Dietary Docosahexaenoic Acid and Arachidonic Acid in Early Life:What Is the Best Evidence for Policymakers?

Background: A wealth of information on the functional roles of docosahexaenoic acid (DHA) and arachidonic acid (ARA) from cellular, animal, and human studies is available. Yet, there remains a lack of cohesion in policymaking for recommended dietary intakes of DHA and ARA in early life. This is predominantly driven by inconsistent findings from a relatively small number of randomised clinical trials (RCTs), which vary in design, methodology, and outcome measures, all of which were conducted in high-income countries. It is proposed that this selective evidence base may not fully represent the biological importance of DHA and ARA during early and later life and the aim of this paper is to consider a more inclusive and pragmatic approach to evidence assessment of DHA and ARA requirements in infants and young children, which will allow policymaking to reflect the marked diversity of need worldwide. Summary: Data from clinical RCTs is considered in the context of the extensive evidence from experimental, animal and human observational studies. Although the RCT data shows evidence of beneficial effects on visual function and in specific cognitive domains, early methodological approaches do not reflect current thinking and this undermines the strength of evidence. An outline of a framework for an inclusive and pragmatic approach to policy development on dietary DHA and ARA in early life is described. Conclusion: High-quality RCTs that will determine long-term health outcomes in appropriate real-world settings need to be undertaken. In the meantime, a collective pragmatic approach to evidence assessment, may allow public health policymakers to make comprehensive reasoned judgements on the merits, costs, and expediency of dietary DHA and ARA interventions

Food supplementation among HIV-infected adults in Sub-Saharan Africa: Impact on treatment adherence and weight gain

This is the author's manuscript of an article published in the Proceedings of the Nutrition Society.Sub-Saharan Africa has the highest proportion of undernourished people in the world, along with the highest number of people living with HIV and AIDS. Thus, as a result of high levels of food insecurity many HIV patients are also undernourished. The synergism between HIV and undernutrition leads to poor treatment adherence and high mortality rates. Undernutrition has a debilitating effect on the immune system due to key nutrient deficiencies and the overproduction of reactive species (oxidative stress), which causes rapid HIV progression and the onset of AIDS. Therapeutic food supplementation used in the treatment of severe acute malnutrition is being applied to HIV palliative care; however, little biochemical data exist to highlight its impact on oxidative stress and immune recovery

Epidemiological and nutrition transition in developing countries: impact on human health and development

Whereas common infectious and parasitic diseases such as malaria and the HIV/AIDS pandemic remain major unresolved health problems in many developing countries, emerging non-communicable diseases relating to diet and lifestyle have been increasing over the last two decades, thus creating a double burden of disease and impacting negatively on already over-stretched health services in these countries. Prevalence rates for type 2 diabetes mellitus and CVD in sub-Saharan Africa have seen a 10-fold increase in the last 20 years. In the Arab Gulf current prevalence rates are between 25 and 35% for the adult population, whilst evidence of the metabolic syndrome is emerging in children and adolescents. The present review focuses on the concept of the epidemiological and nutritional transition. It looks at historical trends in socio-economic status and lifestyle and trends in nutrition-related non-communicable diseases over the last two decades, particularly in developing countries with rising income levels, as well as the other extreme of poverty, chronic hunger and coping strategies and metabolic adaptations in fetal life that predispose to non-communicable disease risk in later life. The role of preventable environmental risk factors for obesity and the metabolic syndrome in developing countries is emphasized and also these challenges are related to meeting the millennium development goals. The possible implications of these changing trends for human and economic development in poorly-resourced healthcare settings and the implications for nutrition training are also discussed

Knowledge and Determinants of Fruit and Vegetable Consumption among Adults in Hohoe Municipality, Ghana

The World Health Organization (WHO) recommends that a person consumes at least 400g of Fruit and Vegetable (FV) daily to prevent chronic disease risk. We assessed knowledge of current WHO guidelines and other determinants of FV intake among adults (≥ 18 years, n = 397) in Hohoe Municipality, Ghana. Face-to-face interviews using a questionnaire adopted from WHO Risk Factor Surveillance System were undertaken. Knowledge of FV daily servings and determinants of intake were evaluated by descriptive statistics and binary logistic regression. There was a 99.2% response rate with approximately 9% of participants correctly stating the WHO daily recommended amount (P = .296). Most (54%) of respondents’ FV intake was affected by unavailability of desired choice (P = .050). Odd of inadequate consumption for persons aware of adequate amount was 1.97 (95% CI: 0.64, 6.05, P = .234) higher than persons without awareness. Participants with problems accessing their desired choice of FV had 0.59 odds (95% CI: 0.36, 0.95, P = .030) of consuming inadequate amount compared to those with easy access. Adequate FV intake depends on availability of consumer preference regardless of knowledge of recommendations. Individual FV cultivation is relevant for availability of preferred choice and adequate consumption for NCDs risk reductions among Ghanaians

Is Geophagia a Health-Seeking Behavior or an Ethnic Remedy towards Greater Personal Resilience?

Objective: We investigated if Geophagia was a health-seeking behavior or a socio-cultural remedy towards enhanced personal resilience. Method: We used a sample size of 2,000 with 90% power to detect an effect size of 30% at significance level of 5%. We randomly selected one or more district, municipality or metropolitan area from each of the 10 regions (Rosemary and Valadez, 2013). We randomly selected one or more communities from each of that and then use the random walk method to evaluate households within each community till the quota for the region was met (Milligan, et al., 2004). Regional comparisons were made possible due to the stratified and random selection of representations that were similar in characteristics such as being urban or rural, then ethnicity, religion and gender. We obtained Ethical Approval to conduct the assessment. Result: The result shows that Geophagia is a cultural nutritional reality which is practiced widely in Ghana. It also appears to be a health-seeking behavior that seems to enhance the resilience of the practitioners against certain health challenges. Discussion: The research on Geophagia needs to be reconsidered without any prejudicial biases to reflect the true cultural and health reasons for it. Conclusion: Geophagia is not a result of food insecurity or food scarcity. It is a nutritional habit which may require more than the presence of food to break it

Self-reported breast and cervical cancer screening practices among women in Ghana:predictive factors and reproductive health policy implications from the WHO study on global AGEing and adult health

BackgroundBreast and cervical cancers constitute the two leading causes of cancer deaths among women in Ghana. This study examined breast and cervical screening practices among adult and older women in Ghana.MethodsData from a population-based cross-sectional study with a sample of 2749 women were analyzed from the study on global AGEing and adult health conducted in Ghana between 2007 and 2008. Binary and multivariable ordinal logistic regression analyses were performed to assess the association between socio-demographic factors, breast and cervical screening practices.ResultsWe found that 12.0 and 3.4% of adult women had ever had pelvic screening and mammography respectively. Also, 12.0% of adult women had either one of the screenings while only 1.8% had both screening practices. Age, ever schooled, ethnicity, income quantile, father’s education, mother’s employment and chronic disease status were associated with the uptake of both screening practices.ConclusionNationwide cancer awareness campaigns and education should target women to improve health seeking behaviours regarding cancer screening, diagnosis and treatment. Incorporating cancer screening as a benefit package under the National Health Insurance Scheme can reduce financial barriers for breast and cervical screening

Informal payments and willingness to pay informally for health care among older adults:equity perspectives for geriatric care in Ghana

BackgroundOut-of-Pocket (OOP) payment is one mechanism for funding health care in low- and middle-income countries (LMICs). The wider implications mean OOP payments have the potential to increase, with catastrophic effects for a vulnerable population group such as older adults. This study aimed to determine the prevalence of informal patient payments (IPPs) and willingness and ability to pay informally, and its associated factors among older adults in Ghana.MethodsWe conducted a community-based cross-sectional study to collect data among 462 older adults (60+ years) across three municipal areas in the Volta Region of Ghana. Data were collected using an interviewer-administered semi-structured questionnaire. Binary logistic regression was performed to identify factors associated with IPP. The significance level was set at P < 0.05.ResultsThe prevalence of IPP was 21.2%. About 64.5% of respondents were willing to make IPP if they had good financial standing. Factors significantly associated with IPP were age (75 years and above) (odds ratios [OR], 1.76; 95% confidence interval [CI], 1.37–2.26), being uninsured (OR, 1.68; 95% CI, 1.48–1.91), having a urinary health problem (OR, 2.49; 95% CI, 1.56–3.97), and having a stronger preference for private healthcare facilities (OR, 1.35; 95% CI, 1.26–1.44). Not having a chronic condition (OR, 0.59; 95% CI, 0.41–0.83) and unwillingness to make IPP (OR, 0.48; 95% CI, 0.26–0.87) were associated with lower odds of IPP.ConclusionThe existence IPP reflects important inequity gaps within the formal healthcare system and requires urgent sustainable policy actions to protect economically vulnerable older adults from financial catastrophe. We recommend measures of informal payments and “perceived corruption” in the health system be included in the Ghana Living Standard Surveys and Demographic Health Surveys to inform future policy decisions in this area

Exploring the health status of older persons in Sub Saharan Africa

Sub-Saharan Africa has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation; Sub-Saharan Africa is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases. The aim of this review is to highlight available research on the health status of older persons in Sub-Saharan Africa, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in Sub-Saharan Africa on older persons (aged 50 years and older) related to health indicators including nutritional status, non-communicable diseases and HIV burden. Whilst it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions

Investigating foods and beverages sold and advertised in deprived urban neighbourhoods in Ghana and Kenya: a cross-sectional study

Objectives The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods. Design Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability. Setting Three deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya). Main outcome measure Types of foods and beverages sold and/or advertised. Results Jamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets. Conclusion Our study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action