School feeding contributes to micronutrient adequacy of Ghanaian schoolchildren

The Impact of Malnutrition on the Developing Lung and Long-Term Lung Health: A Narrative Review of Global Literature

Worldwide, over 2 billion children under the age of 5 experience stunting, wasting, or are underweight. Malnutrition contributes to 45% of all deaths in this age group (approximately 3.1 million deaths) [1]. Poverty, food insecurity, suboptimal feeding practices, climate change, and conflict are all contributing factors. Malnutrition causes significant respiratory problems, including increased risk of respiratory infections, impaired lung function, and increased risk of subsequent adult respiratory disease, including asthma, COPD, and lung cancer. Childhood malnutrition not only has serious consequences for children's health but it also has numerous consequences on wellbeing and educational attainment. Childhood malnutrition is a complex and multifaceted problem. However, by understanding and addressing the underlying causes, and investing in prevention and treatment programs, it is possible to maximize children's health and wellbeing on a global scale. This narrative review will focus on the impact of childhood malnutrition on lung development, the consequent respiratory disease, and what actions can be taken to reduce the burden of malnutrition on lung health.

Risk factors associated with anaemia among pregnant women in the Adaklu District, Ghana

Background

Anaemia during pregnancy is a major public health concern in both advanced and less-developed countries including Ghana. The prevalence of anaemia in Ghana has a serious repercussion on the country's social and economic development. This prevalence has been linked to various factors, including educational level and occupational status.

Methods

A prospective study was conducted to investigate the factors influencing anaemia among 150 pregnant women, aged 15-49 years, who attended antenatal clinics in the Adaklu District of the Volta region of Ghana. Haemoglobin levels were assessed in the first, second, and third trimesters, and a questionnaire was also used to collect data on demographic information and barriers to maintaining haemoglobin levels. The data were analysed using frequencies, percentages, and binary logistic regression.

Results

The prevalence of pregnancy anaemia in the district was 78.5%. The study found that 92% and 8% of pregnant women had excellent and good knowledge on anaemia in pregnancy, respectively. The study also identified several barriers to maintaining an appropriate haemoglobin level during pregnancy, such as long distances to healthcare facilities, non-intake of antimalarial drugs, and lack of nutritious meals. Finally, the study found that low education level, number of pregnancies, and number of children a woman had were significant determinants of anaemia during pregnancy in the district.

Conclusion

The findings of the study suggest that targeted interventions are needed to reduce the burden of anaemia during pregnancy in the district. These interventions should address the social and environmental determinants of anaemia during pregnancy, such as improving access to healthcare facilities and promoting healthy eating habits. In addition, interventions that address social determinants of health, such as education and occupation, may be effective in reducing the burden of anaemia during pregnancy in the district.

Effects of a locally available dietary interventions counselling on the community-based management of anaemia in children under five years in Ghana: Kumbungu cluster randomized controlled trial protocol

Anaemia in children under five years remains a significant cause of mortality and morbidity in low-middle income countries. Globally, 27% of the world’s population is anaemic, of which developing countries account for more than 89%. The global prevalence is worse in Africa and Asia. Anaemia has the potential of maintaining the cycle of poverty, as it prevents children from attaining their full development potential. An important part of anaemia in children under-five years are preventable. Locally available dietary (LAD) interventions may be the sustainable interventions to address the high prevalence of anaemia in our communities. The aim of the study is to determine the effect of counselling on Locally Available Diet, on anaemia among children aged 6–59 months in the Kumbungu District of the Northern Region, Ghana. This study will be a community-based cluster randomized, controlled trial, with two parallel arms; Iron + Folic Acid (IFA arm) hereby referred to as the Standard care arm and Iron + Folic Acid + Counselling on Locally available dietary intervention (IFA+LAD arm) referred to as the Standard Plus arm. Study participants are children between the ages of 6 to 56 months. All study participants would receive iron plus folic acid. The minimum number of children per arm is 330 and the number of community clusters is 10 (5 per study arm). Also, considering this study proposes two parallel arms, the total minimum study sample size of children under five years is 496, the minimum total number of community clusters is 10 and a minimum of 25 households per community cluster, 124 households per study arm and 248 households for the study. Randomization is at the level of the clusters (selected communities). The intervention group receives counselling on LAD at a household level aimed at promoting the intake of locally available iron, folate and vitamin B12 rich foods. Also encourage the intake of food rich in enhancers of iron absorption and discouraging the intake of food rich in inhibitors of iron absorption. The primary outcome is mean haemoglobin levels in study arms. Secondary outcomes would include measurement of weight, height/length, mid upper arm circumference, dietary record, serum iron, ferritin, and other parameters of full blood count. Ethical clearance has been obtained and trial registered with Pan African Trial Registry (www.pactr.org) PACTR201906918438423.

Effect of school feeding program on the anthropometric and haemoglobin status of school children in Sidama region, Southern Ethiopia: a prospective study

Ethiopia recently scaled up the implementation of a school feeding program (SFP) as a targeted intervention for protecting disadvantaged school children from hunger and food insecurity. However, the contribution of the program to advancing the nutritional status of children has not been adequately explored. We assessed the effect of SFP on the anthropometric and haemoglobin status of school children in Sidama Region, Southern Ethiopia. Our prospective cohort study compared the height-for-age z-score (HAZ), BMI-for-age z-score (BAZ) and haemoglobin concentration of SFP beneficiary (n 240) and non-beneficiary (n 240) children, 10–14 years of age. The children were recruited from 8 SFP implementing and 8 control schools using a multistage sampling procedure and were followed for an academic year. The SFP intervention and control schools were matched one-to-one based on agro ecological features and geographical proximity. Exposure, outcome and pertinent extraneous variables were collected through baseline and end-line surveys. Multilevel difference-in-differences (DID) analysis was used to measure the net effect on the outcomes of interest. In the multivariable DID model adjusted for potential confounders including maternal and paternal literacy, household monthly income, wealth index and household food insecurity, the SFP did not show significant effects on the haemoglobin concentration (β = 0⋅251, 95 % confidence interval (CI): −0⋅238, 0⋅739), BAZ (β = 0⋅121, 95 % CI: −0⋅163, 0⋅405) and HAZ (β = −0⋅291, 95 % CI: −0⋅640, 0⋅588) of children.

Nutrient intake and gender differences among Saudi children

Dietary surveillance is necessary to determine community needs for nutrition interventions. Yet, the nutrient intake of Saudi children has not been previously investigated. The objective of the present study is to evaluate dietary data of Saudi children and investigate gender differences in nutrient intake. In this cross-sectional study, dietary data of 424 Saudi children (6-12 years of age) were collected using telephone-administered single 24-h dietary recall. Three 24-h dietary recalls were collected from a subsample of 168 children (39⋅6 %) and compared with the Dietary Recommended Intakes (DRIs). Nutrient intakes and proportions of children meeting the DRI requirements were similar and did not vary by children's gender. Over two-thirds of the children had an adequate usual intake of vitamin B12, and over half had adequate intakes (AIs) of vitamin C and phosphorus. On the other hand, our data indicated that low proportions of children consumed adequate usual intakes of magnesium and vitamin E. Over half of the children in our sample met the AI for sodium and vitamin D. Only small proportions of children met the AI for calcium, potassium and fibre. Cholesterol and saturated fat intake exceeded the limits of 300 mg and 10 % of total energy intake by 13⋅7 % (n 23) and 80⋅4 % (n 135) of the sample, respectively. Suboptimal intake of several micronutrients was observed among children, suggesting an urgent need to identify barriers to high-quality diet and to develop evidence-based interventions to promote optimal dietary efficacy for children in Saudi Arabia.

Locally-Procured Fish Is Essential in School Feeding Programmes in Sub-Saharan Africa

Fish make an important contribution to micronutrient intake, long-chained polyunsaturated omega-3 fatty acids (n-3 LC-PUFAS), and animal protein, as well as ensuring food and nutrition security and livelihoods for fishing communities. Micronutrient deficiencies are persistent in sub-Saharan Africa (SSA), contributing to public health issues not only in the first 1000 days but throughout adolescence and into adulthood. School feeding programs (SFPs) and home-grown school feeding programs (HGSF), which source foods from local producers, particularly fisherfolk, offer an entry point for encouraging healthy diets and delivering essential macro- and micronutrients to schoolchildren, which are important for the continued cognitive development of children and adolescents and can contribute to the realization of sustainable development goals (SDGs) 1, 2, 3, 5, and 14. The importance of HGSF for poverty alleviation (SDG1) and zero hunger (SDG 2) have been recognized by the United Nations Hunger Task Force and the African Union Development Agency-New Partnership for African Development (AUDA-NEPAD), which formulated a strategy for HGSF to improve nutrition for the growing youth population across Africa. A scoping review was conducted to understand the lessons learned from SFPs, which included fish and fish products from small-scale producers, identifying the challenges and best practices for the inclusion of fish, opportunities for improvements across the supply chain, and gaps in nutritional requirements for schoolchildren which could be improved through the inclusion of fish. Challenges to the inclusion fish in SFPs include food safety, supply and access to raw materials, organizational capacity, and cost, while good practices include the engagement of various stakeholders in creating and testing fish products, and repurposing fisheries by-products or using underutilized species to ensure cost-effective solutions. This study builds evidence of the inclusion of nutritious fish and fish products in SFPs, highlighting the need to replicate and scale good practices to ensure sustainable, community-centred, and demand-driven solutions for alleviating poverty, malnutrition, and contributing to greater health and wellbeing in adolescence.

COVID-19-Induced Disruptions of School Feeding Services Exacerbate Food Insecurity in Nigeria

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown measures have disrupted educational and nutrition services globally. Understanding the overall and differential impacts of disruption of nutritional (school feeding) services is critical for designing effective post-COVID-19 recovery policies.

OBJECTIVES

The aim of this study was to examine the impact of COVID-19-induced disruption of school feeding services on household food security in Nigeria.

METHODS

We combined household-level, pre-COVID-19 in-person survey data with postpandemic phone survey data, along with local government area (LGA)-level information on access to school feeding services. We used a difference-in-difference approach and examined temporal trends in the food security of households with and without access to school feeding services. Of the sampled households, 83% live in LGAs with school feeding services.

RESULTS

Households experienced an increase in food insecurity in the post-COVID-19 survey round. The share of households skipping a meal increased by 47 percentage points (95% CI: 44-50 percentage points). COVID-19-induced disruptions of school feeding services increased households' experiences of food insecurity, increasing the probability of skipping a meal by 9 percentage points (95% CI: 3-17 percentage points) and the likelihood of going without eating for a whole day by 3 percentage points (95% CI: 2-11 percentage points). Disruption of school feeding services is associated with a 0.2 SD (95% CI: 0.04-0.41 SD) increase in the food insecurity index. Households residing in states experiencing strict lockdown measures reported further deterioration in food insecurity. Single mothers and poorer households experienced relatively larger deteriorations in food security due to disruption of school feeding services.

CONCLUSIONS

Our findings show that COVID-19-induced disruptions in educational and nutritional services have exacerbated households' food insecurity in Nigeria. These findings can inform the designs of immediate and medium-term policy responses, including the designs of social protection policies and alternative programs to substitute nutritional services affected by the pandemic.

Integrating nutrition into the education sector in low- and middle-income countries: A framework for a win-win collaboration

Malnutrition—both undernutrition and overnutrition—is a public health concern worldwide and particularly in low‐ and middle‐income countries (LMICs). The education sector has high potential to improve immediate nutrition outcomes by providing food in schools and to have more long‐term impact through education. We developed a conceptual framework to show how the education sector can be leveraged for nutrition. We reviewed the literature to identify existing frameworks outlining how nutrition programs can be delivered by and through the education sector and used these to build a comprehensive framework. We first organized nutrition programs in the education sector into (1) school food, meals, and food environment; (2) nutrition and health education; (3) physical activity and education; (4) school health services; and (5) water, sanitation, and hygiene (WASH) sector. We then discuss how each one can be successfully implemented. We found high potential in improving nutrition standards and quality of school foods, meals and food environment, especially through collaboration with the agriculture sector. There is a need for well‐integrated, culturally appropriate nutrition and health education into the existing school curriculum. This must be supported by a skilled workforce—including nutrition and public health professionals and school staff. Parental and community engagement is cornerstone for program sustainability and success. Current monitoring and evaluation of nutrition programming in schools is weak, and effectiveness, including cost‐effectiveness, of interventions is not yet adequately quantified. Finally, we note that opportunities for leveraging the education sector in the fight against rising overweight and obesity rates are under‐researched and likely underutilized in LMICs.

Free Senior High School Lunch Contributes to Dietary Quality of Nonresidential Students in Ghana

Background:

School feeding offers an excellent opportunity for targeted intervention to students not only as means for improving educational outcomes but also enhancing nutritional outcomes. The Government of Ghana introduced the free lunch feeding policy for nonresidential students in senior high schools (SHS) in 2018.

Objective:

We assessed unintended benefits of the free lunch program to dietary improvement.

Methods:

This was an analytical cross-sectional study among 403 (202 beneficiary and 201 non-beneficiary) students in SHS. The Food and Agriculture Organization’s standard procedure for measuring dietary diversity score (DDS) was followed. A 3-day dietary recall was used to assess school day DDS, while a 24-hour recall was used to assess weekend DDS of students. Differences in DDS and food group consumption were determined using student t test and χ² test, respectively.

Results:

Nearly all (98.5%) beneficiary students consumed the free school lunch and 7 (70%) in 10 of them consumed it on all school days. While the students did not differ in their weekend meal DDS (6.3 ± 1.4 vs 6.5 ± 1.4, P = .39), beneficiaries of the school lunch had higher lunch DDS (7.5 ± 0.5 vs 6.5 ± 1.4, P < .001) and whole day DDS (11.5 ± 1 vs 9.3 ± 2.0, P < .001) compared to non-beneficiary students on school days. Even though the school lunch increased food group intake, vitamin-A rich vegetables and tubers, fruits, flesh and organ meats, and dairy products were hardly provided as components of school lunch.

Conclusion:

Provision of free school lunch meal to nonresidential students in SHSs in Ghana could contribute to improved diet quality.

Dietary patterns and associated factors of schooling Ghanaian adolescents

BACKGROUND

Assessment of single nutrients or foods does not normally reflect the diet of population groups. Dietary pattern analyses are useful in understanding the overall diet and its relationship with disease conditions. The objective of the present study was to determine the dietary patterns and associated factors among schooling adolescents in Northern Ghana.

METHODS

A cross-sectional study involving 366 pupils in 10 junior high schools in the Tamale metropolis was conducted. A Food Frequency Questionnaire (FFQ) which consisted of 60 commonly consumed foods was used to assess pupils' 7-day intake. Foods grouped (14) from FFQ data based on shared nutritional value were used to identify dietary patterns using principal component analysis (PCA). Bivariate and multivariate logistic regression analyses were used to determine the association between identified patterns and sociodemographic, anthropometric status, and household characteristics of pupils.

RESULTS

Half of the pupils were female (50.3%) and average age was 15.6 ± 2.0 years. PCA identified two dietary patterns which in total explained 49.7% of the variability of the diet of pupils. The patterns were sweet tooth pattern (STP) with high factor loadings for sugar sweetened snacks, energy and soft drinks, sweets, tea and coffee, and milk and milk products, and a traditional pattern (TP) which showed high factor loadings for cereals and grains, local beverages, nuts, seeds and legumes, vegetables, and fish and seafood. Logistic regression showed that pupils who lived with their parents [AOR = 1.95; 95% CI (1.1-3.4); p = 0.019], those who went to school with pocket money [AOR = 4.73; 95% CI (1.5-15.0); p = 0.008], and those who lived in the wealthiest homes [AOR = 3.4; 95% CI (1.6-7.5); p = 0.002)] had higher odds of following the STP. The TP was associated with high dietary diversity (p = 0.035) and household wealth [AOR = 3.518; 95% CI (1.763-7.017); p < 0.001)]. None of the patterns was associated with anthropometric status of pupils.

CONCLUSION

Adolescents in the present study followed a sweet tooth or a traditional diet pattern which associated more with household- and individual-level factors but not anthropometric status.

Food and nutrient gaps in rural Northern Ghana: Does production of smallholder farming households support adoption of food-based dietary guidelines?

Food-based dietary guidelines (FBDGs) provide guidance to policy makers, the private sector and consumers to redesign food systems and to improve diets of vulnerable populations. As appropriate FBDGs are based on the actual dietary patterns and their costs, it is assumed that the recommended foods are available, affordable and acceptable for the population under study. Using quantitative dietary intake data of young children in rural Northern Ghana, we developed local FBDGs and studied whether these are supported by the diversity and quantity of the production of a household among 329 households. We found that 40% of rural Northern Ghanaian infants and young children were stunted and their nutrient intakes were far below the recommendations: the probability of adequacy for most nutrient intakes was less than 50%. At household level, the developed FBDGs were, on average, unable to sufficiently cover the household requirements for fat (60.4% of recommended nutrient intake (RNI)), calcium (34.3% RNI), iron (60.3% RNI), vitamin A (39.1% RNI), vitamin B12 (2.3% RNI) and vitamin C (54.6% RNI). This implies that even when these FBDGs are fully adopted the requirements for these nutrients will not be met. In addition, the nutrient needs and food needs (according to the developed FBDGs) of a household were only marginally covered by their own food production. The food production of over half the households supplied insufficient calcium (75.7%), vitamin A (100%), vitamin B12 (100%) and vitamin C (77.5%) to cover their needs. The food production of about 60% of the households did not cover their required quantities of grains and legumes and none covered their required quantities of vegetables. Further analysis of the food gaps at district and national level showed that sufficient grains were available at both levels (267% and 148%, respectively) to meet requirements; availability of legumes was sufficient at district level (268%) but not at national level (52%); and vegetables were insufficient at both levels (2% and 49%, respectively). Diversifying household food production is often proposed as a means to increase the diversity of foods available and thereby increasing dietary diversity of rural populations. We found that the diversity of the production of a household was indeed positively related with their food and nutrient coverage. However, the diversity of the production of a household and their food and nutrient coverage were not related with children's dietary diversity and nutrient adequacy. Our results show that the production of a households does not support the adoption of FBDGs in rural Northern Ghana, especially for vegetables. This suggests that the promotion of FBDGs through nutrition education or behaviour change communications activities alone is insufficient to lead to improvements in diets. Additional strategies are needed to increase the food availability and accessibility of the households, especially that of fruits and vegetables, such as diversification of the crops grown, increased production of specific crops and market-based strategies.

Ramadan fasting alters food patterns, dietary diversity and body weight among Ghanaian adolescents

BACKGROUND

Ramadan is a monthlong fast for healthy adolescents and adult Muslims. The quality of foods eaten and eating patterns in Ramadan may be different from other months of the year. Food intake of adolescents is a concern as energy and nutrient requirements are higher and needed to support the growth spurt of this stage. The objective of the present study was to describe the food patterns, dietary diversity and body weight changes among adolescents during Ramadan.

METHODS

A prospective cohort study design with four measurement points (baseline, midline, endline and post endline) was conducted among 366 adolescents in Junior High Schools. Food pattern was assessed with a food frequency questionnaire, a 24-h dietary recall was used to assess dietary diversity and body weight was measured using an electronic scale. A repeated measures ANOVA was used to compare changes in dietary diversity scores (DDS) and weight of pupils.

RESULTS

Half of the pupils (50.3%) were female and average age was 15.9 ± 1.8 years. Pupils fasted for an average of 28.3 ± 4.0 days and 14.3 ± 0.5 h a day (dawn to dusk) during Ramadan. The number and types of dishes taken at meal times differed substantially between Ramadan periods and outside Ramadan. Consumption of vitamin A-rich fruits, other fruits, and milk and milk products increased markedly during Ramadan. However, fasting came with a reduction in consumption of foods from roots and tubers, legumes and nuts, and dark green leafy vegetables while other food groups remained unchanged. Mean DDS increased significantly during Ramadan (F (2.933, 1070.573) = 7.152, p < 0.001) while mean daily meal frequency decreased (F (2.936, 1071.623) = 51.653, p < 0.001). There was significant body weight loss (-1.5 kg (95% CI: -1.1 kg to -1.6 kg)) among adolescents (F (2.656, 958.95) = 304.90, p < 0.001). Weight loss was short-lived; regained one month after Ramadan.

CONCLUSION

In this prospective cohort study among schooling Ghanaian adolescents who fast during Ramadan, fasting was characterised by marked changes in usual food patterns, increased dietary diversity and significant body weight loss.

Nutrient composition and dietary diversity of on-site lunch meals, and anthropometry of beneficiary children in private and public primary schools in Ghana

BACKGROUND

On-site lunch provided through the Ghana School Feeding Programme is expected to be nutritionally adequate thereby contributing to reducing hunger and malnutrition.

AIM

The aim of this study was to assess the dietary diversity and nutrient composition of on-site school lunch and estimate the extent to which it met the Food and Agriculture Organization Reference Nutrient Intakes for children aged 3-12 years.

METHODS

In this cross-sectional food consumption survey, on-site lunch menus were reviewed, dietary diversity assessed and meal preparation/serving observed during a typical school week. Three randomly selected portion sizes were weighed and the average weight (grams) entered into the RIING nutrient software to estimate the nutrient composition. Anthropometry of participants enrolled in seven public (n = 113) and six private (n = 216) primary schools in Hohoe municipality, Ghana was analysed using World Health Organization Anthroplus software.

RESULTS

The menu consisted largely of energy-dense staples, some vegetables and fish. Eggs, dairy and fruits were never served. Meals served in the public and private schools were statistically similar. Fat (23.8 vs. 27.7 g), iron (3.0 vs. 2.8 mg), vitamins A (417.3 vs. 280.8 µg retinol equivalent) and C (25.1 vs. 16.5 mg) requirements were fully met. Energy (420.6 vs. 462.2 kcal), protein (6.8 vs. 6.8 g), thiamin (0.18 vs. 0.17 mg) and zinc (1.3 vs. 1.2 mg) were 50-75% met. Calcium (62.6 vs. 61.4 mg), riboflavin (0.09 vs. 0.07 mg) and niacin (1.6 vs. 1.3 mg) were 26-37% met. Concerning nutritional status, prevalence of stunting (8.9% vs. 7.9%), underweight (3.6% vs. 5.7%), thinness (1.8% vs. 3.7%) and overweight/obesity (3.5% vs. 4.2%) were also statistically similar.

CONCLUSION

Enhancing dietary diversity is crucial to achieving nutrient-dense school meals.

Seasonality affects dietary diversity of school-age children in northern Ghana

BACKGROUND AND OBJECTIVES

Dietary diversity score (DDS) is relatively easy to measure and is shown to be a very useful indicator of the probability of adequate micronutrient intake. Dietary diversity, however, is usually assessed during a single period and little is known about the effect of seasonality on it. This study investigates whether dietary diversity is influenced by seasonality.

METHODS

Two cross-sectional surveys were conducted in two different seasons-dry season (October 2010) and rainy season (May 2011) among the same school-age children (SAC) in two rural schools in northern Ghana. The study population consisted of 228 school-age children. A qualitative 24-hour dietary recall was conducted in both seasons. Based on 13 food groups, a score of 1 was given if a child consumed a food item belonging to a particular food group, else 0. Individual scores were aggregated into DDS for each child. Differences in mean DDS between seasons were compared using linear mixed model analysis.

RESULTS

The dietary pattern of the SAC was commonly plant foods with poor consumption of animal source foods. The mean DDS was significantly higher (P < 0.001) in the rainy season (6.95 ± 0.55) compared to the dry season (6.44 ± 0.55) after adjusting for potential confounders such as age, sex, occupation (household head and mother) and education of household head. The difference in mean DDS between dry and rainy seasons was mainly due to the difference in the consumption of Vitamin A-rich fruits and vegetables between the seasons. While vitamin A-rich fruits (64.0% vs. 0.9%; P < 0.0001) and vitamin A rich dark green leafy vegetables (52.6% vs. 23.3%, P < .0001) were consumed more during the rainy season than the dry season, more children consumed vitamin A-rich deep yellow, orange and red vegetables during the dry season than during the rainy season (73.7% vs. 36.4%, P <0.001).

CONCLUSION

Seasonality has an effect on DDS and may affect the quality of dietary intake of SAC; in such a context, it would be useful to measure DDS in different seasons. Since DDS is a proxy indicator of micronutrient intake, the difference in DDS may reflect in seasonal differences in dietary adequacy and further studies are needed to establish this.

Adolescent health in rural Ghana: A cross-sectional study on the co-occurrence of infectious diseases, malnutrition and cardio-metabolic risk factors

In sub-Saharan Africa, infectious diseases and malnutrition constitute the main health problems in children, while adolescents and adults are increasingly facing cardio-metabolic conditions. Among adolescents as the largest population group in this region, we investigated the co-occurrence of infectious diseases, malnutrition and cardio-metabolic risk factors (CRFs), and evaluated demographic, socio-economic and medical risk factors for these entities. In a cross-sectional study among 188 adolescents in rural Ghana, malarial infection, common infectious diseases and Body Mass Index were assessed. We measured ferritin, C-reactive protein, retinol, fasting glucose and blood pressure. Socio-demographic data were documented. We analyzed the proportions (95% confidence interval, CI) and the co-occurrence of infectious diseases (malaria, other common diseases), malnutrition (underweight, stunting, iron deficiency, vitamin A deficiency [VAD]), and CRFs (overweight, obesity, impaired fasting glucose, hypertension). In logistic regression, odds ratios (OR) and 95% CIs were calculated for the associations with socio-demographic factors. In this Ghanaian population (age range, 14.4-15.5 years; males, 50%), the proportions were for infectious diseases 45% (95% CI: 38-52%), for malnutrition 50% (43-57%) and for CRFs 16% (11-21%). Infectious diseases and malnutrition frequently co-existed (28%; 21-34%). Specifically, VAD increased the odds of non-malarial infectious diseases 3-fold (95% CI: 1.03, 10.19). Overlap of CRFs with infectious diseases (6%; 2-9%) or with malnutrition (7%; 3-11%) was also present. Male gender and low socio-economic status increased the odds of infectious diseases and malnutrition, respectively. Malarial infection, chronic malnutrition and VAD remain the predominant health problems among these Ghanaian adolescents. Investigating the relationships with evolving CRFs is warranted.

Subclinical inflammation influences the association between vitamin A- and iron status among schoolchildren in Ghana

BACKGROUND AND OBJECTIVE

In resource-poor settings, micronutrient deficiencies such as vitamin A deficiency may co-exist with iron-deficiency. In this study we assessed the iron and vitamin A status of schoolchildren and the association between vitamin A and iron status.

METHODS

A cross-sectional design using the baseline data of a dietary intervention trial conducted among randomly selected 5-12 years old schoolchildren (n = 224) from 2 rural schools in northern Ghana. Hemoglobin (Hb), serum ferritin (SF) and serum transferrin receptor (sTfR) concentrations were used as measures of iron status. Retinol binding protein (RBP) was used as a measure of vitamin A status. Subclinical inflammation (SCI) was measured using C-reactive protein (CRP) and α1-acid glycoprotein (AGP) concentrations. We examined the cross-sectional association between vitamin A and iron status biomarkers with multiple linear regressions.

RESULTS

The proportions of schoolchildren with anemia (WHO criteria), iron-deficiency (ID, SF <15μg/l and/or sTfR >8.5mg/l) and iron-deficiency anemia (IDA, concurrent anemia and ID) were 63.8%, 68.3% and 46.4% respectively. Low or marginal vitamin A status (0.70 μmol/l ≤ RBP < 1.05μmol/l) was present in 48.2% while 37.5% of the schoolchildren had vitamin A deficiency (VAD, RBP <0.70 μmol/l). The prevalence of SCI as well as concurrent VAD and ID were 48.7% and 25% respectively. RBP was associated with Hb (β = 7.2, P = 0.05) but not SF (β = 20.7, P = 0.33) and sTfR concentration (β = 12.0, P = 0.63). In the presence of SCI, RBP was not associated with hemoglobin status but a significant positive association was observed among children without SCI.

CONCLUSIONS

The study shows that RBP is significantly associated with Hb concentration but not with SF and sTfR. The observed relationship between RBP and Hb is only significant in the absence of SCI.

Fortified Snack Reduced Anemia in Rural School-Aged Children of Haiti: A Cluster-Randomized, Controlled Trial

BACKGROUND

Nutrition in the school-aged child matters for brain development and public policy investments globally. Our group previously conducted a trial in urban schools of Haiti to examine the effects of a fortified peanut butter snack, Vita Mamba, with limited findings for anemia.

OBJECTIVE

We aimed to test the hypothesis that Vita Mamba, with systematic deworming in both study arms, would significantly reduce anemia among rural, school-aged children.

METHODS

A cluster, randomized longitudinal study was conducted in two rural communities of the North-East Department of Haiti, 2014-2015. Healthy children ages 3-16 years were enrolled (n = 321) and assigned by school to intervention (Vita Mamba and deworming) and control (deworming). Vita Mamba contains 260 kcal and meets >75% of the Recommended Dietary Allowance for critical micronutrients. Multivariate regression analyses including propensity score matching techniques to correct for potential group imbalance (Kernel-based Matching and Propensity Score Weighting) were applied to examine difference-in-difference intervention effects.

RESULTS

At baseline, 51% of the children were anemic with no significant differences between study groups. Vita Mamba supplementation showed a consistent, positive effect across regression models on increasing Hb concentration and reducing the odds of anemia compared to the control group after adjusting for child age, vitamin A supplementation, milk consumption, and height-for-age z score. The average treatment effect for the treated in the Propensity Score Weighting models was 0.62±0.27 grams per 100 milliliters (g/dL) for Hb concentration (F = 4.64, P = 0.001), and the odds of anemia were reduced by 88% (Wald χ² = 9.77, P = 0.02). No differences in change in anthropometric markers were evident.

CONCLUSIONS

School feeding programs that integrate fortified foods with deworming could reduce anemia burden with important implications for learning, health, and well-being. The rural-urban differences in anemia require further study.

Nutrient Intake Is Insufficient among Senegalese Urban School Children and Adolescents: Results from Two 24 h Recalls in State Primary Schools in Dakar

Due to rapid urbanization and high food prices and in the absence of nutrition programs, school children from urban areas in West Africa often have insufficient and inadequate diet leading to nutrient deficiencies that affect their health and schooling performance. Acute malnutrition and micronutrient deficiencies are prevalent in children from primary state schools of Dakar (Senegal). The objectives of the present study were to assess the overall diet of these children, to report insufficient/excessive energy and nutrient intakes and to investigate association between insufficient nutrient intake and micronutrient deficiencies. Children attending urban state primary schools in the Dakar area were selected through a two-stage random cluster sampling (30 schools × 20 children). Dietary intake data were obtained from two 24 h recalls and blood samples were collected from 545 children (aged 5-17 years, 45% < 10 years, 53% girls) and adjusted for intra-individual variability to estimate nutrient usual intakes. Energy intake was insufficient and unbalanced with insufficient contribution of protein and excessive contribution of fat to global energy intake in one third of the children. Proportions of children with insufficient intake were: 100% for calcium, 100% for folic acid, 79% for vitamin A, 69% for zinc, 53% for vitamin C and 46% for iron. Insufficient iron and protein intake were risk factors for iron deficiency (odds ratio, OR 1.5, 2.2). Insufficient zinc intake and energy intake from protein were risk factors for zinc deficiency (OR 1.8, 3.0, 1.7, 2.9). Insufficient iron and vitamin C intake, and insufficient energy intake from protein were risk factors for marginal vitamin A status (OR 1.8, 1.8, 3.3). To address nutritional deficiencies associated with a diet deficient in energy, protein and micronutrients, nutrition education or school feeding programs are needed in urban primary schools of Senegal.

Enhancing Linkages Between Healthy Diets, Local Agriculture, and Sustainable Food Systems: The School Meals Planner Package in Ghana

BACKGROUND

Interventions that enhance linkages between healthy diets and local agriculture can promote sustainable food systems. Home-grown school feeding programs present a promising entry point for such interventions, through the delivery of nutritious menus and meals.

OBJECTIVE

To describe the adaptation of the School Meals Planner Package to the programmatic and environmental reality in Ghana during the 2014 to 2015 school year.

METHODS

Guided by a conceptual framework highlighting key considerations and trade-offs in menu design, an open-source software was developed that could be easily understood by program implementers. Readily available containers from markets were calibrated into "handy measures" to support the provision of adequate quantities of food indicated by menus. Schools and communities were sensitized to the benefits of locally sourced, nutrient-rich diets. A behavior change communication campaign including posters and songs promoting healthy diets was designed and disseminated in schools and communities.

RESULTS

The School Meals Planner Package was introduced in 42 districts in Ghana, reaching more than 320 000 children. Monitoring reports and feedback on its use were positive, demonstrating how the tool can be used by planners and implementers alike to deliver nutritious, locally-sourced meals to schoolchildren. The value of the tool has been recognized at the highest levels by Ghana's government who have adopted it as official policy.

CONCLUSIONS

The School Meals Planner Package supported the design of nutritious, locally sourced menus for the school feeding program in Ghana. The tool can be similarly adapted for other countries to meet context-specific needs.

Nutritional composition of school meals serving children from 7 to 36 months of age in municipal day-care centres in the metropolitan area of Curitiba, Paraná, Brazil

The Brazilian National School Feeding Program (PNAE) seeks to meet student's nutritional needs during the period they remain in school. This study aimed to determine the nutritional composition of meals provided in municipal day-care centres serving children of 7-11 months (group A) and 12-36 months (group B) of age and to compare observed values with the PNAE's and dietary reference intakes' (DRI) recommendations. This cross-sectional study was conducted in 4 day-care centres in the metropolitan area of Curitiba, Paraná, Brazil, between June and November 2013. Food samples of six daily meals were collected during 20 non-consecutive days, totalling 120 samples. For each meal, average served and consumed portions were submitted for laboratory analysis of moisture, ash, proteins, lipids, carbohydrates, dietary fibre, Na, Ca and Fe and compared with the PNAE's and DRI's values. No statistically significant difference was found between age groups (P=0·793) regarding portion sizes and nutritional composition. The same menu was offered to both groups in 95 % of the meals (n 114), although the groups' nutritional needs were different. For group A, served meals met PNAE's recommendations for energy, carbohydrates, proteins, Na and Ca content, and consumed portions provided 70 % of the nutritional needs for carbohydrates, proteins and Ca. For group B, served portions complied with the PNAE's values for proteins, Na and Ca. Proteins and Na reached 70 % of the nutritional needs when consumed food was evaluated. School feeding in day-care centres partially meet PNAE's guidelines and children's nutritional requirements, contradicting the primary objective established by the national programme.