Academic literature on the topic 'Infants – Nutrition – Ghana'

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.

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.

Background: This article summarizes a presentation given at the 2017 Dairy for Global Nutrition Conference in Boise, Idaho. Objective: To give an overview of the pattern of early growth faltering in developing countries and examine the implications of the iLiNS-DYAD randomized trial in Ghana. Methods: The pattern of growth faltering in developing countries was outlined. In Ghana, 1320 women ≤ 20 weeks of pregnancy were assigned to 20 g/d small-quantity lipid-based nutrient supplement (SQ-LNS; LNS group) or multiple micronutrients (MMNs) containing 22 and 18 vitamins and minerals, respectively, until 6 months postpartum, or iron and folic acid (IFA) until delivery, and thereafter placebo until 6 months postpartum. Infants in the LNS group were assigned to SQ-LNS from 6 to 18 months of age. Results: Mean anthropometric z-scores for infants in developing countries start below the World Health Organization standard at 1 month of age, and generally decline until about age of 24 months. In the Ghana trial, mean (SD) birth weight (g) was greater ( P = .044) for the LNS group (3030 [414]) than the IFA group (2945 [442]) but not the MMN group (3005 [435]). Among primiparous mothers, the LNS group had significantly greater mean birth length, weight, and head circumference than the IFA or MMN group. By 18 months of age, the mean length (95% confidence interval) for the LNS group was +0.6 (0.1-1.1) cm greater than for the IFA group and +0.6 (0.1-1.2) cm greater than for the MMN group. Conclusion: Pre- and post-natal SQ-LNS consumption may improve fetal and infant growth in similar populations.

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.

ABSTRACT 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.

AbstractObjectiveTo 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.DesignThe 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.SettingGhana.SubjectsChildren (n 822) aged 6–23 months.ResultsThe 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).ConclusionsThe 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.

Objective: The study was conducted with the objective of assessing the possible associations between dietary diversity, nutrient intakes and young child nutritional status in Ghana. Material & Methods: A cross-sectional survey involving one hundred mothers with young children between the ages of 6 and 18 months was conducted using a combination of methods. Structured interview using questionnaire, dietary assessment and anthropometry were used to collect the data. Dietary diversity was assessed by using food group count. The WHO (1998) recommended daily nutrient needs from complementary foods for infants receiving average breast milk intakes were used to assess the energy and nutrient content of the diets consumed by the children. The WHO (1983) reference was used to assess child nutritional status. The data was analyzed using Statistical Package for Social Science (SPSS) version 16 in Windows. Results: About 16% of the study children were underweight whiles 8% were both stunted and wasted. The mean dietary diversity score was 4.6. Significant differences were observed between dietary diversity groupings and energy/nutrient intakes of the children. Generally, as dietary diversity improved, energy and nutrients intakes also in-creased. Again, dietary diversity was significantly associated with weight-for-age, length-for-age and weight-for-length. As dietary diversity increased, child nutritional status also improved. Children who had low dietary diversity exhibited low scores in terms of weight for age, length for age and weight for length. Conclusion: High dietary diversity improves energy and nutrients intakes, and hence dietary adequacy, as well as child growth and nutrition. Key Words: Dietary Diversity; Nutrient Intakes; Child Nutritional Status DOI: http://dx.doi.org/10.3126/ajms.v2i2.4179 Asian Journal of Medical Sciences 2 (2011) 105-109

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.

ABSTRACT 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 μg 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-for-age 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 &lt; 0.001), WAZ (+0.56; P &lt; 0.001), BMIZ (+0.52; P &lt; 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. This trial was registered at clinicaltrials.gov as NCT00970866.

Background. Iodine deficiency causes maternal hypothyroidism which can lead to growth, cognitive, and psychomotor deficit in neonates, infants, and children. This study examined the iodine status of pregnant women in a periurban setting in Ghana. Methods. This longitudinal study recruited 125 pregnant women by purposeful convenience sampling from the antenatal clinic of the Sefwi Wiawso municipal hospital in Ghana. Urinary iodine concentration (UIC) was estimated by the ammonium persulfate method at an estimated gestational age (EGA) of 11, 20, and 32 weeks. Demographic information, iodized salt usage, and other clinical information were collected using a questionnaire. Results. The prevalence of iodine deficiency among the pregnant women was 47.2% at EGA 11 and 60.8% at both EGA of 20 and 32, whereas only 0.8% of participants not using iodized salt had iodine sufficiency at EGA 32. 18.4%, 20%, and 24% of participants using iodized salt had iodine sufficiency at EGA 11, 20, and 32, respectively. Conclusion. A high prevalence of iodine deficiency was observed among our study cohort.

Incidence, prevalence and determinants of infant diarrhoea and acute respiratory infections (ARI) were examined in 292 infants of HIV positive (HIV-P), HIV negative (HIV-N), and unknown HIV status (HIV-U) women in the Eastern region, Ghana. Incidence of diarrhoea and ARI was 1.0 and 1.2 episodes per child per 100-days at risk, respectively. There was no difference in morbidity by infant feeding mode or maternal HIV status. HIV-P women were more likely to be stressed and to report symptoms of postpartum depression (PPD). Maternal stress and PPD were associated with an increase in the risk of diarrhoea. Among HIV-P women only, the risk of infant diarrhea increased 3-fold with PPD and 15% for every unit increase of the maternal stress score. Poor maternal nutritional status and illiteracy, and infant male sex were associated with increased risk of diarrhoea and ARI. Maternal stress and postpartum depression should be taken into account when drafting policies and planning interventions to improve infant health, especially in HIV-affected communities.
Le taux, la prévalence et les déterminants de la diarrhée infantile et des infections respiratoires aigues (IRA) ont été examinés chez 292 enfants de mères séropositives, séronégatives ou de statut VIH inconnu dans la région est du Ghana. Les taux de diarrhée et IRA étaient de 1.0 et 1.2 épisodes par enfant par 100 jours d'exposition, respectivement. Le statut VIH de la mère ou le mode d'alimentation des enfants n'avait pas d'effet sur la morbidité de ces maladies. Les mères séropositives avaient plus de tendances d'être stressées et de présenter avec des symptômes de dépression postpartum (DPP). L'augmentation de la diarrhée était associée au stress maternel et au DPP. Parmi les mères séropositives seulement, le risque de la diarrhée infantile a augmenté trois fois avec le DPP et de 15% pour chaque augmentation d'une unité dans le résultat du test de stress maternel. Une prévalence plus élevée de diarrhée et IRA était associée à un mauvais statut nutritionnel, à l'analphabétisme maternel et au sexe de l'enfant, étant plus communs chez les garçons. Le stress maternel, la dépression postpartum et d'autres facteurs devront être pris en considération lors de l'esquisse de politiques et de plans d'intervention visant à améliorer la santé des enfants, particulièrement dans les communautés touchées par le VIH.

Inappropriate complementary feeding (CF) practices and inadequate nutrient intakes contribute to the high level of malnutrition among children 6-24 months of age in Ghana. In communities where the economy is agricultural-based, interventions aimed at addressing malnutrition among infants and young children may need to focus on both food production and caregivers' nutrition knowledge. The aim of this study was to assess the effectiveness of a combined nutrition and agricultural education intervention, delivered through community health workers and agricultural extension agents, to improve infant and young child diet and growth in the Upper Manya Krobo district of Ghana. The current CF practices, and facilitators and barriers of CF education were identified through in-depth interviews of community health workers (n = 28) and staff of the Ministry of Food and Agriculture (n = 3), as well as three focus group discussions with caregivers (n = 22) of children 6-24 months of age. The Trials of Improved Practices method was used to test the feasibility of potential nutrition education messages. This process guided the development of the subsequent intervention. A cluster-randomised study design was used to compare the feeding practices, nutrient intakes, and growth of infants and young children (n = 367) in two intervention groups (combined nutrition and agricultural education [IE], nutrition education only [NE]), and a control group [CT]. Each child's diet and anthropometric data, and household demographic and agricultural production information were collected at baseline and at three-month intervals for nine months. Food insecurity can influence the types and amounts of food that young children consume, which may then affect their nutritional status and health. Therefore, the level of household food insecurity during the pre-harvest season and its relation with infant morbidity and growth were also assessed (n = 333). The results indicate that in this rural setting, 21.6% of households experienced food insecurity in the previous month. Household food insecurity was associated with respiratory infections in the second half of infancy, but not with diarrhea or stunting. Inclusion of animal source products, fruits, and vegetables in young children's diet was not common in the area. Poverty and maternal time constraints, and lack of teaching materials and language barrier, were identified as challenges to optimal CF practices and provision of CF education, respectively. Almost half of intervention mothers (45%) never attended an education session. Children in the IE were twice as likely to meet the minimum meal frequency compared to the CT children (aOR = 2.62; 95% CI; 1.11, 6.16), but energy, vitamin A, calcium, and iron intakes from complementary foods, and growth indicators did not differ among the three groups. Additionally, children of mothers who attended at least one nutrition education session in the IE group tended to receive the minimum acceptable diet (aOR = 2.30, 95% CI; 0.98, 5.39, p = 0.055) compared to children in the CT group at the end of the study. There were no differences between the two intervention groups, and feeding practices among children in the NE group did not improve at the end of the study. Future education interventions will need to increase the involvement of participants at the development phase of interventions, as a way of improving participation among caregivers of infants and young children.
Des pratiques inappropriées d'alimentation de complément et des apports nutritionnels inadéquats contribuent au taux élevé de malnutrition parmi les enfants de 6 à 24 mois au Ghana. Dans les communautés où l'économie est basée sur l'agriculture, les interventions doivent mettre l'accent sur la production alimentaire et les connaissances des parents ou personnes qui s'occupent d'enfants (PPE) pour réduire la malnutrition chez les nourrissons et les jeunes enfants. Le but de la présente étude est d'évaluer l'efficacité d'une intervention combinée d'éducation nutritionnelle et agricole implémentée à travers des agents de santé communautaire et des agents de vulgarisation agricole pour améliorer l'alimentation et la croissance des nourrissons et des jeunes enfants dans la zone de Upper Manya au Ghana. Les pratiques d'alimentation de complément ainsi que les barrières et facilitateurs à l'éducation sur l'alimentation de complément ont été identifiées aux travers d'entrevues approfondies avec les agents de santé communautaire (n=28) et le personnel du ministère de l'alimentation et de l'agriculture (n=3) et à travers trois groupes de discussions avec les PPE (n=22) d'enfants de 6 à 24 mois. La méthode des essais pour de meilleures pratiques (Trials of Improved Practices method) a été utilisée pour évaluer la faisabilité de potentiels messages d'éducation nutritionnelle. Ce processus a guidé le développement de l'intervention ultérieure. Une étude randomisée par grappes a permis de comparer les pratiques d'alimentation, les apports nutritionnels et la croissance des nourrissons et des jeunes enfants (n=367) dans deux groupes d'intervention (éducation nutritionnelle et agricole [IE]; éducation nutritionnelle seule [NE]) et un groupe contrôle [CT]. L'alimentation et les données anthropométriques de chaque enfant, les données démographiques des ménages ainsi que de l'information sur la production agricole ont été recueillies à l'étude de base puis à trois mois d'intervalle pendant neuf mois. L'insécurité alimentaire peut avoir une influence sur le type et la quantité d'aliments consommés par les jeunes enfants, ce qui peut affecter leur état nutritionnel et de santé. Par conséquent, le niveau d'insécurité alimentaire des ménages avant les récoltes et sa relation avec la morbidité et la croissance des nourrissons ont été évalués (n=333). Les résultats indiquent que dans ce milieu rural, 21,6% des ménages étaient en' insécurité alimentaire. L'insécurité alimentaire des ménages été associée à des infections respiratoires dans la deuxième moitié de la petite enfance, mais pas à la diarrhée ni au retard de croissance. L'utilisation des aliments de source animale, des fruits et légumes dans l'alimentation des jeunes enfants n'était pas une habitude dans cette région. La pauvreté et les contraintes de temps des mères, ainsi le manque de matériel éducatif et les barrières linguistiques ont été identifiés comme des défis à des pratiques d'alimentation complémentaire optimales et à l'éducation nutritionnelle, respectivement. Il était deux fois plus probable que les enfants dans le groupe IE satisfassent les recommandations minimales de fréquence alimentaire que les enfants du groupe CT (aOR = 2.62; 95% CI; 1.11, 6.16). Par contre, aucune différence n'a été trouvée dans les apports en énergie, en vitamine A, en calcium et en fer ni dans les indicateurs de croissance entre les trois groupes. Par ailleurs, les enfants des mères qui ont assisté à au moins une session d'éducation nutritionnelle dans le groupe IE avaient tendance à recevoir une alimentation minimalement acceptable (aOR = 2.30, 95% CI; 0.98, 5.39, p = 0.055) comparativement aux enfants du groupe CT à la fin de l'étude. La participation à l'intervention été faible parmi les mères. Les futures interventions en éducation devront accroître l'implication des participants dès la phase de conception de celles-ci afin d'améliorer la participation des PPE des nourrissons et des jeunes enfants.

Low income is a barrier to optimal feeding practices of infants and young children (IYC). Microcredit programs for rural Ghanaian women aim to increase incomes, which may improve the quantity and quality of foods given to IYC. This study examined (1) the association between a mother's participation in a microcredit-only program and IYC dietary quality and nutritional status, (2) factors influencing IYC feeding among mothers, and (3) factors influencing the incorporation of nutrition education within a microcredit program. Participants included 102 active microcredit (MC) member mothers and 102 non-microcredit (NMC) member mothers and their youngest child (6-23 mo). Information was collected on IYC feeding practices, length, and weight, and household socio-demographic characteristics. Focus group discussions were conducted with 6 NMC mothers and 15 MC mothers. Individual semi-structured interviews were conducted with 5 staff associated with the MC program. A mother's participation in MC was positively associated with her child meeting minimum dietary diversity recommendations. Compared to the NMC group, IYC in the MC group met this indicator more often and consumed more legumes and nuts, and dairy products (p<0.05). There were no differences in nutritional status after adjusting for covariates. NMC mothers cited family as their main influence on IYC feeding practices while MC mothers cited health workers as most influential and reported that loans increased their financial independence but had little to no impact on IYC feeding practices. Barriers to incorporating nutrition education in a MC program included high staff caseload, lack of external training, and low priority status. Private sector activities such as MC may play a role in improving the diet of IYC in Ghana; however, added nutrition education may be necessary to see improvements in child growth. Long-term partnerships between rural banks and nutrition-related organizations are needed to ensure sustainability of education components over time.
Un faible revenu est une barrière aux pratiques d'alimentation optimales des nourrissons et jeunes enfants (NJE). Les programmes de microcrédit pour les femmes ghanéennes vivant en milieu rural ont pour objectif d'accroitre leur revenu, ce dernier pouvant améliorer la quantité et qualité des aliments offerts aux NJE. Cette étude a examiné (1) l'association entre la participation d'une mère à un programme de microcrédit et la qualité alimentaire et l'état nutritionnel des NJE, (2) les facteurs ayant une influence sur les pratiques d'alimentation des NJE parmi les mères, et (3) les facteurs ayant une influence sur l'incorporation d'activités d'éducation nutritionnelle dans un programme de microcrédit. Des mères membres (MC; n=102) et non-membres (NMC; n=102) d'un programme de microcrédit et leur plus jeune enfant (6-23 mois) ont participé à l'étude. De l'information a été recueillie sur les pratiques d'alimentation des NJE, sur leur taille et leur poids ainsi que sur les caractéristiques sociodémographiques des ménages. Des groupes de discussion ont été menés avec 6 mères NMC et 15 mères MC. Des entrevues semi-structurées ont été menées auprès du personnel associé à un programme de microcrédit (n=5). La participation d'une mère à un programme de microcrédit a été positivement associée aux recommandations minimales de diversification alimentaire chez son enfant. En comparaison au groupe NMC, les NJE du groupe MC ont plus souvent atteint ces recommandations et ont consommé davantage de légumineuses et noix et de produits laitiers (p<0.05). Aucune différence dans l'état nutritionnel entre les groupes n'a été trouvée après avoir pris en compte les covariables pertinentes dans l'analyse. Les mères NMC ont cité la famille comme la plus importante influence sur les pratiques d'alimentation de leurs enfants pendant que les mères MC ont cité les professionnels de la santé. Ces dernières ont également rapporté que les prêts ont accru leur indépendance financière mais ont eu peu ou pas d'impact sur les pratiques d'alimentation des leurs enfants. Une clientèle nombreuse, un manque de formation externe, et une faible priorité constituaient les barrières à l'incorporation d'activités d'éducation nutritionnelle dans le programme de microcrédit. Les activités du secteur privé, tel que le microcrédit, peuvent jouer un rôle dans l'amélioration de l'alimentation des NJE au Ghana, par contre l'ajout d'activités d'éducation nutritionnelle pourrait s'avérer nécessaire pour voir des améliorations dans leur croissance. Des partenariats sur le long-terme entre les banques rurales et des organisations travaillant dans le domaine de la nutrition sont nécessaires pour assurer la viabilité des composantes d'éducation à travers le temps.

Ghana subscribed to the global target of reaching at least 50% of exclusive breastfeeding in the first six months of birth by the year 2030. Policies and programmes to promote exclusive breastfeeding have been formulated and implemented in the country. In spite of these efforts, existing evidence showed that the rate of exclusive breastfeeding in the first six months post-delivery has been declining over the past decade. It was therefore important to understand behavioural factors that influence exclusive breastfeeding among teenage-mothers and propose a behavioural conceptual model based on the understanding of exclusive breastfeeding from the perspective of the teenage-mothers and their social environments. The study was conducted in three phases using multistrand mixed methods within the pragmatism philosophical framework. The Theory of Planned Behaviour and the six steps framework for developing models to address public health issues were used as frameworks in the study. In the first phase, the researcher used qualitative exploratory descriptive design to gain an understanding of the behavioural determinants of exclusive breastfeeding from the perspective of teenagers aged between 13 - 19 years attending antenatal care services at public facilities. Data were generated through focus group discussions and analysed using Group-level thematic and content analysis. In the second phase, longitudinal descriptive correlational designs were used to establish the relationships between the exclusive breastfeeding intentions during the prenatal period and actual breastfeeding practices at six months post-delivery. Structured questionnaires were used to collect data during the last visit of antenatal care visits and six months post-delivery. Data generated were analysed through descriptive inferential statistics. In the last phase, the researcher used meta-inferences to identify the key concepts of conceptual model from the integrated qualitative and quantitative results. Theoretical triangulations were used to define and establish relationships between the concepts and to structure the conceptual model. The integrated results of the two phases of the study showed that exclusive breastfeeding practices among teenage-mothers within the social context of Ghana are determined by certain personal and social related behavioural factors. The approval of the exclusive breastfeeding practice by the teenagers’ mothers and nurses/midwives’ capabilities to provide effective breastfeeding education were the strongest determinants of exclusive breastfeeding up to six months among teenage-mothers in Ghana. From these results, the researcher proposed an integrated behavioural conceptual model that provides an understanding of exclusive breastfeeding practice and the process of promoting exclusive breastfeeding among teenage-mothers in the social context of Ghana. The findings of this study have implications for public health policy-makers, health services managers, health sciences education and further research.
Health Studies
D. Lit. et Phil. (Health Studies)

This cross-sectional exploratory and descriptive quantitative study explored the factors that impact on feeding practices of infants 0-12 months, encountered in the Child Welfare Clinic in Tema Manhean Health Centre and to determine the possible factors that lead to malnutrition. The population for this study comprised all infants who attended the Child Welfare Clinic at the Tema Manhean Health Centre. Three hundred and ninety infants participated in this study. Data was collected by means of a structured questionnaire and analysed using the Statistical Package for the Social Sciences (SPSS) Version 20. Findings of the study revealed that a larger number of the mothers were still breastfeeding at the time of data collection. All infants aged six months or older were given complementary foods. Some of the factors found to be associated with infant malnutrition included education of mother, employment status of mother, marital status, cultural practices and parity.
Health Studies
M.A.(Public Health)