Department of Population, Family and Reproductive Health
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Item What influences cancer treatment service access in Ghana? A critical interpretive synthesis(BMJ Open, 2022) Tuck, C.Z.; Aryeetey, R.N.O.; Akparibo, R.; et al.Objectives Multiple social-cultural and contextual factors influence access to and acceptance of cancer treatment in Ghana. This research aimed to assess the existing literature on how these factors interplay and could be susceptible to local and national policy changes. Design This study uses a critical interpretive synthesis approach to review qualitative and quantitative evidence about access to adult cancer treatment services in Ghana, applying the socioecological model and candidacy framework. Results Our findings highlighted barriers to accessing cancer services within each level of the socioecological model (intrapersonal, interpersonal community, organizational and policy levels), which are dynamic and interacting, for example, community-level factors influenced individual perceptions and how they managed financial barriers. Evidence was lacking about determinants of treatment non-acceptance across all cancers and in the most vulnerable societal groups due to methodological limitations. Conclusions Future policy should prioritize multilevel approaches, for example, improving the quality and affordability of medical care while also providing collaboration with traditional and complementary care systems to refer patients. Research should seek to overcome methodological limitations to understand the determinants of accessing treatment in the most vulnerable populations.Item Urban physical food environments drive dietary behaviours in Ghana and Kenya: A photovoice study(Health and Place, 2021) Pradeilles, R.; Laar, A.; Irache, A.; et al.We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Economic access was perceived as a major barrier to accessing nutritionally safe and healthy foods. Home gardening supplemented household nutritional needs, particularly in Nairobi. Policies to enhance food safety in neighbourhood environments are required. Home gardening, food pricing policies and social protection schemes could reduce financial barriers to safe and healthy diets.Item Drivers of anaemia reduction among women of reproductive age in the eastern and upper west regions of Ghana: A secondary data analysis of the Ghana demographic and health surveys(African Journal of Food, Agriculture, Nutrition and Development, 2023) Tetteh, A.; Adanu, R.M.K.; Folson, G.; et al.Anaemia among women of reproductive age (WRA) increases the risk of pregnancy-related morbidity, mortality, and poor pregnancy outcomes. Globally, there is growing interest in reducing anaemia among WRA. In Ghana, anaemia among WRA declined at the national level between 2008 (59%) and 2014 (42%). There were also important declines at the sub-national level. The Eastern region (in the south) and Upper West region (in the north) provide an interesting opportunity to understand the decline. Identifying the drivers of anaemia reduction among WRA in Ghana provides important implementation science evidence for designing effective interventions. This current study examined the drivers of reduced anaemia prevalence in women of reproductive age using data from the Ghana Demographic and Health Surveys for 2008 and 2014. Anaemia was diagnosed as haemoglobin<12.0g/dl. Data were summarized using proportions and 95% confidence intervals. A weighted binary logistic-based multivariate decomposition technique was used to identify the potential drivers of anaemia across surveys for 2003, 2008 and 2014. Sensitivity analysis was carried out to test the robustness of the results of the decomposition analysis using haemoglobin concentration. The results of the decomposition analysis were presented as endowment and coefficient effects. Statistical analysis was carried out using Stata version 15. There was an improvement in access to water and sanitation, health services, family planning, and health insurance across surveys. Drivers of anaemia reduction over time at the national level included wealth index and maternal age, education, use of hormonal contraception and body mass index (BMI). In the Eastern region, the drivers of change were household wealth index, maternal age, hormonal contraceptive use and BMI. The drivers of change in the Upper West region, were household access to water, maternal education and BMI. The findings suggest that multi-level interventions are needed across sectors to further reduce anaemia among WRA.Item Strengthening Maternal, Infant, and Young Child Nutrition Training and Counseling in Ghana: A Community-Based Approach(Current Developments in Nutrition, 2022) Sandow, A.; Aryeetey, R.; Tice, M.; et al.Background: Evidence-based maternal, infant, and young child nutrition (MIYCN) counseling provides caregivers with essential nutrition education to optimize infant and young child feeding practices and subsequently improve child growth and development. Effective integration of responsive feeding (RF) into current MIYCN training requires working with priority communities. Objectives: The study objectives were to 1) assess MIYCN knowledge and practices among Ghanaian caregivers, 2) identify factors influencing RF/responsive parenting (RP) among Ghanaian caregivers, 3) identify barriers and facilitators influencing MIYCN training and counseling among Ghanaian health care providers, and 4) document recommendations for integrating an RF curriculum into the existing MIYCN training. Methods: This was a qualitative study, conducted within the Central Region of Ghana, based on 1) 6 focus groups with caregivers of young children (<36 mo; n = 44) and 2) in-depth interviews with health care providers (n = 14). Focus group transcripts were coded independently, consensus was reached, and a final codebook was developed. The same coding process and thematic analysis were applied to the in-depth interviews. Results: Caregivers identified 3 domains influencing the primary outcome of RF/RP knowledge and practices and the secondary outcome of MIYCN: 1) health care provider counseling; 2) support from family, friends, and community members; and 3) food safety knowledge and practice. Providers identified barriers to MIYCN provider training as well as caregiver counseling which included limited access to financial and counseling resources and limited qualified staff to deliver infant and young child feeding counseling. Identified facilitators included the availability of funding and counseling staff with adequate resources. Healthcare providers strongly endorsed integrating an RF curriculum into MIYCN training and counseling along with providing RF training and distribution of RF materials/tools to facilities. Conclusions: Healthcare providers directly influenced RF/RP practices through MIYCN counseling. Strengthening MIYCN counseling through the integration of an RF curriculum into MIYCN training is desired by the community.Item Nutritional quality and diversity in Ghana’s school feeding programme: a mixed-methods exploration through caterer interviews in the Greater Accra Region(BMC Nutrition, 2024) Liguori, J.; Amevinya, G.S.; Holdsworth, M.; Savy, M.; Laar, A.Background The Ghana School Feeding Programme (GSFP) provides public primary school pupils with a free daily meal. Each meal is expected to follow set menus, providing 30% of children’s’ (6-12 years) energy requirements. This study assessed the nutritional quality and diversity of planned and provided GSFP meals, engaging school caterers to identify how meal quality in the Greater Accra Region could be enhanced. Methods A cross-sectional mixed methods study design was used. Multistage sampling was used to select 129 schools implementing the GSFP in six districts of the Greater Accra Region. GSFP district menus were collected as well as a one-week school caterer recall of provided school meals. The meal served on the day of data collection was recorded and photographed. Nutritional quality was evaluated based on nutrient profling methods: energy density (low<125kcal/100g; medium 125-225kcal/100g; high>225kcal/100g) and nutrient density (low<5%; medium 5-10%; high>10%). Meal diversity was assessed by a simple count composed of 5 food groups: cereals, pulses/nuts/ seeds, animal-source, vegetables and fruits. Caterers’ views on programme facilitators and barriers were also explored. Results Planned menus included 14-20 weekly options, composed of eight minimally processed traditional dishes. All meals, except white rice, had a high nutrient density/100g. Energy density was varied (low, n=2; medium, n=2; high, n=4). Meals included only 2/5 or 3/5 food groups, mainly starchy staples, pulses/nuts/seeds, and sometimes vegetables. Fruit was never reported. About half of caterers (51.1%) reported deviating from the planned menus: 11.7% served alternative meals, with some including animal-sourced food (17.0%), and 39.4% repeated meals pro vided during the week, often based on starchy staples, infuencing overall nutritional quality. Most caterers reported food item cost and lack of food purchase guidelines as barriers to providing school meals, while food safety training and guidelines for food preparation were facilitators. Conclusions While school meals are composed of minimally processed, nutrient dense, local foods, there are nota ble gaps in meal diversity and compliance, as refected in provided meals. Caterer compliance to planned menus var ied greatly, refecting recent food price infation. Upwardly adjusting the current meal allocation of 1.2 cedis (0.22USD) per child per day could enhance access to more afordable, nutritious and diverse foods in school mealsItem Providing Measurement, Evaluation, Accountability, and Leadership Support (MEALS) for Non-communicable Diseases Prevention in Ghana: Project Implementation Protocol(Frontiers in Nutrition, 2021) Laar, A.; Aryeetey, R.; Kelly, B.; et al.Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support public sector actions that create healthy food marketing, retail, and provisioning environments for Ghanaian children using adapted methods from the International Network for Food and Obesity/NCDs Research Monitoring and Action Support (INFORMAS). Methods: The protocol for this observational study draws substantially from the INFORMAS’ Food Promotion and Food Provision Modules. However, to appraise the readiness of local communities to implement interventions with strong potential to improve the food environments of Ghanaian children, the MEALS4NCDs protocol has innovatively integrated a local community participatory approach based on the community readiness model (CRM) into the INFORMAS approaches. The setting is Ghana and the participants include health and nutrition policy-makers, nutrition and food service providers, consumers, school authorities, and pupils of Ghanaian basic schools. Results: The study establishes a standardized approach to providing implementation science evidence for the prevention of non-communicable diseases (NCDs) in Ghana. It demonstrates the feasibility and the innovative application of the INFORMAS expanded food promotion and food provision modules, together with the integration of the CRM in a lower-middle income setting. Conclusion: The research will facilitate the understanding of the processes through which the INFORMAS approach is contextualized to a lower-middle-income African context. The protocol could be adapted for similar country settings to monitor relevant aspects of the food environments of children.Item Review Of Ghana’s Food Environment: Drivers Of Availability, Barriers To Healthy Food Access, And Impact Of Interventions And Policies(African Journal of Food, Agriculture, Nutrition and Development, 2022) Annan, R.A.; Aryeetey, R.; Agyapong, N.A.F.; Apprey, C.Food environments exert a significant effect on the population's dietary choices and health outcomes. Policies that influence the food environment, can have a significant impact on individual and population dietary choices. This rapid review assessed the nature and interaction within the Ghanaian food environment and the impact that existing school, workplace, and national food policies have on dietary intake and nutritional outcomes. Online databases and university repositories were searched for relevant articles and documents. A total of forty articles and documents were included in the review. The majority of the reviewed papers (85%) used a cross-sectional design. The findings show that traditional outlets (open markets) constitute the main food source in the Ghanaian populace, while convenience stores serve as an important source of processed foods. Prepared local foods are often consumed outside the home and are mainly sourced from street food vendors. Street foods are perceived as less expensive, convenient, and delicious. The food environment was found to influence dietary acquisition, intake, and nutritional outcomes. Although most nutrients provided by the School Feeding Programme (SFP) are below recommended intake standards, the SFP contributes positively to improved diets and nutrition status of school-age children. Children attending SFP-implementing schools experience higher intakes of protein, iron, zinc, calcium, vitamin A, and folate, and have higher hemoglobin, and lower prevalence of stunting, underweight, and thinness than children in non-SFP implementing schools. The availability of a private room for breastfeeding mothers improved breastfeeding frequency. Ghana’s fatty meat restriction policy has reduced the availability and sale of fatty meat on the Ghanaian market. Reported drivers and barriers to healthy food consumption include socio-economic factors, media information, food storage facilities, cultural perception, fruit seasonality, knowledge of the nutrient value of fruits and vegetables, safety profile of fruits and vegetables, and contribution of household production to dietary intake. In conclusion, the food environment review reveals the drivers of availability, barriers to healthy food access, and the impact of interventions and policies on the Ghanaian food environment.Item Prevalence and predictors of overweight and obesity among school-aged children in urban Ghana(BMC Obesity, 2017) Aryeetey, R.; Lartey, A.; Marquis, G.S.; et al.Background: Childhood overnutrition is a serious public health problem, with consequences that extend into adulthood. This study aimed to determine the prevalence and determinants of overweight and obesity among school-age children in two urban settings in Ghana. Methods: This cross-sectional study involved 3089 children (9–15 years) recruited between December 2009 and February 2012 in Accra and Kumasi, Ghana. Socio-demographic, dietary, and physical activity data were collected using pretested questionnaires. BMI-for-age z-scores were used to categorize anthropometric data of the children as thin, normal, or overweight/obese. Determinants of overweight were examined using multiple logistic regressions. Results: Seventeen percent of children were overweight or obese. Children who reported lower participation (< 3 times/week) in sports activity were 44% more likely to be overweight or obese (AOR = 1.44; 95% CI: 1.07, 1.94). Maternal tertiary education (AOR = 1.91, 95% CI: 1.07, 3.42), higher household socioeconomic status (AOR = 1. 56, 95% CI: 1.18, 2.06), and attending private school (AOR = 1.74, 95% CI: 1.31, 2.32) were also associated with elevated risk of overweight and obesity. Conclusions: Physical inactivity is a modifiable independent determinant of overweight or obesity among Ghanaian school-aged children. Promoting and supporting a physically active lifestyle in this population is likely to reduce the risk of childhood overnutrition.Item Dietary patterns and associated risk factors among school age children in urban Ghana(BMC Nutrition, 2018) Ogum Alangea, D.; Aryeetey, R.N.; Gray, H.L.; et al.Background: Understanding dietary patterns in the study of diet-disease relationships is crucial for designing dietary behavior interventions. This study aimed to determine associations between dietary patterns and background characteristics among school-age children (9–15 years) in Ghana. Methods: A cross-sectional sample of 487 urban-dwelling children aged 9–15 years was recruited using simple random sampling from 24 schools (12 private and 12 public) in the Ga-East Municipality in Southern Ghana. A 7-day food frequency questionnaire was used to record children’s consumption of over 100 unique food items. Principal component analyses based on 14 food groups were used to describe emerging dietary patterns (DP). BMI-for-age z-scores segregated by sex were derived using WHO Anthro plus software. Linear regression was used to test associations between ‘diet factor’ scores, and weight status controlling for age. Results: Four DPs were identified that explained 53.2% of the variation in the diets of children: (1) energy dense; (2) starchy root staples and vegetables; (3) cereal-grain staples and poultry; and (4) fish & seafood. Energy-dense DP characterized by processed meat, fried foods, and sugary foods was associated with child overweight/obese status after controlling for age, sex, SES, and school type [F(5, 484) = 6.868, p < 0.001]. Starchy root with vegetable DP was negatively associated with overweight/obese status, private school attendance, and higher SES after controlling for age at the bivariate level. However, the relationship between ‘starchy root staples and vegetables’ DP and overweight/obese status lost significance after controlling for other covariates. Conclusion: Our data identified energy-dense dietary patterns to be significantly associated with childhood overweight and obesity. Targeted dietary messages are required to address energy-dense dietary patterns among school-age children.Item Nutritional quality and diversity in Ghana’s school feeding programme: a mixed-methods exploration through caterer interviews in the Greater Accra Region(BMC Nutrition, 2024) Liguori, J.; Amevinya, G.S.; Holdsworth, M.; Savy, M.; Laar, A.Background The Ghana School Feeding Programme (GSFP) provides public primary school pupils with a free daily meal. Each meal is expected to follow set menus, providing 30% of children’s’ (6-12 years) energy requirements. This study assessed the nutritional quality and diversity of planned and provided GSFP meals, engaging school caterers to identify how meal quality in the Greater Accra Region could be enhanced. Methods A cross-sectional mixed methods study design was used. Multistage sampling was used to select 129 schools implementing the GSFP in six districts of the Greater Accra Region. GSFP district menus were collected as well as a one-week school caterer recall of provided school meals. The meal served on the day of data collection was recorded and photographed. Nutritional quality was evaluated based on nutrient profiling methods: energy density (low<125kcal/100g; medium 125-225kcal/100g; high>225kcal/100g) and nutrient density (low<5%; medium 5-10%; high>10%). Meal diversity was assessed by a simple count composed of 5 food groups: cereals, pulses/nuts/ seeds, animal-source, vegetables and fruits. Caterers’ views on programme facilitators and barriers were also explored. Results Planned menus included 14-20 weekly options, composed of eight minimally processed traditional dishes. All meals, except white rice, had a high nutrient density/100g. Energy density was varied (low, n=2; medium, n=2; high, n=4). Meals included only 2/5 or 3/5 food groups, mainly starchy staples, pulses/nuts/seeds, and sometimes vegetables. Fruit was never reported. About half of caterers (51.1%) reported deviating from the planned menus: 11.7% served alternative meals, with some including animal-sourced food (17.0%), and 39.4% repeated meals provided during the week, often based on starchy staples, influencing overall nutritional quality. Most caterers reported food item cost and lack of food purchase guidelines as barriers to providing school meals, while food safety training and guidelines for food preparation were facilitators. Conclusions While school meals are composed of minimally processed, nutrient dense, local foods, there are nota ble gaps in meal diversity and compliance, as reflected in provided meals. Caterer compliance to planned menus varied greatly, reflecting recent food price inflation. Upwardly adjusting the current meal allocation of 1.2 cedis (0.22USD) per child per day could enhance access to more affordable, nutritious and diverse foods in school meals.