Multiple pathways towards achieving a living income for different types of smallholder tree-crop commodity farmers.

Many sources indicate that smallholder tree-crop commodity farmers are poor, but there is a paucity of data on how many of them are poor and the depth of poverty. The living income concept establishes the net annual income required for a household in a place to afford a decent standard of living. Based on datasets on smallholder cocoa and tea farmers in Ghana, Ivory Coast and Kenya and literature, we conclude that a large proportion of such farmers do not have the potential to earn a living income based on their current situation. Because these farmers typically cultivate small farm sizes and have low capacity to invest and to diversify, there are no silver bullets to move them out of poverty. We present an assessment approach that results in insights into which interventions can be effective in improving the livelihoods of different types of farmers. While it is morally imperative that all households living in poverty are supported to earn a living income, the assessment approach and literature indicate that focussing on short- to medium-term interventions for households with a low likelihood of generating a living income could be: improving food security and health, finding off-farm and alternative employment, and social assistance programmes. In the long term, land governance policies could address land fragmentation and secure rights. Achieving living incomes based on smallholder commodity production requires more discussion and engagement with farmers and their household members and within their communities, coordination between all involved stakeholders, sharing lessons learnt and data.

Design and testing of communication materials for a breastfeeding social media marketing campaign: Breastfeed4Ghana.

Breastfeed4Ghana was a social media-based campaign implemented to address identified gaps in the protection, promotion, and support of breastfeeding in Ghana. This paper describes the process of campaign materials development and testing to ensure their cultural and content appropriateness. The 60 campaign materials, each consisting of an image and text message, underwent a process of creation, testing, revision, and finalization. Existing research evidence and infant and young child feeding communication tools that were culturally relevant for Ghana were used to develop the materials. All materials were tested and finalized through an iterative process that incorporated input from six focus group discussions (FGDs) with mothers, and content and technical experts. The materials were revised to ensure scientific accuracy, understandability, and cultural appropriateness of the messages, as well as alignment of the messages with the images. Finalized materials were reviewed and approved by the Ghana Food and Drugs Authority. Analysis for this paper involved summarizing and categorizing the types and sources of input as well as the research team's responses to the input received. The 60 campaign materials received a total of 132 inputs. Most inputs came from FGDs (78.4%); and most inputs were on the campaign material images. The evidence-informed process of materials creation, use of multiple input sources, and a broad-based iterative process allowed the creation of 60 evidence-based and culturally appropriate materials for a breastfeeding social media campaign in Ghana. This paper could serve as a guide for other social media campaign efforts looking to develop culturally appropriate materials.

Socio-economic differences in cost of pregnancy-related health services in the peri-urban Accra, Ghana.

BACKGROUND: Financial and physical barriers are known to limit access to maternal health services in developing countries. These limitations are often compounded by the low socio-economic status of women. This study examined socio-economic differences in health services cost incurred by pregnant women. METHODS: A cross-sectional cost survey of 300 women who had delivered a live birth in the last 12 months was undertaken. RESULTS: Majority of the women were aged between 20 and 39 years. About 63% of the women claimed they were registrants of the National Health Insurance Scheme (NHIS). However, only 64% of them provided valid NHIS identification cards. There were relatively more insured women in the rich quintiles (44%) compared with insured women in the poor quintiles (33%). Generally, women who were in the rich quintile incurred the highest average medical and non-medical costs, spent the highest time prior to service provision and lost the highest average incomes. CONCLUSIONS: Women socio-economic differences play a critical role in access to health services. We recommend that awareness campaigns on the NHIS must be intensified. The Ghana Health Services through its Community-based Health Planning Service should carefully structure its home visits to cover education on pregnancy-related health services.

State of dietetics practice in Ghana

Objective: Prevalence of obesity and related diseases has increased in Ghana. Dietitians have essential skills to prevent and manage dietary diseases. However; little is known about dietetic practice in Ghana. This paper describes the history and current state of dietetics practice in Ghana. Methods: A questionnaire was administered to 13 dietitians and six dietetic interns in February 2012. The questionnaire collected data on perceptions about dietetics practice; career progression; and challenges in dietetics practice in Ghana. Key informant interviews (KII) on history of dietetics in Ghana were also held with four retired dietitians; and two dietetics educators. Additional KII were conducted with the Chief dietitian; two officers of the Ghana Dietetic Association; and three other dietitians. Most KII were conducted faceto-face but a few were only possible via telephone. Some of the KII were audio-recorded; in addition to handwritten notes. Following transcription of audiorecorded interviews; all data were subjected to content analysis. Results: Dietetic practice in Ghana has evolved from low-skilled cadre (catering officers) offering hospitalbased meal services to the current era of available trained dietitians providing diet therapy in diverse settings. However; 80 of the 35 dietitians identified are working in Accra. In three regions of Ghana; there are no dietitians. There remain limited opportunities for continuous learning and professional career advancement. Additionally; there are many unqualified dietitians in practice. Conclusion: A huge unmet need for dietitians exists in all regions of Ghana; except Greater Accra. Bridging this gap is essential to increase access to dietetic care throughout Ghana

State of dietetics practice in Ghana.

OBJECTIVE: Prevalence of obesity and related diseases has increased in Ghana. Dietitians have essential skills to prevent and manage dietary diseases. However, little is known about dietetic practice in Ghana. This paper describes the history and current state of dietetics practice in Ghana. METHODS: A questionnaire was administered to 13 dietitians and six dietetic interns in February 2012. The questionnaire collected data on perceptions about dietetics practice, career progression, and challenges in dietetics practice in Ghana. Key informant interviews (KII) on history of dietetics in Ghana were also held with four retired dietitians, and two dietetics educators. Additional KII were conducted with the Chief dietitian, two officers of the Ghana Dietetic Association, and three other dietitians. Most KII were conducted face-to-face but a few were only possible via telephone. Some of the KII were audio-recorded, in addition to handwritten notes. Following transcription of audiorecorded interviews, all data were subjected to content analysis. RESULTS: Dietetic practice in Ghana has evolved from low-skilled cadre (catering officers) offering hospital-based meal services to the current era of available trained dietitians providing diet therapy in diverse settings. However, 80% of the 35 dietitians identified are working in Accra. In three regions of Ghana, there are no dietitians. There remain limited opportunities for continuous learning and professional career advancement. Additionally, there are many unqualified dietitians in practice. CONCLUSION: A huge unmet need for dietitians exists in all regions of Ghana, except Greater Accra. Bridging this gap is essential to increase access to dietetic care throughout Ghana.

Duration of exclusive breastfeeding and subsequent child feeding adequacy.

OBJECTIVE: Mothers of young children in Ghana believe that breastfeeding exclusively for six months impairs subsequent introduction of other foods. The current study was designed to determine whether feeding adequacy among 9-23 months old children is influenced by duration of exclusive breastfeeding. DESIGN: We surveyed 300 mother-infant pairs attending child-welfare-clinic at the University of Ghana Hospital, Accra. Data collected included sociodemographic characteristics, morbidity, breastfeeding history, and maternal practices and perception on child feeding and temperament. Current child feeding was assessed using 24-hour dietary recall. Adequately fed children were defined as 9-23 month old children meeting three basic feeding adequacy thresholds: 1) was fed complementary foods, at least three times in the last 24 hours, 2) was fed from at least three food groups, and 3) received breast milk in the last 24 hours. Multiple logistic regressions were used to identify independent predictors of child feeding adequacy. RESULTS: About 66% of children were exclusively breastfed for six months and only 56% were adequately fed in the in the 24 hours preceding the survey. Child feeding adequacy was unrelated to duration of exclusive breastfeeding (OR=0.73; p=0.30). After controlling for child sex, age, and maternal education, the independent determinants of feeding adequacy included recent child morbidity (OR=0.41; p=0.03), number of caregivers who feed child (OR=1.33; p=0.03), and maternal perception that child does not like food (OR=0.25; p<0.01). Child temperament was unrelated to feeding adequacy. CONCLUSION: Child feeding adequacy is not affected by duration of exclusive breastfeeding. The study provides evidence to address misperceptions about exclusively breastfeeding for six months.

An exploratory study of physical activity and over-weight in two senior high schools in the Accra Metropolis.

BACKGROUND: Overweight and physical inactivity are major risk factors for non-communicable diseases. However, little evidence on physical activity, and overweight exists to support intervention in specific sub-populations including adolescents in low-income settings like Ghana. This study aimed at estimating overweight and determining the pattern and level of physical activity among senior high school students in the Accra Metropolis. METHODS: A cross-sectional study was conducted in the Accra Metropolis, among senior high school students, ages 15 to 19 years. Participants were selected using a two-stage cluster sampling technique. Structured questionnaire and anthropometric measurement were employed to gather information for the study. Students were considered as overweight if their Body Mass Index (BMI) ≥ +1SD, and obese if BMI ≥ +2SD. RESULTS: Out of 444 students, 17% were classified as engaging in low level physical activity, 49% in moderate activity, and 34% in high level of physical activity. Much of the activity in boys was recreational while among girls, was due to domestic chores. The prevalence of overweight was 11.7%. Overweight prevalence was higher among female students (15.6%) compared to 4.5% in males. Furthermore the risk of overweight was lower among students who engaged in high physical activity than those engaged in low activity. Overweight was independently associated with physical activity (p=0.01), sex (p=0.001) and age (p=0.01), after controlling for age sex and physical activity and diet. CONCLUSION: Majority of students in the study engaged in moderate to high physical activity. The prevalence of overweight was 11.7%. Physical activity was significantly related to overweight among students in the study.

Knowledge, perceptions and ever use of modern contraception among women in the Ga East District, Ghana.

A survey of 332 women, ages 15-49 years, was carried out in the Ga East district of Ghana to identify community knowledge, perceptions, and factors associated with ever using modern family planning (FP). Knowledge of modern FP was almost universal (97 percent) although knowledge of more than three methods was 56 percent. About 60 percent of all and 65 percent of married respondents reported ever use of a modern method. Among ever users, 82 percent thought contraceptives were effective for birth control. However, one-third did not consider modern FP safe. About 20 percent indicated their male partner as a barrier, and 65 percent of users reported at least one side effect. In a multivariate model that controlled for age, education, religion, and occupation, being married remained significantly associated (OR = 2.14; p=0.01) with ever use of a modern contraceptive method. Interventions are needed to address service- and knowledge-related barriers to use.

Knowledge, perceptions and ever use of modern contraception among women in the Ga East District, Ghana

A survey of 332 women, ages 15-49 years, was carried out in the Ga East district of Ghana to identify community knowledge, perceptions, and factors associated with ever using modern family planning (FP). Knowledge of modern FP was almost universal (97 percent) although knowledge of more than three methods was 56 percent. About 60 percent of all, and 65 percent of married respondents reported ever use of a modern method. Among ever users, 82 percent thought contraceptives were effective for birth control. However, one-third did not consider modern FP safe. About 20 percent indicated their male partner as a barrier, and 65 percent of users reported at least one side effect. In a multivariate model that controlled for age, education, religion, and occupation, being married remained significantly associated (OR=2.14; p=0.01) with ever use of a modern contraceptive method. Interventions are needed to address service- and knowledge-related barriers to use (Afr J Reprod Health 2010; 14[4]: 27-32)