Browsing by Author "Brouwer, I.D."
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Item Agro-ecological zone and farm diversity are factors associated with haemoglobin and anaemia among rural school-aged children and adolescents in Ghana(Maternal and Child Nutrition, 2018-07) Azupogo, F.; Aurino, E.; Gelli, A.; Bosompem, K.M.; Ayi, I.; Osendarp, S.J.M.; Brouwer, I.D.; Folson, G.Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school-aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6-9 years; n = 323) and adolescents (10-17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro-ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro-ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro-ecological zone and age were pre-dictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro-ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Item Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study(Journal of Health, Population and Nutrition, 2019-12-12) Armar-Klemesu, M.; Ahishakiye, J.; Bouwman, L.; Brouwer, I.D.; Matsiko, E.; Koelen, M.Background: Despite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6–23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda. Methods: Sixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti. Results: Two main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women’s heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges. Conclusion: Factors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge onlyItem Cowpeas in Northern Ghana and the Factors that Predict Caregivers' Intention to Give Them to Schoolchildren(Public Library of Science, 2013) Abizari, A.R.; Pilime, N.; Pilime, M.; Brouwer, I.D.Background:Cowpeas are important staple legumes among the rural poor in northern Ghana. Our objectives were to assess the iron and zinc content of cowpea landraces and identify factors that predict the intention of mothers/caregivers to give cowpeas to their schoolchildren.Methods and Findings:We performed biochemical analysis on 14 landraces of cowpeas and assessed the opinion of 120 caregiver-child pairs on constructs based on the combined model of the Theory of Planned Behaviour and Health Belief Model. We used correlations and multiple regressions to measure simple associations between constructs and identify predictive constructs. Cowpea landraces contained iron and zinc in the range of 4.9-8.2 mg/100 g d.w and 2.7-4.1 mg/100 g d.w respectively. The landraces also contained high amounts of phytate (477-1110 mg/100 g d.w) and polyphenol (327-1055 mg/100 g d.w). Intention of mothers was strongly associated (rs = 0.72, P<0.001) with and predicted (β = 0.63, P<0.001) behaviour. The constructs, barriers (β = -0.42, P = 0.001) and attitudes towards behaviour (β = 0.25, P<0.028), significantly predicted intention albeit the predictive ability of the model was weak.Conclusions:We conclude that some cowpea landraces from northern Ghana have appreciable amounts of iron and zinc but probably with poor bioavailability. Attitudes towards giving cowpeas and perception of barriers are important predictors of caregivers' intention to give cowpeas to their schoolchildren. Finally our results suggest that increasing knowledge on nutritional benefits of cowpeas may increase health values caregivers hold for their children in support of giving cowpeas to schoolchildren.Item Phytic acid-to-iron molar ratio rather than polyphenol concentration determines iron bioavailability in whole-cowpea meal among young women(Journal of Nutrition, 2012-11) Abizari, A.-R.; Moretti, D.; Schuth, S.; Zimmermann, M.B.; Armar-Klemesu, M.; Brouwer, I.D.Limited data exist on iron absorption from NaFeEDTA and FeSO4 in legume-based flours. The current study compared iron absorption from NaFeEDTA and FeSO4 as fortificants within and between red and white varieties of cowpea with different concentrations of polyphenols (PP) but similar phytic acid (PA)-to-iron molar ratios. We performed a paired crossover study in young women (n = 16). Red-cowpea (high-PP) and white-cowpea (low-PP) test meals (Tubani) were each fortified with (57Fe)-labeled NaFeEDTA or (58Fe)-labeled FeSO4 and were randomly administered. Iron absorption was measured as erythrocyte incorporation of stable iron isotopes. Per serving, the mean (6SD) PP concentrations of the white- and red-cowpea-basedmeals were 7463.6 and 15861.8mg, respectively, and themolar ratio of PA to ironwas 3.0 and 3.3. Iron bioavailabilities from red and white cowpeas were 1.4 and 1.7%, respectively, in NaFeEDTA-fortified meals and 0.89 and 1.2%, respectively, in FeSO4-fortified meals. Compared with FeSO4, fortification with NaFeEDTA increased the amount of iron absorbed from either of the cowpeameals by 0.05 to0.08mg(P < 0.05). Irrespective of the fortificant used, therewas no significant difference in the amount of iron absorbed fromthe 2 varieties of cowpea. The results suggest that NaFeEDTA ismore bioavailable in legume-based flours comparedwith FeSO4. In cowpea-based flours, themajor determinant of lowiron absorptionmay be the highmolar ratio of PA to iron and not variations in PP concentration. © 2012 American Society for Nutrition.Item School feeding contributes to micronutrient adequacy of Ghanaian schoolchildren(British Journal of Nutrition, 2014-07) Abizari, A.-R.; Buxton, C.; Kwara, L.; Mensah-Homiah, J.; Armar-Klemesu, M.; Brouwer, I.D.Without gains in nutritional outcomes, it is unlikely that school feeding programmes (SFP) could improve cognition and academic performance of schoolchildren despite the improvements in school enrolment. We compared the nutrient intake adequacy and Fe and nutritional status of SFP and non-SFP participants in a cross-sectional survey involving 383 schoolchildren (aged 5-13 years). Quantitative 24h recalls and weighed food records, repeated in 20% subsample, were used to estimate energy and nutrient intakes adjusted for day-to-day variations. The probability of adequacy (PA) was calculated for selected micronutrients and the mean of all PA (MPA) was calculated. The concentrations of Hb, serum ferritin, and soluble transferrin receptor (sTfR) and anthropometric measurements were used to determine Fe and nutritional status. Energy and nutrient intakes and their adequacies were significantly higher among SFP participants (P<0·001). The MPA of micronutrients was significantly higher among SFP participants (0·61 v. 0·18; P<0·001), and the multiple-micronutrient-fortified corn soya blend was a key contributor to micronutrient adequacy. In SFP participants, 6g/l higher Hb concentrations (P<0·001) and about 10% points lower anaemia prevalence (P=0·06) were observed. The concentration of sTfR was significantly lower among SFP participants (11·2 v. 124mg/l; P=0·04); however, there was no difference in the prevalence of Fe deficiency and Fe-deficiency anaemia between SFP and non-SFP participants. There was also no significant difference in the prevalence of thinness, underweight and stunting. In conclusion, the present results indicate that school feeding is associated with higher intakes and adequacies of energy and nutrients, but not with the prevalence of Fe and nutritional status indicators. The results also indicate an important role for micronutrient-dense foods in the achievement of micronutrient adequacy within SFP. Copyright © 2014 The Authors.Item Whole cowpea meal fortified with NaFeEDTA Reduces iron deficiency among ghanaian school children in a malaria endemic area(Journal of Nutrition, 2012-10) Abizari, A.-R.; Moretti, D.; Zimmermann, M.B.; Armar-Klemesu, M.; Brouwer, I.D.Cowpeas, like other legumes, contain high amounts of native iron but are rich in phytic acid (PA) and polyphenols (PP) that inhibit iron absorption. NaFeEDTA may overcome the combined inhibitory effect of PA and PP. Our objective was to test the efficacy of NaFeEDTA-fortified cowpea meal in improving iron status of school children in a malaria endemic area. We conducted a double-blind, controlled trial with 5- to 12-y-old school children from 2 rural communities in northern Ghana (n = 241). Eligible children were randomly assigned to 2 treatment groups to receive either cowpea meal fortified with 10 mg Fe/meal as NaFeEDTA, or an identical but nonfortified cowpea meal. Meals were provided 3 d/wk for a period of ;7 mo under strict supervision. Mass deworming and malaria antigenemia screening and treatment were carried out at baseline and 3.5 mo into the trial. Consumption of cowpea flour fortified with NaFeEDTA resulted in improvement of hemoglobin (P < 0.05), serum ferritin (P < 0.001), and body iron stores (P < 0.001) and reduction of transferrin receptor (P < 0.001) compared with nonfortified flour. Fortification resulted in a 30 and 47% reduction in the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) (P < 0.05), respectively. The results indicate that fortification of cowpea flour with NaFeEDTA overcomes the combined inhibitory effect of PA and PP and, when used for targeted school-based fortification of cowpea flour, is effective in reducing the prevalence of ID and IDA among school children in malaria endemic rural northern Ghana. © 2012 American Society for Nutrition.