Van Den Berg, V. L.Louw, V.J.Abu, Brenda Ariba Zarhari2016-01-252016-01-252015http://hdl.handle.net/11660/2230English: 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.Afrikaans: Wanneer die voorkoms van anemie in 'n bevolking bo 40%, soos in Noord-Ghana die geval is onder kinders (81%) en vroue van reproduktiewe ouderdom (59%), kan dit aanvaar word dat die hele bevolking aan 'n mate van ystertekort ly. Hierdie studie het gepoog om die sosio-demografiese profiel, voedingstatus en kennis, houdings en praktyke (KHP), ten opsigte van bekende risikofaktore vir ID / bloedarmoede en pika te evalueer, onder moeders en hul kinders van ses tot 59 maande oud in Noord-Ghana; ‘n 'n voeding onderwys program te ontwerp, te implementer, en te evalueer om die die gapings geïdentifiseer by basislyn te spreek 'n Opname mbv ‘n gestruktureerde vraelys insluitende vrae mbt sosio-demografie, huishoudelike voedselproduksie, gewoontlike dieet, huishoudelike voedselsekuriteit (vlg CHIPP indeks), drie 24-uur herroepe, en KHP rakende pika (oormatige drang na / eet van nie-eetbare stowwe) en ystertekort; asook opnames van LMI en Z-tellings, is onder nie-swanger moeders met kinders (ses tot 59 maande) in die Tolon-Kumbungu distrik (in Gbullung (81 moeders, 85 kinders) en in die Tamale Metropool (in Tugu & Tugu-yepala (80 moeders; 90 kinders) uitgevoer. Dieetinnames is met die Ghana Nutrient Database® (weergawe 6.02) ontleed. Ysterinname is mbv die waarskynlikheidsmetode teen 5% en 10% biobeskikbaarheid geevalueer, en vitamiene A, B12, C, folaatinname is mbv geskatte gemiddelde vereistes (EAR) afsnypunte geëvalueer. Data is ontleed met SAS® weergawe 16.0. By basislyn was die gemiddelde ouderdom vir moeders 33.0 ± 8.3 jaar. Die meeste was van die Dagomba etniese groep; het die Moslem-godsdiens (98,1%) beoefen, en was getroud (97,5%) in poligamiese huwelike. Meer as 90.0% het geen formele opleiding gehad nie. Meer as die helfte van die huishoudings het nie voedselsekuriteit gehad nie. Gewone daaglikse inname het meestal uit onverfynde mieliemeel (tuo zaafi (TZ)) (96.2%), groen blaargroentes (7%) (meestal amarantblare), shea-botter en tee bestaan. Peulgewasse en neute is op 'n weeklikse basis ingesluit en vleis, eiers en sitrusvrugte slegs per geleentheid. Kinders het basies dieselfde dieetpatrone getoon. Gebaseer op 24-uur herroep, is onvoldoende inname van proteïen (30%) en vitamien B12 (94.4%) waargeneem. By kinders is onvoldoende inname van vitamien A (58,5%), vitamien B12 (98,2%), en vitamien C (21.3%) waargeneem. Gemiddelde veselinname was 47,8 ± 19.0 g/dag onder moeders en 19.8 ± 13.9 g/dag onder kinders. Met 'n veronderstelde biobeskikbaarheid van 5%, het 80,3% van die moeders en 67.3% van die kinders, waarskynlik onvoldoende yaterinname gehad. 'n Tiende van moeders was ondermassa en 11.3% oormassa / vetsugtig. Ongeveer die helfte van die kinders (47,3%) was groei-ingekort (≤-2SD), 38.0% (≤-2SD) ondermasssa, en 17.2% (≤-2SD) uitgeteer. Die kennistellings van die moeders was onder gemiddeld tov bronne van yster en faktore wat ysterabsorpsie bevorder. Pika is onder 16.8% van die moeders en 9.0% van kinders aangemeld; en onder 29.3% van swangerskappe met die indekskinders; meestal vir klei, kola neute en grond. 'n Kind se huidige pika-praktyk het beduidend verband gehou (p = 0,002) met sy / haar ma se pika-praktyk toe sy hom / haar verwag het. Moeder se standpunte oor pika was meestal negatiewe en hulle het gedink dit was onbehandelbare. Gapings wat uit die basislynopname geïdentifiseer is, is opgesom in 10 temas, en tot sleutelboodskappe verwerk, wat in Julie 2013, as 'n 5-dag (90 minute/dag) voedingsonderrig-intervensie in die Tolon-Kumbungu distrik geimplimenteer is, met die Tamale Metropolis as kontrol. Drie maande na die intervensie (uitval: 20 moeders, 23 kinders), is die data-insameling in beide die oorspronklike groepe moeders herhaal. Vir beide die moeder en kinders, is onvoldoende inname van vitamiene A, B12, proteïen en yster volgehou. BMI, HAZ en WHZ het vanaf basislyn afgeneem in beide groepe, maar die afname was beduidend hoër (p <0.05) in die intervensie groep. ‘n Beduidende verbetering in totale kennistelling mbt ysterbronne en faktore war ysterabsorpsie verbeter, is in beide die intervensie- (p <0.0001) en kontrole- (p = 0,0016) groepe waargeneem. Hande-was, was die sleutelboodskap wat die beste deur die intervensiegroep opgeneem is. Finansiële beperking en die gebrek aan sosiale ondersteuning was die belangrikste uitdagings vir gedragsverandering. Post-intervensie het 128% van die moeders in die intervensiegroep anemie / ystertekort as 'n moontlike oorsaak van pika genoem, en 7.1% het gesê dat wanneer anemie / ystertekort behandel word, pika sal verdwyn. Gevolgtrekking: 'n Konteks-spesifieke voedingsonderig-intervensie het kennis rakende ysterbronne en die moeder se vermoë om pika met ystertekort te assosieer, verbeter, maar het nie ‘n beteknisvolle affek op voedingstofinname of antropometrie teen drie maande post-intervensie gehad nie.enAnemia -- Nutritional aspects -- GhanaHealth education -- GhanaMothers -- Nutrition -- GhanaChildren -- Nutrition -- GhanaIron deficiency anemiaThesis (Ph.D. (Nutrition and Dietetics))--University of the Free State, 2015ThesisUniversity of the Free State