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Awuuh, Vincent Adocta, Collins Afriyie Appiah, and Faustina O. Mensah. "Impact of nutrition education intervention on nutritional status of undernourished children (6-24 months) in East Mamprusi district of Ghana." Nutrition & Food Science 49, no. 2 (March 11, 2019): 262–72. http://dx.doi.org/10.1108/nfs-05-2018-0134.
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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.
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Laar, Amos, Agnes Kotoh, Megan Parker, Peiman Milani, Charlotte Tawiah, Shobhita Soor, Jacob P. Anankware, et al. "An Exploration of Edible Palm Weevil Larvae (Akokono) as a Source of Nutrition and Livelihood: Perspectives From Ghanaian Stakeholders." Food and Nutrition Bulletin 38, no. 4 (October 2, 2017): 455–67. http://dx.doi.org/10.1177/0379572117723396.
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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.
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Adu-Afarwuah, Seth. "From the Field: Improving Fetal and Infant Growth in Vulnerable Populations." Food and Nutrition Bulletin 39, no. 2_suppl (May 7, 2018): S60—S68. http://dx.doi.org/10.1177/0379572118773035.
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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.
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Tano-Debrah, Kwaku, Firibu Kwesi Saalia, Shibani Ghosh, and Masashi Hara. "Development and Sensory Shelf-Life Testing of KOKO Plus: A Food Supplement for Improving the Nutritional Profiles of Traditional Complementary Foods." Food and Nutrition Bulletin 40, no. 3 (June 26, 2019): 340–56. http://dx.doi.org/10.1177/0379572119848290.
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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.
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Adu-Afarwuah, Seth, Rebecca T. Young, Anna Lartey, Harriet Okronipa, Per Ashorn, Ulla Ashorn, Brietta M. Oaks, Mary Arimond, and Kathryn G. Dewey. "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." Journal of Nutrition 149, no. 1 (January 1, 2019): 149–58. http://dx.doi.org/10.1093/jn/nxy225.
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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.
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Issaka, Abukari I., Kingsley E. Agho, Penelope Burns, Andrew Page, and Michael J. Dibley. "Determinants of inadequate complementary feeding practices among children aged 6–23 months in Ghana." Public Health Nutrition 18, no. 4 (May 20, 2014): 669–78. http://dx.doi.org/10.1017/s1368980014000834.
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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.
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Nti, Chistina Antwiwaa. "Dietary Diversity is Associated with Nutrient Intakes and Nutritional Status of Children in Ghana." Asian Journal of Medical Sciences 2, no. 2 (September 17, 2011): 105–9. http://dx.doi.org/10.3126/ajms.v2i2.4179.
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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
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Agyei, Emmanuel Amoako, Stephen Kofi Afrifa, Adam Munkaila, Patience Kanyiri Gaa, Eugene Dogkotenge Kuugbee, and Victor Mogre. "Income Level but Not Nutrition Knowledge Is Associated with Dietary Diversity of Rural Pregnant Women from Northern Ghana." Journal of Nutrition and Metabolism 2021 (July 12, 2021): 1–7. http://dx.doi.org/10.1155/2021/5581445.
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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.
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Adu-Afarwuah, Seth, Anna Lartey, Harriet Okronipa, Per Ashorn, Mamane Zeilani, Janet M. Peerson, Mary Arimond, Stephen Vosti, and Kathryn G. Dewey. "Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana." American Journal of Clinical Nutrition 101, no. 4 (February 11, 2015): 835–46. http://dx.doi.org/10.3945/ajcn.114.091546.
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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 < 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. This trial was registered at clinicaltrials.gov as NCT00970866.
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Simpong, David Larbi, Yaw Asante Awuku, Kenneth Kwame Kye-Amoah, Martin Tangnaa Morna, Prince Adoba, Stephen Kofi Anin, and Patrick Adu. "High Iodine Deficiency among Pregnant Women in Periurban Ghana: A Hospital-Based Longitudinal Study." Journal of Nutrition and Metabolism 2018 (June 3, 2018): 1–5. http://dx.doi.org/10.1155/2018/9706805.
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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.
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Danquah, Ina, Ekkehart Dietz, Philipp Zanger, Klaus Reither, Peter Ziniel, Ulrich Bienzle, and Frank P. Mockenhaupt. "Reduced Efficacy of Intermittent Preventive Treatment of Malaria in Malnourished Children." Antimicrobial Agents and Chemotherapy 53, no. 5 (February 17, 2009): 1753–59. http://dx.doi.org/10.1128/aac.01723-08.
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ABSTRACT 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.
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Zotor, F. B., B. Ellahi, and P. Amuna. "Applying the food multimix concept for sustainable and nutritious diets." Proceedings of the Nutrition Society 74, no. 4 (August 11, 2015): 505–16. http://dx.doi.org/10.1017/s0029665115002372.
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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.
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Kumordzie, Sika M., Seth Adu-Afarwuah, Rebecca R. Young, Brietta M. Oaks, Solace M. Tamakloe, Maku E. Ocansey, Harriet Okronipa, Elizabeth L. Prado, and Kathryn G. Dewey. "Maternal–Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Does Not Affect Child Blood Pressure at 4–6 Y in Ghana: Follow-up of a Randomized Trial." Journal of Nutrition 149, no. 3 (February 11, 2019): 522–31. http://dx.doi.org/10.1093/jn/nxy285.
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ABSTRACT Background In the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana trial, prenatal small-quantity lipid-based nutrient supplements (LNSs) had a positive effect on birth weight. Birth weight may be inversely related to blood pressure (BP) later in life. Objectives We examined the effect of the intervention on BP at 4–6 y of age, and maternal and child factors related to BP. Methods The iLiNS-DYAD-Ghana study was a partially double-blind, randomized controlled trial which assigned women (n = 1320) ≤20 weeks of gestation to daily supplementation with: 1) iron and folic acid during pregnancy and 200 mg Ca for 6 mo postpartum , 2) multiple micronutrients during pregnancy and postpartum, or 3) LNSs during pregnancy and postpartum plus LNSs for infants from 6 to 18 mo of age. At 4–6 y of age (n = 858, 70% of live births), we compared BP, a secondary outcome, between non-LNS and LNS groups and examined whether BP was related to several factors including maternal BP, child weight-for-age z score (WAZ), and physical activity. Results Non-LNS and LNS groups did not differ in systolic (99.2 ± 0.4 compared with 98.5 ± 0.6 mm Hg; P = 0.317) or diastolic (60.1 ± 0.3 compared with 60.0 ± 0.4 mm Hg; P = 0.805) BP, or prevalence of high BP (systolic or diastolic BP ≥90th percentile of the US National Heart, Lung, and Blood Institute reference: 31% compared with 28%; P = 0.251). BP at 4–6 y of age was positively related to birth weight; this relation was largely mediated through concurrent WAZ in a path model. Concurrent WAZ and maternal BP were the factors most strongly related to child BP. Conclusions Despite greater birth weight in the LNS group, there was no intervention group difference in BP at 4–6 y. In this preschool population at high risk of adult hypertension based on BP at 4–6 y, high maternal BP and child WAZ were key factors related to BP. This trial was registered at clinicaltrials.gov as NCT00970866.
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Okronipa, Harriet, Mary Arimond, Charles D. Arnold, Rebecca R. Young, Seth Adu-Afarwuah, Solace M. Tamakloe, Maku E. Ocansey, et al. "Exposure to a slightly sweet lipid-based nutrient supplement during early life does not increase the level of sweet taste most preferred among 4- to 6-year-old Ghanaian children: follow-up of a randomized controlled trial." American Journal of Clinical Nutrition 109, no. 4 (March 27, 2019): 1224–32. http://dx.doi.org/10.1093/ajcn/nqy352.
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ABSTRACT Background The impact of feeding a slightly sweet nutrient supplement early in life on later sweet taste preference is unknown. Objective We tested the hypothesis that the level of sucrose most preferred by 4–6-y-old children exposed to a slightly sweet lipid-based nutrient supplement (LNS) early in life would not be higher than that of children never exposed to LNS. Design We followed up children born to women (n = 1,320) who participated in a randomized trial in Ghana. In one group, LNS was provided to women on a daily basis during pregnancy and the first 6 mo postpartum and to their infants from age 6 to 18 mo (LNS group). The control groups received daily iron and folic acid or multiple micronutrients during pregnancy and the first 6 mo postpartum, with no infant supplementation (non-LNS group). At age 4–6 y, we randomly selected a subsample of children (n = 775) to assess the concentration of sucrose most preferred using the Monell 2-series, forced-choice, paired-comparison tracking procedure. We compared LNS with non-LNS group differences using a noninferiority margin of 5% weight/volume (wt/vol). Results Of the 624 children tested, most (61%) provided reliable responses. Among all children, the mean ± SD sucrose solution most preferred (% wt/vol) was 14.6 ± 8.6 (LNS group 14.9 ± 8.7; non-LNS group 14.2 ± 8.4). However, among children with reliable responses, it was 17.0 ± 10.2 (LNS group 17.5 ± 10.4; non-LNS group 16.5 ± 10.0). The upper level of the 95% CI of the difference between groups did not exceed the noninferiority margin in either the full sample or those with reliable responses, indicating that the LNS group did not have a higher sweet preference than the non-LNS group. Conclusion Exposure to a slightly sweet nutrient supplement early in life did not increase the level of sweet taste most preferred during childhood. This trial was registered at clinicaltrials.gov as NCT00970866.
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Okronipa, Harriet, Mary Arimond, Rebecca R. Young, Charles D. Arnold, Seth Adu-Afarwuah, Solace M. Tamakloe, Helena J. Bentil, et al. "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." Journal of Nutrition 149, no. 3 (February 15, 2019): 532–41. http://dx.doi.org/10.1093/jn/nxy293.
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ABSTRACT 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. This trial was registered at clinicaltrials.gov as NCT00970866.
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Lartey, Anna, Grace S. Marquis, Robert Mazur, Rafael Perez-Escamilla, Lucy Brakohiapa, William Ampofo, Daniel Sellen, and Seth Adu-Afarwuah. "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." Maternal & Child Nutrition 10, no. 4 (August 20, 2012): 604–16. http://dx.doi.org/10.1111/j.1740-8709.2012.00441.x.
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Choi, Sunhea, Ho Ming Yuen, Reginald Annan, Michele Monroy-Valle, Trevor Pickup, Nana Esi Linda Aduku, Andy Pulman, Carmen Elisa Portillo Sermeño, Alan A. Jackson, and Ann Ashworth. "Improved care and survival in severe malnutrition through eLearning." Archives of Disease in Childhood 105, no. 1 (July 30, 2019): 32–39. http://dx.doi.org/10.1136/archdischild-2018-316539.
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BackgroundScaling 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.ObjectiveTo 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.DesignA 2-year preintervention and postintervention study between January 2015 and February 2017.SettingEleven healthcare facilities: nine in Ghana, one in Guatemala, and one in El Salvador.InterventionScenario-based eLearning course ‘Caring for infants and young children with severe malnutrition’.Main outcome measuresIdentification of children with SAM, quality of care, case-fatality rate.MethodsMedical 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.ResultsPostintervention 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).ConclusionsHigh 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.
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Prado, Elizabeth L., Elizabeth Yakes Jimenez, Stephen Vosti, Robert Stewart, Christine P. Stewart, Jérôme Somé, Anna Pulakka, et al. "Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso." BMJ Global Health 4, no. 1 (January 2019): e001155. http://dx.doi.org/10.1136/bmjgh-2018-001155.
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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.
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Kumordzie, Sika M., Harriet Okronipa, Mary Arimond, Seth Adu-Afarwuah, Maku E. Ocansey, Rebecca R. Young, Helena J. Bentil, Solace M. Tamakloe, Brietta M. Oaks, and Kathryn G. Dewey. "Maternal and child factors associated with child body fatness in a Ghanaian cohort." Public Health Nutrition 23, no. 2 (July 25, 2019): 309–18. http://dx.doi.org/10.1017/s1368980019001745.
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AbstractObjective: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.
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Armar-Klemesu, Margaret, Sarah Osei-Menya, Sawudatu Zakariah-Akoto, Alison Tumilowicz, James Lee, and Christine Hotz. "Using Ethnography to Identify Barriers and Facilitators to Optimal Infant and Young Child Feeding in Rural Ghana: Implications for Programs." Food and Nutrition Bulletin 39, no. 2 (February 27, 2018): 231–45. http://dx.doi.org/10.1177/0379572117742298.
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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.
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Umniyati, Helwiah. "Sprinkles: Strategi Baru Pengendalian Defisiensi Zat Besi dan Anemia pada Bayi dan Anak di Negara Berkembang." Kesmas: National Public Health Journal 5, no. 5 (April 1, 2011): 195. http://dx.doi.org/10.21109/kesmas.v5i5.126.
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Anemia defisiensi besi pada bayi dan anak-anak merupakan masalah gizi di negara-negara berkembang termasuk di Indonesia, sementara program suplementasi dengan sirup atau tetes besi folat tidak efektif sehingga kepatuhannya rendah akibat keluhan rasa logam, pewarnaan gigi, gangguanlambung, dan potensi overdosis. Untuk meningkatkan kepatuhan suplementasi, telah dikembangkan formula micronutrient sprinkles, suatu metode baru fortifikasi zat besi yang dienkapsulasi dalam bentuk serbuk pada makanan tambahan berisi multi vitamin dan mineral. Studi kepustakaan ini bertujuan untuk mengetahui efektivitas pengobatan anemia pada bayi dan anak dengan formula sprinkles. Studi ini didasarkan pada rangkaian studi efikasi di Ghana dan beberapa negara lainnya. Hasil studi membuktikan bahwa suplementasi besi dengan sprinkles mempunyai efektivitas yang sama dengan sirup atau tetes besi dalam mengobati anemia dengan tingkat kepatuhannya sangat tinggi. Di Indonesia, sprinkles besi telah banyak digunakan, termasuk untuk meningkatkan status gizi anak-anak pada saat bencana. Kementerian Kesehatan RI melalui Badan Penelitian dan Pengembangan Gizi Bogor telah mengembangkan sprinkles dengan nama Taburia yang telah diuji efikasi di Jakarta. Saat ini Taburia digunakan di Provinsi Sumatera Selatan, Sumatera Utara, Nusa Tenggara Barat, Nusa Tenggara Timur, Sulawesi Selatan, dan Kalimantan Barat. Kata kunci: Anemia, bayi, anak-anak, defisiensi besi, sprinklesAbstractIron deficiency anemia in infants and children is one of nutritional problems in developing countries including Indonesia, where supplementation program using iron folic acid syrup or drops is not effective with low compliancedue to complaint in metallic taste, teeth staining, stomach disorders, and potential overdose. To improve the supplementation compliance, micronutrient sprinkles formula, a new encapsulated iron fortification in powder form containingmultivitamins and minerals has been developed. The objective of this literature study is to know the affectivity of sprinkles formula for anemia cure in infants and children. This study was based on series of efficacy in Ghana and other countries. It shows that the sprinkles formula is effective as the syrup or drop formula in curing infants and children anemia with very high level of compliance. In Indonesia, iron sprinkles have been used widely including for improving nutritional status of children during disaster. Indonesian Ministry of Health through Bogor Nutritional Agency for Research and Development has developed sprinkles formula Taburia that already tested in Jakarta. Currently, Taburia is used in Province of South Sumatra, North Sumatra, West Nusa Tenggara (NTB), East Nusa Tenggara (NTT), South Sulawesi, and West Kalimantan.Key words: Anemia, infant, children, iron deficiency, sprinkles
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Appiah, Prince Kubi, Wilson Mensah Dzata, Duut Abdulai Bonchel, Anang Rhoda Naa Korklu, Doe Jessica Naa Ayeley, Georgina Agartha Fenu, and Timay Ibrahim Abdul-Rahman. "Mothers Adherence to Global Infant and Young Child Feeding Strategies in Ketu North District, Volta Region - Ghana." European Scientific Journal, ESJ 13, no. 30 (October 31, 2017): 183. http://dx.doi.org/10.19044/esj.2017.v13n30p183.
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Background: Infant and young child nutrition has been engaging the attention of scientists and governments over the years. Their feeding practices comprise both breastfeeding as well as complementary feeding which have major role in determining the nutritional status of the child, therefore, there has been a well-established link between malnutrition and infant feeding. Children are the future of the world and yet the most vulnerable population, with some 6.6 million children dying before their fifth birthday globally. Studies have shown that poor breastfeeding and complementary feeding practices, coupled with high rates of morbidity from infectious diseases are the primary causes of malnutrition and death in the first two years of life. Ketu-North district noted that even though nutrition and health programmes were in place, breastfeeding coverage has been between 53% in 2013 and 69% in 2015. This study sought to assess mothers or caregivers adherence to Infant and Young Child Feeding (IYCF) practices in Ketu North District of the Volta Region in Ghana. Method: A crosssectional study among mothers/caregivers with children 0-24 months in the district. Multistage sampling techniques was used to select 518 respondents. A semi-structured questionnaire was used to conduct face-to-face interviews. Statistical software Epi Data version 3.1 and Stata version 12.1 were used for data entry and analysis respectively. Descriptive statistics was presented in tables and graphs. Beyond descriptive statistics, associations between the outcome and predictor variables were analysed using Pearson chi-square and logistics regression. P-value < .05 was considered as statistically significant. Findings: Respondents had a mean age of 25.6 years (±3.6 SD). Only 8.7% of the mothers adhered to IYCF strategies with practices of exclusive breastfeeding, complementary feeding, hygiene and sanitation practices, meal variety, and meal frequency being 57.9%, 38.0%, 16.2%, 37.1%, and 33.2% respectively. Ethnicity (p < .000), age of child (p = .032), employment (p =.041) and level of education (p = .042) were found to be associated with adherence to IYCF strategies. Conclusions: Adherence to infant and young child feeding practices were not encouraging in the district therefore the district health management team need to strengthen health education and implement other behaviour change interventions to improve on the adherence to feeding strategies. Further studies should be conducted to assess factors influencing the low adherence to the feeding strategies in the district.
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Pelto, Gretel H. "Applying focused ethnographic methods: examining implications of intracultural diversity for nutrition interventions." Nutrition Reviews 78, Supplement_2 (November 10, 2020): 71–79. http://dx.doi.org/10.1093/nutrit/nuaa002.
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Abstract 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.
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Agbemafle, Isaac, Doris Hadzi, Francis Amagloh, Francis Zotor, and Manju Reddy. "Nutritional Content and Microbial Quality of Complementary Foods Produced from Blends of Orange-Fleshed Sweet Potato and Edible Insects." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 732. http://dx.doi.org/10.1093/cdn/nzaa052_001.
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Abstract Objectives Improved formulations of complementary foods (CFs) with animal-source foods (ASFs) is an eminent strategy to improve infant nutrition, but they are expensive and not readily available in many food insecure settings which are a haven of edible insects. Hence, we developed orange-fleshed sweet potato (OFSP) based CFs supplemented with Cricket or palm weevil larvae (PWL), examined its nutritional content and microbial quality for infant feeding. Methods OFSP roots were sourced from local farmers, peeled, sliced, steam cooked and mechanically dried into OFSP flour. Cricket powder and PWL paste were obtained from commercial producers, steam cooked, and mechanically dried into Cricket/PWL flours. OFSP flour was mixed with either Cricket/PWL flours in the ratios of 100:0 (control), 85:15, 70:30, and 50:50 and used to produce ready-to-eat CFs. The CFs were evaluated for nutrient composition and microbial contamination using standard methods. ANOVA followed by Dunnett's test was used to compare all the formulations to the control. Results There were increase in protein (4.80 to 36.75%), iron (1.26 to 4.38 mg/100 g), zinc (0.69 to 10.65 mg/100 g) and calcium (45.54 to 152.77 mg/100 g) contents of the OFSP-based CFs with increased supplementation with Cricket/PWL flour. The carbohydrate and β-carotene content decreased but the energy content increased with increased supplementation with cricket/PWL flour from 344.52 Kcal/100 g in 100% OFSP CF to 541.09 Kcal/100 g in 50:50 CFs (OFSP: PWL) (P = 0.001). Aerobic mesophilic count (AMC) of the OFSP: Cricket CFs was 60 cfu/g as compared to 1300 cfu/g for the OFSP: PWL CFs. Comparing the OFSP-based Cricket/PWL CFs to the commercial Cricket or PWL, there was 35–331-fold reduction in AMC. Bacillus cereus (BC), aerobic (APC) and anaerobic plate count (NPC) was 0 cfu/g for the OFSP: Cricket CFs. BC, APC and NPC were 100, 260 and 130 cfu/g respectively for the OFSP: PWL CFs. Conclusions Steam cooking, then mechanical drying significantly reduced microbial concentrations in commercial Cricket and PWL to below minimum limits set by the Ghana Standards Authority for CFs requiring heating to boiling before consumption. OFSP-based Cricket/PWL composite flours could be safe viable alternatives as nutritious CFs in countries where they are culturally accepted as food. Funding Sources Nutritional Sciences Council at Iowa State University.
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He, Zhifei, Ghose Bishwajit, Sanni Yaya, Zhaohui Cheng, Dongsheng Zou, and Yan Zhou. "Prevalence of low birth weight and its association with maternal body weight status in selected countries in Africa: a cross-sectional study." BMJ Open 8, no. 8 (August 2018): e020410. http://dx.doi.org/10.1136/bmjopen-2017-020410.
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ObjectivesThe 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.SettingUrban and rural household in Burkina Faso, Ghana, Malawi, Senegal and Uganda.ParticipantsMothers (n=11 418) aged between 15 and 49 years with a history of childbirth in the last 5 years.ResultsThe 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)).ConclusionUnderweight 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.
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MINAKAMI, KOREBUMI, REGINALD K. ANTESON, and MAXWELL A. APPAWU. "Effects of nutritional deficiency on parasitic infection of the infant in Greater Accra, Ghana." Japanese Journal of Tropical Medicine and Hygiene 20, no. 2 (1992): 143–47. http://dx.doi.org/10.2149/tmh1973.20.143.
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Anin, Stephen Kofi, Mahama Saaka, Florian Fischer, and Alexander Kraemer. "Association between Infant and Young Child Feeding (IYCF) Indicators and the Nutritional Status of Children (6–23 Months) in Northern Ghana." Nutrients 12, no. 9 (August 24, 2020): 2565. http://dx.doi.org/10.3390/nu12092565.
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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.
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Jaacks, Lindsay M., Justine Kavle, Abigail Perry, and Albertha Nyaku. "Programming maternal and child overweight and obesity in the context of undernutrition: current evidence and key considerations for low- and middle-income countries." Public Health Nutrition 20, no. 7 (January 9, 2017): 1286–96. http://dx.doi.org/10.1017/s1368980016003323.
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AbstractThe 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.
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Balogun, Hamudat, Jouni J. K. Jaakkola, and A. Kofi Amegah. "Association of Sunlight Exposure and Consumption of Vitamin D-Rich Foods During Pregnancy with Adverse Birth Outcomes in an African Population." Journal of Tropical Pediatrics 65, no. 6 (January 27, 2019): 526–36. http://dx.doi.org/10.1093/tropej/fmz001.
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Abstract 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.
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Kubreziga, Kubuga Clement. "The Role of Prelacteal Feeding in Infant Methemoglobinemia Risk: Case Study in the Upper East Region of Ghana." Pakistan Journal of Nutrition 11, no. 10 (September 15, 2012): 998–1003. http://dx.doi.org/10.3923/pjn.2012.998.1003.
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Edmond, Karen M., Betty R. Kirkwood, Seeba Amenga-Etego, Seth Owusu-Agyei, and Lisa S. Hurt. "Effect of early infant feeding practices on infection-specific neonatal mortality: an investigation of the causal links with observational data from rural Ghana." American Journal of Clinical Nutrition 86, no. 4 (October 1, 2007): 1126–31. http://dx.doi.org/10.1093/ajcn/86.4.1126.
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Sandow, Adam, Madelynn Tice, Rafael Pérez-Escamilla, Richmond Aryeetey, and Amber Hromi-Fiedler. "Facilitators of Responsive Feeding/Parenting Knowledge and Practices Among Parents in the Central Region of Ghana." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1069. http://dx.doi.org/10.1093/cdn/nzaa054_141.
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Abstract Objectives Identify facilitators of the practice of Responsive Feeding/Parenting (RF/P) among parents of children under 3 years of age in the Central Region of Ghana. Methods Qualitative data was collected through six audiotaped focus group discussions with mothers (n = 27) and fathers (n = 18) living in the Central Region of Ghana who a) were 18 years of age or older; b) had a child under 3 years of age; c) were involved in feeding the child. Transcripts were read and coded independently by three authors, consensus was reached about emerging domains and themes, and a final codebook was developed. Results Three factors were identified as direct facilitators of the practice of RF/P: support, health care providers infant and young child feeding (IYCF) education delivery, and IYCF practice. Family, friends and the community gave parents informational, instrumental and emotional support including education/counseling on childcaring practices, doing chores for parents, giving parents the time off to respond to their children's needs. This support enabled parents to learn and adopt some RF/P behaviours. Health care providers delivered education on IYCF, food safety and, in some instances, provided some RF/P counselling/guidance. This then enabled parents to identify the nutritional and the psychosocial needs of their children and to recognize they should attend to these needs using RF/P knowledge and practice. Non-responsive feeding/parenting practices also emerged within IYCF practices demonstrating the need for more high-quality RF/P education. Conclusions Health care providers as well as family/friends facilitate parent's IYCF practices, which in turn influences their RF/P practices. Strengthening IYCF knowledge delivery through enhanced antenatal and postnatal counselling targeting parents as well as family/friends can promote RF/P knowledge and practices among Ghanaian parents. Funding Sources Hecht-Albert Leadership Award to Dr. Hromi-Fiedler through the Global Health Leadership Institute, Yale University.
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Ocansey, Maku E., Anna Pulakka, Seth Adu-Afarwuah, Rebecca R. Young, Sika M. Kumordzie, Harriet Okronipa, Brietta M. Oaks, Kathryn G. Dewey, and Elizabeth L. Prado. "The effects of supplementing maternal and infant diets with lipid-based nutrient supplements on physical activity and sedentary behaviour at preschool age in Ghana." British Journal of Nutrition 122, no. 8 (September 16, 2019): 884–94. http://dx.doi.org/10.1017/s0007114519001636.
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AbstractEvidence 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.
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Anderson, Alex, Megan McCrory, Matilda Steiner-Asiedu, Richard Ansong, Clara Lewis, Tonmoy Ghosh, Janine Higgins, and Edward Sazonov. "Household Food-Related Assessment Using an Innovative Passive Dietary Assessment Device in Ghana." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1157. http://dx.doi.org/10.1093/cdn/nzaa056_004.
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Abstract Objectives Traditional dietary assessment methods in low-middle income countries (LMICs) have considerable limitations. the objective of this study was to test the feasibility of using the Automatic Ingestion Monitor (AIM), an eyeglasses-mounted wearable chewing sensor and micro-camera, to monitor food acquisition, preparation and consumption of households in a LMIC setting. Methods Data from households in Mampong-Akuapem (n = 5), a semi-rural community, and Kweiman (n = 7), a peri-urban community, in the Eastern and Greater Accra Regions of Ghana, respectively, were evaluated. The AIM was used to monitor household activities for one day. Within each household, the primary caregiver (mother) wore the AIM during waking hours on the chosen day as she went about her daily activities, except any activities where she wanted to preserve privacy. Mothers also responded to a socio-demographic questionnaire and evaluated their perceived burden of wearing the AIM. Images captured by the AIM were processed and annotated in custom-designed software. Time spent in major household related activities around food are described. Results Households had 1.9 ± 0.3 adults and 2.8 ± 1.6 children (mean ± SD). Primary caregivers were 30.5 ± 5.2 years of age, all were married (1 separated), and had a median of 9 years of formal education. Two mothers were breastfeeding at data collection, but only 1 household had an infant <1 year. Total AIM wear time was 8 h, 19 min ± 2 h, 11 min, representing 58% of waking hours. All members of each household consumed the same prepared meals, and all meals were captured by the AIM. Among mothers, time spent cooking varied widely (2 h, 19 min ± 1 h, 42 min), ranging from 0.5 to 6 h. Time spent eating and drinking was 41 ± 15 min. Most of the mothers (n = 10) spent time feeding children (17 ± 23 min, including breastfeeding), with 6 mothers feeding younger children (11 ± 10 min), 5 feeding older children (7 ± 4 min), and 2 breastfeeding (53 ± 25 min). The AIM was generally accepted by the primary caregivers and household members although they would prefer a smaller size version. Conclusions In this pilot study, the AIM successfully captured household food related activities and practices that are associated with dietary intake and nutritional health in LMIC. Funding Sources The Bill and Melinda Gates Foundation.
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Appiah, Collins Afriyie, Faustina O. Mensah, Frank E. A. Hayford, Vincent A. Awuuh, and Daniel Edem Kpewou. "Predictors of undernutrition and anemia among children aged 6–24 months in a low-resourced setting of Ghana: a baseline survey." Journal of Health Research 35, no. 1 (June 19, 2020): 27–37. http://dx.doi.org/10.1108/jhr-05-2019-0095.
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PurposeThe purpose of this study was to identify the predictors of child undernutrition and anemia among children 6–24 months old in the East Mamprusi district, Northern region, Ghana.Design/methodology/approachThis cross-sectional study recruited 153 children and their mothers. Weight, height and hemoglobin levels of the children were measured. A structured questionnaire based on the World Health Organization's indicators for assessing infant and young child feeding practices was used to collect data on parents' socioeconomic status, household characteristics, hygiene and sanitation practices, mothers' knowledge on feeding practices such as child's meal frequency and dietary diversity and child morbidity within the past two weeks. Predictors of child nutritional status were determined using multinomial logistic regression analysis.FindingsUnderweight in the children was significantly predicted by maternal knowledge on protein foods (AOR = 0.045, p = 0.008), time of initiation of complementary feeding (AOR = 0.222, p = 0.032) and maternal age (AOR = 9.455, p = 0.017). Feeding child from separate bowls (AOR = 0.239, p = 0.005), minimum meal frequency per child's age (AOR = 0.189, p = 0.007) and time of initiation of complementary feeding (AOR = 0.144, p = 0.009) were significant determinants of stunting among the children. Exclusive breast feeding (AOR = 7.975, p = 0.012) and child's past morbidity (AOR = 0.014, p = 0.001) significantly contributed to anemia among the children.Research limitations/implicationsThis is a cross-sectional study and cannot establish causality. The small sample size also limits the generalizability of study findings. However, findings of the study highlight factors which could potentially influence the high rate of child undernutrition in the study setting.Practical implicationsThis study identifies determinants of undernutrition in the East Mamprusi district, an underresourced area in Ghana. This information could inform the development/reformulation of locally sensitive key messages and targeted intervention strategies to curb the high levels of child undernutrition in the East Mamprusi district of Ghana.Originality/valueThis study identifies maternal care practices as key potential drivers of undernutrition in a low-resource setting known for high prevalence of child undernutrition. It suggests insight for large-scale studies on the predictors of child undernutrition in Northern Ghana and other resource-poor settings.
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Ocansey, Maku E., Seth Adu-Afarwuah, Sika M. Kumordzie, Harriet Okronipa, Rebecca R. Young, Solace M. Tamakloe, Brietta M. Oaks, Kathryn G. Dewey, and Elizabeth L. Prado. "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." American Journal of Clinical Nutrition 109, no. 2 (February 1, 2019): 322–34. http://dx.doi.org/10.1093/ajcn/nqy303.
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ABSTRACT 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 = −0.12, 95% CI: −0.25, 0.02, P = 0.087; fully adjusted β = −0.16, 95% CI: −0.29, −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.
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Kumordzie, Sika M., Seth Adu-Afarwuah, Mary Arimond, Rebecca R. Young, Theodosia Adom, Rose Boatin, Maku E. Ocansey, et al. "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." Journal of Nutrition 149, no. 5 (April 29, 2019): 847–55. http://dx.doi.org/10.1093/jn/nxz005.
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ABSTRACT 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.
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Amakye, William Kwame, Sladana Bozovic, Arafat Faraque, Maojin Yao, and Jiaoyan Ren. "Nutrition education in medical school: the case of international medical students in China." BMJ Nutrition, Prevention & Health, December 1, 2020, bmjnph—2020–000117. http://dx.doi.org/10.1136/bmjnph-2020-000117.
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ObjectiveTo 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.DesignCross-sectional study.SettingsChina, Ghana, India and Montenegro.ParticipantsInternational medical students in China and medical students studying in their home countries of Ghana, India and Montenegro.Main measureAn 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.ResultIn 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.ConclusionInternational 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.
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Dadzie, Louis Kobina, Joshua Amo-Adjei, and Kobina Esia-Donkoh. "Women empowerment and minimum daily meal frequency among infants and young children in Ghana: analysis of Ghana demographic and health survey." BMC Public Health 21, no. 1 (September 17, 2021). http://dx.doi.org/10.1186/s12889-021-11753-1.
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Abstract 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.
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Bimpong, Kingsley Appiah, Ernest Kaa-Emabong Cheyuo, Alhassan Abdul-Mumin, Martin A. Ayanore, Clement K. Kubuga, and Victor Mogre. "Mothers’ knowledge and attitudes regarding child feeding recommendations, complementary feeding practices and determinants of adequate diet." BMC Nutrition 6, no. 1 (December 2020). http://dx.doi.org/10.1186/s40795-020-00393-0.
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Abstract 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.
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Nsiah-Asamoah, Christiana Naa Atsreh. "Socio-cultural Factors Associated with Complementary Feeding in Two Rural Districts in Ghana: A qualitative study involving Health Workers." European Journal of Nutrition & Food Safety, June 3, 2020, 10–24. http://dx.doi.org/10.9734/ejnfs/2020/v12i530224.
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Aim: This study sought to explore the cultural factors that are associated with complementary feeding from the reports of Community Health Workers (CHWs) and Volunteers (CHVs) in two rural districts in Ghana.
Study Design: This was a cross-sectional qualitative study that assessed cultural beliefs, norms, superstitions and practices that influence complementary feeding practices of young children under two years in two rural farming districts in Ghana
Study Area: The study was conducted at Kwahu Afram Plains North and South Districts in the Eastern Region of Ghana.
Methodology: The study employed qualitative methods which entailed conducting 9 focus group discussions among CHWs and CHVs working at two rural districts in Ghana. The focus group discussions were conducted with the aid of a validated, interview guide, after obtaining informed consent (written) from the health workers. Ethical clearance for the study was obtained from the Institutional Review Boards of the Dodowa Health Research Centre and the University of Cape Coast. Thematic content analytical procedures were applied to analyze the transcripts, interpret and present findings as a narrative account.
Results: The reports of the health workers indicate a common practice of early introduction of solid foods to infants before they attain six(6) months of age. Cultural beliefs, superstitions, beliefs, food taboos and prohibitions influence mothers’ complementary-feeding practices and result in limiting the food scope and dietary diversity of their young children.
Conclusions: Interventions designed to promote appropriate complementary feeding practices should incorporate an understanding of social context, family, and cultural factors in developing nutrition promotion messages that are tailored to meet the needs of rural populations. More community interventions that draw on the support of key influential persons in the community and fathers are needed to address cultural barriers to appropriate complementary feeding practices.
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Adu-Afarwuah, Seth, Rebecca R. Young, Anna Lartey, Harriet Okronipa, Per Ashorn, Ulla Ashorn, Brietta M. Oaks, and Kathryn G. Dewey. "Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Does Not Increase Child Morbidity in a Semiurban Setting in Ghana: A Secondary Outcome Noninferiority Analysis of the International Lipid-Based Nutrient Supplements (iLiNS)–DYAD Randomized Controlled Trial." Journal of Nutrition, October 11, 2019. http://dx.doi.org/10.1093/jn/nxz243.
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ABSTRACT Background Adequate knowledge about the safety of consumption of small-quantity lipid-based nutrient supplements (SQ-LNSs) is needed. Objective We aimed to test the hypothesis that SQ-LNS consumption is noninferior to control with respect to child morbidity. Methods Women (n = 1320) ≤20 wk pregnant were assigned to iron and folic acid until delivery with no supplementation for offspring; or multiple micronutrient supplements until 6 mo postpartum with no supplementation for offspring; or SQ-LNSs until 6 mo postpartum, and SQ-LNSs for offspring (6 mg Fe/d) from 6 to 18 mo of age [the lipid-based nutrient supplement (LNS) group]. We assessed noninferiority (margin ≤20%) between any 2 groups during 0–6 mo of age, and between the non-LNS and LNS groups during 6–18 mo of age for caregiver-reported acute respiratory infection, diarrhea, gastroenteritis, fever/suspected malaria, poor appetite, and “other illnesses.” Results During 0–6 mo of age, 1197 infants contributed 190,503 infant-days. For all morbidity combined, overall mean incidence (per 100 infant-days) was 3.3 episodes, overall mean prevalence (percentage of infant-days) was 19.3%, and the 95% CIs of the incidence rate ratio (IRR) and longitudinal prevalence rate ratio (LPRR) between any 2 groups were ≤1.20. During 6–18 mo, there were 240,097 infant-days for the non-LNS group and 118,698 for the LNS group. For all morbidity combined, group mean incidences were 4.3 and 4.3, respectively (IRR: 1.0; 95% CI: 1.0, 1.1), and mean prevalences were 28.2% and 29.3%, respectively (LPRR: 1.0; 95% CI: 1.0, 1.1). Noninferiority was inconclusive for diarrhea, fever/suspected malaria, and poor appetite. Conclusions SQ-LNS consumption does not increase reported overall child morbidity in this population compared with the 2 other treatments. This trial was registered at clinicaltrials.gov as NCT00970866.
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Hampel, Daniela, Rebecca Young, Setareh Shahab-Ferdows, Kathryn Dewey, Per Ashorn, Kenneth Maleta, Ulla Ashorn, Stephen Vosti, and Lindsay Allen. "Maternal Lipid-based Nutrient and Multiple Micronutrient Supplementation Affect B-vitamins in Milk Differently in Malawian Compared to Ghanaian Mothers (P24-045-19)." Current Developments in Nutrition 3, Supplement_1 (June 1, 2019). http://dx.doi.org/10.1093/cdn/nzz044.p24-045-19.
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Abstract Objectives Little is known about the influence of maternal micronutrient (MN) supplementation during pregnancy/lactation on human milk (HM) MN concentrations. We evaluated B-vitamin (BV) concentrations in milk from mothers in Ghana and Malawi who participated in the International Lipid-Based Nutrient Supplements (iLiNS) Project. Methods Women (<20 wk gestation) were randomized to receive: 1 x daily iron/folic acid (IFA) during pregnancy only, or a multiple micronutrient (MMN) tablet or LNS containing equal amounts of vitamins during pregnancy and 6 mo of lactation. HM at 6mo postpartum was analyzed for vitamins B1, B2, B3 (nicotinamide only), B5, B6, and B12 and compared to the recommended Adequate Intakes (AI) for infants 0–6 mo, which are based on values from milk from well-nourished mothers, assuming 780 mL/d milk intake. Results Concentrations and responses to supplementation differed greatly between countries. Comparing the IFA groups’ concentrations (geom. mean), women in Ghana had significantly lower HM B1 (121 vs. 183 µg/L), B2 (139 vs. 321 µg/L), and B6 (21.3 vs. 89.2 µg/L), and significantly higher B3 (1057 vs. 151 µg/L) and B12 (439 vs. 239 pmol/L). In Ghana, use of MMN/LNS increased all HM BV (10 - 30%); but even with supplementation, only up to 5.7% (B1, B2, B3, B6), and 47.9 and 73.2% (B5 and B12) of the samples reached AI values. In Malawi, only HM B2 was significantly increased by MMN/LNS (371 vs. 321 µg/L), resulting in 47.2% of samples reaching the AI value, compared to 36.0% in the IFA group. None of Malawian samples reached the AI value for B3, and 9.0 to 34.6% reached the AI values for the remaining vitamins. Conclusions HM BV concentrations differed greatly by geographic origin, possibly due to differences in diet or fortification. Maternal MMN/LNS supplementation during pregnancy/lactation increased all HM B-vitamins in Ghana. Only HM B2 was increased in Malawi, for reasons that are unclear. Funding Sources Bill & Melinda Gates Foundation (OPP49817), USDA/ARS Intramural Project (5306–51,530-019–00), U.S. Agency for International Development (USAID, AID-OAA-A-12–00005), and the Food and Nutrition Technical Assistance III Project (FANTA). All authors declare no conflict of interest.
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"Promoting Optimal Monitoring of Child Growth in Canada: Using the New WHO Growth Charts." Canadian Journal of Dietetic Practice and Research 71, no. 1 (March 2010): e1-e3. http://dx.doi.org/10.3148/71.1.2010.54.
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Growth monitoring and promotion of optimal growth are essential components of primary health care for infants, children and adolescents. Growth monitoring includes serial measurements of weight, length or height for all children, head circumference for infants and toddlers, and interpretation of those measurements relative to the growth of a large sample population of children depicted on a selected growth chart. These measures help to confirm a child's healthy growth and development, or identify early a potential nutritional or health problem. This enables health professionals and parents to initiate action before the child's nutritional status or health are seriously compromised. Over the last three decades there has been substantial discussion on which reference population to use in assessing adequacy of childhood growth. In 2004, Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada and Community Health Nurses of Canada published recommendations for use of the 2000 American growth charts from the Centers for Disease Control and Prevention. At that time, limitations of the charts were noted, including the fact that these charts were growth references, describing how a sample population of children grew, regardless of whether or not their rate of growth was optimal or not. It was also noted that the decision on which growth charts to recommend would be revisited as more appropriate data became available. Increasing evidence that growth patterns of well-fed healthy preschool children from diverse ethnic backgrounds were comparable, supported the use of a single international growth reference based on healthy, wellnourished children from different geographic and genetic origins, who had fully met their growth potential. Until recently, no such growth charts existed. In 2006, the World Health Organization (WHO), in conjunction with the United Nations Children's Fund and others, released new international growth charts depicting the growth of children from birth to age five years, who had been raised in six different countries (Brazil, Ghana, India, Norway, Oman, USA) according to recommended nutritional and health practices, including exclusive breastfeeding for the first four to six months of life. The optimal growth displayed in the WHO growth charts for infants and preschool children represents the prescribed gold standard for children's growth; hence these charts are considered growth standards. In 2007, the WHO also released charts for monitoring the growth of older children and adolescents that had been updated and improved to address the growing epidemic of childhood obesity. Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada, and Community Health Nurses of Canada make the following recommendations, intended as a practice guideline for medical practitioners and other health professionals. The desired outcome is that wide dissemination of these recommendations will promote consistent practices in monitoring growth to improve the nutritional status and health outcomes of Canadian infants, children and adolescents.
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Ghosh, Shibani A., Nicholas R. Strutt, Gloria E. Otoo, Devika J. Suri, Judith Ankrah, Thomas Johnson, Paul Nsiah, et al. "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." Journal of Nutritional Science 8 (2019). http://dx.doi.org/10.1017/jns.2019.18.
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AbstractInadequate 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.
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Vuvor, Frederick, Sir Paul, Richard Ansong, Rose Otema Baah, Daniel Amo Annor, Obed Akwaa Harrison, Dominic Datoghe, et al. "Effect of an Iron-Fortified Complementary Food on Anemia and Nutritional Status of Infants Aged 6–18 Months in Ghana (P10-103-19)." Current Developments in Nutrition 3, Supplement_1 (June 1, 2019). http://dx.doi.org/10.1093/cdn/nzz034.p10-103-19.
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Abstract Objectives Anemia remains widely prevalent in Ghana, affecting about 75% of children aged 6–23 months, with iron deficiency a common cause. The objective of this study was to assess the effect of a micronutrient-fortified complementary food on hemoglobin, anemia prevalence, and growth of infants in the La Nkwantanang Municipality of the Greater Accra Region, Ghana. Methods In this double-blind, cluster-randomized, controlled study, infants (aged 6–18 months) received either micronutrient-fortified infant cereal with iron (3.75 mg iron as ferrous fumarate/50 g cereal: INT, n = 107) or the same cereal without iron (CTL; n = 101) to complement other family foods and breast milk for a 6 month period. Recommended cereal intake differed by age (50 g/day for ages 6–8mo, 75 g/d for ages 9–11mo, and 100 g/d for ages 12–18mo). Hemoglobin (Hb), weight, height, and mid-upper arm circumference were assessed at baseline and every 2 months for 8 months. Infants’ usual dietary intake was assessed using questionnaires. Differences between groups were analyzed using ANCOVA, adjusted for potential confounders such as child's age, socioeconomic background of caregivers, worm infestation, and malaria. Results There were no significant differences between groups in maternal/household characteristics or infant baseline anthropometry. At 6 months, adjusted mean ± SE Hb change from baseline in CTL and INT was 1.16 ± 0.21 and 1.97 ± 0.19 g/dL, respectively (P < 0.01 for each); the increase over time was significantly larger in INT vs. CTL (0.68 ± 0.30 g/dL; P = 0.02). Similar results were found in unadjusted models. Hb levels declined slightly in both groups in the 2 month period after the intervention but remained higher in INT (Figure). Prevalence of anemia declined in both groups (CTL: 89.1% to 62.8%, INT: 84.1% to 42.8%); the magnitude of decrease was 57% greater in INT. There was no significant difference between groups in length gain (CTL: 6.24 ± 0.28, INT: 5.62 ± 0.27 cm; P = 0.21) or weight gain (CTL: 1.03 ± 0.24, INT: 1.31 ± 0.24 kg; P = 0.41). Conclusions Iron-fortified infant cereal consumed for 6 months promoted greater reductions in iron-deficiency anemia in infants aged 6–18 months, which is a public health concern in Ghana and most developing countries. Funding Sources This study was sponsored by Nestlé Company Limited (Ghana) in collaboration with the University of Ghana School of Biological Sciences. Supporting Tables, Images and/or Graphs
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Okonogi, Satoru, Reginald Annan, and Takeshi Sakurai. "Improving Infant Nutrition through the Market: Experimental Evidence in Ghana." SSRN Electronic Journal, 2021. http://dx.doi.org/10.2139/ssrn.3771891.
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Omari, R., and G. Anyebuno. "Risk Assessment of Aflatoxins in Maize-Groundnuts Complemen-tary Foods Consumed by Ghanaian Infants." Journal of Food Quality and Hazards Control, September 7, 2020. http://dx.doi.org/10.18502/jfqhc.7.3.4144.
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Background: Complementary foods are given to infants when breast milk alone becomes insufficient in meeting their nutritional needs. The major objective of this study was to assess the prevalence of Aflatoxins (AFs) in Weanimix complementary foods purchased from shops in Accra (Ghana), and to estimate risk of liver cancer development in infants.
Methods: In total, 32 samples of Weanimix were purchased from shops in Accra, an urban centre and analyzed for AFs by Reverse-Phase High Performance Liquid Chromatography (RP-HPLC). Previously published data on levels of AFs in Weanimix prepared in rural households were also collected. The data was analyzed to estimate infants’ daily exposure to AFs as well as the risk of liver cancer development.
Results: AFs levels of 18.8% of samples were above the maximum permitted limit of 10 µg/kg. The minimum and maximum levels of total AFs detected in all samples were 2.51 and 98.87 µg/kg, respectively with a mean value of 16.43 µg/kg. Exposure assessment showed that the minimum and maximum daily AFs exposures were 0.044 and 2.805 µg/kg bw/d, respectively for Weanimix from rural households; these rates for Weanimix purchased from urban shops were 0.014 and 0.55 µg/kg bw/d, respectively. The chances of liver cancer development would increase to 0.6 per year if infants were fed on Weanimix prepared in rural households with minimum AF level of 7.9 µg/kg.
Conclusion: The infants fed on Weanimix prepared in rural households would be at a higher risk of AF exposure and liver cancer development than infants fed on Weanimix purchased from urban shops of Ghana.
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Adda, Louisa, Kwabena Opoku-Mensah, and Phyllis Dako-Gyeke. "“Once the child is delivered, he is no more your baby,” Exclusive Breastfeeding experiences of first-time mothers in Kassena-Nankana Municipality, Ghana - a qualitative study." BMC Pregnancy and Childbirth 20, no. 1 (September 29, 2020). http://dx.doi.org/10.1186/s12884-020-03272-5.
Full textAbstract:
Abstract Background Exclusive Breastfeeding (EBF), for the first 6 months of life, is globally accepted as the preferred method for infant feeding. In Ghana, an estimated 84% of children < 2 months old are exclusively breastfed. But by age 4 to 5 months, only 49% continue to receive EBF. This situation continues to deteriorate. Thus, the need to explore perceptions, practices as well as factors that influence EBF in Ghana. Methods Using a qualitative design, four focus group discussions were conducted among first-time mothers and eight in-depth interviews with health workers and traditional birth attendants. The study was conducted in four communities in the Kassena-Nankana municipality of Ghana. Discussions and interviews were recorded and later transcribed verbatim to English language. The transcribed data was then coded with the aid of analysis computer software (Nvivo version 10.0) and later analyzed for the generation of themes. Results Exclusive breastfeeding is practiced among first-time mothers due to its perceived benefits; which include nutritional advantage, ability to enhance growth whilst boosting immunity and its economic value. However misconceptions as well as, certain cultural practices (e.g. giving herbal concoctions, breastmilk purification rites), and relational influences, may threaten a mother’s intention to exclusively breastfeed. Relational influences are mainly from mother in-laws, traditional birth attendants, grandmothers, herbalists and other older adults in the community. Conclusions Although first time mothers attempt EBF, external influences make it practically challenging. The availability and utilization of information on EBF was found to positively influence perceptions towards EBF, leading to change in attitude towards the act. Thus, the practice of community-based health services may be strengthened to provide support for first-time mothers as well as continuous education to the mother in laws, female elders and community leaders who influence decision making on breastfeeding of infants.
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Aborigo, Raymond Akawire, Cheryl A. Moyer, Sarah Rominski, Philip Adongo, John Williams, Gideon Logonia, Gideon Affah, Abraham Hodgson, and Cyril Engmann. "Infant nutrition in the first seven days of life in rural northern Ghana." BMC Pregnancy and Childbirth 12, no. 1 (August 2, 2012). http://dx.doi.org/10.1186/1471-2393-12-76.
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