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Adarkwa SA, Oduro MS, Morgan AK, Arhin-Donkor S. Association between exposure to smoke from cooking fuels and anaemia among women of reproductive age in Ghana. Sci Rep 2024; 14:15664. [PMID: 38977757 PMCID: PMC11231134 DOI: 10.1038/s41598-024-66602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
In low- and middle-income countries, indoor air pollution (IAP) is a serious public health concern, especially for women and children who cook with solid fuels. IAP exposure has been linked to a number of medical conditions, including pneumonia, ischemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lung cancer, and anaemia. Around 500 million women of reproductive age (WRA) suffer from anaemia globally, with an estimated 190 million cases in sub-Saharan Africa (SSA). This study, which is based on prior research, investigates the relationship between IAP exposure and anaemia among WRA in Ghana. A diverse sample of 2,406 WRA living in Ghana were interviewed, of which 58.06% were anaemic and used high-pollutant fuels for cooking. Age, place of residence, region, education level, religion, ethnicity, wealth index, type of drinking water, type of toilet facility, and type of cooking fuels were all found to be significantly linked with anaemic state by bivariate analysis. Type of cooking fuels utilized, age, region of residence, and the type of residence were shown to be significant predictors of anaemia status using sequential binary logit regression models. The results emphasise the critical need for efforts to promote the usage of clean cooking fuel in an attempt to lower anaemia prevalence in Ghana. To reduce dependency on solid fuels for cooking, initiatives should promote the use of cleaner cooking fuels and enhance the socioeconomic status of households. These interventions could have significant public health effects by reducing the burden of anaemia and improving maternal and child health outcomes due to the prevalence of anaemia among WRA. Overall, this study sheds light on the relationship between IAP exposure and anaemia in Ghana and highlights the demand for focused public health initiatives to address this serious health problem.
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Affiliation(s)
| | - Michael Safo Oduro
- Pfizer Worldwide Research and Development, Pharm Sci and PGS Statistics, Groton, CT, 06340, USA
| | - Anthony Kwame Morgan
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Seth Arhin-Donkor
- Humana Inc., Market Finance Analysis - Sr - Prd - Regional, Louisville, KY, 4020, USA
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Asare J, Lim JJ, Amoah I. Low Dietary Diversity and Low Haemoglobin Status in Ghanaian Female Boarding and Day Senior High School Students: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1045. [PMID: 39064474 PMCID: PMC11279379 DOI: 10.3390/medicina60071045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/07/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Anaemia is one of the most common forms of malnutrition globally, with most anaemia cases related to micronutrient deficiency. Diets with higher dietary diversity scores (DDS) are usually nutritionally diverse and could positively impact micronutrient status, including haemoglobin (Hb) concentration improvement. The study aimed to determine DDS and its association with the Hb concentration of Boarding and Day adolescent Senior High School students in Ghana. Materials and Methods: A semi-structured and three 24 h dietary recalls were used to obtain the participants' demographic and diet intake data, respectively. Hb concentration was assessed using a validated portable haemoglobinometer. DDS was evaluated using the Minimum Dietary Diversity for Women (MDD-W) approach. Results: A significant difference in the DDS between Boarding and Day students existed. Only 22% of the Boarding students had adequate dietary diversity, whereas 64% of the Day students had adequate dietary diversity. A significantly smaller proportion of the Boarding students consumed nuts and seeds, dairy, flesh foods, eggs, vitamin A-rich vegetables and fruits, other vegetables, and other fruits compared to Day students (p < 0.05, all). No significant difference (p = 0.925) in mean (±SD) Hb concentrations between Boarding (11.9 ± 1.1 g/dL) and Day (11.9 ± 1.1 g/dL) students was found. Additionally, no significant correlation between mean DDS and Hb concentration (p = 0.997) was recorded. Using Hb < 12 g/dL as the determination of anaemia, 55.1% Boarding and 57.8% Day students had anaemia. Conclusions: Low dietary diversity in Boarding students highlighted inadequate nutrition provided by school meals. Strategies to increase meal diversity should be prioritised by stakeholders in Ghana's educational sector.
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Affiliation(s)
- Joyce Asare
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana;
| | - Jia Jiet Lim
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1024, New Zealand;
| | - Isaac Amoah
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana;
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Jenkins M, Amoaful EF, Abdulai M, Quartey V, Situma R, Ofosu-Apea P, Aballo J, Demuyakor ME, Gosdin L, Mapango C, Jefferds MED, Addo OY. Comparison of venous and pooled capillary hemoglobin levels for the detection of anemia among adolescent girls. Front Nutr 2024; 11:1360306. [PMID: 38912302 PMCID: PMC11191668 DOI: 10.3389/fnut.2024.1360306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/17/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Blood source is a known preanalytical factor affecting hemoglobin (Hb) concentrations, and there is evidence that capillary and venous blood may yield disparate Hb levels and anemia prevalence. However, data from adolescents are scarce. Objective To compare Hb and anemia prevalence measured by venous and individual pooled capillary blood among a sample of girls aged 10-19 years from 232 schools in four regions of Ghana in 2022. Methods Among girls who had venous blood draws, a random subsample was selected for capillary blood. Hb was measured using HemoCue® Hb-301. We used Lin's concordance correlation coefficient (CCC) to quantify the strength of the bivariate relationship between venous and capillary Hb and a paired t-test for difference in means. We used McNemar's test for discordance in anemia cases by blood source and weighted Kappa to quantify agreement by anemia severity. A multivariate generalized estimating equation was used to quantify adjusted population anemia prevalence and assess the association between blood source and predicted anemia risk. Results We found strong concordance between Hb measures (CCC = 0.86). The difference between mean venous Hb (12.8 g/dL, ± 1.1) and capillary Hb (12.9 g/dL, ± 1.2) was not significant (p = 0.26). Crude anemia prevalence by venous and capillary blood was 20.6% and 19.5%, respectively. Adjusted population anemia prevalence was 23.5% for venous blood and 22.5% for capillary (p = 0.45). Blood source was not associated with predicted anemia risk (risk ratio: 0.99, 95% CI: 0.96, 1.02). Discordance in anemia cases by blood source was not significant (McNemar p = 0.46). Weighted Kappa demonstrated moderate agreement by severity (ĸ = 0.67). Among those with anemia by either blood source (n = 111), 59% were identified by both sources. Conclusion In Ghanaian adolescent girls, there was no difference in mean Hb, anemia prevalence, or predicted anemia risk by blood source. However, only 59% of girls with anemia by either blood source were identified as having anemia by both sources. These findings suggest that pooled capillary blood may be useful for estimating Hb and anemia at the population level, but that caution is needed when interpreting individual-level data.
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Affiliation(s)
- Mica Jenkins
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Esi Foriwa Amoaful
- Nutrition Department, Family Health Division, Ghana Health Service, Ministry of Health, Accra, Ghana
| | - Mutala Abdulai
- Nutrition Department, Family Health Division, Ghana Health Service, Ministry of Health, Accra, Ghana
| | - Veronica Quartey
- Nutrition Department, Family Health Division, Ghana Health Service, Ministry of Health, Accra, Ghana
| | | | | | | | - Maku E. Demuyakor
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Lucas Gosdin
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Carine Mapango
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Maria Elena D. Jefferds
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - O. Yaw Addo
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Feng SY, Su LC, Liu XY, Qin Z, Fu L, Huang AF, Xu WD. Prediction model for developing neuropsychiatric systemic lupus erythematosus in lupus patients. Clin Rheumatol 2024; 43:1881-1896. [PMID: 38676758 DOI: 10.1007/s10067-024-06970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/15/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE This study aimed to construct a predictive model for assessing the risk of development of neuropsychiatric systemic lupus erythematosus (NPSLE) among patients with SLE based on clinical, laboratory, and meteorological data. METHODS A total of 2232 SLE patients were included and were randomly assigned into training and validation sets. Variables such as clinical and laboratory data and local meteorological data were screened by univariate and least absolute shrinkage and selection operator (LASSO) logistic regression modelling. After 10-fold cross-validation, the predictive model was built by multivariate logistic regression, and a nomogram was constructed to visualize the risk of NPSLE. The efficacy and accuracy of the model were assessed by receiver operating characteristic (ROC) curve and calibration curve analysis. Net clinical benefit was assessed by decision curve analysis. RESULTS Variables that were included in the predictive model were anti-dsDNA, anti-SSA, lymphocyte count, hematocrit, erythrocyte sedimentation rate, pre-albumin, retinol binding protein, creatine kinase isoenzyme MB, Nterminal brain natriuretic peptide precursor, creatinine, indirect bilirubin, fibrinogen, hypersensitive C-reactive protein, CO, and mild contamination. The nomogram showed a broad prediction spectrum; the area under the curve (AUC) was 0.895 (0.858-0.931) for the training set and 0.849 (0.783-0.916) for the validation set. CONCLUSION The model exhibits good predictive performance and will confer clinical benefit in NPSLE risk calculation. Key Points • Clinical, laboratory, and meteorological data were incorporated into a predictive model for neuropsychiatric systemic lupus erythematosus (NPSLE) in SLE patients. • Anti-dsDNA, anti-SSA, LYM, HCT, ESR, hsCRP, IBIL, PA, RBP, CO, Fib, NT-proBNP, Crea, CO, and mild contamination are predictors of the development of NPSLE and may have potential for research. • The nomogram has good predictive performance and clinical value and can be used to guide clinical diagnosis and treatment.
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Affiliation(s)
- Si-Yu Feng
- Department of Evidence-Based Medicine, School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
| | - Lin-Chong Su
- Hubei Provincial Key Laboratory of Occurrence and Intervention of Rheumatic diseases, Affiliated Minda Hospital of Hubei Institute for Nationalities, Enshi, Hubei, China
- Department of Rheumatology and Immunology, Affiliated Minda Hospital of Hubei Institute for Nationalities, Enshi, Hubei, China
| | - Xiao-Yan Liu
- Department of Evidence-Based Medicine, School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
| | - Zhen Qin
- Department of Rheumatology and Immunology, the Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Lu Fu
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, China
| | - An-Fang Huang
- Department of Rheumatology and Immunology, the Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Wang-Dong Xu
- Department of Evidence-Based Medicine, School of Public Health, Southwest Medical University, Luzhou, Sichuan, China.
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Obeagu EI, Obeagu GU. Malnutrition in sickle cell anemia: Prevalence, impact, and interventions: A Review. Medicine (Baltimore) 2024; 103:e38164. [PMID: 38758879 PMCID: PMC11098235 DOI: 10.1097/md.0000000000038164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/17/2024] [Indexed: 05/19/2024] Open
Abstract
Sickle Cell Anemia (SCA) is a hereditary hemoglobinopathy characterized by chronic hemolytic anemia, vaso-occlusive events, and a wide range of clinical complications. Malnutrition, often an underexplored aspect of this complex condition, plays a critical role in disease management and overall patient well-being. This publication provides a comprehensive review of the prevalence, impact, and interventions related to malnutrition in individuals with SCA. A thorough literature review reveals the multifaceted challenges faced by SCA patients in maintaining adequate nutrition. The pathophysiology of SCA, involving chronic inflammation, oxidative stress, and hypermetabolism, contributes to increased nutritional requirements and altered dietary patterns. Factors such as reduced appetite, nutrient malabsorption, dietary restrictions, and socioeconomic disparities further exacerbate the risk of malnutrition. Malnutrition is a prevalent issue among individuals with SCA, affecting patients of different age groups and disease severities. Nutritional deficiencies, including vitamins, minerals, and essential nutrients, are common in this population. The impact of malnutrition on disease outcomes is significant, with associations between nutrient status and complications such as pain crises, infections, and impaired quality of life. This paper also reviews nutritional interventions aimed at addressing malnutrition in SCA patients. While dietary counseling, supplementation, and personalized nutrition plans have shown promise in improving nutritional status, challenges such as patient adherence and access to healthcare must be addressed to optimize their effectiveness.
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Pienaah CKA, Saaka SA, Yengnone HZ, Molle MN, Luginaah I. Does government food demonstration intervention influence household dietary diversity in the Upper West Region of Ghana? PLoS One 2024; 19:e0302869. [PMID: 38718020 PMCID: PMC11078389 DOI: 10.1371/journal.pone.0302869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Dietary diversity is crucial in ensuring food and nutrition security. In low-middle-income countries, people frequently prioritize the quantity of food they consume over its quality due to a lack of availability and financial limitations. As a result, achieving dietary diversity is often overlooked in favor of ensuring adequate caloric intake. Through a social cognitive theory perspective, our study examines the relationship between food demonstrations and household dietary diversity in Ghana's Upper West Region utilizing cross-sectional survey data from 517 smallholder farmer households. The results from ordered logistic regression presented in odds ratio (OR) show that participating in food demonstrations (OR: 2.585, p<0.01), engaging in home gardening (OR: 1.932, p<0.001), having access to credit (OR: 1.609, p<0.01), self-rated good nutritional status (OR: 1.747, p<0.01), and Waala ethnicity (OR: 3.686, p<0.001) were all positively associated with high household dietary diversity. Conversely, living in the Wa West district was associated with lower dietary diversity (OR: 0.326, p<0.001). Our research findings suggest that policymakers may want to consider implementing community-based educational programs, such as home and school visits for food demonstrations and sensitizations, promoting mother-to-mother support groups for dietary diversity education, nutrition counseling services, and using role-play and local media. In addition, strengthening local agricultural policies through food banks, indigenous seed development, and mobile food markets and enhancing public-private partnerships like the Ghana Schools Feeding Programme and National Food Buffer Stock company could improve the supply chain and distribution networks for diverse food items. Implementing these interventions in the Upper West Region of Ghana could improve health, well-being, food security, and nutritional outcomes.
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Affiliation(s)
- Cornelius K. A. Pienaah
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | - Sulemana Ansumah Saaka
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | - Herwin Ziemeh Yengnone
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | | | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
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Engle-Stone R, Wessells KR, Haskell MJ, Kumordzie SM, Arnold CD, Davis JN, Becher ER, Fuseini AD, Nyaaba KW, Tan X, Adams KP, Lietz G, Vosti SA, Adu-Afarwuah S. Effect of multiple micronutrient-fortified bouillon on micronutrient status among women and children in the Northern Region of Ghana: Protocol for the Condiment Micronutrient Innovation Trial (CoMIT), a community-based randomized controlled trial. PLoS One 2024; 19:e0302968. [PMID: 38709803 PMCID: PMC11073681 DOI: 10.1371/journal.pone.0302968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Micronutrient deficiencies are prevalent in West Africa, particularly among women of reproductive age (WRA) and young children. Bouillon is a promising food fortification vehicle due to its widespread consumption. This study aims to evaluate the impact of multiple micronutrient-fortified bouillon cubes, compared to control bouillon cubes (fortified with iodine only), on micronutrient status and hemoglobin concentrations among lactating and non-lactating WRA and young children in northern Ghana. METHODS This randomized, controlled doubly-masked trial will be conducted in the Kumbungu and Tolon districts in the Northern Region of Ghana, where prior data indicate multiple micronutrient deficiencies are common. Participants will be: 1) non-pregnant non-lactating WRA (15-49 y), 2) children 2-5 y, and 3) non-pregnant lactating women 4-18 months postpartum. Eligible participants will be randomly assigned to receive household rations of one of two types of bouillon cubes: 1) a multiple micronutrient-fortified bouillon cube containing vitamin A, folic acid, vitamin B12, iron, zinc, and iodine, or 2) a control cube containing iodine only. Each participant's household will receive a ration of bouillon cubes every 2 weeks, and households will be advised to prepare meals as usual, using the study-provided cubes. The trial duration will be 9 months for non-pregnant non-lactating WRA and children, and 3 months for lactating women. The primary outcomes will be changes in biomarkers of micronutrient status and hemoglobin among WRA and children and milk micronutrient concentrations among lactating women. Secondary outcomes will include change in prevalence of micronutrient deficiency and anemia; dietary intake of bouillon and micronutrients; inflammation, malaria, and morbidity symptoms; and child growth and development. DISCUSSION Evidence from this study will inform discussions about bouillon fortification in Ghana and West Africa. TRIAL REGISTRATION The trial was registered on ClinicalTrials.gov (NCT05178407) and the Pan-African Clinical Trial Registry (PACTR202206868437931). This manuscript reflects protocol version 4 (August 29, 2022).
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Affiliation(s)
- Reina Engle-Stone
- Department of Nutrition, University of California, Davis, California, United States of America
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - K Ryan Wessells
- Department of Nutrition, University of California, Davis, California, United States of America
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Marjorie J. Haskell
- Department of Nutrition, University of California, Davis, California, United States of America
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Sika M. Kumordzie
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Charles D. Arnold
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Jennie N. Davis
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Emily R. Becher
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Ahmed D. Fuseini
- Department of Food Science and Nutrition, University of Ghana, Legon, Ghana
| | - Kania W. Nyaaba
- Department of Food Science and Nutrition, University of Ghana, Legon, Ghana
| | - Xiuping Tan
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Katherine P. Adams
- Department of Nutrition, University of California, Davis, California, United States of America
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Georg Lietz
- Institute of Cellular Medicine, Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stephen A. Vosti
- Institute for Global Nutrition, University of California, Davis, California, United States of America
- Department of Agricultural and Resource Economics, University of California, Davis, California, United States of America
| | - Seth Adu-Afarwuah
- Department of Food Science and Nutrition, University of Ghana, Legon, Ghana
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Ayanful-Torgby R, Shabanova V, Essuman AA, Boafo E, Aboagye F, Al-Mahroof Y, Amponsah J, Tetteh JK, Amoah LE, Paintsil E. High prevalence of impaired glucose metabolism among children and adolescents living with HIV in Ghana. HIV Med 2024; 25:577-586. [PMID: 38240173 PMCID: PMC11078607 DOI: 10.1111/hiv.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/08/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Antiretroviral therapy (ART)-associated metabolic abnormalities, including impairment of glucose metabolism, are prevalent in adults living with HIV. However, the prevalence and pathogenesis of impaired glucose metabolism in children and adolescents living with HIV, particularly in sub-Saharan Africa, are not well characterized. We investigated the prevalence of impaired glucose metabolism among children and adolescents living with perinatally infected HIV in Ghana. METHODS In this multicentre, cross-sectional study, we recruited participants from 10 paediatric antiretroviral treatment clinics from January to June 2022 in 10 facilities in Greater Accra and Eastern regions of Ghana. We determined impaired glucose metabolism in the study sample by assessing fasting blood sugar (FBS), insulin resistance as defined by the homeostatic model assessment for insulin resistance (HOMA-IR) index and glycated haemoglobin (HbA1c) levels. The prevalence of impaired glucose metabolism using each criterion was stratified by age and sex. The phenotypic correlates of glucose metabolism markers were also assessed among age, sex, body mass index (BMI) and waist-to-hip ratio (WHR). RESULTS We analysed data from 393 children and adolescents living with HIV aged 6-18 years. A little over half (205/393 or 52.25%) of the children were female. The mean age of the participants was 11.60 years (SD = 3.50), with 122/393 (31.00%) aged 6-9 years, 207/393 (52.67%) aged 10-15 years, and 62/393 (15.78%) aged 16-18 years. The prevalence rates of glucose impairment in the study population were 15.52% [95% confidence interval (CI): 12.26-19.45], 22.39% (95% CI: 18.54-26.78), and 26.21% (95% CI: 22.10-30.78) using HbA1c, HOMA-IR, and FBS criteria, respectively. Impaired glucose metabolism detected by FBS and HOMA-IR was higher in the older age group, whereas the prevalence of abnormal HbA1c levels was highest among the youngest age group. Age and BMI were positively associated with FBS and HOMA-IR (p < 0.001). However, there was negative correlation of WHR with HOMA-IR (p < 0.01) and HbA1c (p = 0.01). CONCLUSION The high prevalence of impaired glucose metabolism observed among the children and adolescents living with HIV in sub-Saharan Africa is of concern as this could contribute to the development of metabolic syndrome in adulthood.
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Affiliation(s)
- Ruth Ayanful-Torgby
- Department of Pediatrics, Yale School of Medicine, New Haven, CT USA
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, CT USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT USA
| | - Akosua A. Essuman
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Emmanuel Boafo
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Frank Aboagye
- Biomedical & Public Research Unit, Council for Scientific & Industrial Research-Water Research Institute, Accra, Ghana
| | - Yusuf Al-Mahroof
- Biomedical & Public Research Unit, Council for Scientific & Industrial Research-Water Research Institute, Accra, Ghana
| | - Jones Amponsah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - John K.A. Tetteh
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Linda E. Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT USA
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Akwaa Harrison O, Ifie I, Nkwonta C, Dzandu BA, Gattor AO, Adimado EE, Odoi KK, Aziavor B, Saalia FK, Steiner-Asiedu M. Knowledge, awareness, and use of folic acid among women of childbearing age living in a peri-urban community in Ghana: a cross-sectional survey. BMC Pregnancy Childbirth 2024; 24:241. [PMID: 38580949 PMCID: PMC10996122 DOI: 10.1186/s12884-024-06408-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/11/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Folic acid, a water-soluble B-complex vitamin, plays a crucial role in DNA synthesis and maintenance, making it particularly significant during reproduction. Its well-known ability to reduce the risk of congenital anomalies during the periconceptional period underscores its importance. The increased requirement for folate during pregnancy and lactation is essential to support the physiological changes of the mother and ensure optimal growth and development of the foetus and offspring. This study assessed the knowledge, awareness, and use of folic acid among pregnant and lactating women of reproductive age residing in Dodowa in the Shai Osu-Doku District, Accra, Ghana. METHODS The study was a cross-sectional design that involved 388 randomly selected participants (97 pregnant and 291 lactating women). Structured questionnaires were administered to gather information on the socioeconomic demographic characteristics, knowledge, awareness, and use of folic acid of the participants. Dietary intake was assessed using a food frequency questionnaire. The data were analysed using descriptive statistics and Pearson's chi-square analysis tests and are presented as frequencies and percentages, means, standard deviations, bar graphs, and pie charts. The significance of the results was determined at a 95% confidence interval. RESULTS The mean age of the participants was 31 ± 5.0 years. Among the study participants, 46.1% demonstrated knowledge of folic acid deficiency, while approximately 68.3% had a high awareness of folic acid supplementation. Approximately 75% of the participants indicated that they had not used folic acid supplements within the week, and 15.5% reported consuming folic acid-fortified food per week. CONCLUSIONS The women exhibited high awareness but poor knowledge regarding the usage of folic acid supplementation during pregnancy and lactation. Consequently, this lack of knowledge influenced the low use of folic acid supplements and low intake of folate-rich foods among pregnant and lactating mothers.
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Affiliation(s)
- Obed Akwaa Harrison
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.
| | - Idolo Ifie
- Department of Food Science, University of Leeds, Leeds, England
| | - Chikere Nkwonta
- Department of Food Science, University of Leeds, Leeds, England
| | - Bennett Atta Dzandu
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Albert Owusu Gattor
- Faculty of Chemistry and Pharmacy, Medicinal Chemistry II, University of Regensburg, Regensburg, Germany
| | | | - Kofi Kafui Odoi
- Institutional Care Division, Ghana Health Services, Accra, Ghana
| | | | - Firibu Kwesi Saalia
- Department of Food Process Engineering, University of Ghana, Legon, Accra, Ghana
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Melariri P, Ihemanma C, Chigbo U, Eastwood K, Uche C, Etusim P. Plasmodium Parasitaemia and Urine Alterations among Pregnant Women Attending Antenatal Care in Aba Metropolis, Abia State, Nigeria. J Parasitol Res 2024; 2024:6681943. [PMID: 38605974 PMCID: PMC11008972 DOI: 10.1155/2024/6681943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Malaria presents a huge threat to pregnant women, their foetus, and children below five years. This study is aimed at assessing malaria prevalence, associated clinical symptoms, and urine abnormalities among pregnant women in Aba metropolis, Abia State, Nigeria. A cross-sectional study involving 450 pregnant women purposively selected from nine health care centres was conducted. Data were analysed using SPSS version 26. The overall malaria prevalence rate was 68.4% (n = 308). Age group of 21-25 years had the highest prevalence rate of 20.4% (n = 92) while the least was recorded among the age group of 41-45 years (17 (3.8%)). Pregnant women in their first trimester had the greatest prevalence rate of 28.6% (n = 129), and the least prevalence was recorded among those in their third trimester (7 (15.6%)). The primigravidae were mostly infected at the rate of 27.7% (n = 125) whereas the multigravidae recorded the least prevalence of 85 (18.9%). Participants with secondary education were the most susceptible at the rate of 38.6% (n = 174). The infected participants exhibited significantly higher frequencies of reported fever (p > 0.001, OR 12.881, 95% CI 3.977-41.725) and headaches (p < 0.001, OR 4.688, 95% CI 1.819-12.083). However, cold, cough, body pains, poor appetite, and catarrh showed no significant association with malaria infection at p > 0.05. Participants using long-lasting insecticidal nets (LLINs) showed significantly lower prevalence rate of malaria infection (p < 0.001, OR 2.485, 95% CI 1.619-3.814). Malaria-infected participants showed statistically significant frequencies of proteinuria (p < 0.001, OR 274.14, 95% CI 16.91-4444.0), bilirubinuria (p < 0.001, OR 49.29, 95% CI 11.01-186.34), and urobilinogenuria (p < 0.001, OR 65.16, 95% CI 4.00-1062.40) than those not infected. Ascorbic acid, nitrate, and ketone showed no significant associations with malaria infection at p > 0.005. Infected participants had statistically significant amber and clear urine colour whereas there was no statistically significant difference between the pH levels of urine of the malaria-infected and malaria-noninfected pregnant women.
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Affiliation(s)
- Paula Melariri
- Department of Environmental Health, School of Behavioural and Lifestyle Sciences, Faculty of Health Sciences, Nelson Mandela University, Gqeberha 6019, South Africa
| | - Chioma Ihemanma
- Unit of Medical Parasitology and Entomology, Department of Biology/Microbiology, Abia State Polytechnic, Aba, Abia State, Nigeria
- Unit of Medical Parasitology and Entomology, Department of Animal and Environmental Biology, Faculty of Biological Sciences, Abia State University, Uturu, Nigeria
| | - Udoka Chigbo
- Department of Medical Microbiology, College of Medicine, Imo State University, Owerri, Nigeria
| | - Kirstie Eastwood
- Unit for Statistical Consultation, Research Development, Nelson Mandela University, Gqeberha 6019, South Africa
| | - Chika Uche
- Department of Haematology, College of Medicine, Abia State University, Uturu, Nigeria
| | - Paschal Etusim
- Unit of Medical Parasitology and Entomology, Department of Animal and Environmental Biology, Faculty of Biological Sciences, Abia State University, Uturu, Nigeria
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Fisberg M, Duarte Batista L, Previdelli AN, Ferrari G, Fisberg RM. Exploring Diet and Nutrient Insufficiencies across Age Groups: Insights from a Population-Based Study of Brazilian Adults. Nutrients 2024; 16:750. [PMID: 38474878 DOI: 10.3390/nu16050750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Assessing dietary inadequacies can contribute to understanding the nutritional vulnerabilities of a country. This study aimed to investigate nutrient intakes and micronutrient inadequacies in the Brazilian adult population, with an interest in different age subgroups. We conducted a cross-sectional study with 1812 individuals aged 19 to 65 years from a population-based study with a representative sample of Brazilian adults. Dietary intake was assessed by two 24 h food recalls, and the probabilities of inadequate intake were estimated using the Dietary Reference Intake targets. Adequate macronutrient intake was over 99% for proteins, 84.7% for carbohydrates, and 80.7% for total fats. There was a high probability of inadequacy (above 90%) for vitamins D and E, but vitamin D inadequacy was very similar between the sexes. In contrast, vitamin E was more likely to be inadequately consumed among women. A high probability of inadequacies (above 85%) of calcium and magnesium were found in the population, regardless of age group. Except for iron, the probability of an inadequacy of other minerals increased with age. The results showed a relevant proportion of nutrient inadequacies, with those most at risk being women and older individuals, helping with the better targeting and monitoring of public-health policies that address nutritional problems in the population.
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Affiliation(s)
- Mauro Fisberg
- Centro de Excelência em Nutrição e Dificuldades Alimentares (CENDA), Instituto Pensi, Fundação José Luiz Egydio Setúbal, Hospital Infantil Sabará, São Paulo 01227-200, Brazil
- Department of Pediatrics, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - Lais Duarte Batista
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | | | - Gerson Ferrari
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia 7500912, Chile
| | - Regina Mara Fisberg
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
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12
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Davis JN, Kumordzie SM, Arnold CD, Wessells KR, Nyaaba KW, Adams KP, Tan XJ, Becher E, Vosti SA, Adu-Afarwuah S, Engle-Stone R. Consumption of Discretionary Salt and Salt from Bouillon among Households, Women, and Young Children in Northern Region, Ghana: A Mixed-Methods Study with the Condiment Micronutrient Innovation Trial (CoMIT) Project. Curr Dev Nutr 2024; 8:102088. [PMID: 38419834 PMCID: PMC10897853 DOI: 10.1016/j.cdnut.2024.102088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Background Information on salt consumption patterns is needed to inform the need for and design of salt reduction strategies. Objectives In northern Ghana, this study aimed to estimate household consumption of salt, including salt from bouillon, and compare (estimated) women and children's salt intake to global recommendations; to estimate the proportion of salt consumed from bouillon; and to identify factors, including knowledge, attitudes, and practices, associated with household salt consumption. Methods Employing mixed-methods methodology, we conducted a pilot survey (n = 369 households enrolled) and focus group discussions (FGDs; n = 20) in Tolon and Kumbungu districts (14 urban, 14 rural clusters) (clinicaltrials.gov registry: NCT04632771). Households reported purchases of discretionary salt (DS, "table salt") and bouillon cubes. DS and total salt (TS; DS+salt from bouillon) consumption for women (15-49 y) and children (2-5 y) were estimated using the Adult Male Equivalent method and compared with global recommendations (<5 g/d women; <3.75 g/d children). Women's salt intake was also predicted from urinary sodium excretion (INTERSALT equation). Associations between DS and TS consumption, as well as household and women's characteristics, were tested with minimally adjusted and multivariable linear mixed-effects models. Qualitative FGD themes were generated using the Framework Method. Results From household purchase data, estimated TS consumption exceeded global recommendations for 44% of children [median: 2.9 (IQR: 1.9, 5.2) g/d] and 60% of women [6.0 (4.0, 10.2) g/d]; 35% of children and 50% of women exceeded recommendations from DS alone. Bouillon contributed <25% of households' TS consumption. Few characteristics were associated with DS or TS consumption. Salient qualitative themes that shaped salt consumption behaviors included salt's ubiquity as a seasoning, key household members' influence on food procurement and preparation, and perceptions about health. Conclusions Purchase data suggest salt consumption among women and children exceeds recommendations, even when excluding salt from bouillon; food prepared outside the home likely further contributes. Salt reduction interventions may be warranted in this context.
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Affiliation(s)
- Jennie N Davis
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Sika M Kumordzie
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Charles D Arnold
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - K Ryan Wessells
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Kania W Nyaaba
- University of Ghana, Department of Nutrition and Food Science, Legon, Accra, Ghana
| | - Katherine P Adams
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Xiuping Jenny Tan
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Emily Becher
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Stephen A Vosti
- University of California, Department of Agriculture and Resource Economics, Institute for Global Nutrition, Davis, CA, United States
| | - Seth Adu-Afarwuah
- University of Ghana, Department of Nutrition and Food Science, Legon, Accra, Ghana
| | - Reina Engle-Stone
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
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Sewor C, Jayalakshmi R. Trends of risk factors associated with childhood stunting and anaemia in Ghana: evidence from the Demographic Health Survey and Multiple Indicator Cluster Survey (2003-2017). Public Health Nutr 2024; 27:e29. [PMID: 38253537 PMCID: PMC10830376 DOI: 10.1017/s1368980023002951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 11/12/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE This study investigated the trend of effect estimates of the key risk factors of childhood stunting and anaemia between 2003 and 2017. DESIGN A secondary analysis of the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data for the Ghanaian population between 2003 and 2017. Associations of selected socio-demographic (child age and gender; maternal age and education), economic (household wealth), environmental, dietary (minimum dietary diversity and iodine use) and health system (place of delivery and vaccination) factors were explored using the Poisson regression model. Trend analysis was explored using a fitted linear regression line on a time series plot. SETTING Ghana. PARTICIPANTS Children under 5 years. RESULTS The results showed a reduction in the prevalence of stunting and anaemia over the 15-year duration. These health outcomes were found to be negatively associated with a wide array of socio-demographic (child age and gender, maternal age and education, residency), economic (household wealth), dietary (iodised salt use) and health service (place of delivery and vaccination) factors; however, the most consistent statistically significant association was observed between child's age and belonging to the poor wealth quintile. CONCLUSION In order to prevent these indicators of child malnutrition, key consideration must be given to the early developmental stages of life. Child health policies must focus on addressing the key contextual factors of child malnutrition.
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Affiliation(s)
- Christian Sewor
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, KL671316, India
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Rajeev Jayalakshmi
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, KL671316, India
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Yadav K, Ramaswamy G, Puri S, Vohra K, Achary T, Jaiswal A, Kaur R, Bairwa M, Singh A, Sethi V. Prevalence and determinants of anemia due to micronutrient deficiencies among children aged 12-59 months in India-Evidence from Comprehensive National Nutrition Survey, 2016-18. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002095. [PMID: 38236794 PMCID: PMC10796069 DOI: 10.1371/journal.pgph.0002095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/15/2023] [Indexed: 01/22/2024]
Abstract
The present study aimed to estimate the prevalence of anemia, and anemia with micronutrient deficiencies (iron/ vitamin B12/ folic acid) and their determinants among children aged 12-59 months in India. Comprehensive National Nutritional Survey (2016-2018) is Asia's largest nutrition survey conducted among 0-19 years aged children in India. We used generalised linear model (modified Poisson) with adjusted prevalence ratio (aPR) to assess the socio-economic and biochemical factors associated with anemia and anemia with micronutrient deficiencies amongst children aged 12 to 59 months. Out of the total of 11,237 children included in the study, 40.5% (95%CI:38·6-42·6) were anemic, 30.0% (95%CI:27·8-32·4) had anemia with micronutrient deficiencies and 60.9% (95%CI:58·2-63·5) had micronutrient deficiencies with or without anemia. Younger age (aPR(95%CI) for one year old: 1.9(1.5-2.4), two year old: 1.8(1.5-2.2), three year old: 1.4(1.2-1.7) compared to four year old children) and lower educational status of the mother (mothers without formal schooling aPR(95%CI):1.4(1.1-1.8); 1-9 standards: 1.4(1.2-1.7)) vs mother educated with high school and above, consumption of less than 100 iron-folic acid tablets during pregnancy (aPR(95%CI):1.3(1.0-1.7) vs consumption of ≥ 180 tablets, any self-reported illness among children within two weeks preceding the interview (aPR(95%CI):1.2(1.1-1.4) vs no-illnesses, iron deficiency (aPR(95%CI):2.2(2.0-2.6)) and zinc deficiency (aPR(95%CI):1.3(1.1-1.4)) were associated with anemia in children. Among anemic, the children from scheduled tribe (aPR(95%CI):1.4(1.1-1.8)) vs other caste categories, and those following unsafe child faeces disposal practices (aPR(95%CI):1.2(1.0-1.4)) vs those who follow safe faeces disposal practices had higher chance of having micronutrient deficiency. One third of children aged 12-59 months had anemia with micronutrient deficiency (iron/ folic acid/ vitamin B12). More than half of children had micronutrient deficiencies irrespective of anemia. Micronutrient deficiencies, antenatal IFA intake, safe hygiene practices need to be strengthened to leave no stone unturned in control of anemia among under-five children in India.
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Affiliation(s)
- Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
- National Centre of Excellence and Advanced Research on Anemia Control, All India Institute of Medical Sciences, New Delhi, India
| | - Gomathi Ramaswamy
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bibinagar, India
| | - Surabhi Puri
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kashish Vohra
- National Centre of Excellence and Advanced Research on Anemia Control, All India Institute of Medical Sciences, New Delhi, India
| | - Thejas Achary
- National Centre of Excellence and Advanced Research on Anemia Control, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Jaiswal
- Employee State Insurance Corporation Medical College and Hospital, Faridabad, Haryana, India
| | - Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mohan Bairwa
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Singh
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Vani Sethi
- United Nations International Children’s Emergency Fund, Regional Office for South Asia, Kathmandu, Nepal
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15
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Wiafe MA, Yeboah GB, Gyamerah E, Konlaa HD, Ibrahim I, Benewaa A. Knowledge, prevalence and factors associated with anaemia among women of reproductive age in Tamale Metropolis, Ghana: A cross-sectional study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241263826. [PMID: 39044441 DOI: 10.1177/17455057241263826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Anaemia is a global public health concern. Anaemia in women of reproductive age has negative outcomes on their health and reproduction. OBJECTIVE This study assessed the knowledge, prevalence and associated factors of anaemia among non-pregnant and non-lactating women of reproductive age in Northern Ghana. DESIGN This is a cross-sectional study. METHOD A systematic random sampling was used to select 317 participants from the Tamale Metropolis. A semi-structured questionnaire was used to collect data on the sociodemographic, knowledge level of anaemia and iron foods. Haemoglobin levels were determined using URIT-12. Haemoglobin status was classified according to the World Health Organization standards. Descriptive statistics and chi-square were used in the statistical analysis. RESULTS The mean age (SD) of participants was 26.4 ± 6.9. A large proportion (68.8%) of the women had knowledge about anaemia, and the source of information was mainly health professionals (56.4%). More than half of the participants knew of the symptoms (80%), causes (83.9%), prevention measures (81.2%), consequences of anaemia (64.2%) and iron-rich food sources (76%). A greater share of the participants, however, had no knowledge of both iron-enhancing foods (53.7%) and iron-inhibiting foods (51.8%). The prevalence of anaemia was high generally (63.1%) and was highest among females at the tertiary institutions (43%) and who were single (60.5%). A significant association existed between income status and haemoglobin status (χ2 = 6.3, p = 0.044). CONCLUSION The majority of participants knew about anaemia; however, they had limited knowledge of iron-enhancing and inhibiting foods. The prevalence of anaemia was high among women of reproductive age. Integrating economic empowerment and nutrition education with the inclusion of iron-enhancing and iron-inhibiting foods could help to reduce the high prevalence of anaemia among women of reproductive age.
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Affiliation(s)
| | | | - Emmanuel Gyamerah
- Department of Nutritional Sciences, University for Development Studies, Tamale, Ghana
| | - Happy Dubique Konlaa
- Department of Nutritional Sciences, University for Development Studies, Tamale, Ghana
| | - Ikimah Ibrahim
- Department of Nutritional Sciences, University for Development Studies, Tamale, Ghana
| | - Anita Benewaa
- Department of Nursing and Midwifery, Christian Service University College, Kumasi, Ghana
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Mulungu K, Tekelewold H, Abro Z, Sevgan S, Muriithi B, Ecuru J, Beesigamukama D, Kassie M. Pollinator-dependent crops significantly contribute to diets and reduce household nutrient deficiencies in sub-Saharan Africa. Sci Rep 2023; 13:15452. [PMID: 37723171 PMCID: PMC10507062 DOI: 10.1038/s41598-023-41217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/23/2023] [Indexed: 09/20/2023] Open
Abstract
Recent literature highlights the potential of animal pollinator-dependent (PD) crops in enhancing food and nutrition security, although there is a lack of detailed household-level estimates. In this study, we investigate the nutrient composition, productivity, and contribution of PD and pollinator-independent (PI) crops to household nutrition in four sub-Saharan African (SSA) countries. We also evaluate the impact of reallocating resources from PI crops to PD crops on nutrient deficiencies, utilizing nationally representative panel data from three waves and over 30,000 household-year observations. Our findings reveal that PD crops exhibit higher micronutrient content per unit, albeit with lower macronutrient content compared to PI crops. PI crops have higher yield of calories per hectare while PD crops have higher vitamin A yield per hectare. However, protein and iron yield for PD and PI crops varies across countries. PI crops predominantly contribute to macronutrients and iron, while PD crops significantly contribute to vitamin A production. Our econometric results demonstrate that increasing the cultivation of PD crops relative to PI crops reduces the prevalence of nutrient deficiencies and increases crop income without compromising macronutrients production. This suggests that greater investment in PD crop production can be an integral approach to achieving nutrition security in SSA.
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Affiliation(s)
- Kelvin Mulungu
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya.
| | | | - Zewdu Abro
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 5689, Addis Ababa, Ethiopia
| | - Subramanian Sevgan
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya
| | - Beatrice Muriithi
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya
| | - Julius Ecuru
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya
| | - Dennis Beesigamukama
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya
| | - Menale Kassie
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya
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Singh SK, Lhungdim H, Shekhar C, Dwivedi LK, Pedgaonkar S, James KS. Key drivers of reversal of trend in childhood anaemia in India: evidence from Indian demographic and health surveys, 2016-21. BMC Public Health 2023; 23:1574. [PMID: 37596564 PMCID: PMC10436448 DOI: 10.1186/s12889-023-16398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/25/2023] [Indexed: 08/20/2023] Open
Abstract
AIM Recent National Family Health Survey results portray striking improvements in most population and health indicators, including fertility, family planning, maternal and child health, gender treatment, household environments, and health insurance coverage of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), with all India resonance. However, the prevalence of any anaemia (< 11 g/dl) among children under age five has exhibited a reversed trajectory in recent years. Therefore, the present study explores key drivers of the reversal of the trend in the prevalence of childhood anaemia between 2015 and2021. METHODS Data of four rounds of the National Family Health Survey (NFHS) were used to show the overall trend of anaemia among children. However, for the analysis of key drivers of the reversal trend of childhood anaemia, only the recent two rounds (NFHS-4 & NFHS-5) were used. Descriptive, bivariate multivariable analysis and Fairlie decomposition model were used to explore the drivers of the reversal of the trend in childhood anaemia. RESULTS During the past two decades, India has seen a decline in the prevalence of childhood anaemia (NFHS-2 to NFHS-4). However, a reversal of trend was observed recently. The prevalence of anaemia among children aged 6-59 months increased from 59 percent in NFHS-4 to 67 percent in NFHS-5. In addition, the prevalence of mild anaemia increased from 23.3 percent in NFHS-2 to 28.7 percent in NFHS-5. However, the prevalence of moderate and severe anaemia declined considerably from NFHS-2 (40 percent and 4.1 percent) to NFHS-4 (28.7 percent and 1.6 percent), but showed an increase in the prevalence in NFHS-5 (36.3 percent and 2.2 percent). Among others, mothers' educational attainment, anaemia status and socio-economic status emerge as the key drivers of the change in the prevalence of childhood anaemia. CONCLUSION These findings may have vital implications for the ongoing Anaemia Mukt Bharat Programme, one of the government's dream projects in India.
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Affiliation(s)
- S K Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India.
| | - H Lhungdim
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Chander Shekhar
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - L K Dwivedi
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - S Pedgaonkar
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - K S James
- International Institute for Population Sciences, Mumbai, India
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Floridia M, Galluzzo CM, Orlando S, Luhanga R, Mphwere R, Kavalo T, Andreotti M, Amici R, Ciccacci F, Marazzi MC, Giuliano M. Micronutrient and Nutritional Status of HIV-Exposed and HIV-Unexposed Malawian Infants in the First Year of Life: Assessment of Ferritin, Vitamin A, and D Status and Its Association with Growth. Nutrients 2023; 15:3282. [PMID: 37513701 PMCID: PMC10386663 DOI: 10.3390/nu15143282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Breastfed Malawian infants from Human Immunodeficiency Virus (HIV)-uninfected and HIV-infected women who received antiretroviral therapy were followed until 12 months of age, allowing us to evaluate plasma levels of ferritin, vitamin A (as retinol-binding protein, RBP), and vitamin D (25(OH)D) at six months, as well as nutritional status and growth between six and 12 months. Ferritin and RBP levels were adjusted for inflammation. The study included 88 infants, 63 of whom were part of a recent cohort (2019-2021) that included 49 HIV-exposed but uninfected (HEU) and 14 HIV-unexposed and uninfected (HUU) infants, as well as 25 infants (all HEU) from an earlier cohort (2008-2011). No differences were observed between HEU and HUU infants regarding micronutrient levels, anthropometric indexes, growth, and rates of stunting, being underweight, or wasting. HEU infants from the earlier cohort, when compared to more recent HEU infants, had significantly worse anthropometric measures at six months and inferior growth between six and twelve months. Overall, ferritin deficiency involved 68.6% of infants, while vitamin A and vitamin D deficiency involved 8% and 1.2% of infants, respectively. Micronutrient deficiencies were not associated with HIV exposure, cohort, stunting, being underweight, or wasting. At six months, stunting, being underweight, and wasting involved 25.0%, 2.7% and 2.8% of infants, respectively, with no differences related to HIV exposure. Ferritin deficiency at six months was associated with inferior subsequent growth. In this small observational study conducted in Malawian infants, no major nutritional gap was observed between HIV-exposed and HIV-unexposed infants, though the study highlighted specific nutritional deficiencies that deserve attention. High rates of stunting and ferritin deficiency were observed in the first year of life in Malawian infants, irrespective of maternal HIV status; a significant association between ferritin deficiency and worse subsequent growth was found. Vitamin A and vitamin D deficiencies were much less frequent. Based on the data observed, nutritional interventions should give priority to the correction of ferritin deficiency and chronic undernutrition.
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Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | | | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Robert Mphwere
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Fausto Ciccacci
- UniCamillus, Department of Medicine, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
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Kassie GA, Gebrekidan AY, Enaro EY, Asgedom YS. Minimum acceptable dietary intake among children aged 6-23 months in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0287247. [PMID: 37384754 PMCID: PMC10310018 DOI: 10.1371/journal.pone.0287247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/01/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND In the absence of minimum acceptable diet, children aged 6-23 months are vulnerable to malnutrition. Not feeding at least the minimum acceptable diet is a major global problem, particularly in developing countries. Even though many studies have been conducted in Ethiopia there are inconsistencies. Therefore, this review aimed to estimate the pooled prevalence of a minimum acceptable diet in Ethiopia. METHODS Published articles from various electronic databases, such as PubMed/MEDLINE, EMBASE, Google Scholar, and Science Direct were systematically searched. All cross-sectional studies conducted on the minimum acceptable diet of children aged 6-24 months and published up to October 30/2021 were included in this review. Data were extracted using an Excel spreadsheet and analyzed using STATA version 14.1. The random-effects model was used to estimate the pooled prevalence, and a subgroup analysis was performed to identify the possible source of heterogeneity. Begg's and Egger's tests were used to identify possible publication bias. RESULTS Nine cross-sectional studies involving 4,223 participants were included. Significant heterogeneity was observed across the studies (I2 = 99.4%). The pooled prevalence of minimum acceptable diet in Ethiopia was found to be 25.69% (95% CI: 11.96, 39.41). CONCLUSION This review revealed that the minimum acceptable dietary intake among children aged 6-23 months in Ethiopia was relatively low; only 1 in 4 of children met the minimum acceptable diet. This indicates that the government should promote child feeding practices according to guidelines to increase the proportion of children with a minimum acceptable diet.
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Affiliation(s)
- Gizachew Ambaw Kassie
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eskinder Yilma Enaro
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yordanos Sisay Asgedom
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Pathiraje D, Carlin J, Der T, Wanasundara JPD, Shand PJ. Generating Multi-Functional Pulse Ingredients for Processed Meat Products-Scientific Evaluation of Infrared-Treated Lentils. Foods 2023; 12:foods12081722. [PMID: 37107516 PMCID: PMC10138159 DOI: 10.3390/foods12081722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
In the last decade, various foods have been reformulated with plant protein ingredients to enhance plant-based food intake in our diet. Pulses are in the forefront as protein-rich sources to aid in providing sufficient daily protein intake and may be used as binders to reduce meat protein in product formulations. Pulses are seen as clean-label ingredients that bring benefits to meat products beyond protein content. Pulse flours may need pre-treatments because their endogenous bioactive components may not always be beneficial to meat products. Infrared (IR) treatment is a highly energy-efficient and environmentally friendly method of heating foods, creating diversity in plant-based ingredient functionality. This review discusses using IR-heating technology to modify the properties of pulses and their usefulness in comminuted meat products, with a major emphasis on lentils. IR heating enhances liquid-binding and emulsifying properties, inactivates oxidative enzymes, reduces antinutritional factors, and protects antioxidative properties of pulses. Meat products benefit from IR-treated pulse ingredients, showing improvements in product yields, oxidative stability, and nutrient availability while maintaining desired texture. IR-treated lentil-based ingredients, in particular, also enhance the raw color stability of beef burgers. Therefore, developing pulse-enriched meat products will be a viable approach toward the sustainable production of meat products.
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Affiliation(s)
- Darshika Pathiraje
- Department of Food Science and Technology, Wayamba University of Sri Lanka, Makandura 60000, Gonawila, Sri Lanka
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, SK S7N 5A8, Canada
| | | | - Tanya Der
- Pulse Canada, Winnipeg, MB R3C 0A5, Canada
| | - Janitha P D Wanasundara
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, SK S7N 5A8, Canada
- Agriculture and Agri-Food Canada, Saskatoon Research and Development Centre, Saskatoon, SK S7N 0X9, Canada
| | - Phyllis J Shand
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, SK S7N 5A8, Canada
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Ampofo GD, Osarfo J, Aberese-Ako M, Asem L, Komey MN, Mohammed W, Ofosu AA, Tagbor H. Malaria in pregnancy control and pregnancy outcomes: a decade's overview using Ghana's DHIMS II data. Malar J 2022; 21:303. [PMID: 36303165 PMCID: PMC9615308 DOI: 10.1186/s12936-022-04331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Malaria in pregnancy control interventions have been implemented through antenatal care services for more than 2 decades in Ghana. The uptake of these interventions has seen steady improvement over the years. This has occurred within the context of decreasing global trends of malaria infection confirmed by decreasing malaria in pregnancy prevalence in Ghana. However, not much is known about how these improvements in interventions uptake and reduction in malaria infection prevalence have impacted pregnancy outcomes in the country. This study aimed at describing trends of maternal anaemia and low birth weight prevalence and uptake of malaria in pregnancy control interventions over the last decade using data from Ghana’s District Health Information Management System (DHIMS II). Methods Data from Ghana’s DHIMS II on variables of interest covering the period 2012 to 2021 was analysed descriptively using Microsoft Excel 365. Results were computed as averages and percentages and presented in tables and graphs. Results The prevalence of maternal anaemia at booking and at term and low birth weight increased marginally from 31.0%, 25.5% and 8.5% in 2012 to 36.6%, 31.9% and 9.5% in 2021 respectively. Severe anaemia prevalence at booking and at term remained under 2% over the study period. Women making at least 4 ANC visits, receiving at least 3 doses of intermittent preventive treatment of malaria and an insecticide-treated net increased from 77.0%, 41.4% and 4.1% in 2012 to 82%, 55.0% and 93.3% in 2021, respectively. Malaria test positivity rate reduced from 54.0% to 34.3% between 2014 and 2021 while women receiving iron and folate supplementation for 3 and 6 months rose from 43.0% and 25.5% to 89.7% and 61.8%, respectively between 2017 and 2021. Conclusion Maternal anaemia and low birth weight prevalence showed marginal upward trends over the last decade despite reduced malaria infection rate and improved uptake of malaria in pregnancy control interventions. There is room for improvement in current intervention implementation levels but the complex and multi-factorial aetiologies of maternal anaemia and low birth weight need urgent investigation and quantification to inform policy and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04331-2.
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Affiliation(s)
| | - Joseph Osarfo
- University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | | | | | - Mildred Naa Komey
- National Malaria Control Programme-Ghana Health Service, Accra, Ghana
| | - Wahjib Mohammed
- National Malaria Control Programme-Ghana Health Service, Accra, Ghana
| | | | - Harry Tagbor
- University of Health and Allied Sciences, PMB 31, Ho, Ghana
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22
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Dzando G, Sanyaolu A, Okorie C, Jaferi U, Marinkovic A, Prakash S, Patidar R, Desai P, Younis K. The magnitude of anemia and preventive practices in mothers with children under five years of age in Dodi Papase, Volta region of Ghana. PLoS One 2022; 17:e0272488. [PMID: 35984853 PMCID: PMC9390896 DOI: 10.1371/journal.pone.0272488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Socio-demographic factors influence the magnitude of anemia in endemic areas. The purpose of this study is to establish the magnitude of anemia and to determine anemia preventive practices carried out by mothers with children under five years of age in the Kadjebi District of the Volta region of Ghana. Methods This purposive sampling study involved women of reproductive age with children less than five years of age from Saint Mary Theresa Hospital and nurses practicing in the pediatric ward of the hospital. A questionnaire and interview guide were administered respectively, and the data collected were analyzed using the Statistical Package for Social Sciences version 21. Results A total of 150 participants were studied; among which analysis of anemia was carried out on 129 women whose children had their hemoglobin levels checked and recorded in the laboratory. Hemoglobin levels recorded for these children showed that 85.3% were anemic, even though 93.8% of the mothers had been given iron supplements during their pregnancy. Furthermore, anemia prevention practices comprised whether the child had been given any anti-malaria prophylaxis (98.4% denied), if the child had been dewormed in the last three months (89.9% denied), whether the child was given iron supplements in the last three months (59.7% denied), if the child had been given vitamin supplements in the last three months (24.0% denied). Conclusion Most of the children in the study were anemic. Mothers practiced exclusive breastfeeding, iron, and vitamin supplementation, and ensured that children slept under insecticide-treated mosquito nets as a means of preventing malaria.
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Affiliation(s)
| | | | - Chuku Okorie
- Union County College, Plainfield, New Jersey, United States of America
| | - Urooj Jaferi
- All Saints University School of Medicine, Roseau, Dominica
| | | | | | | | - Priyank Desai
- American University of Saint Vincent School of Medicine, Saint Vincent and the Grenadines, Kingstown
| | - Kokab Younis
- Mount Royal University, Calgary, Alberta, Canada
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23
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Dhillon P, Sahoo H, Usman M, Srivastava A, Agrawal PK, Johnston R, Unisa S. Status and correlates of micronutrient deficiencies in slum and non-slum areas of India's four metropolitan cities: Investigation from CNNS. Soc Sci Med 2022; 309:115259. [DOI: 10.1016/j.socscimed.2022.115259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/24/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
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Lambrecht NJ, Bridges D, Wilson ML, Adu B, Eisenberg JNS, Folson G, Baylin A, Jones AD. Associations of bacterial enteropathogens with systemic inflammation, iron deficiency, and anemia in preschool-age children in southern Ghana. PLoS One 2022; 17:e0271099. [PMID: 35802561 PMCID: PMC9269377 DOI: 10.1371/journal.pone.0271099] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
Anemia remains a pervasive public health problem among preschool-age children in Ghana. Recent analyses have found that anemia in Ghanaian children, particularly in Southern regions, is largely attributable to infectious causes, rather than nutritional factors. Infections with enteropathogens can reduce iron absorption and increase systemic inflammation, but few studies have examined direct links between enteropathogens and anemia. This study investigated associations between detection of individual bacterial enteropathogens and systemic inflammation, iron deficiency, and anemia among 6- to 59-month-old children in Greater Accra, Ghana. Serum samples were analyzed from a cross-sectional sample of 262 children for concentrations of hemoglobin (Hb), biomarkers of systemic inflammation [C-reactive protein (CRP) and α-1-acid glycoprotein (AGP)], and biomarkers of iron status [serum ferritin (SF) and serum transferrin receptor (sTfR)]. Stool samples were analyzed for ten bacterial enteropathogens using qPCR. We estimated associations between presence of each enteropathogen and elevated systemic inflammation (CRP > 5 mg/L and AGP > 1 g/L), iron deficiency (SF < 12 μg/L and sTfR > 8.3 mg/L) and anemia (Hb < 110 g/L). Enteropathogens were detected in 87% of children’s stool despite a low prevalence of diarrhea (6.5%). Almost half (46%) of children had anemia while one-quarter (24%) had iron deficiency (low SF). Despite finding no associations with illness symptoms, Campylobacter jejuni/coli detection was strongly associated with elevated CRP [Odds Ratio (95% CI): 3.49 (1.45, 8.41)] and elevated AGP [4.27 (1.85, 9.84)]. Of the pathogens examined, only enteroinvasive Escherichia coli/Shigella spp. (EIEC/Shigella) was associated with iron deficiency, and enteroaggregative Escherichia coli (EAEC) [1.69 (1.01, 2.84)] and EIEC/Shigella [2.34 (1.15, 4.76)] were associated with anemia. These results suggest that certain enteroinvasive pathogenic bacteria may contribute to child anemia. Reducing exposure to enteropathogens through improved water, sanitation, and hygiene practices may help reduce the burden of anemia in young Ghanaian children.
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Affiliation(s)
- Nathalie J. Lambrecht
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute of Public Health, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- * E-mail:
| | - Dave Bridges
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Mark L. Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Bright Adu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Joseph N. S. Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Gloria Folson
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Ana Baylin
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
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25
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Profiling household double and triple burden of malnutrition in sub-Saharan Africa: prevalence and influencing household factors. Public Health Nutr 2022; 25:1563-1576. [PMID: 33896443 PMCID: PMC9991556 DOI: 10.1017/s1368980021001750] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA. SETTING The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017. PARTICIPANTS The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15-49 years and children under 5 years). DESIGN Logistic regression analyses were used to determine household correlates of household burden of malnutrition. RESULTS Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition. CONCLUSIONS The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.
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26
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Hasselberg AE, Nøstbakken OJ, Aakre I, Madsen L, Atter A, Steiner-Asiedu M, Kjellevold M. Nutrient and contaminant exposure from smoked European anchovy (Engraulis encrasicolus): Implications for children's health in Ghana. Food Control 2022. [DOI: 10.1016/j.foodcont.2021.108650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Co-Occurrence of Overweight/Obesity, Anemia and Micronutrient Deficiencies among Non-Pregnant Women of Reproductive Age in Ghana: Results from a Nationally Representative Survey. Nutrients 2022; 14:nu14071427. [PMID: 35406039 PMCID: PMC9002982 DOI: 10.3390/nu14071427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 12/10/2022] Open
Abstract
Overweight/obesity (OWOB) often co-occurs with anemia or micronutrient deficiencies (MNDs) among women of reproductive age (WRA) in Ghana; identifying the risk factors of these conditions is essential for prevention. We aimed to examine the prevalence of OWOB, anemia, and MNDs and their co-occurrence and risk factors among non-pregnant women 15–49 years of age in Ghana. Data were from a 2017 two-stage national survey of 1063 women. We estimated the weighted prevalence of single and co-occurring malnutrition, and used logistic regression to explore risk factors. The prevalence of OWOB, anemia, and ≥1 MND was 39%, 22%, and 62%, respectively; that of OWOB co-occurring with anemia was 6.7%, and OWOB co-occurring with ≥1 MND was 23.6%. There was no significant difference between observed and expected prevalence of co-occurrence OWOB with anemia or MND. Risk factors were: living in southern (vs. northern) belt, high- (vs. low-) wealth household, being ≥ 25 years old, and being married (vs. single) for OWOB, and living in northern (vs. southern) belt and medium- (vs. low-) wealth household for anemia and ≥1 MND, respectively. Different interventions are required for addressing OWOB in WRA than those for anemia and MNDs.
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28
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Fatima B, Saeed U, Hussain D, Jawad SEZ, Rafiq HS, Majeed S, Manzoor S, Qadir SY, Ashiq MN, Najam-Ul-Haq M. Facile hydrothermal synthesis of NiTe nanorods for non-enzymatic electrochemical sensing of whole blood hemoglobin in pregnant anemic women. Anal Chim Acta 2022; 1189:339204. [PMID: 34815043 DOI: 10.1016/j.aca.2021.339204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023]
Abstract
Electrochemical sensing methods monitor biomolecules because of their specificity, rapid response, lower cost, and automation. Hemoglobin is an abundant protein in the human body and is correlated with various physiological processes. Levels of hemoglobin in blood are associated with anemia in pregnant women. In this research, a non-enzymatic sensor based on NiTe nanorods is developed for the detection and quantification of hemoglobin (Hb) from anemic pregnant patients. NiTe nanorods are synthesized by the single-step method. After characterizing the material, sensing parameters such as the effect of scan rate, pH, concentration, and interferences are optimized using standard hemoglobin samples. Linearity, the limit of detection (LOD), and the limit of quantification (LOQ) for NiTe nanorods are 0.99698, 0.012 nM, and 0.04 nM, respectively. Stability is measured by cyclic chronoamperometry (12 h) and voltammetry (100 cycles). Recovery of hemoglobin from blood samples is in the range of 63-90%. NiTe nanorods quantitatively determine hemoglobin from the blood samples of anemic pregnant women.
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Affiliation(s)
- Batool Fatima
- Department of Biochemistry, Bahauddin Zakariya University, Multan, 60800, Pakistan.
| | - Ummama Saeed
- Department of Biochemistry, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Dilshad Hussain
- HEJ Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Shan-E-Zahra Jawad
- Department of Biochemistry, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Hafiza Sana Rafiq
- Department of Biochemistry, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Saadat Majeed
- Institute of Chemical Sciences, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Sumaira Manzoor
- Institute of Chemical Sciences, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | | | - Muhammad Naeem Ashiq
- Institute of Chemical Sciences, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Najam-Ul-Haq
- Institute of Chemical Sciences, Bahauddin Zakariya University, Multan, 60800, Pakistan.
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29
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Dalaba MA, Nonterah EA, Chatio ST, Adoctor JK, Dambayi E, Nonterah EW, Azalia S, Ayi-Bisah D, Erzse A, Watson D, Hardy-Johnson P, Kehoe SH, Tugendhaft A, Ward K, Debpuur C, Oduro A, Ofosu W, Danis M, Barker M. Engaging community members in setting priorities for nutrition interventions in rural northern Ghana. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000447. [PMID: 36962493 PMCID: PMC10022374 DOI: 10.1371/journal.pgph.0000447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/13/2022] [Indexed: 11/18/2022]
Abstract
This study used "Choosing All Together" (CHAT), a deliberative engagement tool to prioritise nutrition interventions and to understand reasons for intervention choices of a rural community in northern Ghana. The study took an exploratory cross-sectional design and used a mixed method approach to collect data between December 2020 and February 2021. Eleven nutrition interventions were identified through policy reviews, interaction with different stakeholders and focus group discussions with community members. These interventions were costed for a modified CHAT tool-a board-like game with interventions represented by colour coded pies and the cost of the interventions represented by sticker holes. Supported by trained facilitators, six community groups used the tool to prioritise interventions. Discussions were audio-recoded, transcribed and thematically analysed. The participants prioritised both nutrition-sensitive and nutrition-specific interventions, reflecting the extent of poverty in the study districts and the direct and immediate benefits derived from nutrition-specific interventions. The prioritised interventions involved livelihood empowerment, because they would create an enabling environment for all-year-round agricultural output, leading to improved food security and income for farmers. Another nutrition-sensitive, education-related priority intervention was male involvement in food and nutrition practices; as heads of household and main decision makers, men were believed to be in a position to optimise maternal and child nutrition. The prioritised nutrition-specific intervention was micronutrient supplementation. Despite low literacy, participants were able to use CHAT materials and work collectively to prioritize interventions. In conclusion, it is feasible to modify and use the CHAT tool in public deliberations to prioritize nutrition interventions in rural settings with low levels of literacy. These communities prioritised both nutrition-sensitive and nutrition-specific interventions. Attending to community derived nutrition priorities may improve the relevance and effectiveness of nutrition health policy, since these priorities reflect the context in which such policy is implemented.
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Affiliation(s)
- Maxwell Ayindenaba Dalaba
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Engelbert A Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Julius Global Health, Julius Centre for Health Science and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Samuel T Chatio
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - James K Adoctor
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Edith Dambayi
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Esmond W Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Stephen Azalia
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Doreen Ayi-Bisah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Agnes Erzse
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Daniella Watson
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Polly Hardy-Johnson
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- AECC University College, Bournemouth, United Kingdom
| | - Sarah H Kehoe
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Aviva Tugendhaft
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Kate Ward
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Cornelius Debpuur
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Abraham Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Winfred Ofosu
- Upper East Regional Health Directorate, Ghana Health Service, Bolgatanga, Ghana
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, United States of America
| | - Mary Barker
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton Foundation Trust, Southampton General Hospital, Southampton, United Kingdom
- School of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom
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30
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Donkor WES, Adu-Afarwuah S, Wegmüller R, Bentil H, Petry N, Rohner F, Wirth JP. Complementary Feeding Indicators in Relation to Micronutrient Status of Ghanaian Children Aged 6-23 Months: Results from a National Survey. Life (Basel) 2021; 11:969. [PMID: 34575118 PMCID: PMC8468967 DOI: 10.3390/life11090969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Optimal complementary feeding is critical for adequate growth and development in infants and young children. The associations between complementary feeding and growth have been studied well, but less is known about the relationship between complementary feeding and micronutrient status. METHODS Using data from a national cross-sectional survey conducted in Ghana in 2017, we examined how multiple WHO-recommended complementary feeding indicators relate to anemia and the micronutrient status of children aged 6-23 months. RESULTS In total, 42%, 38%, and 14% of the children met the criteria for minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), respectively. In addition, 71% and 52% of the children consumed iron-rich foods and vitamin A-rich foods, respectively. The prevalence of anemia, iron deficiency (ID), iron deficiency anemia (IDA) and vitamin A deficiency (VAD) was 46%, 45%, 27%, and 10%, respectively. Inverse associations between MMF and socio-economic status were found, and MMF was associated with an increased risk of ID (55%; p < 0.013) and IDA (38%; p < 0.002). CONCLUSION The pathways connecting complementary feeding and micronutrient status are complex. Findings related to MMF should be further investigated to ensure that complementary feeding programs account for the potential practice of frequent feeding with nutrient-poor foods.
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Affiliation(s)
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon P.O. Box LG 25, Ghana; (S.A.-A.); (H.B.)
| | - Rita Wegmüller
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
| | - Helena Bentil
- Department of Nutrition and Food Science, University of Ghana, Legon P.O. Box LG 25, Ghana; (S.A.-A.); (H.B.)
| | - Nicolai Petry
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
| | - Fabian Rohner
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
| | - James P. Wirth
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
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Azupogo F, Abizari AR, Aurino E, Gelli A, Osendarp SJM, Bras H, Feskens EJM, Brouwer ID. Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data. Public Health Nutr 2021; 25:1-16. [PMID: 34482854 PMCID: PMC9991666 DOI: 10.1017/s1368980021003827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. DESIGN Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. SETTING Countrywide, covering rural and urban areas in Ghana. PARTICIPANTS Non-pregnant adolescent girls aged 15-19 years. RESULTS Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. CONCLUSIONS The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.
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Affiliation(s)
- Fusta Azupogo
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- Department of Family and Consumer Sciences, Faculty of Agriculture, Food and Consumer Sciences, University for Development Studies, Box TL 1882, Tamale, Ghana
| | - Abdul-Razak Abizari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Elisabetta Aurino
- Centre for Health Economics and Policy Innovation, Department of Management, Imperial College Business School, Imperial College London, London, UK
| | - Aulo Gelli
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Saskia JM Osendarp
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Hilde Bras
- Faculty of Arts, The University of Groningen, The Netherlands
| | - Edith JM Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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Dao F, Djonor SK, Ayin CTM, Adu GA, Sarfo B, Nortey P, Akuffo KO, Danso-Appiah A. Burden of malaria in children under five and caregivers' health-seeking behaviour for malaria-related symptoms in artisanal mining communities in Ghana. Parasit Vectors 2021; 14:418. [PMID: 34419123 PMCID: PMC8380373 DOI: 10.1186/s13071-021-04919-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/02/2021] [Indexed: 01/21/2023] Open
Abstract
Background Artisanal mining creates enabling breeding ground for the vector of malaria parasites. There is paucity of data on the effects of artisanal mining on malaria. This study assessed burden of malaria and caregivers’ health-seeking behaviour for children under five in artisanal mining communities in East Akim District in Ghana. Methods A cross-sectional study involving caregivers and their children under five was conducted in three artisanal mining communities in the East Akim District in Ghana. Caregivers were interviewed using a structured questionnaire. Finger prick blood samples were collected and analysed for haemoglobin concentration using a rapid diagnostic test, and thick and thin blood smears were analysed to confirm the presence of malaria parasites. Results Of the 372 children under 5 years included in the study, 197 (53.1%) were male, with a mean age (± SD) of 23.0 ± 12.7 months. The proportion of children with malaria (Plasmodium falciparum and P. malariae) was 98.1% and 1.9%, respectively, whilst the proportion with anaemia (Hb < 11.0 g/dl) was 39.5% (n = 147). Almost all caregivers were female (98.9%), and 28.6% (n = 106) did not have access to any malaria control information. Caregivers associated malaria infection with mosquito bites (68.3%, n = 254) and poor sanitation (21.2%, n = 79). Malaria in children under five was significantly associated with anaemia (OR 11.07, 95% CI 6.59–18.68, n = 111/160, 69.4%; P < 0.0001), residing close to stagnant water (≤ 25 m) from an artisanal mining site (AOR 2.91, 95% CI 1.47–5.76, P = 0.002) and caregiver age younger than 30 years (OR 0.44, 95% CI 0.208–0.917, n = 162, 43.55%, P = 0.001). Conclusions There is a high burden of malaria and anaemia among children under five in artisanal mining communities of the East Akim District, and far higher than in non-artisanal mining sites. Interventions are needed to effectively regulate mining activities in these communities, and strengthen malaria control and health education campaigns to curtail the high malaria burden and improve health-seeking behaviour. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04919-8.
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Affiliation(s)
- Francois Dao
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.,Malaria Research and Training Center, Department of Epidemiology and Infectious Diseases, University of Science Techniques and Technologies of Bamako, Bamako, Mali
| | - Sampson Kafui Djonor
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Christian Teye-Muno Ayin
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | | | - Bismark Sarfo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Pricillia Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana. .,University of Ghana Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Legon, Ghana.
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Suri DJ, Wirth JP, Adu-Afarwuah S, Petry N, Rohner F, Sheftel J, Tanumihardjo SA. Inflammation Adjustments to Serum Retinol and Retinol-Binding Protein Improve Specificity but Reduce Sensitivity when Estimating Vitamin A Deficiency Compared with the Modified Relative Dose-Response Test in Ghanaian Children. Curr Dev Nutr 2021; 5:nzab098. [PMID: 34386690 PMCID: PMC8352745 DOI: 10.1093/cdn/nzab098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Serum retinol and retinol-binding protein (RBP) concentrations are commonly used biomarkers of vitamin A deficiency (VAD); however, evidence indicates that they are not always accurate, especially in populations with high exposure to inflammation. OBJECTIVE The aim was to assess sensitivity and specificity of serum retinol and RBP concentrations to predict VAD, with and without adjustment for inflammation (using categorical and regression-adjusted approaches), using the modified relative dose-response (MRDR) as the reference standard for liver reserves. METHODS This secondary analysis of diagnostic accuracy used inflammation and RBP data and analyzed serum retinol and MRDR from a subsample of women of reproductive age (n = 178) and preschool children (n = 166) in the cross-sectional 2017 Ghana Micronutrient Survey. RESULTS Inflammation (elevated C-reactive protein and/or α1-acid glycoprotein) was present in 41% of children and 16% of women. Among children, estimates of VAD prevalence were as follows: 7% (MRDR), 40% (serum retinol), 29% (categorical-adjusted serum retinol), 24% (RBP), 13% (categorical-adjusted RBP), and 7% (regression-adjusted RBP). Sensitivity (95% CI) ranged from 22.2% (2.81%, 60.0%; both adjusted RBPs) to 80.0% (44.4%, 97.5%; serum retinol), whereas specificity ranged from 63.3% (54.7%, 71.3%; serum retinol) to 93.5% (88.0%, 97.0%; regression-adjusted RBP). Among women, VAD prevalence ranged from 1% (RBP) to 4% (all others); sensitivity was 0% and specificity was >96% for all indicators. CONCLUSIONS Serum retinol and RBP had varying accuracy in estimating VAD, especially in children; adjustment for inflammation increased accuracy by increasing specificity at the expense of sensitivity. Effects of inflammation adjustment in the context of high inflammation and VAD prevalence need to be further explored. Especially in populations with high inflammation, the MRDR test should accompany serum retinol or RBP measurements in a subsample of subjects in population-based surveys. This trial was registered with the Open Science Framework registry (doi: 10.17605/OSF.IO/J7BP9).
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Affiliation(s)
- Devika J Suri
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana-Legon, Legon, Accra, Ghana
| | | | | | - Jesse Sheftel
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
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34
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Petry N, Wirth JP, Adu‐Afarwuah S, Wegmuller R, Woodruff BA, Tanumihardjo SA, Bentil H, Donkor WE, Williams TN, Shahab‐Ferdows S, Selenje L, Mahama A, Steiner‐Asiedu M, Rohner F. Risk factors for anaemia among Ghanaian women and children vary by population group and climate zone. MATERNAL & CHILD NUTRITION 2021; 17:e13076. [PMID: 32945623 PMCID: PMC7988882 DOI: 10.1111/mcn.13076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/27/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
Anaemia has serious effects on human health and has multifactorial aetiologies. This study aimed to determine putative risk factors for anaemia in children 6-59 months and 15- to 49-year-old non-pregnant women living in Ghana. Data from a nationally representative cross-sectional survey were analysed for associations between anaemia and various anaemia risk factors. National and stratum-specific multivariable regressions were constructed separately for children and women to calculate the adjusted prevalence ratio (aPR) for anaemia of variables found to be statistically significantly associated with anaemia in bivariate analysis. Nationally, the aPR for anaemia was greater in children with iron deficiency (ID; aPR 2.20; 95% confidence interval [CI]: 1.88, 2.59), malaria parasitaemia (aPR 1.96; 95% CI: 1.65, 2.32), inflammation (aPR 1.26; 95% CI: 1.08, 1.46), vitamin A deficiency (VAD; aPR 1.38; 95% CI: 1.19, 1.60) and stunting (aPR 1.26; 95% CI: 1.09, 1.46). In women, ID (aPR 4.33; 95% CI: 3.42, 5.49), VAD (aPR 1.61; 95% CI: 1.24, 2.09) and inflammation (aPR 1.59; 95% CI: 1.20, 2.11) were associated with anaemia, whereas overweight and obese women had lower prevalence of anaemia (aPR 0.74; 95% CI: 0.56, 0.97). ID was associated with child anaemia in the Northern and Middle belts, but not in the Southern Belt; conversely, inflammation was associated with anaemia in both children and women in the Southern and Middle belts, but not in the Northern Belt. Anaemia control programmes should be region specific and aim at the prevention of ID, malaria and other drivers of inflammation as they are the main predictors of anaemia in Ghanaian children and women.
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Affiliation(s)
| | | | - Seth Adu‐Afarwuah
- Department of Nutrition and Food ScienceUniversity of GhanaLegonGhana
| | | | | | | | - Helena Bentil
- Department of Nutrition and Food ScienceUniversity of GhanaLegonGhana
| | - William E.S. Donkor
- GroundWorkFläschSwitzerland
- Department of Nutrition and Food ScienceUniversity of GhanaLegonGhana
| | | | - Setareh Shahab‐Ferdows
- USDA Agricultural Research Service Western Human Nutrition Research CenterDavisCaliforniaUSA
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35
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Muriuki JM, Mentzer AJ, Mitchell R, Webb EL, Etyang AO, Kyobutungi C, Morovat A, Kimita W, Ndungu FM, Macharia AW, Ngetsa CJ, Makale J, Lule SA, Musani SK, Raffield LM, Cutland CL, Sirima SB, Diarra A, Tiono AB, Fried M, Gwamaka M, Adu-Afarwuah S, Wirth JP, Wegmüller R, Madhi SA, Snow RW, Hill AVS, Rockett KA, Sandhu MS, Kwiatkowski DP, Prentice AM, Byrd KA, Ndjebayi A, Stewart CP, Engle-Stone R, Green TJ, Karakochuk CD, Suchdev PS, Bejon P, Duffy PE, Davey Smith G, Elliott AM, Williams TN, Atkinson SH. Malaria is a cause of iron deficiency in African children. Nat Med 2021; 27:653-658. [PMID: 33619371 PMCID: PMC7610676 DOI: 10.1038/s41591-021-01238-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334 ), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n = 7,453), but not among individuals living in malaria-free areas (n = 3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%.
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Affiliation(s)
- John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Open University, KEMRI-Wellcome Trust Research Programme, Accredited Research Centre, Kilifi, Kenya.
| | - Alexander J Mentzer
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Ruth Mitchell
- Medical Research Council (MRC) Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony O Etyang
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Alireza Morovat
- Department of Clinical Biochemistry, Oxford University Hospitals, Oxford, UK
| | - Wandia Kimita
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Francis M Ndungu
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alex W Macharia
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Caroline J Ngetsa
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Makale
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Swaib A Lule
- MRC/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Clare L Cutland
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sodiomon B Sirima
- Groupe de Recherche Action en Sante (GRAS), 06 BP 10248, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Groupe de Recherche Action en Sante (GRAS), 06 BP 10248, Ouagadougou, Burkina Faso
| | - Alfred B Tiono
- Groupe de Recherche Action en Sante (GRAS), 06 BP 10248, Ouagadougou, Burkina Faso
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Moses Gwamaka
- Mother Offspring Malaria Studies (MOMS) Project, Seattle Biomedical Research Institute, Seattle, WA, USA
- Muheza Designated District Hospital, Muheza, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | | | | | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert W Snow
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Adrian V S Hill
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Centre for Clinical Vaccinology and Tropical Medicine and the Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | - Kirk A Rockett
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Wellcome Sanger Institute, Hinxton, UK
| | | | - Dominic P Kwiatkowski
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Wellcome Sanger Institute, Hinxton, UK
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | | | | | | | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Tim J Green
- SAHMRi Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parminder S Suchdev
- Department of Pediatrics, Emory University and Emory Global Health Institute, Atlanta, GA, USA
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - George Davey Smith
- Medical Research Council (MRC) Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison M Elliott
- MRC/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas N Williams
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Institute of Global Health Innovation, Imperial College, London, UK
| | - Sarah H Atkinson
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Department of Paediatrics, University of Oxford, Oxford, UK.
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Abreu AM, Young RR, Buchanan A, Lofgren IE, Okronipa HET, Lartey A, Ashorn P, Adu-Afarwuah S, Dewey KG, Oaks BM. Maternal Blood Pressure in Relation to Prenatal Lipid-Based Nutrient Supplementation and Adverse Birth Outcomes in a Ghanaian Cohort: A Randomized Controlled Trial and Cohort Analysis. J Nutr 2021; 151:1637-1645. [PMID: 33704494 PMCID: PMC8169808 DOI: 10.1093/jn/nxab018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/05/2020] [Accepted: 01/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is unknown whether prenatal lipid-based nutrient supplements (LNSs) affect blood pressure (BP). Associations between hypertension and birth outcomes using recently updated BP cutoffs are undetermined. OBJECTIVES We aimed to assess the impact of LNSs on maternal hypertension and associations between hypertension and birth outcomes. METHODS Pregnant Ghanaian women at ≤20 weeks of gestation (n = 1320) were randomly assigned to receive daily 1) iron and folic acid (IFA), 2) multiple micronutrients (MMN), or 3) LNSs until delivery. BP was measured at enrollment and 36 weeks of gestation. We analyzed the effect of LNSs on BP using ANOVA and associations between hypertension [systolic BP (SBP) ≥130 mm Hg or diastolic BP (DBP) ≥80 mm Hg] and birth outcomes by linear and logistic regressions. RESULTS Mean ± SD SBP and DBP were 110 ± 11 and 63 ± 8 mm Hg at 36 weeks of gestation and did not differ by supplementation group (SBP, P > 0.05; DBP, P > 0.05). At enrollment, higher DBP was associated with lower birth weight and shorter gestation; women with high DBP had greater risk of low birth weight (LBW) [risk ratio (RR): 2.58; 95% CI: 1.09, 6.08] and preterm birth (PTB) (RR: 3.30; 95% CI: 1.47, 7.40). At 36 weeks of gestation, higher SBP was associated with lower birth weight, length, and head circumference and shorter gestation; higher DBP was associated with lower birth weight and length; and women with high DBP had greater risk of LBW (RR: 3.39; 95% CI: 1.32, 8.69). Neither high SBP nor hypertension were associated with birth outcomes at either time point. CONCLUSIONS Daily provision of LNSs does not affect maternal hypertension, compared with IFA and MMN. Higher SBP and DBP are associated with a shorter gestation and smaller birth size; however, only high DBP is associated with LBW and PTB. The new BP cutoffs may help identify pregnancies at risk of adverse birth outcomes.This trial was registered at clinicaltrials.gov as NCT00970866.
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Affiliation(s)
| | - Rebecca R Young
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Ashley Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Ingrid E Lofgren
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | | | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
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Faye MH, Diémé MMA, Idohou-Dossou N, Badiane A, Diouf A, Ndiaye Ndome NM, Tanumihardjo SA. Adequate vitamin A liver stores estimated by the modified relative dose response test are positively associated with breastfeeding but not vitamin A supplementation in Senegalese urban children 9-23 months old: A comparative cross-sectional study. PLoS One 2021; 16:e0246246. [PMID: 33513162 PMCID: PMC7846024 DOI: 10.1371/journal.pone.0246246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/18/2021] [Indexed: 01/08/2023] Open
Abstract
Vitamin A supplementation (VAS) in 6-59-month-old children is recommended but its sustainability is currently questioned. In Senegal, available data suggest that VAS should be maintained, but geographic and age-related specificities need to be addressed to better implement and target VAS programming. The objective of this comparative cross-sectional study, conducted in urban settings of Dakar, was to compare the vitamin A liver stores (VALS) assessed using the modified-relative dose response (MRDR) test between supplemented and non-supplemented 9-23 month-old children and to study their relationship with VAS. The supplemented group (n = 119) received VAS (either 100 000 UI or 200 000 UI) 2 to 6 months before evaluation while the non-supplemented group (n = 110) had not received VAS during the past 6 months. In addition to MRDR, serum retinol concentrations (SR), and biomarkers of subclinical inflammation were measured. Children's health-related data and feeding patterns were collected. Mean MRDR values (VAS: 0.030 ± 0.017, non-VAS: 0.028 ± 0.016, P = 0.389) and inflammation-adjusted SR (VAS: 1.34 ± 0.37, non-VAS: 1.3 ± 0.35, P = 0.515) of children were adequate. Low prevalence of VALS (VAS: 5.2%, non-VAS: 5.4%) and inflammation-adjusted VAD (VAS: 2.6%, non-VAS: 0.9%) were detected despite high presence of infections and inflammation. Children were mostly still being breastfed (VAS: 85.7%, non-VAS: 77.3%) and complementary feeding indicators were similar in both groups. Only breastfeeding was associated with VALS and was found to reduce by 76% at least, the odds of VAD (adjusted OR = 0.24, 95% CI: 0.07-0.8, P = 0.020). Based on MRDR values, VAS was not related to improved VALS and SR as well as VAD reduction among these children with adequate VALS. Reinforcing breastfeeding advocacy and morbidity prevention/control are essential in this setting. Scaling-back VAS in this subpopulation should be examined regarding the risk of hypervitaminosis A after an evaluation of dietary vitamin A intake sufficiency and a more quantitative assessment of VALS.
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Affiliation(s)
- Mane Hélène Faye
- Faculté des Sciences et Techniques, Laboratoire de Recherche en Nutrition et Alimentation Humaine, Département de Biologie Animale, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Marie-Madeleine A. Diémé
- Faculté des Sciences et Techniques, Laboratoire de Recherche en Nutrition et Alimentation Humaine, Département de Biologie Animale, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Nicole Idohou-Dossou
- Faculté des Sciences et Techniques, Laboratoire de Recherche en Nutrition et Alimentation Humaine, Département de Biologie Animale, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Abdou Badiane
- Faculté des Sciences et Techniques, Laboratoire de Recherche en Nutrition et Alimentation Humaine, Département de Biologie Animale, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Adama Diouf
- Faculté des Sciences et Techniques, Laboratoire de Recherche en Nutrition et Alimentation Humaine, Département de Biologie Animale, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | | | - Sherry A. Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
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Abu BAZ, Buttner N, Garror OD, Stefanic R, Sandow A, Pereko KA. Qualitative assessments of anemia-related programs in Ghana reveal gaps and implementation challenges. Ann N Y Acad Sci 2020; 1492:27-41. [PMID: 33368337 PMCID: PMC8246908 DOI: 10.1111/nyas.14538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 12/04/2022]
Abstract
In spite of multiple program efforts in Ghana, progress in reducing the burden of anemia is slow. The objective was to conduct multilevel assessments of existing childhood (<5 years) anemia prevention and treatment programs according to UNICEF's conceptual framework of malnutrition, and to elucidate implementation gaps in Ghana. Purposive and snowball sampling strategies recruited 25 program personnel from 20 organizations to participate in audiorecorded interviews conducted through in‐person, telephone, or email correspondence in August 2018. Interview guides constructed around UNICEF's conceptual framework of malnutrition identified context‐specific immediate, underlying, and basic causes of anemia, and corresponding programs. Interviews were transcribed, coded, and analyzed using the Dedoose software version 8.1.8. Few programs addressed identified basic causes of anemia, such as inadequate human resources, housing/water/toilet facilities, and poverty/poor access to financial resources. Organizations implemented programs addressing ≥1 underlying cause. Five organizations provided food rations and/or supplements to address immediate causes. A key food‐based gap identified was minimal education on fruit intake or antinutritive factors in foods; however, no interventions included vitamin C supplements. Food manufacturers mainly used cereals and grains in commercial food products. Multiple organizations worked in the same region on anemia with instances of an overlapping program focus. Food sources of vitamin C or supplements could be promoted in food‐based interventions to increase the absorption of nonheme iron consumed.
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Affiliation(s)
- Brenda A Z Abu
- Rochester Institute of Technology, College of Health Sciences and Technology, Wegmans School of Health and Nutrition, Rochester, New York
| | - Nicole Buttner
- Rochester Institute of Technology, College of Health Sciences and Technology, Wegmans School of Health and Nutrition, Rochester, New York
| | - Olivia D Garror
- Rochester Institute of Technology, College of Health Sciences and Technology, Wegmans School of Health and Nutrition, Rochester, New York
| | - Rachel Stefanic
- Rochester Institute of Technology, College of Health Sciences and Technology, Wegmans School of Health and Nutrition, Rochester, New York
| | - Adam Sandow
- Point Hope International, Ghana Program, Kasoa, Ghana
| | - Kinglsey A Pereko
- Community Medicine, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
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Kushitor SB, Owusu L, Kushitor MK. The prevalence and correlates of the double burden of malnutrition among women in Ghana. PLoS One 2020; 15:e0244362. [PMID: 33370352 PMCID: PMC7769247 DOI: 10.1371/journal.pone.0244362] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 12/08/2020] [Indexed: 01/23/2023] Open
Abstract
Anaemia and underweight or overweight/obesity are major public health problems driving maternal and child mortality in low- and middle-income countries. While the burden of these conditions is recognised, the evidence for the co-occurrence of these conditions is fragmented and mixed, especially at the individual level. Further, many studies have focused on families and communities. The different pathways for the occurrence of anaemia and BMI challenges indicate that an individual can potentially live with both conditions and suffer the complications. This study examined the prevalence and factors associated with the co-occurrence of anaemia and BMI challenges among a cohort of women in Ghana. Data from the 2014 Ghana Demographic and Health Survey were used. The sample size was 4 337 women aged 15-49 years who were not pregnant during the survey. Women who suffered simultaneously from underweight or overweight/obesity and anaemia were considered as having the double burden of malnutrition. The data were analysed using descriptive statistics, Chi-square test and logistic regression in STATA. One-fifth of the participants were overweight (21%), 4% were underweight and about one-tenth were obese (12%). The prevalence of anaemia was 41%. Only one in three women had normal weight and was not anaemic (34%). About 14% of the women experienced the double burden of malnutrition. Being overweight and anaemic (57%) was the most common form of this double burden. Age, marital status, parity, and wealth were t key risk factors associated with the double burden of malnutrition. The findings from this study show that women experience multiple nutritional challenges concurrently and that only a few women had healthy nutritional status. This information is particularly important and can be introduced into health education programmes to help address misconceptions about body weight and health.
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Affiliation(s)
- Sandra Boatemaa Kushitor
- Food Security Initiative and Centre for Complex Systems in Transition, Stellenbosch University, Stellenbosch, South Africa
| | - Lily Owusu
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Mawuli Kobla Kushitor
- Department of Health Policy, Planning and Management, University of Health and Allied Sciences, Hohoe, Ghana
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