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 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 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 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 “I Did Not Choose to Be Obese”-Experiences of Stigma among Market Women in Kaneshie, Ghana(Open Access Library Journal, 2020) Arday, M.; Aryeetey, R.; De-Gaulle, V.F.; Agyabeng, K.Excess body fat is associated with impaired physical and socio-emotional health outcomes. There is limited evidence on stigma and discrimination associated with overweight and obesity in developing country settings like Ghana where the rate of overweight is rapidly increasing. This current study explored the experiences of obesity-related stigma and discrimination among adult female vendors in the Kaneshie Market in Accra, Ghana. Employing a mixed concurrent method, both qualitative and quantitative data were collected. Quantitatively, about half (56%) of the survey respondents were obese, however, most of them misperceived their weight. Using Pearson Chi-square test of association, respondent age, marital status, educational level, ethnicity, and parity were significantly associated with BMI status. Multiple (adjusted) ordered logistic regression model showed age, ethnicity marital status, and parity to be significant demographic characteristics predictive of weight status. Single women had about four times lesser odds of having a higher weight status compared to those who were either married, divorced/separated/widowed, or cohabiting. Educational status was not significantly associated with BMI status in the adjusted model. The qualitative findings revealed derogatory name-calling, limitations to the use of public spaces, and denial of opportunities as stigmatizing and discriminatory attitudes experienced by obese respondents.Item Analysis of stakeholder networks for breastfeeding policies and programs in Ghana(International Breastfeeding Journal, 2020) Aryeetey, R.; Harding, K.; Hromi-Fiedler, A.; Pérez-Escamilla, R.Background: Suboptimal breastfeeding practices are driven by multiple factors. Thus, a multi-sectoral approach is necessary to design and implement appropriate policies and programs that protect, promote, and support breastfeeding. Methods: This study used Net-Map, an interactive social network interviewing and mapping technique, to: a) identify key institutional actors involved in breastfeeding policy/programs in Ghana, b) identify and describe links between actors (i.e., command, dissemination, funding, and technical assistance (TA)), and c) document actors' influence to initiate or modify breastfeeding policy/programs. Ten experts were purposively selected from relevant institutions and were individually interviewed. Interview data was analyzed using social networking mapping software, Gephi (version 0.9.2). Results: Forty-six unique actors were identified across six actor categories (government, United Nations agencies, civil society, academia, media, and others), with one-third being from government agencies. Dissemination and TA links accounted for two-thirds of the identified links between actors (85/261 links for dissemination; 85/261 for TA). Command links were mainly limited to government agencies, while other link types were observed across all actor groups. Ghana Health Service (GHS) had the greatest in-degree centrality for TA and funding links, primarily from United Nations Children’s Fund (UNICEF) and development partners. The World Health Organization, UNICEF, Ministry of Health and GHS had the highest weighted average relative influence scores. Conclusions: Although diverse actors are involved in breastfeeding policy and programming in Ghana, GHS plays a central role. United Nations and donor agencies are crucial supporters of GHS providing breastfeeding technical and financial assistance in Ghana.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:nzaa117