Scoping review of diet-related health outcomes and associated risk factors in Ghana

As part of a process to develop food-based dietary guidelines (FBDGs), the national Multi-sectoral Technical Task Team coordinating FBDGs development in Ghana has commissioned a desk review of the nutrition and health situation, and trends for all persons living in Ghana, across the entire life cycle. Using a rapid scoping review method, multiple electronic databases were systematically searched using keywords related to nutrition and health outcomes, as well as potential drivers of nutrition and health in Ghana. The review included evidence from peer-reviewed articles, unpublished manuscripts, dissertations, reports of nationally representative surveys, and other grey literature (reports of nutrition situation evaluations commissioned by international and local agencies), spanning the decade starting from 2010. A total of 48 documents were included in this review: 15 for infants and young children, 14 for adolescents, 19 for adults and women of reproductive age, and five for the elderly. Among children under five, anemia and stunting were the most prevalent nutritionrelated outcomes, 62% and 19%, respectively. Underweight prevalence of 11% was observed among young children; wasting rates have remained below 10%, but registered about 20% prevalence in northern Ghana. Different levels of micronutrient deficiencies, particularly iron deficiency were reported across all age groups. Nutrient deficiency rates were higher among adolescent girls and women of reproductive age. Vitamin A deficiency was also high (21%) among under-fives. Overweight and obesity rates were high among women of reproductive age (40%) and adolescents (11% to 18% between 2013 and 2017), and still increasing. Underweight and overweight coexists among the elderly (50 years and above), at a rate of 10% and 20%, respectively. An increasing prevalence of central adiposity has also been reported among women of reproductive age (high waist circumference of 80.6%) and persons older than 60 years (67% in 2015). Rates of hypertension and cancers have also increased within the study period. Hypertension rates have been increasing with age, particularly among urban dwellers. Majority of persons with hypertension are not receiving treatment . Incidence of breast, cervical, and liver cancers were 20%, 14%, and 12% in 2018. Ghana is experiencing a double burden of malnutrition characterized by co-existing high levels of undernutrition and overnutrition. The national FBDGs for Ghana should prioritize recommendations and actions that address the dual burden of undernutrition and overnutrition

Implementing nutrition interventions in Ghana at district level: Gaps and opportunities

Malnutrition among women and children is an underlying cause of high morbidity and mortality in the developing world. Ghana is one of 36 countries with a high prevalence (> 20%) of chronic stunting in childhood. Although proven and inexpensive technologies and interventions exist to address maternal and child malnutrition, their implementation remains at a low scale in many developing countries, including Ghana. In Ghana,  barriers to scaling up nutrition actions have been identified at the national level, yet little is known about the situation at the district and sub-district levels where nutrition interventions are directly delivered. The current study assessed district-level capacity and commitment for accelerating implementation of effective nutrition interventions to address the high burden of maternal and child malnutrition. In June 2010, key informant interviews involving technical officers, clinicians, nurses, and administrative staff, and a desk review of program and administrative reports were  conducted in the Omanye District (pseudonym). Using the framework from the WHO landscape analysis of readiness to scale up nutrition actions, interviews explored questions of commitment (financial, planning,  collaborations) and capacity (human resources, job aids, skills) to implement nutrition actions in the district. Most key nutrition interventions were being implemented in the Omanye District including growth  promotion, micronutrient supplementation, behavior change  communication on infant and young child feeding, and a pilot project for community management of severe acute malnutrition. Interventions are challenged, however, by barriers including inadequate financial  commitment, low prioritization of nutrition, inadequate personnel, and insufficient job aids. Because nutrition was relatively underfunded in the district, nutrition technical officers had been shifted to perform other or additional tasks. Insufficient investment and inadequate capacity prevents delivery of quality nutrition services in the Omanye District. Interventions that prioritize and improve investment in nutrition actions are needed to optimize nutrition services at the district level in Ghana. Key words: Nutrition, Capacity, Commitment, District, Ghan

A review of food and nutrition communication and promotion in Ghana

Dietary perception, behavior, and nutritional status can all be influenced by exposure to information. Behavior change communication that is appropriately designed and implemented is critical for motivating optimal dietary behavior. On the other hand, inadvertent or deliberate misinformation can drive unhealthy dietary behaviors. As part of the process to develop food-based dietary guidelines (FBDGs) for Ghana, this rapidevidence review examined the nature, extent, sources, and medium of food and nutrition information dissemination and promotion in Ghana.  PubMed, Cochrane, Google Scholar, and Open Access Theses Dissertations (OATD) databases were searched systematically using keywords to  identify relevant peer-reviewed and grey literature. The review included 31 documents, after excluding 1,302 documents for ineligibility (based on  irrelevant title, abstract, and duplicates). Limited reporting of undernutrition was found in print and electronic media. Unhealthy foods, including sugar-sweetened beverages, snacks, yogurt, instant noodles, candy/chocolate, and ice cream were frequently advertised through various  communication media. Children are highly exposed to food advertisements, which target them. Promotional characters, animation, billboards, and  front-of-store displays; product-branded books, and toys are common strategies for food marketing and advertisement in Ghana. The most frequently reported sources of health and nutrition information were television, radio, social media, health professionals, families, and friends.  Children and adults experienced changes in food preferences and choices as a result of exposure to food advertised on television. The commonly  used traditional media were radio and television; printed newspaper use has declined tremendously in the past decade. Social media use  (particularly WhatsApp, Facebook, and YouTube) is highest in urban areas, and is growing rapidly; young adults are the most active users of social  media platforms. Experts recommend regulation as a mitigation for nutrition miscommunication and inaccurate promotion. The current review  highlights the need for regulation of food marketing, and advertisement to safeguard a healthy food environment in Ghana. &nbsp

A review of food and nutrition communication and promotion in Ghana

Dietary perception, behavior, and nutritional status can all be influenced by exposure to information. Behavior change communication that is appropriately designed and implemented is critical for motivating optimal dietary behavior. On the other hand, inadvertent or deliberate misinformation can drive unhealthy dietary behaviors. As part of the process to develop food-based dietary guidelines (FBDGs) for Ghana, this rapid evidence review examined the nature, extent, sources, and medium of food and nutrition information dissemination and promotion in Ghana. PubMed, Cochrane, Google Scholar, and Open Access Theses Dissertations (OATD) databases were searched systematically using keywords to identify relevant peer-reviewed and grey literature. The review included 31 documents, after excluding 1,302 documents for ineligibility (based on irrelevant title, abstract, and duplicates). Limited reporting of undernutrition was found in print and electronic media. Unhealthy foods, including sugar-sweetened beverages, snacks, yogurt, instant noodles, candy/chocolate, and ice cream were frequently advertised through various communication media. Children are highly exposed to food advertisements, which target them. Promotional characters, animation, billboards, and front-of-store displays; product-branded books, and toys are common strategies for food marketing and advertisement in Ghana. The most frequently reported sources of health and nutrition information were television, radio, social media, health professionals, families, and friends. Children and adults experienced changes in food preferences and choices as a result of exposure to food advertised on television. The commonly used traditional media were radio and television; printed newspaper use has declined tremendously in the past decade. Social media use (particularly WhatsApp, Facebook, and YouTube) is highest in urban areas, and is growing rapidly; young adults are the most active users of social media platforms. Experts recommend regulation as a mitigation for nutrition miscommunication and inaccurate promotion. The current review highlights the need for regulation of food marketing, and advertisement to safeguard a healthy food environment in Ghana

Scoping review of diet-related health outcomes and associated risk factors in Ghana

As part of a process to develop food-based dietary guidelines (FBDGs), the national Multi-sectoral Technical Task Team coordinating FBDGs development in Ghana has commissioned a desk review of the nutrition and health situation, and trends for all persons living in Ghana, across the  entire life cycle. Using a rapid scoping review method, multiple electronic databases were systematically searched using keywords related to  nutrition and health outcomes, as well as potential drivers of nutrition and health in Ghana. The review included evidence from peer-reviewed  articles, unpublished manuscripts, dissertations, reports of nationally representative surveys, and other grey literature (reports of nutrition situation  evaluations commissioned by international and local agencies), spanning the decade starting from 2010. A total of 48 documents were  included in this review: 15 for infants and young children, 14 for adolescents, 19 for adults and women of reproductive age, and five for the elderly.  Among children under five, anemia and stunting were the most prevalent nutritionrelated outcomes, 62% and 19%, respectively. Underweight  prevalence of 11% was observed among young children; wasting rates have remained below 10%, but registered about 20% prevalence in northern  Ghana. Different levels of micronutrient deficiencies, particularly iron deficiency were reported across all age groups. Nutrient deficiency rates were  higher among adolescent girls and women of reproductive age. Vitamin A deficiency was also high (21%) among under-fives. Overweight and  obesity rates were high among women of reproductive age (40%) and adolescents (11% to 18% between 2013 and 2017), and still increasing.  Underweight and overweight coexists among the elderly (50 years and above), at a rate of 10% and 20%, respectively. An increasing prevalence of  central adiposity has also been reported among women of reproductive age (high waist circumference of 80.6%) and persons older than 60 years  (67% in 2015). Rates of hypertension and cancers have also increased within the study period. Hypertension rates have been increasing with age,  particularly among urban dwellers. Majority of persons with hypertension are not receiving treatment . Incidence of breast, cervical, and liver  cancers were 20%, 14%, and 12% in 2018. Ghana is experiencing a double burden of malnutrition characterized by co-existing high levels of  undernutrition and overnutrition. The national FBDGs for Ghana should prioritize recommendations and actions that address the dual burden of  undernutrition and overnutrition.&nbsp

A rapid review of key policies and programs linked with nutrition and health in Ghana

As part of the process by the government of Ghana to develop food-based dietary guidelines, a review of policies and programs was commissioned. The review aimed to identify and describe the policy environment, with a focus on identifying the type of existing policies, priorities, and programs  related to nutrition and health between 2010 and 2020. The review also tracked the evolution of changes in policies and programs over the same  period. Using a systematic rapid scoping review approach, policy and program documents were identified and classified according to relevant  nutritionspecific and nutrition-sensensitive sectors, including health, agriculture and food, human development, social protection, and trade. Data  from included documents were extracted using an excel extraction tool. The extracted data including policies, programs, objectives, coverage of the  policies/programs, intended outcomes, target groups, and agencies responsible for implementing these policies and programs. More than 70  government documents, plus other reports and literature sources describing government policy and programs with relevance for nutrition were  identified. Most of these policies and programs were not designed to directly address malnutrition. This is because, the policies and programs  neither referenced nutrition objectives, nor nutrition outcomes. However, the existing policies and programs had aspects that can be leveraged  (either through redesign or implementation) to contribute to improved nutrition outcomes. A key challenge in the nutrition programming landscape  is the nonexistence of a comprehensive and costed national nutrition strategic plan to accompany the national nutrition policy. The key  nutrition priorities of the Government of Ghana and its partners, as expressed in the documents reviewed included infant and young child feeding,  stunting reduction, anemia, and food security. There were key nutritionrelated issues which have not been prioritized, although current local and  global evidence as well as stakeholder opinion suggests these have already become, or are rapidly becoming important priorities. These include  overweight and obesity, dietrelated chronic diseases, nutrition of school-age children, and nutrition of the elderly. These nutrition issues, if not  appropriately addressed, will continue to exact significant human health, economic, and social costs for Ghana. There is need for a comprehensive  nutrition strategy that leverages opportunities across multiple sectors to improve nutrition for today and for the future.&nbsp

Process and lessons learned in the development of food-based dietary guidelines in Ghana

Food-based dietary guidelines (FBDGs) are used, globally, as a tool for promoting awareness of healthy diets and, thereby, to improve dietary behaviour. It is also used as a policy framework for creating a health-promoting food environment. In sub-Saharan Africa, only a few countries have developed FBDGs. In 2016, Ghana commenced the process for developing a national FBDG. Four years down the line, significant progress has been achieved towards developing dietary guidelines for persons living in Ghana. The process for developing Ghana's FBDGs has, generally, follow the plan proposed by the 1998 FAO/WO consultative meeting on development of FBDGs, but with minor deviations. These deviations have been occasioned by the need to adapt the process to accommodate context-relevant circumstances relating to local capacity and financial resources constraints. The first step in developing Ghana’s FBDGs was to set up a national Multisectoral Technical Task Team (MTTT) under the policy direction of the Ministry of Food and Agriculture. Thereafter, an evidence review exercise was carried out, involving systematic review of existing literature, complemented by primary data collection, all aimed at understanding the priority foods, nutrition and health issues to be addressed by recommendations in the FBDGs. The key issues identified in the evidence review were validated by the MTTT and subsequently prioritized using an online survey, as well as a prioritization workshop that convened key stakeholders in nutrition and health in Ghana. Subsequently, the priority issues served as the basis for the crafting of technical recommendations. The aim of this paper is to describe the processes, people, data, and resources that have facilitated progress towards development of Ghana’s FBDGs. The challenges, and limitations of the process, as well as the solutions that have been employed to overcome them, have also been highlighted here. For the benefit of future FBDGs development in Ghana and elsewhere, the key lessons that have been learned in the development of Ghana’s FBDGs have been presented, including lessons on political will, planning and time management, resources, capacity development, and multi-sectoral action.&nbsp

Process and lessons learned in the development of food-based dietary guidelines in Ghana

Food-based dietary guidelines (FBDGs) are used, globally, as a tool for promoting awareness of healthy diets and, thereby, to improve dietary behaviour. It is also used as a policy framework for creating a health-promoting food environment. In sub-Saharan Africa, only a few countries have  developed FBDGs. In 2016, Ghana commenced the process for developing a national FBDG. Four years down the line, significant progress has been  achieved towards developing dietary guidelines for persons living in Ghana. The process for developing Ghana's FBDGs has, generally, follow the  plan proposed by the 1998 FAO/WO consultative meeting on development of FBDGs, but with minor deviations. These deviations have been  occasioned by the need to adapt the process to accommodate context-relevant circumstances relating to local capacity and financial resources  constraints. The first step in developing Ghana’s FBDGs was to set up a national Multisectoral Technical Task Team (MTTT) under the policy direction  of the Ministry of Food and Agriculture. Thereafter, an evidence review exercise was carried out, involving systematic review of existing literature,  complemented by primary data collection, all aimed at understanding the priority foods, nutrition and health issues to be addressed by  recommendations in the FBDGs. The key issues identified in the evidence review were validated by the MTTT and subsequently prioritized using an  online survey, as well as a prioritization workshop that convened key stakeholders in nutrition and health in Ghana. Subsequently, the priority issues served as the basis for the crafting of technical recommendations. The aim of this paper is to describe the processes, people, data, and resources  that have facilitated progress towards development of Ghana’s FBDGs. The challenges, and limitations of the process, as well as the solutions that  have been employed to overcome them, have also been highlighted here. For the benefit of future FBDGs development in Ghana and elsewhere, the  key lessons that have been learned in the development of Ghana’s FBDGs have been presented, including lessons on political will, planning and  time management, resources, capacity development, and multi-sectoral action.&nbsp

A rapid review of key policies and programs linked with nutrition and health in Ghana

As part of the process by the government of Ghana to develop food-based dietary guidelines, a review of policies and programs was commissioned. The review aimed to identify and describe the policy environment, with a focus on identifying the type of existing policies, priorities, and programs related to nutrition and health between 2010 and 2020. The review also tracked the evolution of changes in policies and programs over the same period. Using a systematic rapid scoping review approach, policy and program documents were identified and classified according to relevant nutritionspecific and nutrition-sensensitive sectors, including health, agriculture and food, human development, social protection, and trade. Data from included documents were extracted using an excel extraction tool. The extracted data including policies, programs, objectives, coverage of the policies/programs, intended outcomes, target groups, and agencies responsible for implementing these policies and programs. More than 70 government documents, plus other reports and literature sources describing government policy and programs with relevance for nutrition were identified. Most of these policies and programs were not designed to directly address malnutrition. This is because, the policies and programs neither referenced nutrition objectives, nor nutrition outcomes. However, the existing policies and programs had aspects that can be leveraged (either through redesign or implementation) to contribute to improved nutrition outcomes. A key challenge in the nutrition programming landscape is the nonexistence of a comprehensive and costed national nutrition strategic plan to accompany the national nutrition policy. The key nutrition priorities of the Government of Ghana and its partners, as expressed in the documents reviewed included infant and young child feeding, stunting reduction, anemia, and food security. There were key nutritionrelated issues which have not been prioritized, although current local and global evidence as well as stakeholder opinion suggests these have already become, or are rapidly becoming important priorities. These include overweight and obesity, dietrelated chronic diseases, nutrition of school-age children, and nutrition of the elderly. These nutrition issues, if not appropriately addressed, will continue to exact significant human health, economic, and social costs for Ghana. There is need for a comprehensive nutrition strategy that leverages opportunities across multiple sectors to improve nutrition for today and for the future.&nbsp

Food retail assessment and family food purchase behavior in ashongman estates, Ghana

A key feature of the nutrition transition in developed countries is the rapid transformation of the food system towards increasing availability and access to cheaper, and more processed foods. These changes are associated with alterations in dietary behavior with implications for chronic disease risk. However, the process of change in the food system begins with changes in the food retail system and its subsequent effect on consumer behavior. Currently, little is known about the nature of the food marketplace in emerging economies like Ghana, and also how the changing economy and food retail situation are influencing consumer behavior. The current paper presents a case study of the food retail system and consumer food purchase behavior in suburban Accra. Between May and August 2012, an assessment of food retail outlets was carried out in Ashongman Estates, a suburb of Accra. The study involved observations, in-depth interviews with retailers, and a survey of households. Data from the study allowed classification of retail food vendors across the urban food retail system. In addition, data on food purchase preferences and purchase behavior were obtained from a household survey of 75 randomly selected households in Ashongman Estates. The data showed that traditional markets still constitute the most important source of household food purchases. A majority of households (87%) reported preference for traditional markets, and almost all households (99%) indicated traditional markets as their main source for purchasing household food. Foods available from supermarkets were mainly processed foods. However, processed foods are also commonly available through the traditional markets and minimarkets. The preference for traditional markets was attributed to greater variety of foods, lower price, and proximity of food source. Minimarket vendors, including corner stores, table top vendors, hawkers, and fuel station shops that are located within the community, served as an additional food source, complementing food purchases from the traditional markets. The study concluded that although traditional markets remain the main source of household food, interventions are needed to ensure that food markets in the community include access to a variety of fresh produce rather than promote processed foods, in order to promote consumer health.Key words: Food environment, traditional market, retail, supermarket, minimarkets, suburban food marke