Margaret Armar-Klemesu

Good Care Practices Can Mitigate the Negative Effects of Poverty and Low Maternal Schooling on Children’s Nutritional Status: Evidence from Accra

This study uses data from a representative survey of households with preschoolers in Accra, Ghana to (1) examine the importance of care practices for childrens height-for-age z-scores (HAZ); and (2) identify subgroups of children for whom good maternal care practices may be particularly important. Good caregiving practices related to child feeding and use of preventive health services were a strong determinant of childrens HAZ, specially among children from the two lower income terciles and children whose mothers had less than secondary schooling. In this population, good care practices could compensate for the negative effects of poverty and low maternal schooling on childrens HAZ. Thus, effective targeting of specific education messages to improve child feeding practices and use of preventive health care could have a major impact on reducing childhood malnutrition in Accra.

Working Women in an Urban Setting: Traders, Vendors and Food Security in Accra

Data collected from a 1997 household survey carried out in Accra, Ghana, are used to look at the crucial role that women play as income earners and in securing access to food in urban areas. The high number of female-headed households and the large percent of working women in the sample provide a good backdrop for looking at how women earn and spend income differently than men in an urban area. Livelihood strategies for both men and women are predominantly labor based and dependent on social networks. For all households in the sample, food is still the single most important item in the total budget. Yet, important and striking differences between men and womens livelihoods and expenditure patterns exist. Compared to men, women are less likely to be employed as wage earners, and more likely to work as street food vendors or petty traders. Women earn lower incomes, but tend to allocate more of their budget to basic goods for themselves and their children, while men spend more on entertainment for themselves only. Despite lower incomes and additional demands on their time as housewives and mothers, female-headed households, petty traders, and street food vendors have the largest percentage of food secure households. This paper explores differences in income, expenditure, and consumption patterns in an effort to answer this question, and suggests ways that urban planners and policymakers can address special concerns of working women in urban areas.

Alternative food-security indicators: revisiting the frequency and severity of `coping strategies'

Abstract Recent research on the multi-factorial nature of food security has provided a wealth of analytical insight, but measurement problems remain a major challenge, not only for research, but particularly for targeting, program management, monitoring and evaluation. Building on an approach suggested in a 1996 article, this paper constructs a series of alternative food-security indicators based on the frequency and severity of consumption-related coping strategies. These alternative indicators are then compared with more standard measures, including a consumption benchmark, a poverty benchmark and a nutritional benchmark using data from the 1997 Accra Urban Food and Nutrition Study. Against these more traditional indicators, the coping strategy indicators are best at ruling out cases—that is, minimizing the risk of classifying a food-insecure household as food-secure. They also help to identify sources of vulnerability and the trade-offs made with other basic needs to acquire sufficient food. The measures outlined here are much less time-consuming and less expensive in terms of data collection and analysis, and therefore perhaps offer a pragmatic alternative to food and livelihood program managers. However, the comparative analysis of conventional benchmarks with the coping strategies indicator reveals some shortcomings with the benchmark indicators as well—a sign that perhaps the indicators of food security proposed here are both alternative and complementary measures.

Does Geographic Targeting of Nutrition Interventions Make Sense in Cities? Evidence from Abidjan and Accra

Although most developing country cities are characterized by pockets of substandard housing and inadequate service provision, it is not known to what degree low incomes and malnutrition are confined to specific neighborhoods. This analysis uses representative household surveys of Abidjan and Accra to quantify small-area clustering in service provision, demographic characteristics, consumption, and nutrition. Both cities showed significant clustering in housing conditions but not in nutrition, while income was clustered in Abidjan, but less so in Accra. This suggests that neighborhood targeting of poverty-alleviation or nutrition interventions in these and similar cities could lead to undercoverage of the truly needy.

Providing free maternal health care: ten lessons from an evaluation of the national delivery exemption policy in Ghana.

Background: There is a growing movement, globally and in the Africa region, to reduce financial barriers to health care generally, but with particular emphasis on high priority services and vulnerable groups. Objective: This article reports on the experience of implementing a national policy to exempt women from paying for delivery care in public, mission and private health facilities in Ghana. Design: Using data from a complex evaluation which was carried out in 2005–2006, lessons are drawn which can inform other countries starting or planning to implement similar service-based exemption policies. Results: On the positive side, the experience of Ghana suggests that delivery exemptions can be effective and cost-effective, and that despite being universal in application, they can benefit the poor. However, certain ‘negative’ lessons are also drawn from the Ghana case study, particularly on the need for adequate funding, and for strong institutional ownership. It is also important to monitor the financial transfers which reach households, to ensure that providers are passing on benefits in full, while being adequately reimbursed themselves for their loss of revenue. Careful consideration should also be given to staff motivation and the role of different providers, as well as quality of care constraints, when designing the exemptions policy. All of this should be supported by a proactive approach to monitoring and evaluation. Conclusion: The recent movement towards making delivery care free to all women is a bold and timely action which is supported by evidence from within and beyond Ghana. However, the potential for this to translate into reduced mortality for mothers and babies fundamentally depends on the effectiveness of its implementation.

Balancing nurturance, cost and time: complementary feeding in Accra, Ghana

This paper presents a picture of the general patterns of complementary feeding behaviours in urban Ghana. A focused ethnographic study protocol for assessing complementary feeding developed for the Global Alliance for Improved Nutrition was used to collect data from caregivers of children 6-24 months of age. We examined the multiple factors that influence the selection of foods for infants and young children in this urban setting, and found that economic factors, health beliefs and other nurturing-related values, access to food and issues of convenience all play important roles. We conclude that the interactions of nurturance, cost and time are vectors that affect feeding decisions.

The focused ethnographic study ‘assessing the behavioral and local market environment for improving the diets of infants and young children 6 to 23 months old’ and its use in three countries

The concept of a focused ethnographic study (FES) emerged as a new methodology to answer specific sets of questions that are required by agencies, policymakers, programme planners or by project implementation teams in order to make decisions about future actions with respect to social, public health or nutrition interventions, and for public-private partnership activities. This paper describes the FES on complementary feeding that was commissioned by the Global Alliance for Improved Nutrition and highlights findings from studies conducted in three very different country contexts (Ghana, South Africa and Afghanistan) burdened by high levels of malnutrition in older infants and young children (IYC). The findings are analysed from the perspective of decision-making for future interventions. In Ghana, a primary finding was that in urban areas the fortified, but not instant cereal, which was being proposed, would not be an appropriate intervention, given the complex balancing of time, costs and health concerns of caregivers. In both urban and rural South Africa, home fortification products such as micronutrient powders and small quantity, lipid-based nutrient supplements (LNS) are potentially feasible interventions, and would require thoughtful behaviour change communication programmes to support their adoption. Among the important results for future decision-making for interventions in Afghanistan are the findings that there is little cultural recognition of the concept of special foods for infants, and that within households food procurement for IYC are in the hands of men, whereas food preparation and feeding are womens responsibilities.

Phytic Acid-to-Iron Molar Ratio Rather than Polyphenol Concentration Determines Iron Bioavailability in Whole-Cowpea Meal among Young Women

Limited data exist on iron absorption from NaFeEDTA and FeSO(4) in legume-based flours. The current study compared iron absorption from NaFeEDTA and FeSO(4) as fortificants within and between red and white varieties of cowpea with different concentrations of polyphenols (PP) but similar phytic acid (PA)-to-iron molar ratios. We performed a paired crossover study in young women (n = 16). Red-cowpea (high-PP) and white-cowpea (low-PP) test meals (Tubani) were each fortified with ((57)Fe)-labeled NaFeEDTA or ((58)Fe)-labeled FeSO(4) and were randomly administered. Iron absorption was measured as erythrocyte incorporation of stable iron isotopes. Per serving, the mean (±SD) PP concentrations of the white- and red-cowpea-based meals were 74 ± 3.6 and 158 ± 1.8 mg, respectively, and the molar ratio of PA to iron was 3.0 and 3.3. Iron bioavailabilities from red and white cowpeas were 1.4 and 1.7%, respectively, in NaFeEDTA-fortified meals and 0.89 and 1.2%, respectively, in FeSO(4)-fortified meals. Compared with FeSO(4), fortification with NaFeEDTA increased the amount of iron absorbed from either of the cowpea meals by 0.05 to 0.08 mg (P < 0.05). Irrespective of the fortificant used, there was no significant difference in the amount of iron absorbed from the 2 varieties of cowpea. The results suggest that NaFeEDTA is more bioavailable in legume-based flours compared with FeSO(4). In cowpea-based flours, the major determinant of low iron absorption may be the high molar ratio of PA to iron and not variations in PP concentration.

Immunological background in children with persistent diarrhea in Ghana

Abstract Background: Persistent diarrheal diseases have become one of the most serious medical problems in developing countries, but few studies have been conducted to determine the risk factors. In the present study, we investigated the nutritional and immunological background in children with persistent diarrhea in comparison with those with acute diarrhea.

Regular peanut consumption improves plasma lipid levels in healthy Ghanaians

Objective To determine whether the daily intake of 2,092 kJ (500 kcal) from peanuts will improve the lipid profiles and diet quality of healthy Ghanaians. Design A 30-week, randomized, cross-over trial study was conducted with healthy adults. Method There were three treatment arms: Treatment 1 (T1), subjects were provided 2,092 kJ/day (500 kcal/day) peanuts to incorporate into their daily diet for 8 weeks at any time and in any form they chose; Treatment 2 (T2), subjects were provided 2,092 kJ/day (500 kcal/day) peanuts and were instructed to consume them in addition to their customary daily diet for 3 weeks; Treatment 3 (T3), substitution of 2,092 kJ/day fat, with energy from peanuts. Total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol and triglyceride were measured at baseline, week 4 and week 8 (T1 and T3) or at baseline and week 3 (T2). Three-day dietary intake records were kept during each treatment. Results There was significant decrease in total cholesterol (7.2%) and triacylglycerol (20.0%) after T1. However, individually, high-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol levels did not change significantly. Total fat intake increased by 9%, due to elevations of monounsaturated fatty acid of 60% and polyunsaturated fatty acid of 50%. Similar non-significant trends were observed during T2 and T3. Conclusion The results suggest that regular consumption of peanuts lowers the total cholesterol and triacylglycerol concentrations among healthy Ghanaians. Regular consumption of peanuts should therefore be encouraged.