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Women's activities within the local food system are linked to their dietary quality. Their ability to consume a nutritious diet may be influenced by socio-cultural norms; often, the influence of these norms has not been adequately studied. This study examined how socio-cultural norms linked with rural food systems can potentially exert adverse effects on women's diets. The study was conducted in two rural communities, Yilkpene and Kpachilo, in Northern Ghana, between May and July 2016. Both selected study communities were chosen because they had similar population sizes, dietary patterns, and access to social services. Using a qualitative approach, sixteen key informant interviews with community and institutional leaders, 11 focus group discussions comprising 87 community members, and forty 24-hour dietary recall interviews with women of reproductive age were used to explore the nature of the local food system linked with sociocultural norms. Transcribed interviews were coded and analyzed, thematically, using pre-determined and emerging themes. A total of 143 women and men participated in the study with women dominating the sample. The components of the food system in both communities were constructed, primarily, around men. Quantities, quality, and varieties of produce, its distribution, and intra-household allocation were dominated by male perceptions and practices that determine access and ownership of productive resources, and pre-determined roles and responsibilities of household members. Men dominated production of economic crops (cereals, and legumes); women produced vegetables, and limited quantities of legumes and cereals, mainly for home consumption. Men controlled allocation of cereals for household meal preparation; more expensive complementary ingredients were provided by women. Although women prepared household meals, men received the 'lion's share' of nutrient-dense components. Forty-five percent of women could not meet minimum dietary diversity of at least five food groups in their diets. The local food system in Northern Ghana is dominated by gender-driven socio-cultural norms, which constitutes a potential barrier to women achieving dietary adequacy. Interventions should deliberately address these culturally-established barriers, especially in contexts where subsistence farming is the main source of livelihood. Key words: Food system, Socio-cultural norms, Barriers, Women, dietary quality, INTRODUCTION Low dietary quality is a global public health challenge that exerts adverse consequences on human health and well-being with children and women of reproductive age (WRA) being the most [...]

Diet modelling is one of the important steps in developing food-based dietary guidelines (FBDGs). However, this component remains uncommon in the FBDGs of many low-and middle-income countries. A diet modelling package (DietSolve) provided by the Food and Agriculture Organization (FAO) was used to formulate a healthy diet based on estimating the daily proportions of food groups that best meet the dietary goals established for the FBDGs for Ghana. Input data for the modelling included a list of commonly eaten foods across the agreed food groups, nutrient and energy content of the foods, current energy and nutrient consumption, and energy and nutrient constraints linked to the dietary goals, as determined by the FBDG multi-Sectoral Technical Task Team (MTTT). The modelling was based on assumptions and constraints including a total daily dietary energy target of 2000 kcal/day; the percentage contribution (energy targets) of the macronutrients as follows: carbohydrates (55-70%), protein (10-20%), and fat (20-30%) to the total energy target; and calcium (1100 mg/day), iron (20 mg/day), and zinc (11 mg/day) constraints. The situation analysis and evidence review carried out as a prior step guided the diet modelling constraints. Energy contributions were also set for a serving of each food group. The final recommendations were based on food groups with each food group consisting of a variety of commonly consumed foods. The total weight of the optimized diet was estimated at 1514 g/day, including 144g/day of animal-source foods, 41.5g/day of discretionary choices, 226g/day of fruit, 227g/day of vegetables, 6g/day of healthy fats and oil, 198g/day of legumes, nuts, and seeds, and 672g/day of staples. This food group composition will provide an estimated 2639 kcal/day, a deviation of about 32% above the energy target set, made up of ~59% from carbohydrates, ~15% from protein and ~25% from fat, and meeting/exceeding the micronutrient targets set. The Optimised diet is healthier compared to the present dietary patterns of the population; its lower ASF component is known to impact less on the environment. Key words: Food-based dietary guidelines, linear programming, diet modelling, healthy diet, infood-graphic, Ghana, INTRODUCTION Consuming healthy diets throughout the life-course helps to prevent malnutrition in all its forms [1]. However, the current food system in Ghana does not ensure adequate and healthy food [...]

Building the capacity of a new generation of scholars is both a necessary and an exciting quest. It is an opportunity to be intentional in passing on the baton of [...]

Galamsey, a popular name for small-scale mining in Ghana, is an important livelihood for many rural Ghanaians. Although concerns have been raised in the popular media about the adverse effects of galamsey on the environment, human health, and livelihoods, there is a representational paucity of evidence regarding its links with local food systems, particularly, from the perspective of affected mining communities. The current study explored community perceptions and experiences of galamsey and its perceived effects on food security and livelihoods in the East Akim Municipality in the Eastern region of Ghana. Primary data was collected in the East Akim Municipality of Ghana, using a photovoice method. Thirty-six male and female adults were purposively selected with the help of a community focal persons and advertisements in the study communities. Respondents participated in a one-day photography training and thereafter, were deployed to take at least fifteen photos that portray the effect of galamsey on food security and health. Subsequently, each participant was asked to select five of the photographs they have taken and explain why they captured that image. A photo exhibition was held to facilitate community conversation and perspectives on the effects of galamsey on food and nutrition security. Galamsey has resulted in degradation of, otherwise, fertile agricultural land, and contamination of freshwater sources. As a consequence, there is reduced cultivable land, reduced crop production, shortage of essential staple foods, increase in food price, and increased consumption of ultra-processed foods. There is also perception of increased exposure to heavy metals like mercury in locally-produced food. Given the adverse health consequences of both food and nutrition insecurity, and increased consumption of processed foods, it is important that public and policy discussions to minimize the effects of galamsey in Ghana should include considerations about food and nutrition insecurity in mining communities. Key words: mining, galamsey, food security, health, agriculture, land degradation, food system, INTRODUCTION Small scale indigenous mining, popularly known in Ghana as 'galamsey', is a common rural livelihood activity that has been practiced in Ghana prior to arrival of colonial explorers on [...]

Anaemia among women of reproductive age (WRA) increases the risk of pregnancy-related morbidity, mortality, and poor pregnancy outcomes. Globally, there is growing interest to reduce anaemia among WRA. In Ghana, anaemia among WRA declined at the national level between 2008 (59%) and 2014 (42%). There were also important declines at the sub-national level. The Eastern region (in the south) and Upper West region (in the north) provide an interesting opportunity to understand the decline. Identifying the drivers of anaemia reduction among WRA in Ghana provides important implementation science evidence for designing effective interventions. This current study examined the drivers of reduced anaemia prevalence in women of reproductive age using data from the Ghana Demographic and Health Surveys for 2008 and 2014. Anaemia was diagnosed as haemoglobin Key words: Anaemia, Women, Nutrition, Reproductive-age, Ghana, Haemoglobin, Regression, Decomposition analysis, INTRODUCTION Anaemia among women of reproductive age (WRA) is a key public health challenge linked with adverse health, nutrition, social, and economic challenges [1]. Anaemia increases the risk of pregnancy-related [...]

Nutrition-sensitive agriculture approaches can improve farming household incomes, food security, and diet quality. Adopting nutrition-sensitive agriculture approaches means placing a nutrition lens on the policies, strategies, and investments in the food and agriculture sector without detracting from the sector's traditional goals of food supply. To understand the processes involved in developing agriculture-for-nutrition policies in Ghana, this paper examined the influence of stakeholders' interconnections using a visual participatory mapping technique, Virtual Net-Map. Three convening platforms were identified for stakeholder engagement: the Agriculture Sector Working Group, the National Agricultural Technical Committee, and the Public-Private Partnership Dialogue Platform. Sixty stakeholders with 188 connections were recognised for their involvement in agriculture-for-nutrition policymaking in Ghana. Fourteen stakeholders, twelve from government organizations and two from donor and development partner organizations, were identified as the most influential. International stakeholders (donors and development partners) were critical in funding agriculture-for-nutrition policymaking activities. While all stakeholders had a joint mandate to ensure policies were developed, the Ministry of Food and Agriculture led the policy development process in Ghana's food and agriculture sector. Moreover, government stakeholders notably received more support from other stakeholders for funding, advocacy, dissemination, and technical assistance than the support they offered. Generally, stakeholders were more engaged in technical assistance activities and least involved in disseminating agriculture nutrition information in the agriculture-for-nutrition policymaking process. The information on stakeholders' interconnections and influence showed areas that had the most and least stakeholder engagements, which will enable potential stakeholders to identify niche(s) to support the nutrition agenda in Ghana's food and agriculture sector and help Ghana meet the Global Nutrition Targets and the Sustainable Development Goals for 2025 and 2030, respectively. In addition, the evidence presented on Ghana's agriculture-for-nutrition policymaking network can lead to better ways of centralizing nutrition in agricultural policies and designing initiatives that encompass most, if not all, relevant stakeholders. Key words: Agriculture, Nutrition, Policymaking, Net-Map, Influence, Connections, Ghana, Nutrition-sensitive agriculture the ASWG approved the third, INTRODUCTION Ghana has made notable progress in reducing the prevalence of child undernutrition [1]. Stunting decreased from 30% in 2003 to 19% in 2014, and the prevalence of wasting and [...]

Dietary perception, behavior, and nutritional status can all be influenced by exposure to information. Behavior change communication that is appropriately designed and implemented is critical for motivating optimal dietary behavior. On the other hand, inadvertent or deliberate misinformation can drive unhealthy dietary behaviors. As part of the process to develop food-based dietary guidelines (FBDGs) for Ghana, this rapid evidence review examined the nature, extent, sources, and medium of food and nutrition information dissemination and promotion in Ghana. PubMed, Cochrane, Google Scholar, and Open Access Theses Dissertations (OATD) databases were searched systematically using keywords to identify relevant peer-reviewed and grey literature. The review included 31 documents, after excluding 1,302 documents for ineligibility (based on irrelevant title, abstract, and duplicates). Limited reporting of undernutrition was found in print and electronic media. Unhealthy foods, including sugar-sweetened beverages, snacks, yogurt, instant noodles, candy/chocolate, and ice cream were frequently advertised through various communication media. Children are highly exposed to food advertisements, which target them. Promotional characters, animation, billboards, and front-of-store displays; product-branded books, and toys are common strategies for food marketing and advertisement in Ghana. The most frequently reported sources of health and nutrition information were television, radio, social media, health professionals, families, and friends. Children and adults experienced changes in food preferences and choices as a result of exposure to food advertised on television. The commonly used traditional media were radio and television; printed newspaper use has declined tremendously in the past decade. Social media use (particularly WhatsApp, Facebook, and YouTube) is highest in urban areas, and is growing rapidly; young adults are the most active users of social media platforms. Experts recommend regulation as a mitigation for nutrition miscommunication and inaccurate promotion. The current review highlights the need for regulation of food marketing, and advertisement to safeguard a healthy food environment in Ghana. Key words: advertisement, promotion, diet, regulation, social media, food, Ghana, INTRODUCTION Due to modern technological innovations, information can be communicated these days via multiple media including radio, television, magazines, and the world wide web. Depending on the target group and [...]

Food environments exert a significant effect on population dietary choices and health outcomes. Policies that influence the food environment, can have a significant impact on individual and population dietary choices. This rapid review assessed the nature and interaction within the Ghanaian food environment, and the impact that existing school, workplace, and national food policies have on dietary intake and nutritional outcomes. Online databases and university repositories were searched for relevant articles and documents. A total of forty articles and documents were included in the review. Majority of the reviewed papers (85%) used a cross-sectional design. The findings show that traditional outlets (open markets) constitute the main food source among the Ghanaian populace, while convenience stores serve as an important source of processed foods. Prepared local foods are often consumed outside the home and are mainly sourced from street food vendors. Street foods are perceived as less expensive, convenient, and delicious. The food environment was found to influence dietary acquisition, intake, and nutritional outcomes. Although most nutrients provided by the School Feeding Programme (SFP) are below recommended intake standards, the SFP contributes positively to improved diets and nutrition status of school-age children. Children attending SFP-implementing schools experience higher intakes of protein, iron, zinc, calcium, vitamin A, folate, and have higher haemoglobin, and lower prevalence of stunting, underweight, and thinness than children in non-SFP implementing schools. Availability of a private room for breastfeeding mothers improved breastfeeding frequency. Ghana's fatty meat restriction policy has reduced the availability and sale of fatty meat on the Ghanaian market. Reported drivers and barriers to healthy foods consumption include socio-economic factors, media information, food storage facilities, cultural perception, fruit seasonality, knowledge on the nutrient value of fruits and vegetables, safety profile of fruits and vegetables, and contribution of household production to dietary intake. In conclusion, the food environment review reveals the drivers of availability, barriers to healthy food access, and impact of interventions and policies on the Ghanaian food environment. Key words: Ghana, Food environment, policies, nutritional impact, health impact, BACKGROUND Population health, well-being, and development are linked intimately with the physical environments they live, work, play, eat, and interact [1]. The food environment constitutes the domain or conditions within [...]

Food-Based Dietary Guidelines (FBDG) provide culturally-appropriate and actionable recommendations based on which populations can make healthy food choices. Food systems sustainability, from production to consumption, and disposal of food and food-related items, should be a critical consideration for developing such guidelines. This rapid review assesses Ghana's food systems to determine the level of sustainability to inform the FBDG recommendations. Peer-reviewed articles, documents and reports of relevance to Ghana were included in this rapid review. A hundred and eight papers, answering different questions on food system sustainability were reviewed. Bread, cereals, fish and indigenous vegetables are the most frequently consumed food groups. Sugar-Sweetened Beverages are the most consumed imported foods. In rural areas, 53% of dietary protein comes from plant sources. Fish is the main the source of animal protein for most Ghanaian households. There is intensive exploitation of marine and fresh water resources. Most livestock are raised by smallholder farmers using free-range system. Poultry is frequently kept on deep litter system and only a few are large-scale. Crop production for household consumption and small-scale animal rearing are predominant, especially in Northern Ghana. By weight, fruits and vegetables are the least cultivated and consumed crops at the household level. Wood is the commonest source of fuel for cooking, especially in rural areas. Single use plastic is the most used and preferred material for food packaging. Indiscriminate and poor management of waste and pesticide misuse is commonly reported. The findings suggest the need for promoting production diversification, use of clean fuel and reusable food packaging as part of FBDGs to enhance sustainability of Ghana's food systems. Key words: sustainability, food system, Ghana, Food-based Dietary Guidelines, production, diversification, INTRODUCTION As the world's population continues to rise steadily [1], there is increased global awareness and efforts to produce adequate quantities and variety of nutritious, affordable foods, while preserving the [...]

Access to safe, nutritious, and sufficient food is essential to ensure food and nutrition security and healthy lives for all. Secure access to nutritious food ensures healthy eating habits, economic growth, and stability in an economy. However, food insecurity and malnutrition persist globally. In Ghana, more than half of food-insecure people reside in the Northern ecological zones of the country. Moreover, Ghana lacks a systematic food security monitoring system to track food insecurity among vulnerable populations. This study reviewed existing evidence on the current situation and changes related to food production, trade, safety, and consumption in Ghana, as part of the process to develop food-based dietary guidelines for the country. The literature review included peer-reviewed articles published from 2010-2020 in Ghana to document household-level food production, consumption, and safety issues. In addition, food disappearance data (from 2010 to 2018) from the Food and Agriculture Organization of the United Nations was analysed. Means and compound annual growth rates were calculated for each food item included. The results showed that per capita food production was higher than per capita consumption in all the food categories studied, except for vegetables, and fish and fishery products. Food consumption was centred on a few priority staple crops such as cassava, maize, rice, and yams, with less consideration given to underutilised foods such as akokono (palm weevil larvae). Food imports exceeded food exports in all food categories except 1) cocoa beans and products, 2) root crops and tubers, 3) oil-bearing crops and nuts, and 4) fruits and products. Fruit and vegetable consumption in Ghana has been declining since 2013. There was also a rise in the import and consumption of processed foods, especially tomato paste, sugars, and alcoholic and non-alcoholic beverages. Food safety issues included microbial contamination, aflatoxin contamination, polycyclic aromatic hydrocarbons in smoked fish, mercury in fish, pesticide and heavy metal residues in vegetables and fruits, and food adulteration. The evidence synthesized from this study will be useful to inform the development of food-based dietary guidelines for Ghana. Key words: Food, production, trade, consumption, food security, safety, Ghana, INTRODUCTION In 1996, the Rome Declaration on World Food Security highlighted food availability, accessibility, and utilisation as the three dimensions of food security [1]. Food availability includes producing, distributing, and [...]

As part of a process to develop food-based dietary guidelines (FBDGs), the national Multi-sectoral Technical Task Team coordinating FBDGs development in Ghana has commissioned a desk review of the nutrition and health situation, and trends for all persons living in Ghana, across the entire life cycle. Using a rapid scoping review method, multiple electronic databases were systematically searched using keywords related to nutrition and health outcomes, as well as potential drivers of nutrition and health in Ghana. The review included evidence from peer-reviewed articles, unpublished manuscripts, dissertations, reports of nationally representative surveys, and other grey literature (reports of nutrition situation evaluations commissioned by international and local agencies), spanning the decade starting from 2010. A total of 48 documents were included in this review: 15 for infants and young children, 14 for adolescents, 19 for adults and women of reproductive age, and five for the elderly. Among children under five, anemia and stunting were the most prevalent nutrition-related outcomes, 62% and 19%, respectively. Underweight prevalence of 11% was observed among young children; wasting rates have remained below 10%, but registered about 20% prevalence in northern Ghana. Different levels of micronutrient deficiencies, particularly iron deficiency were reported across all age groups. Nutrient deficiency rates were higher among adolescent girls and women of reproductive age. Vitamin A deficiency was also high (21%) among under-fives. Overweight and obesity rates were high among women of reproductive age (40%) and adolescents (11% to 18% between 2013 and 2017), and still increasing. Underweight and overweight coexists among the elderly (50 years and above), at a rate of 10% and 20%, respectively. An increasing prevalence of central adiposity has also been reported among women of reproductive age (high waist circumference of 80.6%) and persons older than 60 years (67% in 2015). Rates of hypertension and cancers have also increased within the study period. Hypertension rates have been increasing with age, particularly among urban dwellers. Majority of persons with hypertension are not receiving treatment . Incidence of breast, cervical, and liver cancers were 20%, 14%, and 12% in 2018. Ghana is experiencing a double burden of malnutrition characterized by co-existing high levels of undernutrition and overnutrition. The national FBDGs for Ghana should prioritize recommendations and actions that address the dual burden of undernutrition and overnutrition. Key words: Nutritional status, Micronutrient Deficiency, Ghana, undernutrition, Overweight, Anemia, Stunting, non-communicable disease, INTRODUCTION Malnutrition in all its forms is linked with reduced productivity, increased susceptibility to infections, and impaired recovery from illness. Addressing malnutrition is, thus, recognized as a global human development [...]

Food-based dietary guidelines (FBDGs) are important tools for promoting healthy eating and nutrition education at the population level. Currently, more than 100 countries worldwide have developed FBDGs with majority of existing FBDGs in high-income countries. However, there are a few countries in Africa which have developed FBDGs. This review describes and compares the characteristics of existing FBDGs in Africa. Data were extracted from all existing FBDGs from African countries which have been archived in the Food and Agriculture Organization's (FAO) online repository of FBDGs. In addition, supporting documentation from other sources linked to the identified FBDGs were also reviewed. Extracted data were coded and synthesized to describe the purpose of the FBDGs, the process for developing the FBDGs, and how healthy diets were expressed in the FBDGs. In addition, the FBDGs were examined for content on considerations for planetary health, and non-dietary recommendations. A checklist was used to extract the evidence in the identified documents. Of the 47 African countries in the WHO Africa region, only eight FBDGs were identified from seven countries. South Africa had two FBDGs (including a FBDG for young children). Multi-disciplinary technical working groups were convened in developing majority of the FBDGs. The working groups utilised scientific evidence on diet-related diseases and nutrient requirements as a basis for recommendations. All the FBDGs were intended as a tool for promoting healthy diets among the lay population. The FBDGs that were reviewed included between six and sixteen dietary messages. Diet diversification was promoted as the most common recommendation across African country FBDGs. The recommendations often promoted consumption of four to six food groups communicated using text as well as images (food guide). Local availability and cultural acceptability were important values promoted as part of an optimal diet in some of the countries. However, none of the recommendations addressed environmental sustainability. Apart from South Africa, none of the FBDGs had been evaluated or revised. Across Africa, there is a need for increased focus on developing new FBDGs or revising existing ones as a tool for meeting the dietary information needs of populations at risk of malnutrition in all its forms. Key words: Food-based, Dietary, Guidelines, diversity, Africa, Health, Non-communicable, Sustainability, INTRODUCTION Unhealthy diets are a major avoidable risk factor for mortality and morbidity across the lifespan [1,2]. One in five deaths, globally, has been linked to unhealthy diets [1]. On [...]

The prevalence of obesity and diet related non-communicable diseases (NCDs) are rapidly increasing in Africa. Consumption of pre-packaged foods is one of the main drivers of these NCDs. Pre-packaged foods tend to contain high levels of energy, fat, sugar, and salt, which are known risk factors for NCDs. Food labels can guide consumers to make informed healthy food choices. Therefore, it is important to analyze how health-related information is communicated on food labels. In Ghana, there is paucity of evidence on what health-related information is available to consumers of pre-packaged foods. This study describes health-related information on labelled pre-packaged foods sold in local retail shops in Accra. A cross-sectional survey and quantitative content analysis of food label information were employed in this study. Pre-packaged food labels photograph data were sourced from shops and content analyzed to describe their health-related information. Nutrition and health-related information were classified using the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support (INFORMAS) system. Three hundred and fifty-one (N=351) pre-packaged foods and non-alcoholic beverages were sampled, out of which 2.3% products were unlabelled. Out of 343 labelled products, 92% disclosed ingredient list information and 68.8% had nutrition declaration. Between the two nutrition labelling formats: Back-of-Pack (BOP) and Front of Pack (FOP), BOP was the dominant (87.3%) format. Various types of FOPs were identified however, Guidelines Daily Allowance (GDA) was the most common format. The study found that 18% of labelled pre-packaged foods carried nutrition claim and about 7% had a health claim. Most of the claims were written and the others were a combination of words, numbers, and pictures/symbols. This study has shown a high disclosure of health-related label information on pre-packaged food but information presentations on labels were not consistent. The insight gained from this study shows that the presentation of health-related label information does not meet the current recommendations of Codex and the benchmarks set out by INFORMAS in promoting a healthy food environment. Key words: Pre-packaged Foods, Food/Nutrition labels, health-related information, retail shops, Accra, INTRODUCTION Obesity and diet-related non communicable diseases (NCDS) are the leading cause of death and disability worldwide [1]. In Ghana, obesity and diet--related NCDs are increasing and have become a [...]

Anemia remains a serious public health concern, globally, affecting learning ability and physical development of children. Anemic children are at a higher risk of diminished economic productivity and low earning capacity in adulthood due to impaired school performance and reduced work capacity. Anemia contributes to about a quarter of Africa's nutrition-related Disability Adjusted Life Years. The objective of this study was to determine the prevalence of anemia and its associated risk factors among school-aged children (SAC) between ages 9 and 15 years in urban Ghana. The analysis included a randomly selected subsample of 1,634 children from a larger study on nutrition of SAC enrolled between 2009 and 2012 in private and public basic schools in the Accra and Kumasi Metropolis in Ghana. Socio-demographic and household characteristics were collected with questionnaires. Weight and height were taken to the nearest 0.1kg and 0.1cm, respectively. Dietary information was collected using a food frequency questionnaire. Data were analyzed using IBM SPSS Statistic version 23. The relationship between hemoglobin levels and socio-demographic variables, and predictors of hemoglobin levels were determined using Chi-square and binary logistic regression. The mean hemoglobin concentration of the study participants was 12.9[+ or -]1.3 g/dL. In Kumasi, SAC had higher mean hemoglobin concentration (13.1[+ or -]1.2 g/dL) compared to those from Accra (12.6[+ or -]1.3 g/dL; p=0.001). Mean hemoglobin concentration was significantly higher among males than females (13.0[+ or -]1.4 g/dL vs 12.8[+ or -]1.2 g/dL; p=0.002). Prevalence of anemia was 20.4%; mild anemia was most common (13.6% of total sample). Anemia cases were higher in public schools (24.6%) compared to private (18.2%). Two-thirds of anemia cases (64.0%) were from schools in Accra. Males had significantly higher prevalence of anemia (26.5%) than females (15.9%; p Key words: anemia, Ghana, hemoglobin, schoolchildren, urban settings, metropolis, Accra, Kumasi, INTRODUCTION Anemia is an important public health problem that affects about 305 million (25%) school-aged children (SAC), globally [5]. The estimated prevalence of anemia reaches about 50% in low- and [...]

Food-related beliefs and attitudes influence dietary behaviors and are important drivers of nutrition outcomes. Understanding beliefs and attitudes that drive dietary behaviors, as part of the process for developing Food-based Dietary Guidelines is critical for targeting messages to motivate healthy dietary diets. This rapid review was undertaken to summarize readily available local evidence on food-related beliefs, attitudes, and associated practices in Ghana. A rapid review of 39 peer-reviewed publications and graduate-level theses on the dietary behaviors of Ghanaians was conducted between November and December 2020. The study only included articles published between 1990 and 2020 involving apparently healthy populations living in Ghana. Documents were identified through a systematic literature search of Google Scholar and PubMed. Data on food-related knowledge, beliefs, attitudes, and practices were extracted into an excel template and analyzed using thematic content analysis. The sampled research included primarily cross-sectional studies of urban, rural, peri-urban and mixed localities throughout Ghana: one was a prospective research. A range of food-related taboos were identified and classified as taboos for the general population, pregnancy-related, or child-related. Although awareness of food-related taboos was common, they were not extensively practiced. Energy-giving and nutrient-dense foods are commonly promoted during pregnancy. Culturally prescribed pre-lacteal feeds and other infant and young child feeding (IYCF) behaviors reported in the studies were not aligned with IYCF recommendations. A 3-meals-a-day pattern was observed, commonly, across all age groups; most adult meals, particularly supper, was prepared at home. However, ready-to-eat meals were regularly purchased by adults and adolescents. Adolescents frequently reported snacking and skipping meals; breakfast was the most frequently skipped meal. Fruits and vegetables were the least consumed food groups across all age groups. Muslim faith was associated with consuming more diverse diets and greater fruit and vegetable consumption. The findings of this review provide an overview of food-related beliefs and practices of Ghanaians and can inform decisions on areas to emphasize in food-based dietary guidelines and associated nutrition education messages to promote healthy diets in the Ghanaian population. Effective nutrition education is needed to dispel harmful food beliefs and practices and promote healthy food choices across the life cycle. Dietary patterns in Ghana are linked with cultural and religious practices that are often unique to particular subgroups, although there are common strands of beliefs across ethnic groups. These beliefs can result in either adverse or beneficial outcomes, depending on what eating patterns it determines. Key words: food prohibitions, dietary practices, dietary pattern, Nutrition, Ghana, INTRODUCTION Dietary behaviors encompass the various processes associated with food choice, eating behaviors, and actual dietary intake, all of which are regulated by environmental, socioeconomic, and sociocultural influences [1,2]. It [...]

Anaemia among women of reproductive age (WRA) increases the risk of pregnancy-related morbidity, mortality, and poor pregnancy outcomes. Globally, there is growing interest to reduce anaemia among WRA. In Ghana, anaemia among WRA declined at the national level between 2008 (59%) and 2014 (42%). There were also important declines at the sub-national level. The Eastern region (in the south) and Upper West region (in the north) provide an interesting opportunity to understand the decline. Identifying the drivers of anaemia reduction among WRA in Ghana provides important implementation science evidence for designing effective interventions. This current study examined the drivers of reduced anaemia prevalence in women of reproductive age using data from the Ghana Demographic and Health Surveys for 2008 and 2014. Anaemia was diagnosed as haemoglobin<12.0g/dl. Data were summarized using proportions and 95% confidence intervals. A weighted binary logistic-based multivariate decomposition technique was used to identify the potential drivers of anaemia across surveys for 2003, 2008 and 2014. Sensitivity analysis was carried out to test the robustness of the results of the decomposition analysis using haemoglobin concentration. The results of the decomposition analysis were presented as endowment and coefficient effects. Statistical analysis was carried out using Stata version 15. There was an improvement in access to water and sanitation, health services, family planning, and health insurance across surveys. Drivers of anaemia reduction over time at the national level included wealth index and maternal age, education, use of hormonal contraception and body mass index (BMI). In the Eastern region, the drivers of change were household wealth index, maternal age, hormonal contraceptive use and BMI. The drivers of change in the Upper West region, were household access to water, maternal education and BMI. The findings suggest that multi-level interventions are needed across sectors to further reduce anaemia among WRA. [ABSTRACT FROM AUTHOR]

Galamsey, a popular name for small-scale mining in Ghana, is an important livelihood for many rural Ghanaians. Although concerns have been raised in the popular media about the adverse effects of galamsey on the environment, human health, and livelihoods, there is a representational paucity of evidence regarding its links with local food systems, particularly, from the perspective of affected mining communities. The current study explored community perceptions and experiences of galamsey and its perceived effects on food security and livelihoods in the East Akim Municipality in the Eastern region of Ghana. Primary data was collected in the East Akim Municipality of Ghana, using a photovoice method. Thirty-six male and female adults were purposively selected with the help of a community focal persons and advertisements in the study communities. Respondents participated in a one-day photography training and thereafter, were deployed to take at least fifteen photos that portray the effect of galamsey on food security and health. Subsequently, each participant was asked to select five of the photographs they have taken and explain why they captured that image. A photo exhibition was held to facilitate community conversation and perspectives on the effects of galamsey on food and nutrition security. Galamsey has resulted in degradation of, otherwise, fertile agricultural land, and contamination of freshwater sources. As a consequence, there is reduced cultivable land, reduced crop production, shortage of essential staple foods, increase in food price, and increased consumption of ultra-processed foods. There is also perception of increased exposure to heavy metals like mercury in locally-produced food. Given the adverse health consequences of both food and nutrition insecurity, and increased consumption of processed foods, it is important that public and policy discussions to minimize the effects of galamsey in Ghana should include considerations about food and nutrition insecurity in mining communities. [ABSTRACT FROM AUTHOR]

Diet modelling is one of the important steps in developing food-based dietary guidelines (FBDGs). However, this component remains uncommon in the FBDGs of many low-and middle-income countries. A diet modelling package (DietSolve) provided by the Food and Agriculture Organization (FAO) was used to formulate a healthy diet based on estimating the daily proportions of food groups that best meet the dietary goals established for the FBDGs for Ghana. Input data for the modelling included a list of commonly eaten foods across the agreed food groups, nutrient and energy content of the foods, current energy and nutrient consumption, and energy and nutrient constraints linked to the dietary goals, as determined by the FBDG multi-Sectoral Technical Task Team (MTTT). The modelling was based on assumptions and constraints including a total daily dietary energy target of 2000 kcal/day; the percentage contribution (energy targets) of the macronutrients as follows: carbohydrates (55-70%), protein (10-20 %), and fat (20-30%) to the total energy target; and calcium (1100 mg/day), iron (20 mg/day), and zinc (11 mg/day) constraints. The situation analysis and evidence review carried out as a prior step guided the diet modelling constraints. Energy contributions were also set for a serving of each food group. The final recommendations were based on food groups with each food group consisting of a variety of commonly consumed foods. The total weight of the optimized diet was estimated at 1514 g/day, including 144g/day of animal-source foods, 41.5g/day of discretionary choices, 226g/day of fruit, 227g/day of vegetables, 6g/day of healthy fats and oil, 198g/day of legumes, nuts, and seeds, and 672g/day of staples. This food group composition will provide an estimated 2639 kcal/day, a deviation of about 32% above the energy target set, made up of ~59% from carbohydrates, ~15% from protein and ~25% from fat, and meeting/exceeding the micronutrient targets set. The Optimised diet is healthier compared to the present dietary patterns of the population; its lower ASF component is known to impact less on the environment. [ABSTRACT FROM AUTHOR]

Microcredit schemes have been shown to enhance women's Income Generation Activities (IGA), household food security, and child nutrition. However, spouses or Male Household Heads (MHH) can influence how women's loans are invested and how incomes ensuing from the investments are expended. This study describes how MHH perceived and experienced the participation of female caregivers from their household in the Enhancing Child Nutrition through Animal Source Food Management (ENAM) project. The ENAM project was designed as an integrated intervention providing microcredit, entrepreneurship and nutrition education to women in rural communities in Ghana. Eighty-five MHH of ENAM project caregivers in two regions of Ghana were interviewed about their awareness of the microcredit and education intervention, their involvement in the IGA that the caregivers' loans were invested in, and their perceptions of the impact of the project on the caregivers' IGA as well as household and child nutrition. The majority of MHH indicated that they had been consulted by the caregivers about the decision to participate in the ENAM project. The most common reasons given for consenting to the caregivers' decision to participate in the program were expectations that the caregiver would receive business capital (30.6%), education on optimal child feeding (36.5%), and income to enable caregivers to contribute more to household expenses (31.8%). With respect to the project's impact, MHH perceived that the caregivers' project participation had a positive impact on their business practices, particularly with respect to improved customer relations. The MHH perceived that caregivers' incomes increased because of their participation in ENAM as evidenced by regular income savings and increased contributions to household food and non-food expenditures. However, MHH reported decreases in their own contributions to almost all household expenditure categories in response to the perceived increase in caregivers' incomes. The MHH also perceived improvements in home meal quality. In summary, MHH credited the ENAM project with improved caregiver's incomes and increased share of household expenses. However, this outcome resulted in unanticipated declines in MHH contribution to household expenses. Further studies are needed to understand the impact of empowering women through social experiments on households. Key words: Microcredit, Men, Income, Household expenditures, INTRODUCTION A key assumption of microcredit programmes is that it can help the poor, especially rural women, develop new or strengthen existing Income Generation Activities (IGA) [1]. These programmes seek [...]

The contribution of Street Foods (SF) to the energy and nutrient intakes of young children in rural African communities has been understudied. Under the Enhancing Child Nutrition through Animal Source Food Management (ENAM) project, a microcredit and nutrition education intervention with caregivers of children 2-to 5-years old in rural Ghana, the prevalence of SF consumption by young children and the contribution SF make to children's energy, nutrient and Animal Source Food (ASF) intakes were assessed. A simple random sample of 172 caregiver-child pairs residing in the ENAM intervention communities in Winneba and Techiman municipalities participated in this study. A semi-structured questionnaire was used to interview caregivers about SF purchased for their 2-to 5-years old children in the previous week. During two non-consecutive 12-hour home observations, all foods consumed by a subsample of the children (n=45) were weighed. Energy and nutrient content of weighed foods were estimated using the Ghanaian food composition table. About 80% of caregivers purchased SF for their child at least once that previous week. Most (76%) SF purchased were grain-based and were purchased as complete meals. The children's total ASF intake was 69.9 ± 11.0 g; quantity of ASF consumed was similar but their sources of ASF differed between the two municipalities. In Techiman, SF contributed 36% of the ASF consumed over the two observation days compared to 4.2% in Winneba (P=0.003). Overall, SF contributed 35% of energy, 43% of vitamin A, 20% of vitamin B12, 30% of zinc, 34% of iron, and 54% of calcium consumed by children. The contribution of SF to young children's dietary intakes, especially their ASF intakes and hence micronutrient intakes, may improve overall dietary quality. This study provides evidence that, SF is an important part of children's diets in rural Ghana and could be an important target for food-based interventions to enhance nutrition in young children. Key words: Street foods, Children, Rural Ghana, INTRODUCTION Street Foods (SF) are prepared and sold by vendors and hawkers in streets and other public places [1]. According to the United Nations Food and Agriculture Organization, 2.5 million [...]

Malnutrition among women and children is an underlying cause of high morbidity and mortality in the developing world. Ghana is one of 36 countries with a high prevalence (> 20%) of chronic stunting in childhood. Although proven and inexpensive technologies and interventions exist to address maternal and child malnutrition, their implementation remains at a low scale in many developing countries, including Ghana. In Ghana, barriers to scaling up nutrition actions have been identified at the national level, yet little is known about the situation at the district and sub-district levels where nutrition interventions are directly delivered. The current study assessed district-level capacity and commitment for accelerating implementation of effective nutrition interventions to address the high burden of maternal and child malnutrition. In June 2010, key informant interviews involving technical officers, clinicians, nurses, and administrative staff, and a desk review of program and administrative reports were conducted in the Omanye District (pseudonym). Using the framework from the WHO landscape analysis of readiness to scale up nutrition actions, interviews explored questions of commitment (financial, planning, collaborations) and capacity (human resources, job aids, skills) to implement nutrition actions in the district. Most key nutrition interventions were being implemented in the Omanye District including growth promotion, micronutrient supplementation, behavior change communication on infant and young child feeding, and a pilot project for community management of severe acute malnutrition. Interventions are challenged, however, by barriers including inadequate financial commitment, low prioritization of nutrition, inadequate personnel, and insufficient job aids. Because nutrition was relatively underfunded in the district, nutrition technical officers had been shifted to perform other or additional tasks. Insufficient investment and inadequate capacity prevents delivery of quality nutrition services in the Omanye District. Interventions that prioritize and improve investment in nutrition actions are needed to optimize nutrition services at the district level in Ghana. Key words: Nutrition, Capacity, Commitment, District, Ghana, INTRODUCTION Maternal and child undernutrition contributes an estimated 45% of deaths in children under five [1] and 11% of the global burden of disease [2]. There is strong evidence demonstrating [...]