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Nationally representative data sets, such as the Demographic and Health Surveys (DHS), are valuable resources for evaluating country trends within the field of nutrition. Teaching health professionals to analyze DHS data using public domain software enables them to build capacity for: a) evaluating national and local trends of key indicators, and b) understanding risk factors for key health and nutrition outcomes. We piloted the efficacy of teaching Ghanaian health professionals how to analyze DHS data, including children's anthropometry, using Epi Info for Windows through an intensive 4-day workshop at the University of Ghana, Legon. We also developed a 200+ page manual that was provided to all participants. Twenty-two participants traveled from several regions in Ghana to attend the workshop. Over half of participants represented the Ghanaian Health Services, while the rest were from research organizations, NGOs, as well as educational and 528.10 health institutions. Evaluations indicated the workshop was successful at meeting its objectives. Replication of this workshop worldwide has important implications for nutrition programming and research in developing countries. [ABSTRACT FROM AUTHOR]

Engagement in income generation activities (IGA) that involve animal source foods (ASF) may influence children's intake of animal products through increased availability of ASF in the home and increased income that can be used to purchase ASF. This study compared the diversity of ASF in the diet of children whose caregivers' engaged in ASF-related IGA and those engaged in an IGA unrelated to ASF. Data on household income and sociodemographics, and diets of 2- to 5-y-old children were collected through interviews with 251 caregivers in 6 rural and semi-rural communities in 3 regions of Ghana. About 34% (n= 83) of caregivers were engaged in an ASF-related IGA. Rural caregivers with ASF-related IGA had a significantly higher weekly income than those in ASF-unrelated IGA (p<0.05); however, a similar difference was not noted among semi-rural caregivers. Rural children tended to have higher dietary ASF diversity than semi-rural children (P=0.05). Children's ASF diversity was not predicted by type of IGA. Weekly income of at least US$10.90, caregiver formal education, and rural location predicted children's ASF diversity (P<0.001). Ability to purchase ASF in the market rather than its accessibility in the home through an IGA may be a more important determinant of ASF in children's diets in rural and semi-rural communities in Ghana. [ABSTRACT FROM AUTHOR]

Demographic and Health Surveys (DHS) have shown that exclusive breastfeeding rates among Ghanaian children under 6 months have increased from 2.2% in 1988, to 31.1% in 1998 and to 53.6% in 2003. These results may be partly explained by the fact that the infant feeding module used by DHS changed substantially during this period of time. We applied a structured questionnaire containing the two different DHS infant feeding modules to 200 Ghanaian women with children 0 to 60 months old. Women were recruited from child welfare centers and various communities in the 3 main ecological zones of the country: coastal, forest and savanna zones. Among these women, the prevalence of EBF during the previous 24 hrs was 24% regardless of the infant feeding module used to derive this estimate. The EBF correlation between the two modules was highly significant (r² =.945, p<.01). Thus the secular EBF improvements in Ghana cannot be attributed to variations in the methods for EBF assessment. Rather the strong EBF promotion programs and policies put into place during this time period are likely to explain this successful outcome. [ABSTRACT FROM AUTHOR]

This study assesses the feasibility of exclusive breastfeeding (EBF) in Ghana's Eastern region. We conducted 4 focus group to elicit the perceived incentives and barriers to exclusively breastfeed. The 35 breastfecding mothers recruited from the Manya and Yilo Krobo districts of the Eastern region, had a mean age of 27.5 years and had at least one child <4 months old. Almost all of the participants believed that EBF is superior for infants for the first 6 months and should be the preferred infant feeding method. However, there was a widespread belief that infants can be given water if it is clean. The main obstacles to EBF identified were: maternal occupation, breast problems (e.g., sore nipples), shyness to breastfeed in public, fear of sagging breasts, infant refusal to BF and perceived milk insufficiency. Mothers reported that EBF was easy when breasts are full and breastmilk is flowing. In Ghana where a strong BF tradition exists, addressing the concerns put forward by these participants can be used to enhance EBF promotion in this region. [ABSTRACT FROM AUTHOR]

Pregnant women from the Eastern region who were HIV-positive (n=113), HIV-negative (n=96) or of unknown HIV status (n=106) responded to a modified version of the 18-item US Household Food Security Module. The reference time period was the month preceding the survey. Cronbach's alpha for the 10 adult items was 0.84. Women were classified as food secure (score=0), at risk of food insecurity (1-2), food insecure without hunger (3-5), experiencing moderate hunger (6-8), or experiencing severe hunger (score 8-10). None of the women lived in food secure households. The proportion experiencing each level of food insecurity was 67.0%, 21.6%,-9.5% and 1.9%, respectively. All women experiencing severe hunger (n=6) were HIV-positive compared to HIV-negative and unknown status participants(p=0.06). These preliminary results suggest an association between severe hunger and maternal HIV infection. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding (EBF) is a key behavior to improve child health and reduce the risk of HIV transmission. Data on daily infant feeding practices were available from birth-6 mo for 218 Ghanaian infants participating in an on-going cohort study (Research to Improve Infant Nutrition and Growth, RIING) whose mothers were HIV-infected (HIVI, n=63), uninfected (HIVN, n=82) or not tested (NT, n=73). Total months of EBF did not vary by HIV status; 46% EBF for 6 mo. However, breastfeeding patterns varied from month-to-month. At 1 mo, the majority of mothers exclusively breastfed (94%); however, HIVI mothers had lower rates of EBF compared to the other participants (87.3% vs. 96.7%; P<0.05). Compared to other mothers, HIVI women were less likely to continue to EBF from 1-2 mo (81% vs. 92%; P<0.05) but if they were PBF between 1 and 3 mo, they were more likely to change their feeding patterns and start EBF (P<0.05). More (16%) of HIVI mothers changed from EBF to PBF between 3-4 mo compared to only 6% of other mothers (P<0.05). These preliminary results highlight the dynamic nature of breastfeeding among study mothers. Appropriate counseling throughout the first six months postpartum can help mothers exclusively breastfeed to secure their infant's health. [ABSTRACT FROM AUTHOR]

Delayed onset of lactation may decrease the likelihood of exclusive breastfeeding. This study examines the impact of maternal HIV status on the onset of lactation (OL) among Ghanaian mothers who were participants in an on-going Research to Improve Infant Nutrition and Growth (RIING) Project. Pregnant women were recruited from 3 antenatal clinics in the Eastern region, based on HIV status (77 HIV-infected, 96 HIV-uninfected and 85 unknown HIV status). OL was assessed by maternal perception. Of the 258 mothers studied thus far, OL>72 h occurred in only 5.0% and OL>48 h occurred in 19.3%. Median OL occurred at 27.5h, 21.3h, and 25.5h post-partum for positive, negative and unknown HIV status mothers respectively. OL>48 h was not associated with HIV status, (χ²=0.790; p=0.674). OL<48 h was significantly associated with a full or heavy feeling in the breast, (OR, 8.05; p=.045). These preliminary findings do not support an association between maternal HIV status and OL. [ABSTRACT FROM AUTHOR]

Subclinical mastitis (SCM) has been associated with poor infant growth and HIV transmission. Diagnosis of SCM is expensive and not routine. We compared the sensitivity and specificity of simple, inexpensive tests, traditionally used with dairy cattle, with sodium potassium ratio (Na/K) as the standard, among 117 lactating Ghanaian women 3-4 mo postpartum. Milk samples were analyzed using Na/K, somatic cell count (SCC), California Mastitis Test (CMT) with and without Trace score, and electrical conductivity (ELEC). SCM prevalence using Na/K was 31.0%. Na/K was correlated with ELEC (r=0.586, p<0.01), SCC (r=0.372, p<0.01) and CMT (r=0.431, p<0.01). There were significant correlations between SCC and CMT (r=0.679, p<0.01); SCC and ELEC (r=0.497, p<0.01); and CMT and ELEC (r=0.493, p<0.01). There was significant agreement in SCM diagnosis between Na/K and SCC (K =0.271, p<0.01); Na/K and ELEC (K =0.291, p<0.01); and Na/K and CMT (K =0.126, p<0.05). The sensitivity and specificity, respectively, were: CMT (52.2%; 58.8%), CMT without Trace score (17.9%, 92.5%), ELEC (40.6%, 86.2%), SCC (42.9%, 82.8%). Despite low sensitivity, the high specificity of these simple tests could prove useful in clinical settings where there are limited resources for supporting lactation. [ABSTRACT FROM AUTHOR]

The poor micronutrient status of children in developing countries has been attributed partially to a heavy reliance on plant-based diets. 66 Ghanaian children aged 2 to 5 y were recruited from 2 farming and 2 fishing communities to assess the contribution of animal source foods (ASF) to the total iron intake. Dietary data were collected on 2 d using weighed food records and hemoglobin (Hb) was measured. Daily intakes of iron for children in farming and fishing communities were 10.6 ± 0.7 mg and 11.0 ± 0.9 mg, respectively. ASF contributed more to the iron intake of children from farming communities than those from the fishing communities (13.9 ± 2.1% vs. 8.9 ± 1.3%, p=0.05). Red meats tended to be consumed more by children from farming than fishing communities (21% vs. 6%, p=0.09). The prevalence of low Hb (<11 g/dL) tended to be lower among children in farming communities compared to those in fishing communities (79.4% vs. 93.8%, p=0.09). Children's low Hb status may partly be due to a low consumption of ASF. Interventions to improve ASF intake may be heeded in these poor communities. [ABSTRACT FROM AUTHOR]

Purchase of ready-to-eat foods (RTEF) for children is common in urban Ghana but little is known about this practice in rural areas. We collected data on the purchase of RTEF in the past week by caregivers (N=530) of preschoolers living in 6 rural communities in 3 regions of Ghana. About 82% (N=433) of caregivers purchased RTEF in the past week. RTEF were purchased less frequently in northern (2.3 ± 0.1 times/wk) than in forest and coastal communities (3.0 ± 0.1 and 3.1 ± 0.2 times/wk, respectively; p<0.0001). RTEF was purchased most frequently for children in forest communities (56.9 ± 3.3%) and least frequently in northern communities (34.1 ± 3.4%; p<0.05). At least 60% of RTEF purchased for children were obtained in the morning. RTEF for children in forest communities was more likely to contain animal foods than in northern communities (34% vs 16% of the time, respectively; p<0.05). There were regional differences in the time of day when ASF-based RTEF were given to children (p<0.05). The magnitude and patterns of purchased RTEF have implications for nutrition interventions in rural communities. [ABSTRACT FROM AUTHOR]