Background commentary on the Researching the Obesogenic Food Environment (ROFE) project.

OBJECTIVE: The objective of this commentary is to provide an overview of the rationale and objectives of the Researching the Obesogenic Food Environment (ROFE) project that was conducted in Ghana and South Africa. DESIGN: Narration has been used to describe the main objectives, phases as well as the methods used for the conduct of this project. SETTING: The project described in this commentary was conducted in Khayelitsha and Mount Frere in South Africa and Ahodwo and Ejuratia for Ghana. PARTICIPANT: Participants of the study described here include households in South Africa and Ghana, stakeholders and policymakers, and various actors within the food chain in both countries. RESULTS: The ROFE findings provide a good understanding of the extent of the impact of the food environment on consumption, characteristics of value chains of healthy and unhealthy foods, as well as the potential for improved governance and policy that is relevant to the region. The supplement provides the opportunity to share the extensive findings of the ROFE project. Nine papers that describe the process and findings of the three phases of the ROFE project have been presented. Some of the papers focus on phases of the ROFE, while others cut across different phases and explore the linkages between the phases. Briefly descriptions of key findings of some of the papers in the supplement are provided. CONCLUSION: Together, the findings of the ROFE study presented in this supplement have increased understanding of how communities in SA and Ghana interact with their food supplies and have led to identification of specific opportunities to improve food supply policies, in ways that create incentives for the production and consumption of healthy, relative to unhealthy foods.

10-year level, trends and socio-demographic disparities of obesity among Ghanaian adults-A systematic review and meta-analysis of observational studies.

The double burden of malnutrition has assumed severer forms in Low and Middle Income Countries (LMICs) arising from sharper increases in prevalence rates of overweight and obesity in these countries compared to higher income countries. Considering that LMICs already have fragile health systems, the rising obesity levels may just be a ticking time bomb requiring expeditious implementation of priority actions by all global and national actors to prevent an explosion of cardiovascular disease related deaths. The aim of this systematic review and meta-analysis was to provide a current estimate of obesity and overweight prevalence among Ghanaian adults and assess socio-demographic disparities following the PRISMA guidelines. We searched Pubmed with Medline, Embase, Science direct and African Journals Online (AJOL) for studies on overweight and obesity published between 2013 and January 2023. Applying a quality effects model, pooled mean Body Mass Index (BMI) and prevalence of overweight and obesity were obtained from 42 studies conducted across all three geographical locations of Ghana with a combined sample size of 29137. From the analysis, the mean BMI of adults in Ghana was 24.7 kgm-2 while overweight and obesity prevalence was estimated as 23.1% and 13.3% respectively. Temporal analysis showed sharper increases in overweight and obesity prevalence from 2017/2018. Mean BMI (Females: 25.3kgm-2 vrs Males: 23.1 kgm-2), overweight (Females: 25.9% vrs Males: 16.5%) and obesity (Females: 17.4% vrs Males: 5.5%) prevalence were higher among females than males. Gender differences in mean BMI and obesity prevalence were both significant at p<0.001. Urban dwellers had higher mean BMI than their rural counterparts (24.9kgm-2 vrs 24.4kgm-2). Overweight (27.6% vrs 18.2%) and obesity (17.3% vrs 11.0%) prevalence were also higher in urban areas than in rural areas. Body weight indicators for the various geographical areas of Ghana were; southern sector: 25.4kgm-2, 28.9% and 15.4%, middle sector: 24.8kgm-2, 26.4% and 16.2% and northern sector: 24.2kgm-2, 15.4% and 8.5% for mean BMI, overweight and obesity prevalence respectively. The southern part of Ghana was similar to the middle part in terms of mean BMI, overweight and obesity but higher than the northern part. We conclude that overweight and obesity prevalence in Ghana has risen to high levels in recent years with women and urban dwellers disproportionately more affected. There is a possible implication for increased cardiovascular diseases and a generally poor quality of life for the people. Evidence-based public health interventions are needed to reverse the current situation.

Factors associated with food consumption and dietary diversity among infants aged 6-18 months in Ashanti Region, Ghana.

BACKGROUND: Studies have reported a poor diet quality among children in Ghana and other developing countries. Inadequate dietary diversity among children may lead to deficiencies in micronutrient intake necessary for growth and other cognitive functions. Understanding factors associated with infants' diverse diets is a key step to promoting adequate infant and young child nutrition. This study sought to determine the factors associated with food consumption and dietary diversity (DD) among infants. METHODS: In this cross-sectional study among 1503 mothers-infant (aged 6-18 months) pairs from rural, urban, and peri-urban districts of Ashanti Region, factors associated with food consumption and DD were evaluated. The FAO 18-food group DD questionnaire was used to determine previous food group intake, while a structured questionnaire was used to capture data on the mother's socio-demographic parameters and child morbidity. Data were analyzed using descriptive statistics, the Chi-square test, and binary logistic regression to compare mothers and infants who had adequate and inadequate DDS of 9 out of 18 food groups and the predictors of dietary diversity. RESULTS: About 64.7% of the infants did not meet the minimum dietary diversity. Over two-third (77.4%) of the children consumed maize porridge the previous day. Foods which were less consumed included vegetables (35%), animal milk (38.9%), and meat (organ 14%, any meat 26%). The mean food group intake from 18 food groups was 7.0, and the majority (64.7%) did not meet the recommended 9 food group intake. Significantly more younger children (6-11 months) (74%, p<0.001) compared with older children (12-18 months) (52.5%) did not meet the minimum DDS. Also compared with the older children, the younger ones had above two times increased odds of inadequate DD (OR = 2.5, p<0.001, 95% CI = 1.4-4.4). When controlled for gender, children from peri-urban areas (OR = 5.2, p = 0.260, 95% CI = 0.2-93.2) and rural areas (OR = 1.8, p = 0.650, 95% CI = 0.2-9.3) had increased odds of lower DD than urban children. Children of unemployed caregivers had an increased odds of low DD (OR = 2.3 p<0.001, 95% CI 1.7-3.2) compared with children of employed caregivers. Finally, children of caregivers with better nutrition knowledge (nine correct answers from 12 questions) had lower odds of having lower dietary diversity (adjusted OR = 0.9, p = 0.85, 95%CI = 0.5-1.6) than those with less knowledge. CONCLUSIONS: Low DD was common among infants and associated with infants age, caregivers' areas of residence, employment status, and level of nutrition education. Children who did not meet the minimum dietary diversity were not fed particular foods such as vegetables, animal milk, and organ meat. Proper maternal nutrition education and feeding practices targeting age-specific needs and community livelihood support systems are necessary to improve dietary diversity of infants.

Nutrition Education Improves Knowledge of Iron and Iron-Rich Food Intake Practices among Young Adolescents: A Nonrandomized Controlled Trial.

Introduction: Nutrition education targeting adolescents' health has the potential to enhance their well-being into adulthood. This study assessed the impact of nutrition education on the knowledge of iron and iron-rich food intake practices of adolescents living in rural communities in Ghana. Method: An intervention study was conducted among 137 adolescents; 69 were assigned to the intervention group and 68 to the control group. Participants and guardians in the intervention group were involved in the nutrition education programme for six months. Participants in both groups completed sociodemographic, knowledge of iron, and iron-rich food intake practice questionnaires at pre- and postintervention. Data were analyzed by chi-square and t-tests. Results: At postintervention, the mean knowledge score (p < 0.05) in the intervention group and control group was 5.3 ± 1.7 and 3.9 ± 1.9, respectively. Interventions (76%) and controls (46%) had good knowledge status. The mean knowledge score of participants with good knowledge status in the intervention group was 6.1 ± 0.8 (p < 0.05), and the control group was 5.6 ± 0.7 (p < 0.05). Forty-two percent of participants in the interventions and 26% in the controls had good food intake status. Participants with good food intake status had mean food intake scores of 3.2 ± 0.4 (p < 0.05) and 3.8 ± 0.7 (p < 0.05) for the intervention and control groups, respectively. Both groups increased and had the same mean food intake score (1.5 ± 1.4, p > 0.05), however, relatively higher in the intervention group. Conclusion: Nutrition education improved the knowledge of iron and iron-rich food intake practices of participants in the intervention group compared to the control group. Nutrition education should be a critical component in the management and prevention of micronutrient deficiency in adolescents.

Dietary Diversity and Nutritional Status of Adolescents in Rural Ghana.

Background: The rapid biological and physical changes during adolescence require adequate nutrient intake. This study assessed dietary diversity and nutritional status of adolescents living in selected rural areas in Ghana. Method: In this cross-sectional study, 137 young adolescents, aged 10 to 14 years were recruited. Structured questionnaire was used to collect data on sociodemographic, household size and food intake practices. A multiple past 24-hour recall was used to estimate the micronutrients intake. Haemoglobin and anthropometry data were assessed. Dietary diversity score was assessed with 10 food groups described by Food and Agricultural Organization. Descriptive, chi-square, binary regression and partial correlation were used in the data analysis. Results: The prevalence of underweight was 5.5%, overweight 5.8% and anaemia 29.9%. The mean dietary diversity score was 3.8 ± 0.8 and about 84.7% of participants had inadequate dietary diversity. Proportions of adolescents who consumed from the different food groups over a 24-hour period were: grains, white roots and tubers, plantain (100%); pulses (10.2%); nuts and seeds (34.1%); dairy (8%); meat, poultry and fish (86.9%); eggs (7.3%); dark green leafy vegetables (29.9%); other vitamin-A rich fruits and vegetables (2.2%); other vegetables (81%); other fruits (7.3%). Dietary diversity scores were positively and significantly correlated with intake of micronutrient, with correlation coefficients of .169, .186, .191, .173 and .175 for vitamin A, niacin, vitamin B6, iron and zinc, respectively. Meal skipping (AOR = 12.2, P < .001, 95% CI: 3.6-41.7) and snacking (AOR = 5.0, P = .007, 95% CI:1.6-16.7) increased odds of inadequate dietary diversity. Conclusion: The high prevalence of inadequate dietary diversity was positively related to meal skipping and snacking among adolescents. Dietary diversity score was significantly related to the intake of vitamin A, niacin, vitamin B6, iron and zinc. The prevalence of anaemia among our study participants is of public health concern. Adolescents should be encouraged both at home and school to eat from diverse food groups to promote adequate intake of micronutrients.

Comparative analysis of methyl-donor nutrient intakes and RCPM cognitive performance among school-aged children.

BACKGROUND: Evidence shows a link between methyl-donor nutrient intakes and a child's cognitive ability. However, this is less known among Ghanaian children who might be at higher risk of methyl-donor nutrient deficiencies. This study showed comparative analysis of methyl-donor nutrient intakes and Raven's Coloured Progressive Matrices (RCPM) test performance among 2073 Ghanaian school children aged 9-13 years across four regions of Ghana. METHODS: Data for the present study were obtained from the Child Nutrition, Fitness, and Cognition project; a cross-sectional survey conducted in four regions of Ghana. Dietary methyl-donor nutrient values were based on repeated 24 h recall data collected during the study periods. Cognitive tests were performed on the 2073 children using Raven's Coloured Progressive Matrices (RCPM) test. RESULTS: We found dietary zinc (adjusted: ß = 0.21, p = 0.003) and methionine (adjusted: ß = 0.60, p = 0.044) intakes to be associated with RCPM scores in the linear regression model. School children living in Northern Region (adjusted OR = 0.6, p < 0.001, 95% CI = 0.4-0.7) and Volta Region (adjusted OR = 0.7, p = 0.006, 95% CI = 0.5-0.9) had lower odds of scoring above the 50th percentile on the RCPM test compared with those living in Greater Accra Region. Children who consumed below the RDA for dietary folate (unadjusted OR = 0.8, p = 0.055, 95% CI = 0.7-1.0) and zinc (unadjusted OR = 0.8, p = 0.049, 95%CI = 0.7-1.0) had lower odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the RDA for dietary folate and zinc respectively. Children who consumed below the EAR for dietary vitamin B12 (unadjusted OR = 0.7, p = 0.004, 95% CI = 0.6-0.9) had reduced odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the EAR for dietary vitamin B12. CONCLUSIONS: Higher dietary methionine intake was strongly associated with higher RCPM scores. Regional differences, and children's dietary consumption below the EAR/RDA for dietary folate, vitamin B12, and zinc were associated with poor RCPM test performance. School children's nutrient intake should be prioritized for improved cognition.

Effectiveness of nutrition education and counselling programme on iron deficiency anaemia among adolescents: A study protocol of a randomized trial.

BACKGROUND: [GQ4]Adolescents tend to explore their dietary environment without prior consideration of their nutritional needs. This attitude is due to low nutrition knowledge and it contributes to micronutrient deficiency such as anaemia. The study aims to investigate the effect of nutrition education and counselling on dietary iron intake and iron status of early adolescents. METHODS/DESIGN: One hundred and twenty-six early adolescents will be recruited and randomized to receive nutrition education (intervention group) and no nutrition education (control group) in the Asante-Akim South Municipality of Ghana. Data on socio-demographics, dietary factors, dietary intake, knowledge of iron and anaemia will be collected at baseline and post-intervention. Blood samples will be collected for haemoglobin, ferritin and c-reactive protein analyses. The primary outcome measures include haemoglobin and ferritin levels, secondary outcomes such as dietary iron intake, dietary vitamin C intake and knowledge level of iron will be assessed at pre-and post-intervention (6 months). The study will comply with the Consolidated Standards of Reporting Trials (CONSORT) for randomized trials. DISCUSSION: The effectiveness of iron dietary guidelines developed will serve as a manual to aid, prevent and manage iron deficiency anaemia as well as reduce the prevalence of anaemia in the long term in Ghana.

The relationship between nutrition and physical activity knowledge and body mass index-for-age of school-aged children in selected schools in Ghana.

BACKGROUND: Nutrition knowledge contributes significantly to the nutritional status and habits of individuals as it influences their food consumption. And body mass index (BMI) of individuals. Recent data suggests a relationship between nutrition and physical activity knowledge, attitude, practices, and anthropometric indices of Ghanaian children. OBJECTIVE: To determine the relationship between nutrition and physical activity knowledge and using BMI-for-age of school-aged children. METHODS: A cross-sectional study involving 591 school-aged children (8-13 years) chosen at random from schools in Ghana's Ho Municipality. Socio-demographic information was gathered. Data on nutrition and physical activity knowledge, attitude, and practice were also collected using structured questionnaires. BMI was calculated after weight and height were measured. RESULTS: Majority of the participants had poor knowledge on nutrition (46.6%) and physical activity (49.8%) even though more children in private schools (63.3%) had better (good and excellent) knowledge in nutrition than children from public schools (48.2%). Older children (11-13 years) had 'good' knowledge of physical activity (54.7%) as opposed to younger children. Males (59.5%) and children in private schools (66.3%) also had better overall scores in combined nutrition and physical activity knowledge than their female and public-school counterparts, respectively. Physical activity knowledge was significantly (p < 0.05) associated with the BMI-for-age categories. Nutrition knowledge (p < 0.05) and total nutrition and physical activity knowledge scores (p < 0.001) were weakly but positively associated with BMI-for-age. CONCLUSION: The results suggest that BMI-for-age of the participants was positively correlated to the nutrition knowledge and the total nutrition and physical activity knowledge (NutPA).

Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana.

Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13-19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended.

Knowledge and practices of dietary iron and anemia among early adolescents in a rural district in Ghana.

The study assessed knowledge and practices of dietary iron intake and anemia among early adolescents in the Asante-Akim Municipality of Ghana. A cross-sectional study was conducted among 137 adolescents, aged 10-14 years. Structured questionnaire was used to collect data on sociodemographic, knowledge of iron, and anemia, and iron intake practices. Hemoglobin levels were determined using Hemocue 301. Data were analyzed using descriptive, chi-square test, and binary logistics regression. The mean age of participants was 11.5 years. About 40% had knowledge of iron deficiency anemia, 29.4% knew anemia causes, 86% knew symptoms of anemia, and 35% knew anemia consequences. Although 41.2% of participants knew its prevention as eating iron-rich foods, 31.4% knew the food sources of iron, and 4.4% mentioned animal-based foods as rich sources, with the bulk (27%) mentioning plant-based foods instead. Moreover, 18.2% knew iron enhancers, while 0.7% knew iron inhibitors. More chicken consumers (72.2%) than nonconsumers (56.6%) met the Estimated Average Requirement for dietary iron intake (Chi-square 3.4, p = .073), while more dried fish consumers (88%) than nonconsumers (66.7%) had normal hemoglobin levels (Chi-square 4.5, p = .050). Knowledge of food sources of iron and iron-rich foods was positively associated with intake of chicken, fresh fish, and dried fish. Moreover, lower knowledge of iron-based food sources (ß = -1.015, p = .020) and iron-rich foods (ß = -2.188, p = .015) was inversely associated with beef intake. Anemia was negatively associated with chicken (ß = -0.310, p = .416) and dried fish (ß = -1.299, p = .045) consumption. Majority of the adolescents had low knowledge of iron. Chicken and dried fish intake reduced the risk of anemia development. Our study may be the first to assess knowledge on iron, anemia, and its impact among young Ghanaian adolescents. Our findings provide insights into this topic, calling for to improve knowledge, and practices on anemia in Ghanaian adolescents.

Iron status predicts cognitive test performance of primary school children from Kumasi, Ghana.

BACKGROUND: Good nutritional status of school-aged children is crucial in achieving improved cognition. The objective of this study was to assess the relationship between nutritional status and cognition of school-aged children in the Kumasi metropolis, Ghana. METHODS: 389 children were selected from ten government-owned schools. Socio-demographic and anthropometric data were collected. Blood samples were collected and analyzed for nutrients levels. Dietary intakes were assessed using food frequency questionnaire and previous day's nutrients intake. Cognition test was performed using the Ravens Colored Progressive Matrix (RCPM). RESULTS: Mean age of participants was 8.9±1.4 years, mean RCPM score was 17.9±5.4. More girls scored RCPM below the 40th percentile (45.5%) than boys (33.7%), while mother's level of education significantly associated with RCPM percentiles of the children (p = 0.037). Four dietary patterns were generated from food frequency data, and scores of the second pattern, depicting vegetables, non-fruits, bread and cereals, showed a weak negative correlation (r = -0.132, p = 0.026) with previous day's dietary zinc intake. Cognitive status did not vary by anthropometric and dietary patterns. More anemic (54.4%) than non-anemic (33.3%) children were below the 40th RCPM percentile. Mean previous day's intake for folate (p<0.001), vitamin B6 (p = 0.018), iron (p<0.001), and zinc (p = 0.001) differed significantly between the cognitive test score percentiles of the children. Spearman rank correlation showed weak positive associations between RCPM score and hemoglobin (r = 0.246, p = 0.003) and serum ferritin (r = 0.176, p = 0.036). Binary regression analysis showed anemic children (aOR = 0.4; 95%CI = 0.2-0.8, p = 0.014), compared with non-anemic had decreased odds, while boys, compared with girls had increased odds (aOR = 2.0 95%CI = 1.0-4.0, p = 0.035) for scoring above the 50th RCPM percentile. CONCLUSIONS: Iron status, especially hemoglobin levels, correlated with the cognitive performance of school-aged children in the metropolis. Thus nutritional strategies aimed at reducing iron deficiency anemia are needed.

Factors associated with iron deficiency anaemia among pregnant teenagers in Ashanti Region, Ghana: A hospital-based prospective cohort study.

BACKGROUND: Iron Deficiency Anaemia (IDA) is reportedly high in pregnant adults and the causes well studied. However, among pregnant teenagers, the levels and associated factors of IDA are not fully understood. METHODS: In a prospective cohort study among Ghanaian pregnant teenagers, aged 13-19 years, IDA prevalence and associated factors were investigated. Sociodemographic data, household hunger scale (HHS), lived poverty index (LPI), FAO's women's dietary diversity score (WDDS) and interventions received during antenatal care (ANC) were obtained from 416 pregnant teenagers in Ashanti Region, Ghana. Micronutrient intakes using a repeated 24-hour dietary recall, and mid-upper arm circumference (MUAC) were determined and blood samples analysed for haemoglobin (Hb), serum levels of ferritin, prealbumin, vitamin A, total antioxidant capacity (TAC), C-reactive protein (CRP), and zinc protoporphyrin (ZPP). RESULTS: Anaemia (Hb cutoff <11.0 g/dL) was 57.1%; deficient systemic supply of iron stores (31.4%), depleted body stores of iron (4.4%), inadequate dietary iron intake (94.5%), and inadequate multiple micronutrient intakes (49.5%), were all notable among study participants. Between-subject effects using Generalized Linear Modelling indicated malaria tablet given at ANC (p = 0.035), MUAC (p = 0.043), ZPP (p<0.001), ZPP/Hb ratio (p<0.001) and depleted body iron stores (DBIS) (p<0.001) to significantly affect Hb levels. Pregnant teenagers with a high ZPP/Hb ratio (OR = 9.7, p<0.001, 95%CI = 6.0-15.8) had increased odds of being anaemic compared to those with normal ZPP/Hb ratio. Participants who were wasted (OR = 1.2, p = 0.543, 95%CI = 0.6-2.3), and those with depleted iron stores (OR = 3.0, p = 0.167, 95%CI = 0.6-14.6) had increased odds of being anaemic. Participants who experienced hunger were close to 3 times more likely (OR = 2.9, p = 0.040, 95%CI = 1.1-7.8) for depleted iron stores, compared to those who did not experience hunger. Also, participants with inadequate multiple micronutrients intakes (OR = 2.6, p = 0.102, 95%CI = 0.8-8.4), and those with low serum levels of ferritin (OR = 3.3, p = 0.291, 95%CI = 0.4-29.2) had increased odds of depleted body iron stores. CONCLUSIONS: IDA is common among pregnant teenagers and the related factors include malaria tablets given at ANC, maternal hunger, maternal MUAC, a deficient systemic supply of iron, depleted body iron stores, ZPP, and ZPP/Hb ratio. Appropriate interventions are urgently needed to address the causes of IDA among pregnant teenagers.

Dietary diversity and its correlates among pregnant adolescent girls in Ghana.

BACKGROUND: Dietary diversity, a qualitative measure of dietary intake, which reflects the variety of foods consumed has been recommended to assuage nutritional problems related to insufficient micronutrients, and food insecurity. To better understand the underlying factors for poor birth outcomes in Ghana, we assessed factors associated with dietary diversity among rural and urban pregnant adolescents in the Ashanti Region of Ghana. METHODS: As part of a larger longitudinal cohort of 416 pregnant adolescents, the FAO minimum dietary diversity for women index was used to determine the dietary diversity score (DDS) of the participants from a previous days' 24-hour dietary recall data. The household hunger scale (HHS) and lived poverty index (LPI) were used to determine hunger and socioeconomic status. Eating behavior and socio-demographic data were gathered using interviewer-administered questionnaires. RESULTS: The mean age of the participants was 17.5 (±1.4) years with an MDD-W of 4.4 and 56% recording inadequate MDD score. More rural (63.6%) than urban dwellers (50.6%) had inadequate DDS (p = 0.008). Among all the multiple variables tests of associations on dietary diversity, only hunger status (p = 0.028) and both food aversion and poverty status (p = 0.003) had a significant effect on the adolescents' dietary diversity. Rural dwelling adolescents (AOR = 1.7, p = 0.035, 95% CI = 1.0-2.6) recorded higher odds for inadequate DD compared with the urban respondents. Pregnant adolescents with severe hunger had higher odds (Unadjusted OR = 1.9, p = 0.053, 95% CI 1.1-3.8) for inadequate dietary diversity compared with those with no hunger. CONCLUSIONS: Inadequate DD is common among pregnant adolescents in this study and is associated with rural living, food insecurity, poverty, and food craving. Livelihood support for pregnant teenagers and nutrition education are recommended interventions to improve dietary quality and limit the consequences of poor dietary diversity.

Physical fitness and cognitive function among school-aged children in selected basic schools in the Ho Municipality of Ghana.

Physical fitness is thought to promote cognitive function. Evidence about this is however lacking in the Ghanaian context. This study aimed to investigate the association between physical fitness and cognitive function among basic school children aged 8-13 years. A cross-sectional study involving 591 school children, recruited from 12 randomly selected public and private basic schools was conducted. Physical fitness tests were done using a five-test battery (Fifty metre run, handgrip strength, sit-up, flexibility and standing board jump) following standardized procedures. Cognitive function test using the Raven's Coloured Progressive Matrices (RCPM) were carried out. More girls (55%), children from 8-13 years old (49.1%) and public school children (66.1%) participated in the study. For fitness, boys performed better than girls in sit ups 3.4 ± 2.2 (mean ± SD), p = 0.012, handgrip 4.3 ± 2.0, p = 0.001 and overall fitness 4.3 ± 2.0, p = 0.007. Children in public schools performed significantly better in forward jump (p < 0.001) while those in private schools did better in 50m run (p < 0.001). For cognition, 46.1% of participants had less than 50% of the total score. Cognitive test score varied for forward jump and handgrip alone and not for sit ups, 50m run and overall score. Mean forward jump score was lowest in poor cognition group (4.9 ± 2.3), followed by good (5.3 ± 2.2) and highest among excellent (5.5 ± 2.3, p = 0.044) cognition group. Similar observation was made for handgrip. Cognition score and hand grip strength were positively but weakly correlated. (r = 0.132, p = 0.026). Although handgrip strength (measuring muscular strength) was significantly associated with cognitive function, this study found no significant association between overall physical fitness and cognitive function. These results indicate that only some components of physical fitness may be associated with cognitive function. This study is however correlational and one cannot infer causality.

Implementing effective eLearning for scaling up global capacity building: findings from the malnutrition elearning course evaluation in Ghana.

BACKGROUND: Global demand for capacity building has increased interest for eLearning. As eLearning resources become more common, effective implementation is required to scale up utilization in Low- and Middle-Income Countries (LMICs). OBJECTIVE: This paper describes the process of implementing a malnutrition eLearning course, effectiveness of course delivery models devised, factors affecting course completion, and cost comparison between the models and face-to-face training at healthcare and academic institutions in Ghana. METHODS: Four delivery models: Mobile Training Centre (MTC), Online Delivery (OD), Institutional Computer Workstation (ICW) and Mixed Delivery (MD) - a combination of OD and ICW - were determined. Participants were enabled to access the course using one of the four models where contextually appropriate. Pre and post-assessments and questionnaires were administered to compare participants' course completion status and knowledge gain between delivery models. The effect of access to computer and Internet at home and relevance of course to job and academic progression on course completion were further investigated. Comparison of delivery model costs against face-to-face training was also undertaken. RESULTS: Of 7 academic and 9 healthcare institutions involving 915 people, 9 used MTC (34.8%), 3 OD (18.8%), 3 ICW (34.2%) and 1 MD (12.2%). Course completion was higher among institutions where the course was relevant to job or implemented as part of required curriculum activities. Knowledge gain was significant among most participants, but higher among those who found the course relevant to job or academic progression. The implementation costs per participant for training with MTC were £51.0, OD £2.2, ICW £1.2 and MD £1.1, compared with a face-to-face training estimate of £105.0 (1 GHS = 0.14 GBP). CONCLUSION: The malnutrition eLearning course makes global capacity building in malnutrition management achievable. Adopting contextually appropriate delivery models and ensuring training is relevant to job/academic progression can enhance eLearning effectiveness in LMICs.

Borassus aethiopum-Fortified Bread Reduces Metabolic Risk Factors among Cardiovascular Disease Outpatients at 37 Military Hospital, Accra: A Pilot Study.

BACKGROUND: Dyslipidemia and hypertension are the leading causes of morbidity and mortality in patients with cardiovascular diseases (CVDs). OBJECTIVE: The study sought to evaluate the effects of Borassus aethiopum-fortified bread on metabolic risk factors among CVD outpatients. METHOD: From August 2016 to April 2017, a pilot study using a single-blinded randomized placebo-controlled trial was conducted by administering Borassus-fortified bread (150 g) and indistinguishable placebo (150 g white flour bread) daily to 122 CVD outpatients at 37 Military Hospital, Accra, Ghana, for 90 days. Body composition, blood pressure, and biochemical parameters were evaluated before and after the intervention. RESULTS: Following the intervention, the mean waist circumference (before: 98.3 ± 14.6 cm, after: 95.9 ± 15.8 cm, P = 0.030), BMI (before: 31.4 ± 6.9 kg/m2, after: 28.0 ± 5.8 kg/m2, P = 0.027), and visceral fat (before: 10.4 ± 3.2, after: 9.9 ± 3.0, P = 0.013), as well as systolic (from 161.2 ± 25.5 to 137.6 ± 22.9and diastolic (from 99.2 ± 13.6 to 85.1 ± 10.8) blood pressure, were significantly reduced among the experimental group. Likewise, serum total cholesterol (TC), LDL, and HDL were significantly reduced within the experimental group before (TC: 5.9 ± 1.1, LDL: 3.4 ± 1.1, and HDL: 2.2 ± 0.5) and after the intervention (TC: 4.9 ± 1.1, LDL: 2.8 ± 0.9, and HDL: 1.5 ± 0.4) (TC: P = 0.001, LDL: P = 0.016, and HDL: P < 0.001, in mmol/L). These reductions were not observed in the controls. CONCLUSION: The Borassus-fortified bread significantly reduced blood pressure and improved lipid profile and other metabolic risk factors among the CVD outpatients studied. Therefore, its potential in the management of CVDs and other metabolic-related diseases should be looked at.

Palm Weevil Larvae (Rhynchophorus phoenicis Fabricius) and Orange-Fleshed Sweet Potato-Enriched Biscuits Improved Nutritional Status in Female Wistar Albino Rats.

Edible insects have emerged as an inexpensive alternative source of protein for reducing the burden of malnutrition worldwide. However, there is a dearth of evidence on its efficacy, and thus, the aim of this study was to investigate the effect of edible insect consumption on the nutritional status of female Wistar albino rats. The study assessed the subchronic effect of palm weevil larvae (PWL) and orange-fleshed sweet potato- (OFSP-) enriched biscuits (fortified biscuits (FB), plain biscuits (PB), biscuits fortified with PWL (PWB), and biscuits fortified with OFSP only (SPB)) as a model to predict the potential of PWL to improve the nutritional status of pregnant women in Ghana. Twenty-five female Wistar albino rats were randomly assigned to five experimental groups to receive one of the five feed supplements for 28 days. After which, the effects of treatment on haematological and biochemical parameters including lipid profile were assessed. No significant differences were observed with haematological (Hb) parameters. However, total cholesterol levels of the FB, PB, PWB, and SPB were significantly higher than in the N group. Apart from elevated total cholesterol concentrations, biscuits fortified with PWL had no adverse effects and can be a nutritious snack for maintaining acceptable HB levels.

Relationship between breakfast consumption, BMI status and physical fitness of Ghanaian school-aged children.

BACKGROUND: Good nutrition and physical activity of school-aged children are important for ensuring optimum growth and reducing obesity. This present study assessed associations between breakfast consumption, BMI-for-Age (BMI) and physical fitness in a cross-section of school-aged children attending government-owned primary schools in Kumasi, Ghana. METHOD: The sample consisted of 438 pupils (boys = 213; girls = 225; mean age 11.1 ± 1.1), attending 10 randomly selected schools. Weight (kg), height (cm) and Mid Upper Arm Circumference (MUAC) were measured for each participant, and BMI-for-age z-scores determined using the World Health Organisation (WHO) anthroplus software. Participants were stratified into thinness, normal weight, overweight/obese using WHO cut offs. Physical fitness was assessed using forward jump, left and right handgrips, flexibility, sit-ups and 50 metre run following standard procedures and converted to scores of 1 to 10 following Japanese standards, based on which percentiles were derived. Total fitness score for each pupil was computed by adding all scores. A questionnaire was used to assess meal intake patterns. RESULTS: The mean BMI-for-age z-score for participants was - 0.24 ± 0.99. Thinness, normal weight and overweight/obesity were 2.7, 86.5, and 10.5% respectively among the pupils. Overweight was higher in girls (14.2%) compared to boys (4.2%), p = 0.003. Similarly, mean MUAC was significantly (p = 0.021) higher in the girls (22.0 ± 3.2 cm) than the boys (20.7 ± 7.3 cm). For physical fitness, the girls scored higher in forward jump (p < 0.0001), 50-m run (p = 0.002) and overall fitness score than the boys (21.0 ± 6.2 versus 19.2 ± 8.3, p = 0.012). However, a larger proportion of boys performed excellently and poorly than girls (p = 0.019). A positive correlation was observed between BMI z-score and hand grip (r = 0.21, p < 0.001), while sit up (r = - 0.11, p = 0.018) showed a negative correlation with BMI z-score. No other fitness test varied by BMI. Overweight children performed best in handgrip. Majority of children said they engaged in exercise (89.9%) and consumed breakfast (78.9%). Breakfast consumption was not associated with BMI z-score (x2 0.0359, p = 0.549) but non-breakfast consumers performed better in 50 m run compared to consumers (7.0 seconds ± 2.3 vrs 6.3 seconds ± 2.5, p = 0.022). Children who reported to exercise were physically fitter than those who did not. CONCLUSION: Underweight levels were low while overweight was over 10% in these children. Girls were more than 3 times affected by overweight than boys, and were also physically fitter than boys. Breakfast consumption was not related to weight or fitness.

Body Weight, Obesity Perception, and Actions to Achieve Desired Weight among Rural and Urban Ghanaian Adults.

Background: Accurate body weight perception is important to maintaining an ideal body weight. In Africa, a preference for a larger body size and its association with health and wellbeing has been well documented. It remains speculative if these perceptions have changed or improved and if differences exist among rural and urban dwellers. The main aim of this study was to assess the body weight and obesity perceptions among rural and urban Ghanaians. Methods: This cross-sectional study involved 565 participants. The Stunkard figure rating scale was used to assess the body weight perception of participants. Participants were to choose from the scale figures they perceived to represent their current body weight, desired body weight, ideal body weight, ideal look for a wealthy person, ideal look for a woman with children, and ideal look for a woman without children. Additionally, participants were asked to describe obesity and its threat to health in their terms. Responses of participants to the above questions are presented as frequencies. Differences between rural and urban participants as well as males and females with respect to the median figure chosen for each question were determined by Mann-Whitney U test. Results: The median age of participants was 40 (IQR 26). The prevalence of overweight and obesity observed among participants was 52.8%. The most frequently selected figure as current body image was figure 5 (23.5%). Figure 4 was most frequently chosen by both males (37.2%) and females (24.6%) as their desired body image (27.4%). Male participants (41.8%) chose figure 5 as ideal for their gender while females (27.4%) maintained figure 4 as ideal for their gender. Study participants associated overweight with wealth and childbirth, and attributed their current weights to hereditary (27%) and childbirth (27%). Most participants were not taking steps to achieve their desired body image, and only a few engaged in both dieting and exercise to lose weight. Majority of participants described obesity as the accumulation of fat (91.0%) and viewed it as a threat to health (91.0%). Differences were observed among rural and urban participants with regard to the figure chosen as ideal for a wealthy person. Conclusion: Results from this study show an improvement in obesity perception and the acknowledgment of obesity as a threat to health. There was a desire for a normal-weight figure among study participants. Attribution of current body weight to hereditary and childbirth seems to be a hindrance to the implementation of actions to achieve this normal figure weight. Public health education, screening for overweight and obesity, creation of supportive food environments, and culture-sensitive interventions are promising to curbing the obesity menace.

Patterns of Dietary Iron Intake, Iron Status, and Predictors of Haemoglobin Levels among Early Adolescents in a Rural Ghanaian District.

INTRODUCTION: Early adolescents are vulnerable to anaemia due to lean body mass and menarche. The study assessed patterns of dietary iron intake, iron status, and predictors of anaemia among early adolescents. METHOD: One hundred and thirty-seven early adolescents were randomly selected in a rural district in Ghana. Multiple-pass 24-hour recall, iron food frequency questionnaire consisting of 27 food items, and semistructured questionnaire were administered. Variables include sociodemographics, dietary factors, and laboratory investigation including haemoglobin, ferritin, and C-reactive protein examination. Statistical Package for the Social Sciences (SPSS) software was used to calculate odds ratio and perform Mann-Whitney U test, chi-square (X2) test, exploratory factor analysis, and partial correlation (r) tests. RESULTS: Participants had mean age of 11.5 years. Three iron dietary patterns explaining 28.7% of the total variance were identified: iron dietary pattern 1 (11%) composed of iron-rich, iron-enhancing, and iron-inhibiting foods; iron dietary pattern 2 (9.9%) comprised of iron-rich, iron-enhancing, and non-iron-inhibiting foods; and iron dietary pattern 3 (7.1%) consisting of stinging nettle, iron-inhibiting foods, non-iron-enhancing foods, non-cocoyam leaves, and non-turkey berries. Meal skipping (X 2 = 5.7, p < 0.05), times of eating a day (X 2 = 12.6, p < 0.05), and guardian educational status (X 2 = 6.7, p < 0.05) significantly affected dietary iron intake. Anaemia was associated with meal skipping (ß = 0.367, p > 0.05), snacking (ß = 0.484, p > 0.05), and junior high school (JHS) education (ß = 0.544, p > 0.05). Partial correlation showed statistically significant relationship between iron dietary pattern 1 and dietary iron (r = -0.234, p < 0.01), iron dietary pattern 2 and dietary iron (r = -0.198, p < 0.05), iron dietary pattern 2 and vitamin C (r = -0.201, p < 0.05), and haemoglobin and ferritin (r = -0.178, p < 0.05). CONCLUSION: Meal skipping, guardian educational status, and number of times of eating a day were significantly associated with dietary iron intake. Meal skipping, snacking, and adolescents with JHS education were positively associated with anaemia.