DEVELOPMENT OF FOOD-BASED DIETARY RECOMMENDATIONS FOR CHILDREN, 6-23 MONTHS OLD, IN KARAGA DISTRICT AND GOMOA EAST DISTRICT, GHANA

Abstract

Optimal child feeding practices are essential to growth, health and development during infancy and early childhood. Undernutrition is an underlying factor in 53% of children’s deaths globally accounting for more than a third of child deaths. The immediate consequences of poor nutrition during the early formative years include significant morbidity, mortality and delayed mental and motor development. In the long term, early nutritional deficits are linked to impairment in intellectual performance, work capacity, reproductive outcome and overall health during adolescence and adulthood. It is well documented that the period from pregnancy to 23 months of age is a critical window for the promotion of optimal growth, health, behavioral and economic development (Black et al, 2013; Victora et al, 2008). Inappropriate feeding practices during this period can have profound consequences for the growth, development and survival of infants and children.

Statistics from the 2012 State of the World’s Children report indicate that about 40% of children in Sub-Saharan Africa are moderately to severely stunted (UNICEF, 2012). Over the past two decades, the prevalence of childhood stunting has hovered around 30% in Ghana, leading to the country’s inclusion, in 2008, in the list of 36 high-burden countries for malnutrition (Black et al, 2008). Ghana also has unacceptable rates of underweight and wasting as well as a high burden of micronutrient deficiencies among children, with a childhood anemia rate in excess of 70% (GSS et al, 2015).

Despite progress in economic growth and poverty reduction over the past decade, critical food security and nutrition problems still persist in Ghana with the three northern regions having the greatest burden. As many as 1.2 million Ghanaians are considered food insecure and chronic under-nutrition, though decreasing in the past five years, still affects about a quarter of Ghanaian children under 5 years of age (GSS et al., 2011). The recent 2014 GDHS, however, shows that there are considerable gains in efforts to reduce the rates of malnutrition although regional and urban/rural disparities still remain (GSS et al., 2015). Prevalence of stunting, underweight and wasting are down from the 2008 GDHS estimates of 28%, 14% and 8% to 19%, 11% and 5% for stunting, underweight and wasting, respectively. Significantly, of the four regions with the highest prevalence rates of stunting, the Central, Eastern and Upper East regions saw marked reductions from the 2008 estimates of 34%, 38% and 36% to 12%, 21% and 22%, respectively, while prevalences for the Northern region still remain high at 33%. Whilst anemia prevalence has also reduced from 78% to 66%, rates for the three northern regions and the Central Region remain unchanged at over 70%, with the Northern region again leading at 82%. The indications from this are that other micronutrient deficiencies are likely to be highly prevalent.

Child malnutrition and, particularly, micronutrient deficiencies primarily result from diets which do not meet energy and nutrient requirements to support the rapid growth of infants and young children. Ensuring optimal infant and young child feeding (IYCF) practices, including optimal complementary feeding practices, has been identified as one of the most effective public health interventions to improve child survival in developing countries (Bhutta et al, 2013). UNICEF and WHO recommend that children be exclusively breastfed during the first 6 months of life and not be given water, juices, other milks, or complementary foods. From age 6 months, children should be given solid or semi-solid complementary food in addition to continued breastfeeding until the child is fully weaned. The IYCF practices recommend that breastfed children be fed from three or more food groups at least twice a day for children 6–8 months, and at least three times a day for children 9–23 months. Infants should not be given complementary foods until six months of age. For non-breastfed children, it is recommended that they receive milk or milk products and foods from four or more food groups at least four times a day. The WHO, in the Global Strategy for Infant and Young Child Feeding, also emphasizes the use of suitable locally available foods while introducing complementary foods (WHO, 2002).

The 2008 GDHS (GSS et al, 2011) indicates that the majority of infants and young children aged 6 – 23 months in Ghana are not being fed appropriately. Overall only 36% of infants and young children meet the minimum IYCF standards. The 2014 GDHS (GSS et al, 2015) paints an even more dismal picture. Using the minimum acceptable diet indicator to assess adequacy of IYCF practices, only 13% of 6 – 23 month old children meet the criteria for being fed appropriately for their age. The breakdown by age group shows that infants 6 – 11 months (i.e. 6% for the 6 – 8 month age group and 10% for the 9 – 11 month age group) are the most vulnerable. The promotion, protection and support of optimal breastfeeding together with appropriate complementary feeding are recognized as key public health strategies for child survival. Continued efforts are therefore needed to understand the myriad of social, cultural and economic influences on child feeding practices in order to develop promising and sustainable interventions to improve the feeding of infants and young children in Ghana and especially those living in rural communities.

Continued efforts are needed to develop promising and sustainable interventions to achieve optimal IYCF in Ghana. Following the re-echo of collaboration across different development sectors as a key requirement to fight malnutrition globally (Gillespie et al, 2013), there is growing interest and investment in understanding how programmatic linkages between agriculture and nutrition can contribute to improved nutritional status, especially in agrarian communities. In line with the above, USAID aims to improve IYCF through strengthening linkages between agriculture and nutrition and one of the first steps is to identify strategies to improve the nutritional quality of the diet of infants and young children based on locally available and affordable foods. USAID therefore commissioned GAIN (Global Alliance for Improved Nutrition) to conduct a Focused Ethnographic Study (FES; Pelto et al, 2013; Pelto and Armar-Klemesu, 2011) and dietary analysis using Optifood software for linear programming (Ferguson et al, 2006). The ultimate aim is to identify a set of evidence-based, population-specific, food-based recommendations (FBRs) that can be promoted to improve the nutritional status of infants and young children in farming communities of Ghana. This report focuses on the Optifood component of the overall study and describes results for Karaga District in Northern Ghana and Gomoa East District in Central Ghana.