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 Equity and expertise in the UN Food Systems Summit(BMJ Global Health, 2021) Nisbett, N.; Aryeetey, R.; Friel, S.; et al.The UN Food Systems Summit is bold but controversial, with important implications for global food systems and public health. ► Alongside claims of corporate capture, many have noted insufficient attention paid to human rights and to rebalancing power in the food system. ► These issues speak to wider issues of participation and equity in the summit itself. Narrow definitions of equity only consider income inequities in outcomes and coverage. Broader definitions consider why such inequities persevere and are interlinked via process es that can be historical and intergenerational. ► The summit’s science group is slanted in disciplinary expertise: it lacks sufficient expertise in equity, health, and noncommunicable diseases, or representatives with expertise in Indigenous knowledge. ► It is not too late to rectify this in the summit structures, as we approach the September summit meeting.Item The Africa Food Environment Research Network (FERN): from concept to practice(Global Health Promotion, 2022) Tandoh, A.; Aryeetey, R.; Agyemang, C.; et al.Background: Africa is contending with unhealthy food environments that are, in part, driving increasing rates of overweight, obesity, and diet-related non-communicable diseases, alongside persistent undernutrition. This current paradigm requires expanded efforts – both in the volume and nature of empirical research, as well as the tools and capacity of those who conduct it. High-quality and context-relevant research supports the development and implementation of policies that create healthy food environments. Aim and approach: This paper sets out the concept of the Africa Food Environment Research Network (FERN) initiative recently established by the Measurement, Evaluation, Accountability, and Leadership Support for non-communicable diseases (NCDs) (MEALS4NCDs) prevention project. Central to the Africa FERN initiatives are: 1) building research capacity for innovative food environment research in Africa; 2) improving South-South, and South-North partnerships to stimulate a robust food environment research and monitoring in Africa and 3) sustaining dialogue and focusing priorities on current and future needs for enhanced food environment research and monitoring in Africa. Conclusion: The FERN initiative presents an opportune platform for researchers in Africa and the global North to weave the threads of experience and expertise for research capacity building, collaboration and advocacy, to advance food environment research.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 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 A Review Of Food And Nutrition Communication And Promotion In Ghana(African Journal of Food, Agriculture, Nutrition and Development, 2022) Parbey, P.; Aryeetey, R.Dietary perception, behavior, and nutritional status can all be influenced by exposure to information. Behavior change communication that is appropriately designed and implemented is critical for motivating optimal dietary behavior. On the other hand, inadvertent or deliberate misinformation can drive unhealthy dietary behaviors. As part of the process to develop food-based dietary guidelines (FBDGs) for Ghana, this rapid evidence review examined the nature, extent, sources, and medium of food and nutrition information dissemination and promotion in Ghana. PubMed, Cochrane, Google Scholar, and Open Access Theses Dissertations (OATD) databases were searched systematically using keywords to identify relevant peer-reviewed and grey literature. The review included 31 documents, after excluding 1,302 documents for ineligibility (based on irrelevant titles, abstracts, and duplicates). Limited reporting of undernutrition was found in print and electronic media. Unhealthy foods, including sugar-sweetened beverages, snacks, yogurt, instant noodles, candy/chocolate, and ice cream were frequently advertised through various communication media. Children are highly exposed to food advertisements, which target them. Promotional characters, animation, billboards, front-of-store displays; product-branded books, and toys are common strategies for food marketing and advertisement in Ghana. The most frequently reported sources of health and nutrition information were television, radio, social media, health professionals, families, and friends. Children and adults experienced changes in food preferences and choices as a result of exposure to food advertising on television. The commonly used traditional media were radio and television; printed newspaper use has declined tremendously in the past decade. Social media use (particularly WhatsApp, Facebook, and YouTube) is highest in urban areas, and is growing rapidly; young adults are the most active users of social media platforms. Experts recommend regulation as a mitigation for nutrition miscommunication and inaccurate promotion. The current review highlights the need for regulation of food marketing, and advertisement to safeguard a healthy food environment in Ghana.Item Global research priorities on COVID-19 for maternal, newborn, child and adolescent health(Journal of Global Health, 2021) Ahmed, N.; Aryeetey, R.; Abdellatif, M.; et al.Background This research prioritization aimed to identify major research gaps in maternal, newborn, child, and adolescent health (MNCAH) to help mitigate the direct and indirect effects of the COVID-19 pandemic. Methods We adapted the Child Health and Nutrition Research Initiative methodology. We defined scope, domains, themes, and scoring criteria. We approached diverse global experts via email to submit their research ideas in MNCAH and MNCAH-related cross-cutting/ health systems area. We curated the research ideas as research questions (RQs) and sent them to the consenting experts for scoring via the online link. For each RQ, the research priority score (RPS) was calculated as an average of individual criterion scores and ranked based on RPS in each area. Results We identified the top-ranked 10 RQs in each maternal, newborn, and child and adolescent health and 5 in the cross-cutting/health systems area. In maternal health, indirect effects on care, measures to improve care, health risks and outcomes, and preventing and managing SARS-CoV-2 infection/COVID-19 disease were priority RQs. In newborn health, clinical characterization and managing SARS-CoV-2 infection/COVID-19 disease, mode of transmission, and interventions to prevent transmission were the focus. For child and adolescent health, top-ranked RQs were indirect effects on care, clinical status, and outcomes, interventions to protect against SARS-CoV-2 infection/COVID-19 disease, and educational institute-related RQs. The cross-cutting RQs were the effects of the pandemic on the availability, access, care-seeking, and utilization of MNCAH services and potential solutions. Conclusions We call on partners, including governments, non-governmental organizations, research institutes, and donors, to address this urgent research agenda.Item Multiple pathways towards achieving a living income for different types of smallholder tree‑crop commodity farmers(Food Security, 2021) Waarts, Y.R.; Aryeetey, R.; Janssen, V.; et al.Many sources indicate that smallholder tree-crop commodity farmers are poor, but there is a lack of data on how many are poor and the depth of poverty. The living income concept establishes the net annual income required for a household in a place to afford a decent standard of living. Based on datasets on smallholder cocoa and tea farmers in Ghana, Ivory Coast, and Kenya and literature, we conclude that a large proportion of such farmers do not have the potential to earn a living income based on their current situation. Because these farmers typically cultivate small farm sizes and have a low capacity to invest and diversify, there are no silver bullets to move them out of poverty. We present an assessment approach that results in insights into which interventions can be effective in improving the livelihoods of different types of farmers. While it is morally imperative that all households living in poverty are supported to earn a living income, the assessment approach and literature indicate that focusing on short- to medium-term interventions for households with a low likelihood of generating a living income could improve food security and health, funding of-farm and alternative employment, and social assistance programs. In the long term, land governance policies could address land fragmentation and secure rights. Achieving living incomes based on smallholder commodity production requires more discussion and engagement with farmers and their household members and within their communities, coordination between all involved stakeholders, and sharing of lessons learned and data.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 Perceptions and experiences of an intervention to improve diets of women and young children in Ghana(World Nutrition, 2024) Kushitor, S.B.; Ewa, C.V.; Aryeetey, R.; et al.Background Efficacious integrated intervention strategies to address the drivers of malnutrition at multiple levels are hardly implemented at scale, although opportunities for cross-sectoral action exist. In 2020, the Improved Feeding Practices (IFP) Project was implemented in Ghana to improve the dietary diversity and well-being of women of reproductive age (15- 49 years) and children >2 years. Objective This paper reports the perceptions and experiences of project beneficiaries and the lessons learned from the IFP project. Methods Using a socio-ecological framework, data from the IFP project documents (n=8) and in-depth interviews with key stakeholders, including local government officers, and direct and indirect beneficiaries (n=61), were triangulated to construct an evidence-based overview of the implementation of the complementary strategies of the IFP project. The interviews explored respondents' knowledge, experiences of the project activities, and perceptions of how the project affected their lives. The data were analyzed and synthesized thematically using ATLAS.ti. Results The IFP project envisaged an impact pathway through promoting community- or home-based nutrient-rich crop production and poultry to enhance diet quality, child care, and feeding practices. Multi-sectoral partners facilitated training and service delivery at community, farm, facility, and household levels. Beneficiaries reported an overall positive experience of participating in the project, including enhanced dietary knowledge, capacity to produce and use eggs and orange-fleshed sweet potatoes (OFSP), earned revenues, and access to nutritious foods. Caregivers reported that the IFP project contributed to enhancing children’s diet quality, reduced disease incidence, and improved child growth. Community-level program implementers experienced capacity strengthening. The dry season, increased poultry feed input prices, diseases (such as fowl pox, Newcastle, and smallpox), and poultry deaths, limited the scale of benefits. Key implementation lessons include leveraging local resources to produce poultry feed at home, crossbreeding local and commercial poultry, and enhancing disease management, leading to improved potential for project sustainability. Conclusions Overall, the communities reported a positive experience of integrated nutrition-sensitive agriculture (NSA) intervention, leading to improved diets of households, women of reproductive age, and young children >2 years. These strategies can be adapted for use in other to improve women's and children's dietary diversity in similar settings, giving due consideration to lessons learned.