56 research outputs found
The interrelations between nutrition, social and economic trajectories during adolescence among girls in Ghana
No full textA dearth of data on the trends, efficacy, and timing (regarding menarche) of intervention impedes progress in the design of targeted policies and interventions that can holistically improve adolescents’ nutrition. This thesis primarily aims to examine the interrelations between nutrition, social, and economic trajectories during adolescence among girls in Ghana using a systematic narrative literature review on the socio-cultural and economic (SCE) determinants and consequences of adolescent undernutrition, analyses of secondary cross-sectional data in Ghana, and a randomised placebo-controlled trial among adolescent girls in north-eastern Ghana. Chapter 1 provides the background and rationale that informed the thesis and describes the specific research objectives for each chapter.In chapter 2, we undertook a systematic review of published literature to provide a narrative overview of the SCE determinants and consequences associated with undernutrition among adolescents in low and lower-middle-income countries. We identified 98 articles from PubMed, SCOPUS and CAB-Abstracts on determinants and consequences of undernutrition as defined by stunting, thinness, overweight and micronutrient deficiencies. At the individual level, significant determinants included age, sex, birth order, religion, ethnicity, educational and literacy level, working and marital status. At the household level, parental education and occupation, household size and composition, income, socio-economic status, and resources were associated with undernutrition. Few determinants were found at the broader community level, which included the residence, sanitation, school type, and seasonality. The sex-specific differences in undernutrition for adolescents were inconclusive. The consequences of adolescent undernutrition were mainly related to education and cognition. Most studies were cross-sectional in design, limiting inferences of causality to the description of associations, and very few studies were found for sub-Saharan Africa, indicating clear research gaps that informed the next parts of this study.In chapter 3, we describe a secondary data analysis of baseline data of an impact evaluation of the Ghana School Feeding Programme indicating that anaemia is a severe public health problem among rural school-aged children (6-9 years; n=323) and adolescents (10-17 years; n=319) in Ghana, irrespective of sex. The mean haemoglobin was 113.8 ± 13.1g/L and the overall prevalence of anaemia was 52.3%, being higher among school-aged children (55.1%) compared to adolescents (49.5%). Agro-ecological zone and age were independent predictors of anaemia, but the effect of age was only significant for girls and not boys.Chapter 4 examines the trends-over-time and the factors associated with malnutrition among adolescent girls in Ghana using cross-sectional data from 3 nationwide Ghana Demographic and Health Surveys (GDHS) conducted in 2003 (n=983), 2008 (n=955) and 2014 (n=857). Stunting was about 8% among the adolescent girls in 2003, declining by only 1.5% points in 2014. Although only 2% of the girls were thin in 2003, the prevalence decreased by <1.0% point in 2014. However, overweight/obesity among the girls increased by 4.3% points in 2014 from 10.0% in 2003, after adjusting for significant predictors of overweight/obesity including household size, wealth index, and the marital status of the girl. Anaemia remained severe (2003: 44.3%; 2008: 62.1% and 2014: 47.3%) without a clear trend.We also undertook a comparative analysis of data of non-pregnant adolescent girls (n=857) and adolescent boys (n=870) aged 15–19 years from the 2014 GDHS to assess and contrast the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents (Chapter 5). Compared to adolescent girls, boys were more than twice likely to be stunted [Prevalence ratio (PR) 2.58, 95% C.I (1.77, 3.76)], thinness [PR 2.67, 95% C. I (1.41, 5.09)] and about twice likely to have PHH [PR 1.96, 95% C. I (1.47, 2.59)] but less likely to be overweight/obese [PR 0.85, 95% C.I (0.08, 0.29)]. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. A higher empowerment index while inversely associated with stunting for girls [PR 0.82, 95% C.I (0.67, 0.99)] also increased their risk of overweight/ obesity [PR 1.31, 95% C.I (1.02, 1.68)]. A higher household wealth index increased the likelihood of overweight/obesity for adolescent girls but was inversely associated with stunting and PHH for adolescent boys.Chapter 6 describes the implementation of our primary study, Ten2Twenty-Ghana, a 26-week randomised placebo-controlled trial with multiple-micronutrient fortified biscuits (MMB) compared to unfortified biscuits (UB) among adolescent girls in north-eastern Ghana. The study evaluated the effect of consuming MMB 5 days/week for 26 weeks compared to UB on micronutrient status, height, and cognitive performance of female adolescents. We also explored to what extent the intervention effect varied in girls that had or did not yet experience menarche. We found no effect of the intervention on plasma ferritin, transferrin receptor concentration and retinol-binding protein. MMB consumption did not affect anaemia, micronutrient deficiencies and anthropometric indices at the population level. After adjusting for the girl’s baseline age, height-for-age z-score and baseline micronutrient status, vitamin A deficiency increased by 6.15% (95% C.I 0.72, 11.59) for pre-menarche girls in the MMB compared to the UB group, but deficient/low vitamin A status decreased substantially by 9.63% (95% C.I -18.94, -0.32) for MMB girls who were post-menarche compared to their UB peers. In anaemic subjects, we found evidence that MMB consumption improves mathematics scores and working memory of pre-menarche girls.Overall, our findings pointed to a triple-burden of malnutrition for Ghanaian adolescent girls which included a steady burden of protein-energy undernutrition, an increasing burden of overnutrition, which was associated with cardiovascular risk and a persistent burden of severe anaemia, affirming the need for double duty actions to holistically tackle malnutrition. Intervention programmes must tackle a broad range of context-specific socio-cultural and economic factors at several levels (individual, household, and community) that influence adolescent nutritional status. We concluded in our primary study that MMB consumption did not improve micronutrient status, cognition, and height, but reduced the prevalence of deficient/low vitamin A status for post-menarche girls. This thesis also suggests menarche may influence the vitamin A status of girls, but this warrants further investigation. Our findings also suggest boys are likewise affected by malnutrition and poor cardiovascular health; hence they should be included alongside girls in nutrition and health intervention programmes
The association between dietary diversity and anthropometric indices of children aged 24-59 months: A cross-sectional study in northern Ghana
No full textThe quality of diet has been shown to influence the nutritional status of children and women in some developing contexts. However, studies on the association between diet quality and the nutritional status of children aged 24-59 months are scanty in sub-Saharan Africa. More so, the conclusions from the few studies that are available are inconsistent. The objective of this study was to determine the association between the dietary diversity score (DDS) and the nutritional status of children aged 24-59 months in the Tolon District of Ghana. The study population included 200 child-mother pairs, randomly selected from 2 large rural communities in the Tolon district of Ghana. A single qualitative 24-hour recall (24HR) and semi-structured questionnaires were used to collect children’s data through face-to-face interviews with their mothers/caregivers. Anthropometry measures were used to define wasting (WHZ < -2SD), underweight (WAZ < -2SD) and stunting (HAZ < -2SD). A summated DDS was based on the Food and Agriculture Organization’s 13 food groupings. Multiple linear regression models, adjusting for potential confounding variables (including the child’s age, sex, birth order, sickness, mother’s age, literacy and occupation, paternal age, occupation and household size, wealth and food security) were fitted to analyse the association between DDS and nutritional status (WHZ, WAZ and HAZ). The prevalence rates of stunting, underweight and wasting among the sampled children were 58.3%, 20.3% and 4.2%, respectively. The mean DDS was 6.3 ± 1.2 out of a possible maximum score of 13, with the dietary pattern mostly plant foods with little consumption of animal source foods. There was a significant positive association between DDS and WHZ (β=0.16, P=0.03) and adjusting for potential confounding variables did not change the observed association. The association between DDS and WAZ was significantly positive only after adjusting for confounding variables (β=0.17, P=0.01). Although positive, the association between DDS and HAZ was not statistically significant in both crude (β=0.03, P=0.73) and adjusted (β=0.10, P=0.29) models. The high prevalence of stunting and underweight among the children requires urgent attention from the ministry of health and its development stakeholders. The findings of the present study suggest improvement in dietary diversity may be an effective approach to improving wasting and underweight during the life phase when young children are completely reliant on family meals. Sensitization programmes on dietary diversification need to be strengthened in child-welfare clinics. Intervention programmes such as backyard gardening, small ruminant rearing and income-generation activities may improve access to a diverse diet
Subclinical inflammation influences the association between Vitamin A-And iron status among schoolchildren in Ghana
No full textBackground and objective In resource-poor settings, micronutrient deficiencies such as Vitamin A deficiency may coexist with iron-deficiency. In this study we assessed the iron and Vitamin A status of schoolchildren and the association between Vitamin A and iron status. Methods A cross-sectional design using the baseline data of a dietary intervention trial conducted among randomly selected 5±12 years old schoolchildren (n = 224) from 2 rural schools in northern Ghana. Hemoglobin (Hb), serum ferritin (SF) and serum transferrin receptor (sTfR) concentrations were used as measures of iron status. Retinol binding protein (RBP) was used as a measure of Vitamin A status. Subclinical inflammation (SCI) was measured using C-reactive protein (CRP) and α1-Acid glycoprotein (AGP) concentrations. We examined the cross-sectional association between Vitamin A and iron status biomarkers with multiple linear regressions. Results The proportions of schoolchildren with anemia (WHO criteria), iron-deficiency (ID, SF 8.5mg/l) and iron-deficiency anemia (IDA, concurrent anemia and ID) were 63.8%, 68.3% and 46.4% respectively. Low or marginal Vitamin A status (0.70 μmol/l RBP <1.05μmol/l) was present in 48.2% while 37.5% of the schoolchildren had Vitamin A deficiency (VAD, RBP </p
Hygiene and Sanitation Practices and the Risk of Morbidity among Children 6–23 Months of Age in Kumbungu District, Ghana
No full textBackground. Poor hygiene and sanitation (WASH) practices are characterised by the manifestation of disease and infections, notably diarrhoea and respiratory tract infections (RTIs) among children. This study aimed to assess the influence of WASH practices on the occurrence of diarrhoea and RTIs among children 6–23 months of age. Methods. An analytical cross-sectional study design was conducted in June 2017. Systematic random sampling technique was used to select 300 mothers/caregivers with children aged 6–23 months from 9 communities in the Kumbungu District. We assessed the WASH practices, socio-demographic characteristics of the households and the occurrence of diarrhoea and RTIs among the children with a semi-structured questionnaire. The Hygiene Improvement Framework observational guide was adapted for household sanitation. Backward binary multiple logistic regression was used to determine the WASH practices that significantly predicted morbidity. Results. About 53% and 55.3% of the children reportedly experienced diarrhoea and RTIs, respectively, two weeks before the survey. Caregiver handwashing with soap after defecation [OR = 0.32 (95% C.I: 0.19, 0.52)] and before feeding [OR = 0.50 (95% C.I: 0.30, 0.84)] as well as washing the child’s hands with or without soap before feeding [OR = 0.21 (95% C.I: 0.04, 1.01)] were associated with lower odds of diarrhoea morbidity. The main determinants of RTI morbidity included caregiver handwashing with or without soap after defecation [OR = 0.29 (95% C.I: 0.10, 0.81)] and washing of the child’s hands with soap before feeding [OR = 0.60 (95% C.I: 0.37, 0.99)] However, we found no association between household sanitation and diarrhoea as well as RTI among the children. Conclusion. About a half each of the children had diarrhoea and RTI 2 weeks before the survey. The results emphasise the need for urgent targeting of handwashing and waste disposal programmes to avert the high burden of diarrhoea and RTIs among children
Additional file 1: of Higher vegetable intake and vegetable variety is associated with a better self-reported health-related quality of life (HR-QoL) in a cross-sectional survey of rural northern Ghanaian women in fertile age
No full textTable S1. Multivariate general linear regression (GLM) of the association between vegetable consumption and HR-QoL, MH and PH among women in fertile age (DOCX 15 kb
The epidemiology of undernutrition and its determinants in children under five years in Ghana
No full textBackgroundUnderstanding the burden and contextual risk factors is critical for developing appropriate interventions to control undernutrition.MethodsThis study used data from the 2014 Ghana Demographic and Health Survey to estimate the prevalence of underweight, stunting, and wasting. Single multiple logistic regressions were used to identify the factors associated with underweight, wasting and stunting. The study involved 2720 children aged 0–59 months old and mother pairs. All analyses were done in STATA/IC version 15.0. Statistical significance was set at pResultsThe prevalence of underweight, wasting and stunting were 10.4%, 5.3%, and 18.4% respectively. The age of the child was associated with underweight, wasting and stunting, whereas the sex was associated with wasting and stunting. Normal or overweight/obese maternal body mass index category, high woman’s autonomy and middle-class wealth index were associated with a lower odds of undernutrition. The factors that were associated with a higher odds of child undernutrition included: low birth weight (th) birth order number of child, primary educational level of husband/partner and domicile in the northern region of Ghana.ConclusionThere is still a high burden of child undernutrition in Ghana. The age, sex, birth weight, birth order and the MDDS of the child were the immediate factors associated with child undernutrition. The intermediate factors that were associated with child undernutrition were mainly maternal related factors and included maternal nutritional status and autonomy. Distal level factors which were associated with a higher odds of child undernutrition were the wealth index of the household, paternal educational status and region of residence. We recommend that interventions and policies for undernutrition should address socioeconomic inequalities at the community level while factoring in women empowerment programmes.</div
Seasonality affects dietary diversity of school-age children in northern Ghana
No full textBackground and objectives: Dietary diversity score (DDS) is relatively easy to measure and is shown to be a very useful indicator of the probability of adequate micronutrient intake. Dietary diversity, however, is usually assessed during a single period and little is known about the effect of seasonality on it. This study investigates whether dietary diversity is influenced by seasonality. Methods: Two cross-sectional surveys were conducted in two different seasons—dry season (October 2010) and rainy season (May 2011) among the same school-age children (SAC) in two rural schools in northern Ghana. The study population consisted of 228 school-age children. A qualitative 24-hour dietary recall was conducted in both seasons. Based on 13 food groups, a score of 1 was given if a child consumed a food item belonging to a particular food group, else 0. Individual scores were aggregated into DDS for each child. Differences in mean DDS between seasons were compared using linear mixed model analysis. Results: The dietary pattern of the SAC was commonly plant foods with poor consumption of animal source foods. The mean DDS was significantly higher (P < 0.001) in the rainy season (6.95 ± 0.55) compared to the dry season (6.44 ± 0.55) after adjusting for potential confounders such as age, sex, occupation (household head and mother) and education of household head. The difference in mean DDS between dry and rainy seasons was mainly due to the difference in the consumption of Vitamin A-rich fruits and vegetables between the seasons. While vitamin A-rich fruits (64.0% vs. 0.9%; P < 0.0001) and vitamin A rich dark green leafy vegetables (52.6% vs. 23.3%, P < .0001) were consumed more during the rainy season than the dry season, more children consumed vitamin A-rich deep yellow, orange and red vegetables during the dry season than during the rainy season (73.7% vs. 36.4%, P <0.001). Conclusion: Seasonality has an effect on DDS and may affect the quality of dietary intake of SAC; in such a context, it would be useful to measure DDS in different seasons. Since DDS is a proxy indicator of micronutrient intake, the difference in DDS may reflect in seasonal differences in dietary adequacy and further studies are needed to establish this
Malnutrition, hypertension risk, and correlates: An analysis of the 2014 Ghana Demographic and Health Survey data for 15–19 years adolescent boys and girls
No full textThe sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes
Determinants of underweight among children under five years in Ghana.
No full textDeterminants of underweight among children under five years in Ghana.</p
Socio-cultural and economic determinants and consequences of adolescent undernutrition and micronutrient deficiencies in LLMICs : a systematic narrative review
No full textAdolescent undernutrition is a persisting public health problem in low and lower middle income countries. Nutritional trajectories are complexly interrelated with socio-cultural and economic (SCE) trajectories. However, a synthesis of the SCE determinants or consequences of undernutrition in adolescents is lacking. We undertook a narrative review of published literature to provide a narrative overview of the SCE determinants and consequences associated with undernutrition among adolescents in LLMICs. We identified 98 articles from PubMed, SCOPUS, and CAB-Abstracts on determinants and consequences of undernutrition as defined by stunting, underweight, thinness, and micronutrient deficiencies. At the individual level, significant determinants included age, sex, birth order, religion, ethnicity, educational and literacy level, working status, andmarital status. At the household level, parental education and occupation, household size and composition, income, socioeconomic status, and resources were associated with undernutrition. Only a few determinants at the commu-nity/environmental level, including residence, sanitation, school type, and seasonality, were identified. The consequences of adolescent undernutrition were mostly related to education and cognition. This review underscores theimportance of the broad range of context-specific SCE factors at several levels that influence adolescent nutritional status and shows that further research on SCE consequences of undernutrition is needed
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