Richmond Aryeetey

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.

Subclinical mastitis is common among Ghanaian women lactating 3 to 4 months postpartum.

Subclinical mastitis (SCM) is an asymptomatic inflammation of mammary tissue and has been associated with lactation failure, suboptimal growth in early infancy, and increased risk of mother-to-child transmission of HIV via breast milk. A rapid survey was carried out to determine the prevalence of SCM among lactating Ghanaian women between 3 and 4 months postpartum. Bilateral breast milk samples were obtained from 117 lactating women in Manya Krobo, Ghana and analyzed for sodium (Na) and potassium (K). An elevated sodium/potassium ratio (Na/K) above 1.0 was considered indicative of SCM. Overall, SCM prevalence was observed among 45.3% of the women. About 30% of the women had unilateral SCM. Na/K was associated with maternal age. The high SCM prevalence in Manya Krobo suggests the need for lactation support to reduce SCM and the risk of poor infant outcomes. J Hum Lact. 24(3):263-267. La mastitis subclínica (MSC) es una inflamación sintomática del tejido mamario y se ha asociado con el fracaso de la lactancia materna, crecimiento subóptimo en la primera infancia, y aumento del riesgo de la transmisión madre-hijo del VIH a través de la leche materna. Hicimos una encuesta rápida para determinar la prevalencia de la MSC entre mujeres lactando en Ghana entre los 3 y 4 meses postparto. Se obtuvieron muestras bilaterales de leche de 117 mujeres lactando en Manya Krobo, Ghana y se analizó el sodio (Na) y el potasio (K). Niveles elevados del rango sodio-potasio (Na/K) sobre 1.0 se consideraron indicativos de MSC. En general, la prevalencia de SCM fue de 45.3% de las cuales 29.9% fueron unilateral. El Na/K se asoció con la edad materna. Alta prevalencia de MSC en Manya Krobo sugiere la necesidad de apoyo a la lactancia para reducir la MSC y el riesgo de impacto en la salud del bebe.

Preferred Interpersonal Distances: A Global Comparison

Human spatial behavior has been the focus of hundreds of previous research studies. However, the conclusions and generalizability of previous studies on interpersonal distance preferences were limited by some important methodological and sampling issues. The objective of the present study was to compare preferred interpersonal distances across the world and to overcome the problems observed in previous studies. We present an extensive analysis of interpersonal distances over a large data set (N = 8,943 participants from 42 countries). We attempted to relate the preferred social, personal, and intimate distances observed in each country to a set of individual characteristics of the participants, and some attributes of their cultures. Our study indicates that individual characteristics (age and gender) influence interpersonal space preferences and that some variation in results can be explained by temperature in a given region. We also present objective values of preferred interpersonal distances in different regions, which might be used as a reference data point in future studies.

Re-assessment of selected Baby-Friendly maternity facilities in Accra, Ghana.

BackgroundThe Baby-Friendly Hospital Initiative (BFHI) has been implemented in Ghana since 1995. At the end of 2011, about 325 maternity facilities in Ghana had been designated Baby Friendly. However, none had been re-assessed for adherence to the Ten Steps to successful breastfeeding (Ten Steps). The current study re-assessed six maternity facilities in Accra for adherence to the Ten Steps and the International Code of Marketing of breast milk substitutes (the Code).MethodsThree independent assessors performed the re-assessment using the revised WHO/UNICEF external re-assessment tool (ERT) between April and June, 2011. All sections of the ERT were implemented, except for the HIV/infant feeding section. Assessors interviewed 90 clinical staff of the facilities, 60 pregnant women, and 150 women who had given birth and waiting to be discharged from the hospital. Additionally, observations were completed on neonate feeding and compliance with the Code. Data was analyzed to assess adherence to the Ten Steps and the Code.ResultsIn 2010, the six facilities recorded a total of 26,339 deliveries. At discharge, the weighted exclusive breastfeeding rate was 93.8%. None of the facilities adhered completely to the Ten Steps. Overall, the rate of adherence to the Ten Steps was 42% (range = 30 - 70%). No facility met the criteria for Steps One and Two. Only Step Seven was adhered to by all facilities. Overall compliance with the Code was about 54%. Trained staff attrition, high client-staff ratios, inadequate in-service training for new staff, and inadequate support for regional and national program monitoring were identified as barriers to adherence.ConclusionPoor adherence to Baby-Friendly practices in designated BFHI facilities was observed in urban Accra. Renewed efforts to support monitoring of designated facilities is recommended.

Construct validity of the neighborhood environment walkability scale for Africa

Purpose The development of valid measures of built environments relevant for physical activity is an important step toward controlling the global epidemic of physical inactivity–related noncommunicable diseases and deaths. This study assessed the construct validity of a self-report neighborhood environment walkability scale adapted for Africa (NEWS-Africa), by examining relationships with self-reported walking for transportation and recreation using pooled data from six sub-Saharan African countries. Methods NEWS was systematically adapted to assess urban, periurban, and rural environments in sub-Saharan Africa. Adults (n = 469, 18–85 yr, 49.7% women) from Cameroon, Ghana, Mozambique, Nigeria, South Africa, and Uganda were purposively recruited from neighborhoods varying in walkability and socioeconomic status, with some from villages. Participants completed the 76-item (13 subscales) NEWS-Africa by structured interview and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire. Results The overall “walkability” index had a positive relationship with both walking for transportation (&eegr;2 = 0.020, P = 0.005) and recreation (&eegr;2 = 0.013, P = 0.028) in the pooled analyses. The mixed-use access and stranger danger scales were positively related with transport walking (&eegr;2 = 0.020, P = 0.006 and &eegr;2 = 0.021, P = 0.040, respectively). Proximity of recreational facilities (&eegr;2 = 0.016, P = 0.015), road/path connectivity (&eegr;2 = 0.025, P = 0.002), path infrastructure (&eegr;2 = 0.021, P = 0.005), and overall places for walking and cycling (&eegr;2 = 0.012, P = 0.029) scales were positively related to recreational walking. Country-specific results were mostly nonsignificant except for South Africa and Uganda. Conclusions Of 14 NEWS-Africa scales, 7 were significantly related to walking behavior in pooled analyses, providing partial support for the construct validity of NEWS-Africa. However, effect sizes appeared to be lower than those from other continents. Further study with larger and more diverse samples is needed to determine whether the instrument performs well in each country.

Results From Ghana's 2014 Report Card on Physical Activity for Children and Youth

BACKGROUND Limited evidence exists on indicators of physical activity (PA) and guidelines for children and youth in Ghana, despite the growing burden of physical inactivity, obesity, and related morbidity. A baseline description of PA indicators of Ghanaian children and youth is hereby presented in the 2014 Ghanaian Physical Activity Report Card. METHODS Data for the report card were obtained from a very limited available literature on PA among children and youth in Ghana. PA experts independently assigned grades to indicators based on available evidence, which were then harmonized and agreed to by group consensus. RESULTS The report card is based on limited evidence. Thus, 2 indicators were not graded (Active Play, and Family and Peer Support). For sedentary behavior, a B grade was assigned based on evidence from the 2012 Ghana School Health Survey which indicated that 21% of children and youth were sedentary. Organized Sports was graded a C, while the remainder of indicators (Overall PA levels, Active Transportation, School, Community, and Government) were graded a D. CONCLUSIONS About one-third of Ghanaian children and youth engage in inadequate PA. More research on PA behavior and enabling environments is needed to better grade the indicators of PA in the future and to inform policy and interventions in Ghana. Appropriate school physical education and after-school sports policies and programs are warranted.

Micronutrient composition and acceptability of Moringa oleifera leaf-fortified dishes by children in Ada-East district, Ghana

Abstract Moringa oleifera (M. oleifera), a green leafy vegetable, is a good source of minerals and vitamins which could be consumed as part of diet to improve human health and well‐being. Drying M. oleifera leaves could make it readily available for use as a food fortificant. The objectives of the study were to determine micromineral and β ‐carotene content of dried M. oleifera leaves, and leaf‐incorporated local dishes, and also assess school childrens (4‐12 yr) acceptability of dried M. oleifera leaf‐incorporated local dishes and feasibility of introducing dried leaves into a school lunch menu. M. oleifera leaves were solar dried, milled into powder, and packaged into polythene bags. Moisture level in the dried leaves and pH were determined. Minerals in the leaf powder were determined by Atomic Absorption Spectrophotometry (AAS). Beta‐carotene levels were determined by spectrophotometry. Acceptability tests of dishes fortified with M. oleifera leaf powder were conducted with score sheets (Smileys) on a 5‐point hedonic scale of “Like Extremely” to “Dislike Extremely”, and dishes ranked to determine preference. Dried M. oleifera leaves contained high levels of micronutrients: 0.36 ± 0.04 mg/100 g Copper (Cu); 5.80 ± 0.68 mg/100 g Manganese (Mn); 20.96 ± 1.37 mg/100 g Iron (Fe); 6.79 ± 1.82 mg/100 g Zn; and 21.42 ± 1.67 mg/100 g β‐carotene. The dishes showed significant levels of these minerals compared to the nonfortified dishes (P < 0.05). M. oleifera leaf‐fortified dishes were also highly acceptable to the children (highest mean score of 5.0 ± 0 of 5 and lowest of 3.50 ± 1.43 of 5). M. oleifera leaf powder contains high levels of the micronutrients β‐carotene, Zn, Mn, and Fe, comparable to levels found in amaranth and spinach. M. oleifera leaf‐fortified local dishes were well accepted by children in Ada‐East district. M. oleifera leaf fortified dishes could be good sources of β‐carotene and other minerals for children vulnerable to malnutrition in Ghana.

Perceptions and Experiences of Overweight among Women in the Ga East District, Ghana.

Introduction Overweight and obesity are a growing public health challenge among women of reproductive age. While cultural norms suggest preference for an overweight body image, limited evidence exists regarding women’s beliefs and experiences of overweight in Ghana. The current study explored beliefs, perceptions, experiences, and practices concerning overweight among women living in suburban Accra, Ghana. Methods Four focus group discussions, and 10 in-depth interviews (IDI) were implemented among 42 adult women (>18 years) seeking preventive child health services in Dome, Accra. All the women in the IDI were overweight. In addition to notes, interviews and discussions were audio-recorded and transcribed for systematic content and narrative analysis. Results Overweight was considered undesirable by most women. Overweight individuals were often stigmatized using uncomplimentary names, such as cargo, obolo, and so on. However, some weight gain was admired and expected by women and their family and friends. Weight gain that was considered beautiful was believed to “evolve naturally.” Weight gain that is either medically induced perceived as excessive was not viewed positively. Weight gain by women was perceived as a sign of financial prosperity and good care by a spouse. Overweight was perceived to be linked with heredity, childbirth, gluttony, and contraception. Adverse experiences of overweight included poor self-image, declining social lifestyle, increased disease risk, and feeling tired always. Strategies that had been used in order to lose weight included skipping meals, avoiding carbohydrate-based foods, and drinking herbal teas. Conclusion There is admiration for some weight gain among women but when it is excessive, overweight is stigmatized. Misperceptions regarding partner expectations, determinants of overweight, and weight reduction strategies require effective behavior change interventions in Ghana.

Data reporting constraints for the lymphatic filariasis mass drug administration activities in two districts in Ghana: A qualitative study

Objectives: Timely and accurate health data are important for objective decision making and policy formulation. However, little evidence exists to explain why poor quality routine health data persist. This study examined the constraints to data reporting for the lymphatic filariasis mass drug administration programme in two districts in Ghana. This qualitative study focused on timeliness and accuracy of mass drug administration reports submitted by community health volunteers. Methods: The study is nested within a larger study focusing on the feasibility of mobile phone technology for the lymphatic filariasis programme. Using an exploratory study design, data were obtained through in-depth interviews (n = 7) with programme supervisors and focus group discussions (n = 4) with community health volunteers. Results were analysed using thematic content analysis. Results: Reasons for delays in reporting were attributed to poor numeracy skills among community health volunteers, difficult physical access to communities, high supervisor workload, poor adherence reporting deadlines, difficulty in reaching communities within allocated time and untimely release of programme funds. Poor accuracy of data was mainly attributed to inadequate motivation for community health volunteers and difficulty calculating summaries. Conclusion: This study has shown that there are relevant issues that need to be addressed in order to improve the quality of lymphatic filariasis treatment coverage reports. Some of the factors identified are problems within the health system; others are specific to the community health volunteers and the lymphatic filariasis programme. Steps such as training on data reporting should be intensified for community health volunteers, allowances for community health volunteers should be re-evaluated and other non-monetary incentives should be provided for community health volunteers.

Capacity for scaling up nutrition: a focus on pre-service training in West Africa and a Ghanaian case study.

The 2013 Lancet series on maternal and child nutrition is identified and advocated for improved institutional and human capacity in nutrition towards scaling up nutrition (SUN) in countries with high stunting rates. Of the fifty-four countries with high burden of child undernutrition who have committed to the SUN movement, thirty-six are in Africa. In the present paper, the academic platform of the SUN movement in Ghana presents an overview of nutrition pre-service capacity in West Africa with a focus on Ghana. The present paper is based on the findings of a sub-region-wide assessment of degree programmes in nutrition in West Africa, plus another report on pre-service nutrition capacity in diploma awarding nursing and nutrition programmes in Ghana. Although there is inadequate evidence on pre-service nutrition training in the sub-region, the two reports provide useful evidence for action, including inadequate number and distribution of pre-service nutrition training programmes, low nutrition graduate output, poor quality of the programme curriculum and instruction, and sub-optimal capital investment. The present paper calls for urgent action to improve pre-service nutrition capacity building as a critical step towards SUN in West Africa.