The nutrition-microcredit synergy: A case for multiple interventions and strategies

Poor diet quality is the primary determinant of the high prevalence rates of malnutrition in Ghana. In this West African country, young children’s diets primarily consist of cereals and roots which have both low energy and nutrient density and poor bioavailability of micronutrients. A 2008 national survey reported that over one-third of children consumed no nutrient-rich Animal Source Foods (ASF) on the previous day. An intervention to enhance children’s diet and nutritional status was developed based on the assumption that improving knowledge, attitudes, and beliefs of caregivers would lead to increased use of ASF for young children only if ASF availability (presence in the communities) and accessibility (families’ ability to obtain ASF through purchase, trade, hunting, or raising animals at home) were also improved. The Enhancing Child Nutrition through Animal Source Food Management (ENAM) project introduced an integrated approach of microcredit and weekly sessions of nutrition education and entrepreneurship training among rural women to increase the use of ASF in the diets of their 2- to 5-year-old children. Although the project may have not reached the poorest women in the community, the integrated activities benefited many households in diverse ways – directly through increased income and improved productivity that improved purchasing power and made foods available in the home, as well as indirectly through the empowerment of women participants. Women reported increased self-confidence, leadership skills, and social capital. Children’s diets benefited the most when caregivers were engaged in enterprises related to ASF because they facilitated sharing ASF with children and the high profits from these activities increased mothers’ ability to purchase other ASF from the market. Other family members also benefited from the project through women sharing loans for joint economic activities, improving the quality of the diet for the whole family, and sharing new knowledge. Integration of rural bank partners from an early stage of the project helped transfer activities to these permanent institutions to expand and sustain project activities. The ENAM project provided the evidence that an integrated package of microcredit and education can improve household food security and improve the diet and growth of young children living in rural communities

Rapid review of research on dietary attitudes, beliefs and practices in Ghana 1990-2020

Food-related beliefs and attitudes influence dietary behaviors and are important drivers of nutrition outcomes. Understanding beliefs and attitudes that drive dietary behaviors, as part of the process for developing Food-based Dietary Guidelines is critical for targeting messages to motivate healthy dietary diets. This rapid review was undertaken to summarize readily available local evidence on food-related beliefs, attitudes, and associated practices in Ghana. A rapid review of 39 peer-reviewed publications and graduate-level theses on the dietary behaviors of Ghanaians was conducted between November and December 2020. The study only included articles published between 1990 and 2020 involving apparently healthy populations living in Ghana. Documents were identified through a systematic literature search of Google Scholar and PubMed. Data on food-related knowledge, beliefs, attitudes, and practices were extracted into an excel template and analyzed using thematic content analysis. The sampled research included primarily cross-sectional studies of urban, rural, peri-urban and mixed localities throughout Ghana: one was a prospective research. A range of food-related taboos were identified and classified as taboos for the general population, pregnancyrelated, or child-related. Although awareness of food-related taboos was common, they were not extensively practiced. Energy-giving and nutrient-dense foods are commonly promoted during pregnancy. Culturally prescribed pre-lacteal feeds and other infant and young child feeding (IYCF) behaviors reported in the studies were not aligned with IYCF recommendations. A 3-meals-a-day pattern was observed, commonly, across all age groups; most adult meals, particularly supper, was prepared at home. However, ready-to-eat meals were regularly purchased by adults and adolescents. Adolescents frequently reported snacking and skipping meals; breakfast was the most frequently skipped meal. Fruits and vegetables were the least consumed food groups across all age groups. Muslim faith was associated with consuming more diverse diets and greater fruit and vegetable consumption. The findings of this review provide an overview of food-related beliefs and practices of Ghanaians and can inform decisions on areas to emphasize in food-based dietary guidelines and associated nutrition education messages to promote healthy diets in the Ghanaian population. Effective nutrition education is needed to dispel harmful food beliefs and practices and promote healthy food choices across the life cycle. Dietary patterns in Ghana are linked with cultural and religious practices that are often unique to particular subgroups, although there are common strands of beliefs across ethnic groups. These beliefs can result in either adverse or beneficial outcomes, depending on what eating patterns it determines.&nbsp

Dietary intakes and iron status of vegetarian and non-vegetarian children in selected communities in Accra and cape coast, Ghana

There is a scarcity of information on dietary intake and iron status of Ghanaian children raised on vegetarian diets. A cross-sectional study design was used to compare the diets and iron status of vegetarian children between the ages of 9 months and 11 years (n= 26) with matched controls, non-vegetarian children (n=26) of similar ages and same sex and living within the same communities in Accra and Cape Coast, Ghana. Dietary information was collected using 24-hr food recall and 12-hr home observation. Haemoglobin, plasma ferritin, C-reactive protein, and Transferrin Receptor (TfR) concentrations were determined on finger prick (haemoglobin) and venous blood samples collected during the study. Based on the 24-hr food recall, vegetarian children’s diets were devoid of vitamin B12whereas non-vegetarian children’s diets were not (0.0 ± 0.0 mg vs. 1.5 ± 1.8 mg, p<0.001). The dietary intake based on 12-hr home observation showed similar results. However, vegetarians had significantly higher intake of dietary fibre (17.1 ± 11.9 g vs. 8.4 ± 6.2 g, p= 0.002), thiamine (1.1 ± 0.8 mg vs. 0.5 ± 0.3 mg, p= 0.001) and vitamin A (1702 ± 1887 Retinol Equivalent (RE)vs. 671 ± 691 RE, p= 0.010) than non-vegetarian children. Dietary diversity based on nine food groups was similar between groups (5.8 ±1.0score). Plasma ferritin was higher for non-vegetarian children compared to the vegetarians (59.2± 48.2 ng/mL vs. 34.1± 25.8ng/ml, p= 0.012) but there was no group difference in plasma TfR. The prevalence of anaemia was about 25% in both groups. Typical diets of Ghanaian children lack variety and both vegetarian and nonvegetarian diets are insufficient to support adequate iron status. Iron-rich foods such as meat or supplements are needed. There is urgent need for immediate vitamin B12 supplementation for all vegetarian children and a general need for nutrition education to diversify all children’s diets

Microfinance with education in rural ghana: Men’s perception of household level impact

Microcredit schemes have been shown to enhance women’s Income Generation Activities (IGA), household food security, and child nutrition. However, spouses or Male Household Heads (MHH) can influence how women’s loans are invested and how incomes ensuing from the investments are expended. This study describes how MHH perceived and experienced the participation of female caregivers from their household in the Enhancing Child Nutrition through Animal Source Food Management (ENAM) project. The ENAM project was designed as an integrated intervention providing microcredit, entrepreneurship and nutrition education to women in rural communities in Ghana. Eighty-five MHH of ENAM project caregivers in two regions of Ghana were interviewed about their awareness of the microcredit and education intervention, their involvement in the IGA that the caregivers’ loans were invested in, and their perceptions of the impact of the project on the caregivers’ IGA as well as household and child nutrition. The majority of MHH indicated that they had been consulted by the caregivers about the decision to participate in the ENAM project. The most common reasons given for consenting to the caregivers’ decision to participate in the program were expectations that the caregiver would receive business capital (30.6%), education on optimal child feeding (36.5%), and income to enable caregivers to contribute more to household expenses (31.8%). With respect to the project’s impact, MHH perceived that the caregivers’ project participation had a positive impact on their business practices, particularly with respect to improved customer relations. The MHH perceived that caregivers’ incomes increased because of their participation in ENAM as evidenced by regular income savings and increased contributions to household food and non-food expenditures. However, MHH reported decreases in their own contributions to almost all household expenditure categories in response to the perceived increase in caregivers’ incomes. The MHH also perceived improvements in home meal quality. In summary, MHH credited the ENAM project with improved caregiver’s incomes and increased share of household expenses. However, this outcome resulted in unanticipated declines in MHH contribution to household expenses. Further studies are needed to understand the impact  of empowering women through social experiments on households

Enhancing backyard poultry enterprise performance in the techiman area: A value chain analysis

Backyard Poultry (BP) production is widespread among rural households in Ghana and provides an opportunity for small scale enterprise development to contribute to poverty alleviation. Traditionally, efforts to improve poultry production activities have emphasized the technical aspects of production while neglecting the social and organizational processes that underlie BP enterprises. A value chain framework was used to qualitatively assess BP enterprises in two communities in the Techiman Municipality of the Brong Ahafo Region in Ghana. The main purpose of the study was to understand how the activities and relationships among actors along the BP value chain influence BP enterprise performance and its implications for development of the industry. Community key informants defined a BP enterprise as ownership of at least ten post vulnerability age chickens (defined as ability to roost on trees to escape predators and disease). All identified BP farmers in the communities were classified as ‘high’ and ‘low’ enterprise performers based on flock size of ‘post- vulnerability age chickens’. The study participants included a purposive sample of ‘low’ (n=10) and ‘high’ (n=10) performing BP farmers from each community as well as service providers and support institutions in the BP value chain identified through snowball sampling. Qualitative data were collected using focus group discussions and key informant interviews. Content analysis was used to summarize themes and patterns from the interview transcripts and to compare high and low performing BP enterprises based on the identified activities and relationships. Higher BP enterprise performance was associated with stronger inter- and intra-actor integration of activities in the various functions of the value chain and higher investment of resources in the activities of the value chain. Additionally, opportunities for import substitution to meet the high national demand for chicken meat were identified. Sustainable improvements in the BP sector must involve social, relational, organizational, as well as technical innovation

Relationship between caregivers’ income generation activities and their children’s animal source food intake

Enhancing Child Nutrition through Animal Source Food Management (ENAM) project provided financial and technical support for caregivers’ Income Generation Activities (IGA) with the aim of increasing their access to Animal Source Foods (ASF) for improved child nutrition. Using baseline data from the ENAM project, this study assessed the relationship between the type of caregivers’ IGA -whether it is related to ASF [ASF-R] or unrelated [ASF-U] - and the quantity and diversity of ASF consumed by their children. Structured questionnaire was used to obtain data on household socioeconomic and demographic characteristics and children’s ASF consumption in the past week from 530 caregivers of children 2-to5 years old in 12 communities in three agro-ecological zones of Ghana. A weighed food record of children’s dietary intakes was also completed during two 12-hour home observations on a randomly selected sample of 117 children. Approximately 6% (n=32) of caregivers were not engaged in any IGA. Of the caregivers who were involved in an IGA (n=498), approximately one-third of them were engaged in an ASF-R IGA, such as selling smoked fish, selling eggs and the selling cooked food that included ASF. Caregivers (67%) were engaged in ASF-U IGA, such as crop farming, petty trading in non ASF items and artisanal work. The quantity and diversity of ASF consumed by the children did not differ (p=0.988 and p=0.593, respectively) by the type of caregiver IGA. However, after accounting for agro-ecological zone, being involved in an ASF-R IGA positively predicted children’s ASF diversity (p<0.001). The number of children in the household negatively predicted children’s ASF diversity (p=0.011) whereas high/medium household wealth status tended to be positively associated with ASF diversity (p=0.064).The study suggested that there is need to promote ASF-R IGA among caregivers to increase the ability to purchase more varied and nutritious food items for improving children’s growth

The Nutrition-Microcredit Synergy: A Case For Multiple Interventions And Strategies

Poor diet quality is the primary determinant of the high prevalence rates of malnutrition in Ghana. In this West African country, young children's diets primarily consist of cereals and roots which have both low energy and nutrient density and poor bioavailability of micronutrients. A 2008 national survey reported that over one-third of children consumed no nutrient-rich Animal Source Foods (ASF) on the previous day. An intervention to enhance children's diet and nutritional status was developed based on the assumption that improving knowledge, attitudes, and beliefs of caregivers would lead to increased use of ASF for young children only if ASF availability (presence in the communities) and accessibility (families' ability to obtain ASF through purchase, trade, hunting, or raising animals at home) were also improved. The Enhancing Child Nutrition through Animal Source Food Management (ENAM) project introduced an integrated approach of microcredit and weekly sessions of nutrition education and entrepreneurship training among rural women to increase the use of ASF in the diets of their 2- to 5-year-old children. Although the project may have not reached the poorest women in the community, the integrated activities benefited many households in diverse ways – directly through increased income and improved productivity that improved purchasing power and made foods available in the home, as well as indirectly through the empowerment of women participants. Women reported increased self-confidence, leadership skills, and social capital. Children's diets benefited the most when caregivers were engaged in enterprises related to ASF because they facilitated sharing ASF with children and the high profits from these activities increased mothers' ability to purchase other ASF from the market. Other family members also benefited from the project through women sharing loans for joint economic activities, improving the quality of the diet for the whole family, and sharing new knowledge. Integration of rural bank partners from an early stage of the project helped transfer activities to these permanent institutions to expand and sustain project activities. The ENAM project provided the evidence that an integrated package of microcredit and education can improve household food security and improve the diet and growth of young children living in rural communities

DEVELOPMENT OF A FACILITATOR GUIDE FOR NUTRITION EDUCATION ON OVERWEIGHT AND OBESITY IN THE EASTERN REGION OF GHANA

Overweight and obesity are global public health problems. Although overweight and obesity are high in urban areas, the prevalence of overweight and obesity is increasing steadily in rural areas. However, interventions to address overweight and obesity in rural areas are limited. This study reports on the process of developing a facilitator guide for a nutrition education program on overweight and obesity in rural Ghana. The transtheoretical model guided this study. The study was conducted in three districts in the Eastern Region of Ghana. The facilitator guide was developed according to the Food and Agriculture Organisation’s (FAO) guidelines for planning community nutrition education. This study engaged nutrition and agricultural officers working in the study area and academics through an iterative process to draft, revise, and design the facilitator guide. The procedures included a desk literature review, analysis of secondary data, telephone interviews, a seminar and two workshops. The guide consists of five lessons. Lesson 1 creates an awareness of overweight and obesity by providing a definition and the Stunkard Figure Rating Scale. It also includes data on the prevalence of overweight and obesity and abdominal obesity of women in the study area. Lesson 2 discusses body image perceptions and their association with overweight and obesity. Lesson 3 highlights the economic, social and health consequences of overweight and obesity. Lesson 4 explains the four-star diet and how to achieve it. The lesson includes a description of each star of the four-star diet with local examples. Lesson 5 discusses physical activity and steps to increase physical activity. Each lesson ends with a key message. Songs were developed for Lessons 3, 4 and 5. This study describes the process of developing a facilitator guide for overweight and obesity education at the community level. The guide can be used to raise awareness of overweight and obesity and weight management

DEVELOPMENT OF A FACILITATOR GUIDE FOR NUTRITION EDUCATION ON OVERWEIGHT AND OBESITY IN THE EASTERN REGION OF GHANA

Overweight and obesity are global public health problems. Although overweight and obesity are high in urban areas, the prevalence of overweight and obesity is increasing steadily in rural areas. However, interventions to address overweight and obesity in rural areas are limited. This study reports on the process of developing a facilitator guide for a nutrition education program on overweight and obesity in rural Ghana. The transtheoretical model guided this study. The study was conducted in three districts in the Eastern Region of Ghana. The facilitator guide was developed according to the Food and Agriculture Organisation’s (FAO) guidelines for planning community nutrition education. This study engaged nutrition and agricultural officers working in the study area and academics through an iterative process to draft, revise, and design the facilitator guide. The procedures included a desk literature review, analysis of secondary data, telephone interviews, a seminar and two workshops. The guide consists of five lessons. Lesson 1 creates an awareness of overweight and obesity by providing a definition and the Stunkard Figure Rating Scale. It also includes data on the prevalence of overweight and obesity and abdominal obesity of women in the study area. Lesson 2 discusses body image perceptions and their association with overweight and obesity. Lesson 3 highlights the economic, social and health consequences of overweight and obesity. Lesson 4 explains the four-star diet and how to achieve it. The lesson includes a description of each star of the four-star diet with local examples. Lesson 5 discusses physical activity and steps to increase physical activity. Each lesson ends with a key message. Songs were developed for Lessons 3, 4 and 5. This study describes the process of developing a facilitator guide for overweight and obesity education at the community level. The guide can be used to raise awareness of overweight and obesity and weight management

LOCAL MEANINGS AND PERCEPTIONS OF WOMEN’S EMPOWERMENT: QUALITATIVE EVIDENCE FROM FEMALE AND MALE FARMERS IN RURAL GHANA

Assessing the relationship between empowerment and nutrition along the agriculturenutrition pathway is limited by dissimilar emic and etic views of the construct, limited understanding of its contextual variation, and measurement difficulties. This study explored local meanings and perceptions of empowerment among women and men farmers in rural Ghana. The qualitative study took place within the LinkINg Up project, a quasi-experimental, nutrition-sensitive agriculture intervention (ClinicalTrials.gov NCT03869853) in three sub-districts of the Eastern Region. The intervention was implemented through farmer-based organizations (FBO) that were selected using a set of criteria such as female representation and level of member participation. Within the FBO, all women were recruited to participate along with one male adult family member (spouse/partner, older son, father). Non-FBO members (women and their male family member) from the same communities were also enrolled as a comparison group. This manuscript addresses an independent research question on empowerment, not the LinkINg Up intervention outcomes. For the question, participants (53 females and 45 males) were selected purposefully based on FBO membership of the woman (member, non-member). During the first three months of the project, eight focus group discussions (FGD) with women and seven FGD with men were conducted to probe into local understandings of empowerment and women’s empowerment (WE). The FGD were translated to English from the local language and transcripts were coded using a Constructivist Grounded Theory approach (open, axial, selective coding) with MAXQDA 2022. Women and men described empowerment in terms of an individual’s capability to improve circumstances by setting and meeting intentional and measurable goals. The construct of empowerment was made up of internal and external components. Internal components were those that were essential to allow one to be empowered, such as self-confidence, while the external components of empowerment were related to personal and community factors that empowered people, for example, asset ownership and social support. Emic understandings of WE were often related to women’s relationships with others and their roles (reproductive, productive, and community) within the studied context. The local descriptions of an empowered woman were categorized as someone who: i) exhibits qualities that are perceived to help one achieve goals, ii) takes actions to achieve goals, and iii) works with others to achieve own goals or common goals. When assessing WE in the study area, it is important to incorporate measures for women’s goal-setting capacity in relation to farming and business activities, and their ability to implement their goals, while taking into account relational aspects