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Despite the importance of magnesium to health and most importantly to women of reproductive age who are entering pregnancy, very few surveys have investigated the magnesium status of women of reproductive age, particularly in Africa. Additionally, the software and programs used to analyze dietary intake vary across countries in the region. To assess the dietary magnesium intake of women of reproductive age in Ghana and to compare the estimate of magnesium intake obtained from two commonly used dietary analysis programs. We collected magnesium intake from 63 Ghanaian women using a semiquantitative 150-item food frequency questionnaire. Dietary data was analyzed using two different dietary analysis programs, Nutrient Data Software for Research (NDSR) and the Elizabeth Stewart Hands and Associates (ESHA) Food Processor Nutrition Analysis software. We used the Wilcoxon signed rank test to compare the mean differences between the two dietary programs. There were significant differences between the average dietary magnesium intake calculated by the two dietary programs, with ESHA estimating higher magnesium intake than NDSR (M±SE; ESHA: 200 ± 12 mg/day; NDSR: 168 ± 11 mg/day; p<0. 05). The ESHA database included some ethnic foods and was flexible in terms of searching for food items which we found to be more accurate in assessing the magnesium intake of women in Ghana. Using the ESHA software, 84% of the study women had intake below the recommended dietary allowances (RDA) of 320mg/day. It is possible that the ESHA software provided an accurate estimate of magnesium in this population because it included specific ethnic foods. Concerted efforts such as magnesium supplementation and nutrition education should be considered to improve the magnesium intake of women of reproductive age in Ghana.

Background Few studies have described the consequences of the COVID − 19 pandemic among caregivers of young adolescents in sub-Saharan Africa. We aimed to explore the consequences of COVID-19 on economic, socio-emotional, and household food security conditions among caregivers of young adolescents in a semi-urban setting in the Eastern Region of Ghana. Methods In this cross-sectional study, caregivers of young adolescents aged 10-12yrs in the Somanya-Kpong area were enrolled. These participants were part of the second follow-up of the iLiNS-DYAD Ghana trial. A questionnaire designed from the PhenX Toolkit COVID-19 Protocol and the Food Access and Food Security During COVID-19 Survey (Version 2.1) was used to collect data over 8 months starting January 2022. We used descriptive statistics to summarize data and McNemar Chi-square tests to compare percentages of agreement to statements of household food security conditions “ one year before” versus “ since” the pandemic outbreak. Results Among 966 caregivers (94% females; 6% males), 89% reported decreased household income compared with the year before the pandemic. Although 72.5% of caregivers continued working during the pandemic, most said they had experienced a reduction in their work hours (72.6%), workload (78.8%) and salaries (63.4%). Many (65%) said their children engaged in educational activities when schools were closed, with 46% hiring private teachers. Caregivers most frequently cited financial concerns (83%) and negative impact on work (79%) as their greatest sources of stress because of COVID-19. Significantly more caregivers reported experiencing household food insecurity conditions “ since the outbreak ” compared to “ one year before the outbreak ” (55.4% vs. 19.6%, P  < 0.05). Conclusions In this setting, COVID-19 had negative consequences on the economic, socio-emotional, and household food security conditions of caregivers and their young adolescents.

Nationally representative data on the micronutrient status of Ghanaian women and children are very scarce. We aimed to document the current national prevalence of micronutrient deficiencies, anemia, malaria, inflammation, α-thalassemia, sickle cell disease and trait, and under- and over-nutrition in Ghana. In 2017, a two-stage cross-sectional design was applied to enroll pre-school children (6-59 months) and non-pregnant women (15-49 years) from three strata in Ghana: Northern, Middle and Southern Belt. Household and individual questionnaire data were collected along with blood samples. In total, 2123 households completed the household interviews, 1165 children and 973 women provided blood samples. Nationally, 35.6% (95%CI: 31.7,39.6) of children had anemia, 21.5% (18.4,25.0) had iron deficiency, 12.2% (10.1,14.7) had iron deficiency anemia, and 20.8% (18.1,23.9) had vitamin A deficiency; 20.3%(15.2,26.6) tested positive for malaria, 13.9% (11.1,17.3) for sickle trait plus disease, and 30.7% (27.5,34.2) for α-thalassemia. Anemia and micronutrient deficiencies were more prevalent in rural areas, poor households and in the Northern Belt. Stunting and wasting affected 21.4% (18.0,25.2) and 7.0% (5.1,9.5) of children, respectively. Stunting was more common in rural areas and in poor households. Among non-pregnant women, 21.7% (18.7,25.1) were anemic, 13.7% (11.2,16.6) iron deficient, 8.9% (6.7,11.7) had iron deficiency anemia, and 1.5% (0.8,2.9) were vitamin A deficient, 53.8% (47.6,60.0) were folate deficient, and 6.9% (4.8,9.8) were vitamin B12 deficient. Malaria parasitemia in women [8.4% (5.7,12.2)] was lower than in children, but the prevalence of sickle cell disease or trait and α-thalassemia were similar. Overweight [24.7% (21.0,28.8)] and obesity [14.3% (11.5,17.7)] were more common in wealthier, older, and urban women. Our findings demonstrate that anemia and several micronutrient deficiencies are highly present in Ghana calling for the strengthening of Ghana's food fortification program while overweight and obesity in women are constantly increasing and need to be addressed urgently through governmental policies and programs.

Nutrition and the home environment contribute to the development of the autonomic nervous system (ANS). However, no study has examined the long‐term effects of prenatal and postnatal small‐quantity lipid‐based nutrient supplements (SQ‐LNS) and home environment on ANS regulation. We investigated the effect of early‐life SQ‐LNS and home environment on ANS regulation at 9–11 years. Participants were children born to women who participated in a randomized controlled trial in Ghana from 2009 to 2014. Women were randomized to receive daily, from pregnancy until delivery, either SQ‐LNS, multiple micronutrients (MMN) or iron and folic acid (IFA) followed by SQ‐LNS, MMN or placebo, respectively, until 6 months postpartum. Infants in the SQ‐LNS group received SQ‐LNS from 6 to 18 months. Quality of home environment was observed at 4–6 and 9–11 years. At 9–11 years, 965 children had their respiratory sinus arrhythmia (RSA) and pre‐ejection period (PEP) measured at baseline and during two inhibitory control tasks, the RACER Simon and Emotion Go/No‐Go (EGNG) tasks. PEP reactivity to the RACER Simon task was greater in the MMN (−2.54 ± 4.45, p = 0.016) and SQ‐LNS (−2.31 ± 4.94, p = 0.093) groups than in the IFA group (−1.57 ± 3.51). A better home environment at 4–6 predicted longer baseline PEP (β = 0.13, 95% CI: 0.02, 0.23, p = 0.016) and more PEP reactivity during the EGNG task (β = −0.06, 95% CI: −0.00, −0.02, p = 0.001). Prenatal micronutrient supplementation appears to increase SNS reactivity. Children raised in disadvantaged early home environments had more tonic SNS activation and less SNS reactivity, suggesting a predisposition for stronger fight‐or‐flight activation and less likelihood to modulate arousal in response to acute situations. Trial Registration: ClinicalTrials.gov identifier: NCT00970866 A long‐term follow‐up study of a randomized controlled trial found that children of mothers who received either prenatal and postnatal small‐quantity lipid‐based nutrient supplements or multiple micronutrient supplements had better cardiac sympathetic activity compared to those who received iron and folic acid. A better early childhood environment also predicted better sympathetic activity. Summary Evidence for the effect of prenatal and postnatal nutrient supplements and the home environment on autonomic nervous system development in children is needed. Children of mothers who received either small‐quantity lipid‐based nutrient supplements or multiple micronutrient supplements had better cardiac sympathetic activity compared to those who received iron and folic acid. The early childhood environment was also significantly associated with SNS regulation at 9–11 years. These findings highlight the importance of improving both early nutrition and the quality of the childhood home environment to improve ANS outcomes for children.

Objective It remains unclear which interventions are effective in promoting more environmentally sustainable food choices within online grocery shopping environments. We set out to (1) use a plug-in (browser extension) to implement a pilot randomised controlled trial of eco-labels providing information on the environmental impact of specific food products, and (2) collect data to inform a larger trial investigating the effectiveness of eco-labels and other interventions promoting environmentally sustainable online food purchases. The plug-in was custom-built and active on a large UK supermarket website, accessed using the Google Chrome browser on a desktop or laptop. Results Of the 504 participants screened, 161 met eligibility criteria and were invited to participate in the study. 57 of these downloaded the plug-in (23 in the control group, 34 in the intervention group), of which 22 shopped at least once over the 1-month trial. There was no significant difference in average eco-score of purchases between the control and intervention groups (mean ± SD: 32 ± 13 vs. 41 ± 14; p  = 0.22). 69/161 eligible participants responded to a follow-up survey and suggested technical support, reminders, greater incentives, and more information about eco-labels were needed for the full trial. We showed that it is feasible to evaluate online grocery shopping interventions without the collaboration of a supermarket using a web browser extension. Trial registration This pilot trial was not registered, as its main purpose was to test the implementation of the plugin and gather data useful for planning the main trial, which is registered under ISRCTN18800054 as of 27/03/2024.

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.

Low magnesium intake has been shown to be associated with an increased risk of type 2 diabetes mellitus (T2DM) in several studies conducted in high-income countries. However, very few studies have been performed in Africa, where many countries have a growing rate of T2DM. We conducted a pilot cross-sectional study among 63 women in Ghana to investigate the association between magnesium intake and glycemic markers. We assessed dietary magnesium using a food frequency questionnaire and glycemic markers using fasting blood glucose and glycated hemoglobin A1c (HbA1c). Our findings showed that the mean magnesium intake was 200 ± 116 mg/day. The prevalence of T2DM was 5% by measuring fasting blood glucose and 8% by measuring HbA1c. Unadjusted linear regression models revealed that higher magnesium intake significantly predicted higher fasting blood glucose levels (β = 0.31; 95% CI: 0.07, 0.55; p = 0.01) and HbA1c levels (β = 0.26; 95% CI: 0.01, 0.51; p = 0.04). In adjusted analyses, magnesium intake was no longer significantly associated with either fasting blood glucose levels (β = 0.22; 95% CI: −0.03, 0.46; p = 0.08) or HbA1c levels (β = 0.15; 95% CI: −0.08, 0.39; p = 0.20). In conclusion, our study did not show a significant association between magnesium intake and glycemic markers in women of reproductive age in Ghana. The results of this study need to be further substantiated because this was the first study to examine magnesium intake and glycemic markers in this population in Africa.

We aimed to identify factors (child diet, physical activity; maternal BMI) associated with body composition of Ghanaian pre-school children. Longitudinal analysis of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana randomized trial, which enrolled 1320 pregnant women at ≤20 weeks' gestation and followed them and their infants until 6 and 18 months postpartum, respectively. At follow-up, child age 4-6 years, we collected data on body composition (by 2H dilution), physical activity and diet, extracted dietary patterns using factor analysis, and examined the association of children's percentage body fat with maternal and child factors by regression analysis. Eastern Region, Ghana. Children 4-6 years of age. The analysis included 889 children with percentage body fat and dietary data at follow-up. We identified two major dietary patterns, a snacking and a cooked foods pattern. Percentage body fat was positively associated (standardized β (se)) with maternal BMI at follow-up (0·10 (0·03); P = 0·003) and negatively associated with physical activity (-0·15 (0·05); P = 0·003, unadjusted for child gender), but not associated with the snacking (0·06 (0·03); P = 0·103) or cooked foods (-0·05 (0·07); P = 0·474) pattern. Boys were more active than girls (1470 v. 1314 mean vector magnitude counts/min; P < 0·0001) and had lower percentage body fat (13·8 v. 16·9 %; P < 0·0001). In this population, maternal overweight and child physical activity, especially among girls, may be key factors for addressing child overweight/obesity. We did not demonstrate a relationship between the dietary patterns and body fatness, which may be related to limitations of the dietary data available.

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.

A child's endowment is a reflection of his/her genetic makeup and the conditions faced in early life. Parents build on their child's endowment by investing resources in their child, and together, a child's endowment and subsequent investments act as input into important later-life outcomes. A positive or negative shock to a child's endowment can have a direct biological effect on a child's long-term outcomes but may also affect parents' decisions about investments in the health and human capital of their children. Using follow-up data collected several years after a randomized trial in Ghana, we explored whether maternal and child supplementation with small-quantity lipid-based nutrient supplements (SQ-LNS) throughout much of the first 1,000 days influenced parental investments in the health and human capital of their children. Across the domains of family planning, breastfeeding, health, education, and paternal financial support, we found that, in general, the intervention did not affect investments in the treated child nor his/her untreated siblings. These results suggest that given production technologies, constraints, and preferences, the intervention either did not change parents' optimal investment strategies or that the effects of the intervention, namely increased birth size and attained length at 18 months of age, were too small for parents to perceive or to have any meaningful impact on parents' expectations about the returns to investments in their children.