Browsing by Author "Colecraft, E.K."

Now showing 1 - 20 of 21

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.
Awareness and Use of Nutrition Labels on Pre-Packaged Foods among Consumers in Accra
(University of Ghana, 2013-06) Aryee, G.A.; Colecraft, E.K.; Asibey-Berko, E.
Introduction and Objective: Nutrition labels may help consumers to make healthier choices when choosing prepackaged foods and thereby reduce the risk for diet-related chronic diseases. Ghanaian consumers are increasingly consuming prepackaged foods, however there is little research on their awareness and use of nutrition labels. The study assessed awareness and use of Nutrition labels on prepackaged foods among shoppers in two selected supermarkets in the Accra Metropolis in Ghana. This will facilitate future public education efforts to promote the use of Nutrition labels. Design and Methods: This was a cross-sectional survey with 403 adult shoppers at the two supermarkets. Convenient sampling was used to recruit participants into the study. Structured pre-coded questionnaires were used to interview participants on socio demographic, health characteristics and awareness and use of food and nutrition labels. Statistical Analysis: The Chi square (χ 2) statistic was used to assess differences between those having high and low awareness of nutrition labels and between those who use nutrition labels and those who do not. Logistic regression was used to determine factors which predicted awareness and use of nutrition labels. Results: Majority (82%) of respondents were aware that some prepackaged foods carried food labels with nutrition information. The components of food labels which were most likely to be used were the expiration date (26.9%) and nutrition label information (19.6%). About 25% of the respondents reported not using nutrition labels. Among those who used nutrition labels, nutrient information most likely to be used were fats (16.4%) and sugar (16.1%) and cholesterol (14%). There were no associations between history of health conditions and special diet status of participants and nutrition label awareness and use. Among the socio demographic factors education and income were found to be positively associated with awareness of nutrition labels. Education, employment status, income and marital status were positively associated with nutrition label use. Level of education was the only significant predictor of nutrition label awareness in this study. No significant predictors of nutrition label use were observed. Compared to respondents who had completed Diploma, Degree or Post graduate education, respondents who were less likely to be aware of nutrition labels were those with Primary/Middle/JHS education or less (OR= 0.2;CI= 95%; P = 0.002) and those with SHS/Vocational/Technical education (OR=0.3;CI=95%; P=0.001). Respondents with ≤Middle school education were 80% less likely to have high awareness and those with SHS/Vocational/Technical school education were 70% less likely to have high awareness compared to individuals with Diploma and beyond. Conclusion: In summary, the study found that educational level plays a significant role in consumers‘ awareness of nutrition labels. There is the need to improve awareness of nutrition labels among the lower educated and encourage consumers who don‘t use nutrition labels to do so when purchasing prepackaged foods. Consumers who have diet-related health conditions and those who want to lose weight should be encouraged to use nutrition label information to choose healthier prepackaged foods as part of dietary and weight management efforts. The results of this study provide useful information that can inform future public education efforts to promote use of nutrition labels for sound food choices.
A behavior change communication intervention, but not livelihood interventions, improves diet diversity and animal-source food consumption among Ghanaian women
(Food & Nutrition Research, 2022) Ludwig-Borycz, E.F.; Wilson, M.L.; Colecraft, E.K.; Jones, A.D.
Background: Women of reproductive age (WRA), especially in sub-Saharan Africa, are vulnerable to micronutrient deficiencies driven largely by poor quality diets. Intervening into food value chains, on which many households in low- and middle-income countries depend for their livelihood, may be a promising approach to improving diets in these contexts. Objective: In this pilot-scale randomized trial, we evaluated whether a multisectoral, food value chain intervention improved the diet diversity and the consumption of animal-source foods (ASFs) among WRA in Ghana. Design: Twelve fish-smoking communities in two regions of Ghana with 296 eligible women were randomly assigned to one of three 9-month treatment arms: 1) behavior change communication (BCC) to promote improved diet quality through twice-weekly audio messages and bi-weekly peer-to-peer learning sessions; 2) BCC with microcredit to increase women’s incomes; or 3) BCC with provision of new smoke-oven technology. We assessed baseline-endline and between-treatment arm differences using a 10-food group diet diversity score (DDS), the Minimum Dietary Diversity for Women (MDD-W) indicator, and 7-day frequency of ASF consumption. Results: Among 118 participants (39 in both treatment arm 1 and treatment arm 3, and 40 in treatment arm 2, with no participant refusals), DDS increased from a mean (SD) of 4.0 (1.3) at baseline to 5.1 (0.9) at endline (P-value < 0.0001). The proportion of women achieving the MDD-W indicator nearly doubled from baseline (35.6%) to endline (69.5%) (P-value < 0.0001). Frequency of ASF consumption similarly increased for meat and poultry (2.7 (4.1) to 4.7 (5.3); P-value < 0.0001) and eggs (1.5 (3.1) to 2.3 (4.9); P-value = 0.02). Few differences in these outcomes were observed among treatment arms. Conclusions: A BCC intervention improved diet diversity and consumption of ASFs among participants. However, neither a group-based microcredit nor improved smoke oven intervention, both of which increased women’s income, led to additional dietary improvements.
Caregivers’ nutrition knowledge and attitudes are associated with household food diversity and children’s animal source food intake across different agro-ecological zones in Ghana
(The British journal of nutrition, 2015-11) Christian, A.K.; Marquis, G.S.; Colecraft, E.K.; Lartey, A.; Sakyi-Dawson, O.; Ahunu, B.K.; Butler, L.M.
Caregivers’nutrition knowledge and attitudes may inﬂuence the variety of foods available in the household and the quality of children’s diets. To test the link, this study collected data on caregivers’(n608) nutrition knowledge and feeding attitudes as well as the diets of their household and of their 2–5-year-old children in twelve rural communities nested in the three main agro-ecological zones of Ghana. Household foods and children’s animal source foods (ASF) consumed in the past 7 d were categorised into one of fourteen and ten groups, respectively. About 28 % of caregivers believed that their children needed to be fed only 2–3 times/d. Reasons for having adult supervision during child meal times, feeding diverse foods, prioritising a child to receive ASF and the perceived child beneﬁts of ASF differed across zones (P<0·001). Households with caregivers belonging to the highest tertile of nutrition knowledge and attitude scores consumed more diverse diets compared with those of caregivers in the lowest tertile group (11·2( SD 2·2) v.10·0(SD 2·4); P<0·001). After controlling for the effect of agro-ecological zone, caregivers’nutrition knowledge and feeding attitudes positively predicted household dietary diversity and the frequency and diversity of children’s ASF intakes (P<0·001). The number of years of formal education of caregivers also positively predicted household dietary diversity and children’s ASF diversity (P<0·001). A key component to improving child nutrition is to understand the context-speciﬁc nutrition knowledge and feeding attitudes in order to identify relevant interventions (PDF) Caregivers' nutrition knowledge and attitudes are associated with household food diversity and children's animal source food intake across different agro-ecological zones in Ghana. Available from: https://www.researchgate.net/publication/283728865_Caregivers%27_nutrition_knowledge_and_attitudes_are_associated_with_household_food_diversity_and_children%27s_animal_source_food_intake_across_different_agro-ecological_zones_in_Ghana [accessed Sep 07 2018].
Concurrent Micronutrient Deficiencies Are Low and Micronutrient Status Is Not Related to Common Health Indicators in Ghanaian Women Expecting to Become Pregnant
(CURRENT DEVELOPMENTS IN NUTRITION, 2019-04-15) Colecraft, E.K.; Gernand, A.D.; Aguree, S.; Pobee, R.; Murray-Kolb, L.E.
Background Micronutrients are important for reproductive health and pregnancy, but the status of multiple vitamins and minerals is rarely measured in women before pregnancy. Objectives We aimed to assess the status and concurrent deficiencies of micronutrients among women before pregnancy and their relation with common health indicators. Methods This was a cross-sectional study that recruited women who expected to become pregnant within the next 6 mo in Asesewa, Ghana, a semi-urban community. Women self-reported demographics and health history. We measured blood pressure, height, and weight and conducted a blood draw and hemoglobin assessment (n = 98). We measured serum/plasma concentrations of ferritin, iron, total iron binding capacity, zinc, copper, retinol, and 25-hydroxyvitamin D, in addition to markers of inflammation. We used established cutoffs for deficiency and insufficiency/low status for each micronutrient after adjusting ferritin, zinc, and retinol for inflammation. We compared biomarker distributions by common health indicators. Results Forty percent of women had overweight/obesity, 33% were anemic, and 23% had elevated blood pressure. Overall, 27% had ≥1 deficiencies, whereas only 4% had 2 deficiencies. Fifty-eight percent of women had ≥1 insufficiencies and 18% had ≥2 insufficiencies. Prevalence of individual deficiencies was 12%, 7%, 7%, 4%, and 0% and prevalence of individual insufficiencies was 18%, 12%, 29%, 13%, and 13% for iron, copper, vitamin A, zinc, and vitamin D, respectively. Iron biomarkers and retinol concentrations differed by anemia status, and copper was higher in those with elevated blood pressure. Micronutrient concentrations were not associated with self-reported medical history (parity or history of anemia, malaria, or night blindness). Conclusions In Asesewa, Ghana, there was a relatively low prevalence of individual micronutrient deficiencies, but the majority of women were insufficient in ≥1 micronutrients. Iron and vitamin A status was lower in those with anemia, but otherwise, micronutrient status did not relate to common health markers.
Development of a Facilitator Guide for Nutrition Education on Overweight and Obesity in the Eastern Region of Ghana
(African Journal of Food, Agriculture and Development, 2023) Kushitor, S.B.; Colecraft, E.K.
Overweight and obesity are global public health problems. Although overweight and obesity are high in urban areas, the prevalence of overweight and obesity is increasing steadily in rural areas. However, interventions to address overweight and obesity in rural areas are limited. This study reports on the process of developing a facilitator guide for a nutrition education program on overweight and obesity in rural Ghana. The transtheoretical model guided this study. The study was conducted in three districts in the Eastern Region of Ghana. The facilitator guide was developed according to the Food and Agriculture Organisation’s (FAO) guidelines for planning community nutrition education. This study engaged nutrition and agricultural officers working in the study area and academics through an iterative process to draft, revise, and design the facilitator guide. The procedures included a desk literature review, analysis of secondary data, telephone interviews, a seminar and two workshops. The guide consists of five lessons. Lesson 1 creates an awareness of overweight and obesity by providing a definition and the Stunkard Figure Rating Scale. It also includes data on the prevalence of overweight and obesity and abdominal obesity of women in the study area. Lesson 2 discusses body image perceptions and their association with overweight and obesity. Lesson 3 highlights the economic, social and health consequences of overweight and obesity. Lesson 4 explains the four-star diet and how to achieve it. The lesson includes a description of each star of the four-star diet with local examples. Lesson 5 discusses physical activity and steps to increase physical activity. Each lesson ends with a key message. Songs were developed for Lessons 3, 4 and 5. This study describes the process of developing a facilitator guide for overweight and obesity education at the community level. The guide can be used to raise awareness of overweight and obesity and weight management
Dietary intake, forest foods, and anemia in Southwest Cameroon
(PLoS ONE, 2019-04) Tata, C.Y.; Ickowitz, A.; Powell, B.; Colecraft, E.K.
BACKGROUND: Forest cover has been associated with higher dietary diversity and better diet quality in Africa. Anemia prevalence among women of reproductive age in sub-Saharan Africa is very high and diet is one known contributor of a high prevalence rate. We investigated whether living in communities with high forest cover was associated with better diet quality and lower anemia prevalence among women of reproductive age in Southwest Cameroon. METHODOLOGY: We conducted a cross-sectional survey of 247 women of reproductive age from four forest-based villages (n = 126) and four non-forest villages (n = 121). We assessed the Hemoglobin (Hb) levels, anthropometric status, and diet (by 24-hour recall), as well as anemia-related morbidity and socio-demographic characteristics. Differences between groups were assessed with Pearson's chi-square and independent T-tests. We used a number of multivariate regression models to estimate the impacts of forest proximity on adjusted hemoglobin status of women of reproductive age, as well as to identify the most likely pathway through which forest proximity was important. RESULTS: We found that women living in forest communities had higher adjusted hemoglobin levels (mean hemoglobin concentration 11.10±1.53 g/dl vs.10.68±1.55g/dl; p = 0.03 for women forest and non-forest communities respectively). Moderate to severe anemia prevalence was significantly higher in women living in the non-forest villages compared to women in forest villages (forest 63% vs. 73%; p = 0.04). Compared with women from non-forest villages, women from forest-based villages had consumed significantly more vitamin A rich fruits and vegetables and animal source foods, and more of these came from the forest (as opposed to the farm or purchased sources). We found that the consumption of Gnetum africanum (Eru), a leafy green vegetable that grows in forests of the Congo Basis, was best able to account for the higher levels of adjusted hemoglobin in women in forest communities. CONCLUSION: This study contributes to the growing evidence that in some circumstances, forests make important contributions to diet quality and nutrition. The results of this study suggest that plant foods from the forest may make important contributions to iron intake and reduce the risk of anemia in women. Efforts to prevent forest loss and maintain ecosystem services are warranted to enhance nutrition and health of forest-based communities.
Food Insecurity and Micronutrient Status among Ghanaian Women Planning to Become Pregnant
(nutrients, 2020-02-13) Colecraft, E.K.; Pobee, R.A.; Aguree, S.; Gernand, A.D.; Murray-Kolb, L.E.
We examined the association between food insecurity (FIS) and micronutrient status among Ghanaian women planning to become pregnant. A cross-sectional analysis was completed of 95 women aged 18–35 years, living in the Upper Manya Krobo District in the Eastern Region of Ghana. Questionnaires were administered to collect sociodemographic and food security data; weight and height were measured. Blood was drawn from an antecubital vein; one drop was used to assess hemoglobin via Hemocue. Zinc and copper were analyzed using flame atomic spectrophotometry while iron biomarkers, retinol and 25-hydroxyvitamin D were analyzed using ELISA, ultra-performance liquid chromatography and liquid chromatography-tandem mass spectrometry, respectively. Logistic regression models were used to determine the relationship between food insecurity (FIS) and micronutrient deficiencies. FIS was reported among 23% of the households, while micronutrient deficiencies ranged from 7–28% irrespective of FIS status. Retinol concentrations were negatively associated with FIS (p = 0.043) after controlling for covariates, although levels were within the normal range in both groups. No statistically significant associations between FIS and micronutrient deficiencies were found. Among those with FIS, 59% were deficient in at least one nutrient with 18% deficient in two nutrients. Unmarried women were at higher risk of FIS (p = 0.017) than married women. FIS was associated with retinol concentrations but not other micronutrient biomarkers in Ghanaian women expecting to become pregnant in the next 6 months
Household food insecurity but not dietary diversity is associated with children's mean micronutrient density adequacy in rural communities across Ghana
(Nutrition, 2019-04) Christian, A.K.; Marquis, G.S.; Colecraft, E.K.; Lartey, A.; Soueida, R.
Objective The aim of this study was to examine predictors of household food insecurity, dietary diversity, and children's mean micronutrient density adequacy and the relationship among these dietary measures. Method Baseline analysis of a quasi-experimental 16-mo intervention study conducted in 12 rural communities in the three main agroecological zones in Ghana. The study included 608 caregivers with their 2- to 5-y-old children. Nutrient density adequacy was estimated for a subsample of 120 children. Results Food insecurity was more severe among farming households than their non-farming counterparts (P = 0.032). Dietary diversity score was significantly higher among non-farming households than farming households (P < 0.001). Food insecurity was negatively correlated with both household dietary diversity (r = –0.385; P < 0.001) and child mean micronutrient adequacy (r = –0.305; P < 0.001). There was no significant correlation between dietary diversity and children's mean micronutrient density adequacy. Belonging to a household that is severely food insecure and household size were significant predictors of children's mean micronutrient density adequacy (ß = –0.124, P = 0.006; ß = 0.011, P = 0.006, respectively). Conclusion Household food insecurity continues to be a good indicator of lower nutrient intake in children.
An integrated microcredit, entrepreneurial training, and nutrition education intervention is associated with better growth among preschool-aged children in rural Ghana
(Journal of Nutrition, 2015-02) Marquis, G.S.; Colecraft, E.K.; Sakyi-Dawson, O.; Lartey, A.; Ahunu, B.K.; Birks, K.A.; Butler, L.M.; Reddy, M.B.; Jensen, H.H.; Huff-Lonergan, E.
Background: Poor diet quality is a determinant of the high prevalence rates of malnutrition in Ghana. There is little evidence on the effectiveness of a multisector intervention to improve children's diets and nutritional status. Objective: The project tested whether participation in an entrepreneurial and nutrition education intervention with microcredit was associated with the nutritional status of children 2-5 y of age. Methods: A quasi-experimental 16-mo intervention was conducted with microcredit loans and weekly sessions of nutrition and entrepreneurship education for 179 women with children 2-5 y of age [intervention group (IG)]. Nonparticipating women and their children from the same villages (nonparticipant, n = 142) and from similar neighboring villages (comparison, n = 287) were enrolled. Repeated measures linear regression models were used first to examine children's weight-for-age (WAZ), height-for-age (HAZ), and body mass index-for-age (BAZ) z scores at baseline and at 4 follow-up time points ~4 mo apart. Time, intervention status, time-by-intervention interaction terms, region of residence, household wealth rank, household head occupation, number of children <5 y of age, and child sex and age were included. Results: There was a significant interaction between the IG and time for BAZ (P = 0.02) with significant Bonferronicorrected pairwise comparisons between the IG and comparison group (CG) at 8 mo (difference of 0.36±0.09 z score, P < 0.0001). The WAZ group difference was significant between 4 and 16 mo (P = 0.01 for interaction) and peaked at 8-12 mo (differences of ~0.28 z). The HAZ of children in the IG was significantly higher than that in the CG, reaching a 0.19 z difference at 16 mo (P < 0.05). When the fixed effects models were fitted in sensitivity analyses, some group anthropometric differences were of lower magnitude but remained significant. Conclusion: An integrated package of microcredit and education may improve nutritional outcomes of children living in poor, rural communities. © 2015 American Society for Nutrition.
Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana
(Social Science & Medicine, 2018) Nyantakyi-Frimpong, H.; Colecraft, E.K.; Awuah, R.B.; et al.
Livestock production and Animal-Source Foods (ASFs) like meat, milk, and eggs are excellent sources of essential micronutrients, including iron and zinc. There is evidence that encouraging increased access to and consumption of these ASFs may either positively or negatively impact anemia, or have no nutritional effects. Drawing upon first-hand experiences in Ghana, this study sought to: (1) identify the main motivations for raising livestock in Ghana; (2) describe the major barriers to consuming ASFs, especially among women of reproductive age (WRA); and (3) explore the feasibility of different livestock-centered interventions to reduce anemia. Key informant interviews and focus group discussions were held with relevant stakeholders at different geographical scales - the national, regional, district, and community levels. The results suggest that livestock enable savings, allow re source-poor households to accumulate assets, and help finance planned and unplanned expenditures (e.g., school fees and illness). Due to these multiple and often pressing uses, direct consumption of home-reared ASFs is not a major priority, especially for poor households. Even when ASFs are consumed, intra-household allocation does not favor women and adolescent girls, demographic groups with particularly high micronutrient requirements. The study participants discussed possible interventions to address these challenges, including (1) increasing livestock ownership through in-kind credit; (2) encouraging nutrition-related behavior change; (3) improving livestock housing; and (4) hatchery management. The paper discusses these interventions based upon potential acceptance, feasibility, cost effectiveness, and sustainability in the Ghanaian context.
Local Meanings and Perceptions of Women’s Empowerment: Qualitative Evidence from Female and Male Farmers in Rural Ghana
(2023) Abdu, A.; Marquis, G.S.; Colecraft, E.K.
Assessing the relationship between empowerment and nutrition along the agriculture nutrition pathway is limited by dissimilar emic and etic views of the construct, limited understanding of its contextual variation, and measurement difficulties. This study explored local meanings and perceptions of empowerment among women and men farmers in rural Ghana. The qualitative study took place within the LinkINg Up project, a quasi-experimental, nutrition-sensitive agriculture intervention (ClinicalTrials.gov NCT03869853) in three sub-districts of the Eastern Region. The intervention was implemented through farmer-based organizations (FBO) that were selected using a set of criteria such as female representation and level of member participation. Within the FBO, all women were recruited to participate along with one male adult family member (spouse/partner, older son, father). Non-FBO members (women and their male family member) from the same communities were also enrolled as a comparison group. This manuscript addresses an independent research question on empowerment, not the LinkINg Up intervention outcomes. For the question, participants (53 females and 45 males) were selected purposefully based on FBO membership of the woman (member, non-member). During the first three months of the project, eight focus group discussions (FGD) with women and seven FGD with men were conducted to probe into local understandings of empowerment and women’s empowerment (WE). The FGD were translated to English from the local language and transcripts were coded using a Constructivist Grounded Theory approach (open, axial, selective coding) with MAXQDA 2022. Women and men described empowerment in terms of an individual’s capability to improve circumstances by setting and meeting intentional and measurable goals. The construct of empowerment was made up of internal and external components. Internal components were those that were essential to allow one to be empowered, such as self-confidence, while the external components of empowerment were related to personal and community factors that empowered people, for example, asset ownership and social support. Emic understandings of WE were often related to women’s relationships with others and their roles (reproductive, productive, and community) within the studied context. The local descriptions of an empowered woman were categorized as someone who: i) exhibits qualities that are perceived to help one achieve goals, ii) takes actions to achieve goals, and iii) works with others to achieve own goals or common goals. When assessing WE in the study area, it is important to incorporate measures for women’s goal-setting capacity in relation to farming and business activities, and their ability to implement their goals, while taking into account relational aspects.
A longitudinal assessment of the diet and growth of malnourished children participating in nutrition rehabilitation centres in Accra, Ghana
(Public Health Nutrition, 2004-07) Colecraft, E.K.; Marquis, G.S.; Bartolucci, A.A.; Pulley, L.; Owusu, W.B.; Maetz, H.M.
Objective: To examine the adoption of feeding recommendations among caregivers of children recuperating from malnutrition and assess the determinants of growth of children attending a nutrition rehabilitation centre (NRC) in Accra, Ghana. Design: Longitudinal study in which attendance and maternal programme participation were recorded daily and children's anthropometry and dietary intake were measured at four time points (admission, interim, exit, post-exit) at the NRC and participants' homes. Setting: NRCs at four polyclinics and participants' homes in Accra, Ghana. Subjects: One hundred and eight caregivers and their 116 children referred to an NRC between November 1999 and July 2000. Results: Most caregivers attended the NRC sporadically (effective length of stay was 1.4 ± 0.1 months). Use of NRC-promoted foods in the home after discharge was low due to inaccessibility of the food items, lack of preparation knowledge or money, child preferences and the common practice of purchasing ready-to-eat foods. Although there were significant increases in children's weight-for-age (P = 0.048) and weight-for-height (P= 0.002) Z-scores between enrolment and discharge, most children discontinued programme participation before adequate recuperation. Conclusions: The NRC education did not address the use of street foods for child feeding and was unsuccessful in changing in-home feeding behaviour. The prominence of street foods in children's diets warrants re-evaluation of the NRC's educational approaches to enhance their responsiveness to caregivers' needs and effectiveness for the continued recuperation of malnourished children at home. NRC feeding strategies need improvement to ensure adequate provision of energy and nutrients to support catch-up growth in children.
Low Consumption of Indigenous Fresh Dairy Products in Ghana Attributed to Poor Hygienic Quality
(Journal of Food Protection, 2019-02) Parry-Hanson Kunadu, A.; Aboagye, E.F.; Colecraft, E.K.; Otoo, G.E.; Adjei, M.Y.B.; Acquaah, E.; Afrifa-Anane, E.; Amissah, J.G.N.
This cross-sectional study was aimed at assessing consumer perceptions and microbiological quality of the fresh cow's milk products available in selected dairying communities in Ghana. Twenty-six focus groups (FGs) were conducted to understand the perceptions on barriers and facilitators to dairy consumption. These included six FGs for lactating mothers and five FGs for each of the following categories: pregnant women, women of reproductive age with children younger than 5 years, not pregnant and nonlactating women, and males. A separate quantitative survey followed and included 176 women of reproductive age (18 to 49 years) and 90 males (18 to 59 years) from 15 dairying communities in the Greater Accra, Eastern, and Central regions of Ghana. Also, 120 locally sourced fresh milk products were assessed for counts of total coliforms, fecal coliforms, and Enterococcus spp., and presence of pathogenic Streptococcus spp. , Escherichia coli, and Klebsiella pneumoniae by using standard microbiological methods. Fecal coliforms in dairy products, such as brukina, wagashi, and yogurt exceeded the specified limit of 10 CFU/mL, while the prevalence of E. coli and K. pneumoniae were 70 and 65%, respectively. Generally, respondents perceived indigenous dairy as unsafe. These perceptions were formed on the basis of visual cues of environmental and personal hygiene. Of the indigenous milk products consumed, brukina, a fermented milk and millet gruel (33%) and wagashie, a soft unfermented cheese (29%), were the most popular. However, only 19% of wagashie and 21% of brukina consumers believed these products were safe. Consistently, the odds of consuming a particular milk product was significantly higher if the consumer believed it was safe. Poor sanitation and unhygienic processing of otherwise healthy but perishable indigenous milk products has justifiably fueled the mistrust of consumers and may hinder potential intervention efforts to increase milk production and consumption in Ghana.
Marital Transition is Associated with Food Insecurity, Low Dietary Diversity, and Overweight in a Female Population in Rural Ghana
(African Journal of Food, Agriculture and Development, 2023) Dallmann, D.; Marquis, G.S.; Colecraft, E.K.; Dodoo, N.D.
Research from high-income countries shows that marital transition affects individuals’ nutrition outcomes. Yet, little is known about its effect on women’s food security status and nutrition outcomes in Sub-Saharan Africa. Moreover, most published studies merge cohabitation and marriage into one category, but these statuses might have a distinct effect on nutrition outcomes in different settings. This study examined the association between the marital transition of women living in a rural district in Ghana and their food security status, minimum dietary diversity, and overweight (body mass index (BMI) ≥ 25 kg/m2). This analysis used representative data from women with a child less than 12 months from the Upper Manya Krobo District, which was collected for the 2014 baseline of the Nutrition Links project in 137 villages (clinicaltrials.gov NCT01985243). Women’s marital transition was assessed by merging their current and previous marital status into five categories: i) continuously married; ii) remarried; iii) cohabitating with a previous union; iv) cohabitating with no previous union; v) single (majority never previously married). The adjusted logistic regression showed that, compared to women who were continuously married, those cohabitating—with or without a previous union—and those who were single were more likely to be food insecure (aOR = 2.49; 95% CI [1.31, 4.72], aOR = 2.01; 95% CI [1.13, 3.58], and aOR = 1.85; 95% CI [1.02, 3.38], respectively). Women who were cohabitating—with or without a previous union—were more likely not to meet the minimum dietary diversity than those who were continuously married (aOR = 1.82; 95% CI [0.98, 3.38] and aOR = 1.78; 95% CI [1.01, 3.12], respectively). Finally, compared to the continuously married group, cohabitating women with no previous union were less likely to be overweight (aOR = 0.40; 95% CI [0.22, 0.74]). These results are consistent with previous publications that showed married women were wealthier and more overweight. Moreover, these results indicate that cohabitation affects nutrition-related outcomes differently compared to marriage in a sub-Saharan setting. More attention must be placed on better understanding the social aspects that link women’s marital transition to diet and nutrition outcomes
Microfinance With Education In Rural Ghana: Men’s Perception Of Household Level Impact
(African Journal of Food, Agriculture, Nutrition and Development, 2012) Hagan, L.L.; Aryeetey, R.; Colecraft, E.K.; et al.
Microcredit schemes have been shown to enhance women’s Income Generation Activities (IGA), household food security, and child nutrition. However, spouses or Male Household Heads (MHH) can influence how women’s loans are invested and how incomes ensuing from the investments are expended. This study describes how MHH perceived and experienced the participation of female caregivers from their household in the Enhancing Child Nutrition through Animal Source Food Management (ENAM) project. The ENAM project was designed as an integrated intervention providing microcredit, entrepreneurship, and nutrition education to women in rural communities in Ghana. Eighty-five MHH of ENAM project caregivers in two regions of Ghana were interviewed about their awareness of the microcredit and education intervention, their involvement in the IGA that the caregivers’ loans were invested in, and their perceptions of the impact of the project on the caregivers’ IGA as well as household and child nutrition. The majority of MHH indicated that they had been consulted by the caregivers about the decision to participate in the ENAM project. The most common reasons given for consenting to the caregivers’ decision to participate in the program were expectations that the caregiver would receive business capital (30.6%), education on optimal child feeding (36.5%), and income to enable caregivers to contribute more to household expenses (31.8%). Concerning the project’s impact, MHH perceived that the caregivers’ project participation had a positive impact on their business practices, particularly concerning improved customer relations. The MHH perceived that caregivers’ incomes increased because they participated in ENAM as evidenced by regular income savings and increased contributions to household food and non-food expenditures. However, MHH reported decreases in their contributions to almost all household expenditure categories in response to the perceived increase in caregivers’ incomes. The MHH also perceived improvements in home meal quality. In summary, MHH credited the ENAM project with improved caregiver’s incomes and increased share of household expenses. However, this outcome resulted in unanticipated declines in MHH contribution to household expenses. Further studies are needed to understand the impact of empowering women through social experiments on households.
Participating in a Nutrition-Sensitive Agriculture Intervention Is Not Associated with Less Maternal Time for Care in a Rural Ghanaian District
(CURRENT DEVELOPMENTS IN NUTRITION, 2023) Goh, Y.E.; Marquis, G.S.; Colecraft, E.K.; Aryeetey, R.
Background: Nutrition-sensitive agriculture (NSA) interventions may increase farm-related work for mothers, with consequences for child nutrition. The Nutrition Links (NL) intervention provided mothers with poultry, gardening inputs, technical support, and education to improve livelihoods and child nutrition outcomes in rural Ghana. Objectives: Our objective was to compare time allocated to child care by a cross-section of mothers in the intervention group of the NL intervention with the control group (NCT01985243). Methods: A cross-section of NL mother-child pairs was included in a time allocation substudy [intervention (NL-I) n = 74 and control (NL-C) n = 69]. In-home observations of the mother-child pair were conducted for 1 min, every 5 min, for 6 h. Observations were categorized into 4 nonoverlapping binary variables as follows: 1) maternal direct care, 2) maternal supervisory care, 3) allocare, and 4) no direct supervision. Allocare was defined as care by another person in the presence or absence of the mother. Any care was defined as the observation of maternal direct care, maternal supervisory care, or allocare. Generalized linear mixed models with binomial data distribution were used to compare the child care categories by group, adjusting for known covariates. Results: Maternal direct care (OR = 1.07; 95% CI: 0.89, 1.28) and any care (OR = 1.56; 95% CI: 0.91, 2.67) did not differ by intervention group. However, there was a higher odds of allocare (OR = 1.36; 95% CI: 1.04, 1.79) in NL-I than in NL-C women. Conclusions: Maternal participation in an NSA intervention was not associated with a decrease in time spent directly on child care but was associated with an increase in care from other household and community members. The clinicaltrials.gov number provided is for the main NL intervention and not this current substudy. Curr Dev Nutr 2022;6:nzac145.
Rapid Review Of Research On Dietary Attitudes, Beliefs And Practices In Ghana 1990-2020
(ajfand, 2022) Colecraft, E.K.; Christian, A.K.; Ammah, G.; Aryeetey, R.
Food-related beliefs and attitudes influence dietary behaviors and are important drivers of nutrition outcomes. Understanding beliefs and attitudes that drive dietary behaviors, as part of the process for developing Food-based Dietary Guidelines is critical for targeting messages to motivate healthy dietary diets. This rapid review was undertaken to summarize readily available local evidence on food-related beliefs, attitudes, and associated practices in Ghana. A rapid review of 39 peer-reviewed publications and graduate-level theses on the dietary behaviors of Ghanaians was conducted between November and December 2020. The study only included articles published between 1990 and 2020 involving apparently healthy populations living in Ghana. Documents were identified through a systematic literature search of Google Scholar and PubMed. Data on food-related knowledge, beliefs, attitudes, and practices were extracted into an excel template and analyzed using thematic content analysis. The sampled research included primarily cross-sectional studies of urban, rural, peri-urban and mixed localities throughout Ghana: one was a prospective research. A range of food-related taboos were identified and classified as taboos for the general population, pregnancyrelated, or child-related. Although awareness of food-related taboos was common, they were not extensively practiced. Energy-giving and nutrient-dense foods are commonly promoted during pregnancy. Culturally prescribed pre-lacteal feeds and other infant and young child feeding (IYCF) behaviors reported in the studies were not aligned with IYCF recommendations. A 3-meals-a-day pattern was observed, commonly, across all age groups; most adult meals, particularly supper, was prepared at home. However, ready-to-eat meals were regularly purchased by adults and adolescents. Adolescents frequently reported snacking and skipping meals; breakfast was the most frequently skipped meal. Fruits and vegetables were the least consumed food groups across all age groups. Muslim faith was associated with consuming more diverse diets and greater fruit and vegetable consumption. The findings of this review provide an overview of food-related beliefs and practices of Ghanaians and can inform decisions on areas to emphasize in food-based dietary guidelines and associated nutrition education messages to promote healthy diets in the Ghanaian population. Effective nutrition education is needed to dispel harmful food beliefs and practices and promote healthy food choices across the life cycle. Dietary patterns in Ghana are linked with cultural and religious practices that are often unique to particular subgroups, although there are common strands of beliefs across ethnic groups. These beliefs can result in either adverse or beneficial outcomes, depending on what eating patterns it determines.
Risk of anaemia among women engaged in biomass-based fish smoking as their primary livelihood in the central region of Ghana: a comparative cross-sectional study
(BMC Nutrition, 2021) Armo-Annor, D.; Colecraft, E.K.; Adu-Afarwuah, S.; Christian, A.K.; Jones, A.D.
Background: Fish smoking using biomass fuel is an important livelihood for women living in the coastal regions of Ghana and may contribute to anaemia risk. We assessed whether women who smoke fish as their primary livelihood are at increased risk of anaemia compared to women in other livelihoods in the Central Region of Ghana. Methods: We conducted a comparative cross-sectional study of 330 randomly selected adult women (18–49 years) whose primary livelihood was either fish smoking (FSL) involving the burning of biomass fuel (n = 175) or other livelihoods (OL) not involving burning of firewood (n = 155). Data on participants’ recent diet were collected from a single, quantitative 24-h dietary recall and qualitative 7-day food frequency questionnaire of animal-source food (ASF) consumption. We further assessed participants’ haemoglobin concentration using the Urit 12 Hemocue system. We compared total iron intakes, the proportion of dietary iron from animal and plant sources, mean haemoglobin concentrations, and anaemia prevalence between FSL and OL women. Results: Fish was the most frequently consumed ASF by both groups of women. Although OL women consumed more diverse ASFs in the past week compared with the FSL women (3.4 ± 1.2 vs. 2.7 ± 1.3; p < 0.001), the contribution of ASFs to total iron intake in the past day was greater for the FSL women (49.5% vs. 44.0%; p = 0.030). Estimated total dietary iron intake in the past day was generally low (5.2 ± 4.7 mg) and did not differ by group. The unadjusted prevalence of anaemia was 32 and 27.1% among the FSL and OL women, respectively (p = 0.33). After covariates adjustment, the FSL women had statistically higher anaemia prevalence (36.4% vs. 20.5%; p = 0.032) and 80% greater risk of being anemic (RR: 1.8; 95% CI: 1.1, 3.0) than the OL women. Conclusion: Women who use biomass fuel to smoke fish as their primary livelihood had an increased risk of anaemia. Furthermore, the average 24-h dietary iron intake among both the FSL and OL women was below their daily iron requirement. Interventions to enhance women’s dietary iron intake and reduce their livelihood related biomass smoke exposure may be warranted in this population.
Risk of anaemia among women engaged in biomass-based fish smoking as their primary livelihood in the central region of Ghana: a comparative cross-sectional study
(Springer Nature, 2021) l Armo-Annor, D.; Colecraft, E.K.; Adu-Afarwuah, S.; Christian, A.K.; Jones, A.D.
Background: Fish smoking using biomass fuel is an important livelihood for women living in the coastal regions of Ghana and may contribute to anaemia risk. We assessed whether women who smoke fish as their primary livelihood are at increased risk of anaemia compared to women in other livelihoods in the Central Region of Ghana. Methods: We conducted a comparative cross-sectional study of 330 randomly selected adult women (18–49 years) whose primary livelihood was either fish smoking (FSL) involving the burning of biomass fuel (n = 175) or other livelihoods (OL) not involving burning of firewood (n = 155). Data on participants’ recent diet were collected from a single, quantitative 24-h dietary recall and qualitative 7-day food frequency questionnaire of animal-source food (ASF) consumption. We further assessed participants’ haemoglobin concentration using the Urit 12 Hemocue system. We compared total iron intakes, the proportion of dietary iron from animal and plant sources, mean haemoglobin concentrations, and anaemia prevalence between FSL and OL women. Results: Fish was the most frequently consumed ASF by both groups of women. Although OL women consumed more diverse ASFs in the past week compared with the FSL women (3.4 ± 1.2 vs. 2.7 ± 1.3; p < 0.001), the contribution of ASFs to total iron intake in the past day was greater for the FSL women (49.5% vs. 44.0%; p = 0.030). Estimated total dietary iron intake in the past day was generally low (5.2 ± 4.7 mg) and did not differ by group. The unadjusted prevalence of anaemia was 32 and 27.1% among the FSL and OL women, respectively (p = 0.33). After covariates adjustment, the FSL women had statistically higher anaemia prevalence (36.4% vs. 20.5%; p = 0.032) and 80% greater risk of being anemic (RR: 1.8; 95% CI: 1.1, 3.0) than the OL women. Conclusion: Women who use biomass fuel to smoke fish as their primary livelihood had an increased risk of anaemia. Furthermore, the average 24-h dietary iron intake among both the FSL and OL women was below their daily iron requirement. Interventions to enhance women’s dietary iron intake and reduce their livelihood related biomass smoke exposure may be warranted in this population.