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Background: The rapid biological and physical changes during adolescence require adequate nutrient intake. This study assessed dietary diversity and nutritional status of adolescents living in selected rural areas in Ghana. Method: In this cross-sectional study, 137 young adolescents, aged 10 to 14 years were recruited. Structured questionnaire was used to collect data on sociodemographic, household size and food intake practices. A multiple past 24-hour recall was used to estimate the micronutrients intake. Haemoglobin and anthropometry data were assessed. Dietary diversity score was assessed with 10 food groups described by Food and Agricultural Organization. Descriptive, chi-square, binary regression and partial correlation were used in the data analysis. Results: The prevalence of underweight was 5.5%, overweight 5.8% and anaemia 29.9%. The mean dietary diversity score was 3.8 ± 0.8 and about 84.7% of participants had inadequate dietary diversity. Proportions of adolescents who consumed from the different food groups over a 24-hour period were: grains, white roots and tubers, plantain (100%); pulses (10.2%); nuts and seeds (34.1%); dairy (8%); meat, poultry and fish (86.9%); eggs (7.3%); dark green leafy vegetables (29.9%); other vitamin-A rich fruits and vegetables (2.2%); other vegetables (81%); other fruits (7.3%). Dietary diversity scores were positively and significantly correlated with intake of micronutrient, with correlation coefficients of .169, .186, .191, .173 and .175 for vitamin A, niacin, vitamin B6, iron and zinc, respectively. Meal skipping (AOR = 12.2, P < .001, 95% CI: 3.6-41.7) and snacking (AOR = 5.0, P = .007, 95% CI:1.6-16.7) increased odds of inadequate dietary diversity. Conclusion: The high prevalence of inadequate dietary diversity was positively related to meal skipping and snacking among adolescents. Dietary diversity score was significantly related to the intake of vitamin A, niacin, vitamin B6, iron and zinc. The prevalence of anaemia among our study participants is of public health concern. Adolescents should be encouraged both at home and school to eat from diverse food groups to promote adequate intake of micronutrients.

Objective To assess the prevalence and factors associated with optimal breastfeeding among health workers in the Kumasi metropolis of Ghana. Methods This was a mixed methods cross-sectional study conducted in four hospitals in Kumasi, Ghana. One hundred and eighty female health workers responded to a structured questionnaire and eight were engaged in a focus group discussion. Aspects of optimal breastfeeding assessed were early initiation of breastfeeding, exclusive breastfeeding and breastfeeding duration. Data were also collected on breastfeeding barriers and infant feeding knowledge. Descriptive statistics and odds ratios were generated for the quantitative data, and thematic analysis was conducted for the qualitative data. Results We found that most (73%) of the health workers initiated breastfeeding within one hour after delivery. However, nearly half (49%) did not practice exclusive breastfeeding for six months. Cesarean section delivery was associated with lower odds of initiating breastfeeding within one hour after birth compared to vaginal delivery (AOR = 0.10, 95% CI 0.05,0.23, p  < 0.001). Early work resumption (Resuming work less than four months after delivery) reduced the odds of practicing exclusive breastfeeding for six months (AOR = 0.50, 95% CI 0.27,0.92, p  = 0.026). Cesarean-section delivery, short maternity leave, family influences and work-related barriers were the themes that emerged as barriers to optimal breastfeeding. Conclusion Health workers experience work-related barriers and limited social support when breastfeeding after delivery. Therefore, policies should address these barriers to encourage optimal breastfeeding among health workers.

Studies have reported a poor diet quality among children in Ghana and other developing countries. Inadequate dietary diversity among children may lead to deficiencies in micronutrient intake necessary for growth and other cognitive functions. Understanding factors associated with infants' diverse diets is a key step to promoting adequate infant and young child nutrition. This study sought to determine the factors associated with food consumption and dietary diversity (DD) among infants. In this cross-sectional study among 1503 mothers-infant (aged 6-18 months) pairs from rural, urban, and peri-urban districts of Ashanti Region, factors associated with food consumption and DD were evaluated. The FAO 18-food group DD questionnaire was used to determine previous food group intake, while a structured questionnaire was used to capture data on the mother's socio-demographic parameters and child morbidity. Data were analyzed using descriptive statistics, the Chi-square test, and binary logistic regression to compare mothers and infants who had adequate and inadequate DDS of 9 out of 18 food groups and the predictors of dietary diversity. About 64.7% of the infants did not meet the minimum dietary diversity. Over two-third (77.4%) of the children consumed maize porridge the previous day. Foods which were less consumed included vegetables (35%), animal milk (38.9%), and meat (organ 14%, any meat 26%). The mean food group intake from 18 food groups was 7.0, and the majority (64.7%) did not meet the recommended 9 food group intake. Significantly more younger children (6-11 months) (74%, p<0.001) compared with older children (12-18 months) (52.5%) did not meet the minimum DDS. Also compared with the older children, the younger ones had above two times increased odds of inadequate DD (OR = 2.5, p<0.001, 95% CI = 1.4-4.4). When controlled for gender, children from peri-urban areas (OR = 5.2, p = 0.260, 95% CI = 0.2-93.2) and rural areas (OR = 1.8, p = 0.650, 95% CI = 0.2-9.3) had increased odds of lower DD than urban children. Children of unemployed caregivers had an increased odds of low DD (OR = 2.3 p<0.001, 95% CI 1.7-3.2) compared with children of employed caregivers. Finally, children of caregivers with better nutrition knowledge (nine correct answers from 12 questions) had lower odds of having lower dietary diversity (adjusted OR = 0.9, p = 0.85, 95%CI = 0.5-1.6) than those with less knowledge. Low DD was common among infants and associated with infants age, caregivers' areas of residence, employment status, and level of nutrition education. Children who did not meet the minimum dietary diversity were not fed particular foods such as vegetables, animal milk, and organ meat. Proper maternal nutrition education and feeding practices targeting age-specific needs and community livelihood support systems are necessary to improve dietary diversity of infants.

Good nutritional status of school-aged children is crucial in achieving improved cognition. The objective of this study was to assess the relationship between nutritional status and cognition of school-aged children in the Kumasi metropolis, Ghana. 389 children were selected from ten government-owned schools. Socio-demographic and anthropometric data were collected. Blood samples were collected and analyzed for nutrients levels. Dietary intakes were assessed using food frequency questionnaire and previous day's nutrients intake. Cognition test was performed using the Ravens Colored Progressive Matrix (RCPM). Mean age of participants was 8.9±1.4 years, mean RCPM score was 17.9±5.4. More girls scored RCPM below the 40th percentile (45.5%) than boys (33.7%), while mother's level of education significantly associated with RCPM percentiles of the children (p = 0.037). Four dietary patterns were generated from food frequency data, and scores of the second pattern, depicting vegetables, non-fruits, bread and cereals, showed a weak negative correlation (r = -0.132, p = 0.026) with previous day's dietary zinc intake. Cognitive status did not vary by anthropometric and dietary patterns. More anemic (54.4%) than non-anemic (33.3%) children were below the 40th RCPM percentile. Mean previous day's intake for folate (p<0.001), vitamin B6 (p = 0.018), iron (p<0.001), and zinc (p = 0.001) differed significantly between the cognitive test score percentiles of the children. Spearman rank correlation showed weak positive associations between RCPM score and hemoglobin (r = 0.246, p = 0.003) and serum ferritin (r = 0.176, p = 0.036). Binary regression analysis showed anemic children (aOR = 0.4; 95%CI = 0.2-0.8, p = 0.014), compared with non-anemic had decreased odds, while boys, compared with girls had increased odds (aOR = 2.0 95%CI = 1.0-4.0, p = 0.035) for scoring above the 50th RCPM percentile. Iron status, especially hemoglobin levels, correlated with the cognitive performance of school-aged children in the metropolis. Thus nutritional strategies aimed at reducing iron deficiency anemia are needed.

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

Vitamin D deficiency remains a significant public health concern especially in Ghana. In pregnant women, it has been associated with various adverse maternal and neonatal outcomes. However, there is inadequate standard measures to reduce vitamin D deficiency and improve total antioxidant capacity (TAC). For the first time, this study investigated the effectiveness of vitamin D fortified probiotic yogurt intake on serum vitamin D and total antioxidant capacity levels in pregnant women in Ghana. This single blinded randomized controlled trial study included 126 (63 fortified and 63 non-fortified group) pregnant women within their first trimester attending antenatal care at selected hospitals in the Ashanti Region, Ghana. Participants were followed up for 6 months. Sociodemographic and clinical data were collected. Venous blood samples were also collected at baseline and end line for serum 25(OH)D and TAC quantification using ELISA (Thermo scientific). Statistical analyses were done in SPSS version 26.0 and R Language version 4.4.4. The baseline Vitamin D deficiency was 88.1% and weak TAC was 73.0%, however not statistically influenced by sunlight exposure ( p  > 0.05). Besides, race of participants ( p  = 0.003) was significantly associated with Vitamin D deficiency. Moreover, Vitamin D deficiency (86.5% vs. 13.5%; p  = 0.985) and weak TAC (84.8% vs. 15.2%; p  = 0.351) were more predominant among pregnant women with inadequate dietary pattern, however not statistically significant. At end line, fortified study group had significantly higher levels of Vitamin D ( p  < 0.01) and TAC ( p  < 0.0001) compared to non-fortified group with higher Vitamin D deficiency (93.0%; p  = 0.022) and weak TAC (55.8%: p  < 0.0001). The prevalence of Vitamin D deficiency and low total antioxidant capacity (TAC) among pregnant women is notably high, especially among Ghanaian populations. Targeted interventions, such as Vitamin D fortification during pregnancy, are essential to enhance Vitamin D and TAC levels, potentially reducing adverse maternal and neonatal outcomes. Trial registration: The Pan African Clinical Trial Registry (PACTR), Random Controlled Trial PACTR202408762065192 on 21st August 2024. Retrospectively registered.

This paper explores the characteristics of Ghanaian households' consumption of obesogenic versus protective foods, including their retail, distribution, and origin. A household food consumption survey was conducted using an adapted Prospective Urban and Rural Epidemiology study Food Frequency Questionnaire. Product pathways for selected obesogenic (processed meat, Sugar-Sweetened Beverages, and biscuits) and protective (cooked vegetables, legumes, and fish) foods were traced from retailers through distributors/wholesalers to producers. Rural and urban communities in the Ashanti Region and selected retail/wholesale/producers nationwide. 612 households, 209 retailers and 185 wholesalers/distributors. About 20% of households consume Sugar-Sweetened Beverages (SSB) and confectionery weekly, and just 2% consumed processed meat. Of the protective foods, fish had the highest proportion of households consuming weekly (74.5%), followed by cooked vegetables (53.1%) and legumes (22.8%). Frequent SSB consumption is higher in younger (p<0.001), male (p=0.010), urban (p<0.001), and more educated (p<0.001) food purchaser households. Below 10% of households followed the healthiest dietary pattern (high-protective-and-low-obesogenic) but higher in older and more educated food purchaser households. In contrast, most households (about 80%) consumption patterns did not discriminate between obesogenic and protective foods. Generally, characteristics of purchasers from retail/wholesale outlets agree with those of households, where obesogenic foods were retailed to younger, less educated buyers than older, more educated ones. While the protective foods had a strong local producer presence, the obesogenic foods were predominantly imported. Household consumption and retail/distribution of obesogenic foods are associated with socio-demographic characteristics, but obesogenic foods are almost entirely produced outside Ghana. Policies that regulate importation on health grounds can promote a healthier food environment.

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

This study aimed to determine differences in food consumption by the NOVA food categories in South Africa and Ghana and how they relate to poverty and food supply systems. This study used a cross-sectional design to assess household food acquisition and lived poverty index. The study was conducted in Khayelitsha and Mount Frere, urban and rural communities in South Africa, respectively, and Ahodwo and Ejuratia, urban and rural communities in Ghana, respectively. An adult in charge of or knowledgeable about household food acquisition and consumption was selected to participate in the study. A total of 1299 households participated in the study. Supermarkets were a prominent source of ultra-processed foods for households in South Africa, while informal outlets were an important source of ultra-processed foods in Ghana. Consumption of unprocessed foods was higher among South African households (58·2 %) than Ghanaian households (41·8 %). In South Africa, deprivation was associated with increased odds of infrequent consumption of both unprocessed foods (OR 3·431 < 0·001) and ultra-processed foods (OR 2·656 < 0·001) compared with non-deprivation. In Ghana, no significant differences were observed between deprived households and non-deprived households in relation to the consumption of the NOVA food classes. Different food supply systems and poverty are associated with household acquisition of the different NOVA food classes. Policies should be geared towards formal shops in South Africa and informal shops in Ghana to reduce the consumption of key obesogenic foods.

Iron Deficiency Anaemia (IDA) is reportedly high in pregnant adults and the causes well studied. However, among pregnant teenagers, the levels and associated factors of IDA are not fully understood. In a prospective cohort study among Ghanaian pregnant teenagers, aged 13-19 years, IDA prevalence and associated factors were investigated. Sociodemographic data, household hunger scale (HHS), lived poverty index (LPI), FAO's women's dietary diversity score (WDDS) and interventions received during antenatal care (ANC) were obtained from 416 pregnant teenagers in Ashanti Region, Ghana. Micronutrient intakes using a repeated 24-hour dietary recall, and mid-upper arm circumference (MUAC) were determined and blood samples analysed for haemoglobin (Hb), serum levels of ferritin, prealbumin, vitamin A, total antioxidant capacity (TAC), C-reactive protein (CRP), and zinc protoporphyrin (ZPP). Anaemia (Hb cutoff <11.0 g/dL) was 57.1%; deficient systemic supply of iron stores (31.4%), depleted body stores of iron (4.4%), inadequate dietary iron intake (94.5%), and inadequate multiple micronutrient intakes (49.5%), were all notable among study participants. Between-subject effects using Generalized Linear Modelling indicated malaria tablet given at ANC (p = 0.035), MUAC (p = 0.043), ZPP (p<0.001), ZPP/Hb ratio (p<0.001) and depleted body iron stores (DBIS) (p<0.001) to significantly affect Hb levels. Pregnant teenagers with a high ZPP/Hb ratio (OR = 9.7, p<0.001, 95%CI = 6.0-15.8) had increased odds of being anaemic compared to those with normal ZPP/Hb ratio. Participants who were wasted (OR = 1.2, p = 0.543, 95%CI = 0.6-2.3), and those with depleted iron stores (OR = 3.0, p = 0.167, 95%CI = 0.6-14.6) had increased odds of being anaemic. Participants who experienced hunger were close to 3 times more likely (OR = 2.9, p = 0.040, 95%CI = 1.1-7.8) for depleted iron stores, compared to those who did not experience hunger. Also, participants with inadequate multiple micronutrients intakes (OR = 2.6, p = 0.102, 95%CI = 0.8-8.4), and those with low serum levels of ferritin (OR = 3.3, p = 0.291, 95%CI = 0.4-29.2) had increased odds of depleted body iron stores. IDA is common among pregnant teenagers and the related factors include malaria tablets given at ANC, maternal hunger, maternal MUAC, a deficient systemic supply of iron, depleted body iron stores, ZPP, and ZPP/Hb ratio. Appropriate interventions are urgently needed to address the causes of IDA among pregnant teenagers.