Browsing by Author "Laar, A."

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Actions in global nutrition initiatives to promote sustainable healthy diets
(Global Food Security, 2021) Reyes, L.I.; Constantinides, S.V.; Laar, A.; et al.
Multiple recent global nutrition initiatives have recommended actions to transform food systems to improve food environments and food choice. This study aimed to identify actions recommended by these initiatives and un derstand their similarities and differences. Twelve global nutrition initiatives were reviewed, collectively spanning 13 action themes and accompanying strategies. Action themes were analyzed according to primary focus on either food environments and their food system drivers or food choice. Representation of the 13 actions varied across initiatives. Some actions overlapped; others were infrequently represented. Strategies targeting food environments and their food system drivers were more frequently recommended than strategies targeting food choice for 11 of the 13 action themes. Although these global initiatives share a mission to improve nutrition through food systems and food environments, less attention has been allocated to individual food choice and sustainability.
Addressing Malnutrition: The Importance of Political Economy Analysis of Power
(International Journal of Health Policy and Management, 2020) Walls, H.; Laar, A.; Nisbett, N.; et.al
Background: The exercise of power is central to understanding global health and its policy and governance processes, including how food systems operate and shape population nutrition. However, the issue of power in food systems has been little explored empirically or theoretically to date. In this article, we review previous work on understanding power in addressing malnutrition as part of food systems that could be used in taking this issue further in future food systems research. In particular, we examine why acknowledging power is vital in addressing food systems for better nutritional outcomes, approaches to assessing power in empirical research, and ways of addressing issues of power as they relate to food systems. Methods: We undertook a narrative review and synthesis. This involved identifying relevant articles from searches of PubMed and Scopus, and examining the reference lists of included studies. We considered for inclusion literature written in English and related to countries of all income levels. Data from the included articles were summarized under several themes. Results: We highlight the importance of acknowledging power as a critical issue in food systems, present approaches that can be taken by food-systems researchers and practitioners in assessing power to understand how power works in food systems and wider society, and present material relating to addressing power and developing strategies to improve food systems for better nutrition, health, and well-being. Conclusion: A range of research approaches exist that can inform the examination of power in food systems, and support the development of strategies to improve food systems for better nutrition, health, and well-being. However, there is considerable scope for further work in this under-researched area. We hope that this review will support the necessary research to understand further power in food systems and drive the much-needed transformative change.
Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal
(BMJ Open, 2023) Tandoh, A.; Laar, A.; Pradeilles, R.; et al.
Objective This study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4–15 years) in Greater Accra Region, the highly urbanized the administrative capital of Ghana. Design The community readiness model was used to conduct in-depth mixed methods interviews with stakeholders. Using predefined anchored rating statements, quantitative readiness scores ranging from 1 to 9 were generated. Thematic qualitative analysis was undertaken to understand barriers and facilitators that could influence the implementation of interventions. Setting Greater Accra Region, Ghana. Participants 18 key informants from various schools/ education/citizen sectors, which together represented the ‘school community’ of Greater Accra Region. Results The mean readiness scores indicated that the ‘school community’ was at the ‘preplanning’ stage of readiness (4.44±0.98) to address the marketing and availability of unhealthy food and beverages in and around schools. The mean readiness score for ‘leadership’ was the highest of all dimensions (5.36±1.60), corresponding to the ‘preparation’ stage. The lowest scores were found for ‘community knowledge of efforts’ (3.19±2.45) and ‘resources for efforts’ (3.64±0.87), both of which were at a ‘vague awareness’ stage. Conclusions The ‘school community’ recognized that the marketing and availability of unhealthy food and beverages was a problem. Additionally, the current leadership was actively supportive of continuing/improving efforts that create healthier children’s food environments. However, actions that aim to increase the ‘school community’s’ knowledge of existing interventions and securing resources to sustain those interventions are needed before introducing readiness-appropriate strategies.
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.
Assessment of the Operational Characteristics of Research Ethics Committees in Ghana
(SAGE, 2022) Owusu, S.A.; Addison, G.; Redman, B.; Kearns, L.; Amuna, P.; Laar, A.
There were eighteen Research Ethics Committees (RECs) operating in Ghana as of December 2019 but no empirical assessment of their operational characteristics had been conducted. We assessed the characteristics of Ghanaian RECs using an existing Self-Assessment Tool for RECs in Developing Countries. We present results from nine RECs that participated in this nation-wide assessment. Our results indicate that the RECs are generally adherent to the recommendations in the Tool including being composed of members with diverse expertise. They also reviewed and approved research protocols as well as had access to some limited funding for their activities. There is no national policy on research human protections or an ethics authority to regulate the activities of the RECs. We recommend the establishment of this authority in Ghana while encouraging institutions to sustain efforts aimed at making their RECs operate independently.
Associated factors of diet quality among people living with HIV/AIDS in Ghana
(BMC Nutrition, 2024) Abdulai, K.; Torpey, T.; Kotoh, A.M.; Laar, A.
Introduction : Nutrition is a very important element of a comprehensive care for people living with HIV/AIDS (PLHIV), especially in resource-constrained settings where malnutrition and food insecurity are common. Dietary diversity is a useful indication of nutritional adequacy (diet quality) in people of all ages. An optimally diverse diet strengthens the body’s immune system. Objective This study aimed to assess diet quality and its associated factors among PLHIV. Methods A facility-based cross-sectional study design was employed to select 440 PLHIV from two hospitals in the Eastern Region of Ghana. Dietary intakes were determined using 24-hour recall. A stadiometer and bioimpedance analysis machine were used to obtain anthropometric and body composition data. Diet quality was assessed using FAO’s individual dietary diversity score (IDDS) as a proxy. SPSS version 20 was used for analysis. Odds ratios and ordinal logistic regression were used to identify factors associated with diet quality among the PLHIV. P-value was set at 0.05. Results Most of the PLHIV (73%) consumed from ‘Starchy staple” food group. Less than 20% of the study sample consumed ‘Fruits’ and ‘Vegetables’ (17% and 14% respectively) a day before the survey. The mean IDDS was 4.11 (SD=1.29). Overall, most of the PLHIV (56%) had medium IDDS which is equivalent to “diet needing improvement’, 14% had higher IDDS (good diet), whiles about 31% of the participants actually had poor diet (lower IDDS). Associated factors of diet quality were age (AOR=0.966: 95%CI: 0.936–0.997: p=0.031), married (AOR=4.634: 95%CI: 1.329– 16.157: p=0.0016), separated (AOR=0.0203: 95%CI: .036–0.994: p=0.049), and daily meal frequency (AOR=0.441: 95%CI: .478–1.948: p=0.020). Overall, the model accounts for about 20% of the variation in diet quality of the participants (pseudo-R square=0.196). Conclusion This study demonstrates that most of the PLHIV did not consume good diet which may have an implication on their immune system, which is already under attack by HIV, and probably emerging infections. Age, marital status, and meal frequency were the variables that predicted diet quality among the study participants.
Availability of integrated family planning services in HIV care and support sites in sub-Saharan Africa: A secondary analysis of national health facility surveys
(Reproductive Health, 2019-05-29) Laar, A.; Kanyangarara, M.; Sakyi, K.
Background: Integrating family planning (FP) with HIV care and treatment programs is a strategy to expand FP service delivery and prevent unintended pregnancies among women living with HIV. However, little is known about the extent to which FP services are available in health facilities providing HIV services across sub-Saharan Africa. In this study, we assessed the availability of integrated FP services and the associated factors in HIV care and support sites across sub-Saharan Africa. Methods: We conducted a secondary analysis of nationally representative facility-level data from Service Availability and Readiness Assessments (SARA) and Service Provision Assessments (SPA) conducted in 10 sub-Saharan African countries between 2012 and 2015. We used six indicators that reflect the structure and process of care essential for FP service delivery in HIV care and support facilities to define the outcome of interest - onsite availability of integrated FP services. Multivariate logistic regression was used to explore facility-level characteristics associated with the outcome. Results: Among the 3161 health facilities offering HIV care and support services, most reported also offering FP services at the same location. The availability of three FP methods was higher than the availability of FP guidelines and trained staff. Onsite availability of integrated FP services ranged from 10 to 61%. Results of multivariate logistic regression indicated that the odds of having onsite integrated FP services available was higher in HIV care and support sites that were operated by the government, classified as a tertiary level care facility, and provided services for PMTCT, antenatal care and basic surgery. Conclusions: Our findings indicate critical shortcomings in the preparedness of HIV care and support sites to deliver onsite integrated FP services. Renewed efforts are needed to address these supply-side barriers and ensure that integrated FP and HIV services meet the unique needs of HIV clients.
Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study
(BMJ Open, 2019-04) Adler, A.J.; Laar, A.; Prieto-Merino, D.; Der, R.M.M.; Mangortey, D.; Dirks, R.; Lamptey, P.; Perel, P.
Objectives To evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control. Setting Lower Manya Krobo, Eastern Region, Ghana. Participants All adult hypertensive community members, except pregnant women, were eligible for inclusion in the study. We enrolled 1339 participants, 69% of whom were female. A total of 552 had a 6-month visit, and 338 had a 12-month visit. Interventions We report on a package of interventions where community-based cardiovascular disease (CVD) nurses were trained by FHI 360. CVD nurses confirmed diagnoses of known hypertensives and newly screened individuals. Participants were treated according to the clinical guidelines established through the project’s Technical Steering Committee. Patients received three types of reminder and adherence messages. We used CommCare, a cloud-based system, as a case management and referral tool. Primary outcome Hypertension control defined as blood pressure (BP) under 140/90 mm Hg. Secondary outcomes: changes in BP and knowledge of risk factors for hypertension. Results After 1 year of intervention, 72% (95% CI: 67% to 77%) of participants had their hypertension under control. Systolic BP was reduced by 12.2 mm Hg (95% CI: 14.4 to 10.1) and diastolic BP by 7.5 mm Hg (95% CI: 9.9 to 6.1). Due to low retention, we were unable to look at knowledge of risk factors. Factors associated with remaining in the programme for 12 months included education, older age, hypertension under control at enrolment and enrolment date. The majority of patients who remained in the programme were on treatment, with two-thirds taking at least two medications. Conclusions Patients retained in ComHIP had increased BP control. However, high loss to follow-up limits potential public health impact of these types of programmes. To minimise the impact of externalities, programmes should include standard procedures and backup systems to maximise the possibility that patients stay in the programme.
Capacity for scaling up nutrition: a focus on pre-service training in West Africa and a Ghanaian case study.
(Proceedings of the Nutrition Society, 2015-11) Aryeetey, R.N.O.; Laar, A.; Zotor, F.; Ghana SUN Academic Platform
The 2013 Lancet series on maternal and child nutrition is identified and advocated for improved institutional and human capacity in nutrition towards scaling up nutrition (SUN) in countries with high stunting rates. Of the fifty-four countries with high burden of child undernutrition who have committed to the SUN movement, thirty-six are in Africa. In the present paper, the academic platform of the SUN movement in Ghana presents an overview of nutrition pre-service capacity in West Africa with a focus on Ghana. The present paper is based on the findings of a sub-region-wide assessment of degree programmes in nutrition in West Africa, plus another report on pre-service nutrition capacity in diploma awarding nursing and nutrition programmes in Ghana. Although there is inadequate evidence on pre-service nutrition training in the sub-region, the two reports provide useful evidence for action, including inadequate number and distribution of pre-service nutrition training programmes, low nutrition graduate output, poor quality of the programme curriculum and instruction, and sub-optimal capital investment. The present paper calls for urgent action to improve pre-service nutrition capacity building as a critical step towards SUN in West Africa.
Capturing the moment: a snapshot review of contemporary food environment research featuring participatory photography methods
(Current Opinion in Environmental Sustainability, 2023) Turner, C.; Salm, L.; Laar, A.; et al.
This snapshot review captures recent advances in the use of participatory photography methods within food environment research, featuring 28 peer-reviewed articles published between 2020 and 2022. Records were retrieved from a systematic search of the databases PubMed and Scopus. Studies featured high income (64%) and low- and middle-income countries (36%). Local and school food environments were common focal sites, with studies typically investigating how food environments influence food acquisition and consumption practices among adult and adolescent consumers. Photovoice was the dominant methodological framing (71%), although we found substantial variation in study designs, camera devices and degree of participation. Going forward, we encourage researchers and practitioners to revisit the roots of participatory photography as a participatory action research strategy, to engage participants as agents of change in their food environment in support of the sustainable transformation of food systems and improved diets, nutrition and health.
Common Food Taboos and Beliefs During Pregnancy in Yilo Krobo District, Ghana
(University of Ghana, 2014-06) Arzoaquoi, S.K.; Laar, A.; University of Ghana, College of Health Sciences, School of Public Health
Background A food considered as a taboo is strictly forbidden, for health, cultural or spiritual reasons. Food taboos are known from virtually all human societies and may be found in various forms all over the world. Pregnancy is viewed as a critical period in the life of women and is usually subjected to a number of food taboos as a way of safeguarding their lives and that of the unborn baby in Yilo Krobo, district Ghana. The study qualitatively assessed the presence of food taboos and related practices during pregnancy in the Yilo Krobo District, Ghana. Various motivating factors and enforcement mechanisms were also documented. Methodology An exploratory cross sectional study using qualitative method was employed to determine the presence and extent of food taboo and beliefs and factors contributing to the adherence to these practices during pregnancy in Yilo Krobo District, Ghana. A total of sixteen focus group discussions (FGDs) were held in six communities in the Yilo Krobo District with a total of 155 respondents which comprised of 46 pregnant women, 30 elderly women, 42 elderly men, and 17 women in fertility age. Respondents were selected using a purposive sampling technique. Analysis was done manually using the principle of systemic text condensation as described by Malterud (1993). Results The study revealed that all the participants were aware of the existence of food prohibitions and beliefs for pregnant women in Yilo Krobo district. The study identified snails, rats, hot food and animal lungs as foods prohibited during pregnancy, although snails and rats are also forbidden to eat outside pregnancy. Concern for healthy pregnancy, good outcome, and respect for the ancestors, parents and community elders were identified as the key reasons for adherence to food taboo and traditional beliefs in pregnancy. On adherence to food taboo and traditional beliefs, the study revealed that food taboos and traditional beliefs are widely practice or adhered in the Yilo Krobo district. Finally, food taboo and traditional practice in Yilo Krobo are essentially enforced by constant reminder by parents, husband of the pregnant women, peers, community leaders and fear of sanction. Conclusion The study revealed that food taboos and traditional beliefs relating to pregnancy exist in Yilo Krobo district. Snails, rats, snakes, hot food and animal lungs are the food types prohibited to eat during pregnancy. Health concern is the core reasons for adherence.
Community perceptions on the factors in the social food environment that influence dietary behaviour in cities of Kenya and Ghana: A Photovoice study
(Public Health Nutrition, 2022) Wanjohi, M.N.; Laar, A.; Aryeteey, R.; et al.
Objective To explore communities’ perspectives on the factors in the social food environment that influence dietary behaviours in African cities. Design A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary behaviours. Follow-up in-depth interviews allowed participants to tell the ‘stories’ of their photographs. Thematic analysis was conducted, using data-driven and theory-driven (based on the socio-ecological model) approaches. Setting Three low-income areas of Nairobi (n=48) in Kenya, and Accra (n=62) and Ho (n=32) in Ghana. Participants Adolescents and adults, male and female aged ≥13 years. Results The ‘people’ who were the most commonly reported as influencers of dietary behaviours within the social food environment included family members, friends, health workers and food vendors. They mainly influenced food purchase, preparation and consumption, through 1) considerations for family members’ food preferences, 2) considerations for family members’ health and nutrition needs, 3) social support by family and friends, 4) provision of nutritional advice and modelling food behaviour by parents and health professionals, 5) food vendors’ services and social qualities. Conclusions The family presents an opportunity for promoting healthy dietary behaviours between family members. Peer groups could be harnessed to promote healthy dietary behaviours among adolescents and youth. Empowering food vendors to provide healthier and safer food options could enhance healthier food sourcing, purchasing and consumption in African low-income urban communities.
Contraceptive Use among Women of Reproductive Age in Jirapa District
(University of Ghana, 2016-07) Deri , M.; Laar, A.; University of Ghana, College of Health Sciences, School of Public Health
Background: Studies have indicated that the use of contraceptives within a woman‘s reproductive ages helps prevent unwanted pregnancies, unsafe abortions, and maternal deaths. In spite of these benefits, the use of contraceptives in Jirapa district is still low. Objectives: This study accessed knowledge on contraceptives, determined the prevalence of use of contraceptives and finally identified factors serving as enablers and barriers to the use of contraceptives in the Jirapa district of the upper west region of Ghana. Methods: The study was a cross-sectional study which employed a purely quantitative method. Using a structured questionnaire, 350 women were interviewed. Data collected were entered and analysed with Statistical package for Social Sciences (SPSS) version 20. Frequencies and percentages of data were displayed using tables. Chi-square (bi-variate analysis) test was done to ascertain associations between the dependent and independent variables. Simple logistics regression was used to test the strength of associations between various variables and the outcome variable. Multiple logistic regressions were also used to control for confounders. Results: Knowledge on contraceptives was universal with almost every respondent being knowledgeable in at least one method. Although knowledge was universal (100%), prevalence was 57.4%. Reasons for use included birth spacing (39%), limiting birth (14%) and to prevent unwanted pregnancy (13%). Reasons for non-usage were: to get pregnant (20%), not being sexually active (41%), fear of side effects (22%), husbands disapproval (1%), financial problems (2%) and currently pregnant (21%). Conclusion: Low percent on the use of contraceptives despite the high knowledge indicates the need to improve awareness among the study population.
Coping strategies of HIV-affected households in Ghana
(BioMed Central Ltd., 2015) Laar, A.; Manu, A.; Laar, M.; El-Adas, A.; Amenyah, R.; Atuahene, K.; Quarshie, D.; Adjei, A.A.; Quakyi, I.
Background: HIV and negative coping mechanisms have a cyclical relationship. HIV infections may lead to the adoption of coping strategies, which may have undesired, negative consequences. We present data on the various coping mechanisms that HIV-affected households in Ghana resort to. Methods: We collected data on coping strategies, livelihood activities, food consumption, and asset wealth from a nationally representative sample of 1,745 Ghanaian HIV-affected households. We computed coping strategies index (CSI), effective dependency rate, and asset wealth using previously validated methodologies. Results: Various dehumanizing coping strategies instituted by the HIV-affected households included skipping an entire day's meal (13%), reducing portion sizes (61.3%), harvesting immature crops (7.6%), and begging (5.6%). Two-thirds of the households were asset poor. Asset-poor households had higher CSI than asset-rich households (p <0.001). CSI were also higher among female-headed households and lower where the education level of the household head is higher. Households caring for chronically ill members recorded higher CSI in comparison with their counterparts without the chronically ill (p < 0.05). Conclusions: Institution of degrading measures by HIV-affected households in reaction to threat of food insecurity was prevalent. The three most important coping strategies used by households were limiting portion size (61.3%), reducing number of meals per day (59.5%) and relying on less expensive foods (56.2%). The least employed strategies included household member going begging (5.6%), eating elsewhere (8.7%) and harvesting immature crop (7.6%). Given that household assets, and caring for the chronically ill were associated with high CSI, a policy focusing on helping HIV-affected households gradually build up their asset base, or targeting households caring for chronically ill member(s) with conditional household-level support may be reasonable.
Decision-Making for Induced Abortion in the Accra Metropolis, Ghana
(African Journal of Reproductive Health, 2015-06) Gbagbo, F.Y.; Amo-Adjei, J.; Laar, A.
Decision-making for induced abortion can be influenced by various circumstances including those surrounding onset of a pregnancy. There are various dimensions to induced abortion decision-making among women who had an elective induced abortion in a cosmopolitan urban setting in Ghana, which this paper examined. A cross-sectional mixed method study was conducted between January and December 2011 with 401 women who had undergone an abortion procedure in the preceding 12 months. Whereas the quantitative data were analysed with descriptive statistics, thematic analysis was applied to the qualitative data. The study found that women of various profiles have different reasons for undergoing abortion. Women considered the circumstances surrounding onset of pregnancy, person responsible for the pregnancy, gestational age at decision to terminate, and social, economic and medical considerations. Pressures from partners, career progression and reproductive intentions of women reinforced these reasons. First time pregnancies were mostly aborted regardless of gestational ages and partners’ consent. Policies and programmes targeted at safe abortion care are needed to guide informed decisions on induced abortions. (Afr J Reprod Health 2015; 19[2]: 34-42) Decision-Making for Induced Abortion in the Accra Metropolis, Ghana | Request PDF. Available from: https://www.researchgate.net/publication/280738008_Decision-Making_for_Induced_Abortion_in_the_Accra_Metropolis_Ghana [accessed Sep 18 2018].
Determinants of Overweight with Concurrent Stunting among Ghanaian Children
(University of Ghana, 2015-07) Atsu, B. K.; Laar, A.; University of Ghana, College of Health Sciences, School of Public Health
Background – Malnutrition is evident in the Ghanaian community. Stunting and overweight conditions occurring independently within individuals are of public health interest. Children under five are most susceptible to this condition. Studies concerning the dual burden of malnutrition in children have indicated the simultaneous occurrence of overweight and stunting within individuals (especially children). Objective - This analysis was performed to assess the prevalence of overweight with concurrent stunting among Ghanaian under-fives. The individual and contextual determinants of stunting; overweight; and overweight with concurrent stunting were also determined. Methodology – This study analyzed data sets of the fourth round of the Ghana Multiple Indicator Cluster Survey (MICS4). Eligible participants were under-fives whose mothers or caretakers provided complete interview responses. Univariate analyses were used to describe selected characteristics assessed from the Ghana MICS4 datasets. Chi-square and simple logistic regression analysis were used to compare the associations between the study outcomes (stunting, overweight and overweight with concurrent stunting) and several explanatory variables. Odds ratios with accompanying, 95% Confidence Intervals were used to assess the strength of association between the outcomes and each explanatory variable. The multiple logistic regression analysis was used to adjust for potential confounders. P < 0.05 was used to denote statistical significance. Results – Data was analyzed using 7550 children. The prevalence of stunting was 27.5%; underweight was 17.3%; wasting was 7.7%; overweight was 2.4% and double burden of malnutrition was 1.2%. Girls had a significantly higher odds than boys to be stunted (aOR = 1.312; 95% CI, 1.111 - 1.549). Children who lived in the northern zones were 13 times as likely as coastal children to be overweight (aOR = 12.888; 95% CI, 1.738 – 95.543). Under-fives who belonged to the fourth quintile, were 4 times as likely as children within the poorest quintile to be overweight and concurrently stunted (aOR = 4.311; 95% CI, 1.219 – 15.241) Conclusion - This analysis showed a 1.2% prevalence of the Double Burden of Malnutrition occurring among Ghanaian under-fives. Child’s age, sex, malaria parasitemia and anemia were individual determinants of stunting. Contextual determinants of stunting were mother’s age, religion of household head, wealth index quintile and mother registered with any health insurance. Individual determinant of overweight was the child’s age, while contextual determinants were the religion of household head, wealth index quintile, marital status and geographic zones. Contextual determinants of DBM were maternal age, wealth index quintile, religion of household head and marital status of women. Keywords: Stunting, overweight, double burden of malnutrition and children under-five, Ghana
Diagnostic capacity, and predictive values of rapid diagnostic tests for accurate diagnosis of Plasmodium falciparum in febrile children in Asante-Akim, Ghana
(Malaria Journal, 2018-12) Quakyi, I.A.; Adjei, G.O.; Sullivan, D.J.; Laar, A.; Stephens, J.K.; Owusu, R.; Winch, P.; Sakyi, K.S.; Coleman, N.; Krampa, F.D.; Essuman, E.et.al.
Background This study seeks to compare the performance of HRP2 (First Response) and pLDH/HRP2 (Combo) RDTs for falciparum malaria against microscopy and PCR in acutely ill febrile children at presentation and follow-up. Methods This is an interventional study that recruited children < 5 years who reported to health facilities with a history of fever within the past 72 h or a documented axillary temperature of 37.5 °C. Using a longitudinal approach, recruitment and follow-up of participants was done between January and May 2012. Based on results of HRP2-RDT screening, the children were grouped into one of the following three categories: (1) tested positive for malaria using RDT and received anti-malarial treatment (group 1, n = 85); (2) tested negative for malaria using RDT and were given anti-malarial treatment by the admitting physician (group 2, n = 74); or, (3) tested negative for malaria using RDT and did not receive any anti-malarial treatment (group 3, n = 101). Independent microscopy, PCR and Combo-RDT tests were done for each sample on day 0 and all follow-up days. Results Mean age of the study participants was 22 months and females accounted for nearly 50%. At the time of diagnosis, the mean body temperature was 37.9 °C (range 35–40.1 °C). Microscopic parasite density ranged between 300 and 99,500 parasites/µL. With microscopy as gold standard, the sensitivity of HRP2 and Combo-RDTs were 95.1 and 96.3%, respectively. The sensitivities, specificities and predictive values for RDTs were relatively higher in microscopy-defined malaria cases than in PCR positive-defined cases. On day 0, participants who initially tested negative for HRP2 were positive by microscopy (n = 2), Combo (n = 1) and PCR (n = 17). On days 1 and 2, five of the children in this group (initially HRP2-negative) tested positive by PCR alone. On day 28, four patients who were originally HRP2-negative tested positive for microscopy (n = 2), Combo (n = 2) and PCR (n = 4). Conclusion The HRP2/pLDH RDTs showed comparable diagnostic accuracy in children presenting with an acute febrile illness to health facilities in a hard-to-reach rural area in Ghana. Nevertheless, discordant results recorded on day 0 and follow-up visits using the recommended RDTs means improved malaria diagnostic capability in malaria-endemic regions is necessary.
Early Infant Diagnosis of Hiv In the Eastern Region of Ghana: Stakeholders’ Knowledge and Implementation Challenges
(University of Ghana, 2016-07) Osei, D.; Laar, A.; University of Ghana, College of Health Sciences School of Public Health
Background Infants who acquire HIV infection vertically experience rapid deterioration, usually leading to death. Early initiation of ART can reverse this trend. The WHO therefore recommends virological HIV testing in all exposed infants by six weeks, and if positive, promptly initiate ART. Despite the implementation of early infant testing in Ghana, coverage among eligible infants remains low and infants are tested late, resulting in erosion of possible benefits. Study Objectives This study was therefore designed to assess the performance of EID, assess service providers’ and caregivers’ knowledge about EID, and document the challenges these stakeholders face in the implementation of EID in the Eastern region of Ghana. Methods The study was a mixed methods research conducted at the Eastern Regional Hospital and St. Martin de Porres Hospital. A desk review of EID tests done in the facilities was conducted to determine the proportion of eligible infants who tested, age at testing and turn-around times for results delivery between 2013 and 2015. In-depth interviews were conducted with the stakeholders to assess their knowledge and find out the challenges they faced in the provision of EID services. Results Only 27.6% of eligible infants were tested for EID. Median age of infants at the time of testing was 9.4 weeks and were over 7 months old before the results reached their EID sites. HIV positive infants would, therefore, have deteriorated before life-saving ART could be initiated. Service providers had adequate knowledge about EID but only laboratory technicians collected and processed DBS samples. Caregivers showed mixed levels of knowledge about EID. Provider related barriers identified were delays in sample transportation, sample testing and result delivery; frequent breakdown of equipment and shortage of supplies; and high workload for few, poorly motivated staff. Caregiver related challenges were incorrect phone numbers and addresses; financial constraints; non-disclosure and denial of HIV status.
Editorial: The African food environments
(Frontiers in Public Health, 2023) Laar, A.; Baye, K.; Zotor, F.; Asiki, G.; Lartey, A.
Ethics-sensitivity of the Ghana national integrated strategic response plan for pandemic influenza
(BMC Medical Ethics, 2015-05) Laar, A.; Debruin, D.
Background Many commentators call for a more ethical approach to planning for influenza pandemics. In the developed world, some pandemic preparedness plans have already been examined from an ethical viewpoint. This paper assesses the attention given to ethics issues by the Ghana National Integrated Strategic Plan for Pandemic Influenza (NISPPI). Methods We critically analyzed the Ghana NISPPI’s sensitivity to ethics issues to determine how well it reflects ethical commitments and principles identified in our review of global pandemic preparedness literature, existing pandemic plans, and relevant ethics frameworks. Results This paper reveals that important ethical issues have not been addressed in the Ghana NISPPI. Several important ethical issues are unanticipated, unacknowledged, and unplanned for. These include guidelines on allocation of scarce resources, the duties of healthcare workers, ethics-sensitive operational guidelines/protocols, and compensation programs. The NISPPI also pays scant attention to use of vaccines and antivirals, border issues and cooperation with neighboring countries, justification for delineated actions, and outbreak simulations. Feedback and communication plans are nebulous, while leadership, coordination, and budgeting are quite detailed. With respect to presentation, the NISPPI’s text is organized around five thematic areas. While each area implicates ethical issues, NISPPI treatment of these areas consistently fails to address them. Conclusions Our analysis reveals a lack of consideration of ethics by the NISPPI. We contend that, while the plan’s content and fundamental assumptions provide support for implementation of the delineated public health actions, its consideration of ethical issues is poor. Deficiencies include a failure to incorporate guidelines that ensure fair distribution of scarce resources and a lack of justification for delineated procedures. Until these deficiencies are recognized and addressed, Ghana runs the risk of rolling out unjust and ethically indefensible actions with real negative effects in the event of a pandemic. Soliciting inputs from the public and consultation with ethicists during the next revision of the NISPPI will be useful in addressing these issues.