Nutrition Department
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Item Cardiovascular disease prevention: Community Based Asset Mapping within religious networks in a rural Sub-Saharan African neighbourhood(Plos Global Public Health, 2024) Willis, A.; Chatio, S.; Zakariah-Akoto, S.; et al.Prevalence of conditions which raise cardiovascular risk, such as hypertension and type 2 diabetes are seeing a dramatic rise in Sub-Saharan Africa. A large proportion of these cases remain undiagnosed and there is limited resources to provide patients with self-management support and education once diagnosed. This study aimed to identify and catalogue community-based assets for the purposes of developing and deploying a screening and education programme for cardiometabolic risk factors (diabetes and hypertension) within religious organisations in a local community in a rural Ghanaian context. We utilised a community-based form of participatory research made up of a number of different components including community-based asset mapping and stakeholder consultation, supplemented by 18 in-depth interviews and 10 focus groups with n = 115 service users, to map existing assets with relevance to cardiometabolic health in this setting and context. Thematic analysis of interview and focus group data was performed to identify themes related to successful implementation of health screening. Two stakeholder workshops with local healthcare professionals, faith leaders and health policymakers were delivered to co-produced a prioritised list of recommendations and ‘asset map’ to aid deployment of mass screening within faith organisations in this context. The findings of this research highlight a number of ‘hidden’ community assets and motivational mechanisms at an individual, community and institutional levels; these have informed a list of recommendations which have been co-developed with the stakeholder group and local community to support the development of effective screening strategies for cardiometabolic conditions within faith organisations in this context. We have identified key mechanisms and assets which would support a sustainable screening approach designed to engage an underserved community at high CVD risk to promote general community health and well-beingItem Validation of Mobile Artificial Intelligence Technology–Assisted Dietary Assessment Tool Against Weighed Records and 24-Hour Recall in Adolescent Females in Ghana(The Journal of Nutrition, 2023) Folson, G.K.; Bannerman, B.; Atadze, V.; et al.Background: Important gaps exist in the dietary intake of adolescents in low- and middle-income countries (LMICs), partly due to expensive assessment methods and inaccuracy in portion-size estimation. Dietary assessment tools leveraging mobile technologies exist but only a few have been validated in LMICs. Objective: We validated Food Recognition Assistance and Nudging Insights (FRANI), a mobile artificial intelligence (AI) dietary assessment application in adolescent females aged 12–18 y (n ¼ 36) in Ghana, against weighed records (WR), and multipass 24-hour recalls (24HR). Methods: Dietary intake was assessed during 3 nonconsecutive days using FRANI, WRs, and 24HRs. Equivalence of nutrient intake was tested using mixed-effect models adjusted for repeated measures, by comparing ratios (FRANI/WR and 24HR/WR) with equivalence margins at 10%, 15%, and 20% error bounds. Agreement between methods was assessed using the concordance correlation coefficient (CCC). Results: Equivalence for FRANI and WR was determined at the 10% bound for energy intake, 15% for 5 nutrients (iron, zinc, folate, niacin, and vitamin B6), and 20% for protein, calcium, riboflavin, and thiamine intakes. Comparisons between 24HR and WR estimated equivalence at the 20% bound for energy, carbohydrate, fiber, calcium, thiamine, and vitamin A intakes. The CCCs by nutrient between FRANI and WR ranged between 0.30 and 0.68, which was similar for CCC between 24HR and WR (ranging between 0.38 and 0.67). Comparisons of food consumption episodes from FRANI and WR found 31% omission and 16% intrusion errors. Omission and intrusion errors were lower when comparing 24HR with WR (21% and 13%, respectively). Conclusions: FRANI AI–assisted dietary assessment could accurately estimate nutrient intake in adolescent females compared with WR in urban Ghana. FRANI estimates were at least as accurate as those provided through 24HR. Further improvements in food recognition and portion estimation in FRANI could reduce errors and improve overall nutrient intake estimations.Item Associations between livestock ownership and lower odds of anaemia among children 6–59 months old are not mediated by animal-source food consumption in Ghana(Wiley, 2021) Lambrecht, N.J.; Wilson, M.L.; Baylin, A.; Folson, G.; Naabah, S.; Eisenberg, J.N.S.; Adu, B.; Jones, A.D.Livestock ownership may mitigate anaemia among young children by providing access to animal-source foods (ASFs) yet exacerbate anaemia by exposing children to animal-source pathogens. This study aimed to assess the association between household livestock ownership and child anaemia and examine whether this relationship is mediated by child ASF consumption or by child morbidity and inflammation. We conducted a cross-sectional study of 470 children aged 6–59 months in Greater Accra, Ghana. Child blood samples were analysed for haemoglobin concentration, iron status biomarkers and inflammatory biomarkers. Caregivers were asked about the child's frequency of ASF consumption in the past 3 months. Livestock ownership was categorized into five typologies to distinguish households by the number and combinations of species owned. In adjusted logistic regression, children from households in Type 5, owning cattle, small livestock (goats, sheep or pigs) and poultry, had lower odds of anaemia compared with those in Type 1, owning no livestock (OR [95% CI]: 0.32 [0.14, 0.71]). Although children from households that owned poultry were more likely to consume chicken meat, and children from households with cattle were more likely to drink cow's milk, consumption of these ASFs did not mediate the observed association between livestock ownership and child anaemia. There were no associations between livestock ownership and children's symptoms of illness or inflammation. Further research is needed to understand how ownership of certain livestock species, or a greater diversity of livestock species, may be associated with the risk of child anaemia, including the role of dietary and income-based pathways.Item Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study(Journal of Health, Population and Nutrition, 2019-12-12) Armar-Klemesu, M.; Ahishakiye, J.; Bouwman, L.; Brouwer, I.D.; Matsiko, E.; Koelen, M.Background: Despite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6–23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda. Methods: Sixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti. Results: Two main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women’s heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges. Conclusion: Factors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge onlyItem Monitoring Diabetes Control(Ghana Medical Journal, 1989-03) Owusu, S.K.Twenty (20) Non-insulin Dependent Diabetic (NIDD) and twenty-four (24) insulin Dependent Diabetic (IDD) patients were studied to determine the best blood test(s) for control of their diabetes. In the NIDD group. a fasting blood sugar of 7.1 mmol/l or less, or a 2-hour post prandial (post breakfast) blood Sugar of 7.7 mmol/l or less, was found to be an accurate predictor of good control throughout the day (24 hours). For the IDD group, a fasting blood sugar of 7.1 mmol/l or less and a 2-hoor post prandial (post breakfast) blood sugar of 7. 7 mmol/l or less, are likely to indicate a good 'control' if the patient is on twice daily infections of Insulin.Item Fresh frozen plasma in the treatment of haemotoxic snake bites.(Ghana Medical Journal, 1990-09) Owusu, S.K.Vipers inject mainly haemotoxins when they bite. This produces shock, capillary bleeding and coagulation changes. An early sign of viper bite poisoning is blood-stained spit, non-clotting blood and other haemorrhagic signs including oozing of blood from the injection site, bleeding from the gums and ecchymosis within half an hour to three hours of the bite, in severe cases, shock may developItem A School Meals Program Implemented at Scale in Ghana Increases Height-for-Age during Midchildhood in Girls and in Children from Poor Households: A Cluster Randomized Trial(The Journal of Nutrition Nutritional Epidemiology, 2019-04-01) Folson, G.; Gelli, A.; Aurino, E.; Arhinful, D.; Adamba, C.; Osei-Akoto, I.; Masset, E.; Watkins, K.; Fernandes, M.; Drake, L.; Alderman, H.Background: Attention to nutrition during all phases of child and adolescent development is necessary to ensure healthy physical growth and to protect investments made earlier in life. Leveraging school meals programs as platforms to scale-up nutrition interventions is relevant as programs function in nearly every country in the world. Objective: The aim of this study was to evaluate the impact of a large-scale school meals program in Ghana on school age children’s anthropometry indicators. Methods: A longitudinal cluster randomized control trial was implemented across the 10 regions of Ghana, covering 2869 school-age children (aged 5–15 y). Communities were randomly assigned to 1) control group without intervention or 2) treatment group providing the reformed national school feeding program, providing 1 hot meal/d in public primary schools. Primary outcomes included height-for-age (HAZ) and BMI-for-age (BAZ) z scores. The analysis followed an intention-to-treat approach as per the published protocol for the study population and subgroup analysis by age (i.e., mid childhood for children 5–8 y and early adolescence for children 9–15 y), gender, poverty, and region of residence. We used single-difference ANCOVA with mixed-effect regression models to assess program impacts. Results: School meals had no effect on HAZ and BAZ in children aged 5–15 y. However, in per-protocol subgroup analysis, the school feeding intervention improved HAZ in 5- to 8-y-old children (effect size: 0.12 SDs), in girls (effect size: 0.12 SDs)—particularly girls aged 5–8 y living in the northern regions, and in children aged 5–8 y in households living below the poverty line (effect size: 0.22 SDs). There was also evidence that the intervention influenced food allocation and sharing at the household level. Conclusion: School meals can provide a platform to scale-up nutrition interventions in the early primary school years, with important benefits accruing for more disadvantaged children. This trial was registered at www.isrctn.com as ISRCTN66918874. J Nutr 2019;149:1434–1442Item Contextualizing Schistosoma haematobium transmission in Ghana: Assessment of diagnostic techniques and individual and community water-related risk factors(Acta Tropica, 2019-03) Kulinkina, A.V.; Kosinski, K.C.; Adjei, M.N.; Osabutey, D.; Gyamfi, B.O.; Biritwum, N.K.; Bosompem, K.M.; Naumova, E.N.Objectives The study assessed associations between Schistosoma haematobium infection (presence of parasite eggs in urine or hematuria) and self-reported metrics (macrohematuria, fetching surface water, or swimming) to evaluate their performance as proxies of infection in presence of regular preventive chemotherapy. It also examined community water characteristics (safe water access, surface water access, and groundwater quality) to provide context for schistosomiasis transmission in different types of communities and propose interventions. Methods Logistic regression was used to assess the associations between the various measured and self-reported metrics in a sample of 897 primary school children in 30 rural Ghanaian communities. Logistic regression was also used to assess associations between community water characteristics, self-reported water-related behaviors and S. haematobium infection. Communities were subsequently categorized as candidates for three types of interventions: provision of additional safe water sources, provision of groundwater treatment, and health education about water-related disease risk, depending on their water profile. Results Microhematuria presence measured with a reagent strip was a good proxy of eggs in urine at individual (Kendall’s τb = 0.88, p < 0.001) and at school-aggregated (Spearman’s rs = 0.96, p < 0.001) levels. Self-reported macrohematuria and swimming were significantly associated (p < 0.05) with egg presence, but self-reported fetching was not. Of the community water characteristics, greater surface water access and presence of groundwater quality problems were significantly associated with increased likelihood of fetching, swimming, and S. haematobium infection. Access to improved water sources did not exhibit an association with any of these outcomes. Conclusions The study illustrates that in presence of regular school-based treatment with praziquantel, microhematuria assessed via reagent strips remains an adequate proxy for S. haematobium infection in primary schoolchildren. Community water profiles, in combination with self-reported water-related behaviors, can help elucidate reasons for some endemic communities continuing to experience ongoing transmission and tailor interventions to these local contexts to achieve sustainable control.Item Is there a “complementary feeding cultural core” in rural Kenya? Results from ethnographic research in five counties(Maternal and Child Nutrition, 2019-01) Thuita, F.M.; Pelto, G.H.; Musinguzi, E.; Armar-Klemesu, M.This investigation used data from focused ethnographic studies in five rural counties in Kenya to determine whether the concept of "special foods for infants and young children" exists in the different ethnic groups in these areas as an identifiable component of cultural beliefs and knowledge, as well as in practice, and whether they can be characterized as a "complementary feeding cultural core." The concept of "cultural core foods" refers to the set of foods that have a central role in diets of a population and, as a consequence, also have significant social and emotional components. We used the ethnographic cognitive mapping technique of "free listing" and a qualitative 24-hr recall of infants and young children (IYC) intake, with probing, to obtain data on caregivers' beliefs and behaviours. The results show that an IYC cultural food core can be identified in all of the counties. A related finding that supports the argument for an "IYC cultural core" with respect to appropriate foods for IYC is the clear cognitive consensus within sites about its content, although in practice, food insecurity and food shortage constrain household abilities to put their beliefs into practice. We conclude that interventions to improve IYC feeding in rural Kenya that build on the concept of "IYC cultural core foods" will be congruent with basic cultural ideas about managing IYC feeding and could take advantage of this cultural feature.Item Balancing nurturance, cost and time: Complementary feeding in Accra, Ghana(Maternal and Child Nutrition, 2011-10) Pelto, G.H.; Armar-Klemesu, M.This paper presents a picture of the general patterns of complementary feeding behaviours in urban Ghana. A focused ethnographic study protocol for assessing complementary feeding developed for the Global Alliance for Improved Nutrition was used to collect data from caregivers of children 6-24months of age. We examined the multiple factors that influence the selection of foods for infants and young children in this urban setting, and found that economic factors, health beliefs and other nurturing-related values, access to food and issues of convenience all play important roles. We conclude that the interactions of nurturance, cost and time are vectors that affect feeding decisions. © 2011 Blackwell Publishing Ltd.