Knowledge, attitudes, and practices of registered dietitians and nutritionists regarding enteral and parenteral nutrition support in Ghana: a needs assessment study.

Background: There is a paucity of data on enteral and parenteral (EN and PN) nutrition support (NS) provided by nutrition and dietetic practitioners in adult acute care settings in Ghana. Furthermore, gray literature suggests that Ghanaian clinical nutrition professionals (CNPs) are seldom involved in advanced nutrition care teams. Objectives: To assess the knowledge, attitudes, and practices of Ghanaian CNPs regarding EN and PN. Methods: An online cross-sectional survey was administered to Ghanaian CNPs ahead of a professional development workshop on EN and PN Support. Participants were asked questions about initiation and timing of NS, and knowledge on availability of commercial formula. A 5-point Likert scale was used to assess self-efficacy in using EN and PN. To assess practical knowledge on EN and PN, participants were asked to identify whether EN or PN was indicated for seven short case scenarios. Open-ended questions were used to assess reasons for participant self-ratings. Results: A total of 76 dietitians, nutritionists, students, and interns completed the survey. For EN, self-efficacy scores were lowest for the calculation of enteral goal rate, and goal volume (mean 3.20 ± 1.27), and writing of EN prescriptions (mean 3.07 ± 1.29). Self-efficacy scores for the formulation of alternative formulas in lieu of commercial formula were the highest (3.63 ± 1.36). For PN, self-efficacy scores for all domains were lower than 3, with the lowest scores observed for writing PN prescriptions (2.19 ± 1.14) and determining micronutrient additives (2.12 ± 1.04). We identified limited training and lack of practical exposure to NS, limited ability to effectively monitor tube feeds, and prohibitive cost and limited availability of EN and PN formula among the barriers impacting self-efficacy scores. Conclusion: Given the vital role that CNPs play in the delivery of EN and PN, it is important to develop professional training programs especially focused on PN to bridge knowledge and practice gaps.

Assessment of malnutrition in patients undergoing chemotherapy at the National Oncology Centre of the Korle-Bu Teaching Hospital, Accra, Ghana.

Background: Globally, cancer is on the rise despite several interventions. The link between nutrition and cancer has long been established with the consequences of poor nutrition on cancer pathway being dire. Early nutrition intervention is recommended for all cancer patients. Objective: To assess malnutrition among patients undergoing chemotherapy at the National Radiotherapy Oncology and Nuclear Medicine Centre of the Korle-Bu Teaching hospital (KBTH) in Accra, Ghana. Methods: A cross-sectional study was conducted among 123 patients with different types and stages of cancer who were undergoing chemotherapy. Data was collected from December 2018 to January 2019. The PG-SGA tool was used to assess weight loss at one and six months, food intake and nutrition impact symptoms. A correlation test was used to test the association between PGSGA score and Nutritional triaging. A T-test was used to determine the association between chemotherapy cycles and nutrition. A p-value <0.05 was considered to be significant. Results: The results revealed that 5.7% (n= 7) of the patients were well nourished, 31.7% (n= 39) were suspected of being malnourished and 62.6% (n=77) were severely malnourished. About half of the participants (48%) had experienced weight loss ranging between 1-20kg with weight loss ≤5kg being most prevalent at both one month and six months prior to the study. More than half (56.9%, n=70) of the participants were consuming less than their usual intake. Majority of the participants had 4-6 nutritional symptoms (39.0%) with symptoms being mostly mild (39.1%). Poor nutritional status was positively correlated with nutritional symptoms (r=0.747, p<0.001). Conclusion: The PGSGA tool identified that more than half of the patients were severely malnourished hence the need for early nutrition intervention in cancer patients.

Ethnic spice use and perceived health benefits among women in a Suburb of the Greater Accra Region of Ghana.

Background: Spices have a long history of both culinary use and health benefits. Ethnic spices are spices specific to a particular geographic location. In Ghana, there are varying perceptions and uses of ethnic spices which are mostly not documented. Objective: To assess the use and perceived health benefits of ethnic spices among women in Accra, Ghana. Methods: A cross-sectional study was conducted among 370 women in randomly selected churches in Accra, Ghana. A semi-structured questionnaire was used to obtain sociodemographic data and information on ethnic spice use. Chi-square test was used to determine the association between socio-demographic characteristics of participants and perceived health benefits of ethnic spice usage. Results: The most commonly consumed spices out of the 19 spices explored in this study were onion (98.4%), garlic (97.6%), ginger (96.8%) and chili pepper (84.1%). Majority of the participants perceived ginger (74.6%) and garlic (73.8%) as having health benefits. Age (p=.001) and self-reported health status (p=0.010) were significantly associated with perceived health benefits of the spices. Conclusion: Onion, garlic, ginger and chili pepper were the four most commonly consumed ethnic spices. Age and self-reported health status of participants influenced perceived health benefits of ethnic spice usage.

Malnutrition in HIV infected children on antiretroviral drugs in a cohort of Ghanaian children.

BACKGROUND: HIV infected children are at increased risk of malnutrition which worsens the depressed immune system, leading to poor disease prognosis. AIM: To assess the nutritional status of children between 6-12 years on antiretroviral drugs (ARV) at two health facilities in Accra. METHODS: The study design was cross sectional among children between 6 and 12 years being administered with antiretroviral drugs at two hospitals in Accra. A purposive sample of 100 children was used. Height and weight measurements were taken and used to compute z-scores for stunting, underweight and wasting. Haemoglobin status was obtained from their folders. A semi-structured questionnaire was used to obtain sociodemographic data and a 24-hour dietary intake used to assess nutrient intakes. Data was analyzed using IBM SPSS version 20.0. Nutrient analysis was done using Micro diet version 3.0. Data was summarized using means and percentages. Chi-squared test was used to test for associations and statistical significance set at p < 0.05. RESULTS: The prevalence of stunting, underweight and wasting was reported as 28%, 16% and 13% respectively. Girls were more stunted and wasted compared to boys. Mean haemoglobin concentration was 10.12 ± 2.77 g/dl. Mild, moderate and severe anaemia were reported in 14.2%, 41.1% and 12.5% of the children respectively. Apart from carbohydrates, less than 50% of the children were able to meet their requirements for the other nutrients". CONCLUSIONS: Our findings reveal high level of malnutrition among the children receiving ARV. There is the need for targeted nutrition interventions to improve the nutritional status of the children.

Food consumption pattern and dietary diversity of a vegetarian population in Ghana.

Objective: This study examined the food consumption pattern and dietary diversity of a vegetarian population in the Greater Accra Region of Ghana. Methods: A cross-sectional study was employed to examine the nutritional status of four (4) vegetarian groups in the Greater Accra Region of Ghana. One hundred and twenty-two (122) vegetarians were recruited using the total enumeration technique. Food consumption pattern and dietary diversity were assessed using a validated qualitative food frequency questionnaire and a 24-hour dietary recall, respectively. Dietary diversity was calculated using the FAO guidelines. Results: Sixty eight percent (68%) of the vegetarians reported daily intakes of vegetable protein. Majority of the vegetarians (80.6%) reported daily intakes of cereals and grains while 54% reported daily intakes of tubers. Eighty two percent (82%) and 72% of the vegetarians consumed vegetables and fruits on daily basis respectively. A few of the vegetarians (29%) reported daily intakes of fruit juices. Soft drinks, deep fried foods and fast foods were occasionally consumed. About 40.3% of the vegetarians obtained a dietary diversity score of four (4). Majority of them (68.9%) had low dietary diversity. Conclusion: The vegetarians had low dietary diversity which may lead to inadequate nutrient intakes. Thus, there is the need for nutrition-related professionals to give appropriate information on a vegetarian diet and educate vegetarians to include a variety of foods in their diet. Funding: None declared.

Effect of complementary foods fortified with Moringa oleifera leaf powder on hemoglobin concentration and growth of infants in the Eastern Region of Ghana.

Complementary foods that are deficient in both macronutrients and micronutrients coupled with a high burden of infections during the complementary feeding period are major underlying causes of child malnutrition in developing countries. Among the recent efforts to combat malnutrition by improving the quality of complementary foods in the developing world is the use of Moringa oleifera leaf powder (MLP) as a food fortificant. We conducted a randomized controlled trial to test the effect of feeding MLP-fortified complementary food on hemoglobin concentration and growth of infants and young children after 4 months of feeding. Infants aged 8-12 months were randomly assigned to receive one of three study foods; Weanimix a cereal-legume blend formulated with Moringa (MCL-35g), MLP sprinkled on infants' usual complementary foods (MS-5g) and the control food Weanimix without Moringa (CF-35g). Blood samples for hemoglobin determination as well as dietary intake and anthropometric data were collected at baseline and endline for 237 infants who completed the study. Data analysis was performed with SPSS (version 20) and comparisons were done by analysis of covariance (ANCOVA). There were no significant differences in hemoglobin concentration or growth indicators at endline between the three study groups. Findings of this study indicated that feeding infants a 5 g daily dose of MLP, either as part of a cereal-legume blend or as a supplement which was sprinkled on infants' usual complementary foods for 4 months, did not significantly improve infants' hemoglobin concentration or growth indicators.

Sociodemographic Characteristics, Dietary Practices, and Nutritional Status of Adults with Hypertension in a Semi-Rural Community in the Eastern Region of Ghana.

INTRODUCTION: Hypertension is a major contributor to the global disease burden and mortality. Evidence suggests increasing hypertension prevalence in Ghana but there is limited public awareness and information on the characteristics of those with the disease. OBJECTIVE: To describe the baseline characteristics of adults with hypertension who were randomized to receive either hypertension related nutrition education plus hospital-based standard of care or only the standard of care (control group) in Asesewa, a semi-rural community in the Eastern Region of Ghana. Only baseline data were used in the present analysis. METHODS: A cross-sectional baseline survey was completed for 63 adults with confirmed hypertension diagnosis. Data on sociodemographic characteristics and diet were obtained through interviews and participants' body mass index (BMI) was computed. Pearson chi-square statistic was used to assess differences between those with both elevated diastolic blood pressure (DBP) and systolic blood pressure (SBP) and those with only elevated SBP. RESULTS: Mean ± SD age of participants was 54.5±13.8 years. Approximately 71% of participants had both elevated SBP (>140 mmHg) and DBP (>90 mmHg) while the remaining 29% had only elevated SBP. The median number of times the food groups beneficial to hypertension management were consumed in the preceding week to the interview was 1 for green leafy vegetables, 1 for dairy products, 2 for fruits, and 4 for legumes. The median number of times for consuming harmful food groups was 3 for salted fish and 7 times for fats and oils. Signifcantly more participants in the age group above 50 than the younger participants had elevated SBP (83.3 vs. 16.7:P=0.027) and those with BMI equal to or greater than 25 were more likely to have both elevated SBP and DBP (P=0.047). CONCLUSIONS: Findings from this study have implications for the prevention and management of hypertension in this semi-rural population.

Improving Blood Retinol Concentrations with Complementary Foods Fortified with Moringa oleifera Leaf Powder - A Pilot Study.

Vitamin A deficiency (VAD) remains a major public health issue and is reported to be the cause of about 6 percent of child deaths under the age of 5 years in Africa. Inadequate dietary intake of vitamin A-rich foods is a major cause of VAD. Moringa oleifera leaf powder (MLP) is rich in nutrients particularly vitamin A and its use in infant feeding has been explored. This pilot study was designed to test the efficacy of MLP in improving blood retinol concentrations among infants in a rural district in Ghana. A subset of infants participating in a randomized controlled trial (ISRCTN14377902) were randomly assigned to receive one of the three study foods (MCL-35g and MS-5g both of which were fortified with MLP, and a third food, CF-35g, a cereal legume blend which served as the control food) in a feeding intervention that lasted for 6 weeks. Primary outcome of the pilot study was retinol levels measured in 5 ml of whole blood at baseline and endline using the iCheck™ Fluoro device. A total of 103 infant-mother pairs were recruited at baseline, of which 65 completed the study. All the infants in the study were vitamin A deficient at both baseline and endline when compared to the World Health Organization (WHO) threshold of 0.70µmol/l. There was however a marginal non-significant increase in blood vitamin A concentrations for all three groups at endline, with higher numerical increases seen in the two Moringa supplemented groups. VAD is a significant public health problem and MLP could be an affordable and sustainable means of combatting the issue. The efficacy of MLP in improving vitamin A status of infants however needs to be ascertained in well-designed trials involving larger numbers of infants and which will last for longer periods. Such studies will also be beneficial in helping to establish the long-term acceptability of complementary foods that incorporate MLP in the target population.

Prevalence of cardiovascular disease risk factors among students of a tertiary institution in Ghana.

Cardiovascular diseases (CVDs) are listed as one of the main causes of mortality and morbidity by the World Health Organization. The World Heart Federation lists overweight/obesity, blood lipid profile, and blood pressure as some of the modifiable risk factors to developing CVDs. This study sought to determine the prevalence of some of these modifiable risk factors among University of Ghana students. One hundred and twenty students were sampled for the study. Lipid profile parameters such as high-density lipoprotein (HDL), total cholesterol (TC), and total triglycerides (TG) were measured using the Vitros 5-IFS chemistry analyzer (NY, USA). The Friedewald's equation was used to determine low-density lipoprotein (LDL) levels. Anthropometric indices such as height and weight were measured following standard protocols. Body mass index (BMI) was calculated in kg/m2 using the height and weight measurements. The students were then categorized into underweight, normal, overweight, and obese according to their BMI. Blood pressure measurements were also taken. The mean age of the students was 30.04 ± 7.99 years. A total of 4.2%, 30%, and 67.5% had TG, TC, and LDL, respectively, above normal recommended ranges. Low HDL levels were observed in 32.5% of the students. About 45% had high systolic blood pressure and 32.5% with high diastolic blood pressure. In all, the risk factors studied contributed to about 95% of the variance in explaining the risk of developing CVDs. The study concludes that the cardiovascular risk factors assessed are prevalent among the students and therefore steps must be taken to address the increase in prevalence.

Acceptability of Complementary Foods That Incorporate Moringa oleifera Leaf Powder Among Infants and Their Caregivers.

BACKGROUND: Moringa oleifera leaf powder (MLP) is a nutrient-rich and readily available food resource that has the potential to improve the micronutrient quality of complementary foods in developing countries. OBJECTIVE: To investigate the acceptability of complementary foods fortified with MLP. METHODS: Moringa oleifera leaf powder was fed to infants either as part of a cereal-legume complementary food blend (MCL-35 g) or by sprinkling as a food supplement (MS-5 g) on infant's usual foods. Mother-infant pairs (n = 18 for the MCL-35 g group and n = 16 for the MS-5 g group) attending regular weight monitoring sessions were recruited to participate in the acceptability trial. The study consisted of an initial tasting session after which mothers were to feed the assigned foods to their infants for 14 days. Mothers rated color, odor, taste, and overall liking of the complementary foods using a 5-point hedonic scale. Primary outcome was the proportion of test porridge consumed. RESULTS: On the tasting day, MCL-35 g group infants consumed an average of 64.27% ± 25.02 of the test porridge offered, whereas MS-5 g group infants consumed an average of 66.43% ± 29.09. During the 14-day period, median percent daily consumption for MCL-35 g was 71.5% of the daily recommended intake, whereas median percent daily consumption for MS-5 g was 86.2%. CONCLUSION: We conclude that complementary foods incorporating Moringa oleifera leaf powder either as part of a cereal-legume complementary food blend (MCL-35 g) or when sprinkled as a food supplement (MS-5 g) on infant's usual foods were well accepted.

Anaemia in pregnant adolescent girls with malaria and practicing pica.

INTRODUCTION: Pregnancy during the adolescent period is challenging mainly because of the nutritional demands of both the adolescent and pregnancy period. The risk for anaemia increases especially in developing countries such as Ghana where malaria is endemic and the practice of pica is common. In this study, we sought to determine the prevalence of anaemia, pica practice and malaria infection among pregnant adolescent girls and assess the extent to which these factors are associated. METHODS: Two hundred and sixty five (265) pregnant adolescent girls were recruited from three hospitals in Accra. Haemoglobin levels, malaria infection and the practice of pica were assessed. Pearson's Chi squared tests were used to determine associations and logistic regression analysis was used to determine the odds of being anaemic. Significance was set at p≤0.05. RESULTS: Anaemia prevalence was 76% with severity ranging from mild (47.8%) to severe (0.8%). About 27.5% were moderately anaemic. Pica was practiced in only 9.1% of the girls. Malaria infection was prevalent in 17.7% of the girls. The logistic regression analysis indicated that pregnant girls with malaria infection were 3.56 times more likely to be anaemic when compared to those without malaria. Also, those who practiced pica were 1.23 times more likely to be anaemic when compared to those who did not practice pica. CONCLUSION: Anaemia is very prevalent in pregnant adolescent girls and is a public health problem. Drastic measures should be taken to reduce the high prevalence.

Comparing dietary macronutrient composition and food sources between native and diasporic Ghanaian adults.

BACKGROUND: Dietary acculturation may contribute to the increased burden of non-communicable diseases (NCDs) in diasporic populations of African ancestry. OBJECTIVE: To assess nutritional composition and the contribution that traditional foods make to the diets of native and UK-dwelling Ghanaian adults. DESIGN: An observational study of Ghanaian adults living in Accra (n=26) and London (n=57) was undertaken. Three-day food records were translated to nutrient data using culturally sensitive methods and comparisons were made for energy, macronutrients, and dietary fibre between cohorts. The contribution of traditional foods to dietary intake was measured and the foods contributing to each nutrient were identified. RESULTS: Compared to native Ghanaians, UK-Ghanaians derived a significantly higher proportion of energy from protein (16.9±3.9 vs. 14.1±2.8%, p=0.001), fat (29.9±7.9 vs. 24.4±8.5%, p=0.005), and saturated fat (8.5±3.4 vs. 5.8±3.7%, p<0.001) and a significantly lower energy from carbohydrate (52.2±7.7 vs. 61.5±9.3%, p<0.001). Dietary fibre intake was significantly higher in the UK-Ghanaian diet compared to the native Ghanaian diet (8.3±3.1 vs. 6.7±2.2 g/1,000 kcal, p=0.007). There was significantly less energy, macronutrients, and fibre derived from traditional foods post-migration. Non-traditional foods including breakfast cereals, wholemeal bread, and processed meats made a greater contribution to nutrient intake post-migration. CONCLUSIONS: Our findings show the migrant Ghanaian diet is characterised by significantly higher intakes of fat, saturated fat, and protein and significantly lower intakes of carbohydrate; a macronutrient profile which may promote increased risk of NCDs amongst UK-Ghanaians. These differences in the nutrient profile are likely to be modulated by the consumption of 'Western' foods observed in migrant communities.

Mutagenicity of edible palm oil on the Ghanaian market before and after repeated heating.

Red palm oil produced in Ghana largely by village folks has never been tested for its mutagenic potential. The study aimed at determining the mutagenicity of high-energy heated red palm oil (RRPO) and refined, bleached imported palm oil (PO) on the Ghanaian market. Samples of RRPO and PO were 1× and 5× heated for 10 min at 180 °C with a cooling period of 5 h in-between. Unheated, together with heated samples, were tested for mutagenicity using Salmonella typhimurium TA 98 and TA 100 tester stains. Unheated PO was negative for the Ames mutagenicity test with TA 98 strain. However, 1× and 5× heated PO were mutagenic (P = 0.05, each). Testing PO, using TA 100 strain was negative. RRPO was mutagenic with TA 98 strain for heated oils (P = 0.05, each). Assays with TA 100 strain showed highly significant mutations (P = 0.001, each) that increased with increasing heating frequency. PO 1× and 5× heated samples caused significant frameshift mutation in the S. typhimurium TA 98 strain. RRPO caused highly significant point and frameshift mutations in heated samples. Furthermore, unheated RRPO mutagenic potential has serious health implications.