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Background The co-occurrence of anaemia and stunting (CAS) presents acute development and morbidity challenges to children particularly in sub-Saharan Africa (SSA). Evidence on the effect of child feeding recommendations on CAS is scarce. Methods We used data from 22 recent Demographic and Health Surveys in SSA countries to examine the association between caregivers’ implementation of recommendations on infant and young child feeding and the CAS in their 6- to 23-mo-old children. Results Overall, in multiple logistic regression models, child feed index score, high wealth of household, increasing household size, household head with at least secondary school education, improved sanitation of household, an increase in caregiver’s age and caregiver’s with at least secondary education were associated with lower odds of CAS (i.e., AOR: 0.86; 95% CI; 0.84 – 0.88: 0.75; 0.69 – 0.82: 0.98, 0.98 – 0.99: 0.76, 0.70 – 0.83: 0.81, 0.74 – 0.87: 0.87, 0.81 – 0.94: 0.69, 0.62 – 0.77 respectively). Having a diarrhoea in the past 2 weeks and having fever in the past month were associated with higher odds of CAS (AOR:1.1, 95% CI; 1.0 – 1.2: 1.1, 1.0 – 1.2, respectively). Results from the decision tree analysis showed that the educational level of women was the most important predictor of CAS, followed by child feeding score, the level of education of the family head and state of drinking water. Conclusion The results buttress the importance of interventions aimed at improving feeding practices and parental educational as a vehicle to improve children’s nutritional status.

Few studies have examined the influence of women's participation in farmer groups on female and male empowerment, which is considered essential to improving nutrition.The study aimed toA cross-sectional study investigated secondary outcomes using baseline data from a nutrition-sensitive agriculture intervention implemented through FBOs in rural Ghana. Existing FBOs in 8 communities were selected based on 6 criteria (e.g., participation level, readiness to change). Female FBO (Women's FBO membership was associated with an increased likelihood of women's empowerment [adjusted odds ratio (aOR): 3.25; 95% CI: 1.97, 5.33] and household gender parity (aOR: 2.82; 95% CI: 1.39, 5.84) but not men's empowerment. Household food insecurity, but not nutritional status, was positively associated with women's FBO participation and individual empowerment indicators (financial services). Food insecurity was negatively associated with the women's empowerment indicator related to attitudes about domestic violence [adjusted β coefficient (aβ): -0.78; 95% CI: -1.35, -0.21] and men's overall empowerment (aβ: -0.79; 95% CI: -1.58, -0.01).Understanding the complexity in which FBO participation, empowerment, nutritional status, and food security are linked is critical in designing interventions that promote gender equality and improved nutrition.This trial was registered at clinicaltrials.gov as NCT03869853.

Nutrition-sensitive agriculture (NSA) interventions may increase farm-related work for mothers, with consequences for child nutrition. The Nutrition Links (NL) intervention provided mothers with poultry, gardening inputs, technical support, and education to improve livelihoods and child nutrition outcomes in rural Ghana.Our objective was to compare time allocated to child care by a cross-section of mothers in the intervention group of the NL intervention with the control group (NCT01985243).A cross-section of NL mother-child pairs was included in a time allocation substudy [intervention (NL-I)Maternal direct care (OR = 1.07; 95% CI: 0.89, 1.28) and any care (OR = 1.56; 95% CI: 0.91, 2.67) did not differ by intervention group. However, there was a higher odds of allocare (OR = 1.36; 95% CI: 1.04, 1.79) in NL-I than in NL-C women.Maternal participation in an NSA intervention was not associated with a decrease in time spent directly on child care but was associated with an increase in care from other household and community members.The clinicaltrials.gov number provided is for the main NL intervention and not this current substudy.

The aim of this study was to examine predictors of household food insecurity, dietary diversity, and children's mean micronutrient density adequacy and the relationship among these dietary measures.Baseline analysis of a quasi-experimental 16-mo intervention study conducted in 12 rural communities in the three main agroecological zones in Ghana. The study included 608 caregivers with their 2- to 5-y-old children. Nutrient density adequacy was estimated for a subsample of 120 children.Food insecurity was more severe among farming households than their non-farming counterparts (P = 0.032). Dietary diversity score was significantly higher among non-farming households than farming households (P0.001). Food insecurity was negatively correlated with both household dietary diversity (r = -0.385; P0.001) and child mean micronutrient adequacy (r = -0.305; P0.001). There was no significant correlation between dietary diversity and children's mean micronutrient density adequacy. Belonging to a household that is severely food insecure and household size were significant predictors of children's mean micronutrient density adequacy (ß = -0.124, P = 0.006; ß = 0.011, P = 0.006, respectively).Household food insecurity continues to be a good indicator of lower nutrient intake in children.

Despite the recognition of nutrition as a multisectoral development issue, institutional silos persist as barriers to addressing community nutrition challenges effectively and sustainably. Over the past 2 decades, 3 integrated agriculture, livelihood, nutrition, and health interventions have been implemented in rural communities across Ghana, aimed at nurturing multisectoral collaborations to enhance institutional capacity, women's empowerment, children's diets and nutritional status, and general household well-being. Using information from published articles on the interventions, workshop reports, informal institutional engagements, and field notes, insights are presented on the efforts to garner multisectoral participation to sustain these interventions. Challenges and opportunities encountered in the process of growing and learning together relative to overcoming institutional cultures, building trust, empathizing with partners' institutional challenges, making collective decisions, and building common ownership and accountability are explored. Fostering effective multisectoral participation is a dynamic process of continuous learning.

OBJECTIVES: Assess the perceived influence and value of a participatory video intervention among beneficiaries. METHODS: A 2019 cluster randomized control trial (clinicaltrials.gov NCT03704649) randomly selected 20 schools in one Ghanaian rural district and enrolled adolescent girls, 13–16 y old. All schools received a curriculum about adolescent nutrition. The 181 girls in the 10 intervention schools also received participatory video workshops to increase nutrition literacy. The Most Significant Change (MSC) method was used to involve adolescents in the intervention arm and local stakeholders to identify and evaluate the value of the participatory video experience. Project staff collected 116 stories of change from adolescents. The stories described shifts in 4 domains: participant, peer, and family behavior and structural changes in the school/community. The lead researcher and project staff developed and used a selection rubric to identify stories that reflected heightened nutrition literacy; 14 stories were chosen. Project staff then conducted in-depth interviews with the 14 adolescents to elaborate on story details and perceived resonance. Finally, a panel of local stakeholders reviewed and assessed the 14 stories and chose four MSC stories, one for each domain. A separate thematic analysis by the lead researcher identified emerging patterns of motivation and action across the 14 interviews. RESULTS: The 4 MSC stories revealed how an adolescent: 1) raised and saved money to buy herself iron-rich foods when parents would not comply, 2) encouraged neighbours to eat iron-rich foods 3) taught a father to weed around iron-rich foods on the farm, and 4) encouraged a sister to sell diverse foods at her school. Local stakeholders valued stories that addressed common community nutrition issues in a creative and sustainable way, whereas adolescents prioritized stories that showed a change in health outcomes. CONCLUSIONS: Participatory evaluation highlights valuation of local stakeholders and beneficiaries, perceptions that are vital to better understand the influence and reach of interventions. The MSC technique can reveal unexpected benefits of an intervention. FUNDING SOURCES: The Canadian Queen Elizabeth II Diamond Jubilee Scholarship, funded by IDRC and SSHRC

OBJECTIVES: Little is known about how level of participation affects nutrition outcomes in rural interventions. This study examined the association between participation level in a nutrition-sensitive agriculture intervention (NSA) and children's diet and anthropometric outcomes. METHODS: The Nutrition Links was a 2016–17 cluster RCT (clinicaltrials.gov NCT01985243) which enrolled caregivers with children

Objectives: This study examines the hormonal mediators of the effect of iodized salt in pregnancy on child cognition. Methods: Sixty districts across 6 zones in the Amhara region of Ethiopia were randomly allocated to a control or intervention arm of early market access to iodized salt. Twenty-two villages per arm were randomly selected for this sub-study. A total of 1220 pregnant women who conceived after the intervention began were enrolled and assessed for their iodine and iron status. Data were collected once on the household socio-demographic status and iodized salt use, and maternal urinary iodine during pregnancy. Then, infants’ diet, urinary iodine level, cognitive development (Bayley III), serum hormonal levels, iron status, and inflammation markers were measured between 2 and 13 months of age. Results: The median maternal urinary iodine concentration was adequate and significantly higher in the intervention mothers than that of the controls (163 vs 121 µg/L, P Conclusion: TSH partially mediated the effect of the iodized salt intervention on child cognition.

The World Health Organization recommends deworming to reduce soil-transmitted helminth (STH)-attributable morbidity in women of reproductive age, including pregnant and lactating women, to reduce blood loss, iron deficiency anaemia and nutrient malabsorption. This study assessed the impact of maternal postpartum deworming with albendazole approximately 1 day after delivery on infant milk intake among a subset of 216 randomly selected mother-infant pairs recruited into a large trial in Peru. Infant milk intake was measured using the deuterium-oxide method at 1- and 6-month postpartum. Maternal STH infection was measured at 6-month postpartum. At 1-month postpartum, mean intake was 756 +/- 16 and 774 +/- 18 mL day(-1) in the albendazole and placebo groups, respectively (mean difference: -18 mL day(-1); 95% CI: -65, 30). At 6-month postpartum, mean intake was 903 +/- 16 and 908 +/- 18 mL day(-1) in the albendazole and placebo groups, respectively (mean difference: -5 mL day(-1); 95% CI: -52, 43). There was no statistically significant difference in milk intake between groups at either time point. At 6-month postpartum, mothers infected with Trichuris trichiura had infants with higher milk intakes (adjusted mean difference: 70 mL day(-1); 95% CI: 20, 120) compared with uninfected mothers. However, there was no statistically significant difference in infant milk intake between mothers who had moderate-and-heavy intensity infection compared with the comparison group (mothers with no and light intensity infection). A lower prevalence and intensity of infection, and inclusion of uninfected mothers in both arms of the trial, resulting in effect dilution, may explain the null findings.

Little is known about how the level of program participation affects child nutrition in rural interventions.This study examined the association between participation level in a nutrition-sensitive agriculture intervention and children's diet and anthropometric outcomes in rural Ghana.Nutrition Links was a cluster randomized controlled trial (clinicaltrials.gov NCT01985243), which enrolled caregivers with children (aged less than 2 mo in 2014-2015 and less than 18 mo in 2016-2017). Of the 287 caregivers in 19 intervention communities who enrolled, 233 adopted the intervention and received layer poultry, garden inputs, and weekly child feeding education. The egg production and repayment of poultry were monitored, and feed was sold at the weekly meetings. After endline, the nutrition educators rated each woman who adopted the intervention on a scale [very poor (1) to excellent (5)] for:Compared with the control category, only high participation was associated with egg consumption [adjusted OR (aOR) = 3.03; 95% CI: 1.15, 7.94]. Both medium and high participation levels were associated with length-for-ageThese results highlight the importance of promoting and monitoring the level of beneficiary participation to estimate the full potential of nutrition-sensitive agriculture interventions to improve nutritional outcomes.

Selenium (Se) is an integral component of iodothyronine deiodinase, glutathione peroxidase and thioredoxin reductase enzymes and thus is important for normal thyroid function. This study investigated the influence of Se inadequacy on thyroid response of iodine-replete young children. Serum thyroxine (T4), triiodothyronine (T3), thyroglobulin (Tg), thyroid stimulating hormone (TSH), and Se were analyzed in 54–60 mo old children (n = 628) from the Amhara region of Ethiopia before salt iodization was commenced; analyses were repeated (n = 555) 15 mo after iodized salt became available. Iodized salt coverage increased from 12.2% to 91.6% of households. Median urinary iodine concentration (UIC) among children increased from 9 μg/l to 167 μg/l (p

Purpose This study examined whether micro-savings programs can improve young adolescent girls' financial knowledge, savings behaviors, and schooling outcomes in Ghana. Methods We evaluated the short- and medium-term effects of a randomized control trial in which a sub-sample of over 1400 girls living in the Eastern Region of Ghana received financial literacy training and a micro-savings account. Results Girls in the intervention arm of the study initially exhibited higher levels of financial knowledge, planning, and savings, but some of these effects disappeared within two years. Nonetheless, girls with micro-savings retained their greater knowledge of interest rates, had higher levels of savings, and were more likely to save for school. The effects on girls' educational enrollment was strongest in the second year. Conclusions Our results suggest that even relatively young girls can manage micro-savings accounts and that such programs, if sustained, can effectively build girls' financial and educational assets.

Background Length measurements are important in growth, monitoring and promotion (GMP) for the surveillance of a child’s weight-for-length and length-for-age. These two indices provide an indication of a child’s risk of becoming wasted or stunted, and are more informative about a child’s growth than the widely used weight-for-age index (underweight). Although the introduction of length measurements in GMP is recommended by the World Health Organization, concerns about the reliability of length measurements collected in rural outreach settings have been expressed by stakeholders. Our aim was to describe the reliability and challenges associated with community health personnel measuring length for rural outreach GMP activities. Methods Two reliability studies (A and B), using 10 children less than 24 months each, were conducted in the GMP services of a rural district in Ghana. Fifteen nurses and 15 health volunteers (HV) with no prior experience in length measurements were trained. Intra- and inter-observer technical error of measurement (TEM), average bias from expert anthropometrist, and coefficient of reliability (R) of length measurements were assessed and compared across sessions. Observations and interviews were used to understand the ability and experiences of health personnel with measuring length at outreach GMP. Results Inter-observer TEM was larger than intra-observer TEM for both nurses and HV at both sessions and was unacceptably (compared to error standards) high in both groups at both time points. Average biases from expert’s measurements were within acceptable limits, however, both groups tended to underestimate length measurements. The R for lengths collected by nurses (92.3%) was higher at session B compared to that of HV (87.5%). Length measurements taken by nurses and HV, and those taken by an experienced anthropometrist at GMP sessions were of moderate agreement (kappa = 0.53, p

Food insecurity is a major challenge facing Peru’s Indigenous Shawi communities, who receive food support through national level programs. There is limited research, however, on how national food and social programming support is perceived, received and used among Indigenous communities. We address this research gap by characterizing the preferred diet and coping mechanisms among Shawi Indigenous households, and investigating community perspectives on the national food program and national social supports. We used a mixed methods approach, including a quantitative survey among eleven Shawi communities in the Peruvian Amazon (n = 177 households), and semi-structured interviews with key informants (n = 24). We found that national food programs in Peru rarely provide foods that are desired and preferred among the Shawi, particularly familiar and locally-sourced protein sources such as bushmeat and fish. Food and social programming requirements do not integrate consideration of the remoteness of many vulnerable households, and are considered culturally or linguistically inaccessible to many families. In some cases, foods supplied by national programs are not consumed as they are perceived as unfamiliar. Key opportunities to improve food and social programing include: monitoring and revising eligibility requirements for remote and highly vulnerable households; increasing provision of locally-preferred protein food and familiar food types; avoiding use of written Spanish as a sole source of information to support programming; extending food provision outside of school months; developing contingency plans during education sector strikes; considering hiring of staff with working knowledge of local languages for community distributions; using visual or oral communication rather than written communication to increase accessibility of programs; increasing knowledge on the use and nutritional value of external food; and considering exemptions to school and health eligibility requirements during the rainy season and during sector strikes. Nationally-developed programming that does not consider Indigenous and cultural contexts risks inefficiency, limited improvement of health outcomes, and the potential to increase inequities in Indigenous health.

OBJECTIVES: Two studies aimed to assess the provision of nutrition and psychosocial stimulation in the home and to examine associations between mental development and nutrition and stimulation using a validated measure of development milestones. METHODS: The first study consisted of secondary analyses on health and nutrition data from 1081 mother–child pairs (the children aged 0–12 months) and their households in Ghana’s Eastern Region. For the second study, the Ghana Milestones Measure, consisting of items assessing cognitive and language development, was used to assess child development in a subsample ( N = 330) of Study 1 participants one year later (children 10–24 months of age). This measure was mother-reported and had been validated in a separate community in Ghana. Correlation and linear regression analyses were used to analyze the data. RESULTS: Family assets and maternal education were identified as key factors of the family context. Both variables were positively associated with preventive health practices ( r = 0.08 to 0.13, p < 0.0001 to 0.01), and dietary diversity ( r = 0.15, p = 0.0001 to 0.0006), and negatively associated with maternal depressive symptoms ( r = −0.19 to −0.12, p < 0.0001). Taller children had higher receptive (standardized beta = 0.16; p = 0.04) and expressive (0.21; 0.003) language, but not cognitive (0.15; 0.07) milestone scores, and psychosocial stimulation was positively associated with all three milestones (receptive = 0.13, p = 0.01; expressive = 0.21, p < 0.0001; and cognitive = 0.24, p < 0.0001). CONCLUSION: Our study provides the first validated measure of children’s language and cognitive development in Ghana, finding associations with nutrition and stimulation. The Ghana Milestones Measure can be used to assess and help promote children’s mental development.

Background: Iron deficiency is a global public health concern and has implications on the health status of women in reproductive age. Objective: We hypothesized that improving iron intake with double fortified salt would improve food intake, resulting in higher energy, nutrient intakes, and weight indicators of female tea plantation workers. Methods: In this randomized double-masked study, the participants (n = 245) were assigned to receive salt double fortified with iron and iodine (DFS; treatment) or salt fortified with iodine (control) and followed for 7.5 to 9 months. Dietary intakes were measured at three time points, baseline, midpoint, and end line using (1) food frequency questionnaire, (2) 24-hour recall, and (3) weighed lunch intake. Anthropometric measures of height (cm), weight (kg), and mid-upper arm circumference (cm) were also recorded at three time points. Mixed-model repeated-measures approach was used to detect group differences across time. Results: Double fortified salt improved dietary iron intake in the treatment group compared to the control group ( P < .001). No other dietary or anthropometric differences could be attributed to treatment. Significant effect of time was observed in the intake frequency of major food groups and calcium, vitamin A and C ( P Conclusion: Addition of DFS in the diet improved dietary iron intake but did not affect the intake of energy, other nutrients, or nutritional status indicators. The improvement observed in the dietary iron intake demonstrates that fortification is an effective strategy to address iron deficiency in at-risk populations.

The overarching Ethiopia project examined the effects of early market introduction of iodized salt on the growth and mental development of young children. Sixty districts were randomly assigned to intervention (early market access to iodized salt) or control (later access through market forces), and one community per district was randomly chosen as the sampling unit. For this project, 22 of the districts were included. The participants were 1,220 pregnant women who conceived after the intervention began. When their children were 2 to 13 months old, field staff collected information on household sociodemographic status and iodized salt intake, child stimulation, maternal depression symptoms, children's diet, anthropometry, urinary iodine concentration (UIC), hemoglobin, and mental development scores (Bayley III scales). Fewer mothers prepartum (28% vs. 41%, p < .05) and their children (13% vs. 20%, p < .05) were iodine deficient (UIC .05) compared with their controls. Iodized salt intake improved iodine status of both pregnant women and their children and also child cognitive development.

Selenium (Se) as part of glutathione peroxidase and iodothyronine deiodinase enzymes influences thyroid metabolism. This study investigated the association of serum Se levels with thyroid metabolism of severely iodine-deficient young children from the Amhara region of Ethiopia.In a cross-sectional study, Se, thyroid-stimulating hormone, total thyroxin, total triiodothyronine and thyroglobulin in serum of children (N=628) 54-60 months of age from the Amhara region, Ethiopia, were analyzed. In addition, iodine in urine and household salt was analyzed, and the presence of goiter was assessed.The median serum Se concentration was 61.4 μg/l (10.7-290.9 μg/l). Selenium deficiency (serum Se70 μg/l) was detected in 57.8% (N=349) of the children. The median urinary iodine concentration (UIC) was 9.8 μg/l. The majority (86.6%, N=449) of children had UIC below the recommended value (100 μg/l). In addition, 59.8% (N=310) of children were severely iodine deficient (UIC20 μg/l). Only 12.7% of salt samples had iodine. Goiter was present in 44.6% (N=280) of the children. Selenium-deficient children had higher serum thyroxin (T4) than children with normal serum Se concentration (P0.001).Serum Se was negatively associated with T4 level in young children from the Amhara region of Ethiopia and may endanger the effectiveness of the salt iodization program.

Selenium is an important nutrient for humans and livestock. Soil selenium concentration in the world is highly variable; deficiency and toxicity occur in populations living short distance apart. Knowledge of Se concentrations in humans and the environments, especially because the range for toxicity and deficiency is narrow, is important for effective intervention. Dietary data and serum samples were collected from children (n = 555) 69–78 months old from rural villages of the Amhara Region, Ethiopia. In addition, information on the socio-demography of households was collected. Serum Se was analyzed by inductively coupled plasma mass spectrometer. Almost all (90.3%) of participants reported eating grain, roots, or tubers 24 h preceding the survey followed by legumes, nuts, and seeds (64.6%). Consumption of animal source foods was very low (4.6%). Compared to children from the western part of the region, children from eastern Amhara had higher dietary diversity score (2.1 ± 0.9 vs 1.8 ± 0.7; p

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using mixed linear models adjusted for covariates and clusters. The trial was registered at ClinicalTrials.gov, NCT013496. We assessed 1835 infants aged 5–11 months at baseline. The same children (85 % of the sample) were re-assessed at 20–29 months when all villages had iodised salt. At endline, urinary iodine concentration was higher in children in the intervention group compared with those in the control group (median 228·0v. 155·1 µg/l,P=0·001). The intervention group had higher scores compared with the control group on the Bayley composite score (raw scores:130·60v. 128·51; standardised scores: 27·8v. 26·9;d=0·13; 95 % CI 0·02, 0·23) and three of the four subscales: cognitive (53·27v. 52·54,d=0·13; 95 % CI 0·03, 0·23), receptive language (20·71v. 20·18,d=0·13; 95 % CI 0·03, 0·24) and fine motor (35·45v. 34·94,d=0·15; 95 % CI 0·04, 0·25). The introduction of iodised salt contributes to children’s higher urinary iodine concentration and mental development.

Stunting in Ghana is associated with rural communities, poverty, and low education; integrated agricultural interventions can address the problem. This cluster randomized controlled trial tested the effect of a 12-month intervention (inputs and training for poultry farming and home gardening, and nutrition and health education) on child diet and nutritional status. Sixteen clusters were identified and randomly assigned to intervention or control; communities within clusters were randomly chosen, and all interested, eligible mother-child pairs were enrolled (intervention: 8 clusters, 19 communities, and 287 households; control: 8 clusters, 20 communities, and 213 households). Intention-to-treat analyses were used to estimate the effect of the intervention on endline minimum diet diversity (≥4 food groups), consumption of eggs, and length-for-age (LAZ)/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WLZ)/weight-for-height (WHZ) z-scores; standard errors were corrected for clustering. Children were 10.5 ± 5.2 months (range: 0-32) at baseline and 29.8 ± 5.4 months (range: 13-48) at endline. Compared with children in the control group, children in the intervention group met minimum diet diversity (adjusted odds ratio = 1.65, 95% CI [1.02, 2.69]) and a higher LAZ/HAZ (β = 0.22, 95% CI [0.09, 0.34]) and WAZ (β = 0.15, 95% CI [0.00, 0.30]). Sensitivity analyses with random-effects and mixed-effects models and as-treated analysis were consistent with the findings. There was no group difference in WLZ/WHZ. Integrated interventions that increase access to high-quality foods and nutrition education improve child nutrition.

Background Dyslipidemia during childhood has been associated with higher risk of atherosclerosis later in life. Information on the lipid profile of Ghanaian children is scarce. The aim of this study was to assess the lipid profiles of school children between the ages of 9–15 years, living in urban Ghana. Methods A total of 802 randomly selected school-age children participated in the Ghana School Survey implemented in Kumasi and Accra, Ghana. A structured questionnaire was used to collect information on child and maternal socio-demographic characteristics (including age, education, and occupation), 7-day food frequency, home and school activity, as well as measurement of weight and standing height. Weight, height, and age data were converted into BMI-for-age indices to determine weight status. Finger-prick fasting blood samples were taken from the school-age children. Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol levels were determined using the CardioChek® PA Test System. Reference lipid levels based on the US National Cholesterol Education Program 2001 guidelines were used to determine the proportion of children with dyslipidemia. Results The mean TC, LDL-C, HDL-C, and TG levels were 149.0 ± 57.0 mg/dl, 80.1 ± 38.6 mg/dl, 53.5 ± 19.4 mg/dl, and 71.4 ± 54.7 mg/dl, respectively. Mean TC/HDL-C ratio was 3.0 ± 1.0. The proportion of children with abnormal values were 12.1% for TC, 4.5% for TG, 28.4% for HDL-C, 9.2% for LDL-C, and 6.6% for TC/HDL-C ratio. The levels of dyslipidemia (HDL, LDL, and TC/HDL-C ratio) were higher among overweight/obese compared to normal-weight children. More frequent fruit consumption was also linked with lower LDL-C (p = 0.020) while watching television (TV) in the mornings was linked with both higher TC (p = 0.011) and TG (p = 0.006). Conclusions Majority of urban-dwelling Ghanaian school children had normal lipid profiles. However, the higher levels of dyslipidemia observed among overweight and obese children suggest the need for population level physical activity and dietary interventions among children to reduce risk of cardiovascular diseases in adult life.

Background Childhood overnutrition is a serious public health problem, with consequences that extend into adulthood. The aim of this study was to determine the prevalence and determinants of overweight and obesity among school-age children in two urban settings in Ghana. Methods This cross-sectional study involved 3089 children (9–15 years) recruited between December 2009 and February 2012 in Accra and Kumasi, Ghana. Socio-demographic, dietary, and physical activity data were collected using pretested questionnaires. BMI-for-age z-scores were used to categorize anthropometric data of the children as thin, normal, or overweight/obese. Determinants of overweight were examined using multiple logistic regressions. Results Seventeen percent of children were overweight or obese. Children who reported lower participation (< 3 times/week) in sports activity were 44% more likely to be overweight or obese (AOR = 1.44; 95% CI: 1.07, 1.94). Maternal tertiary education (AOR = 1.91, 95% CI: 1.07, 3.42), higher household socioeconomic status (AOR = 1.56, 95% CI: 1.18, 2.06), and attending private school (AOR = 1.74, 95% CI: 1.31, 2.32) were also associated with elevated risk of overweight and obesity. Conclusions Physical inactivity is a modifiable independent determinant of overweight or obesity among Ghanaian school-aged children. Promoting and supporting a physically active lifestyle in this population is likely to reduce risk of childhood overnutrition.

Background. Low caregiver income and poor nutrition knowledge and skills are important barriers to achieving optimal child feeding in rural Ghana. OBJECTIVE: An integrated microcredit and nutrition education intervention was implemented to address these barriers. METHODS: Using a quasi-experimental design 134 caregivers of children 2 to 5 years of age in six intervention communities were enrolled into self-selected savings and loan groups. They received small individual loans over four 16-week cycles to support their income-generating activities. Nutrition and entrepreneurial education was provided during weekly loan repayment meetings. Another 261 caregivers in six comparison communities did not receive the intervention. Data on household sociodemographic and economic characteristics perception of income-generating activity profits and childrens consumption of animal-source foods in the previous week were collected at baseline and at four additional time points. Differences according to group (intervention vs. control) and time (baseline vs. endline) were analyzed with chi-square and Students t-tests. RESULTS: The intervention and comparison groups did not differ by caregivers age and formal education; few (35) had previous experience with microcredit loans. At endline more intervention than comparison caregivers perceived that their business profits had increased (59% vs. 23% p < .001). In contrast to comparison children after 16 months of intervention children consumed more livestock meat (p =.001) organ meat (p = .04) eggs (p = .001) and milk and milk products (p < .0001) in the previous week in comparison with baseline. CONCLUSIONS: Integrated food-centered strategies can improve childrens diets which will enhance their nutritional status health and cognitive outcomes.

OBJECTIVES: Cohabiting but previously divorced women may be at increased risk of food insecurity. This study explored women's perceptions of how current and prior marital status could influence food security status. METHODS: Nine focus group (FG) discussions were held with mothers of young children who participated in a nutrition-sensitive agriculture intervention (Nutrition Links) in rural Ghana. Nine of 13 intervention communities were purposively selected to participate. Each FG had 5 to 9 women who were asked about the support they received from their partners regarding food for the household, entrepreneurship activities, and their children's healthcare. How this support changed with marital status, and from where else women could get support was further probed. Translated transcriptions of FG were thematically analyzed. RESULTS: Most women reported that men helped with money for food for the household or food stuff from farm. Divorced women would not receive that kind of support. The only support women agreed that men provided independent of marital status was for children's healthcare. Often, the main support network women counted on was that of their immediate family. Co-habiting women would be “pampered” by their partners. However, they would receive little support to develop their own business because men feared that a woman might leave if she were successful. FG participants complained about the lack of freedom married women had, but most of them agreed that married women had a better economic and social standing and had more support from their husband's family than non-married women. FG women reported that married men were more likely to support their wives’ business - assuming that they would also benefit - but a man would hinder his wife's entrepreneurial growth out of jealousy if he perceived that she was moving ahead of him. CONCLUSIONS: Marital status might affect the support women receive for food security in complex ways. Divorced women do not receive economic support from their ex-husbands and cohabiting women do not receive support to develop their business. As previous studies suggested, focusing solely on female household headship might not be enough to identify the most vulnerable individuals. Thus, interventions and policies targeting maternal and child nutrition should consider women's marital status as well as their support networks. FUNDING SOURCES: 1. International Development Research Centre (IDRC). 2. Global Affairs Canada. 3. McGill University. 4. World Vision. 5. University of Ghana.

Several reviews and meta-analyses have examined the effects of iodine on mental development. None focused on young children, so they were incomplete in summarizing the effects on this important age group. The current systematic review therefore examined the relationship between iodine and mental development of children 5 years old and under. A systematic review of articles using Medline (1980–November 2011) was carried out. We organized studies according to four designs: (1) randomized controlled trial with iodine supplementation of mothers; (2) non-randomized trial with iodine supplementation of mothers and/or infants; (3) prospective cohort study stratified by pregnant women’s iodine status; (4) prospective cohort study stratified by newborn iodine status. Average effect sizes for these four designs were 0.68 (2 RCT studies), 0.46 (8 non-RCT studies), 0.52 (9 cohort stratified by mothers’ iodine status), and 0.54 (4 cohort stratified by infants’ iodine status). This translates into 6.9 to 10.2 IQ points lower in iodine deficient children compared with iodine replete children. Thus, regardless of study design, iodine deficiency had a substantial impact on mental development. Methodological concerns included weak study designs, the omission of important confounders, small sample sizes, the lack of cluster analyses, and the lack of separate analyses of verbal and non-verbal subtests. Quantifying more precisely the contribution of iodine deficiency to delayed mental development in young children requires more well-designed randomized controlled trials, including ones on the role of iodized salt.

Background Nutritional interventions targeting the critical growth and development period before two years of age can have the greatest impact on health trajectories over the life course. Compelling evidence has demonstrated that interventions investing in maternal health in the first 1000 days of life are beneficial for both mothers and their children. One such potential intervention is deworming integrated into maternal postpartum care in areas where soil-transmitted helminth (STH) infections are endemic. Methodology/Principal Findings From February to August 2014, 1010 mother-infant pairs were recruited into a trial aimed at assessing the effectiveness of maternal postpartum deworming on infant and maternal health outcomes. Following delivery, mothers were randomly assigned to receive either single-dose 400 mg albendazole or placebo. Participants were followed-up at 1 and 6 months postpartum. There was no statistically significant difference in mean weight gain between infants in the experimental and control groups (mean difference: -0.02; 95% CI: -0.1, 0.08) at 6 months of age. Further, deworming had no effect on measured infant morbidity indicators. However, ad hoc analyses restricted to mothers who tested positive for STHs at baseline suggest that infants of mothers in the experimental group had greater mean length gain in cm (mean difference: 0.8; 95% CI: 0.1, 1.4) and length-for-age z-score (mean difference: 0.5; 95% CI: 0.2, 0.8) at 6 months of age. Conclusions/Significance In a study population composed of both STH-infected and uninfected mothers, maternal postpartum deworming was insufficient to impact infant growth and morbidity indicators up to 6 months postpartum. Among STH-infected mothers, however, important improvements in infant length gain and length-for-age were observed. The benefits of maternal postpartum deworming should be further investigated in study populations having higher overall prevalences and intensities of STH infections and, in particular, where whipworm and hookworm infections are of public health concern. Trial registration ClinicalTrials.gov (NCT01748929)., Author Summary Worldwide, over one billion people are infected with intestinal worms (roundworms, whipworms, and hookworms). In worm-endemic areas, women of reproductive age are a high risk group for infection because of their poor nutritional status and increased physiological needs during pre-pregnancy, pregnancy, and lactation. To measure the effect of providing mothers with deworming treatment soon after delivery, we conducted a trial in 1010 mother-infant pairs. Mothers were randomly assigned to receive either a single-dose deworming tablet or a placebo tablet. Mothers and their infants were visited in their homes at 1 and 6 months following delivery. At the 6-month time point, among all mother-infant pairs, we could not detect an effect of deworming on infant growth or morbidity. We did, however, observe that, among women who were infected with intestinal worms at baseline, deworming had a beneficial effect on important infant growth outcomes. The potential benefit of maternal postpartum deworming in populations with higher prevalences and intensities of intestinal worms, particularly where infections with whipworm and hookworm predominate, warrants further investigation.

Excessive demands on maternal nutritional status may be a risk factor for poor birth outcomes. This study examined the association between breastfeeding during late pregnancy (≥ 28 weeks) and the risk of having a small-for-gestational-age (SGA) newborn, using a matched case-control design (78 SGA cases: birthweight

The Global-Livestock Collaborative Research Support Program’s (GL-CRSP) Child Nutrition Project, a controlled feeding trial in rural Kenya, demonstrated the importance of Animal Source Foods (ASF) for children’s micronutrient status and cognitive development. These findings prompted research efforts to understand the constraints to ASF in children’s diets in Africa so as to design targeted interventions to improve the ASF quality of children’s diets. The Enhancing Child Nutrition through Animal Source Management (ENAM) project (2004-2009) emanated from participatory formative research that identified six principal constraints to the inclusion of Animal Source Foods (ASF) in children’s diets in Ghana, including low income of caregivers, poor producer-consumer linkages, inadequate nutrition knowledge and skills of extension staff and caregivers, cultural beliefs, and inequitable household food distribution. To address these constraints, the ENAM project undertook a multidisciplinary community development, research and capacity building initiative with the goal of augmenting caregivers’ access to and use of ASF in children’s diets. Participatory processes were used to implement an integrated microcredit, entrepreneurship and nutrition education intervention with 181 caregivers of children 2- to5-years old in six rural communities across three agro-ecological zones (Guinea Savannah, Forest-Savannah Transitional and Coastal Savannah) of Ghana. Six matched communities from the same ecological zones served as comparison sites. Quantitative methods that included surveys, child anthropometry, and dietary assessment as well as qualitative case studies were used to assess the effect of the intervention on household, caregiver and child outcomes of interest. This paper presents the key features of the planning, design and implementation of the community intervention and the research processes undertaken to assess the project’s impacts. The ENAM project model presents a unique approach for addressing caregivers’ income and knowledge barriers to improve child nutrition in rural Ghana and may be a promising intervention model for scale-up in Ghana and other African countries.

Communal School Feeding Programs (SFP) are based on local foods brought by children from home which are cooked and shared at school. These programs may be a sustainable food-based strategy for improving children’s diets in low-resource areas. The objective of this study was to compare the dietary intakes of children who attend Day Care Centres (DCC) with communal SFP to children who do not attend any DCC or school in rural Ghana. Interviewer-administered questionnaires were used to collect dietary and other household information for 104 DCC and 89 non-DCC children aged two to five years living in two communities. In addition, the DCC lunches (ingredients and servings of each food preparation) were weighed. The Day Care Centres’ lunch was higher in energy (by 64 kcal; p

Backyard Poultry (BP) production is widespread among rural households in Ghana and provides an opportunity for small scale enterprise development to contribute to poverty alleviation. Traditionally, efforts to improve poultry production activities have emphasized the technical aspects of production while neglecting the social and organizational processes that underlie BP enterprises. A value chain framework was used to qualitatively assess BP enterprises in two communities in the Techiman Municipality of the Brong Ahafo Region in Ghana. The main purpose of the study was to understand how the activities and relationships among actors along the BP value chain influence BP enterprise performance and its implications for development of the industry. Community key informants defined a BP enterprise as ownership of at least ten post vulnerability age chickens (defined as ability to roost on trees to escape predators and disease). All identified BP farmers in the communities were classified as ‘high’ and ‘low’ enterprise performers based on flock size of ‘post- vulnerability age chickens’. The study participants included a purposive sample of ‘low’ (n=10) and ‘high’ (n=10) performing BP farmers from each community as well as service providers and support institutions in the BP value chain identified through snowball sampling. Qualitative data were collected using focus group discussions and key informant interviews. Content analysis was used to summarize themes and patterns from the interview transcripts and to compare high and low performing BP enterprises based on the identified activities and relationships. Higher BP enterprise performance was associated with stronger inter- and intra-actor integration of activities in the various functions of the value chain and higher investment of resources in the activities of the value chain. Additionally, opportunities for import substitution to meet the high national demand for chicken meat were identified. Sustainable improvements in the BP sector must involve social, relational, organizational, as well as technical innovation.

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.

The Enhancing Child Nutrition through Animal Source Food Management (ENAM) project, part of the Global Livestock Collaborative Research Support Program (GLCRSP), integrated a microcredit and savings program with entrepreneurial and nutrition education to strengthen women’s income-generation activities with the intent of increasing women’s (caregivers)abilities to purchase more Animal Source Foods (ASF) for family meals. The model stressed the integration of research, community development and capacity strengthening and the full participation of partners. The aim of this qualitative study was to provide an understanding of how the microcredit, entrepreneurship and nutrition education program impacted the daily lives of the women who participated in the interventions. Three questions were addressed: What factors lead to success in a microcredit and nutrition education program? What are the obstacles to women’s successful participation and what strategies are employed to overcome these obstacles? What are the lessons learned for future programs? The qualitative analysis was based on case studies of 12 women considered by their peers to be ‘successful’ ENAM participants, and six case studies of women considered to be ‘less successful’ ENAM participants. The qualitative methodology complimented knowledge gained through quantitative investigations as reported by other authors in this supplement. Data were collected through focus group discussions, in-depth interviews and observations. The findings suggested that the greatest benefit to participants from the ENAM experience was its translation into opportunities for obtaining microcredit, which in turn, helped increase women’s business success. Women who were doing well in business before the ENAM interventions did even better as a result of their participation in the ENAM project. Successful women employed multiple strategies to overcome business challenges. Anecdotal evidence suggested that the microcredit-education link in this particular situation did positively impact women’s lives with respect to their small businesses, their personal development, and the health of their families.

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.

Human immunodeficiency virus (HIV) seropositive women living in low-income communities may have difficulty meeting the increased energy requirements that are associated with both lactation and HIV infection. Data on household food security and maternal socio-demographic characteristics perceived stress anthropometry reported illness dietary intakes and preferences and exposure to nutrition education were collected from 70 lactating women [16 seropositive (HP) 27 seronegative (HN) and 27 who refused to be tested and had unknown HIV status (HU)]. Diet was assessed with three 24-h recalls (one market day one weekend day and one non-market weekday). Data were collected at 8.4 (SD = 4.7) months postpartum. Most women (74.3%) reported being in good health at the time of study. Three-day mean energy intakes did not differ by HIV status [HP: 12000 kJ (SD = 3600) HN: 12600 kJ (SD = 5100) and HU: 12300 kJ (SD = 4800); P = 0.94]. Protein fat vitamin A thiamin riboflavin niacin vitamin C calcium iron and zinc intakes also did not differ by group (P > 0.10). There was a higher proportion of women with high stress levels in food insecure households compared with food secure households (55.6% vs. 26.5%; P = 0.01). Energy intake was independently negatively associated with food insecurity [high: 11300 kJ (SD = 3500) vs. low: 13400 kJ (SD = 5400) respectively; P = 0.050] and stress [high: 10800 kJ (SD = 2800) vs. low: 13400 kJ (SD = 5300) P = 0.021]. These results suggest the need to integrate multi-dimensional interventions that address economic and mental health constraints which may limit some womens ability to meet their dietary needs. (c) 2010 Blackwell Publishing Ltd.

In Ghana, stunting rates in children below 5 years of age vary regionally. Dietary fatty acids (FAs) are crucial for linear growth. The objective of this study was to determine the association between blood FAs and growth parameters in southern Ghanaian children 2&ndash, 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 calculated. Relationships between FAs and growth were analyzed by linear regressions and factor analysis. Of the 209 subjects, 22% were stunted and 10.6% were essential FA deficient (triene/tetraene ratio &gt, 0.02). Essential FA did not differ between stunted and non-stunted children and was not associated with height-for-age z-score or weight-for-age z-score. Similarly, no relationships between other blood fatty acids and growth parameters were observed in this population. However, when blood fatty acid levels in these children were compared to previously reported values from northern Ghana, the analysis showed that blood omega-3 FA levels were significantly higher and omega-6 FA levels lower in the southern Ghanaian children (p &lt, 0.001). Fish and seafood consumption in this southern cohort was high and could account for the lower stunting rates observed in these children compared to other regions.

This is a longitudinal cohort study investigating the association between maternal HIV status and the reported onset of lactation. The Research to Improve Infant Nutrition and Growth project recruited 442 mothers from 3 antenatal clinics in the eastern region of Ghana, based on positive, negative, and unknown HIV status. Onset of lactation was assessed by maternal perception and validated with 2 subsamples: measurement of infant breast milk intake (n = 40) and daily infant weight measurement for 2 weeks (n = 150). Multivariate logistic regression was used to identify predictors of very early onset of lactation (onset of lactation < 6 hours). Predictors of very early onset of lactation include HIV-negative status (odds ratio = 2.68; P = .014), multiparity (odds ratio = 2.93; P = .009), vaginal delivery (odds ratio = 2.55; P = .035), and having a male child (odds ratio = 1.86; P = .032). The findings indicate an association between maternal HIV status and very early onset of lactation.

ObjectiveChildren from low-income countries consuming predominantly plant-based diets but little animal products are considered to be at risk of Fe deficiency. The present study determined the Fe status of children from resource-limited rural households.DesignA cross-sectional study.SettingTwenty sixkebeles(the smallest administrative unit) from six zones of the Amhara region, Ethiopia.SubjectsChildren aged 54–60 months (n628).ResultsGrain, roots or tubers were the main dietary components consumed by 100 % of the study participants, followed by pulses, legumes or nuts (66·6 %). Consumption of fruit and vegetables (19·3 %) and meat, poultry and fish (2·2 %) was low. Children had a mean dietary diversity score of 2·1 (sd0·8). Most children (74·8 %,n470) were in the lowest dietary diversity group (1–2 food groups). Rate of any morbidity in the preceding 14 d was 22·9 % (n114). Infection or inflammation (α1-acid glycoprotein >1·2 g/l) was present in 30·2 % (n184) of children. Children had a high rate of stunting (43·2 %). Of the total sample, 13·6 % (n82) of children were anaemic, 9·1 % (n57) were Fe deficient and 5·3 % (n32) had Fe-deficiency anaemia. Fe-deficiency erythropoiesis was present in 14·2 % (n60) of children.ConclusionsDespite consuming a predominantly plant-based diet and little animal-source foods, there was a low prevalence of Fe-deficiency anaemia. This illustrates that dietary patterns can be inharmonious with Fe biochemical status; thus, Fe-related interventions require biochemical screening.

Antioxidant nutrient deficiencies may hasten the progression of HIV disease by impairing antioxidant defenses.The objective of the study was to determine whether HIV infection is associated with poor selenium status and low antioxidant protection by glutathione and glutathione peroxidase (GPX).In a cross-sectional study of 365 HIV-positive and HIV-negative adolescents and young adults, we examined the relation of plasma selenium, whole-blood glutathione, and whole-blood GPX to HIV status, disease severity, immune activation, and oxidative damage.Selenium deficiency (plasma selenium0.070 microg/mL) was not seen in any subjects, and plasma selenium in 244 HIV-positive subjects (0.120 +/- 0.0013 microg/mL) did not differ significantly (P = 0.071) from that in 121 HIV-negative subjects (0.125 +/- 0.0020 microg/mL) . However, multiple regression analysis after adjustment for covariates showed a significant (P = 0.002) negative association between HIV-associated immune activation (plasma neopterin) and plasma selenium concentrations. GPX activity was highest in HIV-positive subjects taking antiretroviral therapy (median: 14.2; 25th, 75th percentiles: 11.1, 18.7 U/mL; n = 130), intermediate in HIV-positive subjects not taking antiretroviral therapy (11.8; 9.4, 15.1 U/mL; n = 114), and lowest in HIV-negative subjects (10.6; 8.6, 12.7 U/mL; n = 121; P0.05 for all comparisons). GPX was also positively associated with malondialdehyde, a marker of oxidative damage.Subjects had adequate selenium status, although HIV-related immune activation was associated with lower plasma selenium concentrations. GPX activity appears to have been induced by the oxidative stress associated with HIV infection and use of antiretroviral therapy. Thus, young, well-nourished subjects can mount a compensatory antioxidant response to HIV infection.

Introduction Soil-transmitted helminth infections are endemic in 114 countries worldwide, and cause the highest burden of disease among all neglected tropical diseases. The WHO includes women of reproductive age as a high-risk group for infection. The primary consequence of infection in this population is anaemia. During lactation, anaemia may contribute to reduced quality and quantity of milk, decreasing the duration of exclusive breastfeeding and lowering the age at weaning. To date, no study has investigated the effects of maternal postpartum deworming on infant or maternal health outcomes. Methods and analysis A single-centre, parallel, double-blind, randomised, placebo-controlled trial will be carried out in Iquitos, Peru, to assess the effectiveness of integrating single-dose 400 mg albendazole into routine maternal postpartum care. A total of 1010 mother-infant pairs will be randomised to either the intervention or control arm, following inhospital delivery and prior to discharge. Participants will be visited in their homes at 1, 6, 12 and 24 months following delivery for outcome ascertainment. The primary outcome is infant mean weight gain between birth and 6 months of age. Secondary outcomes include other infant growth indicators and morbidity, maternal soil-transmitted helminth infection and intensity, anaemia, fatigue, and breastfeeding practices. All statistical analyses will be performed on an intention-to-treat basis. Ethics and dissemination Research ethics board approval has been obtained from the McGill University Health Centre (Canada), the Asociacion Civil Impacta Salud y Educacion (Peru) and the Instituto Nacional de Salud (Peru). A data safety and monitoring committee is in place to oversee study progression and evaluate adverse events. The results of the analyses will be published in peer-reviewed journals, and presented at national and international conferences. Trial registration number Clinicaltrials.gov: NCT01748929.

The effectiveness of growth monitoring and promotion (GMP) activities depend on the motivation and performance of nutrition educators. A 12-mo capacity-building intervention was carried out to improve identification and mitigation of child wasting. 30 community-based GMP clinics in Upper Manya Krobo District, Ghana were randomized into: algorithm (A), length measurement (L), or control (C) groups. In A group, a simple algorithm based on predictors of wasting, helped community health workers (CHW) identify at-risk children and provide tailored counseling. Length in addition to usual weight measurements allowed L group CHW to identify children with low weight-for-length. Standard-of-care was used in C group. Type of nutrition counseling given and caregivers' recall of nutrition messages were documented through direct observations of CHW and interviews with caregivers at monthly GMP sessions. About 30% of scheduled sessions were missed because of poor road conditions, disabled transportation, and scheduling ...

Iodized has been associated with the physical and mental development of children. We examined the effects of iodized salt on the growth and mental development of infant. Forty-four communities in t...

Poor diet quality is a determinant of the high prevalence rates of malnutrition in Ghana. There is little evidence on the effectiveness of a multisector intervention to improve children's diets and nutritional status.The project tested whether participation in an entrepreneurial and nutrition education intervention with microcredit was associated with the nutritional status of children 2-5 y of age.A quasi-experimental 16-mo intervention was conducted with microcredit loans and weekly sessions of nutrition and entrepreneurship education for 179 women with children 2-5 y of age [intervention group (IG)]. Nonparticipating women and their children from the same villages (nonparticipant, n = 142) and from similar neighboring villages (comparison, n = 287) were enrolled. Repeated measures linear regression models were used first to examine children's weight-for-age (WAZ), height-for-age (HAZ), and body mass index-for-age (BAZ) z scores at baseline and at 4 follow-up time points ∼4 mo apart. Time, intervention status, time-by-intervention interaction terms, region of residence, household wealth rank, household head occupation, number of children5 y of age, and child sex and age were included.There was a significant interaction between the IG and time for BAZ (P = 0.02) with significant Bonferroni-corrected pairwise comparisons between the IG and comparison group (CG) at 8 mo (difference of 0.36 ± 0.09 z score, P0.0001). The WAZ group difference was significant between 4 and 16 mo (P = 0.01 for interaction) and peaked at 8-12 mo (differences of ∼0.28 z). The HAZ of children in the IG was significantly higher than that in the CG, reaching a 0.19 z difference at 16 mo (P0.05). When the fixed effects models were fitted in sensitivity analyses, some group anthropometric differences were of lower magnitude but remained significant.An integrated package of microcredit and education may improve nutritional outcomes of children living in poor, rural communities.