Impact of an education intervention addressing risk factors for iron deficiency among mothers and their young children in Northern Ghana

[摘要] English: When anemia prevalence in a population is above 40%, as is the case in Northern Ghana among children (81%) and women of reproductive age (59%), it may be assumed that the entire population suffers from some degree of iron deficiency (ID). This study aimed to assess the socio-demographic profile, nutritional status, and knowledge, attitude and practices (KAP), regarding known risk factors for ID/anemia and pica, among mothers and their children six to 59 months old in Northern Ghana; and to design, implement and evaluate a nutrition education programme (NEP) to address the gaps identified at baseline. A questionnaire on socio-demographics, household food production, food frequencies, household food security (CHIPP index), and three 24-hour recalls, KAP regarding pica (excessive craving/eating of food and/or non-food substances) and ID were administered via structured interviews; and BMI and Z-Scores were assessed among non-pregnant mothers with children (six to 59months) in Tolon-Kumbungu district (Gbullung (n=81 mothers; 85children) and Tamale metropolitan (Tugu & Tugu-yepala (n=80) mothers; 90 children). Dietary intakes were analysed with the Ghana Nutrient Database® (Version 6.02). Iron intakes were assessed by the probability method at 5% and 10% bioavailability, and vitamins A, B12, folate and vitamin C intakes were evaluated in relation to estimated average requirements (EAR) cut-points. Data was analysed with SAS® version 16.0. At baseline the mean age for mothers was 33.0 ± 8.3 years. Most were from the Dagomba ethnic group; practiced the Muslim religion (98.1%), and were married (97.5%) in polygamist marriages. Over 90.0% had no formal education. More than half the households were food insecure. A usual daily intakes consisted of (of maize meal (tuo zaafi (TZ)) (mostly whole) 96.2%), green leafy vegetables (7%) (mostly amaranth leaves), shea butter and tea. Legumes and nuts were included on a weekly basis and meat, eggs and citrus fruits occasionally. Children had basically the same dietary patterns. Based on 24-hour recall, inadequate intakes of protein (30%), and vitamin B12 (94.4%) were observed. Similarly, inadequate intake of vitamin A (58.5%), vitamin B12 (98.2%), and vitamin C (21.3%) were observed for children. Mean fibre intakes were 47.8 ± 19.0 among mothers and 19.8 ± 13.9 g/day among children. At an assumed bioavailability of 5% , 80.3% of mothers and 67.3% of the children, had probable inadequate intakes of iron. A tenth of mothers were underweight and 11.3% overweight/obese. About half of children (47.3%) were stunted (�?2SD), 38.0% (�?2SD) underweight, and 17.2% (�?2SD) wasted. The knowledge scores of the mothers were below average regarding sources of iron and enhancers of iron absorption. Pica practice was reported among 16.8% of mothers and 9.0% of children; and among 29.3% of pregnancies with the index children; mostly for clay, kola nuts and soil. A child's current pica practice was significantly associated (p=0.002) with his/her mother's pica practice when she was expecting him/her. Mother's views on pica were mostly negative and they thought it was untreatable. Gaps identified from the baseline survey, were summarised into 10 themes, and translated into key messages presented in July, 2013, as a 5-day (90 minutes/day) NEP in the Tolon-Kumbungu district, while Tamale Metropolis was the control. Three months after the intervention (attrition: 20 mothers, 23 children), the data collection were repeated in both the original groups of mothers. For both mother and children inadequate intakes of vitamins A, B12, protein and iron persisted. BMI, HAZ and WHZ decreased from baseline in both groups with a significantly higher (p<0.05) decrease in the intervention group. A significant improvement in total score on knowledge of iron sources and iron absorption enhancers was observed in both the intervention (p<0.0001) and control (P=0.0016) groups. Hand washing was the most practiced key message. Financial constraint and lack of social support was the main challenges to behavioural change. Post-intervention 12.8% of mothers in the intervention group mentioned anemia/ID as a possible cause of pica, and 7.1% stated that when you treat ID/Anemia, pica may also be treated compared to 1.4% in the control group. Conclusion: A context specific NEP on ID and pica improved the knowledge on iron sources, and mother's ability to associated pica with ID, but did not improve nutrient intake or anthropometry at three months post intervention.

[发布机构] University of the Free State