The lancet series nutritional interventions in Ghana: a determinants analysis approach to inform nutrition strategic planning

BACKGROUND: Malnutrition is a leading cause of mortality and morbidity among children in low- and middle-income countries. Ghana is one of 36 countries with the highest burden of stunting, globally. The aim of this work is to use data driven planning methods to conduct in-depth analysis on the Lancet series nutrition interventions in Ghana to inform nutritional strategic planning. METHODS: A mixed methods approach was employed for this national nutritional assessment conducted in May 2016. Quantitative data on nutritional interventions were generated by application of the Determinants Analysis Tool and phenomenological approach was employed to explain the causes of barriers identified. Outputs from the tool were analyzed by simple descriptive statistics and data from group discussions were assessed by thematic content analysis. The base line years for this assessment were 2014 and 2015. RESULTS: Overall in Ghana, 21.0% of frontline health workers are trained on lactation management and breastfeeding counselling and support, 56.6% of mothers of children 0–2 years initiated breastfeeding within one hour of birth, and 59.4% of mothers with children 0–5 months took iron folate supplementation for 90 or more days during pregnancy. In addition, only 19.9% of children 12–59 months received two doses of vitamin A supplementation in a calendar year, and 32.5% of children 6–59 months with severe acute malnutrition were admitted for treatment at health facilities. In all, among infants 6–8 months old, 6.9% were fed with minimum dietary diversity, 50.6% received age appropriate meal frequency and 21.6% received iron rich diet. Inadequate pre-service and in-service training for staff, low prioritization and coordination (at higher levels) and weak integration of services (at lower levels) were key barriers to nutrition coverage in Ghana. CONCLUSION: Data driven analysis and planning based on proven nutritional interventions in Ghana demonstrated gaps and barriers and garnered workable strategies to improve nutrition services

Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: findings from a national survey

Nationally representative data on the micronutrient status of Ghanaian women and children are very scarce. We aimed to document the current national prevalence of micronutrient deficiencies, anemia, malaria, inflammation, α-thalassemia, sickle cell disease and trait, and under- and over-nutrition in Ghana. In 2017, a two-stage cross-sectional design was applied to enroll pre-school children (6–59 months) and non-pregnant women (15–49 years) from three strata in Ghana: Northern, Middle and Southern Belt. Household and individual questionnaire data were collected along with blood samples. In total, 2123 households completed the household interviews, 1165 children and 973 women provided blood samples. Nationally, 35.6% (95%CI: 31.7,39.6) of children had anemia, 21.5% (18.4,25.0) had iron deficiency, 12.2% (10.1,14.7) had iron deficiency anemia, and 20.8% (18.1,23.9) had vitamin A deficiency; 20.3%(15.2,26.6) tested positive for malaria, 13.9% (11.1,17.3) for sickle trait plus disease, and 30.7% (27.5,34.2) for α-thalassemia. Anemia and micronutrient deficiencies were more prevalent in rural areas, poor households and in the Northern Belt. Stunting and wasting affected 21.4% (18.0,25.2) and 7.0% (5.1,9.5) of children, respectively. Stunting was more common in rural areas and in poor households. Among non-pregnant women, 21.7% (18.7,25.1) were anemic, 13.7% (11.2,16.6) iron deficient, 8.9% (6.7,11.7) had iron deficiency anemia, and 1.5% (0.8,2.9) were vitamin A deficient, 53.8% (47.6,60.0) were folate deficient, and 6.9% (4.8,9.8) were vitamin B12 deficient. Malaria parasitemia in women [8.4% (5.7,12.2)] was lower than in children, but the prevalence of sickle cell disease or trait and α-thalassemia were similar. Overweight [24.7% (21.0,28.8)] and obesity [14.3% (11.5,17.7)] were more common in wealthier, older, and urban women. Our findings demonstrate that anemia and several micronutrient deficiencies are highly present in Ghana calling for the strengthening of Ghana’s food fortification program while overweight and obesity in women are constantly increasing and need to be addressed urgently through governmental policies and programs

Putative risk factors for anemia vary by population group and climate zone – results from a national survey in Ghana among women of reproductive age and pre-school children

Background: Anemia has serious effects on human health and has multifactorial etiologies. Objective: To determine putative risk factors for anemia in children 6-59 months and 15-49 years old non-pregnant women living in Ghana. Methods: Data from a nationally representative cross-sectional survey were analyzed for associations between anemia and various anemia risk factors. National and stratum specific multivariable regressions were constructed separately for children and women to calculate the adjusted prevalence ratio (aPR) for anemia of variables found to be statistically significantly associated with anemia in bivariate analysis. Results: Nationally, the aPR for anemia was greater in children with iron deficiency (ID; aPR 2.20; 95%CI:1.88, 2.59), malaria parasitemia (aPR 1.96; 95%CI:1.65, 2.32), inflammation (aPR 1.26; 95%CI:1.08, 1.46), vitamin A deficiency (VAD; aPR 1.38; 95%CI:1.19, 1.60) and stunting (aPR 1.26; 95%CI:1.09; 1.46). In women, ID (aPR 4.33; 95%CI:3.42, 5.49), VAD (aPR 1.61; 95%CI:1.24, 2.09) and inflammation (aPR 1.59, 95%CI:1.20, 2.11) were associated with anemia, whereas overweight and obese women had lower prevalence of anemia (aPR 0.74; 95%CI:0.56, 0.97). ID was associated with child anemia in the Northern and Middle Belts, but not in the south; conversely, inflammation was associated with anemia in both children and women in the Southern and Middle Belts, but not in the north. Conclusion: Anemia control programs should be region specific and aim at the prevention of ID, malaria and other drivers of inflammation as they are the main predictors of anemia in Ghanaian children and women

Risk factors for anaemia among Ghanaian women and children vary by population group and climate zone

Anaemia has serious effects on human health and has multifactorial aetiologies. This study aimed to determine putative risk factors for anaemia in children 6-59 months and 15- to 49-year-old non-pregnant women living in Ghana. Data from a nationally representative cross-sectional survey were analysed for associations between anaemia and various anaemia risk factors. National and stratum-specific multivariable regressions were constructed separately for children and women to calculate the adjusted prevalence ratio (aPR) for anaemia of variables found to be statistically significantly associated with anaemia in bivariate analysis. Nationally, the aPR for anaemia was greater in children with iron deficiency (ID; aPR 2.20; 95% confidence interval [CI]: 1.88, 2.59), malaria parasitaemia (aPR 1.96; 95% CI: 1.65, 2.32), inflammation (aPR 1.26; 95% CI: 1.08, 1.46), vitamin A deficiency (VAD; aPR 1.38; 95% CI: 1.19, 1.60) and stunting (aPR 1.26; 95% CI: 1.09, 1.46). In women, ID (aPR 4.33; 95% CI: 3.42, 5.49), VAD (aPR 1.61; 95% CI: 1.24, 2.09) and inflammation (aPR 1.59; 95% CI: 1.20, 2.11) were associated with anaemia, whereas overweight and obese women had lower prevalence of anaemia (aPR 0.74; 95% CI: 0.56, 0.97). ID was associated with child anaemia in the Northern and Middle belts, but not in the Southern Belt; conversely, inflammation was associated with anaemia in both children and women in the Southern and Middle belts, but not in the Northern Belt. Anaemia control programmes should be region specific and aim at the prevention of ID, malaria and other drivers of inflammation as they are the main predictors of anaemia in Ghanaian children and women