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The sustainable development goals seek to end all forms of malnutrition of women of reproductive age (WRA) by 2030. As such, recent data on nutrient adequacy are needed to aid in tracking progress. However, data on specific dietary nutrient intakes includes only iron, folate, vitamin A, and vitamin B 12 in Ghana. Therefore, women's dietary diversity score (W-DDS) is often used as a proxy measure of nutrient adequacy. It is hypothesised that there is no association between W-DDS and Nutrient Adequacy among WRA in peri-urban Ghana. Hence, this research evaluated the associations between W-DDS and nutrient adequacy ratio (NAR) and assessed the determinants of mean nutrient adequacy ratio (MAR) in the Bosomtwe District of Ghana. A community-based cross-sectional study was conducted, and data collected on anthropometry, food insecurity, socio-demographic characteristics and dietary intake using the 24-hour recall from 407 WRA. In all, 21 nutrients were assessed. The mean age, W-DDS, and MAR were 29.0 ± 6.7 years, 5.3 ± 1.9, and 0.65 ± 0.19 respectively. The NAR were generally high for the macronutrients as compared to micronutrients and the nutrients with low NAR included vitamin C (0.27 ± 0.19), vitamin A (0.15 ± 0.23), vitamin B 12 (0.54 ± 0.32), calcium (0.28 ± 0.20), zinc (0.52 ± 0.23) and iron (0.57 ± 0.28) - signifying the WRA may be consuming monotonous carbohydrate-based diet. The hierarchical multivariable linear regression found a significant association between W-DDS and MAR after controlling for confounders (β = 0.404, p < 0.001). The determinants of MAR were ethnicity (β = 0.110, p = 0.006) and body mass index (β = 0.189, p < 0.001). This study supports the use of W-DDS as a proxy indicator of nutrient adequacy. Strategies meant to address nutrient inadequacies should be adaptable to different ethnic groups and overweight-reducing strategies should be incorporated into broader nutrition initiatives., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Iron (Fe) deficiency anaemia is a public health concern among adolescent girls worldwide. Food-to-food fortification may be a sustainable and effective solution to Fe deficiency anaemia. However, the effect of food-to-food fortification on Fe deficiency anaemia reduction is understudied particularly in Ghana. This study seeks to investigate the efficacy of baobab pulp-fortified pearl millet beverage powder in improving the Fe and anaemia status of adolescent girls in Ghana. A three-arm cluster randomised controlled trial design, which will involve 258 anaemic adolescent girls (86/arm) selected through multi-stage cluster sampling in Kumbungu District of Ghana, will be used. Participants in arm 1 will receive 350 ml of baobab pulp-fortified pearl millet beverage, containing 13 mgFe (96 % of average RDA), 18·8 mg vitamin C (30·4 % of average RDA) and 222·1 mg citric acid, while participants in arm 2 will receive similar volume of unfortified pearl millet beverage, once a day, five times a week, for six months. Participants in arm 3 will receive the routine weekly Fe (60 mg)-folate (400 μg) supplementation for six months. Serum ferritin, C-reactive protein and haemoglobin (Hb) of participants will be assessed at baseline and end-line. The primary outcomes will be serum ferritin and Hb concentrations. Secondary outcomes will be prevalence of Fe deficiency, Fe deficiency anaemia and BMI-for-age. One-way ANOVA and paired t test will be used to compare means of serum ferritin and Hb levels among and within groups, respectively. This study will provide novel concrete evidence on the efficacy of pearl millet-baobab pulp beverage powder in improving Fe and anaemia status of adolescent girls.

The double burden of malnutrition has assumed severer forms in Low and Middle Income Countries (LMICs) arising from sharper increases in prevalence rates of overweight and obesity in these countries compared to higher income countries. Considering that LMICs already have fragile health systems, the rising obesity levels may just be a ticking time bomb requiring expeditious implementation of priority actions by all global and national actors to prevent an explosion of cardiovascular disease related deaths. The aim of this systematic review and meta-analysis was to provide a current estimate of obesity and overweight prevalence among Ghanaian adults and assess socio-demographic disparities following the PRISMA guidelines. We searched Pubmed with Medline, Embase, Science direct and African Journals Online (AJOL) for studies on overweight and obesity published between 2013 and January 2023. Applying a quality effects model, pooled mean Body Mass Index (BMI) and prevalence of overweight and obesity were obtained from 42 studies conducted across all three geographical locations of Ghana with a combined sample size of 29137. From the analysis, the mean BMI of adults in Ghana was 24.7 kgm-2 while overweight and obesity prevalence was estimated as 23.1% and 13.3% respectively. Temporal analysis showed sharper increases in overweight and obesity prevalence from 2017/2018. Mean BMI (Females: 25.3kgm-2 vrs Males: 23.1 kgm-2), overweight (Females: 25.9% vrs Males: 16.5%) and obesity (Females: 17.4% vrs Males: 5.5%) prevalence were higher among females than males. Gender differences in mean BMI and obesity prevalence were both significant at p<0.001. Urban dwellers had higher mean BMI than their rural counterparts (24.9kgm-2 vrs 24.4kgm-2). Overweight (27.6% vrs 18.2%) and obesity (17.3% vrs 11.0%) prevalence were also higher in urban areas than in rural areas. Body weight indicators for the various geographical areas of Ghana were; southern sector: 25.4kgm-2, 28.9% and 15.4%, middle sector: 24.8kgm-2, 26.4% and 16.2% and northern sector: 24.2kgm-2, 15.4% and 8.5% for mean BMI, overweight and obesity prevalence respectively. The southern part of Ghana was similar to the middle part in terms of mean BMI, overweight and obesity but higher than the northern part. We conclude that overweight and obesity prevalence in Ghana has risen to high levels in recent years with women and urban dwellers disproportionately more affected. There is a possible implication for increased cardiovascular diseases and a generally poor quality of life for the people. Evidence-based public health interventions are needed to reverse the current situation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yussif et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The objective of this commentary is to provide an overview of the rationale and objectives of the Researching the Obesogenic Food Environment (ROFE) project that was conducted in Ghana and South Africa., Design: Narration has been used to describe the main objectives, phases as well as the methods used for the conduct of this project., Setting: The project described in this commentary was conducted in Khayelitsha and Mount Frere in South Africa and Ahodwo and Ejuratia for Ghana., Participant: Participants of the study described here include households in South Africa and Ghana, stakeholders and policymakers, and various actors within the food chain in both countries., Results: The ROFE findings provide a good understanding of the extent of the impact of the food environment on consumption, characteristics of value chains of healthy and unhealthy foods, as well as the potential for improved governance and policy that is relevant to the region. The supplement provides the opportunity to share the extensive findings of the ROFE project. Nine papers that describe the process and findings of the three phases of the ROFE project have been presented. Some of the papers focus on phases of the ROFE, while others cut across different phases and explore the linkages between the phases. Briefly descriptions of key findings of some of the papers in the supplement are provided., Conclusion: Together, the findings of the ROFE study presented in this supplement have increased understanding of how communities in SA and Ghana interact with their food supplies and have led to identification of specific opportunities to improve food supply policies, in ways that create incentives for the production and consumption of healthy, relative to unhealthy foods.

Background: Studies have reported a poor diet quality among children in Ghana and other developing countries. Inadequate dietary diversity among children may lead to deficiencies in micronutrient intake necessary for growth and other cognitive functions. Understanding factors associated with infants' diverse diets is a key step to promoting adequate infant and young child nutrition. This study sought to determine the factors associated with food consumption and dietary diversity (DD) among infants., Methods: In this cross-sectional study among 1503 mothers-infant (aged 6-18 months) pairs from rural, urban, and peri-urban districts of Ashanti Region, factors associated with food consumption and DD were evaluated. The FAO 18-food group DD questionnaire was used to determine previous food group intake, while a structured questionnaire was used to capture data on the mother's socio-demographic parameters and child morbidity. Data were analyzed using descriptive statistics, the Chi-square test, and binary logistic regression to compare mothers and infants who had adequate and inadequate DDS of 9 out of 18 food groups and the predictors of dietary diversity., Results: About 64.7% of the infants did not meet the minimum dietary diversity. Over two-third (77.4%) of the children consumed maize porridge the previous day. Foods which were less consumed included vegetables (35%), animal milk (38.9%), and meat (organ 14%, any meat 26%). The mean food group intake from 18 food groups was 7.0, and the majority (64.7%) did not meet the recommended 9 food group intake. Significantly more younger children (6-11 months) (74%, p<0.001) compared with older children (12-18 months) (52.5%) did not meet the minimum DDS. Also compared with the older children, the younger ones had above two times increased odds of inadequate DD (OR = 2.5, p<0.001, 95% CI = 1.4-4.4). When controlled for gender, children from peri-urban areas (OR = 5.2, p = 0.260, 95% CI = 0.2-93.2) and rural areas (OR = 1.8, p = 0.650, 95% CI = 0.2-9.3) had increased odds of lower DD than urban children. Children of unemployed caregivers had an increased odds of low DD (OR = 2.3 p<0.001, 95% CI 1.7-3.2) compared with children of employed caregivers. Finally, children of caregivers with better nutrition knowledge (nine correct answers from 12 questions) had lower odds of having lower dietary diversity (adjusted OR = 0.9, p = 0.85, 95%CI = 0.5-1.6) than those with less knowledge., Conclusions: Low DD was common among infants and associated with infants age, caregivers' areas of residence, employment status, and level of nutrition education. Children who did not meet the minimum dietary diversity were not fed particular foods such as vegetables, animal milk, and organ meat. Proper maternal nutrition education and feeding practices targeting age-specific needs and community livelihood support systems are necessary to improve dietary diversity of infants., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Opoku Agyemang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Nutrition education targeting adolescents' health has the potential to enhance their well-being into adulthood. This study assessed the impact of nutrition education on the knowledge of iron and iron-rich food intake practices of adolescents living in rural communities in Ghana., Method: An intervention study was conducted among 137 adolescents; 69 were assigned to the intervention group and 68 to the control group. Participants and guardians in the intervention group were involved in the nutrition education programme for six months. Participants in both groups completed sociodemographic, knowledge of iron, and iron-rich food intake practice questionnaires at pre- and postintervention. Data were analyzed by chi-square and t -tests., Results: At postintervention, the mean knowledge score ( p < 0.05) in the intervention group and control group was 5.3 ± 1.7 and 3.9 ± 1.9, respectively. Interventions (76%) and controls (46%) had good knowledge status. The mean knowledge score of participants with good knowledge status in the intervention group was 6.1 ± 0.8 ( p < 0.05), and the control group was 5.6 ± 0.7 ( p < 0.05). Forty-two percent of participants in the interventions and 26% in the controls had good food intake status. Participants with good food intake status had mean food intake scores of 3.2 ± 0.4 ( p < 0.05) and 3.8 ± 0.7 ( p < 0.05) for the intervention and control groups, respectively. Both groups increased and had the same mean food intake score (1.5 ± 1.4, p > 0.05), however, relatively higher in the intervention group., Conclusion: Nutrition education improved the knowledge of iron and iron-rich food intake practices of participants in the intervention group compared to the control group. Nutrition education should be a critical component in the management and prevention of micronutrient deficiency in adolescents., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Michael Akenteng Wiafe et al.)

Background: The rapid biological and physical changes during adolescence require adequate nutrient intake. This study assessed dietary diversity and nutritional status of adolescents living in selected rural areas in Ghana., Method: In this cross-sectional study, 137 young adolescents, aged 10 to 14 years were recruited. Structured questionnaire was used to collect data on sociodemographic, household size and food intake practices. A multiple past 24-hour recall was used to estimate the micronutrients intake. Haemoglobin and anthropometry data were assessed. Dietary diversity score was assessed with 10 food groups described by Food and Agricultural Organization. Descriptive, chi-square, binary regression and partial correlation were used in the data analysis., Results: The prevalence of underweight was 5.5%, overweight 5.8% and anaemia 29.9%. The mean dietary diversity score was 3.8 ± 0.8 and about 84.7% of participants had inadequate dietary diversity. Proportions of adolescents who consumed from the different food groups over a 24-hour period were: grains, white roots and tubers, plantain (100%); pulses (10.2%); nuts and seeds (34.1%); dairy (8%); meat, poultry and fish (86.9%); eggs (7.3%); dark green leafy vegetables (29.9%); other vitamin-A rich fruits and vegetables (2.2%); other vegetables (81%); other fruits (7.3%). Dietary diversity scores were positively and significantly correlated with intake of micronutrient, with correlation coefficients of .169, .186, .191, .173 and .175 for vitamin A, niacin, vitamin B 6 , iron and zinc, respectively. Meal skipping (AOR = 12.2, P  < .001, 95% CI: 3.6-41.7) and snacking (AOR = 5.0, P  = .007, 95% CI:1.6-16.7) increased odds of inadequate dietary diversity., Conclusion: The high prevalence of inadequate dietary diversity was positively related to meal skipping and snacking among adolescents. Dietary diversity score was significantly related to the intake of vitamin A, niacin, vitamin B 6 , iron and zinc. The prevalence of anaemia among our study participants is of public health concern. Adolescents should be encouraged both at home and school to eat from diverse food groups to promote adequate intake of micronutrients., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Evidence shows a link between methyl-donor nutrient intakes and a child's cognitive ability. However, this is less known among Ghanaian children who might be at higher risk of methyl-donor nutrient deficiencies. This study showed comparative analysis of methyl-donor nutrient intakes and Raven's Coloured Progressive Matrices (RCPM) test performance among 2073 Ghanaian school children aged 9-13 years across four regions of Ghana., Methods: Data for the present study were obtained from the Child Nutrition, Fitness, and Cognition project; a cross-sectional survey conducted in four regions of Ghana. Dietary methyl-donor nutrient values were based on repeated 24 h recall data collected during the study periods. Cognitive tests were performed on the 2073 children using Raven's Coloured Progressive Matrices (RCPM) test., Results: We found dietary zinc (adjusted: β = 0.21, p = 0.003) and methionine (adjusted: β = 0.60, p = 0.044) intakes to be associated with RCPM scores in the linear regression model. School children living in Northern Region (adjusted OR = 0.6, p < 0.001, 95% CI = 0.4-0.7) and Volta Region (adjusted OR = 0.7, p = 0.006, 95% CI = 0.5-0.9) had lower odds of scoring above the 50th percentile on the RCPM test compared with those living in Greater Accra Region. Children who consumed below the RDA for dietary folate (unadjusted OR = 0.8, p = 0.055, 95% CI = 0.7-1.0) and zinc (unadjusted OR = 0.8, p = 0.049, 95%CI = 0.7-1.0) had lower odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the RDA for dietary folate and zinc respectively. Children who consumed below the EAR for dietary vitamin B 12 (unadjusted OR = 0.7, p = 0.004, 95% CI = 0.6-0.9) had reduced odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the EAR for dietary vitamin B 12 ., Conclusions: Higher dietary methionine intake was strongly associated with higher RCPM scores. Regional differences, and children's dietary consumption below the EAR/RDA for dietary folate, vitamin B 12 , and zinc were associated with poor RCPM test performance. School children's nutrient intake should be prioritized for improved cognition., Competing Interests: Declaration of Competing Interest The authors have declared that there were no competing interest regarding the publication of this study., (Copyright © 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: [GQ4]Adolescents tend to explore their dietary environment without prior consideration of their nutritional needs. This attitude is due to low nutrition knowledge and it contributes to micronutrient deficiency such as anaemia. The study aims to investigate the effect of nutrition education and counselling on dietary iron intake and iron status of early adolescents., Methods/design: One hundred and twenty-six early adolescents will be recruited and randomized to receive nutrition education (intervention group) and no nutrition education (control group) in the Asante-Akim South Municipality of Ghana. Data on socio-demographics, dietary factors, dietary intake, knowledge of iron and anaemia will be collected at baseline and post-intervention. Blood samples will be collected for haemoglobin, ferritin and c-reactive protein analyses. The primary outcome measures include haemoglobin and ferritin levels, secondary outcomes such as dietary iron intake, dietary vitamin C intake and knowledge level of iron will be assessed at pre-and post-intervention (6 months). The study will comply with the Consolidated Standards of Reporting Trials (CONSORT) for randomized trials., Discussion: The effectiveness of iron dietary guidelines developed will serve as a manual to aid, prevent and manage iron deficiency anaemia as well as reduce the prevalence of anaemia in the long term in Ghana.

The Ghanaian population is experiencing an upsurge in obesity and type 2 diabetes (T2D) due to rapid urbanization. Besides dietary factors, vitamin D-related genetic determinants have also been shown to contribute to the development of obesity and T2D. Hence, we aimed to examine the interactions between dietary factors and vitamin D-related genetic variants on obesity and T2D related outcomes in a Ghanaian population. Three hundred and two healthy Ghanaian adults (25-60 years old) from Oforikrom, Municipality in Kumasi, Ghana were randomly recruited and had genetic tests, dietary consumption analysis, and anthropometric and biochemical measurements of glucose, HbA1c, insulin, cholesterol, and triglycerides taken. A significant interaction was identified between vitamin D-GRS and fiber intake (g/day) on BMI ( p interaction = 0.020) where those who were consuming low fiber (≤16.19 g/d) and carrying more than two risk alleles for vitamin D deficiency ( p = 0.01) had a significantly higher BMI. In addition, an interaction between vitamin D-GRS and fat intake (g/day) on HbA1c (total fat, p interaction = 0.029) was found, where participants who had a lower total fat intake (≤36.5 g/d), despite carrying more than two risk alleles, had significantly lower HbA1c ( p = 0.049). In summary, our study has identified novel gene-diet interactions of vitamin D-GRS with dietary fiber and fat intakes on metabolic traits in Ghanaian adults.

Background: Nutrition knowledge contributes significantly to the nutritional status and habits of individuals as it influences their food consumption. And body mass index (BMI) of individuals. Recent data suggests a relationship between nutrition and physical activity knowledge, attitude, practices, and anthropometric indices of Ghanaian children., Objective: To determine the relationship between nutrition and physical activity knowledge and using BMI-for-age of school-aged children., Methods: A cross-sectional study involving 591 school-aged children (8-13 years) chosen at random from schools in Ghana's Ho Municipality. Socio-demographic information was gathered. Data on nutrition and physical activity knowledge, attitude, and practice were also collected using structured questionnaires. BMI was calculated after weight and height were measured., Results: Majority of the participants had poor knowledge on nutrition (46.6%) and physical activity (49.8%) even though more children in private schools (63.3%) had better (good and excellent) knowledge in nutrition than children from public schools (48.2%). Older children (11-13 years) had 'good' knowledge of physical activity (54.7%) as opposed to younger children. Males (59.5%) and children in private schools (66.3%) also had better overall scores in combined nutrition and physical activity knowledge than their female and public-school counterparts, respectively. Physical activity knowledge was significantly (p < 0.05) associated with the BMI-for-age categories. Nutrition knowledge (p < 0.05) and total nutrition and physical activity knowledge scores (p < 0.001) were weakly but positively associated with BMI-for-age., Conclusion: The results suggest that BMI-for-age of the participants was positively correlated to the nutrition knowledge and the total nutrition and physical activity knowledge (NutPA)., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13-19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended., (© The Author(s) 2021.)

Background: Adequate nutrition is required for growth and development in children. This study tested the effectiveness of nutrition education on knowledge and BMI-for-age (BFA) of school-aged children in the Kumasi Metropolis., Methods: Children, aged 9-13 years old were recruited from ten randomly selected primary schools in the Metropolis. The schools were randomly allocated into 3 groups: nutrition education (3 schools), physical activity (PA) education (3 schools), both interventions (2 schools), or control (2 schools). Following a baseline nutrition and PA knowledge and status assessment in 433 children, twice-monthly nutrition and PA education and demonstrations were carried out for 6 months, followed by a post-intervention assessment., Results: PA and nutrition knowledge improved in all groups (P<0.001); the highest improvement was among those who received both interventions (31.0%), followed by the nutrition education group (29.8%), and the least, the control group (19.1%). Overall, BFA improved by +0.36, from baseline (-0.26) to end of the intervention (+0.10, P<0.001). Within the groups, the nutrition group (+0.65, P<.001) had the highest improvement, then, both the intervention group (+0.27, P<0.001), the PA group (+0.23, P<0.001) and lastly, the control group (+0.18, P=0.001)., Conclusion: Nutrition education could improve knowledge and BMI-for-age in school-aged children in Ghana., (© 2021 Annan RA et al.)

Background: Good nutritional status of school-aged children is crucial in achieving improved cognition. The objective of this study was to assess the relationship between nutritional status and cognition of school-aged children in the Kumasi metropolis, Ghana., Methods: 389 children were selected from ten government-owned schools. Socio-demographic and anthropometric data were collected. Blood samples were collected and analyzed for nutrients levels. Dietary intakes were assessed using food frequency questionnaire and previous day's nutrients intake. Cognition test was performed using the Ravens Colored Progressive Matrix (RCPM)., Results: Mean age of participants was 8.9±1.4 years, mean RCPM score was 17.9±5.4. More girls scored RCPM below the 40th percentile (45.5%) than boys (33.7%), while mother's level of education significantly associated with RCPM percentiles of the children (p = 0.037). Four dietary patterns were generated from food frequency data, and scores of the second pattern, depicting vegetables, non-fruits, bread and cereals, showed a weak negative correlation (r = -0.132, p = 0.026) with previous day's dietary zinc intake. Cognitive status did not vary by anthropometric and dietary patterns. More anemic (54.4%) than non-anemic (33.3%) children were below the 40th RCPM percentile. Mean previous day's intake for folate (p<0.001), vitamin B6 (p = 0.018), iron (p<0.001), and zinc (p = 0.001) differed significantly between the cognitive test score percentiles of the children. Spearman rank correlation showed weak positive associations between RCPM score and hemoglobin (r = 0.246, p = 0.003) and serum ferritin (r = 0.176, p = 0.036). Binary regression analysis showed anemic children (aOR = 0.4; 95%CI = 0.2-0.8, p = 0.014), compared with non-anemic had decreased odds, while boys, compared with girls had increased odds (aOR = 2.0 95%CI = 1.0-4.0, p = 0.035) for scoring above the 50th RCPM percentile., Conclusions: Iron status, especially hemoglobin levels, correlated with the cognitive performance of school-aged children in the metropolis. Thus nutritional strategies aimed at reducing iron deficiency anemia are needed., Competing Interests: The authors have declared that no competing interests exist.

Background: Iron Deficiency Anaemia (IDA) is reportedly high in pregnant adults and the causes well studied. However, among pregnant teenagers, the levels and associated factors of IDA are not fully understood., Methods: In a prospective cohort study among Ghanaian pregnant teenagers, aged 13-19 years, IDA prevalence and associated factors were investigated. Sociodemographic data, household hunger scale (HHS), lived poverty index (LPI), FAO's women's dietary diversity score (WDDS) and interventions received during antenatal care (ANC) were obtained from 416 pregnant teenagers in Ashanti Region, Ghana. Micronutrient intakes using a repeated 24-hour dietary recall, and mid-upper arm circumference (MUAC) were determined and blood samples analysed for haemoglobin (Hb), serum levels of ferritin, prealbumin, vitamin A, total antioxidant capacity (TAC), C-reactive protein (CRP), and zinc protoporphyrin (ZPP)., Results: Anaemia (Hb cutoff <11.0 g/dL) was 57.1%; deficient systemic supply of iron stores (31.4%), depleted body stores of iron (4.4%), inadequate dietary iron intake (94.5%), and inadequate multiple micronutrient intakes (49.5%), were all notable among study participants. Between-subject effects using Generalized Linear Modelling indicated malaria tablet given at ANC (p = 0.035), MUAC (p = 0.043), ZPP (p<0.001), ZPP/Hb ratio (p<0.001) and depleted body iron stores (DBIS) (p<0.001) to significantly affect Hb levels. Pregnant teenagers with a high ZPP/Hb ratio (OR = 9.7, p<0.001, 95%CI = 6.0-15.8) had increased odds of being anaemic compared to those with normal ZPP/Hb ratio. Participants who were wasted (OR = 1.2, p = 0.543, 95%CI = 0.6-2.3), and those with depleted iron stores (OR = 3.0, p = 0.167, 95%CI = 0.6-14.6) had increased odds of being anaemic. Participants who experienced hunger were close to 3 times more likely (OR = 2.9, p = 0.040, 95%CI = 1.1-7.8) for depleted iron stores, compared to those who did not experience hunger. Also, participants with inadequate multiple micronutrients intakes (OR = 2.6, p = 0.102, 95%CI = 0.8-8.4), and those with low serum levels of ferritin (OR = 3.3, p = 0.291, 95%CI = 0.4-29.2) had increased odds of depleted body iron stores., Conclusions: IDA is common among pregnant teenagers and the related factors include malaria tablets given at ANC, maternal hunger, maternal MUAC, a deficient systemic supply of iron, depleted body iron stores, ZPP, and ZPP/Hb ratio. Appropriate interventions are urgently needed to address the causes of IDA among pregnant teenagers., Competing Interests: The authors have declared that no competing interests existed regarding the publication of this study.

The study assessed knowledge and practices of dietary iron intake and anemia among early adolescents in the Asante-Akim Municipality of Ghana. A cross-sectional study was conducted among 137 adolescents, aged 10-14 years. Structured questionnaire was used to collect data on sociodemographic, knowledge of iron, and anemia, and iron intake practices. Hemoglobin levels were determined using Hemocue 301. Data were analyzed using descriptive, chi-square test, and binary logistics regression. The mean age of participants was 11.5 years. About 40% had knowledge of iron deficiency anemia, 29.4% knew anemia causes, 86% knew symptoms of anemia, and 35% knew anemia consequences. Although 41.2% of participants knew its prevention as eating iron-rich foods, 31.4% knew the food sources of iron, and 4.4% mentioned animal-based foods as rich sources, with the bulk (27%) mentioning plant-based foods instead. Moreover, 18.2% knew iron enhancers, while 0.7% knew iron inhibitors. More chicken consumers (72.2%) than nonconsumers (56.6%) met the Estimated Average Requirement for dietary iron intake (Chi-square 3.4, p  = .073), while more dried fish consumers (88%) than nonconsumers (66.7%) had normal hemoglobin levels (Chi-square 4.5, p  = .050). Knowledge of food sources of iron and iron-rich foods was positively associated with intake of chicken, fresh fish, and dried fish. Moreover, lower knowledge of iron-based food sources (β = -1.015, p  = .020) and iron-rich foods (β = -2.188, p  = .015) was inversely associated with beef intake. Anemia was negatively associated with chicken (β = -0.310, p  = .416) and dried fish (β = -1.299, p  = .045) consumption. Majority of the adolescents had low knowledge of iron. Chicken and dried fish intake reduced the risk of anemia development. Our study may be the first to assess knowledge on iron, anemia, and its impact among young Ghanaian adolescents. Our findings provide insights into this topic, calling for to improve knowledge, and practices on anemia in Ghanaian adolescents., Competing Interests: The authors declare that they have no conflicts of interest., (© 2021 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: Dietary diversity, a qualitative measure of dietary intake, which reflects the variety of foods consumed has been recommended to assuage nutritional problems related to insufficient micronutrients, and food insecurity. To better understand the underlying factors for poor birth outcomes in Ghana, we assessed factors associated with dietary diversity among rural and urban pregnant adolescents in the Ashanti Region of Ghana., Methods: As part of a larger longitudinal cohort of 416 pregnant adolescents, the FAO minimum dietary diversity for women index was used to determine the dietary diversity score (DDS) of the participants from a previous days' 24-hour dietary recall data. The household hunger scale (HHS) and lived poverty index (LPI) were used to determine hunger and socioeconomic status. Eating behavior and socio-demographic data were gathered using interviewer-administered questionnaires., Results: The mean age of the participants was 17.5 (±1.4) years with an MDD-W of 4.4 and 56% recording inadequate MDD score. More rural (63.6%) than urban dwellers (50.6%) had inadequate DDS (p = 0.008). Among all the multiple variables tests of associations on dietary diversity, only hunger status (p = 0.028) and both food aversion and poverty status (p = 0.003) had a significant effect on the adolescents' dietary diversity. Rural dwelling adolescents (AOR = 1.7, p = 0.035, 95% CI = 1.0-2.6) recorded higher odds for inadequate DD compared with the urban respondents. Pregnant adolescents with severe hunger had higher odds (Unadjusted OR = 1.9, p = 0.053, 95% CI 1.1-3.8) for inadequate dietary diversity compared with those with no hunger., Conclusions: Inadequate DD is common among pregnant adolescents in this study and is associated with rural living, food insecurity, poverty, and food craving. Livelihood support for pregnant teenagers and nutrition education are recommended interventions to improve dietary quality and limit the consequences of poor dietary diversity., Competing Interests: The authors have declared that no competing interests exist.

Physical fitness is thought to promote cognitive function. Evidence about this is however lacking in the Ghanaian context. This study aimed to investigate the association between physical fitness and cognitive function among basic school children aged 8-13 years. A cross-sectional study involving 591 school children, recruited from 12 randomly selected public and private basic schools was conducted. Physical fitness tests were done using a five-test battery (Fifty metre run, handgrip strength, sit-up, flexibility and standing board jump) following standardized procedures. Cognitive function test using the Raven's Coloured Progressive Matrices (RCPM) were carried out. More girls (55%), children from 8-13 years old (49.1%) and public school children (66.1%) participated in the study. For fitness, boys performed better than girls in sit ups 3.4 ± 2.2 (mean ± SD), p = 0.012, handgrip 4.3 ± 2.0, p = 0.001 and overall fitness 4.3 ± 2.0, p = 0.007. Children in public schools performed significantly better in forward jump (p < 0.001) while those in private schools did better in 50m run (p < 0.001). For cognition, 46.1% of participants had less than 50% of the total score. Cognitive test score varied for forward jump and handgrip alone and not for sit ups, 50m run and overall score. Mean forward jump score was lowest in poor cognition group (4.9 ± 2.3), followed by good (5.3 ± 2.2) and highest among excellent (5.5 ± 2.3, p = 0.044) cognition group. Similar observation was made for handgrip. Cognition score and hand grip strength were positively but weakly correlated. (r = 0.132, p = 0.026). Although handgrip strength (measuring muscular strength) was significantly associated with cognitive function, this study found no significant association between overall physical fitness and cognitive function. These results indicate that only some components of physical fitness may be associated with cognitive function. This study is however correlational and one cannot infer causality., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Background: Global demand for capacity building has increased interest for eLearning. As eLearning resources become more common, effective implementation is required to scale up utilization in Low- and Middle-Income Countries (LMICs)., Objective: This paper describes the process of implementing a malnutrition eLearning course, effectiveness of course delivery models devised, factors affecting course completion, and cost comparison between the models and face-to-face training at healthcare and academic institutions in Ghana., Methods: Four delivery models: Mobile Training Centre (MTC), Online Delivery (OD), Institutional Computer Workstation (ICW) and Mixed Delivery (MD) - a combination of OD and ICW - were determined. Participants were enabled to access the course using one of the four models where contextually appropriate. Pre and post-assessments and questionnaires were administered to compare participants' course completion status and knowledge gain between delivery models. The effect of access to computer and Internet at home and relevance of course to job and academic progression on course completion were further investigated. Comparison of delivery model costs against face-to-face training was also undertaken., Results: Of 7 academic and 9 healthcare institutions involving 915 people, 9 used MTC (34.8%), 3 OD (18.8%), 3 ICW (34.2%) and 1 MD (12.2%). Course completion was higher among institutions where the course was relevant to job or implemented as part of required curriculum activities. Knowledge gain was significant among most participants, but higher among those who found the course relevant to job or academic progression. The implementation costs per participant for training with MTC were £51.0, OD £2.2, ICW £1.2 and MD £1.1, compared with a face-to-face training estimate of £105.0 (1 GHS = 0.14 GBP)., Conclusion: The malnutrition eLearning course makes global capacity building in malnutrition management achievable. Adopting contextually appropriate delivery models and ensuring training is relevant to job/academic progression can enhance eLearning effectiveness in LMICs.

Introduction: Early adolescents are vulnerable to anaemia due to lean body mass and menarche. The study assessed patterns of dietary iron intake, iron status, and predictors of anaemia among early adolescents., Method: One hundred and thirty-seven early adolescents were randomly selected in a rural district in Ghana. Multiple-pass 24-hour recall, iron food frequency questionnaire consisting of 27 food items, and semistructured questionnaire were administered. Variables include sociodemographics, dietary factors, and laboratory investigation including haemoglobin, ferritin, and C-reactive protein examination. Statistical Package for the Social Sciences (SPSS) software was used to calculate odds ratio and perform Mann-Whitney U test, chi-square (X 2 ) test, exploratory factor analysis, and partial correlation ( r ) tests., Results: Participants had mean age of 11.5 years. Three iron dietary patterns explaining 28.7% of the total variance were identified: iron dietary pattern 1 (11%) composed of iron-rich, iron-enhancing, and iron-inhibiting foods; iron dietary pattern 2 (9.9%) comprised of iron-rich, iron-enhancing, and non-iron-inhibiting foods; and iron dietary pattern 3 (7.1%) consisting of stinging nettle, iron-inhibiting foods, non-iron-enhancing foods, non-cocoyam leaves, and non-turkey berries. Meal skipping ( X 2  = 5.7, p < 0.05), times of eating a day ( X 2  = 12.6, p < 0.05), and guardian educational status ( X 2  = 6.7, p < 0.05) significantly affected dietary iron intake. Anaemia was associated with meal skipping ( β  = 0.367, p > 0.05), snacking ( β  = 0.484, p > 0.05), and junior high school (JHS) education ( β  = 0.544, p > 0.05). Partial correlation showed statistically significant relationship between iron dietary pattern 1 and dietary iron ( r  = -0.234, p < 0.01), iron dietary pattern 2 and dietary iron ( r  = -0.198, p < 0.05), iron dietary pattern 2 and vitamin C ( r  = -0.201, p < 0.05), and haemoglobin and ferritin ( r  = -0.178, p < 0.05)., Conclusion: Meal skipping, guardian educational status, and number of times of eating a day were significantly associated with dietary iron intake. Meal skipping, snacking, and adolescents with JHS education were positively associated with anaemia., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Michael Akenteng Wiafe et al.)

Background: Dyslipidemia and hypertension are the leading causes of morbidity and mortality in patients with cardiovascular diseases (CVDs)., Objective: The study sought to evaluate the effects of Borassus aethiopum -fortified bread on metabolic risk factors among CVD outpatients., Method: From August 2016 to April 2017, a pilot study using a single-blinded randomized placebo-controlled trial was conducted by administering Borassus -fortified bread (150 g) and indistinguishable placebo (150 g white flour bread) daily to 122 CVD outpatients at 37 Military Hospital, Accra, Ghana, for 90 days. Body composition, blood pressure, and biochemical parameters were evaluated before and after the intervention., Results: Following the intervention, the mean waist circumference (before: 98.3 ± 14.6 cm, after: 95.9 ± 15.8 cm, P = 0.030), BMI (before: 31.4 ± 6.9 kg/m 2 , after: 28.0 ± 5.8 kg/m 2 , P = 0.027), and visceral fat (before: 10.4 ± 3.2, after: 9.9 ± 3.0, P = 0.013), as well as systolic (from 161.2 ± 25.5 to 137.6 ± 22.9and diastolic (from 99.2 ± 13.6 to 85.1 ± 10.8) blood pressure, were significantly reduced among the experimental group. Likewise, serum total cholesterol (TC), LDL, and HDL were significantly reduced within the experimental group before (TC: 5.9 ± 1.1, LDL: 3.4 ± 1.1, and HDL: 2.2 ± 0.5) and after the intervention (TC: 4.9 ± 1.1, LDL: 2.8 ± 0.9, and HDL: 1.5 ± 0.4) (TC: P = 0.001, LDL: P = 0.016, and HDL: P < 0.001, in mmol/L). These reductions were not observed in the controls., Conclusion: The Borassus -fortified bread significantly reduced blood pressure and improved lipid profile and other metabolic risk factors among the CVD outpatients studied. Therefore, its potential in the management of CVDs and other metabolic-related diseases should be looked at., Competing Interests: The authors declare no competing interest regarding publication of this manuscript., (Copyright © 2020 Charles Apprey et al.)

Obesity is a multifactorial condition arising from the interaction between genetic and lifestyle factors. We aimed to assess the impact of lifestyle and genetic factors on obesity-related traits in 302 healthy Ghanaian adults. Dietary intake and physical activity were assessed using a 3 day repeated 24 h dietary recall and global physical activity questionnaire, respectively. Twelve single nucleotide polymorphisms (SNPs) were used to construct 4-SNP, 8-SNP and 12-SNP genetic risk scores (GRSs). The 4-SNP GRS showed significant interactions with dietary fat intakes on waist circumference (WC) (Total fat, P interaction = 0.01; saturated fatty acids (SFA), P interaction = 0.02; polyunsaturated fatty acids (PUFA), P interaction = 0.01 and monounsaturated fatty acids (MUFA), P interaction = 0.01). Among individuals with higher intakes of total fat (>47 g/d), SFA (>14 g/d), PUFA (>16 g/d) and MUFA (>16 g/d), individuals with ≥3 risk alleles had a significantly higher WC compared to those with <3 risk alleles. This is the first study of its kind in this population, suggesting that a higher consumption of dietary fatty acid may have the potential to increase the genetic susceptibility of becoming centrally obese. These results support the general dietary recommendations to decrease the intakes of total fat and SFA, to reduce the risk of obesity, particularly in individuals with a higher genetic predisposition to central obesity., Competing Interests: The authors declare no conflict of interest.

Background: Overweight and obesity have become threats to public health in all regions across the globe including sub-Saharan Africa where prevalence used to be low. Policies to regulate the food environment and promote healthy food consumption look promising to reducing the prevalence of obesity but in Ghana there is not enough data to elicit a policy response. This study assessed the association between dietary consumption, anthropometric measures, body composition and physical activity among rural and urban Ghanaian adults., Methods: This was a cross-sectional study involving 565 Ghanaian adults. Structured interviewer administered questionnaires were used to collect information on socio-demographics. Dietary consumption was assessed using household food frequency questionnaire and 24-h recall. Height, weight, BMI, waist circumference and body composition of all participants were determined. The World Health Organization's Global Physical Activity Questionnaire (GPAQ) was used to assess physical activity levels. Mann-Whitney U test was used to analyze differences in anthropometric measures, body composition and consumption among rural and urban participants. Principal component analysis was used to analyze household food frequency data and nutrient analysis template was used to analyze 24-h recall. Chi-square was used to measure differences in obesity prevalence by community and gender. Multinomial logistic regression was used to model the risk factors associated with obesity., Results: The prevalence of overweight and obesity using BMI were 29.9 and 22.9% respectively. Use of waist circumference measurement resulted in the highest overall obesity prevalence of 41.5%. Prevalence of obesity was higher among females compared to males across all measures with the exception of visceral fat that showed no significant difference. Four different patterns were derived from principal component analysis. Among urban participants, the staple pattern showed a significant negative correlation with visceral fat (r - 0.186, p -value 0.013) and BMI (r - 0.163, p -value 0.029). Multinomial logistic regression revealed that males (AOR 19.715, CI 9.723-39.978, p-value < 0.001) had higher odds of being of normal weight compared to females., Conclusion: Prevalence of overweight and obesity continue to rise in Ghana, especially among females. Public education and screening as well as interventions that regulate the food environment and make affordable and available healthy food options are needed to control the rise in obesity prevalence., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Edible insects have emerged as an inexpensive alternative source of protein for reducing the burden of malnutrition worldwide. However, there is a dearth of evidence on its efficacy, and thus, the aim of this study was to investigate the effect of edible insect consumption on the nutritional status of female Wistar albino rats. The study assessed the subchronic effect of palm weevil larvae (PWL) and orange-fleshed sweet potato- (OFSP-) enriched biscuits (fortified biscuits (FB), plain biscuits (PB), biscuits fortified with PWL (PWB), and biscuits fortified with OFSP only (SPB)) as a model to predict the potential of PWL to improve the nutritional status of pregnant women in Ghana. Twenty-five female Wistar albino rats were randomly assigned to five experimental groups to receive one of the five feed supplements for 28 days. After which, the effects of treatment on haematological and biochemical parameters including lipid profile were assessed. No significant differences were observed with haematological (Hb) parameters. However, total cholesterol levels of the FB, PB, PWB, and SPB were significantly higher than in the N group. Apart from elevated total cholesterol concentrations, biscuits fortified with PWL had no adverse effects and can be a nutritious snack for maintaining acceptable HB levels., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Jessica Ayensu et al.)

Background: Good nutrition and physical activity of school-aged children are important for ensuring optimum growth and reducing obesity. This present study assessed associations between breakfast consumption, BMI-for-Age (BMI) and physical fitness in a cross-section of school-aged children attending government-owned primary schools in Kumasi, Ghana., Method: The sample consisted of 438 pupils (boys = 213; girls = 225; mean age 11.1 ± 1.1), attending 10 randomly selected schools. Weight (kg), height (cm) and Mid Upper Arm Circumference (MUAC) were measured for each participant, and BMI-for-age z-scores determined using the World Health Organisation (WHO) anthroplus software. Participants were stratified into thinness, normal weight, overweight/obese using WHO cut offs. Physical fitness was assessed using forward jump, left and right handgrips, flexibility, sit-ups and 50 metre run following standard procedures and converted to scores of 1 to 10 following Japanese standards, based on which percentiles were derived. Total fitness score for each pupil was computed by adding all scores. A questionnaire was used to assess meal intake patterns., Results: The mean BMI-for-age z-score for participants was - 0.24 ± 0.99. Thinness, normal weight and overweight/obesity were 2.7, 86.5, and 10.5% respectively among the pupils. Overweight was higher in girls (14.2%) compared to boys (4.2%), p  = 0.003. Similarly, mean MUAC was significantly ( p  = 0.021) higher in the girls (22.0 ± 3.2 cm) than the boys (20.7 ± 7.3 cm). For physical fitness, the girls scored higher in forward jump ( p  < 0.0001), 50-m run ( p  = 0.002) and overall fitness score than the boys (21.0 ± 6.2 versus 19.2 ± 8.3, p  = 0.012). However, a larger proportion of boys performed excellently and poorly than girls ( p  = 0.019). A positive correlation was observed between BMI z-score and hand grip ( r  = 0.21, p  < 0.001), while sit up ( r  = - 0.11, p  = 0.018) showed a negative correlation with BMI z-score. No other fitness test varied by BMI. Overweight children performed best in handgrip. Majority of children said they engaged in exercise (89.9%) and consumed breakfast (78.9%). Breakfast consumption was not associated with BMI z-score (x 2 0.0359, p  = 0.549) but non-breakfast consumers performed better in 50 m run compared to consumers (7.0 seconds ± 2.3 vrs 6.3 seconds ± 2.5, p  = 0.022). Children who reported to exercise were physically fitter than those who did not., Conclusion: Underweight levels were low while overweight was over 10% in these children. Girls were more than 3 times affected by overweight than boys, and were also physically fitter than boys. Breakfast consumption was not related to weight or fitness., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: Accurate body weight perception is important to maintaining an ideal body weight. In Africa, a preference for a larger body size and its association with health and wellbeing has been well documented. It remains speculative if these perceptions have changed or improved and if differences exist among rural and urban dwellers. The main aim of this study was to assess the body weight and obesity perceptions among rural and urban Ghanaians., Methods: This cross-sectional study involved 565 participants. The Stunkard figure rating scale was used to assess the body weight perception of participants. Participants were to choose from the scale figures they perceived to represent their current body weight, desired body weight, ideal body weight, ideal look for a wealthy person, ideal look for a woman with children, and ideal look for a woman without children. Additionally, participants were asked to describe obesity and its threat to health in their terms. Responses of participants to the above questions are presented as frequencies. Differences between rural and urban participants as well as males and females with respect to the median figure chosen for each question were determined by Mann-Whitney U test., Results: The median age of participants was 40 (IQR 26). The prevalence of overweight and obesity observed among participants was 52.8%. The most frequently selected figure as current body image was figure 5 (23.5%). Figure 4 was most frequently chosen by both males (37.2%) and females (24.6%) as their desired body image (27.4%). Male participants (41.8%) chose figure 5 as ideal for their gender while females (27.4%) maintained figure 4 as ideal for their gender. Study participants associated overweight with wealth and childbirth, and attributed their current weights to hereditary (27%) and childbirth (27%). Most participants were not taking steps to achieve their desired body image, and only a few engaged in both dieting and exercise to lose weight. Majority of participants described obesity as the accumulation of fat (91.0%) and viewed it as a threat to health (91.0%). Differences were observed among rural and urban participants with regard to the figure chosen as ideal for a wealthy person., Conclusion: Results from this study show an improvement in obesity perception and the acknowledgment of obesity as a threat to health. There was a desire for a normal-weight figure among study participants. Attribution of current body weight to hereditary and childbirth seems to be a hindrance to the implementation of actions to achieve this normal figure weight. Public health education, screening for overweight and obesity, creation of supportive food environments, and culture-sensitive interventions are promising to curbing the obesity menace., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Nana Ama Frimpomaa Agyapong et al.)

Background: The prevalence of iron deficiency anaemia remains high in pregnant women and the situation may be worse for pregnant adolescents. This study aimed to comparatively analyse the trends and determinants of anaemia between adult and teenage pregnant women in rural Ghana., Methods: A retrospective study design was employed. Data including primarily pregnancy history, haemoglobin levels and anaemia status were collected from the manual medical records of 1002 women stored in the repositories of two rural district hospitals in the Ashanti Region of Ghana over the years 2011-2015. Data was analysed using chi-square analysis, t-test, two-way ANOVA and binary logistic regression. Bivariate and multivariate analyses were also done to establish associations and predictors of anaemia., Results: An overall drop in mean haemoglobin from 11.1 g/dl in 2011 to 10.6 g/dl in 2015 was observed for adults, while an overall increase from 9.4 g/dl to 10.2 g/dl occurred in teenagers. Further, anaemia prevalence declined at the 36th week of pregnancy, and from 2011 to 2015, for both teenagers and adults. Among factors tested for association with haemoglobin levels using bivariate and multivariate analyses, gestational age alone was significant (P = 0.028). Between-subject effects determined using 2-way ANOVA indicated year of pregnancy alone, as well as in combination with age group (F = 3.1, P = 0.019) significantly affected haemoglobin levels. From binary regression analysis, BMI (OR 0.967, 95% CI:0.936-0.999, P = 0.042), gestational age (OR 1.058, 95% CI:1.013-1.106, P = 0.011) and pregnancy year (OR-2012(0.402); 2013(0.53); 2014(0.569); 2015(0.817), 95% CI: 2012(0.256-0.631); 2013(0.338-0.829); 2014(0.366-0.886); 2015(0.501-1.333), P = 0.001) were found to be significant predictors of anaemia at first antenatal visit. Also, the trimester of reporting for antenatal care, specifically the second trimester (OR-0.261, 95% CI: 0.072-0.951, P = 0.042) and the pregnancy year (OR-2012(0.235); 2013(0.206); 2014(0.530); 2015(0.222), 95% CI: 2012(0.101-0.545); 2013(0.081-0.522); 2014(0.197-1.428); 2015(0.049-1.018), P = 0.003) were more significant at the 36th pregnancy week., Conclusions: Although the trends observed were decreasing in both adults and teenagers in the years reported, anaemia levels remained high for each year in either group. Anaemia, therefore remains a major health problem, especially in the areas studied, and antenatal interventions need a second look to know what might make them more effective.

Nutrients are critical for optimal brain development, and good nutritional status is associated with cognitive development and improvement. The relationship between micronutrients intake and cognition in Ghanaian school-aged children has not been studied. The study investigated dietary intakes of micronutrients and cognition test performance of school-aged children. A cross-sectional study was undertaken among 438 school children, aged 9-13 years from ten randomly selected basic schools in Kumasi, Ghana. Socio-demographic data were obtained from a structured questionnaire. Dietary intakes of iron, zinc, vitamin B 6 , folate, vitamin B 12 , and vitamin A were determined from repeated 24-hr dietary recall data from 351 children, while cognition test was performed using a Raven's Coloured Progressive Matrices (RCPM), a 36-question test . Among 351 children, 156 (44.4%) had inadequate zinc intake, whereas 96 (27.4%) had inadequate iron intake. More than 1 in 2 children had inadequate vitamin A intake while 55.8% and 53.0% had inadequate vitamin B 12 and folate intakes, respectively. More school-aged boys (66.3%) than girls (46.8%) had inadequate vitamin B 12 intake ( χ 2  = 13.393, p  < .001), while for iron, folate, vitamin B 6 , zinc, and vitamin A, the differences were not significant. Mean RCPM test score differed significantly between school type ( p  < .001), but did not differ between the different ages, and between children with adequate and inadequate iron, zinc, vitamin B 12, vitamin B 6 , and vitamin A intakes, except for folate intake ( p  = .050). Weak positive significant associations were observed between RCPM test score and zinc and folate intakes ( p  = .050) . Dietary micronutrient intakes were inadequate in majority of these children, which put them at risk of weakened immune system and poor health, but did not show significant associations with RCPM performance. Further studies using other forms of cognition tests may help confirm our findings, and provide the impetus for the necessary interventions., Competing Interests: The authors declare that they do not have any conflict of interest regarding publication of this study., (© 2019 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc.)

Edible insects are currently being promoted as an inexpensive alternative source of protein in underdeveloped countries due to the rising cost of conventional animal protein and the foreseen future deficit in its supply. A supplemental palm weevil larvae and orange-fleshed sweet potato biscuit was developed as part of efforts to understand the nutritional benefits of edible insects and to predict whether these benefits will contribute to better nutrition among pregnant women in Ghana. The palm weevil larvae flour and the orange-fleshed sweet potato flour were mixed with wheat flour in three formulations that had 0, 35, and 70% of palm weevil larvae flour, before being made into biscuits. The biscuits were subjected to proximate and mineral content analysis and sensory evaluation. Proximate and mineral composition of the biscuits increased with increasing levels of palm weevil larvae flour substitution. Among the blends, biscuits containing 70% palm weevil larvae had the highest energy and fat content, and protein content also increased by 45% compared with biscuits made from 100% wheat flour. Calcium, iron, and zinc levels also increased with increasing levels of palm weevil larvae flour substitution. However, carbohydrate and crude fiber concentrations of the biscuits decreased with increasing substitution. The overall acceptability of the biscuits as determined by sensory evaluation using pregnant women was high. Biscuits fortified with palm weevil larvae can be a nutritious snack for pregnant women., Competing Interests: The authors declare no conflict of interest to disclose.

Several studies demonstrate the importance of essential fatty acids (EFAs), and the long chain polyunsaturated FA docosahexaenoic acid (DHA), on cognition and brain development. The objective of this study was to investigate the relationship between whole-blood FAs and executive function in children from Northern Ghana. A total of 307, 2-to-6-year-old children attempted the dimensional change card sort (DCCS) task to assess executive function, and dried blood spot samples were collected and analyzed for FA content. Significant differences in mean % total whole-blood fatty acids were observed between children who could not follow directions on the DCCS test (49.8% of the sample) and those who could (50.2% of the sample). Positive associations with DCCS performance were observed for DHA (β=0.25, P=.06), total n-3 (β=0.17, P=.06) and dihomo-gamma-linolenic acid (DGLA; β=0.60, P=.06). Children with the highest levels of total n-3 and DHA were three and four times, respectively, more likely to pass at least one condition of the DCCS test of executive function than those with the lowest DHA levels. The results of this study indicate an association between n-3 FAs and high-level cognitive processes in children two to six years of age, providing impetus for further studies into possible interventions to improve EFA status of children in developing countries., (Copyright © 2017 Elsevier Inc. All rights reserved.)

In Northern Ghana, 33% of children are stunted due to economic disparities. Dietary fatty acids (FA) are critical for growth, but whether blood FA levels are adequate in Ghanaian children is unknown. The objective of this study was to determine the association between whole blood FAs and growth parameters in Northern 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 were calculated. Relationships between FAs and growth parameters were analyzed by Spearman correlations, linear regressions, and factor analysis. Of the 307 children who participated, 29.7% were stunted and 8% 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 (HAZ) or weight-for-age z-score (WAZ). In hemoglobin adjusted regression models, both HAZ and WAZ were positively associated with arachidonic acid (p≤0.01), dihomo-gamma-linolenic acid (DGLA, p≤0.05), docosatetraenoic acid (p≤0.01) and the ratio of DGLA/linoleic acid (p≤0.01). These data add to the growing body of evidence indicating n-6 FAs are critical in childhood linear growth. Our findings provide new insights into the health status of an understudied Northern Ghanaian population.

Background: The nutrition transition, currently observed across the world is driven by trade liberalization, urbanization and more sedentary lifestyles. Ghana implemented a restrictive policy to limit the availability and access to fatty meat in the 1990s. This paper sought to determine public awareness and perception of the policy's enforcement and impact, as well as the general attitude towards fatty meat, preference and consumption of meat types., Method: A cross-sectional qualitative study was carried out among 377 adults, aged ≥18 years, living in Kumasi Metropolis in the Ashanti Region, the second largest city in Ghana. An interviewer administered structured questionnaire and a food frequency questionnaire were used for data collection. Body composition parameters were determined with OMRON body composition analyser and blood pressure was measured with a digital sphygmomanometer., Results: Majority of respondents were females (62.9%), aged 18-35 years old (72.1%) and were labourers, traders or teachers (52.5%). Mean Body Mass Index of participants was 25.4 kg/m 2 and percent body fat was 30.4%. Over half (58.9%) of the participants were aware of, and most (81.2%) supported the restrictions, although majority (57%) thought there was low public awareness and less than 15% felt the restrictions were well enforced. About 59.4% believed the restriction could improve health, prevent disease and reduce deaths in the long-term. Two thirds (67.1%) of the participants considered the fat content of the meat they bought and related fat to health problems (38.5%) and obesity/stroke (7.4%). Local meat products (meat produced in Ghana) were more preferred due to taste, freshness and healthiness than imported meat, but imported meat types (meat imported from other countries) were more available (56.5%), cheaper (69.5%) and regularly consumed than the local types., Conclusion: There was a good level of public awareness, strong support and positive attitude towards Ghana's restrictive food standards on meat. Although preference for local meat type was greater, imported meat was more consumed due to cost and availability. Policies which limit access to, and availability of 'unhealthy' food should be implemented and enforced to improve the food environment in order to help address the growing obesity and non communicable disease trend., Competing Interests: Competing interestThe authors declare that they have no competing interests., (© The Author(s). 2018.)

Glycemic index (GI), a measure of blood glucose level as influenced by foods has become a concern due to the increasing cases of diabetes in Ghana. In spite of this, little is known of the GI of commonly consumed carbohydrate-rich foods of the Ghanaian diet. The GI of five Ghanaian staples: fufu (locally pounded), kenkey (Ga), banku , Tuo Zaafi (TZ), and fufu (Processed powder) were determined in a crossover trial among 10 healthy nondiabetics. Participants were given 50 g portions of pure glucose on two different occasions and subsequently the test foods containing 50 g available carbohydrates. Capillary blood glucose levels of the subjects at fasting and after ingestion of the glucose and test foods were measured within a 2-hour period. The GI of the test foods were calculated by dividing the incremental area under the glucose response curve (IAUC) of the test food by the IAUC for the reference food and multiplying the result by 100. Processed-powdered fufu had the least glycemic response (31), followed by Ga kenkey (41) and locally pounded fufu (55), all recording low GI. Tuo Zaafi (68) had a medium GI and banku (73) , moderately high GI. Comparison of GI between the foods using ANOVA revealed a significant difference between GIs of locally pounded fufu versus I- fufu (industrially processed fufu flour) ( p  = 0.026). This study showed that the five major Ghanaian staples showed low to moderately high GI. These should be considered in recommendations for diabetics.