Esi Colecraft

HIV/AIDS : nutritional implications and impact on human development

HIV/AIDS is associated with biological and social factors that affect the individuals ability to consume and utilize food and to acquire food. These biological and social factors lead to poor nutritional status and weight loss, which are an important cause of morbidity in individuals infected with HIV, resulting in a poor quality of life; weight loss is an important predictor of death from AIDS. The links between nutrition and HIV/AIDS amplify the negative effects of HIV infection on human development at individual, household, community and national levels. For many developing countries the incidence of HIV/AIDS and malnutrition is impeding progress towards achieving the UN millennium development goals. Aggressive interventions to curb the spread of HIV continue to be needed. Concurrent efforts to improve nutrition for populations living with HIV/AIDS should also be given priority.

Constraints on the Use of Animal Source Foods for Young Children in Ghana: A Participatory Rapid Appraisal Approach

Micronutrient deficiencies limit child health and development. Although animal source foods (ASF) provide highly bioavailable micronutrients, Ghanaian preschoolers consume little. Participatory rapid appraisal methods identified constraints to the availability, accessibility, and utilization of ASF. Stakeholders working with or living in six communities in three agro-ecological zones reported constraints including low income, lack of access to technology and markets, inequitable household food allocation, inadequate knowledge, and beliefs. The least expensive ASF was fish, which was easy to preserve and consumed by all communities. Since ASF was primarily purchased, interventions that increase income may be most successful in improving Ghanaian childrens diets.

An Integrated Microcredit, Entrepreneurial Training, and Nutrition Education Intervention Is Associated with Better Growth Among Preschool-Aged Children in Rural Ghana

BACKGROUND Poor diet quality is a determinant of the high prevalence rates of malnutrition in Ghana. There is little evidence on the effectiveness of a multisector intervention to improve childrens diets and nutritional status. OBJECTIVE The project tested whether participation in an entrepreneurial and nutrition education intervention with microcredit was associated with the nutritional status of children 2-5 y of age. METHODS A quasi-experimental 16-mo intervention was conducted with microcredit loans and weekly sessions of nutrition and entrepreneurship education for 179 women with children 2-5 y of age [intervention group (IG)]. Nonparticipating women and their children from the same villages (nonparticipant, n = 142) and from similar neighboring villages (comparison, n = 287) were enrolled. Repeated measures linear regression models were used first to examine childrens weight-for-age (WAZ), height-for-age (HAZ), and body mass index-for-age (BAZ) z scores at baseline and at 4 follow-up time points ∼4 mo apart. Time, intervention status, time-by-intervention interaction terms, region of residence, household wealth rank, household head occupation, number of children <5 y of age, and child sex and age were included. RESULTS There was a significant interaction between the IG and time for BAZ (P = 0.02) with significant Bonferroni-corrected pairwise comparisons between the IG and comparison group (CG) at 8 mo (difference of 0.36 ± 0.09 z score, P < 0.0001). The WAZ group difference was significant between 4 and 16 mo (P = 0.01 for interaction) and peaked at 8-12 mo (differences of ∼0.28 z). The HAZ of children in the IG was significantly higher than that in the CG, reaching a 0.19 z difference at 16 mo (P < 0.05). When the fixed effects models were fitted in sensitivity analyses, some group anthropometric differences were of lower magnitude but remained significant. CONCLUSION An integrated package of microcredit and education may improve nutritional outcomes of children living in poor, rural communities.

Impact of type of child growth intervention program on caregivers’ child feeding knowledge and practices: a comparative study in Ga West Municipality, Ghana

Abstract Community‐based growth promotion (CBGP) delivered by community volunteers aims at enhancing the traditional growth monitoring and promotion (GMP) program delivered by community health nurses through the promotion of optimum infant and young child feeding (IYCF) leading to improved child growth. This study compared IYCF knowledge and practices among caregiver–child pairs (0–24 months) receiving child welfare services from CBGP (n = 124) and GMP (n = 108) programs. Semistructured questionnaires were used to interview caregivers on IYCF knowledge/practices and validated food frequency questionnaire used to record infants’ food intakes. Group differences were determined using Chi‐square and independent samples t‐tests (P < 0.05; 95% confidence interval [CI]). Mean IYCF knowledge scores were similar (CBGP: 10.84 ± 1.69 vs. GMP: 10.23 ± 1.38, P = 0.062). However, more CBGP caregivers (17%) were highly knowledgeable than their GMP counterparts (5%) (P = 0.011). Early breastfeeding initiation (CBGP: 54% vs. GMP: 28%, P < 0.0001), exclusive breastfeeding (CBGP: 73% vs. GMP: 56%, P = 0.001), and timely complementary feeding (CBGP: 72% vs. GMP: 49%, P = 0.014) were reportedly higher among CBGP caregivers. Underweight was 11% (CBGP: 8% vs. GMP: 14%, P = 0.154). Mean dietary diversity scores (10 food groups) were similar (CBGP: 4.49 ± 1.89 vs. GMP: 3.87 ± 1.89, P = 0.057) but more CBGP caregivers (77%) achieved minimum dietary diversity than their GMP counterparts (61%) (P = 0.035). Few caregivers achieved minimum meal frequency (CBGP: 31% vs. GMP: 29%, P = 0.486) and minimum acceptable diet (CBGP: 23% vs. GMP: 21%, P = 0.464) indicators. Number of children under 5 years owned by caregiver (adjusted odds ratio [AOR]: 0.405; 95% CI: 1.13–78.53, P = 0.038), her educational level (AOR: 0.112; 95% CI: 0.02–0.90, P = 0.040), and IYCF knowledge (AOR: 0.140; 95% CI: 0.03–0.79, P = 0.026) significantly predicted optimum child feeding. Nutrition education on optimum complementary feeding and birth spacing strategies should intensify.

Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana

Livestock production and Animal-Source Foods (ASFs) like meat, milk, and eggs are excellent sources of essential micronutrients, including iron and zinc. There is evidence that encouraging increased access to and consumption of these ASFs may either positively or negatively impact anemia, or have no nutritional effects. Drawing upon first-hand experiences in Ghana, this study sought to: (1) identify the main motivations for raising livestock in Ghana; (2) describe the major barriers to consuming ASFs, especially among women of reproductive age (WRA); and (3) explore the feasibility of different livestock-centered interventions to reduce anemia. Key informant interviews and focus group discussions were held with relevant stakeholders at different geographical scales - the national, regional, district, and community levels. The results suggest that livestock enable savings, allow resource-poor households to accumulate assets, and help finance planned and unplanned expenditures (e.g., school fees and illness). Due to these multiple and often pressing uses, direct consumption of home-reared ASFs is not a major priority, especially for poor households. Even when ASFs are consumed, intra-household allocation does not favor women and adolescent girls, demographic groups with particularly high micronutrient requirements. The study participants discussed possible interventions to address these challenges, including (1) increasing livestock ownership through in-kind credit; (2) encouraging nutrition-related behavior change; (3) improving livestock housing; and (4) hatchery management. The paper discusses these interventions based upon potential acceptance, feasibility, cost effectiveness, and sustainability in the Ghanaian context.

Association of Whole Blood Fatty Acids and Growth in Southern Ghanaian Children 2–6 Years of Age

In Ghana, stunting rates in children below 5 years of age vary regionally. Dietary fatty acids (FAs) are crucial for linear growth. The objective of this study was to determine the association between blood FAs and growth parameters in southern Ghanaian children 2–6 years of age. A drop of blood was collected on an antioxidant treated card and analyzed for FA composition. Weight and height were measured and z-scores calculated. Relationships between FAs and growth were analyzed by linear regressions and factor analysis. Of the 209 subjects, 22% were stunted and 10.6% were essential FA deficient (triene/tetraene ratio > 0.02). Essential FA did not differ between stunted and non-stunted children and was not associated with height-for-age z-score or weight-for-age z-score. Similarly, no relationships between other blood fatty acids and growth parameters were observed in this population. However, when blood fatty acid levels in these children were compared to previously reported values from northern Ghana, the analysis showed that blood omega-3 FA levels were significantly higher and omega-6 FA levels lower in the southern Ghanaian children (p < 0.001). Fish and seafood consumption in this southern cohort was high and could account for the lower stunting rates observed in these children compared to other regions.

Livestock ownership is associated with higher odds of anaemia among preschool-aged children, but not women of reproductive age in Ghana

Abstract Livestock ownership may influence anaemia through complex and possibly contradictory mechanisms. In this study, we aimed to determine the association of household livestock ownership with anaemia among women aged 15–49 years and children aged 6–59 months in Ghana and to examine the contribution of animal source foods (ASFs) to consumption patterns as a potential mechanism mediating this association. We analysed data on 4,441 women and 2,735 children from the 2014 Ghana Demographic and Health Survey and 16,772 households from the Ghana Living Standards Survey Round 6. Haemoglobin measurements were used to define anaemia (non‐pregnant women: <120 g/L; children: <110 g/L). Child‐ and household‐level ASF consumption data were collected from 24‐hour food group intake and food consumption and expenditure surveys, respectively. In multiple logistic regression models, household livestock ownership was associated with anaemia among children (OR, 95% CI: 1.5 [1.1, 2.0]), but not women (1.0 [0.83, 1.2]). Household ownership of chickens was associated with higher odds of anaemia among children (1.6 [1.2, 2.2]), but ownership of other animal species was not associated with anaemia among women or children. In path analyses, we observed no evidence of mediation of the association of household livestock ownership with child anaemia by ASF consumption. Ownership of livestock likely has limited importance for consumption of ASFs among young children in Ghana and may in fact place children at an increased risk of anaemia. Further research is needed to elucidate if and how pathogen exposure associated with livestock rearing may underlie this increased risk of anaemia.

Strengthening capacity for evidence-informed decision-making in Africa: evident lessons and opportunities

NMR metabolomic signatures reveal predictive plasma metabolites associated with long-term risk of developing breast cancer. IUNS 21st International Congress of NutritionBackground and objectives: The University of Southampton and International Malnutrition Task Force developed Malnutrition eLearning to reduce child mortality by Severe Acute Malnutrition (SAM) through training health professionals globally. Since made available in 2010, over 14,000 from 100+ countries used the course. To investigate its effectiveness, a 2-year evaluation study was conducted from 2015, face-to-face in Ghana and Central America (CA), and online in other countries.Methods: Using a mixed method approach, the study explored if and how Malnutrition eLearning supported knowledge gain and behavioural change (application of knowledge in clinical practice), and resulting clinical outcomes in the management of SAM. Assessments, questionnaires and interviews/focus groups were conducted with individual in-service and pre-service participants pre- and post-training, and 12 months of medical records data collection, observations and hospital personnel interviews were carried out from participating healthcare institutions.Results: Total 1,261 health professionals (Ghana:915, CA:142, other countries:201), and 10 hospitals and 2 community health centres in Ghana and 2 hospitals in CA participated in the study. 3,955 (pre:01/08/2014–31/07/2015) and 3,737 (post:01/08/2015– 31/07/2016) medical records of children (0-60 months) were collected from the hospitals, and summary data on malnutrition cases (pre:76, post:67) from community health centres. Individual participants scored significantly higher in the post assessment (mean difference(SD): 14.0(12.5), 95%CI(12.7, 15.2), p<0.001). 87% of in-service health professionals (102/117) applied their knowledge and changed clinical practice in screening, assessment, diagnosis and management of SAM. This group demonstrated retained knowledge 6-month after the training (mean difference from pre-assessment(SD): 12.7(11.7), 95%CI(10.4, 15.0),p<0.001). Significant increases (p<0.001) in recording malnutrition-markers, i.e. length/height and weight-for-length/ height z-score, and diagnosed SAM cases (pre: 491(12.4%), post: 810(21.7%)) were observed. Mortality by SAM was declined from 26(5.9%) to 14(1.9%) (p<0.001). The community centres initiated the management of SAM (pre:0/32, post:7/21).Conclusions: The results suggest that Malnutrition eLearning is effective in training the WHO guideline on the management of SAM. After a 2-day self-directed training with Malnutrition eLearning, the participants not only gained knowledge but were also able to apply the knowledge in their clinical practice, leading to significant impacts on clinical outcomes.Acknowledgement: This study was supported by the UK Department for International Development Nutrition Embedding Evaluation Programme, managed by PATH.This paper was presented at IUNS 21st International Congress of Nutrition, Buenos Aires, Argentina, 15-20 October. This is the peer-reviewed but unedited manuscript version of the following article: MARKEY, O. ...et al., 2017. Postprandial lipid responses after long-term intake of dairy products varying in fatty acid composition. Annals of Nutrition and Metabolism, 71 (Suppl 2), pp. 346 (DOI: 10.1159/000480486). The final, published version is available at https://doi.org/10.1159/000480486

Evidence-informed decision making for nutrition : African experiences and way forward

Although substantial amount of nutrition research is conducted in Africa, the research agenda is mainly donor-driven. There is a clear need for a revised research agenda in Africa which is both driven by and responding to local priorities. The present paper summarises proceedings of a symposium on how evidence can guide decision makers towards context-appropriate priorities and decisions in nutrition. The paper focuses on lessons learnt from case studies by the Evidence Informed Decision Making in Nutrition and Health Network implemented between 2015 and 2016 in Benin, Ghana and South Africa. Activities within these countries were organised around problem-oriented evidence-informed decision-making (EIDM), capacity strengthening and leadership and horizontal collaboration. Using a combination of desk-reviews, stakeholder influence-mapping, semi-structured interviews and convening platforms, these country-level studies demonstrated strong interest for partnership between researchers and decision makers, and use of research evidence for prioritisation and decision making in nutrition. Identified capacity gaps were addressed through training workshops on EIDM, systematic reviews, cost-benefit evaluations and evidence contextualisation. Investing in knowledge partnerships and development of capacity and leadership are key to drive appropriate use of evidence in nutrition policy and programming in Africa.