Department of Population, Family and Reproductive Health
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Item Availability, acceptability, and utilization of micronutrient fortification for children 6-23 months in three districts in Ghana(World Nutrition, 2024) Donkor, W.E.S.; Boadu, I.; Babae, P.; et al.Background Micronutrient deficiencies result from multiple factors, including inadequate intake of micronutrients (vitamins and minerals) from nutrient-rich diverse diets. Point-of-use fortification with a nutritional supplement powder is recommended to address micronutrient deficiencies and anemia among infants and young children (6-23 months), particularly, in low-income countries. In Ghana, about a quarter of children aged 6-59 months are anemic, or deficient in iron and vitamin A. World Vision Ghana (WVG) implemented the integrated Improved Feeding Practices (IFP) project between 2020 and 2023 in three districts in Ghana to improve diet quality and practices of women of reproductive age, and young children below age two years. One component of the project involved the distribution of a nutritional supplement powder (KOKO Plus). This is the second in a series of four papers that document the implementation and outcomes of the IFP project; the other papers are published in this journal. The current paper assessed the availability, acceptability, and utilization of KOKO Plus to households who participated in the IFP project as well as lessons learned from implementing the intervention. Methods A mixed-methods design was used, triangulating primary and secondary data. Secondary data originated from a review of IFP project documents, including project mid-year and annual reports, and implementation plans across the three interdependent components of the IFP project. Primary data were obtained from interviews in six purposively selected communities. Key informants included WVG staff, community volunteers, and local government agency staff from health and agriculture sector agencies, and beneficiaries of the intervention. Interview respondents answered questions on the project’s mechanism for KOKO Plus distribution, participant experiences of purchasing and using KOKO Plus, perceived benefits of using KOKO Plus, and lessons learned about KOKO Plus from the IFP project. Beneficiaries also provided information on their perceptions of KOKO Plus acceptability and adverse outcomes. Results The project distributed KOKO Plus free of charge to almost 14,000 (13,942) children, more than its target (4,900). In addition, Village-Based Entrepreneurs (VBE) sold 192,092 sachets of KOKO Plus in the project communities. The KOKO Plus value chain involved WVG purchased the KOKO Plus from the Ghanaian manufacturer and supplied it to VBEs either in their respective communities or at distribution centers in their respective WVG district office. KOKO Plus promotion and marketing were led by trained VBEs, VBE supervisors, and Community-Based Organizations across multiple settings (homes, child welfare clinics, markets, community durbars, and religious gatherings). There was high acceptability of KOKO Plus. Mothers attributed their acceptance of KOKO Plus to its a Corresponding author: raryeetey@ug.edu.gh 33 potential health and nutrition benefits for children. They also attributed increased child weight, and less frequent illness, to feeding meals that included KOKO Plus to their young children. KOKO Plus was added to the diverse local meals fed to young children. Diarrhea was the only mentioned adverse report, albeit rarely. At the end of the IFP project, WVG established a fund to ensure the sustainable distribution of KOKO Plus in the project communities. Conclusions The IFP project established a KOKO Plus value chain, increasing the availability, accessibility, acceptability, and utilization of KOKO Plus in the project communities. VBE successfully distributed KOKO Plus with support from community volunteers and healthcare workers. This approach to KOKO Plus distribution is feasible and sustainable and is recommended for similar contexts.Item 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.Item Counting adolescents in: the development of an adolescent health indicator framework for population-based settings(Elsevier Ltd., 2023) Manu, A.Changing realities in low- and middle-income countries (LMICs) in terms of inequalities, urbanization, globalization, migration, and economic adversity shape adolescent development and health, as well as successful transitions be tween adolescence and young adulthood. It is estimated that 90% of adolescents live in LMICs in 2019, but inade quate data exist to inform evidence-based and concerted policies and programs tailored to address the distinctive developmental and health needs of adolescents. Population-based data surveillance such as Health and Demographic Surveillance Systems (HDSS) and school-based surveys provide access to a well-defined population and provide cost-effective opportunities to fill in data gaps about adolescent health and well-being by collecting population representative longitudinal data. The Africa Research Implementation Science and Education (ARISE) Network, therefore, systematically developed adolescent health and well-being indicators and a questionnaire for measuring these indicators that can be used in population-based LMIC settings. We conducted a multistage collaborative and iterative process led by network members alongside consultation with health-domain and adolescent health experts globally. Seven key domains emerged from this process: socio-demographics, health awareness and behaviors; nutrition; mental health; sexual and reproductive health; substance use; and healthcare utilization. For each domain, we generated a clear definition; rationale for inclusion; sub-domain descriptions, and a set of questions for mea surement. The ARISE Network will implement the questionnaire longitudinally (i.e., at two time-points one year apart) at ten sites in seven countries in sub-Saharan Africa and two countries in Asia. Integrating the questionnaire within established population-based data collection platforms such as HDSS and school settings can provide measured experiences of young people to inform policy and program planning and evaluation in LMICs and improve adolescent health and well-being