Browsing by Author "Aryeetey, R."

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A Review of Leadership and Capacity Gaps in Nutrition Sensitive Agricultural Policies and Strategies for Selected Countries in Sub-Saharan Africa and Asia
(Food and Nutrition Bulletin, 2020) Aryeetey, R.; Covic, N.
Background: Agriculture policies and strategies designed, purposefully, to address malnutrition are considered nutrition-sensitive and are a critical component of global efforts to address malnutrition in all its forms. However, limited evidence exists on the extent and how nutrition is being integrated into agriculture sector policies, strategies, and programs. A review was conducted to address 2 questions: How nutrition-sensitive are agriculture policies, plans, and investments in selected Sub-Saharan African (SSA) and Asian countries? and Which capacity and leadership gaps limit scale up of nutrition-sensitive agriculture Policy and programs? Methods: The review of existing policies was conducted for 11 selected focus countries (9 in SSA and 2 from Asia) of the CGIAR (Consultative Group on International Agricultural Research) Collaborative Research Programme on Agriculture for Nutrition and Health led by the IFPRI (International Food Policy Research Institute). The Food and Agriculture Organization (FAO)’s 10-point key recommendation for designing nutrition-sensitive agricultural interventions was used as an analytical framework. Additionally, a rapid systematic review of published peer-reviewed and grey literature was carried out to identify capacity gaps based on the United Nations Development Program’s capacity assessment framework. Results: We found that there is nutrition sensitivity to the policies and strategies but to varying degrees. There is limited capacity for optimum implementation of these policies, programs, and strategies. For most countries, there is a capacity to articulate what needs to happen, but there are important capacity limitations to translate the given policy/program instruments into effective action. Conclusions: The gaps identified constitute important evidence to inform capacity strengthening of nutrition-sensitive actions for desired nutrition and health outcomes in Africa and Asia.
Advertising of Unhealthy Foods and Beverages Around Primary and Junior High Schools in Ghana’s Most Urbanized and Populous Region
(Frontiers, 2022) Amevinya, G.S.; Vandevijvere, S.; Aryeetey, R.
Introduction: The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively affects their food acquisition and consumption. We examined the extent and nature of food and beverage advertising around primary and junior high schools in Ghana’s most populous and urbanized region, Greater Accra. Materials and methods: Outdoor advertisements for foods and beverages within a 250m road network distance of 200 randomly sampled schools were geocoded. For each food and beverage advertisement, information was collected on the setting, type, size, and number of product types featured in the advertisement. Promotional techniques (promotional characters and premium offers) used in advertisements were documented. Advertised foods and beverages were classified using the INFORMAS and NOVA food classification systems. Results: A total of 5,887 advertisements were identified around the schools surveyed, 42% of which were for foods and beverages. Advertisements were most prevalent at food outlets (78% of all food advertisements), but also along roads and on non-food structures. Overall, 70% of food advertisements featured non-core/unhealthy products, while 12 and 14% had core/healthy and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra- processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most–69% were cartoons or manufacturer’s characters), while 8% of all food advertisements had premium offers (including price discounts and gift/collectables). Conclusions: There is an abundance of unhealthy food advertisements around primary and junior high schools in the Greater Accra Region. Policy actions such as restricting the promotion of unhealthy foods in children’s settings are needed to protect pupils from such advertising practices.
Advertising of unhealthy foods and beverages around primary and junior high schools in Ghana’s most urbanized and populous region
(Frontiers in Public Health, 2022) Amevinya, G.S.; Aryeetey, R.; Vandevijvere, S.; et al.
Introduction: The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra-processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most–69% were cartoons or manufacturer’s characters), while 8% of all food advertisements had premium offers o
The Africa Food Environment Research Network (FERN): from concept to practice
(Sage, 2022) Tandoh, A.; Aryeetey, R.; et al.
Background: Africa is contending with unhealthy food environments that are, in part, driving increasing rates of overweight, obesity and diet-related non-communicable diseases, alongside persistent undernutrition. This current paradigm requires expanded efforts – both in the volume and nature of empirical research, as well as the tools and capacity of those who conduct it. High quality and context-relevant research supports the development and implementation of policies that create healthy food environments. Aim and approach: This paper sets out the concept of the Africa Food Environment Research Network (FERN) initiative recently established by the Measurement, Evaluation, Accountability, and Leadership Support for non-communicable diseases (NCDs) (MEALS4NCDs) prevention project. Central to the Africa FERN initiative are: 1) building research capacity for innovative food environment research in Africa; 2) improving South–South, South–North partnerships to stimulate robust food environment research and monitoring in Africa and 3) sustaining dialogue and focusing priorities around current and future needs for enhanced food environment research and monitoring in Africa. Conclusion: The FERN initiative presents an opportune platform for researchers in Africa and the global North to weave the threads of experience and expertise for research capacity building, collaboration and advocacy, to advance food environment research.
The African urban food environment framework for creating healthy nutrition policy and interventions in urban Africa
(PLOS ONE, 2021) Osei-Kwasi, H.A.; Laar, A.; Zotor, F.; Pradeilles, R.; Aryeetey, R.; Green, M.; Griffiths, P.; Akparibo, R.; Wanjohi, M.N.; Rousham, E.; Barnes, A.; Booth, A.; Mensah, K.; Asiki, G.; Kimani-Murage, E.; Bricas, N.; Holdsworth, M.
This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and inter vention development in Africa. A multi-component methodology, drawing on concept map ping, was employed to construct a framework of factors influencing dietary behaviours in urban Africa. The framework adapted a widely used socio-ecological model (developed in a high-income country context) and was developed using a mixed-methods research approach that comprised: i. Evidence synthesis consisting of a systematic review of 39 papers covering 14 African countries; ii. Qualitative interview data collected for adolescents and adults (n = 144) using photovoice in urban Ghana and Kenya; and iii. Consultation with interdisciplinary African experts (n = 71) from 27 countries, who contributed to at least one step of the framework (creation, validation/evaluation, finalisation). The final framework included 103 factors influencing dietary behaviours. Experts identified the factors influencing dietary behaviours across all the four levels of the food environment i.e. the individual, social, physical and macro levels. Nearly half (n = 48) were individual-level factors and just under a quarter (n = 26) were at the macro environmental level. Fewer factors associated with social (n = 15) and physical (14) environments were identified. At the macro level, the factors ranked as most important were food prices, cultural beliefs and seasonality. Factors ranked as important at the social level were household composition, family food habits and dietary practices. The type of food available in the neighbourhood and convenience were seen as important at the physical level, while individual food habits, food preferences and socioeconomic status were ranked highly at the individual level. About half of the factors (n = 54) overlap with those reported in an existing socio-ecological food environment framework developed in a high-income country context. A further 49 factors were identified that were not reported in the selected high-income country framework, underlining the importance of contextualisation. Our conceptual framework offers a useful tool for research to understand dietary transitions in urban African adolescents and adults, as well as identification of factors to intervene when promoting healthy nutritious diets to prevent multiple forms of malnutrition.
Age at Menarche among School Girls in Madina -Ga East District of Accra
(University of Ghana, 2010-03) Ashinyo, A.; Aryeetey, R.; University of Ghana, College of Health Sciences, School of Public Health
Age at menarche is an important indicator of sexual maturity in females. It is known to be modified by both genetic and environmental factors. Downward trends in menarche have been recorded in many countries.. In Ghana, a cross-sectional study has been done about two decades ago that determined the age at menarche among school girls in Kumasi. The determinants of age at menarche onset in the Ghanaian population are unknown. This study was done to determine the mean age at menarche and its determinants among school girls in Madina, Ga East District of the Greater Accra Region. A cross-sectional study was conducted. Data for the study was obtained through questionnaires administered to 600 school girls in class 5, 6, JHS 1& 2 in four schools chosen at random through balloting. The heights and weights of the girls were also measured. The mean age at menarche was estimated by the recall method and linear regression used to determine the association between ages at menarche and the predictor variables. Mean age at menarche (±SD) was 12.7±1.2 years. In a multivariate regression model, age at menarche was positively associated with birth order and inversely associated with nutritional status (BMI) and socio-economic status. There was an association between the girl‘s age at menarche and that of their mothers. In conclusion, the mean age at menarche estimated for girls was 12.7 ± 1.2 years, a decline from the age of 13.98 years reported two decades ago by Adadevoh and colleagues (Adadevoh et al., 1989). Socioeconomic status was the strongest predictor of age at menarche. Health and sex education targeted at teenage youth needs revision to take into account the lower age at which girls are reaching menarche.
Age of menarche among basic level school girls in medina, accra.
(2011) Aryeetey, R.; Ashinyo, A.; Adjuik, M.
The current study was designed to determine the age at which menarche occurs among school girls in Madina, Accra. A survey was conducted among 529 girls selected using multi-stage sampling from basic schools in Madina, Accra. Respondents completed a questionnaire that recorded age-at-first menstruation by recall, household characteristics, and anthropometry. Mean age at menarche was 12.74 +/- 1.15 years; probit analysis yielded a median age of 12.09 years. Menarcheal age was significantly correlated with current age (r = 0.48; p < 0.01). Most girls (90%) had first menstruation before age 13. Their mothers' mean age at menarche was 13.6 +/- 1.08 years. In a multivariate linear regression model, household wealth (p < 0.01) and body mass index (p < 0.01) were the main modifiable independent predictors of age at onset of menarche. School girls in Madina attained menarche earlier than previously estimated. Our study suggests an influence of household level improvement in socio-economic status on menarcheal age.
Ageing in Ghana: A Public Health and Cultural Perspective
(Ageing, Physical Activity and Health: International Perspectives, 2018-03) Badasu, D.M.; Aryeetey, R.; Bitugu, B.B.; Ocansey, R.
This chapter discusses the current situation of aging in Ghana from a cultural and public health perspective. There are traditionally established norms by which aging is integrated into societal living. However, due to the processes of modernization, particularly increasing urbanization and migration, these norms are being transformed rapidly in such a way that the traditional safety nets have come under severe stress. Emerging formal care systems are, therefore, expected to complement the traditional debilitated norms. However, these formal care systems are still a long way off from adequately supporting the huge unmet need for care of the elderly, especially in urban settings. Gender differences as well as local cultural norms are taken into consideration for the proposal of options and programs to adequately address the needs of the elderly and support them in their aging process, including physical activity. In the absence of structured interventions, volunteer and club activities can be promoted to keep the elderly in an active lifestyle. © 2018 selection and editorial matter, Karin Volkwein-Caplan and Jasmin Tahmaseb McConatha.
An agriculture–nutrition intervention improved children's diet and growth in a randomized trial in Ghana
(Maternal and Child Nutrition, 2018-10) Marquis, G.S.; Colecraft, E.K.; Kanlisi, R.; Aidam, B.A.; Atuobi-Yeboah, A.; Pinto, C.; Aryeetey, R.
Stunting in Ghana is associated with rural communities, poverty, and low education; integrated agricultural interventions can address the problem. This cluster randomized controlled trial tested the effect of a 12-month intervention (inputs and training for poultry farming and home gardening, and nutrition and health education) on child diet and nutritional status. Sixteen clusters were identified and randomly assigned to intervention or control; communities within clusters were randomly chosen, and all interested , eligible mother-child pairs were enrolled (intervention: 8 clusters, 19 communities, and 287 households; control: 8 clusters, 20 communities, and 213 households). Intention to treat analyses were used to estimate the effect of the intervention on endline minimum diet diversity (≥4 food groups), consumption of eggs, and length-forage (LAZ)/height-forage (HAZ), weight-forage (WAZ), and weight-for-length (WLZ)/ weight-for-height (WHZ) z-scores; standard errors were corrected for clustering. Children were 10.5 ± 5.2 months (range: 0-32) at baseline and 29.8 ± 5.4 months (range: 13-48) at endline. Compared with children in the control group, children in the intervention group met minimum diet diversity (adjusted odds ratio = 1.65, 95% CI [1.02, 2.69]) and a higher LAZ/HAZ (β = 0.22, 95% CI [0.09, 0.34]) and WAZ (β = 0.15, 95% CI [0.00, 0.30]). Sensitivity analyses with random-effects and mixed-effects models and as-treated analysis were consistent with the findings. There was no group difference in WLZ/WHZ. Integrated interventions that increase access to high-quality foods and nutrition education improve child nutrition.
Analysis of stakeholder networks for breastfeeding policies and programs in Ghana
(International Breastfeeding Journal, 2020) Aryeetey, R.; Harding, K.; Hromi-Fiedler, A.; Pérez-Escamilla, R.
Background: Suboptimal breastfeeding practices are driven by multiple factors. Thus, a multi-sectoral approach is necessary to design and implement appropriate policies and programs that protect, promote, and support breastfeeding. Methods: This study used Net-Map, an interactive social network interviewing and mapping technique, to: a) identify key institutional actors involved in breastfeeding policy/programs in Ghana, b) identify and describe links between actors (i.e., command, dissemination, funding, and technical assistance (TA)), and c) document actors' influence to initiate or modify breastfeeding policy/programs. Ten experts were purposively selected from relevant institutions and were individually interviewed. Interview data was analyzed using social networking mapping software, Gephi (version 0.9.2). Results: Forty-six unique actors were identified across six actor categories (government, United Nations agencies, civil society, academia, media, and others), with one-third being from government agencies. Dissemination and TA links accounted for two-thirds of the identified links between actors (85/261 links for dissemination; 85/261 for TA). Command links were mainly limited to government agencies, while other link types were observed across all actor groups. Ghana Health Service (GHS) had the greatest in-degree centrality for TA and funding links, primarily from United Nations Children’s Fund (UNICEF) and development partners. The World Health Organization, UNICEF, Ministry of Health and GHS had the highest weighted average relative influence scores. Conclusions: Although diverse actors are involved in breastfeeding policy and programming in Ghana, GHS plays a central role. United Nations and donor agencies are crucial supporters of GHS providing breastfeeding technical and financial assistance in Ghana.
Anemia among Women Seeking Treatment for Uterine Fibroids in three Selected Hospitals in Accra Metropolis
(University of Ghana, 2016-07) Buadi, L.O.; Aryeetey, R.; University of Ghana, College of Health Sciences, School of Public Health
Background: Anemia, defined as blood hemoglobin level below established cut-off points, is a pervasive global public health problem. An estimated 2 billion people are affected globally. Anemia prevalence is highest in developing countries but also high in developed countries. Worldwide, over 30% of all women suffer from anemia, with abnormal uterine bleeding being a risk factor for anemia. Uterine fibroids are the most common benign gynecologic tumors affecting premenopausal women, with commonest presentation being abnormal uterine bleeding. The current study aim to assess the relationship between anemia and heavy bleeding as a result of uterine fibroids among women seeking care in three selected hospitals in the Accra Metropolis. Method: A sample of 385 non-pregnant women with uterine fibroids were recruited to participate in a cross-sectional survey. Data on uterine size, fibroid location, hemoglobin level and reason(s) why they seek treatment was collected using a structured questionnaire and analyzed using SPSS Version 23. Means and medians of continuous variables and proportions of categorical variables were calculated. Associations between continuous variables were determined using Pearson correlation while between categorical variables using Chi-Square, Fisher’s exact test and logistic regression. All of these statistics were tested at 95% confidence level and standard error of 5%. Findings: The current study found that 8 in 10 women seeking care for uterine fibroids had anemia. There was an association between uterine fibroid location and anemia (p =0.002) but not uterine size and anemia (r = 0.014, p = 0.779). Also 79.5% of the women sought care due uterine fibroid symptoms, inability to conceive (36.9%), cosmetic reasons (7.5%) and risk of cancer (1.6%). Conclusion: The study documented high prevalence of anemia among women with uterine fibroids. Anemia was significantly associated with uterine fibroid location but not uterine size. A large proportion of women with uterine fibroids sought care as a result of symptoms due to fibroids.
Anemia Prvalence And Associated Factors Among School Age Children In Accra And Kumasi Metropolis In Ghana
(ajfand, 2022) Egbi, G.; Larbi, I.A.; Nti, H.; Marquis, G.S.; Lartey, A.; Aryeetey, R.
Anemia remains a serious public health concern, globally, affecting learning ability and physical development of children. Anemic children are at a higher risk of diminished economic productivity and low earning capacity in adulthood due to impaired school performance and reduced work capacity. Anemia contributes to about a quarter of Africa’s nutrition-related Disability Adjusted Life Years. The objective of this study was to determine the prevalence of anemia and its associated risk factors among school-aged children (SAC) between ages 9 and 15 years in urban Ghana. The analysis included a randomly selected subsample of 1,634 children from a larger study on nutrition of SAC enrolled between 2009 and 2012 in private and public basic schools in the Accra and Kumasi Metropolis in Ghana. Socio-demographic and household characteristics were collected with questionnaires. Weight and height were taken to the nearest 0.1kg and 0.1cm, respectively. Dietary information was collected using a food frequency questionnaire. Data were analyzed using IBM SPSS Statistic version 23. The relationship between hemoglobin levels and socio-demographic variables, and predictors of hemoglobin levels were determined using Chi-square and binary logistic regression. The mean hemoglobin concentration of the study participants was 12.9±1.3 g/dL. In Kumasi, SAC had higher mean hemoglobin concentration (13.1±1.2 g/dL) compared to those from Accra (12.6±1.3 g/dL; p=0.001). Mean hemoglobin concentration was significantly higher among males than females (13.0±1.4 g/dL vs 12.8±1.2 g/dL; p=0.002). Prevalence of anemia was 20.4%; mild anemia was most common (13.6% of total sample). Anemia cases were higher in public schools (24.6%) compared to private (18.2%). Two-thirds of anemia cases (64.0%) were from schools in Accra. Males had significantly higher prevalence of anemia (26.5%) than females (15.9%; p <0.05). In the adjusted logistic regression model, only city of residence (OR+1.65, 95% CI: 1.44–1.83), thinness (OR=2.60, 95% CI: 1.11-5.75), stunting (OR=1.85, 95% CI: 1.99-3.10) and overweight (OR=0.60, 95% CI: 0.36-0.94) were significantly associated with anemia. In this study, anemia was significantly associated with location and nutritional status.
Anthropometric characteristics of children living in food-insecure households in the USA
(Public Health Nutrition, 2021) Tayie, F.A.; Lambert, L.A.; Aryeetey, R.; Xu, B.; Brewer, G.
Objective: This study provides information on food insecurity and child malnutrition in a technologically advanced nation. Design: Population-based study using multistage probability cluster sampling design to collect survey data. Multivariable regression models were used to determine associations between food security status and various malnutrition indices. Setting: We used a national sample from the US National Health and Nutrition Examination Survey 2011–2014. Participants: The anthropometric and demographic data sets of 4121 children <7 years old were analysed for this study. Results: Food-insecure infants younger than 6 months had shorter upper arm length (–0·4 cm, P = 0·012) and smaller mid-upper arm circumference (–0·5 cm, P = 0·004); likewise those aged 6 months–1 year had shorter upper arm length (–0·4 cm, P = 0·008), body length (–1·7 cm, P = 0·007) and lower body weight (–0·5 kg, P = 0·008). Food-insecure children younger than 2 years were more likely to be underweight (OR: 4·34; 95 % CI 1·99, 9·46) compared with their food-secure counterparts. Contrariwise, food-insecure children older than 5 years were more likely to be obese (OR: 3·12; 95 % CI 1·23, 7·96). Conclusions: Food insecurity associates with child growth deficits in the USA. Food-insecure infants and young children are generally smaller and shorter, whereas older children are heavier than their food-secure counterparts, implying a double burden of undernutrition–overnutrition associated with child food insecurity. Child food and nutrition programmes to improve food insecurity should focus on infants and children in the transition ages.
Assessment of Clinic-Based Growth Monitoring and Promotion in the Accra Metropolitan Area of Ghana
(University of Ghana, 2012-07) Gyampoh, S.; Otoo, G.E.; Aryeetey, R.
Growth Monitoring and Promotion (GMP) is a public health intervention which makes use of frequent assessment of the growth of children under five years. The programme enables health workers to early detect growth failure and take corrective actions through improvements in feeding and care practices. Despite evidence that most caregivers in Ghana have contact with GMP through monthly child welfare clinics (CWC), child feeding practices remain sub-optimal and child undernutrition persists. The study assessed the implementation of GMP in Ghana and the relationship between caregiver exposure to GMP and child feeding knowledge and practices, the nutritional status of their children and knowledge of GMP. The study was cross-sectional, involving 206 caregiver-child pairs attending child welfare clinics (CWC) and 17 health workers providing GMP services at the CWC in the Accra Metropolitan Area (AMA). Observation checklists were used to assess health worker implementation of GMP activities for caregiver-child pairs. Child health records provided data on caregiver attendance. Structured questionnaires were used to collect data on caregiver-child pair characteristics, child feeding knowledge and practices, and knowledge of GMP activities. Weights and heights of participating children were measured to determine nutritional status. Structured questionnaires were also used to collect data on health worker knowledge of recommended child feeding and GMP activities. Comprehension of the child growth chart by caregivers and health workers was assessed using sample charts. Recording of child weights on the appropriate growth chart for boys and girls were correctly done in over 97% of children. However, over 50% of children did not have all their monthly weight points connected on the growth chart to show the trend of growth. More than 60% of caregiver-child pairs in the study received no growth promotion education and only about 3% of children experiencing faltering growth in two consecutive months were referred for appropriate intervention as prescribed in the health records book by the Ghana Health Service. Caregivers who had not missed any CWC attendance had significantly better growth chart comprehension scores (p=0.026). Nutritional status of children and caregiver knowledge of recommended child feeding was not significantly associated with CWC attendance (p= 0.707; p=0.136). The relationship between caregiver CWC attendance and child feeding practices was also not found to be significant. Overall, over half of the percentage of health workers in the study had poor knowledge scores of recommended child feeding practices and the growth chart. Generally most health workers knew recommended child feeding practices and GMP activities, however some health workers could not adequately indicate recommended actions for particular growth trends on the growth chart. Data recording and charting practices were appropriately carried with the exception of plotting of child weights. Growth promotion education was also observed to be inadequately carried out. Among caregivers breastfeeding practices were well practiced while complementary feeding practices were suboptimal. Not missing any CWC was not significantly associated good feeding knowledge and practice scores and child nutritional status as with good growth chart comprehension. For GMP to achieve its goals, it is necessary for the government/GHS to routinely train health workers on GMP. It is also equally essential to provide the needed logistics and improve the organisation of CWC in order to reduce health worker workload and enhance effectiveness.
Assessment of Dietary Intakes and Nutritional Status of School Age Children Participating in School Feeding Programmes at Otinibi and Danfa
(University of Ghana, 2013-07) Owusu, J.S.; Colecraft, E.; Aryeetey, R.
Background: School age children (SAC) are vulnerable to malnutrition which can negatively influence their growth and maturity, health and academic attainment. School feeding programmes (SFP) have the potential to improve dietary intakes and nutrition of SAC. However there is limited information on the nutritional impact of school feeding programmes in Ghana. Objective: The aim of this study was to determine the dietary intakes and nutritional status of SAC participating in an NGO-sponsored (NSFP) and a Government-sponsored (GSFP) school feeding programme in two semi-rural communities in Ghana. Methodology: A cross sectional survey was used to obtain data from 182 school age children (SAC) and caregiver pairs. Structured questionnaires were used to interview the SAC and caregivers on their socio-demographic characteristics and dietary practices. The 24hour dietary recall method was used to collect data of the children’s dietary intakes on 2 non-consecutive days. Children’s weight and height measurements were taken and anthropometric indices (stunting, BMI for age) were computed. The hemocue method was used to assess haemoglobin levels on a sub-sample of children. Predictors of nutritional status of SAC were assessed using linear and logistic regression models. T-test was used to test the differences in school performance and attendance of children who have normal nutritional status and those with at least one nutritional deficit. Results: The mean dietary diversity scores for all the SAC was 5±1 out of 9 food groups. Diets of SAC were low in organ meats, dairy products, eggs and dark green leafy vegetables. SAC met all the DRI for energy and nutrients (protein, iron, zinc, vitamin C and A) intake except for calcium intake. Portion sizes of GSFP meals served to SAC were significantly lower (243 ± 50g vs. 416 ± 96g; p=0.012) than NSFP. Meals provided by the NSFP met recommendations for energy and macronutrient content of school meals whiles those provided by the GSFP did not. Dietary intakes of NSFP participants were higher than GSFP. NSFP contributed significantly higher energy (28 ± 10% vs. 16.2 ± 7%; p=<0.001), protein (24.6 ± 9% vs. 13.3 ± 7%; p=<0.001) and micronutrients (p≤0.042) to the children’s total energy intakes compared to meals provided through the GSFP. 67.0% of SAC were either anaemic, stunted or had low BMI for age. Haemoglobin level was lower among SAC who have received any micronutrient supplement in the past 6 months (β=-0.900; p=0.009)and SAC whose caregivers education was lower than JHS (β=-1.050; p=0.002). Younger age (<10yrs) was associated with high BMI for age (β=0.342, p=0.10) .BMI for age and height for age of SAC were not affected by energy intake (β=0.000; p=≤0.046).Also, younger age (<10yrs), caregivers not working or engaged in occupation (trader and vocational occupation) and educational level higher than JHS were associated with HAZ of SAC (p<0.05). The significant predictors for having at least one nutritional deficit among SAC wereyounger age (odds ratio=0.485; CI=0.243-0.969; P=0.040) and caregivers engaged in other occupationsuch as farmers, stone winnowers and professional workers (odds ratio=3.499; CI=1.065-11.491; p=0.039). None of the nutritional indices that SAC were assessed on was significantly associated with school attendance and performance in the past term. However, there was significant association between having at leastone nutritional deficit and school performance in Mathematics (Mean difference=-4.62; p=0.037) and English (Mean difference=-4.49; p=0.027) but not Science in the past term. Conclusion: Malnutrition was prevalent among the SAC. Both GSFP and NSFP were contributing to daily intakes of SAC. However, the quantity of food served by GSFP need to be reviewed to increase its contribution to daily nutrient intakes.
Assessment of Nutrition Support Services for Persons Living with HIV at Selected Art Sites in Ghana
(University of Ghana, 2013-07) Yakubu, M.B.; Aryeetey, R.; University of Ghana, College of Health Sciences, School of Public Health
According to the 2012 HIV sentinel Survey Report, it is estimated that 235,982 people are living with HIV in Ghana. There have been several interventions all making attempts to address challenges PLHIV face. One of such interventions is the Nutrition Assessment Counselling and Support programme (NACS) which aims at providing a comprehensive nutrition services for PLHIV. The study hopes to bring to the fore the capacity of health workers to deliver NACS services in Ghana, the availability and use of NACS related educational materials and equipments, the adequacy of nutrition counselling as part of NACS services and also to assess the nutrition knowledge of the PLHIV’s receiving NACS services at the selected ART sites. This is a cross-sectional study. Persons Living with HIV (PLHIV) and Health workers were conveniently selected from eight (8) active ART sites implementing NACS. Participants were interviewed with the use of structured questionnaire. A standardized observation checklist was also used to collect information on the quality of nutrition counselling and the availability and use of NACS related equipment and materials. Nutrition knowledge of PLHIV was determined based on knowledge of two or more critical times to wash hands properly, three basic ways to increase energy intake, two or more advantages of eating a nutritionally adequate diet, and eating three or more times a day. Adequacy of nutrition counselling was determined using a standardised checklist from FANTA on nutrition counselling quality. Scoring 75% or more means nutrition counselling was of good quality. The capacity of the health workers delivering nutrition services to PLHIV was also assessed by way of looking at their background training as nurses/nutritionist or dietician or Counsellors and if they have ever received an MOH approved training in nutrition and HIV. The availability on use of NACS related educational material and equipment was also assessed. Data from 261 PLHIV’s 13 health workers and eight ART sites were included in the analysis. For the PLHIV, there were 197 females (75.5%) and 64 females (24.5%), Less than 30.0% have never had any form of education, 81% of them are employed. For the health personnel, four were Nurses, two Dieticians, two Models of Hope Personnel, a Statistician, two Health educators and two Psychologists. Routine individual nutrition counselling was not observed in any of the facilities except for those visibly wasted who needed to be put on therapeutic food. Seven of such sessions were observed using a nutrition quality checklist. All counselling sessions were of good quality as the average scores ranged from 75% to 90%. Almost all (89%) of PLHIV had adequate knowledge on the need to eat three or more times a day. However, less than 20% of them knew three basic ways to increase energy intake. Most health workers have the requisite training to provide NACS services to PLHIV’s. Almost all ART sites are not adequately equipped to deliver NACS services to PLHIV’s. In conclusion, routine nutrition counselling for PLHIV has been found to be inadequate even though most health personnel delivering nutrition services have been trained. There is the need for regular refresher training for health workers and to replace health worker who have gone on transfer or retirement with those with the requisite skills and appropriate training to provide comprehensive nutrition services for PLHIV. Most PLHIV’s were found to have quite an adequate nutrition knowledge but there the need to help improve the availability with the use of BCC/IEC materials like posters that communicates nutrition and HIV messages in languages that are easy to comprehend
Assessment of rehabilitation capacity in Ghana
(2016) Christian, A.; Bentley, J.; Aryeetey, R.; Ackuaku, D.; Mayer, R.S.; Wegener, S.
Purpose: This study describes a cross-sectional assessment of infrastructure, human resources, and types of rehabilitation interventions provided in a sample of healthcare facilities in Ghana. The objectives were to (a) develop and pilot a questionnaire assessing rehabilitation capacity in LMICs, and (b) provide initial data regarding available rehabilitation care in rural Ghana. Methods: Data was collected from a sample of rehabilitation workers at 9 facilities, comprised of 5 regional and 4 district hospitals, located in seven of the ten geographical regions of Ghana. Participants completed a modified version of the World Health Organisation's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, adapted to reflect core indicators of rehabilitation infrastructure. Participating facilities were mailed questionnaires and agreed to subsequent site visits from the first author. Results: There were several limitations associated with basic rehabilitation infrastructure. Consistent with previous research, significant human resources limitations were observed as hospital-based rehabilitation services were primarily rendered by 20 physiotherapists and 21 physiotherapy assistants across the 9 participating sites. No rehabilitation physicians were identified at any of the surveyed facilities. With regard to therapeutic interventions, management of musculoskeletal impairments was generally consistent with current evidencebased practices, whereas rehabilitative approaches for neurologic conditions were limited to physical rather than sensory-motor modalities. Conclusions: For the first time there is study data which details the rehabilitation infrastructure, human resources, and interventions in Ghana. This study furthers the field through the adaptation and initial piloting of a rehabilitation assessment instrument that can be used in LMIC contexts. Limitations: The questionnaire used for the study was modified from the questionnaire for assessing surgical care in resource poor countries, and has not yet been validated. Since the study was conducted in a convenience sample of rehabilitation/physiotherapy centres in Ghana, generalisability may be limited. © 2016, Action for Disability Regional Rehabilitation Centre. All rights reserved.
An assets-based approach to promoting girls' financial literacy, savings, and education
(Journal of Adolescence, 2018-10) Clark, S.; Paul, M.; Aryeetey, R.; Marquis, G.
Purpose This study examined whether micro-savings programs can improve young adolescent girls' financial knowledge, savings behaviors, and schooling outcomes in Ghana. Methods We evaluated the short- and medium-term effects of a randomized control trial in which a sub-sample of over 1400 girls living in the Eastern Region of Ghana received financial literacy training and a micro-savings account. Results Girls in the intervention arm of the study initially exhibited higher levels of financial knowledge, planning, and savings, but some of these effects disappeared within two years. Nonetheless, girls with micro-savings retained their greater knowledge of interest rates, had higher levels of savings, and were more likely to save for school. The effects on girls' educational enrollment was strongest in the second year. Conclusions Our results suggest that even relatively young girls can manage micro-savings accounts and that such programs, if sustained, can effectively build girls' financial and educational assets.
Breastfeed4Ghana: Design and evaluation of an innovative social media campaign
(Maternal & Child Nutrition, 2019-12-22) Aryeetey, R.; Harding, K.; Carroll, G.; Lasisi, O.; Pérez‐Escamilla, R.; Young, M.
Although targeting health behaviour change through social media campaigns has gained traction in recent years, few studies have focused on breastfeeding social media campaigns. Within the context of rising social media utilization and recent declines in exclusive breastfeeding practices in Ghana, we implemented Breastfeed4Ghana, a Facebook‐ and Twitter‐based breastfeeding social media campaign. This study determined feasibility of implementing Breastfeed4Ghana and evaluated its impact on breastfeeding knowledge in Ghana. Key performance indicators of the campaign were monitored on social media platforms, Facebook and Twitter. An online cross‐sectional survey conducted across three time points (n = 451) assessed breastfeeding knowledge, campaign exposure, and understanding and acceptability of Breastfeed4Ghana among Ghanaian adults. Modified Poisson models were used to assess the relationship between campaign exposure and breastfeeding knowledge, adjusting for survey time point, sex, and parenthood status. The campaign acquired 4,832 followers. Based on follower demographics collected from Facebook and Twitter analytics, the target population was successfully reached. Campaign exposure among survey participants was 42.3% and 48.7% at midline and endline, respectively. Campaign acceptability was high (>90%), and >44% of those exposed to the campaign also shared the campaign with others. However, 61.0% of those exposed did not know or could not remember the purpose of the campaign. Campaign exposure was not associated with higher breastfeeding knowledge (APR [95% confidence interval] = 0.96 [0.73, 1.26]). Breastfeed4Ghana was highly feasible. However, campaign understanding yielded mixed findings and may explain the limited impact on breastfeeding knowledge
Breastfeed4Ghana: Design and evaluation of an innovative social media campaign
(Maternal & Child Nutrition, 2019) Harding, K.; Aryeetey, R.; Carroll, G.; et al.
Although targeting health behavior change through social media campaigns has gained traction in recent years, few studies have focused on breastfeeding social media campaigns. Within the context of rising social media utilization and recent declines in exclusive breastfeeding practices in Ghana, we implemented Breastfeed4Ghana is a Facebook‐ and Twitter‐based breastfeeding social media campaign. This study determined the feasibility of implementing Breastfeed4Ghana and evaluated its impact on breastfeeding knowledge in Ghana. Key performance indicators of the campaign were monitored on social media platforms, Facebook and Twitter. An online cross‐sectional survey was conducted across three time points (n = 451) assessed breastfeeding knowledge, campaign exposure, and understanding and acceptability of Breastfeed4Ghana among Ghanaian adults. Modified Poisson models were used to assess the relationship between campaign exposure and breastfeeding knowledge, adjusting for survey time point, sex, and parenthood status. The campaign acquired 4,832 followers. Based on follower demographics collected from Facebook and Twitter analytics, the target population was successfully reached. Campaign exposure among survey participants was 42.3% and 48.7% at midline and endline, respectively. Campaign acceptability was high (>90%), and >44% of those exposed to the campaign also shared the campaign with others. However, 61.0% of those exposed did not know or could not remember the purpose of the campaign. Campaign exposure was not associated with higher breastfeeding knowledge (APR [95% confidence interval] = 0.96 [0.73, 1.26]). Breastfeed4Ghana was highly feasible. However, campaign understanding yielded mixed findings and may explain the limited impact on breastfeeding knowledge.