Relationship between home garden ownership and the consumption of fruits and vegetables.

OBJECTIVE: This study assessed the extent to which access to home gardens associate with the frequency of fruit and vegetable (FV) consumption. SETTING: The study was carried out in fifty rural communities in Northern Ghana where food insecurity and malnutrition including micronutrient deficiencies are prevalent. DESIGN: A community-based comparative analytical cross-sectional study. PARTICIPANTS: A sample of 847 randomly selected rural households. RESULTS: The proportion of households that consumed FV at least 3 d in a week was 45 %. Members in households who owned a home garden were 1·5 times more likely to consume FV at least 3 d in a week (adjusted OR (AOR) = 1·46 (95 % CI 1·06-2·0)), compared with their counterparts who had no home gardens. Furthermore, households in which mothers had a positive attitude towards FV consumption were 1·6 times more likely to consume FV (AOR = 1·63 (95 % CI 1·17-2·27)) compared with mothers who were less positive. CONCLUSIONS: Our results suggest that food and nutrition policy measures that promote home gardens can improve consumption of diversified diets including FV among vulnerable rural households in Northern Ghana. Additionally, households with lower income may benefit from nutrition behaviour change communication campaigns directed towards increasing a positive attitude to FV intake.

Fathers' level of involvement in childcare activities and its association with the diet quality of children in Northern Ghana.

OBJECTIVE: This study assessed the level of fathers' involvement in childcare activities and its association with the diet quality of their children in Northern Ghana. SETTING: The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation. DESIGN: A community-based comparative analytical cross-sectional study. PARTICIPANTS: A sample of 422 rural mother-father pairs who had at least one child aged 6-36 months. RESULTS: The overall level of fathers' involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father's involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)). CONCLUSIONS: The findings confirm earlier studies that show that fathers' involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.

Bias correction and spatial disaggregation of satellite-based data for the detection of rainfall seasonality indices.

Like many other African countries, Ghana's rain gauge networks are rapidly deteriorating, making it challenging to obtain real-time rainfall estimates. In recent years, significant progress has been made in the development and availability of real-time satellite precipitation products (SPPs). SPPs may complement or substitute gauge data, enabling better real-time forecasting of stream flows, among other things. However, SPPs still have significant biases that must be corrected before the rainfall estimates can be used for any hydrologic application, such as real-time or seasonal forecasting. The daily satellite-based rainfall estimate (CHIRPS-v2) data were bias-corrected using the Bias Correction and Spatial Disaggregation (BSCD) approach. The study further investigated how bias correction of daily satellite-based rainfall estimates affects the identification of seasonality and extreme rainfall indices in Ghana. The results revealed that the seasonal and annual rainfall patterns in the region were better represented after the bias correction of the CHIRPS-v2 data. We observed that, before bias correction, the cessation dates in the country's southwest and upper middle regions were slightly different. However, they matched those of the gauge well after bias correction. The novelty of this study is that, in addition to improving rainfall using CHIRPS data, it also enhances the identification of seasonality indices. The paper suggests the BCSD approach for correcting rainfall estimates from other algorithms using long-term historical records indicative of the rainfall variability area under consideration.

Evaluating tuberculosis case detection via real-time monitoring of tuberculosis diagnostic services.

RATIONALE: Tuberculosis case-detection rates are below internationally established targets in high-burden countries. Real-time monitoring and evaluation of adherence to widely endorsed standards of tuberculosis care might facilitate improved case finding. OBJECTIVES: To monitor and evaluate the quality of tuberculosis case-detection and management services in a low-income country with a high incidence of tuberculosis. METHODS: We prospectively evaluated tuberculosis diagnostic services at five primary health-care facilities in Uganda for 1 year, after introducing a real-time, electronic performance-monitoring system. We collected data on every clinical encounter, and measured quality using indicators derived from the International Standards of Tuberculosis Care. MEASUREMENTS AND MAIN RESULTS: In 2009, there were 62,909 adult primary-care visits. During the first quarter of 2009, clinicians referred only 21% of patients with cough greater than or equal to 2 weeks for sputum smear microscopy and only 71% of patients with a positive sputum examination for tuberculosis treatment. These proportions increased to 53% and 84%, respectively, in the fourth quarter of 2009. The cumulative probability that a smear-positive patient with cough greater than or equal to 2 weeks would be appropriately evaluated and referred for treatment rose from 11% to 34% (P = 0.005). The quarterly number of tuberculosis cases identified and prescribed treatment also increased four-fold, from 5 to 21. CONCLUSIONS: Poor adherence to internationally accepted standards of tuberculosis care improved after introduction of real-time performance monitoring and was associated with increased tuberculosis case detection. Real-time monitoring and evaluation can strengthen health systems in low-income countries and facilitate operational research on the effectiveness and sustainability of interventions to improve tuberculosis case detection.

Potential impact of groundnut production technology on welfare of smallholder farmers in Ghana.

This study was conducted to assess the potential impact of applying a new groundnut planting density on welfare of smallholder farmers in northern Ghana. We used data from on-farm experiments, focus group discussions, and a household survey. We followed three steps in our analysis. First, we conducted cost-benefit analysis in which we showed the economic advantage of the new technology over the farmers' practice. Second, we predicted adoption rates along timeline using the Adoption and Diffusion Outcome Prediction Tool (ADOPT). Third, using the results of the first and the second steps, we estimated the potential impact of the technology on poverty at household level using a combination of methods such as economic surplus model and econometric model. The cost-benefit analysis shows that increasing plant density increases farmers' financial returns i.e., the benefit-cost-ratio increases from 1.05 under farmers' practice to 1.87 under the best plant density option, which is 22 plants/sqm. The adoption prediction analysis shows that the maximum adoption rate for the best practice will be 62% which will take about nine years to reach. At the maximum adoption rate the incidence of extreme poverty will be reduced by about 3.6% if farmers have access to the international groundnut market and by about 2% if they do not have. The intervention will also reduce poverty gap and poverty severity. The results suggest that policy actions which can improve farmers' access to the international market will enhance farmers' welfare more than the situation in which farmers have access to domestic markets only. Furthermore, promoting a more integrated groundnut value-chain can broaden the demand base of the produce resulting in higher and sustainable impact of the technology on the welfare of groundnut producers and beyond.

Effect of nutrition behaviour change communication delivered through radio on mothers' nutritional knowledge, child feeding practices and growth.

Childhood undernutrition coupled with poor feeding practices continues to be public health problems in many parts of the world and efforts to address them remain elusive. We tested the hypothesis that women who are exposed to radio health/nutrition education will demonstrate greater nutrition and health knowledge, positive attitudes towards preventive health and better dietary diversity practices for improved child growth. We used a two-arm, quasi-experimental, non-equivalent comparison group design with pre- and post-test observations to evaluate the intervention. The study population comprised 712 mothers with children aged 6-36 months who were randomly selected from five intervention districts and one comparison district in Northern Ghana. Difference-in-difference (DID) analysis was performed to assess study outcomes. After 12-month implementation of intervention activities, the minimum dietary diversity and the minimum acceptable diet improved significantly (DID 9⋅7 percentage points, P 0⋅014 and DID 12⋅1 percentage points, P 0⋅001, respectively) in the intervention study group, compared with the comparison group. Mothers in the intervention communities had a nutrition-related knowledge, attitudes and practices score that was significantly higher than their colleagues in the comparison communities (DID 0⋅646, P < 0⋅001). The intervention did not have significant effects on the nutritional status as measured by height-for-age Z-score or weight-for-height Z-score. The data provide evidence that health and nutrition education using radio drama significantly increased health-/nutrition-related knowledge but had little effect on nutritional status.

Improved malaria case management through the implementation of a health facility-based sentinel site surveillance system in Uganda.

BACKGROUND: Heath facility-based sentinel site surveillance has been proposed as a means of monitoring trends in malaria morbidity but may also provide an opportunity to improve malaria case management. Here we described the impact of a sentinel site malaria surveillance system on promoting laboratory testing and rational antimalarial drug use. METHODOLOGY/PRINCIPAL FINDINGS: Sentinel site malaria surveillance was established at six health facilities in Uganda between September 2006 and January 2007. Data were collected from all patients presenting to the outpatient departments including demographics, laboratory results, diagnoses, and treatments prescribed. Between the start of surveillance and March 2010, a total 424,701 patients were seen of which 229,375 (54%) were suspected of having malaria. Comparing the first three months with the last three months of surveillance, the proportion of patients with suspected malaria who underwent diagnostic testing increased from 39% to 97% (p<0.001). The proportion of patients with an appropriate decision to prescribe antimalarial therapy (positive test result prescribed, negative test result not prescribed) increased from 64% to 95% (p<0.001). The proportion of patients appropriately prescribed antimalarial therapy who were prescribed the recommended first-line regimen artemether-lumefantrine increased from 48% to 69% (p<0.001). CONCLUSIONS/SIGNIFICANCE: The establishment of a sentinel site malaria surveillance system in Uganda achieved almost universal utilization of diagnostic testing in patients with suspected malaria and appropriate decisions to prescribed antimalarial based on test results. Less success was achieved in promoting prescribing practice for the recommended first-line therapy. This system could provide a model for improving malaria case management in other health facilities in Africa.