Knowledge and nutrition-related practices among caregivers of adolescents with sickle cell disease in the Greater Accra region of Ghana.

BACKGROUND: Due to its severe adverse effect on child mortality, sickle cell disease (SCD) has been identified as a set of diseases of public health concern. The high mortality rate among children with SCD in Africa has been attributed to several factors including sub-optimal management and care. This study documented the nutrition-related knowledge and practices of caregivers of teenagers who suffer from sickle cell disease (SCD) to inform decisions on integrated management of the disease. METHODS: The study included caregivers (n = 225) of adolescents with SCD who attended clinic at selected hospitals in Accra, Ghana. Pre-tested semi-structured questionnaire was employed in the gathering of information related to general and nutrition-related knowledge about SCD, as well as data on their nutrition-related practices with regards to their children who suffer from SCD. Pearson's Chi-square test and binary logistic regression analyses were applied to explore the relationship between caregivers' nutrition-related knowledge and practice. RESULTS: Nutrition-related knowledge among the caregivers studied was low, with less than a third of them (29.3%) of the sample being classified as having good knowledge. Caregivers who considered nutrition care when the child experienced crises were few (21.8%), and those with low nutrition-related knowledge were less likely to do this compared with caregivers having high knowledge (OR = 0.37, 95% CI = 0.18, 0.78). The common nutrition actions reported were the provision of more fruits/fruit juices (36.5%) and warm fluids such as soups and teas (31.7%). More than a third of the caregivers (38.7%) admitted that they faced challenges in caring for their adolescents with SCD, particularly in the area of finance for the needed health care. CONCLUSION: Our study findings indicate that it is important to incorporate appropriate nutrition education messages for caregivers as part of a holistic management of SCD.

Household food insecurity is associated with child's dietary diversity score among primary school children in two districts in Ghana.

BACKGROUND: Dietary diversity is generally considered as a good indicator of nutrient adequacy and is influenced by various factors at the national, household, and individual levels. OBJECTIVE: The present study sought to determine the relationships between household food insecurity, primary caregivers' nutrition knowledge, and dietary diversity of school-aged children in Ghana. METHODS: This forms part of a longitudinal study conducted in the Ayawaso West Municipal district in Accra (urban setting) and the Upper Manya Krobo district (rural setting) in Ghana. Data were collected from a total of 116 caregiver-child dyads using 24-h dietary recall and a short version of the US 12-month Household Food Security Survey Module. Nutrition knowledge and sociodemographic data were obtained using a structured questionnaire. Multivariable logistic regression was used to check for factors associated with children's dietary diversity. RESULTS: Majority of households reported food insecurity, with a higher percentage of insecure households located in the rural area (88.9% vs. 46.5%, P ≤ 0.0001), compared to the urban setting. Diet diversity among the study children was low, with a mean (standard deviation [SD]) of 5.8 (2.1) out of 14 food groups. Children living in food insecure households were three times more likely to have received low diverse diet compared to those from food secure households (adjusted odds ratio [OR] =3.3, 95% confidence interval [CI]: 1.4-8.0). Caregivers' nutrition knowledge was, however, not related to children's dietary diversity. DISCUSSION AND CONCLUSION: Household food insecurity was a main predictor of dietary diversity among school-age children in this study. Thus, caregiver knowledge in nutrition may not be enough, particularly in the presence of food insecurity to guarantee adequate nutrition for school-aged children.

Nutrition education incorporation into mainstream primary school curriculum in Ghana: Stakeholders' sources of nutrition information and perceived barriers.

INTRODUCTION: Nutrition literacy has been cited as a crucial life skill. Nutrition education as a primary school subject has been treated inconsequentially when compared to other subjects. We investigated an aspect of the current state of nutrition education in Ghana by engaging stakeholders about their sources of nutrition information and the perceived barriers in implementing nutrition education in mainstream primary schools. METHODS: Three hundred and fifty one (351) primary school children, 121 homebased caregivers, six schoolteachers, two headteachers, two Ghana Education Service (GES) officials, and six school cooks were involved in the study. Surveys were used to collect data on nutrition information acquisition behaviors and to record perceived barriers. Key Informant Interviews were conducted among GES officials, headteachers, schoolteachers and school cooks, while Focus Group Discussions were used among homebased caregivers and children to gather qualitative information. RESULTS: Only 36.3% of the primary school children had heard about nutrition, and 71% of those got nutrition information from their family members. About 70% of homebased caregivers had heard or seen nutrition messages, and their source of nutrition information was predominantly traditional media. Schoolteachers mostly received their nutrition information from non-governmental organizations and the Internet, while most of the school cooks stated their main source of nutrition information was hospital visits. Perceived barriers included schoolteachers' knowledge insufficiency, and lack of resources to adequately deliver nutrition education. Lack of a clear policy appeared to be an additional barrier. CONCLUSION: The barriers to the implementation of nutrition education in the mainstream curriculum at the primary school level that were identified in this study can be resolved by: providing schoolteachers with learning opportunities and adequate nutrition education resources for practical delivery, having specific national policy framework, and including family members and school cooks in the nutrition education knowledge and information dissemination process.

Nutritional perspectives on sickle cell disease in Africa: a systematic review.

BACKGROUND: Sickle cell disease (SCD) is an inherited blood disorder that predominantly affects individuals in sub-Saharan Africa. However, research that elucidates links between SCD pathophysiology and nutritional status in African patients is lacking. This systematic review aimed to assess the landscape of studies in sub-Saharan Africa that focused on nutritional aspects of SCD, and highlights gaps in knowledge that could inform priority-setting for future research. METHODS: The study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria comprised original, peer-reviewed research published between January 1995 and November 2020 involving individuals in Africa with any phenotypic variant of SCD and at least one nutritional status outcome. Nutritional status outcomes were defined as those that assessed dietary intakes, growth/anthropometry, or nutritional biomarkers. Databases used were Ovid Embase, Medline, Biosis and Web of Science. RESULTS: The search returned 526 articles, of which 76 were included in the final analyses. Most investigations (67%) were conducted in Nigeria. Studies were categorized into one of three main categories: descriptive studies of anthropometric characteristics (49%), descriptive studies of macro- or micronutrient status (41%), and interventional studies (11%). Findings consistently included growth impairment, especially among children and adolescents from sub-Saharan Africa. Studies assessing macro- and micronutrients generally had small sample sizes and were exploratory in nature. Only four randomized trials were identified, which measured the impact of lime juice, long-chain fatty acids supplementation, ready-to-use supplementary food (RUSF), and oral arginine on health outcomes. CONCLUSIONS: The findings reveal a moderate number of descriptive studies, most with small sample sizes, that focused on various aspects of nutrition and SCD in African patients. There was a stark dearth of interventional studies that could be used to inform evidence-based changes in clinical practice. Findings from the investigations were generally consistent with data from other regional settings, describing a significant risk of growth faltering and malnutrition among individuals with SCD. There is an unmet need for clinical research to better understand the potential benefits of nutrition-related interventions for patients with SCD in sub-Saharan Africa to promote optimal growth and improve health outcomes.

Primary school-based nutrition education intervention on nutrition knowledge, attitude and practices among school-age children in Ghana.

This study was performed to evaluate the effect of a six-week nutrition education intervention on the nutrition knowledge, attitude, practices, and nutrition status of school-age children (aged 6-12 years) in basic schools in Ghana. Short-term effects of nutrition education training sessions on teachers and caregivers were also assessed. Pre-post controlled design was used to evaluate the program. Intervention groups had significantly higher nutrition knowledge scores (8.8 ± 2.0 vs. 5.9 ± 2.1, P < 0.0001) compared to controls in the lower primary level. A higher proportion of children in the intervention group strongly agreed they enjoyed learning about food and nutrition issues compared to the control group (88% vs. 77%, P = 0.031). There was no significant difference in dietary diversity scores (4.8 ± 2.0 vs. 5.1 ± 1.4, P = 0.184) or in measured anthropometric indices (3.6% vs. 8.2%, P = 0.08). A marginally lower proportion of stunted schoolchildren was observed among the intervention group compared to the control group (3.6% vs. 8.2%, P = 0.080). Nutrition knowledge of teachers and caregivers significantly improved (12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.031) and (5.86 ± 0.73 to 6.24 ± 1.02, P = 0.009), respectively. Nutrition education intervention could have positive impacts on knowledge and attitudes of school children, and may be crucial in the development of healthy behaviors for improved nutrition status.

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.

Sources of nutrition information and level of nutrition knowledge among young adults in the Accra metropolis.

BACKGROUND: Acquiring accurate and adequate nutrition information is important as it could inform nutritional choices positively and promote the maintenance of a healthy nutritional status. This study assessed a sample of young adults' nutrition knowledge and identified where they gather information from to guide nutritional choices. METHOD: This was a cross-sectional study involving young adults (N=192) between 18 to 25 years recruited at shopping areas in the Accra Metropolis of Ghana. A pretested questionnaire was used to collect information on demographic characteristics, sources of nutrition information and basic nutrition knowledge. Pearson chi-square test was used to identify possible differences between high and low scorers of the knowledge assessment in terms of their nutrition information acquisition behaviours and logistic regression was conducted to ascertain whether source of nutrition information was related to participants' nutrition knowledge. RESULTS: Online resources were the most popular source (92.7%) used to seek information on nutrition among study participants, and healthcare professionals were perceived to be the most reliable source of nutrition information. Additionally, participants who used healthcare professionals as a source of nutrition information were 61% (95% CI: 0.15-0.99) more likely to have a high nutrition knowledge than participants who did not consult healthcare professionals for nutrition information. CONCLUSION: Online resources serve as a very common source of nutrition information for young adults. Thus, healthcare professionals may need to adopt this as a useful channel to circulate trustworthy nutrition information to this age group.

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.

Dietary intakes and nutritional status of children with sickle cell disease at the Princess Marie Louise Hospital, Accra - a survey.

BACKGROUND: Sickle cell disease (SCD) is a chronic genetic blood disorder common among people of African descent, which places nutritional burden among affected individuals. The aim of the study was to determine the dietary intake and nutritional status of children with SCD. METHOD: This was a cross sectional study that involved 120 children with SCD aged 3-12 years at the paediatric outpatient department of Princess Marie Louise Hospital (PML) in Accra. A semi-structured questionnaire was used to take information on participant's demographic characteristics and clinical data were obtained from their medical records. Dietary data were obtained using 24-h dietary recall and food frequency questionnaire. Height and weight were measured for participants and their haemoglobin levels were determined to assess their anaemia status. RESULTS: Intakes of participants were below recommendations for most nutrients, particularly for calcium and antioxidant vitamins (vitamin C and E). Adequacy of nutrient intake declined with age and children with genotype HbSS had a lower tendency to meet dietary recommendations (aOR = 0.45, 95% CI: 0.18, 1.10; p = 0.084). More than a third of the study children (38%) were malnourished, with older children having a tendency to be malnourished compared to the younger ones. Children with the SS genotype were more likely to be stunted (aOR = 3.48, 95% CI: 1.10, 11.01), compared to other genotypes. CONCLUSION: Malnutrition is prevalent among children with SCD and hence there is the need to develop comprehensive management coupling nutritional therapy to medical care to improve their nutritional status. Nutritional management should focus much on calcium-rich foods and antioxidants nutrients particularly vitamin C and E to reduce rapid erythrocyte haemolysis and chronic anaemia.

Weight perceptions, weight management practices, and nutritional status of emerging adults living in the Accra Metropolis.

BACKGROUND: Many young people have a tendency to be concerned about their physical appearance and undertake practices in order to achieve certain body ideals. There is however limited information from developing countries on the weight perceptions of emerging adults (i.e. individuals leaving the adolescence life stage and preparing to take on adulthood) and whether these opinions influence their nutritional status and weight management practices. This study sought to assess emerging adults' nutritional status, their weight perceptions and the methods they use to manage their weight. METHODS: This study was cross-sectional, involving emerging adults (N = 192) recruited at shopping areas in the Accra Metropolis of Ghana. A pretested questionnaire was used to collect information on demographic characteristics, weight perceptions, and weight management strategies. Anthropometric measurements were taken using standard procedures. Descriptive analysis was performed on the demographic data, methods used to manage weight, and weight perceptions. Logistic regression was used to assess possible relationships between weight perceptions and nutritional status as well as weight perceptions and weight management practices. RESULTS: The mean age of participants was 21.8(2.2) years with 51.0% of participants being female. Majority of the participants perceived normal weight status as the ideal body for themselves and half of them thought that they were slimmer than they actually were in reality. Three major weight management strategies were identified: engaging in physical activity, dieting and making lifestyle modifications (i.e. changes in normal eating habits coupled with regular physical activity and behavioral changes). Emerging adults who had an inaccurate body image perception were less likely (OR = 0.30, 95% CI: 0.15-0.61) to have a healthy nutritional status than emerging adults who had an accurate body image perception. CONCLUSION: Weight perception was associated with nutritional status. Discussions with nutrition professionals regarding realistic weight ideals would be beneficial for this age-group since half of the study's participants had inaccurate perceptions about their current weight statuses even though their statuses were normal.

The role of nutrition in the pathophysiology and management of sickle cell disease among children: A review of literature.

Sickle cell disease (SCD) is one of the common inherited blood disorders in humans and has been associated with decreased dietary intake which results in poor nutritional status and impaired growth. Nutrition is one of the most important but often forgotten aspect of care of patients with chronic disorders and there have been emerging concern in literature on increased nutritional needs of SCD patients. This paper sought to review the available literature on the roles of individual nutrients in the pathophysiology and management of SCD among children. Children with SCD have been shown to exhibit suboptimal status with respect to both macronutrients and micronutrients. Thus, nutrition could play an important role in the management of SCD. However, there is paucity of evidence coming from trials with large sample sizes to support the suggestion that supplementation with various nutrients that have been considered in this review will be helpful.

Weight loss practices among newly enrolling clients in a commercial weightloss program in Ghana.

BACKGROUND: In Ghana, obesity is showing a rising trend and there are weight loss initiatives being practised by individuals. However, the levels of commitment to such programs and the reasons for discontinuing have not been assessed. The objectives of this study were to investigate the weight loss practices of participants and reasons for quitting chosen weight loss programs. METHODS: This was a cross-sectional study involving 50 subjects conveniently selected from people who were enrolling into a commercial weight loss program. A questionnaire was used to collect data on past weight loss practices and reasons for abandoning chosen programs. Data analysis was conducted using simple frequency and descriptive tests of the Excel software. RESULTS: More than half of the subjects (66%) had undertaken a weight loss practice before enrolment in study. Of these, 88.5% abandoned the strategy before the achievement of their desired weight goal. The three common programs that were practised were internet based diets (67.9%), commercial weight loss shakes (42.9%) and exercises (28.6%). Reasons given for abandoning programs included lack of sustainability (50%), lack of determination on the part of the client (15%), boredom with program (10%), not achieving desired results (10%), safety concerns (10%), and getting pregnant (5%). CONCLUSIONS: The findings suggest that future weight loss programs can be effective and have reduced attrition rates if they are designed to achieve sustainable dietary and other lifestyle changes, as well as boost motivation for weight loss.

Household Food Insecurity is Associated with Respiratory Infections Among 6-11-Month Old Infants in Rural Ghana.

BACKGROUND: To determine the relationship between household food insecurity (HHFI) and symptoms of respiratory infections among infants in rural Ghana. METHODS: The study was cross-sectional. The outcome variables were symptoms of respiratory infections (cough and nasal discharge) in infants. HHFI was measured using a 15-item modified U.S. Department of Agriculture (USDA) household food security module. Households were classified as food insecure if they had an affirmative answer for at least 1 item. Associations were examined using multiple logistic regression analysis. Data were collected in 32 communities located in 3 rural subdistricts in the Upper Manya Krobo district of the Eastern region of Ghana. The sample included 367 infants aged 6-11 months who attended a community-based growth monitoring session. RESULTS: Overall, 20.5% of households reported experiencing food insecurity in the last month. Compared with infants in food secure households, infants living in food insecure households were about twice as likely to experience cough (adjusted odds ratio: 2.25, 95% confidence intervals: 1.25, 4.04) and nasal discharge (adjusted odds ratio: 1.87, 95% confidence intervals: 1.05, 3.36). CONCLUSION: Infants living in food insecure households are at an increased risk of respiratory tract morbidity. Interventions that address HHFI might be important to improve infant health in rural Ghana.