Research Articles
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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community
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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 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 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 Evaluation of the Improved Feeding Practices for the First 1000 Days Project in Ghana(World Nutrition, 2024) Konlan, M.B.; Aryeetey, R.; Kushitor, S.B.; et al.Background Sub-optimal nutrition during the first 1000 days of life can impair the physical and cognitive development of children, as well as limit their health and well-being. The improved feeding practices for the first 1,000 days (IFP) project aimed to improve the dietary practices of women of reproductive age (pregnant and lactating) and children below ages two years in three selected districts (Kassena-Nankana West [KNW], Sekyere East[SE], and Kintampo South[KS]) in Ghana. This integrated project combined interventions on micronutrient powder (MNP) distribution, social behavior-change communication, and nutrition-sensitive agriculture to catalyze enhanced awareness and consumption of nutrient-rich foods in selected communities. Objective This paper evaluates the IFP project based on measures associated with relevance, effectiveness, impact, and sustainability. Methods Using a mixed-methods design, data from in-depth interviews of project beneficiaries, and key community-based actors involved in the project’s implementation were triangulated with routine project monitoring data, and documentation to answer the evaluation questions. The evaluation questions and our analyses were guided by the Development Assistance Committee evaluation criteria. Interviews with key stakeholders were conducted in June 2023. Key project data were compared between baseline and end-line assessments to ascertain the extent to which the project met its intended objectives and targets. Results The project demonstrated high relevance of the proposed project among the target groups; for example, nearly half the children were eating low-quality, non-diverse diets (49% in KNW, 46% in KS and 35 in SE). The project enabled almost 14,000 children to be reached with MNP. While 96,000 eggs were produced, <10% was consumed at home. About 35,000 kilograms of orange-fleshed sweet potatoes (OFSP) were produced, resulting in improved access to the nutrient-rich foods produced. Nutrition messages were disseminated widely and were reported to have contributed to improved awareness of nutrition among caregivers. Data-based and reported evidence both indicated there was improved child dietary diversity between the baseline and endline of the project; in KNW, 90% of children met minimum dietary diversity at the endline compared to 75% at baseline. In KS and SE, the endline estimates of dietary diversity were 71% and 70%, up from 65% in both districts at baseline, respectively. Multiple strategies aiming to support project sustainability that were built into the project design were implemented. Additional sustainability strategies evolved during the project’s lifetime, including crossbreeding of project chickens with hardier local breeds, continued multiplication of OFSP vines, and transfer of Village Savings and Loans Association funds accumulated from MNP sale to Village-Based Entrepreneurs to sustain MNP supply. Conclusions The IFP project delivered interventions successfully, leading to improved awareness and practices related to diets of women of reproductive age and young children, in project communities. These strategies can be extended to women and children living in similar settings to improve the diet quality of women and children.Item Advertising of unhealthy foods and beverages around primary and junior high schools in Ghana’s most urbanized and populous region(Frontiers in Public Health, 2022) Amevinya, G.S.; Aryeetey, R.; Vandevijvere, S.; et al.Introduction: The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra-processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most–69% were cartoons or manufacturer’s characters), while 8% of all food advertisements had premium offers oItem Development and Testing of Responsive Feeding Counseling Cards to Strengthen the UNICEF Infant and Young Child Feeding Counseling Package(Current Developments In Nutrition, 2020) Hromi-Fiedler, A.J.; Aryeetey, R.; Carroll, G.J.; et al.Background: The UNICEF Community-based Infant and Young Child Feeding Counseling Package (C-IYCFCP) currently has limited responsive feeding (RF) content, thus limiting the dissemination of RF messages within infant and young child feeding (IYCF) counseling. Objectives: This project 1) developed counseling cards based on existing evidence-based RF guidelines and 2) tested their feasibility in Ghana. Methods: Five RF counseling cards were developed focusing on eating with family; introducing new foods; hunger/satiety cues; food texture; and calming a child. Four focus group discussions (FGDs) were conducted with adult mothers and fathers of children younger than 3 years of age to assess the cultural appropriateness of the cards and accompanying key messages. The feasibility of including cards as part of IYCF counseling was tested via 1) systematic observation of 8 group education sessions utilizing the cards with the same target audience and 2) in-depth interviews with health care providers involved in IYCF training and/or counseling. Results: FGD findings guided changes to all cards to ensure comprehension and cultural appropriateness. The group education sessions suggested that the counseling cards provided important RF messages that are specific, clear, and feasible to implement. Healthcare providers strongly endorsed the need for and utility of the RF counseling cards and felt they were feasible and important to integrate into the C-IYCFCP currently being used to deliver IYCF training and counseling in Ghana. Conclusions: The counseling cards have a strong potential to add key RF dimensions to IYCF training and counseling in Ghana. Curr Dev Nutr 2020;4:nzaa117Item Child development in rural Ghana: Associations between cognitive/ language milestones and indicators of nutrition and stimulation of children under two years of age(Canadian Journal Of Public Health, 2017) Ahun, M.N.; Aryeetey, R.; Colecraft, E.; et al.OBJECTIVES: Two studies aimed to assess the provision of nutrition and psychosocial stimulation in the home and to examine associations between mental development and nutrition and stimulation using a validated measure of development milestones. METHODS: The first study consisted of secondary analyses of health and nutrition data from 1081 mother-child pairs (the children aged 0–12 months) and their households in Ghana’s Eastern Region. For the second study, the Ghana Milestones Measure, consisting of items assessing cognitive and language development, was used to assess child development in a subsample (N = 330) of Study 1 participants one year later (children 10–24 months of age). This measure was mother-reported and had been validated in a separate community in Ghana. Correlation and linear regression analyses were used to analyze the data. RESULTS: Family assets and maternal education were identified as key factors of the family context. Both variables were positively associated with preventive health practices (r = 0.08 to 0.13, p < 0.0001 to 0.01), and dietary diversity (r = 0.15, p = 0.0001 to 0.0006), and negatively associated with maternal depressive symptoms (r = −0.19 to −0.12, p < 0.0001). Taller children had higher receptive (standardized beta = 0.16; p = 0.04) and expressive (0.21; 0.003) language, but not cognitive (0.15; 0.07) milestone scores, and psychosocial stimulation was positively associated with all three milestones (receptive = 0.13, p = 0.01; expressive = 0.21, p < 0.0001; and cognitive = 0.24, p < 0.0001). CONCLUSION: Our study provides the first validated measure of children’s language and cognitive development in Ghana, finding associations with nutrition and stimulation. The Ghana Milestones Measure can be used to assess and help promote children’s mental development.Item Breastfeed4Ghana: Design and evaluation of an innovative social media campaign(Maternal & Child Nutrition, 2019) Harding, K.; Aryeetey, R.; Carroll, G.; et al.Although targeting health behavior change through social media campaigns has gained traction in recent years, few studies have focused on breastfeeding social media campaigns. Within the context of rising social media utilization and recent declines in exclusive breastfeeding practices in Ghana, we implemented Breastfeed4Ghana is a Facebook‐ and Twitter‐based breastfeeding social media campaign. This study determined the feasibility of implementing Breastfeed4Ghana and evaluated its impact on breastfeeding knowledge in Ghana. Key performance indicators of the campaign were monitored on social media platforms, Facebook and Twitter. An online cross‐sectional survey was conducted across three time points (n = 451) assessed breastfeeding knowledge, campaign exposure, and understanding and acceptability of Breastfeed4Ghana among Ghanaian adults. Modified Poisson models were used to assess the relationship between campaign exposure and breastfeeding knowledge, adjusting for survey time point, sex, and parenthood status. The campaign acquired 4,832 followers. Based on follower demographics collected from Facebook and Twitter analytics, the target population was successfully reached. Campaign exposure among survey participants was 42.3% and 48.7% at midline and endline, respectively. Campaign acceptability was high (>90%), and >44% of those exposed to the campaign also shared the campaign with others. However, 61.0% of those exposed did not know or could not remember the purpose of the campaign. Campaign exposure was not associated with higher breastfeeding knowledge (APR [95% confidence interval] = 0.96 [0.73, 1.26]). Breastfeed4Ghana was highly feasible. However, campaign understanding yielded mixed findings and may explain the limited impact on breastfeeding knowledge.Item Moringa Oleifera Leaf Consumption On The Vitamin A And Haematological Status Of School Children In Ada-East District, Ghana(Int. J. Food, Nutrition and Public Health, 2017) Glover-Amengor, M.; Aryeetey, R.; Owusu, W.B.; et al.Background: Vitamin A deficiency (VAD) could be prevented by the consumption of pro-vitamin A (β-carotene)-rich Moringa oleifera (M. oleifera) leaves. M. oleifera grows well in many developing countries and dried leaves also retain a high percentage of β-carotene in storage; they could thus serve as an excellent, convenient source of this pro-vitamin A carotenoid. This study assessed the efficacy of the supplementation of dried M. oleifera leaves on the vitamin A and haematological status of children in Ada-East district, Ghana. Methodology: Children aged 5–12 years were supplemented thrice a week at 0.2 g/kg body weight for nine weeks. Background data were collected on the socio-demographic status of the children. Data were collected on the children's vitamin A and haematological status at baseline and at the end of the study. Malaria and hookworm morbidity were also assessed at baseline and the end of the study. Results: There was a significant increase in mean serum vitamin A levels after supplementation (end of study) in the intervention group (p,0.05), but not in the control group. Haematological parameters Haemoglobin (HGB), Red Blood Count (RBC), Haematocrit (HCT), and Mean Corpuscular Volume (MCV) did not show any significant changes in either group (p,0.05). A bivariate analysis, however, showed a significant association between vitamin A and haematological indices in the intervention group, but not in the control group. Conclusion: M. oleifera leaf consumption significantly increased the vitamin A status of children in Ada-East district, Ghana, has the potential to increase children's haematological status. It could thus play a major role as a food-based strategy in vitamin A deficiency control.Item Four Dissemination Pathways for a Social Media–Based Breastfeeding Campaign: Evaluation of the Impact on Key Performance Indicators(JMIR Nursing, 2019) Harding, K.; Aryeetey, R.; Lasisi, O.; et al.Background: Social media utilization is on the rise globally, and the potential of social media for health behavior campaigns is widely recognized. However, as the landscape of social media evolves, so do techniques used to optimize campaign dissemination. Objective: The primary aim of this study was to evaluate the impact of 4 material dissemination paths for a breastfeeding social media marketing campaign in Ghana on exposure and engagement with campaign material. Methods: Campaign materials (n=60) were posted to a Facebook and Twitter campaign page over 12 weeks (ie, baseline). The top 40 performing materials were randomized to 1 of 4 dissemination arms (control simply posted on each platform, key influencers, random influencers, and paid advertisements). Key performance indicator data (ie, exposure and engagement) were extracted from both Facebook and Twitter 2 days after the material was posted. A difference-in-difference model was used to examine the impact of the dissemination paths on performance. Results: At baseline, campaign materials received an average (SD) exposure of 1178 (670) on Facebook and 1071 (905) on Twitter (n=60). On Facebook, materials posted with paid advertisements had significantly higher exposure and engagement compared with the control arm (P<.001), and the performance of materials shared by either type of influencer did not differ significantly from the control arm. No differences in Twitter performance were detected across arms. Conclusions: Paid advertisements are an effective mechanism to increase exposure and engagement of campaign posts on Facebook, which was achieved at a low cost.