Nutritional status of school-age children and adolescents in low- and middle-income countries across seven global regions: a synthesis of scoping reviews.

OBJECTIVE: To summarise available evidence on the nutritional status of school-age children and adolescents (5-19 years) from seven global regions and on interventions implemented to improve malnutrition in this population. SETTING: Global. DESIGN: Findings were compiled from seven scoping literature reviews, including data from low- and middle-income countries within the following UNICEF-defined global regions: East Asia and Pacific; Europe and Central Asia; South Asia; West and Central Africa; Eastern and Southern Africa; Middle East and North Africa and Latin America and the Caribbean. RESULTS: A double burden of malnutrition was evident across the world regions reviewed: stunting, thinness, anaemia and other micronutrient deficiencies persisted, alongside rising overweight and obesity prevalence. Transitions towards diets increasingly high in energy-dense, processed and micronutrient-poor foods were observed. Evidence from intervention studies was limited, but suggested that providing multiple micronutrient-fortified foods or beverages at school may effectively target micronutrient deficiencies and facilitate weight gain in undernourished populations. Interventions to prevent or manage overweight and obesity were even more limited. There was minimal evidence of using novel technological approaches to engage school-age children and adolescents, or of involving them in designing interventions. CONCLUSION: The limited data available on nutrition of school-age children and adolescents are neither standardised nor comparable. Consensus on methods for assessing nutritional status and its determinants for this age group is urgently needed to set targets and monitor progress. Additionally, strategies are required to ensure that nutritious, safe and sustainable diets are available, affordable and appealing.

The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review.

BACKGROUND: Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival. OBJECTIVE: The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and micronutrient status) may influence both susceptibility to, and progression of, COVID-19. METHODS: We synthesized information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity, and diabetes; protein-energy malnutrition; anemia; vitamins A, C, D, and E; PUFAs; iron; selenium; zinc; antioxidants; and nutritional support. For each section we provide: 1) a landscape review of pertinent material; 2) a systematic search of the literature in PubMed and EMBASE databases, including a wide range of preprint servers; and 3) a screen of 6 clinical trial registries. All original research was considered, without restriction to study design, and included if it covered: 1) severe acute respiratory syndrome coronavirus (CoV) 2 (SARS-CoV-2), Middle East respiratory syndrome CoV (MERS-CoV), or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16 May and 11 August 2020. RESULTS: Across the 13 searches, 2732 articles from PubMed and EMBASE, 4164 articles from the preprint servers, and 433 trials were returned. In the final narrative synthesis, we include 22 published articles, 38 preprint articles, and 79 trials. CONCLUSIONS: Currently there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery. However, results of clinical trials are eagerly awaited. Given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. Furthermore, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes. This review is registered at PROSPERO as CRD42020186194.

Clinical learning environment of nursing and midwifery students in Ghana.

BACKGROUND: Data on student experience of the clinical learning environment in Ghana are scarce. We therefore aimed to assess students' evaluation of the clinical learning environment and the factors that influence their learning experience. METHODS: This was a cross-sectional survey of 225 undergraduate nursing and midwifery students. We used the Clinical Learning Environment and Supervision + Nurse Teacher (CLES +T) evaluation scale to assess students' experience of their clinical placement. The association between student demographic characteristics and clinical placement experience was determined using t-test or ANOVA. RESULTS: Most of the sampled students were Nurses (67%) and in the third year of training (81%). More students received supervision from a nurse (57%) during clinical placement and team supervision (67%) was the most common during clinical placement. Nursing students were more likely to rate their clinical experience better than midwifery students (p=0.002). Students who had increased contact with private supervisors were also more likely to rate their experience higher (p=0.002). Clinical experience was also rated higher by students who received successful supervision compared to those who had unsuccessful or team supervision (p=0.001). CONCLUSION: Team supervision is high in health facilities where students undertake clinical placement in Ghana. Frequent contact with private supervisor and successful supervision are associated with better rating of clinical experience among Ghanaian undergraduate nursing and midwifery students.

Household factors and gestational age predict diet quality of pregnant women.

Adequate diet during pregnancy has positive effects on the mother and pregnancy outcome. Assessment of diet quality during pregnancy is particularly important in areas where household food security is suboptimal, to enable appropriate targeting and intervention. This study assessed diet quality and identified predicting factors among pregnant women in northern Ghana. A cross-sectional study involving 403 pregnant women was conducted in May 2018. Pregnant women attending antenatal care clinics (ANC) were selected using simple random sampling technique. We assessed socio-demographic characteristics, 24-h recall and household food security. The minimum dietary diversity for women (MDD-W) was used as a proxy measure for diet quality based on Food and Agricultural Organization (FAO) guidelines. Logistic regression models were fitted to determine the predictors of diet quality. The mean dietary diversity score (DDS) of 10 food groups was 4.4 ± 1.1 (95% CI: 4.3-4.5). Logistic regression showed that women of high educational level (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI] [1.21-4.84]; P = 0.01), women of high household wealth index (AOR = 1.78; 95% CI [1.14-2.77]; P = 0.01], none/mild household hunger (AOR = 2.71; 95% CI [1.26-5.82]; P = 0.01), medium household size (6-15 members) (AOR = 1.66; 95% CI [1.04-2.66]; P = 0.03) and women of gestational age 20-35 weeks (AOR = 1.89; 95% CI [1.05-3.40]; P = 0.03) were more likely to have quality diets after adjusting for potential confounding variables. Diet quality among pregnant women was low and was predicted by educational level, household wealth, gestational age and food security. Women education and improvements in household food security could impact diets of pregnant women in northern Ghana.

Growth monitoring and promotion practices among health workers may be suboptimal despite high knowledge scores.

BACKGROUND: The child health record booklet (CHRB) is a powerful tool for screening children under five and for education of caregivers by health workers. The objective of the present study was to assess the knowledge and utilization of CHRB by mothers and health workers in child growth monitoring and promotion (GMP) in the East Mamprusi Municipal, Northern region, Ghana. METHODS: A descriptive cross-sectional study was conducted among mothers attending child welfare clinics (CWC) and health workers providing GMP at CWC. Observational checklists were used to assess 73 CHRB on the completeness and correctness of growth charts. Mothers and health workers' knowledge on essential components of CHRB were assessed with a questionnaire. RESULTS: Weight measurements were correctly recorded in all booklets analyzed. Even though a greater proportion (70.7%) of health workers exhibited high knowledge scores on the interpretation of the essential components of the CHRB,most of the charts analyzed were not completely filled (72.6%) but rather correctly filled (74.0%). Mean knowedge score (3.4 ± 1.3) on growth charting was low among mothers who attend GMP. Work overload (26.1%), inadequate supply of CHRB (26.1%) and vaccine shortages (18.7%) were concerns raised by health workers on the effective usage of the CHRB. CONCLUSION: Knowledge scores on the child health record booklets among health workers and mothers in this part of northern Ghana were high but charting of growth of children was sub-optimal among health workers.

Ramadan fasting alters food patterns, dietary diversity and body weight among Ghanaian adolescents.

BACKGROUND: Ramadan is a monthlong fast for healthy adolescents and adult Muslims. The quality of foods eaten and eating patterns in Ramadan may be different from other months of the year. Food intake of adolescents is a concern as energy and nutrient requirements are higher and needed to support the growth spurt of this stage. The objective of the present study was to describe the food patterns, dietary diversity and body weight changes among adolescents during Ramadan. METHODS: A prospective cohort study design with four measurement points (baseline, midline, endline and post endline) was conducted among 366 adolescents in Junior High Schools. Food pattern was assessed with a food frequency questionnaire, a 24-h dietary recall was used to assess dietary diversity and body weight was measured using an electronic scale. A repeated measures ANOVA was used to compare changes in dietary diversity scores (DDS) and weight of pupils. RESULTS: Half of the pupils (50.3%) were female and average age was 15.9 ± 1.8 years. Pupils fasted for an average of 28.3 ± 4.0 days and 14.3 ± 0.5 h a day (dawn to dusk) during Ramadan. The number and types of dishes taken at meal times differed substantially between Ramadan periods and outside Ramadan. Consumption of vitamin A-rich fruits, other fruits, and milk and milk products increased markedly during Ramadan. However, fasting came with a reduction in consumption of foods from roots and tubers, legumes and nuts, and dark green leafy vegetables while other food groups remained unchanged. Mean DDS increased significantly during Ramadan (F (2.933, 1070.573) = 7.152, p < 0.001) while mean daily meal frequency decreased (F (2.936, 1071.623) = 51.653, p < 0.001). There was significant body weight loss (-1.5 kg (95% CI: -1.1 kg to -1.6 kg)) among adolescents (F (2.656, 958.95) = 304.90, p < 0.001). Weight loss was short-lived; regained one month after Ramadan. CONCLUSION: In this prospective cohort study among schooling Ghanaian adolescents who fast during Ramadan, fasting was characterised by marked changes in usual food patterns, increased dietary diversity and significant body weight loss.

Addressing future food demand in The Gambia: can increased crop productivity and climate change adaptation close the supply-demand gap?

With rising demand for food and the threats posed by climate change, The Gambia faces significant challenges in ensuring sufficient and nutritious food for its population. To address these challenges, there is a need to increase domestic food production while limiting deforestation and land degradation. In this study, we modified the FABLE Calculator, a food and land-use system model, to focus on The Gambia to simulate scenarios for future food demand and increasing domestic food production. We considered the impacts of climate change on crops, the adoption of climate change adaptation techniques, as well as the potential of enhanced fertiliser use and irrigation to boost crop productivity, and assessed whether these measures would be sufficient to meet the projected increase in food demand. Our results indicate that domestic food production on existing cropland will not be sufficient to meet national food demand by 2050, leading to a significant supply-demand gap. However, investments in fertiliser availability and the development of sustainable irrigation infrastructure, coupled with climate change adaptation strategies like the adoption of climate-resilient crop varieties and optimised planting dates, could halve this gap. Addressing the remaining gap will require additional strategies, such as increasing imports, expanding cropland, or prioritising the production of domestic food crops over export crops. Given the critical role imports play in The Gambia's food supply, it is essential to ensure a robust flow of food imports by diversifying partners and addressing regional trade barriers. Our study highlights the urgent need for sustained investment and policy support to enhance domestic food production and food imports to secure sufficient and healthy food supplies amidst growing demand and climate change challenges. Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-024-01444-1.

Nutrition of School-Aged Children and Adolescents in Europe and Central Asia Region: A Literature and Survey Review.

BACKGROUND: Middle childhood and adolescence are critical times for the growth, development, and establishment of healthy eating habits. The Europe and Central Asia (ECA) region has been through economic and nutrition transitions over the past 20 years, which are likely to have affected the nutritional status of this group. OBJECTIVE: This review aimed to collate data on the nutritional status and dietary patterns of school-aged children (SAC) and adolescents (5-19 years) across the ECA region in order to inform policy and programming decisions. METHODS: A systematic search of the literature in Pubmed, Cochrane, and ScienceDirect databases was conducted (April 2019), complemented by a systematic review of nationally representative surveys. Inclusion criteria were any data on micronutrient deficiencies, overweight, stunting, wasting, thinness, or dietary patterns in SAC and adolescents in the 21 UNICEF-defined countries of ECA, published since the year 2000. RESULTS: Results included 134 published papers and 6 sources of survey data. The majority of studies were conducted in Turkey (56%), with all other countries having fewer than 10 studies each; 8 countries in the region having no studies on this age group at all. The most significant nutrition issue was overweight and obesity. Micronutrient deficiencies, particularly anemia, emerge as a further challenge. Dietary patterns were worse in urban areas and boys. CONCLUSIONS: The findings of this review suggest that there are 3 critical areas that need immediate attention: the promotion of healthy diets and physical activity to address high levels of overweight/obesity, anemia prevention efforts, and addressing the considerable data gaps for SAC and adolescent nutrition.

Socio-economic and food system drivers of nutrition and health transitions in The Gambia from 1990 to 2017.

In common with many nations undergoing a nutrition transition, micronutrient deficiencies, undernutrition and overnutrition coexist in The Gambia. Addressing these challenges simultaneously would require transformational changes in the country's food system. However, the evidence base that would enable informed decision-making in the Gambian food system has been scant, despite several sources of routinely-collected data being available. This descriptive study brings together data from four open-access global databases on food supply, political, economic, and demographic variables, and nutrition and health between 1990 and 2017 to study potential leverage points for improvement in the food system. It compares trends in food supply and nutritional outcomes in The Gambia against regional and global averages, and identifies potential drivers taken from a food systems framework. The data show that, over the past three decades, total energy supply has increased, and obesity is rising quickly, but iron deficiency persists in a proportion of the population. Overall diet composition is poor, with lower availability of fruit and vegetables and higher supply of sugar and oils compared to regional and global averages. Domestic production is low for most food groups and so a high dependence on imports from other countries bridges the gap in terms of energy supply. Measures of economic development, particularly GDP, were positively related with supply of cereals and animal source foods over time, but no such relationship was observed with fruit and vegetable supply. Food system policy to improve nutrition and health outcomes in The Gambia needs to focus on improving the diversity of food supply - especially fruit and vegetables - and maximizing national domestic production to reduce reliance on food imports. The use of open-source global datasets can be feasible in exploring food system characteristics and trends at the national level and could be applied in other contexts.

Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in Ghana.

INTRODUCTION: Despite the gains on exclusive breastfeeding (EBF), recent nationwide surveys have consistently revealed a decline in EBF rates in Ghana. The World Food Programme implemented an intervention for Enhanced Nutrition and Value Chain (ENVAC) which was based on three pillars including pregnant women, lactating women, adolescent and children under two years old being beneficiaries of the third pillar since the first 1000 days are critical for averting malnutrition. The social behavior change communication (SBCC) interventions implemented as part of this project have a potential to increase EBF among beneficiaries but this has not been measured. Therefore, this study assessed the prevalence of EBF practice among mothers with children under two years old who were beneficiaries of the ENVAC project and its associated factors in northern Ghana. METHODS: This was a cross-sectional study involving 339 mother-child pairs in two districts of the northern region of Ghana. Participants were mother-child pairs who benefitted from the ENVAC project, which used SBCC strategies to promote good feeding and care practices as well as address other causes of malnutrition during antenatal care and child welfare clinic services among pregnant women, lactating mothers, and children under two years. We used WHO standard questionnaire to assess breastfeeding practices. Factors associated with EBF were modelled using multivariable logistic regression. RESULTS: Exclusive breastfeeding was 74.6% (95%CI = 69.5% -79.2%) in the ENVAC project areas, a 31.7% points higher than recent national levels. Adjusted analyses showed that EBF practice was associated with increasing maternal education: moderately educated women [aOR = 4.1 (95% CI = 2.17-7.66), P<0.001], and high [aOR = 9.15, (95% CI = 3.3-25.36), P<0.001], and access to pipe-borne water in households [aOR = 2.87, (95% CI = 1.11-7.43), P = 0.029]. CONCLUSION: A social behaviour change communication strategy implemented by ENVAC to lactating mothers likely improved exclusive breastfeeding practice in two districts of northern Ghana. EBF practices were higher among beneficiaries with high education and households with access to pipe-borne water. A combination of SBCC strategies and maternal and household factors are likely the best way to increase EBF rates in impoverished communities and warrants further investigation through future research.

Research priorities for nutrition of school-aged children and adolescents in low- and middle-income countries.

PURPOSE: A lack of data, intervention studies, policies, and targets for nutrition in school-age children (SAC) and adolescents (5-19 years) is hampering progress towards tackling malnutrition. To stimulate and guide further research, this study generated a list of research priorities. METHODS: Using the Child Health and Nutrition Research Initiative (CHNRI) method, a list of 48 research questions was compiled and questions were scored against defined criteria using a stakeholder survey. Questions covered all forms of malnutrition, including micronutrient deficiencies, thinness, stunting, overweight/obesity, and suboptimal dietary quality. The context was defined as research focused on SAC and adolescents, 5 to 19 years old, in low-and middle-income countries, that could achieve measurable results in reducing the prevalence of malnutrition in the next 10 years. RESULTS: Between 85 and 101 stakeholders responded per question. Respondents covered a broad geographical distribution across 38 countries, with the largest proportion focusing on work in East and Southern Africa. Of the research questions ranked in the top ten, half focused on delivery strategies for reaching adolescents and half on improving existing interventions. There were few differences in the ranked order of questions between age groups but those related to in-school children and adolescents had higher expert agreement than those for out-of-school adolescents. The top ranked research question focused on tailoring antenatal and postnatal care for pregnant adolescent girls. CONCLUSION: Nutrition programmes should incorporate implementation research to inform delivery of effective interventions to this age group, starting in schools. Academic research on the development and tailoring of existing nutrition interventions is also needed; specifically, on how to package multisectoral programmes and how to better reach vulnerable and underserved sub- groups, including those out of school.

Comparative study of stunting measurement in children using WHO procedure and Growth Length Mat in Ghana.

OBJECTIVE: Height data is not useful immediately without further processing. The Growth Length Mat (Stunting Mat) was designed to stunting directly. However, the Mat has not been validated for use in Ghana. This study compared stunting measured with the Mat and stunting measured following the WHO recommended procedure. We sampled 163 children aged 6-24 months in the Bono region of Ghana. We also explored the acceptability and interpretability of the two procedures among mothers and healthcare givers. RESULTS: The prevalence of stunting was 3.7% and 11.7% using the Mat and WHO procedures respectively. The Growth Length Mat had very low sensitivity (21.0%) but high specificity (98.6%) of detecting stunting in children. However, in younger aged children, the Mat was more accurate in detecting stunting. Both healthcare workers and caregivers found it easy to interpret the stunting status of children using the Mat. We conclude that the Growth Length Mat was less sensitive at detecting child stunting compared to the current gold standard of measuring stunting in younger children. There are possibilities to improve the accuracy and utility of the Mat for measuring stunting in low-resource settings by re-designing the mat to be more age appropriate.

Changes in Climate Vulnerability and Projected Water Stress of The Gambia's Food Supply Between 1988 and 2018: Trading With Trade-Offs.

Background: The coexistence of under- and overnutrition is of increasing public health concern in The Gambia. Fruits, vegetables and pulses are essential to healthy and sustainable diets, preventing micronutrient deficiencies and non-communicable diseases, while cereals significantly contribute to energy intake. However, environmental changes are predicted to intensify, reducing future yields of these crops if agricultural productivity and resilience are not improved. The Gambia is highly climate-vulnerable and import-dependent, but the extent of its reliance on other climate-vulnerable countries for its supply of nutritionally important crops is currently unknown. Methods: We used United Nations Food and Agriculture Organization data, with novel origin-tracing algorithms applied, to analyse The Gambia's supply of cereals, fruits, vegetables and pulses between 1988 and 2018. The climate vulnerability of countries was assessed using Notre Dame Global Adaptation Initiative (ND-GAIN) index scores, and projected water stress (2040) assessed using World Resources Institute (WRI) scores. Multilevel generalized linear mixed-effects models were used to identify changes in the overall climate vulnerability and projected water stress of supply. Results: Between 1988 and 2018, The Gambia's supply of cereals, fruits, vegetables and pulses diversified, with the proportion domestically produced falling (Cereals: 61.4%-27.7%; Fruits: 93.0%-55.7%; Vegetables: 24.6%-16.3%; Pulses: 100.0%-76.0%). The weighted-average ND-GAIN scores improved (indicating less climate vulnerability) for supply of all crops except cereals, but the weighted-average WRI score for supply deteriorated (indicating increased projected water stress) for all crops except vegetables. When just considering imports, weighted-average ND-GAIN scores deteriorated for fruits and cereals while showing no significant change for other food groups, and the WRI score deteriorated for cereals only. Conclusions: Despite some notable improvements in the environmental vulnerability of The Gambia's supply of nutritionally important crops (particularly vegetables), considerable, and in some cases increasing, proportions of their supply are produced in countries that are vulnerable to climate change and future water stress. This may have implications for the availability, affordability, and hence consumption of these crops in The Gambia, ultimately exacerbating existing nutritional challenges. Exploring the options to strengthen supply resilience-such as altering trade patterns, agricultural techniques and diets-should be prioritized.

Adherence to EAT-Lancet dietary recommendations for health and sustainability in the Gambia.

Facilitating dietary change is pivotal to improving population health, increasing food system resilience, and minimizing adverse impacts on the environment, but assessment of the current 'status-quo' and identification of bottlenecks for improvement has been lacking to date. We assessed deviation of the Gambian diet from the EAT-Lancet guidelines for healthy and sustainable diets and identified leverage points to improve nutritional and planetary health. We analysed the 2015/16 Gambian Integrated Household Survey dataset comprising food consumption data from 12 713 households. Consumption of different food groups was compared against the EAT-Lancet reference diet targets to assess deviation from the guidelines. We computed a 'sustainable and healthy diet index (SHDI)' based on deviation of different food groups from the EAT-Lancet recommendations and modelled the socio-economic and geographic determinants of households that achieved higher scores on this index, using multivariable mixed effects regression. The average Gambian diet had very low adherence to EAT-Lancet recommendations. The diet was dominated by refined grains and added sugars which exceeded the recommendations. SHDI scores for nutritionally important food groups such as fruits, vegetables, nuts, dairy, poultry, and beef and lamb were low. Household characteristics associated with higher SHDI scores included: being a female-headed household, having a relatively small household size, having a schooled head of the household, having a high wealth index, and residing in an urban settlement. Furthermore, diets reported in the dry season and households with high crop production diversity showed increased adherence to the targets. While average Gambian diets include lower amounts of food groups with harmful environmental footprint, they are also inadequate in healthy food groups and are high in sugar. There are opportunities to improve diets without increasing their environmental footprint by focusing on the substitution of refined grains by wholegrains, reducing sugar and increasing fruit and vegetables consumption.

Grassroots and Youth-Led Climate Solutions From The Gambia.

Climate change and environmental degradation are among the greatest threats to human health. Youth campaigners have very effectively focused global attention on the crisis, however children from the Global South are often under-represented (sometimes deliberately) in the dialogue. In The Gambia, West Africa, the impacts of climate change are already being directly experienced by the population, and this will worsen in coming years. There is strong government and community commitment to adapt to these challenges, as evidenced by The Gambia currently being the only country on target to meet the Paris agreement according to the Nationally Determined Contributions, but again children's voices are often missing-while their views could yield valuable additional insights. Here, we describe a "Climate Change Solutions Festival" that targeted and engaged school children from 13 to 18 years, and is to our knowledge, the first peer-to-peer (and student-to-professional) learning festival on climate change solutions for students in The Gambia. The event gave a unique insight into perceived climate change problems and scalable, affordable and sometimes very creative solutions that could be implemented in the local area. Logistical and practical methods for running the festival are shared, as well as details on all solutions demonstrated in enough detail to be duplicated. We also performed a narrative review of the most popular stalls to explore the scientific basis of these solutions and discuss these in a global context. Overall, we find extremely strong, grass-roots and student engagement in the Gambia and clear evidence of learning about climate change and the impacts of environmental degradation more broadly. Nevertheless, we reflect that in order to enact these proposed local solutions further steps to evaluate acceptability of adoption, feasibility within the communities, cost-benefit analyses and ability to scale solutions are needed. This could be the focus of future experiential learning activities with students and partnering stakeholders.

Free Senior High School Lunch Contributes to Dietary Quality of Nonresidential Students in Ghana.

BACKGROUND: School feeding offers an excellent opportunity for targeted intervention to students not only as means for improving educational outcomes but also enhancing nutritional outcomes. The Government of Ghana introduced the free lunch feeding policy for nonresidential students in senior high schools (SHS) in 2018. OBJECTIVE: We assessed unintended benefits of the free lunch program to dietary improvement. METHODS: This was an analytical cross-sectional study among 403 (202 beneficiary and 201 non-beneficiary) students in SHS. The Food and Agriculture Organization's standard procedure for measuring dietary diversity score (DDS) was followed. A 3-day dietary recall was used to assess school day DDS, while a 24-hour recall was used to assess weekend DDS of students. Differences in DDS and food group consumption were determined using student t test and χ2 test, respectively. RESULTS: Nearly all (98.5%) beneficiary students consumed the free school lunch and 7 (70%) in 10 of them consumed it on all school days. While the students did not differ in their weekend meal DDS (6.3 ± 1.4 vs 6.5 ± 1.4, P = .39), beneficiaries of the school lunch had higher lunch DDS (7.5 ± 0.5 vs 6.5 ± 1.4, P < .001) and whole day DDS (11.5 ± 1 vs 9.3 ± 2.0, P < .001) compared to non-beneficiary students on school days. Even though the school lunch increased food group intake, vitamin-A rich vegetables and tubers, fruits, flesh and organ meats, and dairy products were hardly provided as components of school lunch. CONCLUSION: Provision of free school lunch meal to nonresidential students in SHSs in Ghana could contribute to improved diet quality.

Characteristics of Distinct Dietary Patterns in Rural Bangladesh: Nutrient Adequacy and Vulnerability to Shocks.

Food security in Bangladesh has improved in recent years, but the country is now facing a double burden of malnutrition while also being highly vulnerable to climate change. Little is known about how this may affect food supply to different sectors of the population. To inform this, we used a national dietary survey of 800 rural households to define dietary patterns using latent class analysis. Nutrient adequacy of dietary patterns and their potential vulnerability to climate shocks (based on diversity of calorie sources) were assessed. We fitted mixed effects logistic regression models to identify factors associated with dietary patterns. Four dietary patterns were identified: rice and low diversity; wheat and high diversity; pulses and vegetables; meat and fish. The wheat and high diversity and meat and fish patterns tended to be consumed by households with higher levels of wealth and education, while the rice and low diversity pattern was consumed by households with lower levels of wealth and education. The pulses and vegetables pattern was consumed by households of intermediate socio-economic status. While energy intake was high, fat and protein intake were suboptimal for all patterns except for the wheat and high diversity pattern. All patterns had fruit and vegetable intake below the WHO recommendation. The wheat and high diversity pattern was least vulnerable to shocks, while the rice and low diversity pattern was the most vulnerable, relying mainly on single cereal staples. The diets showed "double vulnerability" where the nutrient inadequate patterns were also those most vulnerable to shocks.

Special foods and local herbs used to enhance breastmilk production in Ghana: rate of use and beliefs of efficacy.

BACKGROUND: Inadequate breastmilk production is one of the key factors associated with suboptimal breastfeeding. In most local African homes, special herbs and some food items are commonly used to promote breastmilk production (known as lactogogue/galactogogue). We describe the use and characterize the herbs and food items used to promote breastmilk production in two regions of Ghana. METHODS: We conducted a cross-sectional study in 2018 involving 402 lactating mothers. The range of foods used as lactogogues was obtained from 20 participants through focus group discussions. Quantitative data on demographics, lactogogue use and feeding practices were obtained through questionnaire administration. RESULTS: The mean age of women was 29.2 years and children were 10 months. Breastmilk production problems were low (22.4%) and the majority of lactating mothers felt they had adequate breastmilk (70.4%) but awareness about lactogogues was widespread in both regions (88.8%) and highest in the Brong-Ahafo region (90.0%). Information about lactogogues was mainly from grandparents (24.6%), parents (31.6), health facilities (16.5%) and friends (12.8%), while the media had little influence (< 1%). The majority of the mothers used lactogogues to enhance breastmilk production (67.7%), and a quarter of them used lactogogues because of their tradition (25.2%). Prevalence of lactogogue use was 83.8%, lactogogues were prepared separate from household meals (59.4%) and consumed one to three times a day (89.6%). Users felt the effectiveness within 24 h of use (98.5%). The most common lactogogues included; groundnut/peanut soup prepared with Bra leaves (Hibiscus sabdariffa), hot black tea, Werewere/Agushi (Citrulus colocynthis) prepared with Bra leaves, and Abemudro (a polyherbal formulation). Only 13.2% of lactating mothers also used lactogogues during pregnancy. CONCLUSIONS: Special foods and selected herbs are widely used to enhance breastmilk production in Ghana and constitute an important part of the diet of lactating mothers. These results could contribute to understanding breastfeeding behaviours and stimulate further research into evaluating the safety and scientific efficacy of these products in Ghana.