ligand binding equation and mid point titres in dose-response curves were then calculated. Vitamin A supplementation had no effect on the midpoint titres of Hepatitis B and H. influenzae type b vaccine derived antibodies. The significant effect of vitamin A supplementation on the Hepatitis B vaccine component observed in a previous seroprotection analysis is probably due to the amount of antibodies since affinity was unaffected. © 2010 Elsevier Ltd. | Open |
| Opintan J.A.; Newman M.J.; Ayeh-Kumi P.F.; Affrim R.; Gepi-Attee R.; Sevilleja J.E.A.D.; Roche J.K.; Nataro J.P.; Warren C.A.; Guerrant R.L. | Pediatric diarrhea in Southern Ghana: Etiology and association with intestinal inflammation and malnutrition | 2010 | American Journal of Tropical Medicine and Hygiene | Diarrhea is a major public health problem that affects the development of children. Anthropometric data were collected from 274 children with ( N = 170) and without ( N = 104) diarrhea. Stool specimens were analyzed by conventional culture, polymerase chain reaction for enteroaggregative Escherichia coli (EAEC), Shigella, Cryptosporidium, Entamoeba, and Giardia species, and by enzyme-linked immunosorbent assay for fecal lactoferrin levels. About 50% of the study population was mildly to severely malnourished. Fecal lactoferrin levels were higher in children with diarrhea ( P = 0.019). Children who had EAEC infection, with or without diarrhea, had high mean lactoferrin levels regardless of nutritional status. The EAEC and Cryptosporidium were associated with diarrhea ( P = 0.048 and 0.011, respectively), and malnourished children who had diarrhea were often co-infected with both Cryptosporidium and EAEC. In conclusion, the use of DNA-biomarkers revealed that EAEC and Cryptosporidium were common intestinal pathogens in Accra, and that elevated lactoferrin was associated with diarrhea in this group of children. Copyright © 2010 by The American Society of Tropical Medicine and Hygiene. | Open |
| Otoo G.E.; Marquis G.S.; Sellen D.W.; Chapman D.J.; Pérez-Escamilla R. | HIV-negative status is associated with very early onset of lactation among ghanaian women | 2010 | Journal of Human Lactation | This is a longitudinal cohort study investigating the association between maternal HIV status and the reported onset of lactation. The Research to Improve Infant Nutrition and Growth project recruited 442 mothers from 3 antenatal clinics in the eastern region of Ghana, based on positive, negative, and unknown HIV status. Onset of lactation was assessed by maternal perception and validated with 2 subsamples: measurement of infant breast milk intake (n = 40) and daily infant weight measurement for 2 weeks (n = 150). Multivariate logistic regression was used to identify predictors of very early onset of lactation (onset of lactation < 6 hours). Predictors of very early onset of lactation include HIV-negative status (odds ratio = 2.68; P =.014), multiparity (odds ratio = 2.93; P =.009), vaginal delivery (odds ratio = 2.55; P =.035), and having a male child (odds ratio = 1.86; P =.032). The findings indicate an association between maternal HIV status and very early onset of lactation. © 2010 International Lactation Consultant Association. | Open |
| Pepping F. | The current capacity for training in public health nutrition in West Africa | 2010 | Global Public Health | This article is based on a paper prepared for the Workshop on Establishing a Regional Institute for Public Health Nutrition Research and Training in West Africa, convened in Dakar, Senegal, 26-28 March, 2009. Information was gathered mainly prior to this workshop; several responses, however, came in after the workshop and these have been included in the current paper. In completion of the article use was made of the views and opinions as expressed during this workshop. Objectives were to provide background information on academic programmes (undergraduate and graduate) and research institutions with a focus on human nutrition in West Africa, to describe the importance of foreign nutrition training programmes for West African students and to detail existing nutrition training activities currently in the region. Data were obtained from a survey of 15 UNICEF country offices in the West African region, previously published reports, United Nations University/International Union of Nutrition Sciences capacity development activities 1996-2009, personal communications and websites of relevant African institutions. Results indicate that West African nutrition academic programmes and research institutes do not adequately meet the demand for nutritionists and technical services in the region. Exceptions seem to be Benin, Ghana and Nigeria. Diploma courses and other short courses have been an important means of attracting people from a variety of disciplines to nutrition. A well-equipped regional institute could directly and indirectly bolster nutrition capacity in the region. To meet the regional nutrition research and training needs in West Africa, it is not necessary to make a choice between creating a new regional institution vs. expanding existing national institutions. Based on solid capacity development principles, both options need action. © 2010 Taylor & Francis. | Open |
| Sadik A. | Orphanage children in Ghana: Are their dietary needs met? | 2010 | Pakistan Journal of Nutrition | Nourishing the body is a basic human right. The literature argued that children are born with the potential to develop both physically and emotionally. However, socioeconomic and environmental factors affect the health and nutrition of many children in developing countries. Little research has been done on the dietary needs of children living in orphanages in Ghana. The main objective of the study was to determine the nutritional status, food consumption patterns and dietary intake of the orphanage children. A non- experimental, descriptive action research with a multi-methodological approach was used. This study was conducted in an orphanage in Tamale. Forty children, 22 boys and 18 girls, aged 2-18 years and 23 orphanage workers formed the sample. Methods included on site observation, completion of a standard demographic questionnaire, a validated quantitative food frequency questionnaire and anthropometric measurements. The nutritional status indicated that, 10% and 15% of the children were severely stunted and wasted respectively (≤-2) Z score. The dietary intake data showed energy intakes for the children aged 1-3 years as 963 kcal, 7-10 years as 1627.4 kcal and 11-14 years as 1547.53 kcal and 15-18 years as 1540.6 kcal. Protein intake for the same age groups was 33, 52.1, 50.6 and 49.3 g respectively, with fat 27 g, 33.9 g, 31.9 g, 31.9 g and carbohydrate 150 g, 284.3 g, 269.1 g and 296.1 g respectively. The top five most frequently consumed foods were coffee (232 ml) and tea (232 ml), maize meal (109 g), bread (77 g), white rice (55 g). Protein was limited with anchovies ("Keta schoolboys") and beans as the only source. Orphanage children are vulnerable and disadvantaged members of the community, especially if measures to provide adequate dietary intakes in terms of macro-and micronutrient are not in place. The findings indicated low intake of both macro-and micronutrients with the exception of protein. Nutritional status indicated that, 10% and 15% of the children were severely stunted and wasted respectively (≤-2) Z score. The results of this study formed the basis for a nutrition education and training programme that was implemented in the orphanage. © Asian Network for Scientific Information, 2010. | Open |
| Samarasekera U. | Regina Obeng—dedicated to improving newborn health in Ghana | 2010 | The Lancet | Not Available | Open |
| Vesel L.; Bahl R.; Martines J.; Penny M.; Bhandari N.; Kirkwoodd B.R.; Arthur P.; Morris S.; Amenga-Etego S.; Zandoh C.; Boahen O.; Bhandari N.; Bhan M.K.; Wahed M.A.; Lanata C.F.; Butron B.; Huapaya A.R.; Rivera K.B.; Moulton L.H.; Ram M.; Kjolhede C.L.; Propper L.; Underwood B. | Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality | 2010 | Bulletin of the World Health Organization | Objective: To compare the estimated prevalence of malnutrition using the World Health Organization's (WHO) child growth standards versus the National Center for Health Statistics' (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy. Methods: A secondary analysis of data on 9424 mother-infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants' weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards. Findings: The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6-12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6-12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%). Conclusion: Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life. | Open |
| Yakoob M.Y.; Khan Y.P.; Bhutta Z.A. | Maternal mineral and vitamin supplementation in pregnancy | 2010 | Expert Review of Obstetrics and Gynecology | Deficiency of vitamins and minerals, collectively known as micronutrients, during pregnancy can have important adverse effects on maternal and birth outcomes. Evidence-based nutrition interventions can make a difference and potentially avert these outcomes. Iron supplementation has been shown to improve maternal mean hemoglobin concentration at term and reduce the risk of anemia. Zinc supplementation has been shown to result in a small but significant reduction in preterm births. A cluster-randomized study in Nepal showed a 40% reduction in maternal mortality up to 12 weeks postpartum with weekly vitamin A and 49% biweekly-carotene supplementation but subsequent large studies in Bangladesh and Ghana have failed to demonstrate any impact on mortality. Maternal vitamin A supplementation has no role in preventing mother-to-child transmission of HIV in HIV-infected pregnant women. Periconceptional folic acid supplementation reduces the risk of neural tube defects, while supplementation with vitamin D reduces the incidence of neonatal hypocalcemia with no impact on craniotabes. Iodine supplementation during pregnancy has also been suggested to reduce the risk of perinatal and infant mortality, and the risk of endemic cretinism at 4 years of age. Calcium supplementation reduced the risk of preeclampsia in women with low baseline calcium dietary intake, while magnesium supplementation has been associated with a lower frequency of preterm births and adverse neurodevelopmental outcomes in childhood. Other vitamins and minerals, such as vitamins B, C and E, copper and selenium, have been associated with fetal development, but their impact on pregnancy outcomes is not clear. Given such widespread maternal vitamin and mineral deficiencies, it is logical to consider supplementation with multiple micronutrient preparations in pregnancy. The clinical benefits of such an approach over single-nutrient supplements are unclear, and this article explores the current concepts, evidence and limitations of maternal multiple-micronutrient supplementation. © 2010 Expert Reviews Ltd. | Open |
| Benn C.S.; Aaby P.; Nielsen J.; Binka F.N.; Ross D.A. | Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial | 2009 | American Journal of Clinical Nutrition | Background: The World Health Organization recommends vitamin A supplementation (VAS) at vaccination contacts after 6 mo of age to reduce mortality. However, it is unknown whether the effect of VAS is independent of vaccinations. One of the original VAS trials from Ghana had collected vaccination information. Objective: We reanalyzed the data to explore the hypothesis that VAS reduces mortality in children who had bacille Calmette-Guérin or measles vaccine as their most recent vaccine but increased mortality when diphtheria-tetanus-pertussis vaccine (DTP) was the most recent vaccine. On the basis of previous studies, we expected the effects to be strongest in girls. Design: At enrollment, children aged 6-90 mo were randomly assigned to receive VAS or placebo every 4 mo for 2 y. Vaccination status was assessed at enrollment and after 1 and 2 y by reviewing the children's health cards. Lack of a health card was presumed to mean that the child had not been vaccinated. Results: VAS had a beneficial effect only in children with no record of vaccination at enrollment (n = 5066); the mortality rate ratio (MRR) was 0.64 (95% CI: 0.47, 0.88) compared with 0.95 (95% CI: 0.72, 1.26) in children with one or more vaccinations (n = 6656). Among vaccinated children, the effect of VAS differed between boys (MRR: 0.74; 95% CI: 0.51, 1.08) and girls (MRR: 1.18; 95% CI: 0.84, 1.67) (P = 0.046 for interaction). VAS had a negative effect in measles-vaccinated girls who were missing one or more doses of DTP at enrollment, a group who often received DTP during follow-up (MRR: 2.60; 95% CI: 1.41, 4.80). Conclusions: The effect of VAS differed by vaccination status. This is potentially problematic because VAS is provided at vaccination contacts. © 2009 American Society for Nutrition. | Open |
| Danquah I.; Dietz E.; Zanger P.; Reither K.; Ziniel P.; Bienzle U.; Mockenhaupt F.P. | Reduced efficacy of intermittent preventive treatment of malaria in malnourished children | 2009 | Antimicrobial Agents and Chemotherapy | Intermittent preventive treatment in infants with sulfadoxine-pyrimethamine (IPTi-SP) reduces malaria episodes by 20 to 59% across Africa. This protective efficacy, however, may be affected by the high frequency of malnutrition in African infants. We analyzed the impact of malnutrition as defined by anthropometry on the incidence of malaria and on the protective efficacy of IPTi in a cohort of 1,200 children in northern Ghana, where malaria is hyperendemic. These children received IPTi-SP or placebo at 3, 9, and 15 months of age and were monitored until 24 months of age. Malnutrition was present in 32, 40, and 50% of children at ages 3, 9, and 15 months, respectively. It was associated with increased risks of severe anemia and death but not an increased risk of malaria. Although malaria slightly contributed to chronic malnutrition, IPTi did not substantially improve child growth. Importantly, the protective efficacies of IPTi in malnourished children were roughly half or even less of those observed in nonmalnourished children. In the first year of life, IPTi reduced the incidence of malaria to a significantly lesser extent in infants who received both doses in a malnourished condition (25%; 95% confidence interval [CI], -7 to 48%) compared to that of nonmalnourished children (46%; 95% CI, 30 to 58%; P = 0.049). Moreover, in contrast to nutritionally advantaged children, the rate of severe malaria appeared to be increased in malnourished children who took IPTi. IPTi might exhibit reduced efficacy in regions of abundant malnutrition. Concomitant nutrition programs may be needed in these places to achieve the desired impact. Copyright © 2009, American Society for Microbiology. All Rights Reserved. | Open |
| Van Eijsden M.; Hornstra G.; Van Der Wal M.F.; Bonsel G.J. | Ethnic differences in early pregnancy maternal n-3 and n-6 fatty acid concentrations: An explorative analysis | 2009 | British Journal of Nutrition | Ethnicity-related differences in maternal n-3 and n-6 fatty acid status may be relevant to ethnic disparities in birth outcomes observed worldwide. The present study explored differences in early pregnancy n-3 and n-6 fatty acid composition of maternal plasma phospholipids between Dutch and ethnic minority pregnant women in Amsterdam, the Netherlands, with a focus on the major functional fatty acids EPA (20:5n-3), DHA (22:6n-3), dihomo - linolenic acid (DGLA; 20:3n-6) and arachidonic acid (AA; 20:4n-6). Data were derived from the Amsterdam Born Children and their Development (ABCD) cohort (inclusion January 2003 to March 2004). Compared with Dutch women (n 2443), Surinamese (n 286), Antillean (n 63), Turkish (n 167) and Moroccan (n 241) women had generally lower proportions of n-3 fatty acids (expressed as percentage of total fatty acids) but higher proportions of n-6 fatty acids (general linear model; P<0001). Ghanaian women (n 54) had higher proportions of EPA and DHA, but generally lower proportions of n-6 fatty acids (P<0001). Differences were most pronounced in Turkish and Ghanaian women, who, by means of a simple questionnaire, reported the lowest and highest fish consumption respectively. Adjustment for fish intake, however, hardly attenuated the differences in relative EPA, DHA, DGLA and AA concentrations between the various ethnic groups. Given the limitations of this observational study, further research into the ethnicity-related differences in maternal n-3 and n-6 fatty acid patterns is warranted, particularly to elucidate the explanatory role of fatty acid intake v. metabolic differences. | Open |
| Walker C.L.F.; Black R.E. | Commentary: What is the role of co-morbidity in child mortality? | 2009 | International Journal of Epidemiology | Not Available | Open |
| Yang Z.; Lönnerdal B.; Adu-Afarwuah S.; Brown K.H.; Chaparro C.M.; Cohen R.J.; Domellöf M.; Hernell O.; Lartey A.; Dewey K.G. | Prevalence and predictors of iron deficiency in fully breastfed infants at 6 mo of age: Comparison of data from 6 studies | 2009 | American Journal of Clinical Nutrition | Background: Iron deficiency (ID) can occur among exclusively breastfed infants before 6 mo of age. Objective: The objective was to determine which subgroups of fully breastfed infants are at highest risk of ID. Design: We assessed the prevalence of ID (ferritin < 12 μg/L) and iron deficiency anemia (IDA; ferritin < 12 μg/L and hemoglobin , 105 g/L) and risk factors associated with ID and IDA at 6 mo among 404 fully breastfed infants with a birth weight >2500 g from 6 studies in Ghana, Honduras, Mexico, and Sweden. Infants with an elevated C-reactive protein concentration (8%) were excluded. Results: The percentages of infants with ID were 6% in Sweden, 17% in Mexico, 13-25% in Honduras, and 12-37% in Ghana. The percentages with IDAwere 2% in Sweden, 4% in Mexico, 5-11% in Honduras, and 8-16% in Ghana. With data pooled, the key predictors of ID (20%) were male sex [adjusted odds ratio (AOR): 4.6; 95% CI: 2.5, 8.5] and birth weight 2500-2999 g (AOR: 2.4; 95% CI: 1.4, 4.3). The predictors of IDA (8%) were male sex (AOR: 7.6; 95% CI: 2.5, 23.0), birth weight of 2500-2999 g (AOR: 3.4; 1.5, 7.5), and weight gain above the median since birth (AOR: 3.4; 95% CI: 1.3, 8.6). The combination of birth weight 2500-2999 g or male sex had a sensitivity of 91% for identifying ID and of 97% for identifying IDA. Conclusions: Among fully breastfed infants with a birth weight>2500 g, IDA is uncommon before 6 mo, but male infants and those with a birth weight of 2500-2999 g are at higher risk of ID and IDA. © 2009 American Society for Nutrition. | Open |
| Adeyinka T.; Ajibola F.; Oyesoji A.; Adedeji T. | A hospital-based assessment of breast-feeding behaviour and practices among nursing mothers in Nigeria and Ghana | 2008 | Pakistan Journal of Nutrition | Exclusive breast-feeding is recommended for infant nutrition during the first 6 months afte birth. Worst still, this behaviour practices have not yet improved in Africa despite this recommendation. This study therefore, examines breast-feeding behaviour and practices among nursing mothers in two African countries: Nigeria and Ghana. A sample of 300 nursing mothers attending ante-natal clinic was randomly drawn from 4 hospitals, two in Nigeria and two in Ghana. The demographic characteristics of the respondents show that their age range between 19 - 51 years with a mean of 35 years and standard deviation of 22.6 years. A modified self-report questionnaire assessing breast-feeding attitudes, intentions and support was used for the collection of data. The reliability co-efficient yielded r = 0.82 after modification. Four research questions were raised to guide the study. The results indicate that nursing mothers do not breast-feed based on personal frustration and painful experience, fear of loosing weight, nature of job, lack of confidence in breast-feeding, long period of recommended exclusive breast-feeding and the fact that infant may become addicted to the behaviour. The result also reveal that nursing mothers may continue exclusive breast-feeding when decided to do so through the provision of social support, modeling, public enlightenment and appointment of care nursing mother. While at the same time, it was shown that there is significant difference in breast-feeding behaviour of mothers based on their occupations and of course no difference exists in the breast-feeding behaviour of Nigeria and Ghana nursing mothers. Recommendations based on the findings of the study were highlighted. © Asian Network for Scientific Information, 2008. | Open |
| Adu-Afarwuah S.; Lartey A.; Brown K.H.; Zlotkin S.; Briend A.; Dewey K.G. | Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana | 2008 | American Journal of Clinical Nutrition | Background: Micronutrient deficiencies are common during infancy, and optimal approaches for their prevention need to be identified. Objective: The objective was to compare the efficacy and acceptability of Sprinkles (SP), crushable Nutritabs (NT), and fat-based Nutributter (NB; 108 kcal/d), which provide 6, 16, and 19 vitamins and minerals, respectively, when used for home fortification of complementary foods. Design: Ghanaian infants were randomly assigned to receive SP (n = 105), NT (n = 105), or NB (n = 103) daily from 6 to 12 mo of age. We assessed dietary intake, morbidity, and compliance weekly. Hemoglobin and plasma ferritin, TfR, C-reactive protein, and zinc were measured at 6 and 12 mo. We used an exit interview to assess acceptability. A randomly selected control group of infants who received no intervention (NI; n = 96) were assessed at 12 mo. Results: All supplements were well accepted, and the mean percentage of days that supplements were consumed (87%) did not differ between groups. At 12 mo, all 3 intervention groups had significantly higher ferritin and lower TfR concentrations than did the NI control group. Mean (± SD) hemoglobin was significantly higher in NT (112 ± 14 g/L) and NB (114 ± 14 g/L) but not in SP (110 ± 14 g/L) infants than in NI infants (106 ± 14 g/L). The prevalence of iron deficiency anemia was 31% in the NI control group compared with 10% in the intervention groups combined (P < 0.0001). Conclusion: All 3 options for home fortification of complementary foods are effective for reducing the prevalence of iron deficiency in such populations. © 2008 American Society for Nutrition. | Open |
| Anthofer J.; Kroschel J. | Effect of mucuna fallow on succeeding maize nutrition and yield in farmer-managed on-farm trials | 2008 | Biological Agriculture and Horticulture | On 18 farmer-managed fields in the Forest-Savannah Transitional zone of Ghana, the response of unfertilized maize was investigated as influenced by either a previous short season natural fallow or Mucuna pruriens (L.) DC var. utilis (Wright) Burck. Comparative vector diagnosis of three weeks old seedlings revealed that N was limiting maize growth. The previous Mucuna fallow was at least partly able to compensate N while there was a dilution of all the other macronutrients due to an increased uptake in the Mucuna system. Maize yields were on average 51% higher after Mucuna fallow with 2850 kg ha−1 compared with 1880 kg ha−1 after natural fallow, but the variability between farmers' fields was high. Adaptability analysis revealed that the slash-and-mulch leguminous fallow system was most effective at locations of high productivity while the yield difference to the slash-and-burn natural fallow system was small in farming environments with low productivity. It was concluded that M. pruriens var. utilis fallow is not a suitable technology to reclaim degraded land or to restore soil fertility if growth-limiting factors are not eliminated. Low available P levels and later maize planting significantly reduced the yield difference and hence the risk for M. pruriens to be outperformed by the natural fallow system increased up to 41% with lower values of plant available P and later maize planting. Besides individual yield components such as cob number and cob seed weight, plant population at final harvest accounted for 58% of the variation in yield. Nutrient use efficiency improved significantly for all macronutrients except P but the harvest index was significantly lower at 0.40 after Mucuna fallow compared with 0.43 after natural fallow. N supplied by the Mucuna fallow supported a better growth of the succeeding maize crop but only in the beginning of the cropping season. When the yield level a farmer usually experiences with his common practice on a specific field was applied to the regression models of the adaptability analysis it was possible to make site- specific yield predictions for the M. pruriens system. It was concluded that the application of the adaptability analysis and individual risk assessments might serve as valuable tools to give more site-specific recommendations to farmers instead of blanket messages for entire regions. © 2008 Taylor & Francis Group, LLC. | Open |
| Ferguson E.L.; Briend A.; Darmon N. | Can optimal combinations of local foods achieve the nutrient density of the F100 catch-up diet for severe malnutrition? | 2008 | Journal of Pediatric Gastroenterology and Nutrition | OBJECTIVES: F100 is a fortified milk-based food used as a standard therapy for severe malnutrition. Our aim was to assess whether optimal combinations of local foods in Ghana, Bangladesh, and Latin America could achieve the nutrient density levels of F100 and, if that was unachievable, to identify the key limiting nutrients. MATERIALS AND METHODS: In all of the analyses, a published list of population-specific foods (n = 59) and maximum food portions were used. The nutrient densities of individual foods were calculated to identify nutrient-dense foods and potential limiting nutrients. The feasibility of formulating diets that achieved the nutrient density of F100, for each region individually and for all regions combined, was explored by the use of linear programming analysis (4 models), which minimized the total grams of food while respecting model constraints on diet energy and nutrients, phytate:zinc molar ratio, and maximum food portion sizes. RESULTS: For vitamin E, riboflavin, zinc, and copper, fewer than 5 foods achieved the nutrient density of F100. All 4 linear programming model solutions were unfeasible, indicating that in all regions, community-based home-prepared rehabilitation diets for severely malnourished children will not achieve the nutrient densities of F100. In model solutions, the densities of vitamin E, riboflavin, zinc, copper, calcium, thiamin, and niacin were unachievable, indicating they are potential key problem nutrients. CONCLUSIONS: Optimal combinations of local foods are unlikely to achieve the nutrient density of F100, especially for vitamin E, riboflavin, thiamin, niacin, zinc, calcium, and copper. Before home-prepared rehabilitation diets with nutrient densities lower than those of F100 are promoted, it is important to establish their clinical efficacy. © 2008 Lippincott Williams & Wilkins, Inc. | Open |
| Leroy J.L.; Razak A.A.; Habicht J.-P. | Only children of the head of household benefit from increased household food diversity in Northern Ghana | 2008 | Journal of Nutrition | In many societies, foods are preferentially channeled to certain members of the household. We studied whether being the child of a powerful household member (head of household or first wife in a polygynous family) was associated with greater child stature in Northern Ghana and how this association varied with differences in household food availability. We used a sample of 464 children between 9 and 36 mo of age in extended households in rural Northern Ghana. Child stature was regressed on household food availability, the status of the child's father (head of household or other male), the status of the child's mother (marital order in a polygynous marriage), and the interaction terms between household food availability and parental status. The models were controlled for child age, sex, maternal height, parity, household size, and potential intra-community clustering. Household dietary diversity was associated with child stature (P < 0.05), but this association was limited to children of the head of household. For children of other males, there was no quantifiable association between household dietary diversity and child stature. Children of monogamous mothers were taller than children of second wives (P < 0.05). Our findings show that studies of intra-household allocation need to investigate beyond gender differences. Other structural household factors need to be considered in designing interventions, because they affect impact and even lead to increased intra-household inequality. Our results are relevant for Northern Ghana and as well as for similar settings elsewhere in the world. © 2008 American Society for Nutrition. | Open |
| Osei A.K.; Hamer D.H. | Management of pediatric malaria: Role of nutritional interventions | 2008 | Annales Nestle | Malaria is a leading cause of morbidity and mortality among children, particularly in sub-Saharan Africa. Although substantial progress has been made in the treatment of pediatric malaria with artemisinin-based combination therapy, there remain many obstacles to the effective implementation of these highly efficacious new treatment options. Similarly, while effective tools are available for the prevention of malaria in children, scaling these up so that they have a clear impact on malaria-associated morbidity and mortality has presented significant challenges to public health officials. Host nutritional status influences the acquisition and potential severity of malaria infection. While there is substantial evidence that malaria contributes to impaired weight and height gain in children, the impact of undernutrition on malaria is complex. There is increasing evidence that supplementation with certain micronutrients may play a critical role in the prevention of malaria in young children. Micronutrient interventions such as zinc or vitamin A supplementation may help reduce the burden of disease due to malaria whereas others such as iron may exacerbate infection. Differences in study design, quality, intensity of malaria transmission, and other study site characteristics complicate the interpretation of the limited number of studies that have evaluated the impact of specific micronutrients for the treatment and prevention of malaria. There has only been one trial to evaluate the use of zinc as an adjunct in the treatment of malaria and it failed to demonstrate any benefit of zinc in this role. This article reviews the clinical management of malaria in children, interactions between malaria and nutritional status, and the potential role of micronutrient supplementation for the prevention of clinical malaria episodes in young children, with a particular focus on whether each nutrient supplement improves or worsens malaria outcomes. Copyright © 2008 Nestec Ltd., Vevey/S. Karger AG. | Open |
| Benson T. | Cross-sectoral coordination failure: How significant a constraint in national efforts to tackle malnutrition in Africa? | 2007 | Food and Nutrition Bulletin | Background. Malnutrition arises from multifaceted causes and requires action from multiple sectors to address. Consequently, oversight and direction are said to be required to ensure that public goods and services needed to reduce malnutrition are delivered by the sectors responsible in a coordinated fashion. To do so, many countries have established cross-sectoral national nutrition coordination agencies. Objective. The performance of such agencies established recently in three African countries is evaluated to determine how critical their intersectoral coordination function is to national public efforts to reduce malnutrition. Methods. This evaluation uses qualitative information on the national institutional frameworks within which nutrition activities are carried out in Mozambique, Nigeria, and Uganda, countries with such agencies, and in Ghana, which has none. Results. None of the agencies has so far effectively carried out the three functions on which they were evaluated: cross-sectoral coordination, advocacy to sustain political commitment to address malnutrition, and resource mobilization. No cross-sectoral national nutrition initiatives are being implemented. Nutrition does not feature strategically in the master development frameworks in any country. No additional government resources have been mobilized, although international resources have been. Conclusions. The agencies have proven of limited value to the malnourished in these countries. However, cross-sectoral barriers are not the primary reason for this ineffectiveness. Rather, inability to maintain continued political commitment for efforts to address malnutrition - in short, advocacy - is the principal deficiency in performance. Cross-sectoral coordination only becomes important if malnutrition itself is treated as a politically important problem, thereby stimulating action in various sectors. © 2007, The United Nations University. | Open |
| Edmond K.M.; Kirkwood B.R.; Amenga-Etego S.; Owusu-Agyei S.; Hurt L.S. | Effect of early infant feeding practices on infection-specific neonatal mortality: An investigation of the causal links with observational data from rural Ghana | 2007 | American Journal of Clinical Nutrition | Background: Strong associations between delayed initiation of breastfeeding and increased neonatal mortality (2-28 d) were recently reported in rural Ghana. Investigation into the biological plausibility of this relation and potential causal pathways is needed. Objective: The objective was to assess the effect of early infant feeding practices (delayed initiation, prelacteal feeding, established neonatal breastfeeding) on infection-specific neonatal mortality in breastfed neonates aged 2-28 d. Design: This prospective observational cohort study was based on 10 942 breastfed singleton neonates born between 1 July 2003 and 30 June 2004, who survived to day 2, and whose mothers were visited in the neonatal period. Verbal autopsies were used to ascertain the cause of death. Results: One hundred forty neonates died from day 2 to day 28; 93 died of infection and 47 of noninfectious causes. The risk of death as a result of infection increased with increasing delay in initiation of breastfeeding from 1 h to day 7; overall late initiation (after day 1) was associated with a 2.6-fold risk [adjusted odds ratio (adj OR): 2.61; 95% CI: 1.68, 4.04]. Partial breastfeeding was associated with a 5.7-fold adjusted risk of death as a result of infectious disease (adj OR: 5.73; 95% CI: 2.75, 11.91). No obvious associations were observed between these feeding practices and noninfection-specific mortality. Prelacteal feeding was not associated with infection (adj OR: 1.11; 95% CI: 0.66, 1.86) or noninfection-specific (adj OR: 1.33; 95% CI: 0.55, 3.22) mortality. Conclusions: This study provides the first epidemiologic evidence of a causal association between early breastfeeding and reduced infection-specific neonatal mortality in young human infants. © 2007 American Society for Nutrition. | Open |
| Essumang D.K.; Dodoo D.K.; Obiri S.; Yaney J.Y. | Arsenic, cadmium, and mercury in Cocoyam (Xanthosoma sagititolium) and Watercocoyam (Colocasia esculenta) in Tarkwa a mining community | 2007 | Bulletin of Environmental Contamination and Toxicology | Cocoyam (Xanthosoma sagititolium) and Watercocoyam (Colocasia esculenta) have gained increased importance in the diets of majority of people in developing countries such as Ghana. The concentration levels of arsenic, cadmium, and mercury in Cocoyam (X. sagititolium) and Watercocoyam (C. esculenta) in Tarkwa and its surrounding villages a mining community in Ghana were measured in this study. From the results of the study, the levels of arsenic, cadmium and mercury in X. sagititolium and C. esculenta were higher than the WHO recommended levels. These root tubers absorb or uptake toxic chemicals from the soil as a result of the mining operations. This means that, the consumption of X. sagititolium and C. esculenta by humans from such environments may pose a serious health risk. There is therefore the need for a concerted effort by all to minimize the negative impact of gold mining in the study area. © 2007 Springer Science+Business Media, LLC. | Open |
| Hong R. | Effect of economic inequality on chronic childhood undernutrition in Ghana | 2007 | Public Health Nutrition | Objective: Food insecurity and undernutrition remain particularly severe in developing countries where improvements in economic conditions have tended to benefit the advantaged groups and resulted in widespread inequalities in health. This study examined how economic inequality is associated with chronic childhood undernutrition. Design: A child was defined as chronically undernourished (stunted) if his or her height-for-age index was more than two standard deviations below the reference median. Household economic status was measured by an index based on household ownership of durable assets. Bivariate and multivariate analyses were used to estimate the effects of household economic status on stunting. Setting: A nationally representative sample of 6251 household interviews in Ghana. Subjects: A total of 3077 children aged 0-59 months included in the 2003 Ghana Demographic and Health Survey. Results: Children in the poorest 20% of households are more than twice as likely to suffer from stunting as children in the richest 20% of households independent of the child's age, sex, birth order, breast-feeding duration, birth weight; mother's age at childbirth, body mass index, education; and household access to safe drinking water, hygienic toilet facilities, residence and geographic region (odds ratio = 2.3; 95% confidence interval 1.4-3.7). Also children in the next poorest and in the middle quintiles are significant more likely to be chronically undernourished than children in the richest 20% of households. Conclusion: This study concludes that economic inequality is strongly associated with chronic childhood undernutrition; and reducing economic inequalities and making services more accessible to the poor will be key to improving the health and nutritional status of children in Ghana. © 2007 The Authors. | Open |
| Lozano De La Torre Ma.J. | New growth references of the World Health Organization based on breast fed infants; [Nuevo patrón de crecimiento infantil de la Organización Mundial de la Salud basado en lactantes amamantados] | 2007 | Anales de Pediatria | The World Health Organization Multicenter Growth Reference Study is a multinational project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of 8440 children. The new WHO Child Growth Standards confirm that all children worldwide, given an optimum start in life, have the same potential for growth and prove that differences in children's growth to the age of 5 years are more influenced by nutrition, feeding practices, environment, and healthcare than by genetics or ethnicity. The new standards are based on the breast fed child as the norm for growth and development. For the first time, this ensures coherence among the tools used to assess growth and national and international infant feeding guidelines, which recommend breast feeding as the optimal source of nutrition during infancy. | Open |
| Mishra V.; Assche S.B.-V.; Greener R.; Vaessen M.; Hong R.; Ghys P.D.; Boerma J.T.; Van Assche A.; Khan S.; Rutstein S. | HIV infection does not disproportionately affect the poorer in sub-Saharan Africa | 2007 | AIDS | BACKGROUND: Wealthier populations do better than poorer ones on most measures of health status, including nutrition, morbidity and mortality, and healthcare utilization. OBJECTIVES: This study examines the association between household wealth status and HIV serostatus to identify what characteristics and behaviours are associated with HIV infection, and the role of confounding factors such as place of residence and other risk factors. METHODS: Data are from eight national surveys in sub-Saharan Africa (Kenya, Ghana, Burkina Faso, Cameroon, Tanzania, Lesotho, Malawi, and Uganda) conducted during 2003-2005. Dried blood spot samples were collected and tested for HIV, following internationally accepted ethical standards and laboratory procedures. The association between household wealth (measured by an index based on household ownership of durable assets and other amenities) and HIV serostatus is examined using both descriptive and multivariate statistical methods. RESULTS: In all eight countries, adults in the wealthiest quintiles have a higher prevalence of HIV than those in the poorer quintiles. Prevalence increases monotonically with wealth in most cases. Similarly for cohabiting couples, the likelihood that one or both partners is HIV infected increases with wealth. The positive association between wealth and HIV prevalence is only partly explained by an association of wealth with other underlying factors, such as place of residence and education, and by differences in sexual behaviour, such as multiple sex partners, condom use, and male circumcision. CONCLUSION: In sub-Saharan Africa, HIV prevalence does not exhibit the same pattern of association with poverty as most other diseases. HIV programmes should also focus on the wealthier segments of the population. © 2007 Lippincott Williams & Wilkins, Inc. | Open |
| Nelson-Quartey F.C.; Oduro I.N.; Ellis W.O.; Amagloh F.K. | Formulation of an infant food based on breadfruit (Artocarpus altilis) and breadnut (Artocarpus camansi) | 2007 | Acta Horticulturae | The availability of nutritious and palatable high-protein infant foods made from local staple crops is essential to proper health and nutrition of children. New product development studies were carried out to formulate an infant food from breadfruit (Artocarpus altilis) pulp and breadnut (Artocarpus camansi) seeds, which are locally available in Ghana, in combination with roasted malted maize and roasted groundnuts. Granulated sugar, full-fat powdered milk and dried powdered carrots were also incorporated into the formula. Physicochemical studies (proximate and functional analyses) on the raw ingredients and the formulated products included moisture, ash, protein, fat, fibre and carbohydrate contents and also water-binding capacity, solubility, swelling power, viscosity and dispersability. Analyses on a local infant food and a commercial infant food, both maize-based, were made for comparison purposes. Roasting of the ingredients reduced their moisture content, increasing shelf life and providing an advantage in product development. Malting the maize reduced its water-binding capacity and viscosity while increasing solubility. Sensory evaluation of the formulated products revealed that the formulation with 50% Artocarpus altilis pulp, 40% malted, roasted maize and 10% roasted groundnuts had the most preferred attributes in terms of aroma, texture, mouthfeel, sweetness, aftertaste and overall acceptability. Proximate analysis of this product showed: 7.9% moisture, 2.2% crude ash, 1.9% crude fibre, 14.7% crude protein, 9.9% crude fat and 63.5% carbohydrate, indicating that this infant food was comparable to the commercial infant food with respect to protein and fat. The incorporation of breadfruit and breadnut into locally-produced infant foods can provide a nutritious and palatable alternative. It is therefore expedient to formulate infant foods from local staples that are nutritious, fit into the traditional culinary and child-feeding practices of the region and are affordable. | Open |
| Newton S.; Owusu-Agyei S.; Ampofo W.; Zandoh C.; Adjuik M.; Adjei G.; Tchum S.; Filteau S.; Kirkwood B.R. | Vitamin A supplementation enhances infants' immune responses to hepatitis B vaccine but does not affect responses to Haemophilus influenzae type b vaccine | 2007 | Journal of Nutrition | Vitamin A supplementation reduces child mortality and severe morbidity in less developed countries, and the Expanded Program on Immunization (EPI) offers an ideal opportunity to deliver supplements in developing countries. High-dose vitamin A supplementation has been shown to have no effect on the immunogenicity of oral polio vaccine, tetanus toxoid, pertussis, or on measles vaccine given at 9 mo, but a negative effect on measles vaccine administered at 6 mo and a potentiating effect on diphtheria vaccine. Its effect on the antibody response to hepatitis B and Haemophilus influenzae type b antigens has not yet been established. To assess these effects, the present trial was carried out in the Offinso district of Ghana; 1077 infants were enrolled shortly after birth and randomized either to receive or not to receive 15 mg retinol equivalent with vitamin A together with the pentavalent "diphtheria-polio-tetanus- Haemophilus influenzae b-hepatitis B" vaccine at 6, 10, and 14 wk of age. All mothers received a postpartum supplement of 120 mg retinol equivalent vitamin A as per national policy. Blood samples were taken from infants at 6 and 18 wk of age. The results are based on 888 infants (82.4%) who completed the trial. The vitamin A supplementation did not affect the immune response to Haemophilus influenzae type b, but there was a significant improvement in the immune response to hepatitis B vaccine (93.9 vs. 90.2%, P = 0.04). However, given the high percentage of infants with seroprotection in the control group, it is doubtful that inclusion of vitamin A in the EPI would be justified on these grounds alone. © 2007 American Society for Nutrition. | Open |
| Nti C.A.; Lartey A. | Young child feeding practices and child nutritional status in rural Ghana | 2007 | International Journal of Consumer Studies | A study was conducted in the Manya Krobo district of Ghana with the objective of studying young child feeding practices and child nutrition situation in the area. The study was a cross-sectional survey involving 400 mothers with young children between 0 and 18 months. A combination of methods, including structured interviews using questionnaire, dietary assessment and anthropometry, was used to collect data for the study. The data obtained were analysed using spss version 10 in Windows. Means and standard deviations were generated for continuous variables and frequency distribution for categorical variables. The results revealed that although breastfeeding rates were high (97%), complementary feeding practices were less than ideal with as many as 14% of the children being introduced to complementary foods below the age of 3 months. The nutritional quality of complementary foods were poor and the prevalence of stunting among the children was high (20%). For adequate complementary feeding and improved child nutrition in this population, nutrition education intervention programmes aimed at improving nutrient intake among young children, through improved diet diversity and increased use of local foods rich in iron and other nutrients, need to be undertaken. © 2017 Wiley. All rights reserved. | Open |
| Wiig K.; Smith C. | An Exploratory Investigation of Dietary Intake and Weight in Human Immunodeficiency Virus-Seropositive Individuals in Accra, Ghana | 2007 | Journal of the American Dietetic Association | In Africa, the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) complex is commonly referred to as "slim disease" because, as the disease progresses, food intake and metabolism are altered, leading to visible body weight loss. In this descriptive, cross-sectional pilot study, 50 HIV-seropositive adults attending the Korle Bu Teaching Hospital in Accra, Ghana, were interviewed during the late spring of 2003. Demographics, medical HIV history and current status of their HIV disease, food safety, and food security information were collected. One 24-hour dietary recall was completed, height and weight were measured, and body mass index (BMI) was calculated for each participant. Results show that women participants had a higher mean BMI and maintained it through disease progression compared with men (P<0.02). The majority of the participants cited cost as a barrier in purchasing adequate amounts of food (92%). Fruit and vegetable intake was low overall (| Open |
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| De Onis M. | Complementary feeding in the WHO Multicentre Growth Reference Study | 2006 | Acta Paediatrica, International Journal of Paediatrics | Aim: To describe complementary feeding practices in the Multicentre Growth Reference Study (MGRS) sample. Methods: Food frequency questionnaires and 24-h dietary recalls were administered to describe child feeding throughout the first 2 y of life. This information was used to determine complementary feeding initiation, meal frequency and use of fortified foods. Descriptions of foods consumed and dietary diversity were derived from the 24-h recalls. Compliance with the feeding recommendations of the MGRS was determined on the basis of the food frequency reports. Descriptive statistics provide a profile of the complementary feeding patterns among the compliant children. Results: Complementary feeding in the compliant group began at a mean age of 5.4 mo (range: 4.8 (Oman)-5.8 mo (Ghana)). Complementary food intake rose from 2 meals/d at 6 mo to 4-5 meals in the second year, in a reverse trend to breastfeeding frequency. Total intake from the two sources was 11 meals/d at 6-12 mo, dropping to 7 meals/d at 24 mo. Inter-site differences in total meal frequency were mainly due to variations in breastfeeding frequency. Grains were the most commonly selected food group compared with other food groups that varied more by site due to cultural factors, for example, infrequent consumption of flesh foods in India. The use of fortified foods and nutrient supplements was also influenced by site-variable practices. Dietary diversity varied minimally between compliance groups and sites. Conclusion: Complementary diets in the MGRS met global recommendations and were adequate to support physiological growth. © 2006 Taylor & Francis. | Open |
| De Onis M. | Breastfeeding in the WHO Multicentre Growth Reference Study | 2006 | Acta Paediatrica, International Journal of Paediatrics | Aim: To document how children in the WHO Multicentre Growth Reference Study (MGRS) complied with feeding criteria and describe the breastfeeding practices of the compliant group. Methods: The MGRS longitudinal component followed 1743 mother-infant pairs from birth to 24 mo in six countries (Brazil, Ghana, India, Norway, Oman and the USA). The study included three criteria for compliance with recommended feeding practices that were monitored at each follow-up visit through food frequency reports and 24-h dietary recalls. Trained lactation counsellors visited participating mothers frequently in the first months after delivery to help with breastfeeding initiation and prevent and resolve lactation problems. Results: Of the 1743 enrolled newborns, 903 (51.8%) completed the follow-up and complied with the three feeding criteria. Three quarters (74.7%) of the infants were exclusively/predominantly breastfed for at least 4 mo, 99.5% were started on complementary foods by 6 mo of age, and 68.3% were partially breastfed until at least age 12 mo. Compliance varied across sites (lowest in Brazil and highest in Ghana) based on their initial baseline breastfeeding levels and sociocultural characteristics. Median breastfeeding frequency among compliant infants was 10, 9, 7 and 5 feeds per day at 3, 6, 9 and 12 mo, respectively. Compliant mothers were less likely to be employed, more likely to have had a vaginal delivery, and fewer of them were primiparous. Pacifier use was more prevalent in the non-compliant group. Conclusion: The MGRS lactation support teams were successful in enhancing breastfeeding practices and achieving high rates of compliance with the feeding criteria required for the construction of the new growth standards. © 2006 Taylor & Francis. | Open |
| De Onis M.; Onyango A.; Borghi E.; Siyam A.; Pinol A.; Garza C.; Martines J.; Martorell R.; Victora C.G.; Bhan M.K.; Araújo C.L.; Lartey A.; Owusu W.B.; Bhandari N.; Norum K.R.; Bjoerneboe G.-E.Aa.; Mohamed A.J.; Dewey K.G.; Belbase K.; Black M.; Chumlea Wm.C.; Cole T.; Frongillo E.; Grummer-Strawn L.; Shrimpton R.; Van Den Broeck J.; Albernaz E.; Tomasi E.; Da Silveira R.D.C.F.; Nader G.; Sagoe-Moses I.; Gomez V.; Sagoe-Moses C.; Taneja S.; Rongsen T.; Chetia J.; Sharma P.; Bahl R.; Baerug A.; Tufte E.; Rudvin K.; Nysaether H.; Alasfoor D.; Prakash N.S.; Mabry R.M.; Al Rajab H.J.; Abdou Helmi S.; Nommsen-Rivers L.A.; Cohen R.J.; Heinig M.J. | Enrolment and baseline characteristics in the WHO Multicentre Growth Reference Study | 2006 | Acta Paediatrica, International Journal of Paediatrics | Aim: To describe the WHO Multicentre Growth Reference Study (MGRS) sample with regard to screening, recruitment, compliance, sample retention and baseline characteristics. Methods: A multi-country community-based study combining a longitudinal follow-up from birth to 24 mo with a cross-sectional survey of children aged 18 to 71 mo. Study subpopulations had to have socio-economic conditions favourable to growth, low mobility and ≥ 20% of mothers practising breastfeeding. Individual inclusion criteria were no known environmental constraints on growth, adherence to MGRS feeding recommendations, no maternal smoking, single term birth and no significant morbidity. For the longitudinal sample, mothers and newborns were screened and enrolled at birth and visited 21 times at home until age 24 mo. Results: About 83% of 13 741 subjects screened for the longitudinal component were ineligible and 5% refused to participate. Low socio-economic status was the predominant reason for ineligibility in Brazil, Ghana, India and Oman, while parental refusal was the main reason for non-participation in Norway and USA. Overall, 88.5% of enrolled subjects completed the 24-mo follow-up, and 51% (888) complied with the MGRS feeding and no-smoking criteria. For the cross-sectional component, 69% of 21 510 subjects screened were excluded for similar reasons as for the longitudinal component. Although low birthweight was not an exclusion criterion, its prevalence was low (2.1% and 3.2% in the longitudinal and cross-sectional samples, respectively). Parental education was high, between 14 and 15 y of education on average. Conclusion: The MGRS criteria were effective in selecting healthy children with comparable affluent backgrounds across sites and similar characteristics between longitudinal and cross-sectional samples within sites. © 2006 Taylor & Francis. | Open |
| Ehrhardt S.; Burchard G.O.; Mantel C.; Cramer J.P.; Kaiser S.; Kubo M.; Otchwemah R.N.; Bienzle U.; Mockenhaupt F.P. | Malaria, anemia, and malnutrition in African children - Defining intervention priorities | 2006 | Journal of Infectious Diseases | Background. Malaria, anemia, and malnutrition contribute substantially to childhood morbidity in sub-Saharan Africa, but their respective roles and interactions in conferring disease are complex. We aimed to investigate these interactions. Methods. In 2002, we assessed plasmodial infection, anemia, and nutritional indices in 2 representative surveys comprising >4000 children in northern Ghana. Results. Infection with Plasmodium species was observed in 82% and 75% of children in the rainy and dry season, respectively. The fraction of fever attributable to malaria was 77% in the rainy season and 48% in the dry season and peaked in children of rural residence. Anemia (hemoglobin level, <11 g/dL) was seen in 64% of children and was, in multivariate analysis, associated with young age, season, residence, parasitemia, P. malariae coinfection, and malnutrition (odds ratio [OR], 1.68 [95% confidence interval {CI}, 1.38-2.04]). In addition, malnutrition was independently associated with fever (axillary temperature, ≥37.5°C; OR, 1.59 [95% CI, 1.13-2.23]) and clinical malaria (OR, 1.67 [95% CI, 1.10-2.50]). Conclusions. Malnutrition is a fundamental factor contributing to malaria-associated morbidity and anemia, even if the latter exhibits multifactorial patterns. Our data demonstrate that malaria-control programs alone may not have the desired impact on childhood morbidity on a large scale without concomitant nutrition programs. © 2006 by the Infectious Diseases Society of America. All rights reserved. | Open |
| Sharieff W.; Zlotkin S.; Tondeur M.; Feldman B.; Tomlinson G. | Physiologic mechanisms can predict hematologic responses to iron supplements in growing children: A computer simulation model | 2006 | American Journal of Clinical Nutrition | Background: Iron deficiency is the most common preventable nutrition problem in developing countries. Several randomized clinical trials (RCTs) have been conducted to determine the effectiveness of various iron dosing schemes in multiple settings. Objective: The objective was to determine whether enough is known about iron metabolism to predict hemoglobin and serum ferritin (SF) concentrations with a computer model and whether the model could be used as a substitute for new RCTs. Design: Guided by the physiology of iron absorption and regulation, we used data from RCTs that tested iron Sprinkles to develop a computer model. Of 2 RCTs in Ghana, we used 1 to compute the amount of iron absorbed from a given dose in anemic and nonanemic children and the other to compute the resulting change in hemoglobin concentrations. We used this model to predict hemoglobin and SF concentrations in a new RCT in China and compared model-predicted values with actual values by using summary statistics (means and medians) and quantile-quantile plots. Results: The model-predicted hemoglobin means were within ±2 g/L, and SF medians were within ±3 μg/L of the corresponding means and medians of the actual values. On quantile-quantile plots, the predicted hemoglobin quantiles were within ±5 g/L, and SF quantiles were within ±10 μg/L of the corresponding quantiles of the actual values. Conclusion: Our model of iron metabolism can accurately predict hemoglobin and SF concentrations after iron supplementation with Sprinkles in children; the model can thus obviate the need for repeating RCTs in multiple settings. © 2006 American Society for Nutrition. | Open |
| Tchum S.K.; Tanumihardjo S.A.; Newton S.; De Benoist B.; Owusu-Agyei S.; Arthur F.K.N.; Tetteh A. | Evaluation of vitamin A supplementation regimens in Ghanaian postpartum mothers with the use of the modified-relative-dose-response test | 2006 | American Journal of Clinical Nutrition | Background: Vitamin A deficiency is an important public health problem in many developing countries. Women of childbearing age and children are documented as the most affected groups. Objective: The objective was to determine the length of time mothers are protected postpartum against vitamin A depletion after receiving either 400 000 IU vitamin A in 2 divided doses or 200 000 IU as a single dose plus a placebo 24 h apart. Design: Mothers (n = 168) were recruited by trained fieldworkers 7-10 d after delivery. Modified-relative-dose- response (MRDR) tests were performed at baseline in 167 women, and vitamin A was administered within 6 wk after delivery. The women were randomly assigned to 2 main treatment groups, and each treatment group was divided into 3 follow-up subgroups. Each subgroup was invited back once at month 1, 3, or 5 for a second MRDR test. Results: The serum retinol concentration and the MRDR value were 1.4 ± 0.5 μmol/L and 0.048 ± 0.037, respectively, at baseline. A significant improvement in vitamin A status occurred after vitamin A treatment as assessed by the MRDR test (P < 0.0001). Serum retinol concentrations were not different after vitamin A treatment (P = 0.87). Conclusions: The mothers had marginally depleted liver reserves of vitamin A at baseline on the basis of MRDR test results. Liver reserves of vitamin A significantly improved in both treatment groups, and the improvement was maintained for ≥ 5 mo. © 2006 American Society for Nutrition. | Open |
| Appoh L.Y.; Krekling S. | Maternal nutritional knowledge and child nutritional status in the Volta Region of Ghana | 2005 | Maternal and Child Nutrition | The relationship between mother's nutritional knowledge, maternal education, and child nutritional status (weight-for-age) was the subject of investigation in this study. The data were collected in Ghana on 55 well nourished and 55 malnourished mother-child pairs. A questionnaire designed to collect data on mother's knowledge and practices related to child care and nutrition was administered to the mothers. Data on mother's demographic and socio-economic characteristics as well as child anthropometric data were also collected. A nutrition knowledge score was calculated based on mother's responses to the nutrition related items. Bivariate analysis gave significant associations between child nutritional status and the following variables: time of initiating of breastfeeding, mother's knowledge of importance of colostrum and whether colostrum was given to child, age of introduction of supplementary food, and mother's knowledge about causes of kwashiorkor. The two groups also showed significant differences in their nutrition knowledge scores. Maternal formal education, and marital status were also found to be associated with child nutritional status in bivariate analyses. Further analysis with logistic regression revealed that maternal nutrition knowledge was independently associated with nutritional status after the effects of other significant variables were controlled for. Maternal education on the other hand was not found to be independently associated with nutritional status. These results imply that mother's practical knowledge about nutrition may be more important than formal maternal education for child nutrition outcome. © Blackwell Publishing Ltd 2005. | Open |
| Dewey K.G.; Hawck M.G.; Brown K.H.; Lartey A.; Cohen R.J.; Peerson J.M. | Infant weight-for-length is positively associated with subsequent linear growth across four different populations | 2005 | Maternal and Child Nutrition | Several studies have documented that length gain often lags behind weight gain during infancy and early childhood, suggesting that linear growth is partly regulated by initial body mass or fatness. To investigate this hypothesis, we analysed data from four longitudinal studies on growth of infants in the first 12 months: (1) U.S. breast-fed and formula-fed infants (n = 89); (2) breast-fed infants in Ghana (n = 190); (3) normal birthweight, breast-fed infants in Honduras (n = 108); and (4) term, low-birthweight breast-fed infants in Honduras (n = 119). The dependent variable was length gain during each 3-month interval (1-4, 2-5, 3-6, 4-7, 5-8, 6-9, 7-10, 8-11 and 9-12 months). Three main independent variables were examined: initial weight-for-length z-score (W/L), weight change during the prior 3 months, and initial skinfold thickness. Controlling for maternal height, infant sex, and initial length-for-age z-score, length gain was positively correlated with initial W/L and prior weight change during all age intervals and with initial skinfold thickness at 3 and 4 months (r = 0.15-0.36; P < 0.01). There was no evidence of a threshold effect. These associations were evident in all four populations, in both boys and girls, and in breast-fed and formula-fed infants. The consistency of this relationship across studies supports the hypothesis that linear growth is partly regulated by initial body mass or fatness in infants. © Blackwell Publishing Ltd 2005. | Open |
| Quinn V.J.; Guyon A.B.; Schubert J.W.; Stone-Jiménez M.; Hainsworth M.D.; Martin L.H. | Improving breastfeeding practices on a broad scale at the community level: Success stories from Africa and Latin America | 2005 | Journal of Human Lactation | Large-scale community-level behavior change programs designed to improve breastfeeding practices were implemented in Bolivia, Ghana, and Madagascar. These programs reached sizable populations: Bolivia, 1 million; Ghana, 3.5 million; and Madagascar, 6 million. Over 3 to 4 years, timely initiation of breastfeeding (within 1 hour of birth) increased from 56% to 74% (P <.001) in Bolivia, 32% to 40% (P <.05) in Ghana, and 34% to 78% (P <.001) in Madagascar. Marked increases in exclusive breastfeeding of infants 0 to 6 months of age were also documented: from 54% to 65% (P <.001) in Bolivia, 68% to 79% (P <.001) in Ghana, and 46% to 68% (P <.001) in Madagascar. In Ghana and Madagascar, significant results were seen within 1 year of community interventions. The authors conclude that large-scale programs designed to improve breastfeeding practices are feasible and should be a central component of any child survival strategy. © Copyright 2005 International Lactation Consultant Association. | Open |
| Colecraft E.K.; Marquis G.S.; Bartolucci A.A.; Pulley L.; Owusu W.B.; Maetz H.M. | A longitudinal assessment of the diet and growth of malnourished children participating in nutrition rehabilitation centres in Accra, Ghana | 2004 | Public Health Nutrition | Objective: To examine the adoption of feeding recommendations among caregivers of children recuperating from malnutrition and assess the determinants of growth of children attending a nutrition rehabilitation centre (NRC) in Accra, Ghana. Design: Longitudinal study in which attendance and maternal programme participation were recorded daily and children's anthropometry and dietary intake were measured at four time points (admission, interim, exit, post-exit) at the NRC and participants' homes. Setting: NRCs at four polyclinics and participants' homes in Accra, Ghana. Subjects: One hundred and eight caregivers and their 116 children referred to an NRC between November 1999 and July 2000. Results: Most caregivers attended the NRC sporadically (effective length of stay was 1.4 ± 0.1 months). Use of NRC-promoted foods in the home after discharge was low due to inaccessibility of the food items, lack of preparation knowledge or money, child preferences and the common practice of purchasing ready-to-eat foods. Although there were significant increases in children's weight-for-age (P = 0.048) and weight-for-height (P= 0.002) Z-scores between enrolment and discharge, most children discontinued programme participation before adequate recuperation. Conclusions: The NRC education did not address the use of street foods for child feeding and was unsuccessful in changing in-home feeding behaviour. The prominence of street foods in children's diets warrants re-evaluation of the NRC's educational approaches to enhance their responsiveness to caregivers' needs and effectiveness for the continued recuperation of malnourished children at home. NRC feeding strategies need improvement to ensure adequate provision of energy and nutrients to support catch-up growth in children. | Open |
| de Onis M.; Garza C.; Victora C.G.; Onyango A.W.; Frongillo E.A.; Martines J. | The WHO Multicentre Growth Reference Study: Planning, study design, and methodology | 2004 | Food and Nutrition Bulletin | The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study sub-populations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development. © 2004, The United Nations University. | Open |
| Lartey A.; Owusu W.B.; Sagoe-Moses I.; Gomez V.; Sagoe-Moses C. | Implementation of the WHO Multicentre Growth Reference Study in Ghana | 2004 | Food and Nutrition Bulletin | The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) African site was Accra, Ghana. Its sample was drawn from 10 affluent residential areas where earlier research had demonstrated the presence of a child subpopulation with unconstrained growth. This subpopulation could be identified on the basis of the father's education and household income. The subjects for the longitudinal study were enrolled from 25 hospitals and delivery facilities that accounted for 80% of the study area's births. The cross-sectional sample was recruited at 117 day-care centers used by more than 80% of the targeted subpopulation. Public relations efforts were mounted to promote the study in the community. The large number of facilities involved in the longitudinal and cross-sectional components, the relatively large geographic area covered by the study, and the difficulties of working in a densely populated urban area presented special challenges. Conversely, the high rates of breastfeeding and general support for this practice greatly facilitated the implementation of the MGRS protocol. © 2004, The United Nations University. | Open |
| Marquis G.S.; Penny M.E.; Colecraft E.K.; Lozada M.F. | A comparison of patterns of breastfeeding and complementary feeding in Peru and Ghana | 2004 | Advances in Experimental Medicine and Biology | Not Available | Open |
| Owusu W.B.; Lartey A.; De Onis M.; Onyango A.W.; Frongillo E.A. | Factors associated with unconstrained growth among affluent Ghanaian children | 2004 | Acta Paediatrica, International Journal of Paediatrics | Aim: To identify socio-economic factors associated with unconstrained growth among children living in well-off neighbourhoods of Accra, Ghana. Methods: A cross-sectional study involving the assessment of the anthropometric status of preschool children. Children (n = 309) between the ages of 12 and 23 mo who live in affluent communities in Accra, Ghana were recruited for the study. Weight, length and mid-upper arm circumference were taken. Information was collected on household demographics and socio-economic status, including parental education and household income. Associations between these variables and attained growth were analysed to establish cutoffs for screening children with unconstrained growth. Results: The mean weight-for-age (WA), length-for-age (LA) and weight-for-length (WL) Z-scores of the sub-sample selected on the basis of high socio-economic criteria were -0.18, -0.40 and 0.16, respectively. Among these well-off children, 0% were underweight, 3.0% were stunted and 0% were wasted (Z-scores <-2). Factors associated with better anthropometric status were paternal education and household income. Two screening criteria combining the two variables were selected: polytechnic education and income > ¢1 000 000 (US$435) or university education and income >¢200 000. Conclusions: The children experiencing unconstrained growth belonged to a sub-population of affluent households characterized by high paternal education and household income. This subpopulation was targeted for screening for the WHO Multicentre Growth Reference Study in Ghana. | Open |
| Whitehead R.G. | Ghanaian infant growth study | 2004 | Acta Paediatrica, International Journal of Paediatrics | The future revised WHO growth references for infancy and early childhood will have an inter-national basis rather than just an American one, as is the case with the current NCHS/WHO ones. The anthropometric data for analysis will be collected from babies breastfed in accordance with WHO guidelines. An important stipulation, however, is that their growth must have been unrestricted by environmental factors. A paper from Ghana describes a quantitative provisional study that has revealed how such a condition can be satisfied within a developing country. Conclusion: Family income and especially the higher education of the father up to university level can still be important variables in the achievement of optimal growth of babies, even those brought up in situations of relative affluence. | Open |
| Amissah J.G.N.; Ellis W.O.; Oduro I.; Manful J.T. | Nutrient composition of bran from new rice varieties under study in Ghana | 2003 | Food Control | A study of the nutrient composition of 16 bran samples from 15 new rice varieties being assessed by agronomists and one local variety was conducted. Parameters measured were moisture, fat, crude fibre, protein, ash and mineral content. Carbohydrate and energy levels were calculated from the appropriate data obtained. Results showed significant differences (P < 0.05) in fat, crude fibre and ash contents of samples. With the exception of GRUG 7, ITA 334 and ITA 402, significant differences existed in moisture content. Significant variations (P < 0.05) also existed in protein content with the exception of ITA 304 and ITA 334. The bran from the different rice varieties had appreciably high levels of K, P and Ca. The order of these minerals was potassium, phosphorus and calcium. Energy levels were within the 300 Kcal/100 g range except that of GRUG 7 and BETA which were lower. Ca:P ratios were quite appreciable making the potential use of the samples for feed preparation high. © 2002 Elsevier Science Ltd. All rights reserved. | Open |
| Buor D. | Mothers' education and childhood mortality in Ghana | 2003 | Health Policy | The significant extent to which maternal education affects child health has been advanced in several sociodemographic-medical literature, but not much has been done in analysing the spatial dimension of the problem; and also using graphic and linear regression models of representation. In Ghana, very little has been done to relate the two variables and offer pragmatic explanations. The need to correlate the two, using a regression model, which is rarely applied in previous studies, is a methodological necessity. The paper examines the impact of mothers' education on childhood mortality in Ghana using, primarily, Ghana Demographic and Health Survey data of 1998 and World Bank data of 2000. The survey has emphatically established that there is an inverse relationship between mothers' education and child survivorship. The use of basic health facilities that relate to childhood survival shows a direct relationship with mothers' education. Recommendations for policy initiatives to simultaneously emphasise the education of the girl-child, and to ensure adequate access to maternal and child health services, have been made. The need for an experimental project of integrating maternal education and child health services has also been recommended. A linear regression model that illustrates the relationship between maternal education and childhood survival has emerged. © 2002 Elsevier Science Ireland Ltd. All rights reserved. | Open |
| Lutter C.K.; Rivera J.A. | Nutritional status of infants and young children and characteristics of their diets | 2003 | Journal of Nutrition | Adoption of the recommended breast-feeding and complementary feeding behaviors and access to the appropriate quality and quantity of foods are essential components of optimal nutrition for infants and young children between ages 6 and 24 mo. Iron, zinc and vitamin B-6 are deficient in complementary food diets in Bangladesh, Ghana, Guatemala, Mexico and Peru. Low intakes of iron are consistent with a high prevalence of anemia seen in this age group. The adequacy of observed intakes for calcium, vitamin A, thiamin, folate and vitamin C depends on the age range in question and the set of requirements used in the assessment. The lipid content of many complementary food diets is low. In addition to providing essential fatty acids, lipids are needed for the absorption of fat-soluble vitamins and also enhance the texture, flavor and aroma of foods, which may lead to increased intake. The relative roles of palatability, micronutrient deficiency and morbidity-induced anorexia in the appetite of infants and young children are not known. However, even among children who were growth retarded and had a total energy deficit compared with requirements, up to 25% of food offered was not consumed. This indicates that dietary quality rather than quantity is the key aspect of complementary food diets that needs to be improved. Targeted fortification or the production of complementary foods fortified with micronutrients and of an adequate macro- and micronutrient composition is one approach to help meet nutritional requirements during the vulnerable period of 6-24 mo. | Open |
| Schultz T.P. | Wage rentals for reproducible human capital: Evidence from Ghana and the Ivory Coast | 2003 | Economics and Human Biology | Education, child nutrition, adult health/nutrition, and labor mobility are critical factors in achieving recent sustained growth in factor productivity. To compare the contribution of these four human capital inputs, an expanded specification of the wage function is estimated from household (LSMS) surveys of the Ivory Coast and Ghana. Specification tests assess whether the human capital inputs are exogenous, and instrumental variable techniques are used to estimate the wage function. Smaller panels from the Ivory Coast imply the magnitude of measurement error in the human capital inputs and provide more efficient instruments to estimate the wage equation. The conclusion emerges that weight-for-height and height are endogenous, particularly prone to measurement error, and heterogeneous in their effects on wages. Overall returns to these four forms of human capital are similar within each country for men and women, but education and migration returns are higher in the more rapidly growing Ivory Coast, and the wage effects of child nutrition proxied by height are greater in poorer, more malnourished Ghana. © 2003 Elsevier B.V. All rights reserved. | Open |
| Shephard G.S. | Aflatoxin and food safety: Recent African perspectives | 2003 | Journal of Toxicology - Toxin Reviews | The issue of food safety in Africa is one which interacts with and is frequently subjugate to issues of food security, especially in geographic areas where food shortages are caused by recurrent natural weather phenomena such as drought. In addition, many subsistence farming communities in Africa are reliant on the consumption of home-grown crops, irrespective of the quality considerations normally applied in the developed world. Nevertheless, some African governments have instituted food safety regulations to control mycotoxin, especially aflatoxin, contamination of the national food supply and research into natural occurrence of aflatoxins in a range of local foods is widely conducted. This review summarises the work published in this field through the previous decade. It emphasizes that much of the research effort has been performed in South Africa, Egypt and in various countries in west Africa including Ghana, Nigeria and The Gambia. Although much of the published research deals with levels of aflatoxin contamination in staple foods such as maize and groundnuts, other particularly local foods such as cured and smoke-dried fish have been implicated as sources of dietary aflatoxin in various areas of Africa. The conclusion to be drawn from this survey is that aflatoxin exposure remains an important aspect of food safety which needs to be addressed by African communities. | Open |
| Nti C.A.; Larweh P.M.; Gyemfua-Yeboah Y. | Food consumption patterns, dietary quality and health status of expectant mothers: Case studies in suburban and rural communities in Ghana | 2002 | International Journal of Consumer Studies | The study was conducted to determine the food consumption patterns, dietary quality and health status of expectant women and also to assess their level of awareness of nutritional requirements during pregnancy. Food beliefs, taboos and superstitions held by the women were also investigated. Using the purposive sampling technique, 30 pregnant women attending the Maternal and Child Health Clinic at Dodowa (rural) and University Hospital, Legon (suburban), were selected for the study. A structured questionnaire was used to collect information on the respondents’ nutritional knowledge, beliefs, taboos and superstitions and health status. A food frequency questionnaire and the 24-h dietary recall method were used to obtain information on food consumption patterns and dietary quality. The study revealed that, although the majority of the respondents (83.3%) had some knowledge of nutrition, not all were applying it in their feeding practices because of financial constraints. With regard to consumption patterns, most of the women (83.3%) were having three meals a day, while the rest either ate twice a day or anytime they were hungry. Seventy-three per cent of the respondents also increased their food intake during pregnancy. Foods eaten were based mainly on starchy roots and tubers, cereals and vegetables. Legumes, oilseeds and fruits were often lacking in the main meals of respondents. Although animal products were consumed daily, the quantities taken were very small to provide for adequate protein, especially in the rural area. Various types of food were avoided by some of the expectant mothers for reasons such as nausea, loss of appetite, taboos and superstition. With regard to dietary quality, respondents from the rural area had diets of poorer quality in terms of nutrient intake compared with those from the suburban area. In both communities, iron contents of diets were quite low. Forty-seven per cent of the women interviewed were anaemic, with a higher prevalence of anaemia being observed in the rural community. Common ailments reported by the women were dizziness, headache, waist pains and malaria. Based on the results of the study, it was recommended that nutrition education for pregnant women should be stepped up at antenatal clinics especially in rural areas. © 2002 Blackwell Publishing Ltd. | Open |
| Nti C.A.; Plahar W.A.; Larweh P.M. | Impact of adoption in Ghana of an improved fish processing technology on household income, health and nutrition | 2002 | International Journal of Consumer Studies | Surveys were conducted in three fishing communities in Ghana, where an improved fish smoking technology (the Chorkor smoker) had been introduced previously, to assess the impact of adopting the improved technology on household income, health and nutritional status. Fifty-one fish processors (all women), who had adopted the improved fish processing technology, were selected for the study, in which the participatory rural appraisal (PRA) technique, nutritional survey methods and structured questionnaires were used to obtain both qualitative and quantitative data. The results revealed that there was an improvement in economic activities. This resulted in a positive impact on household income and food consumption patterns of the processors. Improvement in household income resulted from increases in the quality and quantity of output, price per unit output and profits. Improvement in food consumption pattern was mostly in respect of quality and quantity of food intake, but the types of food consumed remained the same. The nutrient intake of the respondents was good on average, with a majority exceeding the recommended daily allowance (RDA) of protein, vitamin B1 and calcium. The average body mass index (BMI) of the processors was also within the ideal range of 20-25. Adoption of the new technology also improved the health status of the respondents. Lessening of eye problems and headaches as a result of reduced exposure to smoke and heat was reported by 52% of the women. However, preschool children were undernourished as a result of poor child feeding practices. In any technology transfer process, apparently unrelated nutritional factors need to be considered. © 2002 Blackwell Publishing Ltd. | Open |
| Amoaful E.F. | Planning a national food-based strategy for sustainable control of vitamin A deficiency in Ghana: Steps toward transition from supplementation | 2001 | Food and Nutrition Bulletin | In an effort to control the high prevalence of vitamin A deficiency in Ghana, which studies have shown to be of public health significance, a number of interventions are being pursued. Periodic, massive-dose supplementation strategy, developed as a short-term life-saving intervention, is currently under way, either as part of the polio eradication program or combined with the existing health delivery system, schools, or community-based infrastructures. This has been successfully accomplished, and therefore the stage is set for the design and implementation of a long-term, sustainable solution. This is important in order to make the transition from a subsidized periodic capsule-distribution effort to a more sustainable food-based intervention, which could supply other vital nutrients as well as vitamin A in the diet. This report describes a proposal for a food-based strategy against a backdrop of low consumption in spite of the relatively high availability of some vitamin A-rich foods in most parts of Ghana. The aim is to improve vitamin A status of vulnerable groups through increased production, availability, and consumption of vitamin A-rich foods. The proposal is therefore to undertake a range of food-based interventions that will include horticultural interventions that aim to increase production and availability of vitamin A-rich foods, such as dark-green leafy vegetables and orange-colored fruits and vegetables and tubers in the diet of Ghanaian households. There will also be a comprehensive behavior change and communication strategy, to raise awareness of the causes and consequences of vitamin A deficiency and the need for consumption of adequate vitamin A-rich foods at the household level. Further emphasis will be placed on efforts to promote consumption of red palm oil, since this oil is generally available and not subjected to acute seasonal shortages. A phased community-based program will be implemented in four districts during the next three years, with the aim of applying lessons learned to the rest of the country. The monitoring framework will cover the planning process, provision of services, utilization of services, and coverage of target groups. These dietary approaches offer long-term sustainable options for improving the quality of family diets and overcoming vitamin A deficiency. | Open |
| Fentiman A.; Hall A.; Bundy D. | Health and cultural factors associated with enrolment in basic education: A study in rural Ghana | 2001 | Social Science and Medicine | This inter-disciplinary study compares the health status of school-age children in Ghana, both enrolled and non-enrolled, and examines these results within a wider socio-economic and socio-cultural context including kinship and livelihood. Children matched for age and sex who were not enrolled in Primary School were significantly shorter and more stunted than enrolled children were, and 70% of all Primary school-age children were anaemic. Young children from farming communities were significantly more undernourished than children from fishing communities. Adolescent non-enrolled boys were more heavily infected with Schistosoma haematobium, and were more likely to be anaemic than enrolled adolescent boys. The data indicate how health and health related factors may influence and affect enrolment and how socio-economic indicators, livelihood, and kinship may also constrain enrolment and, in turn, affect child health. This study sheds light on the complex factors that may influence enrolment in education and provides novel data on the similarities and differences between the health of enrolled and non-enrolled children in rural Ghana. (C) 2001 Elsevier Science Ltd. | Open |
| Adu E.K.; Aning K.G.; Wallace P.A.; Ocloo T.O. | Reproduction and mortality in a colony of captive greater cane rats, Thryonomys swinderianus, Temminck | 2000 | Tropical Animal Health and Production | The reproductive performance and mortalities in a colony of captive greater cane rats, Thryonomys swinderianus, were monitored from 1992 to 1998 at the Grasscutter Domestication Centre, Achimota, Ghana. The animals were kept in cages and exposed to constant lighting from a 100 W electric light bulb during the night. The diet consisted mainly of freshly cut Panicum maximum (guinea grass) fed ad libitum, with occasional supplements of cassava and cane sugar. The results indicate that the mean litter size and litter weight were 2.9 ± 0.51 and 439.4 ± 81.23 g, respectively. These figures are low compared to those reported elsewhere. However, the mean birth weight was 151.2 ± 11.08 g, higher by 12% than previously reported values. It is considered that poor nutrition, excessive exposure to light and stress were responsible for the relatively poor reproductive performance reported in these animals. The main causes of death were traumatic injuries (32%) and pulmonary congestion (16%). | Open |
| Ahiadeke C. | Breast-feeding, diarrhoea and sanitation as components of infant and child health: A study of large scale survey data from Ghana and Nigeria | 2000 | Journal of Biosocial Science | Using Demographic and Health Survey datasets from Ghana and Nigeria, this study examined whether the protective effects of breast-feeding are greatest where the poorest sanitation conditions prevail. It was found that mixed-fed infants aged between 0 and 11 months tend to have a higher risk of diarrhoea than fully breast-fed children, while the risk of diarrhoea among weaned infants is twice that of mixed-fed infants. The probit regression models employed in the analysis were used to predict the probability of diarrhoea associated with each breast-feeding pattern for both 'poor' and 'good' sanitation areas. It was found that the risk of diarrhoea among mixed-fed infants in the poor sanitation areas tends to be high while the same risk among fully breast-fed infants tends to be minimal. In essence, the health risks of mixed feeding are real, particularly for infants aged less than 7 months, and are even worse for those weaned before 6 months of age.; This paper studies the interactions between breast-feeding practices, household environmental sanitation and diarrhea-related diseases in Ghana and Nigeria, employing the data collected from the Demographic and Health Surveys conducted in Ghana in 1993 and Nigeria in 1990. Results showed that mixed-fed infants aged between 0 and 11 months tend to have a higher risk of diarrhea than fully breast-fed children, while the risk of diarrhea among the weaned infants is twice that of mixed-fed infants. The probit regression models employed in the analysis were used to predict the probability of diarrhea associated with each breast-feeding pattern for both ¿poor¿ and ¿good¿ sanitation areas. Furthermore, it was found that the risk of diarrhea among mixed-fed infants in the poor sanitation areas tends to be high, while the same risk among fully breast-fed infants tends to be minimal. In conclusion, health risks of mixed feeding are substantial, particularly for infants aged under 7 months, and are even worse for those weaned before 6 months of age. | Open |
| Armar-Klemesu M.; Ruel M.T.; Maxwell D.G.; Levin C.E.; Morris S.S. | Poor maternal schooling is the main constraint to good child care practices in Accra | 2000 | Journal of Nutrition | Life in urban areas presents special challenges for maternal child care practices. Data from a representative quantitative survey of households with children < 3 y of age in Accra, Ghana were used to test a number of hypothesized constraints to child care including various maternal (anthropometry, education, employment, marital status, age and ethnic group) and household-level factors (income, availability of food, quality of housing and asset ownership, availability of services, household size and crowding). Three care indices were created as follows: 1) a child feeding index; 2) a preventive health seeking index; and 3) a hygiene index. The first two indices were based on data from maternal recall; the hygiene index was based on spot-check observations of proxies of hygiene behaviors. Multivariate analyses (ordinary least-squares regression for the child feeding index and ordered probit for the two other indices) showed that maternal schooling was the most consistent constraint to all three categories of child care practices. None of the household-level characteristics were associated with child feeding practices, but household socioeconomic factors were associated with better preventive health seeking and hygiene behaviors. Thus, poor maternal schooling was a main constraint for child feeding, health seeking and hygiene practices in Accra, but the lack of household resources was a constraint only for health seeking and hygiene. The programmatic implications of these findings for interventions in nutrition education and behaviors in Accra are discussed. | Open |
| Lartey A.; Manu A.; Brown K.H.; Peerson J.M.; Dewey K.G. | Predictors of growth from 1 to 18 months among breast-fed Ghanaian infants | 2000 | European Journal of Clinical Nutrition | Objective: To examine factors associated with the physical growth of breast-fed Ghanaian infants during the first 18 months of life. Design: A community-based longitudinal study. Setting: The study was carried out in Techiman, a district capital and major food trading center in the Brong Ahafo region of Ghana. Subjects: One-month old infants (n = 216) with birth weight ≥ 2.5 kg were recruited from Maternal and Child Health Centers. Method: From 6 to 12 months, infants were provided with one of four types of nutritionally enhanced complementary foods. Anthropometric assessments were completed monthly from 1 to 12 months and every other month from 12 to 18 months. Information was collected on household characteristics, morbidity from common infections and dietary intakes. Blood samples were collected at 6 and 12 months to assess iron, zinc, riboflavin and vitamin A status. Multiple regression analysis was used to examine factors associated with growth during the age intervals of 1-6, 4-6, 6-12 and 12-18 months as well as size attained at 12 and 18 months. Results: Prevalence of diarrhea and fever were negatively associated with growth during the first year of life. No significant relationship was found between respiratory illness (defined as cough or purulent nasal discharge) and growth. With the exception of dietary zinc intake, dietary variables were generally not significantly associated with growth. Maternal education was positively associated with growth during most of the age intervals. Conclusion: These findings suggest that interventions to reduce morbidity and improve the education of girls may benefit children's growth in this population. | Open |
| Van Der Mei J.; Volmer M.; Boersma E.R. | Growth and survival of low birthweight infants from 0 to 9 years in a rural area of Ghana. Comparison of moderately low (1501-2000 g) and very low birthweight (1000-1500 g) infants and a local reference population | 2000 | Tropical Medicine and International Health | This prospective and descriptive study was conducted to evaluate the growth and survival of 105 low birthweight (LBW, 1000-2000 g) infants discharged during a 4-year period from Agogo Hospital, Ghana, and followed from birth until the age of 4-9 years. Thirty-two babies were very low birthweight children (VLBW, 1000-1500 g) and 73 (70%) were of moderately low birthweight (MLBW, 1501-2000 g). At the age of 3 years, 15 children (14.2%) had not come for follow-up; of the remaining 90 children, nine (10%) had died, five during the first 3 months of life. At follow-up from 4 to 9 years of age, two more children could not be traced and another two had died. Compared to a local reference population and the WHO standard, growth of survivors lagged behind and caught up only slightly during the first 3 years of life. From 3 to 9 years of age, median growth impairment increased, which either suggests impaired growth potential or poor health and inadequate nutrition. This long-term study confirms that LBW (1000-2000 g) infants, particularly VLBW children, are at high risk. | Open |
| Brooker S.; Hall A.; Bundy D.A.P.; Adjei S.; Allen E.; Amuah E.; Asibey-Berko E.; Wen S.-T.; Noswah-Nuamah N.N.N.; Ollennu A.; Kihamia C.M.; Issae W.; Mwanri L.; Magingo J.; Mwaikemwa A.; Kimaro S.; Yona E.; Tatala S. | Short stature and the age of enrolment in Primary School: Studies in two African countries | 1999 | Social Science and Medicine | This study compares age at enrolment in Primary School with a range of nutritional measures for 8-9 year old and 12-13 year old children in Ghana (n = 1566) and Tanzania (n = 1390). The results show that short stature (height- for-age z-score), but not other nutritional variables (weight-for-age and weight-for-height z-scores and haemoglobin concentration), is strongly associated with late enrolment. This relationship holds for both age group, sexes and countries, and is independent of socio-economic status in Tanzania (where this parameter was assessed). The relationship between stature and age-appropriate grade becomes less marked with progression through school, which is compatible with a higher drop out rate for more stunted children. These results suggest an important role for health in education; that stunted children enrol later in school and are more likely to drop out earlier. | Open |
| Hudelson P.; Dzikunu H.; Mensah J.D.; Morris S.; Arthur P.; Kirkwood B. | Dietary patterns in a rural area of Ghana and their relevance for vitamin A consumption | 1999 | Ecology of Food Nutrition | This paper discusses results from research conducted on food acquisition, preparation and consumption patterns in Kintampo District, Brong Ahafo Region, Ghana. The research was conducted as part of a larger project aimed at identifying appropriate strategies for improving consumption of vitamin A among children and pregnant women. This paper focuses on describing the context in which inadequate consumption of vitamin A occurs. The research consisted of open-ended interviews with key informants, observations of meal preparation, spot-check observations of meal ingredients, and market inventories. The study found that: (1) a variety of vitamin A rich foods are available in Kintampo District (2) there are few cultural beliefs that limit consumption of these foods; and (3) adequate consumption of vitamin A rich foods is hindered by the cost and seasonality of these foods, as well as by local cooking, storage and preservation techniques. Based on study findings, recommendations are made concerning potential intervention approaches. | Open |
| Lartey A.; Manu A.; Brown K.H.; Peerson J.M.; Dewey K.G. | A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age | 1999 | American Journal of Clinical Nutrition | Background: Koko, a fermented maize porridge used as the primary complementary food in Ghana, has been implicated in the high prevalence of child malnutrition. Weanimix, a cereal-legume blend developed by the United Nations Children's Fund and the Ghanaian government, has been promoted as an alternative. Objective: We evaluated the effect of feeding Weanimix and 3 other locally formulated, centrally processed complementary foods on the nutritional status of 208 breast-fed infants. Design: Infants were randomly assigned to receive 1 of 4 foods from 6 to 12 mo of age: Weanimix (W), Weanimix plus vitamins and minerals (WM), Weanimix plus fish powder (WF), and koko plus fish powder (KF). Dietary and anthropometric data were collected regularly. Blood was collected at 6 and 12 mo of age to assess iron, zinc, vitamin A, and riboflavin status. Before and after the intervention, cross- sectional data on the anthropometric status of infants not included in the intervention (NI; n = 464) were collected. Results: There were no significant differences between intervention groups in weight or length gain or in hemoglobin, hematocrit, transferrin saturation, plasma zinc, or erythrocyte riboflavin values between 6 and 12 mo of age. From 9 to 12 mo of age, z scores were lower in NI infants than in the combined intervention groups [at 12 mo: -1.71 ± 0.90 compared with - 1.19±0.93 for weight and -1.27 ± 1.02 compared with -0.63 ± 0.84 for length (P < 0.001 for both), respectively]. The percentage of infants with low ferritin values increased significantly between 6 and 12 mo of age in groups W, WF, and KF but not in group WM. Change in plasma retinol between 6 and 12 mo of age was significantly greater in group WM than in the other 3 groups combined (0.14 ± 0.3 compared with - 0.04 ± 0.3 μmol/L, P = 0.003). Conclusions: All 4 foods improved growth relative to the NI group. Infants fed WM had better iron stores and vitamin A status than those fed nonfortified foods. | Open |
| Maxwell D. | The political economy of urban food security in Sub-Saharan Africa | 1999 | World Development | Sub-Saharan African cities in the late 1990s face a daunting set of problems including rapid growth, increasing poverty, deteriorating infrastructure, and inadequate capacity for service provision. Even as a renewed debate is shaping up around issues of urban development, there is little attention given to the question of urban food security. Whereas in the 1970s and 1980s, urban food problems in Africa commanded political attention, the nature of urban food insecurity in the 1990s is such that it has tended to lose political importance. This is largely because in the 1970s, the problem was one of outright food shortages and rapid price changes that affected large portions of the urban population simultaneously. The impact of structural adjustment, continued rapid growth, and an increase in poverty make urban food insecurity in the 1990s primarily a problem of access by the urban poor. Under circumstances where the urban poor spend a very large portion of their total income on food, urban poverty rapidly translates into food insecurity. The lack of formal safety nets, and the shifting of responsibility for coping with food insecurity away from the state towards the individual and household level has tended to atomize and muffle any political response to this new urban food insecurity. This paper briefly reviews urban food insecurity and generates a set of empirical questions for an analysis of food and livelihood security in contemporary urban sub-Saharan Africa, and then examines historical and contemporary evidence from Kampala, Uganda, and Accra, Ghana, to suggest some tentative conclusions. | Open |
| Maxwell D.; Ahiadeke C.; Levin C.; Armar-Klemesu M.; Zakariah S.; Lamptey G.M. | Alternative food-security indicators: Revisiting the frequency and severity of 'coping strategies' | 1999 | Food Policy | Recent research on the multi-factorial nature of food security has provided a wealth of analytical insight, but measurement problems remain a major challenge, not only for research, but particularly for targeting, program management, monitoring and evaluation. Building on an approach suggested in a 1996 article, this paper constructs a series of alternative food-security indicators based on the frequency and severity of consumption-related coping strategies. These alternative indicators are then compared with more standard measures, including a consumption benchmark, a poverty benchmark and a nutritional benchmark using data from the 1997 Accra Urban Food and Nutrition Study. Against these more traditional indicators, the coping strategy indicators are best at ruling out cases-that is, minimizing the risk of classifying a food-insecure household as food-secure. They also help to identify sources of vulnerability and the trade-offs made with other basic needs to acquire sufficient food. The measures outlined here are much less time-consuming and less expensive in terms of data collection and analysis, and therefore perhaps offer a pragmatic alternative to food and livelihood program managers. However, the comparative analysis of conventional benchmarks with the coping strategies indicator reveals some shortcomings with the benchmark indicators as well-a sign that perhaps the indicators of food security proposed here are both alternative and complementary measures. | Open |
| Ruel M.T.; Levin C.E.; Armar-Klemesu M.; Maxwell D.; Morris S.S. | Good care practices can mitigate the negative effects of poverty and low maternal schooling on children's nutritional status: Evidence from Accra | 1999 | World Development | This study uses data from a representative survey of households with preschoolers in Accra, Ghana to: (a) examine the importance of care practices for children's height-for-age Z-scores (HAZ); and (b) identify subgroups of children for whom good maternal care practices may be particularly important. Good caregiving practices related to child feeding and use of preventive health services were a strong determinant of children's HAZ, specially among children from the two lower income terciles and children whose mothers had less than secondary schooling. In this population, good care practices could compensate for the negative effects of poverty and low maternal schooling on children's HAZ. Thus, effective targeting of specific education messages to improve child feeding practices and use of preventive health care could have a major impact on reducing childhood malnutrition in Accra. © 1999 Elsevier Science Ltd. All rights reserved. | Open |
| Takyi E.E.K. | Nutritional status, food-consumption frequency, and nutrient intake of pre-school children in northern Ghana | 1999 | Food and Nutrition Bulletin | Not Available | Open |
| Takyi E.E.K. | Children's consumption of dark green, leafy vegetables with added fat enhances serum retinol | 1999 | Journal of Nutrition | A randomized, double-blind, controlled study was conducted to determine whether the consumption of leafy vegetables by preschool children would enhance their serum vitamin A concentration to acceptable levels. Preschool children (n = 519; 2.5-6 y) in Saboba, northern Ghana, were randomly assigned to five feeding groups, differing essentially in the amount of fat and β- carotene, fed once per d, 7 d per wk, for 3 mo. Serum retinol levels, anthropometric measurements, hemoglobin, rapid turnover proteins (pre- albumin and retinol-binding protein), worm infestation (stool examinations) and level of acute and chronic infection (serum C-reactive protein and acid glycoprotein) were determined before and after study. Relative to the baseline serum retinol values, consumption of dark green, leafy vegetables (Manihot sp. and Ceiba sp.) with fat (10 g/100 g) significantly (P < 0.05) enhanced serum retinol; consequently, the percentage of children with adequate retinol status increased from 28.2-48.2% after feeding (P < 0.05). There were no significant differences among groups, ages or pre- versus post- anthropometric measurements, hemoglobin concentration, or levels of worm infestation. The importance of these findings in alleviating and/or controlling vitamin A deficiency in developing countries is discussed. | Open |
| Taniguchi K.; Rikimaru T.; Yartey J.E.; Akpedonu P.; Armar-Klemesu M.A.; Nkrumah F.K.; Kamiya H.; Kishi K.; Armar D.A. | Immunological background in children with persistent diarrhea in Ghana | 1999 | Pediatrics International | Background: Persistent diarrheal diseases have become one of the most serious medical problems in developing countries, but few studies have been conducted to determine the risk factors. In the present study, we investigated the nutritional and immunological background in children with persistent diarrhea in comparison with those with acute diarrhea. Methods: Children with diarrhea who were brought to the Oral Rehydration Salt Clinic of Princess Marie Louise Children's Hospital in Accra were evaluated from an immunological and nutritional aspect. In the follow-up visit, the cases whose diarrhea stopped within 2 weeks after onset were classified into the acute diarrhea group; those with diarrhea lasting more than 2 weeks were classed in the persistent group. Nutritional and immunological data at the initial visit were compared between these two groups. Results: In general, the diarrhea cases had a tendency to undernutrition and impaired cellular immunity compared with healthy control. Persistent cases had lower values for longer half-life, rapid turn-over proteins. Persistent cases had a higher percentage of CD8+ cells and lower CD4/CD8 ratio. CD25 expression in CD4+ cells stimulated by anti-CD3 antibody was lower in the persistent diarrhea group. Conclusion: These results appear to support the hypothesis that more severe nutritional status and impairment of cellular immunity is related to the persistence of diarrhea. | Open |
| Dewey K.G. | Cross-cultural patterns of growth and nutritional status of breast-fed infants | 1998 | American Journal of Clinical Nutrition | Growth patterns and iron status of infants who were breast-fed throughout their first year of life were examined in four populations: 1) a group of high socioeconomic status in California (the DARLING Study), 2) infants of normal birth weight (NBW) but from low-income families in Honduras, 3) low-birth-weight (LBW), full-term infants in Honduras, and 4) infants in Ghana. z Scores were calculated by using both the current National Center for Health Statistics reference data and a pooled data set based on breast-fed infants in six industrialized countries. The NBW infants in Honduras showed rapid growth in the first few months and were similar in weight-for-age to the DARLING infants until ≃9 mo. By contrast, the LBW infants remained far below the other cohorts throughout the first 12 mo, despite an initial period of catch-up growth. In the Ghanaian infants, weight-for-age faltered beginning at 3-4 mo, but length-for-age did not falter until after 9 mo. Weight-for-length was highest in the NBW Honduran infants and lowest in the Ghanaian infants. When z scores were adjusted for birth weight and maternal height, no significant faltering was evident in either weight or length in any of the cohorts during the first 12 mo. Thus, when breast-feeding is continued during the first year of life and efforts are made to ensure adequate complementary feeding after 6 mo, if growth faltering occurs it is probably attributable to prenatal factors and maternal stature. Population differences in iron status reflected variation in birth weight and in the use of iron-rich foods. Therefore, efforts to prevent child stunting and malnutrition must pay attention to prenatal as well as postnatal factors. | Open |
| Rikimaru T.; Taniguchi K.; Yartey J.E.; Kennedy D.O.; Nkrumah F.K. | Humoral and cell-mediated immunity in malnourished children in Ghana | 1998 | European Journal of Clinical Nutrition | Objective: To examine the relationship between immunological variables and the different types and severity of malnutrition in Ghanaian children. Design: Case-control study. Setting: The study was done at Princess Marie Louise Hospital, Accra, Ghana. Subjects: One hundred and seventy children, aged 8-36 months, were recruited at the clinical ward and public health service section of the hospital: 61 normal children, 49 moderately malnourished (underweight) children and 60 severely malnourished children (19 kwashiorkor, 30 marasmus, and 11 marasmic kwashiorkor children). Method: The children underwent clinical observations, anthropometric measurements and blood sampling for biochemical analysis to evaluate their nutritional and immunological status. Serum immunoglobulins (IgA subclasses, IgG subclasses and IgM), complements (C3 and C4) and lymphocyte subpopulations (T cells, B cells, CD4+, CD8+, NK cells and HLADR) were determined for the assessment of humoral and cell-mediated immunity. Results: Serum levels of IgA1, IgA2 and C4 tended to be higher in severely malnourished children than in normal children, while serum level of C3 and the proportion of B cells were significantly lower in the severely malnourished children than in the normal children (P < 0.05). There were no notable differences in most immunological parameters among the three severely malnourished groups. No differences were observed in the immunological parameters except for the proportion of B cells between normal and moderately malnourished children. Factor analysis revealed that C3 levels were positively correlated with a factor which was strongly associated with weight-for-height z-score and biochemical indicators for evaluating protein nutrition. In addition, IgA2, IgG1 and IgM levels were positively correlated with a factor which was associated with C-reactive protein. Conclusion: Several immunological variables responded positively or negatively with the different levels of severity of malnutrition, but most variables did not on the different types of malnutrition. The changes of C3 level were more associated with the severity of malnutrition. | Open |
| Ross D.A. | Vitamin A and public health: Challenges for the next decade | 1998 | Proceedings of the Nutrition Society | Not Available | Open |
| Annan-Prah A.; Agyeman J.A. | Nutrient content and survival of selected pathogenic bacteria in kenkey used as a weaning food in Ghana | 1997 | Acta Tropica | Kenkey is a cooked, fermented white maize food of the people of the southern half of Ghana. There are three types of kenkey viz: Ga, Fanti-Brown and Fanti-White. Kenkey is widely used as a weaning pap by a lot of low income families. In mashing it into the weaning pap, mothers use their bare hands. This and the use of untreated water, especially in rural communities, introduce the risk of microbial contamination. Kenkey's nutritional contribution to the weanling and the survival of selected pathogenic bacteria in kenkey's milieu were investigated in this study. Crude Protein (CP) was determined by the Kjedahl method. Atomic absorption spectrophotometry was used to determine levels of minerals. Escherichia coli (1955 and 101685), Klebsiella pneumoniae and Staphylococcus aureus populations in kenkey milieu of pH 4 were monitored over a period of time. Our results suggested that, nutritionally, Ga kenkey is the best of the three types of kenkey. A weanling of 9 kg body weight is maximally offered 450 g of kenkey a day. This weight of kenkey offers the following levels of nutrients on as-it-is or wet basis: CP, 13.13 g and dry matter (DM), 141.14 g. Minerals levels were P, 266.22 mg; Ca, 14.1 mg; K, 451.94 mg; Na, 1301.15 mg; Mg, 260 mg; Fe, 8.65 mg; Zn, 3.91 mg; Cu, 0.23 mg; Mn, 1.15 mg; Co, 0.6 mg; and Cr, 0.36 mg. These values did not satisfy the recommended daily dietary allowances (RDAs) for weaning. The populations of our test pathogenic bacteria were reduced by 1-3 logs in 30 min in Ga kenkey milieu of pH 4. In using kenkey for weaning purposes, therefore, breastfeeding and selected nutrient supplementation are necessary to avert malnutrition. Since the extent of microbial reduction on exposure to a lethal agent also depends on the initial microbial load, mothers should wash their hands very well to reduce microbial loads before using them to mash kenkey. They should also use treated water and heat the kenkey pap before serving.; Kenkey, a cooked, fermented, white maize food, is widely used by low-income families in southern Ghana as a weaning pap. Of concern is the use of bare hands to mash the pap and untreated water to moisten the food. This study evaluated kenkey's nutritional value and the survival of selected pathogenic bacteria in kenkey's milieu. 10 samples of each of the 3 types of kenkey were purchased from commercial producers and molded into balls weighing 300 g. The crude protein content of dry matter, determined by the Kjedahl method, was 9.31% for Ga, 9.30% for Fanti-Brown, and 8.23% for Fanti-White kenkey. 450 g of kenkey (the maximum daily amount offered a 9 kg weanling) provides 13.13 g of crude protein and 141.14 g of dry matter. Mineral levels of wet kenkey, determined by atomic absorption spectrophotometry, failed to meet the recommended daily dietary allowances for weaning. Klebsiella pneumoniae and Staphylococcus aurens populations in a kenkey milieu of pH 4 were reduced by 1-3 logs in 30 minutes. The extent of microbial reduction depended on the initial contamination level. These findings indicate that kenkey must be supplemented by breast feeding for as long as possible or animal proteins to prevent malnutrition in weaning children. Recommended, to avert pathogenic contamination, are hand washing before mashing, use of treated water, and heating of the pap before serving. | Open |
| Golding J.; Emmett P.M.; Rogers I.S. | Breast feeding and infant mortality | 1997 | Early Human Development | The evidence linking bottle feeding to infant and early childhood mortality has been reviewed. Ecological studies of national time trends in infant mortality do not parallel breast feeding trends in those countries, and indicate that falling death rates are more likely to be related to better health care facilities and social conditions. Direct studies of deaths provide some contradictory findings; meta-analyses are not informative because of the many differences in statistical and sample methodology. The methodology exhibited in most studies is more likely to have over- rather than under-estimated a relationship between bottle feeding and infant mortality. Retrospective analyses must take account of changes in feeding pattern due to early signs of illness. Prospective population studies able to account for large numbers of potential confounders provide the best estimates, especially if proportional hazards models are used. Two such studies have been carried out - both showed protective effects of breast feeding.; The assumption that breast feeding prevents a large number of infant deaths is not consistently supported by the research literature. In general, infant mortality rates in developing countries have declined during the same period that breast feeding rates have fallen. Declining infant mortality has been linked primarily to affordable health services, improvements in women's status, nutrition standards, universal immunization, and the expansion of prenatal and obstetric services. This should not be interpreted as meaning that breast feeding is not relevant as a child survival intervention. The protective effect of breast feeding becomes more evident when deaths from gastroenteritis and respiratory infections are analyzed. For example, a major case-control study conducted in Brazil found that infants who were fed non-milk supplements had a reduced overall risk of death, but after adjustment for confounders, there was a very strong association between diarrhea mortality and lack of breast feeding. In developed countries, most studies have focused on the relationship between breast feeding and sudden infant death syndrome. In this case, maternal smoking appears more salient than infant feeding method. Needed are more prospective population studies able to account for the large numbers of potential confounders in the breast feeding-infant mortality relationship. | Open |
| Higgins P.A.; Alderman H. | Labor and women's nutrition: The impact of work effort and fertility on nutritional status in Ghana | 1997 | Journal of Human Resources | Economic approaches to nutrition have focused largely on measures of child nutrition and thus have been able to ignore the issue of individual heterogeneity in energy expenditures. Ignoring such an issue may be bad science, however, especially given the case of adults, whose waking hours are devoted mostly to labor activities, the energy costs of which vary enormously. An instrumental variables technique was employed to obtain consistent estimates of the structural parameters of the nutrition production function for adult women in Ghana. Energy expenditure, as embodied in individual time allocations over the previous seven days, was found to be an important determinant of female nutritional status, with time devoted to agricultural tasks, in particular, having a strong negative effect Perhaps most importantly, evidence was found of a substantial downward bias of the calorie elasticity estimate when the energy expenditure proxies were excluded. | Open |
| Plahar W.A.; Nti C.A.; Annan N.T. | Effect of soy-fortification method on the fermentation characteristics and nutritional quality of fermented maize meal | 1997 | Plant Foods for Human Nutrition | Studies were conducted to develop an appropriate household/small-scale enterprise level technique for the production of soy-fortified fermented maize dough (or meal) by comaparing different treatments, processing methods and fortification levels. The effects of fortification method of the Ghanaian traditional fermented maize dough with raw or heat-treated whole soybeans and full-fat soyflour at 0%, 10% and 20% replacement levels, on the rate of fermentation and product quality were investigated. Sensory characteristics, trypsin inhibitor activity, amino acid pattern, proximate composition and hot paste viscosity were used as the indices of quality. Addition of whole soybeans to maize before milling and fermentation reduced the fermentation time by 60% while increasing the protein content by 24% and 70% respectively for 10% and 20% levels of fortification. A significant improvement was also achieved in the amino acids pattern of the fortified dough. However, raw whole soybeans imparted an undesirable color and beany flavor and an appreciable concentration of trypsin inhibitor activity (TIA) to the dough. Boiling soybeans for 20 min before incorporation into the maize for milling and fermentation was found necessary for desirable flavor and low levels od TIA. Little or no changes in the pasting viscosity characteristics occurred in samples containing boiled soybeans, while the usual method of fortifying maize meal with soy flour was found to severely depress the pasting viscosity characteristics and drastically reduced the acidity of the fermented dough. Based on the findings of the study, the most appropriate technique for the production of soy-fortified high protein fermented maize dough has been suggested to involve incorporation of boiled whole soybeans in soaked maize before milling and fermentation for improved sensory characteristics, enhanced nutritive value and optimal functional properties. | Open |
| Brugha R.; Kevany J. | Determinants of nutrition status among children in the eastern region of Ghana | 1995 | Journal of Tropical Pediatrics | A cross-sectional survey of children's weights was included in a population study which was designed to identify and measure the determinants of immunization status of 12-18-month-old children of 294 mothers in the Eastern Region of Ghana. Birth weight, among a subgroup of 91 children where this information was available from the mothers' Road To Health cards, was the variable with which current weight-for-age Z scores was most strongly associated (r=0.38). Associations of current weight-for-age with certain socio-economic variables, at or close to statistically significant levels, corresponded with similar or stronger associations of birth weight with these same socio-economic variables. Cross-sectional studies of young children, to identify associations and possible determinants of nutrition status, are more informative where there is a high Road To Health card coverage and where birth weights have been recorded on these cards. © 1994 Oxford University Press. | Open |
| Annan N.T.; Plahar W.A. | Development and quality evaluation of a soy-fortified Ghanaian weaning food | 1995 | Food and Nutrition Bulletin | Appropriate process characteristics and blend formulations were developed for the preparation of a high protein-energy weaning food, FRI Weaner, using maize, soya beans, groundnut, and milk powder. Its quality was evaluated in terms of its nutritive value. FRI Weaner had physical and sensory characteristics similar to those of a traditional Ghanaian cereal-based weaning food but was of superior nutritional quality. Nutritional information is detailed and the authors conclude that the blend can be used as an ideal weaning food to improve the nutrition status of Ghanaian children and help solve problems associated with protein-energy malnutrition. | Open |
| Armar-Klemesu M.; Rikimaru T.; Kennedy D.O.; Harrison E.; Kido Y.; Takyi E.E.K. | Household food security, food consumption patterns, and the quality of children's diet in a rural northern Ghana community | 1995 | Food & Nutrition Bulletin | Twenty households were studied to ascertain evidence of seasonality and the relationship between household food-security status and the food and nutrient intakes of preschool children. Nutrient intakes were calculated and, diet quality was assessed by quantitative and descriptive analysis. Mean daily intakes of selected food items reflected an over-dependence on cereals and a minimal consumption of animal products. The consumption of vegetables, and nutrient intakes increased during the post-harvest season. There was a significant association between household food-security status and the intakes of calories and protein. Calorie and protein intakes appear to have been more influenced by household food availability and were subject to less seasonal fluctuation, while the reverse held true for the micronutrients. In addition, household food security did not necessarily ensure the quality of children's diets in an area where food consumption patterns are monotonous. -from Authors | Open |
| Glewwe P.; Jacoby H.G. | An economic analysis of delayed primary school enrollment in a low income country: the role of early childhood nutrition | 1995 | Review of Economics & Statistics | This paper investigates why children in low income countries often delay primary school enrollment, despite the prediction of human capital theory that schooling will begin at the earliest possible age. It focuses on the hypothesis that delays are rational responses to early childhood malnutrition. The tests these alternative hypotheses using recent data from Ghana estimates, which address a number of previously ignored econometric issues, firmly support the hypothesis that early childhood malnutrition causes delayed enrollment. They find little or no support for alternative explanations based on borrowing constraints and the rationing of places in school. -Authors | Open |
| Brugha R.; Kevany J. | Determinants of nutrition status among children in the eastern region of Ghana | 1994 | Journal of Tropical Pediatrics | A cross-sectional survey of children's weights was included in a population study which was designed to identify and measure the determinants of immunization status of 12-18-month-old children of 294 mothers in the Eastern Region of Ghana. Birth weight, among a subgroup of 91 children where this information was available from the mothers' Road To Health cards, was the variable with which current weight-for-age Z scores was most strongly associated (r=0.38). Associations of current weight-for-age with certain socio-economic variables, at or close to statistically significant levels, corresponded with similar or stronger associations of birth weight with these same socio-economic variables. Cross-sectional studies of young children, to identify associations and possible determinants of nutrition status, are more informative where there is a high Road To Health card coverage and where birth weights have been recorded on these cards. © 1994 Oxford University Press. | Open |
| Ferguson E.L.; Gibson R.S.; Opare-Obisaw C.; Ounpuu S.; Thompson L.U.; Lehrfeld J. | The zinc nutriture of preschool children living in two African countries | 1993 | Journal of Nutrition | The zinc nutrition of rural Malawian children (24 females, 33 males; age 62 ± 10 mo) consuming cereal-based diets was compared with that of rural Ghanaian children (43 females, 33 males; age 59 ± 10 mo) consuming cereals or starchy staples, using hair zinc concentrations, growth and body composition indices, and dietary intakes. Intakes of energy, protein, Ca, Zn, dietary fiber and phytate at two seasons of the year were estimated from 3-d weighed food records, using analyzed and literature food composition values. The mean annual intakes of energy (5419 ± 1081 vs. 4698 ± 885 kJ), protein (31.8 ± 7.0 vs. 24.1 ± 6.8 g), Zn (7.4 ± 1.9 vs. 5.1 ± 1.1 mg) and phytate (1899 ± 590 vs. 604 ± 151 mg), and the mean molar ratios of [phytate]/[Zn] and [Ca] x [phytate]/[Zn] mmol per MJ (25 ± 4 vs. 12 ± 2 and 44 ± 13 vs 20 ± 8 mmol/MJ), were higher for Malawian than for Ghanaian children. More Malawian than Ghanaian children had [phytate]/[Zn] ≥ 15 (72% vs. 0%) and were severely stunted (57 vs. 28%). Ninety-four percent of children in Malawi and 83% in the Ghanaian village of Slepor had low hair Zn concentrations (<1.68 μmol/g) compared with 39% in Gidantuba, Ghana. In Gidantuba, children with low hair Zn concentrations had low upper-arm- muscle-area-for-age and upper-arm-muscle-area-for-height Z-scores. The high intakes of phytic acid relative to zinc in Malawi suggest that these children were at greater risk for inadequate zinc nutriture than their Ghanaian counterparts. | Open |
| Ocloo E. | Chronic undernutrition and the young. | 1993 | The Proceedings of the Nutrition Society | The problem of chronic undernutrition and its direct and indirect effects, especially in Africa are multi-faceted and integrated, and have roots in socio-economic, cultural, environmental, political, technological and other factors. In this scenario, the immediate victims are children, especially those under 5 years of age. There seems to be a vicious cycle of maternal malnutrition, infant death and high fertility as well as malnutrition, ill-health and low agricultural productivity in Africa. These make the situation serious and chronic. It means that the structures which bring about this problem need critical re-evaluation, particularly in terms of increased agricultural productivity, both in quantity and quality, and normal nutritional status. Increased production of staple and supplementary foods is now a widespread need in the African continent, as is population control. Experience has shown that nutrition is a complex and interacting phenomenon which is very much influenced by policies that affect socio-economic structures. Since the problem of hunger and malnutrition is a structural problem, nutrition may be regarded as an integral part of development planning. Higher priority may be given, therefore, to food and nutrition planning and their subsequent integration into national development plans, especially by taking into consideration the vulnerable groups which are the children in the population (Idusogie, 1977). | Open |
| Lado C. | Female labour participation in agricultural production and the implications for nutrition and health in rural Africa | 1992 | Social Science and Medicine | The broad objectives of this paper are: firstly, to examine the initial impact of colonialism on food production by women, by considering their role and activity patterns within the household in terms of rights, obligations, exchanges, allocation of resources and responsibilities and the division of labour in the selected African Societies of the Luo, Kikuyu and Luhya (Kenya), Ewe and Kusasi (Ghana), Mandinka (The Gambia), Yoruba (Nigeria) and Azande (Sudan). These ethnic groups used as examples were mainly selected on the basis of their predominance and availability of data in these countries lying in the Sub-Saharan Africa having similar historical roots of the British colonial policies. Secondly, some of the possible social, economic and biological effects or implications on the changes in rural women's work in the chosen case studies in Africa are elucidated. It has been hypothesized that the development process in rural Africa has marginalized women (with varying degrees) in the subsistence sector, reducing their productivity and control over resources; and that women's total work burden has relatively increased, a phenomenon which can be understood as an integral process of capital penetration and accumulation. These changes may have significant implications for nutrition and health affecting the overall levels of food production. Although the selected illustrations do not represent the full range of possibilities in Sub-Saharan Africa, the data on the gender roles and workpatterns and the different changing ways do indicate that the women's role in food production has profound implications for socio-economic development in general and nutrition and health in particular with much wider applicability. In fact no such cross-sectional study has been conducted in rural Africa. It is generally concluded that any consideration of women's agricultural production should not neglect the structural bases of their inequality, and the policies can be inadequate if they overlook the relationship between the subsistence and commercial sectors and the women's role in each. In effect, the relative and absolute losses in women's food production and incomes bear immediately on the food crisis of many of the Sub-Saharan African countries, and that the current policies for the food crisis are likely to fail unless there is an improvement of the data base on women's and men's specific food production activities, processing and marketing for use in policy formulation and implementation. Indeed, the integration of women into the development process should be sensitive to and cognizant of their needs, contributions and potentials in Sub-Saharan Africa. © 1992. | Open |
| Owusu W.B.; Lartey A. | Growth monitoring: experience from Ghana | 1992 | Food & Nutrition Bulletin | This study investigated mothers' interpretation of growth charts as they attended child welfare clinics in the greater Accra region of Ghana. Factors impeding attendance at the clinics included business, forgetting, travel, and lack of knowledge. Nearly 40% of the mothers had no idea of the meaning or purpose of growth charts. Efforts to enhance the awareness of mothers and children's caretakers must be intensified. -from Authors | Open |
| Rankins J.; Green N.L. | Feasibility of incorporating a social marketing nutrition module for child survival into education curricula in ghana | 1991 | Ecology of Food and Nutrition | The feasibility of infusing social marketing teaching modules for child survival into school curricula was investigated in Ghana. The topic of the social marketing teaching module was Preventing Protein-Energy Malnutrition for Child Survival (PEMCOM). The module was developed around a nationally endorsed weaning food, “Weanimix”. PEMCOM interactive lectures were conducted with students at Specialist Teacher Training College, Winneba to test the module. The students had no prior training in social marketing. Even so, 83% indicated that the three two-hour interactive training sessions provided sufficient foundation for them to utilize the social marketing technique in teaching. When asked about the appropriateness of the module for use in Junior Secondary Schools, 84% of students ranked the module as good or excellent. All students indicated that they would utilize the social marketing strategy in teaching and that if the approach were applied widely in Ghana. it would make an imDortant contribution to the reduction of PEM. © 1991, Taylor & Francis Group, LLC. All rights reserved. | Open |
| Brakohiapa L. | PROLONGED BREASTFEEDING | 1988 | The Lancet | Not Available | Open |
| Pielemeier N.R. | Mothers' knowledge related to child health and nutrition in Ghana and Lesotho | 1985 | Journal of Tropical Pediatrics | Not Available | Open |
| Tripp R.B. | Farmers and traders: Some economic determinants of nutritional status in Northern Ghana | 1981 | Journal of Tropical Pediatrics | A study was undertaken to delineate the relationship between the economic pursuits carried out by men and women in a farming community in northern Ghana and the nutritional status of their children. Anthropometric measurements were taken for 187 preschool children and data were collected on a large number of socio-economic factors associated with the children's parents. Although certain indicators of farm resources and investment were positively correlated with above average nutritional status, the most significant differences were noted with respect to the trading activities of the parents. The group of children which exhibited the highest proportion above the median weight for age were those whose mothers had their own income from trading. The implications of these findings are discussed. © 1981 Oxford University Press. | Open |
| Shute J.C.M. | International co-operation in agricultural development: Some administrative dimensions | 1980 | Agricultural Administration | This account of a successful eight-year link in agriculture, home science, nutrition and food science between the University of Ghana and the University of Guelph describes the project's origins, provisions and achievements and more particularly the administrative approaches developed to promote its objectives. © 1980. | Open |
| Dagadu J.M. | Distribution of carotene and vitamin A in liver, pancreas and body fat of Ghanaians | 1967 | British Journal of Nutrition | The carotene and vitamin A levels of liver, pancreas and body fat were determined in seventeen Ghanaians coming from areas where carotene-rich foods were freely available. 2. The liver was confirmed as the main storehouse of vitamin A, and vitamin A values for it were exceptionally high. Values for the other tissues were not higher than average. 3. In the study the carotene and vitamin A concentrations in the liver were higher in the females than in the males. 4. Under the conditions of high intake of carotene-rich foods, carotene was found to be distributed more evenly in various tissues than vitamin A. © 1967, The Nutrition Society. All rights reserved. | Open |
| ORRACA-TETTEH R. | The place of food science and technology in the campaign against malnutrition. Problems and some solutions: Ghana. | 1961 | The Proceedings of the Nutrition Society | Not Available | Open |
| Mayer J. | Ghana: A Challenge To Nutritionists | 1959 | Nutrition Reviews | Not Available | Open |
