A school-based food and nutrition education intervention increases nutrition-related knowledge and fruit consumption among primary school children in northern Ghana.

BACKGROUND: Providing children with the opportunity to learn about nutrition is critical in helping them establish a healthy lifestyle and eating behaviours that would remain with them till adulthood. We determined the effect of a school-based food and nutrition education (SFNE) intervention on the nutrition-related knowledge, attitudes, dietary habits, physical activity levels and the anthropometric indices (BMI-for-age z scores, %Body fat and waist circumference) of school-age children in northern Ghana. METHODS: Following a controlled before-and-after study design, we recruited school-age children in primary 4 and 5 from public and private schools and assigned them non-randomly to intervention and control groups (4 schools total). A SFNE intervention called 'Eat Healthy, Grow Healthy (EHGH)' was implemented in intervention schools. Components of the intervention included children, teachers, school officials, and the school environment. Nutrition education didactic sessions, active discussions, nutrition games, charades, art work, and physical activity sessions were among the teaching and learning activities implemented. At 0 and 6 months, primary (anthropometry) and secondary (fruit, vegetable, and breakfast consumption) outcomes were obtained. RESULTS: Mean BMI-for-age z-scores did not differ significantly between intervention and control groups (F1,261 = 0.45, P = 0.503, η2 = 0.01). However, significantly greater nutrition-related knowledge scores were recorded in the intervention group than in the control group at post-intervention (M = 6.07 SD = 2.17 vs. M = 5.22 SD = 1.92; p = 0.002). Mean number of days intervention children consumed fruits differed across time (F1, 263 = 33.04, p = 0.002, η2 = 0.04) but not between the control and intervention groups (F1, 263 = 0.28, p = 0.60, η2 = 0.00). CONCLUSIONS: The EHGH intervention had positive effects on the nutrition-related knowledge and the consumption of fruits among children although it did not impact their anthropometric indices.

Utilization of growth monitoring and promotion is highest among children aged 0-11 months: a survey among mother-child pairs from rural northern Ghana.

BACKGROUND: More than half of all deaths in under 5 children is related to malnutrition. Child malnutrition could be prevented through regular monitoring of the growth and development of children and the implementation of growth promotion activities referred to as growth monitoring and promotion (GMP). Mothers'/caregivers utilization of these activities through child welfare clinics could improve the growth and development of under 5 children. We evaluated mothers' knowledge on GMP, utilization and associated factors among mother-child pairs from a poor socio-economic district in Northern Ghana. METHODS: Using an analytical cross-sectional design, participants included mothers with children aged 0-59 months, grouped into 0-11 months, 12-23 months and 24-59 months. A semi-structured questionnaire containing both closed- and open-ended questions was used to collect data. Multivariate logistic regression was used to identify determinants of GMP utilization. RESULTS: Four hundred mother-child pairs were included in the study. Overall, 28.5% (n = 114) of the mothers utilized GMP services. Almost 60%(n = 237) of the mothers knew the recommended age to seek for GMP service for their children. Only 9% of the mothers could correctly interpret the directions of the growth curves in their children's Health Record booklet. Mothers with children aged 0-11 months were 3.9 times more likely (p = 0.009) to utilize GMP services compared to their counterparts with children aged 12-23 months and 24-59 months. Mothers who had low level of knowledge were 2.19 times (p = 0.003) more likely to utilize GMP services compared to their counterparts with high level of knowledge.. CONCLUSION: Utilization of GMP services was low and particularly lower in children aged 24-59 months. Mothers' knowledge in GMP was optimal although there were notable gaps.

A systematic review of adherence to diabetes self-care behaviours: Evidence from low- and middle-income countries.

AIMS: To determine diabetes patient's adherence to five self-care behaviours (diet, exercise; medication, self-monitoring of blood glucose [SMBG] and foot care) in low- and middle-income countries. DESIGN: Systematic review. DATA SOURCES: We searched MEDLINE, CINAHL, PUBMED, SCOPUS, PsycINFO, EMBASE, Cochrane library and EMCARE for the period January 1990 - June 2017. REVIEW METHODS: Title, abstract and full text screening were done according to eligibility criteria. A narrative synthesis of the literature was conducted. RESULTS: A total of 7,109 studies were identified of which 27 met the review eligibility criteria and were included. All the studies used self-report of adherence to diabetes self-care. Studies reported adherence rates in two major forms: (a) mean number of days participants performed a recommended dietary behaviour/activity during the past week; and (b) proportions of participants adhering to a recommended self-care behaviour. Mean number of days per week participants adhered to a self-care behaviour ranged from 2.34.6 days per week for diet, 5.5-6.8 days per week for medication, 1.8-5.7 days per week for exercise, 0.2-2.2 days per week for SMBG and 2.2-4.3 days per week for foot care. Adherence rates ranged from 29.9%-91.7% for diet, 26.0%-97.0% for medication taking, 26.7%-69.0% for exercise, 13.0%-79.9% for self-monitoring of blood glucose and 17.0%-77.4% for foot care. CONCLUSION: Although most diabetes patients do not adhere to recommended self-care behaviours, adherence rates vary widely and were found to be high in some instances. IMPACT: Health services in low- and middle-income countries should monitor adherence to diabetes self-care behaviours rather than assume adherence and resources should be invested in improving adherence to the self-care behaviours. Large-scale accurate monitoring of adherence to diabetes self-care behaviour is needed and consideration should be given to choice of measurement tool for such exercise.

Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives.

AIMS AND OBJECTIVES: To explore patient and healthcare provider (HCP) perspectives about patients' barriers to the performance of diabetic self-care behaviours in Ghana. BACKGROUND: Sub-Saharan African urban populations are increasingly affected by type 2 diabetes due to nutrition transition, sedentary lifestyles and ageing. Diabetic self-care is critical to improving clinical outcomes. However, little is known about barriers to diabetic self-care (diet, exercise, medication taking, self-monitoring of blood glucose and foot care) in sub-Saharan Africa. DESIGN: Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. METHODS: Semi-structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Interviews were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used and identified themes classified according to constructs of the theory of planned behaviour (TPB): attitudes/behavioural beliefs, subjective norms and perceived behavioural control. RESULTS: Barriers relating to attitudes included misconceptions that diabetes was caused by spiritual forces or curses, use of herbal medicines, intentional nonadherence, difficulty changing old habits, and feeling or lacking motivation to exercise. Barriers relating to subjective norms were inadequate family support, social stigma (usually by spouses and other members of the community) and cultural beliefs. Perceived behavioural control barriers were poor income levels, lack of glucometers, busy work schedules, long distance to the hospital and inadequate access to variety of foods due to erratic supply of foods or seasonality. CONCLUSIONS: Both patients and HCPs discussed similar barriers and those relating to attitude and behavioural control were commonly discussed. RELEVANCE TO CLINICAL PRACTICE: Interventions to improve adherence to diabetic self-care should focus on helping persons with diabetes develop favourable attitudes and how to overcome behavioural control barriers. Such interventions should have both individualised and community-wide approaches.

Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study.

Background: Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students' perspectives on health professionals' nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting. Methods: Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process. Results: Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health-care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors' advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient. Discussion: Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients.

Why nutrition education is inadequate in the medical curriculum: a qualitative study of students' perspectives on barriers and strategies.

BACKGROUND: The provision of nutrition care by doctors is important in promoting healthy dietary habits, and such interventions can lead to reductions in disease morbidity, mortality, and medical costs. However, medical students and doctors report inadequate nutrition education and preparedness during their training at school. Previous studies investigating the inadequacy of nutrition education have not sufficiently evaluated the perspectives of students. In this study, students' perspectives on doctors' role in nutrition care, perceived barriers, and strategies to improve nutrition educational experiences are explored. METHODS: A total of 23 undergraduate clinical level medical students at the 5th to final year in the School of Medicine and Health Sciences of the University for Development Studies in Ghana were purposefully selected to participate in semi-structured individual interviews. Students expressed their opinions and experiences regarding the inadequacy of nutrition education in the curriculum. Each interview was audio-recorded and later transcribed verbatim. Using the constant comparison method, key themes were identified from the data and analysis was done simultaneously with data collection. RESULTS: Students opined that doctors have an important role to play in providing nutrition care to their patients. However, they felt their nutrition education was inadequate due to lack of priority for nutrition education, lack of faculty to provide nutrition education, poor application of nutrition science to clinical practice and poor collaboration with nutrition professionals. Students opined that their nutrition educational experiences will be improved if the following strategies were implemented: adoption of innovative teaching and learning strategies, early and comprehensive incorporation of nutrition as a theme throughout the curriculum, increasing awareness on the importance of nutrition education, reviewing and revision of the curriculum to incorporate nutrition, and involving nutrition/dietician specialists in medical education. CONCLUSION: Though students considered nutrition care as an important role for doctors they felt incapacitated by non-prioritisation of nutrition education, lack of faculty for teaching of nutrition education, poor application of nutrition science and poor collaboration with nutrition professionals. Incorporation of nutrition as a theme in medical education, improving collaboration, advocacy and creating enabling environments for nutrition education could address some of the barriers to nutrition education.

Adherence to and factors associated with self-care behaviours in type 2 diabetes patients in Ghana.

BACKGROUND: Previous research has failed to examine more than one self-care behaviour in type 2 diabetes patients in Ghana. The purpose of this study is to investigate adult Ghanaian type 2 diabetes patients' adherence to four self-care activities: diet (general and specific), exercise, self-monitoring of blood glucose (SMBG) and foot care. METHODS: Consenting type 2 diabetes patients attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the Summary of Diabetes Self-Care Activities Measure, and questions about demographic characteristics and diabetes history. Height and weight were also measured. Multiple linear regression analyses were conducted to identify the factors associated with adherence to each of the four self-care behaviours. RESULTS: In the last 7 days, participants exercised for a mean (SD) of 4.78 (2.09) days and followed diet, foot care and SMBG for a mean (SD) of 4.40 (1.52), 2.86 (2.16) and 2.15 (0.65) days, respectively. More education was associated with a higher frequency of reported participation in exercise (r = 0.168, p = 0.022), following a healthy diet (r = 0.223, p = 0.002) and foot care (r = 0.153, p = 0.037) in the last 7 days. Males reported performing SMBG (r = 0.198, p = 0.007) more frequently than their female counterparts. CONCLUSION: Adherence to diet, SMBG and checking of feet were relatively low. People with low education and women may need additional support to improve adherence to self-care behaviours in this type 2 diabetes population.

The effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in rural communities in Ghana.

BACKGROUND: Career choices and placements of healthcare professionals in rural areas are a major problem worldwide, and their recruitment and retention to these areas have become a challenge to the health sector. The purpose of this study was to investigate the effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in a rural area. METHOD: This cross sectional survey was conducted among 56 pioneering graduates that followed a Problem Based Learning/Community Based Education and Service (PBL/COBES) curriculum. Using a mixed methods approach, open-and closed-ended questionnaire was administered to 56 graduates. Cross tabulation using Chi-square test were used to compare findings of the quantitative data. All qualitative data analysis was performed using the principles of primary, secondary and tertiary coding. RESULTS: All 56 graduates answered and returned the questionnaire giving a 100 % response rate. 57.1 % (32) of them were male. Majority of them lived in towns (41.1 %) and cities (50 %) prior to medical school. A significant number of graduates (53.6 %,) from the cities, without any female or male predominance said COBES had influenced their choice of specialty. Again, a significant proportion of graduates from the towns (60.9 %,) and cities (67.8 %,), indicated that COBES had influenced them to work in the rural area. However, there was no significant difference between males and females from the towns and cities regarding the influence of COBES to work in the rural area. Qualitative data supported the finding that COBES will influence graduates willingness to work in the rural area CONCLUSION: The majority of graduates from the towns and cities in Ghana, with a male predominance, indicated that COBES may have influenced their choice of specialty and willingness to practice in the rural areas despite their town or city based upbringing.

Psychometric properties of the dundee ready educational environment measure in a sample of Ghanaian Medical Students.

BACKGROUND: The Dundee Ready Educational Environment Measure (DREEM) has been widely accepted and recognized for the assessment of the educational environment in a variety of health professions education programs. Concerns regarding the psychometric properties of the DREEM have been raised. This study evaluated the psychometric properties of the DREEM in a sample of Ghanaian medical students following a problem-based learning curriculum. METHODS: A sample of 234 second to fourth year medical students of the University for Development Studies, School of Medicine and Health Sciences were invited to complete the DREEM questionnaire. Psychometric measures employed included Cronbach's alpha analysis, confirmatory factor analysis and principal component analysis with varimax rotation. RESULTS: The internal consistency for the overall DREEM was 0.92. Apart from two subscales that had Cronbach's alpha values < 0.70, the remainder had values ranging from 0.73 - 0.78. Confirmatory factor analysis did not support the original five factor structure of the DREEM. Large significant correlation coefficients were found between the five factors raising concerns about the independency of the individual subscales. Exploratory factor analysis suggested various factor solutions ranging from 4 to 14 factors. The four factor structure was interpretable and was maintained. All of the four factors achieved eigenvalues > 1, and in total they accounted for 37.6% of the variance. Alpha values for the subscales of the new four factor structure ranged from 0.618 - 0.915. DISCUSSION: The overall internal consistency of the DREEM was found to be excellent. The internal consistency of the individual subscales was variable, as two subscales had alpha values < 0.70 and the remainder exceeding 0.70. The original five factor structure of the DREEM was not supported. Exploratory factor analysis suggested a four factor solution as a possible alternative to the five factor structure of the DREEM.

Awareness, use and associated factors of emergency contraceptive pills among women of reproductive age (15-49 years) in Tamale, Ghana.

BACKGROUND: Emergency contraceptive pills (ECPs) are one of the means by which women can use after intercourse to prevent pregnancy. ECPs can be used to reduce the prevalence of unwanted pregnancies and unsafe abortions. This study investigated awareness and use of ECPs among reproductive age (15-49 years) women in Tamale, Ghana. Factors associated with the use of ECPs were also investigated. METHODS: This cross sectional study was conducted among 200 women of reproductive age (15-49 years) in Tamale, Ghana. Data on socio-demographic variables, awareness and usage of ECPs were assessed by means of a previously validated questionnaire. Univariate and multivariate logistic regression analyses were performed to identify factors associated with the use of ECPs. RESULTS: Awareness level of ECPs were found to be 69.0% (n = 138); 42.8% (n = 59) got the awareness from a health worker, 31.8% (n = 44) from the radio/TV and 25.4% (n = 35) from family members/friends. Eighty-five percent (n = 117) knew the correct time-frame for an effective use of ECP to prevent pregnancy. Forty percent (39.9%, n = 55) of the participants who had awareness have ever used ECPs. Factors that were found to be associated with the use of ECPs were; participants who said ECPs were affordable (AOR = 6.1, 95% CI = 2.51-10.40, p = 0.001), available (AOR 2.1, 95% CI = 0.61-6.01, p = 0.001), cultural (AOR = 3.5, 95% CI = 1.01-10.15, p = 0.011) and religious unacceptable (AOR = 4.0, 95% CI = 1.02-10.0, p = 0.005). CONCLUSION: A relatively high level of awareness and usage of ECPs was found. Factors that were associated with the use of ECPs were availability and affordability. Cultural and religious unacceptability did not hinder the use of ECPs. Health authorities should continue to make ECPs available to women of reproductive age.

Adherence to Iron and Folic Acid Supplementation Among Pregnant Women From Northern Ghana.

Iron and folic Acid (IFA) supplementation is an effective intervention for reducing the incidence of anaemia during pregnancy. The WHO recommends at least 6 months intake of IFA to pregnant women. However, in Ghana some women experience challenges with adhering to IFA supplementation. The main objective of the study was to assess the level of adherence to iron and folic acid supplementation and its associated factors among pregnant women in a peri-urban municipality in Northern Ghana. A cross-sectional study was conducted from March to December 2021 among 400 pregnant women who attended ANC in Sagnarigu municipality in Ghana and were selected through a 3-stage random sampling technique. A structured questionnaire was used to collect data. The data were analysed using descriptive statistics, univariate and binary logistic regression statistical tools. Self-reported level of adherence to iron and folic acid supplementation was 84.5%. Knowledge of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) was associated with adherence. Three other factors: time of first antenatal visit (AOR = 0.32: 0.153, 0.649) having history of anaemia [AOR = 2.67: 1.373, 5.201] having side effects of IFA [AOR = 3.70, CI: (1.756, 7.793)], and having knowledge of management of side effects of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) were found to be significantly associated with adherence. Adherence to iron and folic supplementation among the pregnant women was generally frequent. Strategies to increase iron and folic acid supplementation adherence among pregnant women could focus on encouraging pregnant women to have early ANC visits and educating them on how to manage side effects.

A scoping review of nutrition education interventions to improve competencies, lifestyle and dietary habits of medical students and residents.

We reviewed the available research and gave an overview of the effects of nutrition education interventions (NEIs) on medical students' and residents' knowledge of nutrition, attitudes towards nutrition care, self-efficacy, dietary practices and readiness to offer nutrition care. From 28 May through 29 June 2021, we searched Google Scholar, PubMed, ProQuest, Cochrane and ProQuest to retrieve 1807 articles. After conducting de-duplication and applying the eligibility criteria and reviewing the title and abstract, 23 papers were included. The data were descriptively and narratively synthesised, and the results were displayed as frequencies, tables and figures. Twenty-one interventions were designed to increase participants' knowledge of nutrition-related topics, and eighteen studies found that nutrition knowledge had significantly improved post-intervention. Only four of the eleven studies that reported on attitudes about nutrition post-intervention showed a meaningful improvement. The self-efficacy of participants was examined in more than half of the included studies (n 13, 56⋅5 %), and eleven of these studies found a significant increase in the participants' level of self-efficacy to offer nutrition care post-intervention. At the post-intervention point, seven interventions found that dietary and lifestyle habits had significantly improved. The review demonstrated the potential of NEIs to enhance participants' dietary habits and nutrition-related knowledge, attitudes and self-efficacy. Reduced nutrition knowledge, attitude and self-efficacy scores during the follow-up, point to the need for more opportunities for medical students and residents to learn about nutrition after the intervention.

Preparedness of medical students to provide nutrition care following a nutrition education intervention.

BACKGROUND: Globally, 71% of deaths are due to non-communicable diseases (NCDs) of which 77% of these deaths occur in low-and-middle income countries. Nutrition is an important contributor to the occurrence, progression and management NCDs. Health care professionals' promotion of the adoption of healthy dietary habits among individuals has been shown to reduce the occurrence of NCDs. We assessed the effects of a nutrition education intervention on medical students' self-perceived preparedness to provide nutrition care. METHODS: We administered a pre, post and four-weeks follow-up questionnaire to second year medical students who participated in a nutrition education intervention that adapted varied teaching and learning activities. Outcomes were self-perceived preparedness, relevance of nutrition education and perceived need for further training in nutrition. Repeated measures and Friedman tests were used to assess differences in mean scores across pre, post and 4-weeks follow up assessment based on p < 0.5 at 95% confidence interval. RESULTS: The proportion of participants who felt prepared to provide nutrition care increased significantly (p = 0.001) from 38% (n = 35) at baseline to 65.2% (n = 60) immediately post-intervention and to 63.2% (n = 54) at 4-weeks follow-up. At baseline, 74.2% (n = 69) of the students perceived nutrition education to be relevant to their future career as medical doctors which increased to 85% (n = 78) immediately after the intervention (p = 0.026) and to 76% (n = 70) 4-weeks follow-up. The proportion of participants who reportedly said they will benefit from further training in nutrition increased from 63.8% (n = 58) at pre-intervention to 74.0% (n = 68) at post-intervention (p = 0.016). CONCLUSION: An innovative, multiple-strategy nutrition education intervention can improve medical students' self-perceived preparedness to provide nutrition care.

Nutrition education intervention improves medical students' dietary habits and their competency and self-efficacy in providing nutrition care: A pre, post and follow-up quasi-experimental study.

Objective: Most doctors and medical students report inadequate competencies in nutrition care. We evaluated the impact of a nutrition education intervention on medical students' lifestyle habits, dietary diversity, nutrition care knowledge, attitude toward nutrition care, and their level of self-efficacy in the provision of nutrition care. Methods: All 2nd-year medical students were enrolled into a 5 week, 24-h nutrition education intervention that involved both deductive and practical sessions. Pre-, post and 4 weeks follow-up assessments were conducted. Results: At post- and 4-weeks post-intervention the number of days participants consumed vegetables and engaged in moderate-to-vigorous physical activity significantly (p = 0.003 and 0.002) improved respectively from baseline. Mean nutrition care knowledge scores of participants increased by 3.27 points (95% Cl: 1.98-4.56, p < 0.001) from 19.49 at baseline through to 24.78 post- and 22.76 4 weeks follow-up. No significant [ X ( 2 ) 2 = 1.568, p = 0.457] change in mean attitude toward nutrition care score was recorded. Mean level of self-efficacy in the provision of nutrition care improved significantly by 1.73 (95% Cl: 1.17-2.28, p < 0.001) at post-intervention and 4 weeks follow-up compared to the baseline scores. Conclusion: The intervention improved the nutrition care knowledge, self-efficacy in the provision of nutrition care as well as medical students' own consumption of vegetables, dietary diversity and their engagement in moderate-to-vigorous physical activity. However, continuous implementation of nutrition education interventions is needed to sustain these outcomes and further improve the nutrition education experience of medical students.

The competence of street food vendors to provide nutritious and safe food to consumers: a cross-sectional survey among street food vendors in Northern Ghana.

Increasingly most people have their meals outside their homes and are vulnerable to illnesses caused by unsafe foods. Unsafe food preparation and supply by vendors have made food safety a concern for public health. The present study evaluated the nutrition knowledge, attitude and food safety and hygienic practices of street food vendors (SFVs) in Northern Ghana. An analytical cross-sectional study design was conducted among 424 SFVs, and the data were collected using questionnaires and observation. The mean ± sd nutrition knowledge score of the SFVs was 7⋅08 ± 1⋅75 in which the majority of the participants (68⋅6 %) knew foods that help fight diseases and build immunity. The mean ± sd food safety and hygienic practice score was 7⋅61 ± 2⋅66 with more than half of the participants reportedly not using hand gloves while preparing and serving food. Factors that were associated with food safety and hygienic practices of the SFVs were level of education (ß = -0⋅36, P < 0⋅001), number of hours worked (ß = 0⋅15, P = 0⋅002), food hygiene and safety knowledge (ß = 0⋅21, P = 0⋅002), having a business certificate (ß = -0⋅15, P = 0⋅004) and having medical check-up (ß = 0⋅11, P = 0⋅029). The food safety and hygienic practices of the SFVs may constitute a food safety risk to consumers. Improving food safety and hygiene knowledge may be important but regular monitoring and check-up by the FDA could result in SFVs following the required food safety and hygienic practices.

Reported dietary habits and lifestyle behaviors of students before and during COVID-19 lockdown: A cross-sectional survey among university students from Ghana.

Background: COVID-19 lockdowns involved precautions and social rules that resulted in drastic changes to daily life activities in every setting. University students were not left out as their education was affected and they had to resort to online learning from their homes. The lockdowns did not only affect their education but also potentially affected their dietary habits and lifestyle behaviors. We evaluated the reported dietary habits and lifestyle behaviors of students from a Ghanaian University before and during the COVID-19 lockdown. Materials and Methods: Following a cross-sectional design, 220 students were recruited from the University for Development Studies in Ghana. Data was collected by means of an online questionnaire. Chi-square test (χ2 ) analysis was used to examine associations among variables. Results: About 59% of the students skipped meals before COVID-19 whereas 47.8% skipped meals during the COVID-19 lockdown. While 64.1% consumed homemade meals before the COVID-19, 82.3% consumed homemade meals during the COVID-19 lockdown. In addition, there was a significant increase in the consumption of homemade food (p < 0.001), level of healthy foods choices (p = 0.029), and a reduced skipping of meals (0.014) during the COVID-19 lockdown. Again, 56.4% of the students engaged in exercise before the lockdown while 45% participated in exercise during the lockdown. Conclusions: The lockdown had an impact on some of the dietary and lifestyle habits of the students. University students should be supported with appropriate nutrition education and counseling programs to help them adopt healthy dietary and lifestyle habits.

Food advertisement influences food decision making and not nutritional status: a study among university students in Ghana.

BACKGROUND: Consumers are exposed to a wide range of advertisements through different channels daily, which tends to have an influence on their food decision making. The aim of this study was to evaluate the different forms of food advertisements students are exposed to on campus and how they influence their food choices and nutritional status. METHODS: This cross-sectional study was conducted to find out the influence of different forms of food advertisements on students' food choices and nutritional status. A self-reported semi-structured questionnaire was used to elicit responses from 367 students. About 51.5% of the students were females and 48.5% males. Body Mass index (BMI) was derived from weight and height measured according to standard procedures. Data was analysed and presented as frequencies and percentages. Chi-square was used to determine association between categorical variables (socio-demographic characteristics, food choices and nutritional status). RESULTS: The students reported 'use of internet' (58.9%) as the main source of food advertisement on campus, followed by television (21.0%). A large number of students (74.9%) were affirmative about food advertisements influencing their food decision making. Those with poor nutritional status (underweight, overweight and obese) were more likely to patronize sugar sweetened beverages (10.1%) as compared to fruits and vegetables (1.4%). There was statistical significance (p = 0.003) for type of food patronized due to advertisement and the source of advertisement. However, there was no statistical significance (p = 0.832) for type of food patronized due to advertisement and BMI of students. CONCLUSION: Owing to the increased patronage of internet and television as channels of food advertisements by students, policy makers should prioritize the designing and implementation of intervention programmes through these channels that would influence healthy food decision making and promote consumption of nutrient rich foods. As this population has high self-reported advertisements' influence on food choices, it is vital to investigate further the influence of contextual cues such as environment and advertisement on their eating habits and dietary patterns.

Determinants of Nutrition Care Practice by Midwives and Nurses in the Antenatal and Postnatal Care Settings: A Multi-Site Cross-Sectional Survey From Ghana.

Aim. Midwives and nurses are critical in nutrition care for pregnant women and lactating mothers. Ghanaian nurses and midwives' perception of the adequacy and their satisfaction with nutrition education received during training in school, level of nutrition care competencies, and nutrition practice behavior is unknown. We evaluated the adequacy of nutrition education received in nursing and midwifery school; nutrition care competencies; self-efficacy and the nutrition care practice of midwives and nurses. We also evaluated determinants of nutrition care practice during routine antenatal and postnatal care. Methods. Cross-sectional study conducted among midwives and nurses working at antenatal and postnatal clinics in Ghana. Data was collected using a self-administered questionnaire. Data analysis was done using descriptive statistics, correlation, and linear regression. Findings. Almost 90% (n = 267) of the participants received nutrition education during training, 77.5% were unsatisfied with the amount of time allocated for nutrition education and 40% felt inadequately prepared from school to provide nutrition care. Self-efficacy ranged from moderate to low. Determinants of nutrition care practice were age of respondents (B = 0.04; P = .002), nutrition-related knowledge (B = 0.05; P = .016), adequacy of nutrition education (B = 0.14; P = .006), nutrition training after school (B = 0.38; P = .010) and nutrition care self-efficacy (B = 0.03; P = .048). Conclusion. Notable knowledge gaps in basic nutrition, inadequate preparedness, and poor confidence to provide nutrition care was common. There is a need to improve the nutrition education experiences of midwives and nurses through curricula revision and refresher training courses.

Nutrition Knowledge is Associated With the Consumption of Iron Rich Foods: A Survey Among Pregnant Women From a Rural District in Northern Ghana.

INTRODUCTION: Iron deficiency anaemia is an international public health concern and pregnant women are at an increased risk. We investigated the consumption of iron rich foods and associated factors among pregnant women in a rural district from Ghana. METHODS: Following a cross-sectional design, dietary intake of iron rich foods was obtained from 252 pregnant women using a 24-hour recall food check list. Nutrition knowledge, attitudes and socio-demographic characteristics were also assessed. FINDINGS: Participants had a mean (SD) knowledge score of 54.66 (22.74)%. About 73% of the participants had heard about iron-deficiency anaemia. Only 16.3% of the participants knew foods that help the body to absorb and use iron while 9.1% knew beverages that decrease iron absorption. About 71% of the participants ate fish and/or seafood while 67.1% of them ate green leafy vegetables. Only 4.4% of the participants ate organ meat, and 29% took flesh meat. Only 22.4% of the study participants usually drank coffee or tea while 78.2% ate vitamin C-rich foods. With regards to attitudes, 88.5% of the participants perceived anaemia to be a serious disease. Nutrition knowledge was significantly associated with the consumption of iron rich foods (ß = .02; 95% CI = 0.01-0.02). CONCLUSION: Nutrition knowledge may be an important determinant of the consumption of iron rich foods among pregnant women making it necessary for healthcare providers to continue to provide nutrition education to pregnant women during routine antenatal care.

Income Level but Not Nutrition Knowledge Is Associated with Dietary Diversity of Rural Pregnant Women from Northern Ghana.

Essential nutrients are necessary for reducing the risk of maternal mortality, prenatal mortality, and low-birthweight infants. Dietary diversity can play an important role in supplying essential nutrients to both the mother and the foetus. We evaluated nutrition knowledge, attitudes, and dietary diversity of pregnant women. In addition, we investigated the sociodemographic determinants of dietary diversity among pregnant women from a rural district in Ghana. Participants were pregnant women receiving antenatal care from a rural district hospital in Ghana. Dietary diversity was measured using a 24-hour dietary recall questionnaire. Multiple linear regression was used to determine the sociodemographic characteristics of dietary diversity. About 85% of the pregnant women knew that they should eat more in comparison to nonpregnant women, and only 16.9% knew the importance of folic acid supplementation during pregnancy. Mean (SD) dietary diversity score of the participants was 5.27 (1.35), 85.4% did not consume any fruits, and 82.3% did not take milk and milk products. Almost all participants took at least one food item in the starchy staples and green leafy vegetables food groups. Moreover, 53% consumed vitamin A-rich fruits, vegetables, and tubers; 7.7% organ meats; and 30.8% eggs. Those who earned a monthly income of ≥GHC 500 or US$ 87 (B = 1.82; 0.90-2.73; p < 0.001) significantly had higher dietary diversity scores compared to those who earned less. Dietary diversity of the pregnant women was suboptimal. The consumption of vitamin A- and iron-rich foods was inadequate. Income was an important determinant of the dietary diversity of pregnant women from Northern rural Ghana.