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

Microenterprise development coupled with nutrition education can help increase caregivers’ incomes and household accessibility to animal source foods

Low income and lack of knowledge about child nutrition have been identified as key constraints to the use of Animal Source Foods (ASF) in the diets of young Ghanaian children. To improve ASF consumption among children in Ghana, the Enhancing Child Nutrition through Animal Source Food Management (ENAM) project introduced an intervention that combined women’s microenterprise development activities with nutrition education on the importance of ASF in children’s diets. The present study assessed the effects of the intervention on the participants’ enterprise performance, their contribution to key household and child-related expenditures as well as their households’ purchases of ASF. Additionally, household ASF consumption was assessed in monetary terms (measured in Ghana cedis (GH¢):1GH¢ = US$ 0.92).A structured questionnaire was used to interview 80 caregivers who participated in the ENAM project activities in four intervention communities and 80 non-participant caregivers in four control communities. Information solicited included household characteristics, profits from microenterprises and contributions to household food and non-food expenditures. Significantly more participant caregivers expanded (P=0.004) and diversified (P=0.004) their enterprises and, as a result, tended to have higher average enterprise profits (GH¢19.3 ± 2.2 vs. GH¢12.2 ± 1.9; P=0.08) and significantly higher savings (GH¢62.9 ± 2.2 vs. GH¢26.3 ± 1.9; P<0.05) than non-participant caregivers. In addition, the intervention was associated with significantly higher percentage of monetary contributions by caregivers towards children’s health expenses (P<0.05), school expenses (P<0.01) as well as expenses on clothing and footwear (P<0.01). Caregivers’ mean percentage contribution to household food expenses also tended to be higher (P<0.1) for participants (50.8 ± 3.5%) then for non-participants (41.8 ± 4.1%). Participant households also tended to spend more money (P<0.10) and consumed significantly more amounts (in monetary value) of ASF (P<0.01) than non-participant households. Being a participant in the ENAM project’s microenterprise development and nutrition education activities was associated with higher enterprise profits, savings deposits, contributions to householdand children-related expenditures, and ASF consumption at the household level

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

Anemia prevalence and associated factors among schoolage children in Accra and Kumasi Metropolis in Ghana

Anemia remains a serious public health concern, globally, affecting learning ability and physical development of children. Anemic children are at a higher risk of diminished economic productivity and low earning capacity in adulthood due to impaired school performance and reduced work capacity. Anemia contributes to about a quarter of Africa’s nutrition-related Disability Adjusted Life Years. The objective of this study was to determine the prevalence of anemia and its associated risk factors among school-aged children (SAC) between ages 9 and 15 years in urban Ghana. The analysis included a randomly selected subsample of 1,634 children from a larger study on nutrition of SAC enrolled between 2009 and 2012 in private and public basic schools in the Accra and Kumasi Metropolis in Ghana. Socio-demographic and household characteristics were collected with questionnaires. Weight and height were taken to the nearest 0.1kg and 0.1cm, respectively. Dietary information was collected using a food frequency questionnaire. Data were analyzed using IBM SPSS Statistic version 23. The relationship between hemoglobin levels and socio-demographic variables, and predictors of hemoglobin levels were determined using Chi-square and binary logistic regression. The mean hemoglobin concentration of the study participants was 12.9±1.3 g/dL. In Kumasi, SAC had higher mean hemoglobin concentration (13.1±1.2 g/dL) compared to those from Accra (12.6±1.3 g/dL; p=0.001). Mean hemoglobin concentration was significantly higher among males than females (13.0±1.4 g/dL vs 12.8±1.2 g/dL; p=0.002). Prevalence of anemia was 20.4%; mild anemia was most common (13.6% of total sample). Anemia cases were higher in public schools (24.6%) compared to private (18.2%). Two-thirds of anemia cases (64.0%) were from schools in Accra. Males had significantly higher prevalence of anemia (26.5%) than females (15.9%; p <0.05). In the adjusted logistic regression model, only city of residence (OR+1.65, 95% CI: 1.44–1.83), thinness (OR=2.60, 95% CI: 1.11-5.75), stunting (OR=1.85, 95% CI: 1.99-3.10) and overweight (OR=0.60, 95% CI: 0.36-0.94) were significantly associated with anemia. In this study, anemia was significantly associated with location and nutritional status

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 effect of deworming on growth in one-year-old children living in a soil-transmitted helminth-endemic area of Peru: a randomized controlled trial

BACKGROUND:Appropriate health and nutrition interventions to prevent long-term adverse effects in children are necessary before two years of age. One such intervention may include population-based deworming, recommended as of 12 months of age by the World Health Organization in soil-transmitted helminth (STH)-endemic areas; however, the benefit of deworming has been understudied in early preschool-age children. METHODOLOGY/PRINCIPAL FINDINGS:A randomized, double-blind, placebo-controlled trial was conducted to determine the effect of deworming (500 mg single-dose crushed mebendazole tablet) on growth in one-year-old children in Iquitos, Peru. Children were enrolled during their routine 12-month growth and development clinic visit and followed up at their 18 and 24-month visits. Children were randomly allocated to: Group 1: deworming at 12 months and placebo at 18 months; Group 2: placebo at 12 months and deworming at 18 months; Group 3: deworming at both 12 and 18 months; or Group 4: placebo at both 12 and 18 months (i.e. control group). The primary outcome was weight gain at the 24-month visit. An intention-to-treat approach was used. A total of 1760 children were enrolled between September 2011 and June 2012. Follow-up of 1563 children (88.8%) was completed by July 2013. STH infection was of low prevalence and predominantly light intensity in the study population. All groups gained between 1.93 and 2.05 kg on average over 12 months; the average difference in weight gain (kg) compared to placebo was: 0.05 (95% CI: -0.05, 0.17) in Group 1; -0.07 (95%CI: -0.17, 0.04) in Group 2; and 0.04 (95%CI: -0.06, 0.14) in Group 3. There was no statistically significant difference in weight gain in any of the deworming intervention groups compared to the control group. CONCLUSIONS:Overall, with one year of follow-up, no effect of deworming on growth could be detected in this population of preschool-age children. Low baseline STH prevalence and intensity and/or access to deworming drugs outside of the trial may have diluted the potential effect of the intervention. Additional research is required to overcome these challenges and to contribute to strengthening the evidence base on deworming. TRIAL REGISTRATION:ClinicalTrials.gov (NCT01314937)

The relationship between livestock ownership and child stunting in three countries in eastern Africa using national survey data

Livestock ownership has the potential to improve child nutrition through various mechanisms, although direct evaluations of household livestock and child stunting status are uncommon. We conducted an analysis of Demographic and Health Survey (DHS) datasets from Ethiopia (2011), Kenya (2008-2009), and Uganda (2010) among rural children under 5 years of age to compare stunting status across levels of livestock ownership. We classified livestock ownership by summing reported household numbers of goats, sheep, cattle and chickens, as well as calculating a weighted score to combine multiple species. The primary association was assessed separately by country using a log-binomial model adjusted for wealth and region, which was then stratified by child diarrheal illness, animal-source foods intake, sub-region, and wealth index. This analysis included n = 8079 children from Ethiopia, n = 3903 children from Kenya, and n = 1645 from Uganda. A ten-fold increase in household livestock ownership had significant association with lower stunting prevalence in Ethiopia (Prevalence Ratio [PR] 0.95, 95% CI 0.92-0.98) and Uganda (PR 0.87, 95% CI 0.79-0.97), but not Kenya (PR 1.01, 95% CI 0.96-1.07). The weighted livestock score was only marginally associated with stunting status. The findings varied slightly by region, but not by wealth, diarrheal disease, or animal-source food intake. This analysis suggested a slightly beneficial effect of household livestock ownership on child stunting prevalence. The small effect size observed may be related to limitations of the DHS dataset or the potentially complicated relationship between malnutrition and livestock ownership, including livestock health and productivity