Background: School feeding offers an excellent opportunity for targeted intervention to students ... more Background: School feeding offers an excellent opportunity for targeted intervention to students not only as means for improving educational outcomes but also enhancing nutritional outcomes. The Government of Ghana introduced the free lunch feeding policy for nonresidential students in senior high schools (SHS) in 2018. Objective: We assessed unintended benefits of the free lunch program to dietary improvement. Methods: This was an analytical cross-sectional study among 403 (202 beneficiary and 201 non-beneficiary) students in SHS. The Food and Agriculture Organization’s standard procedure for measuring dietary diversity score (DDS) was followed. A 3-day dietary recall was used to assess school day DDS, while a 24-hour recall was used to assess weekend DDS of students. Differences in DDS and food group consumption were determined using student t test and χ2 test, respectively. Results: Nearly all (98.5%) beneficiary students consumed the free school lunch and 7 (70%) in 10 of them c...
Background: Middle childhood and adolescence are critical times for the growth, development, and ... more Background: Middle childhood and adolescence are critical times for the growth, development, and establishment of healthy eating habits. The Europe and Central Asia (ECA) region has been through economic and nutrition transitions over the past 20 years, which are likely to have affected the nutritional status of this group. Objective: This review aimed to collate data on the nutritional status and dietary patterns of school-aged children (SAC) and adolescents (5-19 years) across the ECA region in order to inform policy and programming decisions. Methods: A systematic search of the literature in Pubmed, Cochrane, and ScienceDirect databases was conducted (April 2019), complemented by a systematic review of nationally representative surveys. Inclusion criteria were any data on micronutrient deficiencies, overweight, stunting, wasting, thinness, or dietary patterns in SAC and adolescents in the 21 UNICEF-defined countries of ECA, published since the year 2000. Results: Results included 134 published papers and 6 sources of survey data. The majority of studies were conducted in Turkey (56%), with all other countries having fewer than 10 studies each; 8 countries in the region having no studies on this age group at all. The most significant nutrition issue was overweight and obesity. Micronutrient deficiencies, particularly anemia, emerge as a further challenge. Dietary patterns were worse in urban areas and boys. Conclusions: The findings of this review suggest that there are 3 critical areas that need immediate attention: the promotion of healthy diets and physical activity to address high levels of overweight/obesity, anemia prevention efforts, and addressing the considerable data gaps for SAC and adolescent nutrition.
Agriculture in West Africa faces the challenge of meeting the rising demand for food as national ... more Agriculture in West Africa faces the challenge of meeting the rising demand for food as national incomes and populations increase while production becomes more uncertain due to climate change. Crop production models can provide helpful information on agricultural yields under a range of climate change scenarios and on the impact of adaptation strategies. Here, we report a systematic review of the impact of climate change on the yield of major staple crops in West Africa. Unlike earlier reviews we pay particular attention to the potential of common agricultural adaptation strategies (such as optimised planting dates, use of fertilisers and climate-resilient crop varieties) to mitigate the effects of climate change on crop yields. We systematically searched two databases for literature published between 2005 and 2020 and identified 35 relevant studies. We analysed yield changes of major staple crops (maize, sorghum, rice, millet, yam, cassava and groundnuts) caused by different climate change and field management scenarios. Yields declined by a median of 6% (−8% to +2% depending on the crop) due to climate change in all scenarios analysed. We show that the common adaptation strategies could increase crop yields affected by climate change by 13% (−4% to +19% depending on the strategy) as compared to business-as-usual field management practices, and that optimised planting dates and cultivars with longer crop cycle duration could in fact offset the negative effects of climate change on crop yields. Increased fertiliser use has not mitigated the impact of climate change on crops but could substantially increase yields now and in the future. Our results suggest that a combination of increased fertiliser use and adopting cropping practices that take advantage of favourable climate conditions have great potential to protect and enhance future crop production in West Africa.
Introduction Despite the gains on exclusive breastfeeding (EBF), recent nationwide surveys have c... more Introduction Despite the gains on exclusive breastfeeding (EBF), recent nationwide surveys have consistently revealed a decline in EBF rates in Ghana. The World Food Programme implemented an intervention for Enhanced Nutrition and Value Chain (ENVAC) which was based on three pillars including pregnant women, lactating women, adolescent and children under two years old being beneficiaries of the third pillar since the first 1000 days are critical for averting malnutrition. The social behavior change communication (SBCC) interventions implemented as part of this project have a potential to increase EBF among beneficiaries but this has not been measured. Therefore, this study assessed the prevalence of EBF practice among mothers with children under two years old who were beneficiaries of the ENVAC project and its associated factors in northern Ghana. Methods This was a cross-sectional study involving 339 mother-child pairs in two districts of the northern region of Ghana. Participants ...
Purpose A lack of data, intervention studies, policies, and targets for nutrition in school-age c... more Purpose A lack of data, intervention studies, policies, and targets for nutrition in school-age children (SAC) and adolescents (5-19 years) is hampering progress towards tackling malnutrition. To stimulate and guide further research, this study generated a list of research priorities. Methods Using the Child Health and Nutrition Research Initiative (CHNRI) method, a list of 48 research questions was compiled and questions were scored against defined criteria using a stakeholder survey. Questions covered all forms of malnutrition, including micronutrient deficiencies, thinness, stunting, overweight/obesity, and suboptimal dietary quality. The context was defined as research focused on SAC and adolescents, 5 to 19 years old, in low-and middle-income countries, that could achieve measurable results in reducing the prevalence of malnutrition in the next 10 years. Results Between 85 and 101 stakeholders responded per question. Respondents covered a broad geographical distribution across ...
BackgroundThe coexistence of under- and overnutrition is of increasing public health concern in T... more BackgroundThe coexistence of under- and overnutrition is of increasing public health concern in The Gambia. Fruits, vegetables and pulses are essential to healthy and sustainable diets, preventing micronutrient deficiencies and non-communicable diseases, while cereals significantly contribute to energy intake. However, environmental changes are predicted to intensify, reducing future yields of these crops if agricultural productivity and resilience are not improved. The Gambia is highly climate-vulnerable and import-dependent, but the extent of its reliance on other climate-vulnerable countries for its supply of nutritionally important crops is currently unknown.MethodsWe used United Nations Food and Agriculture Organization data, with novel origin-tracing algorithms applied, to analyse The Gambia's supply of cereals, fruits, vegetables and pulses between 1988 and 2018. The climate vulnerability of countries was assessed using Notre Dame Global Adaptation Initiative (ND-GAIN) in...
Identifying and assessing adaptation options are key pre-requisite steps to adaptation prioritiza... more Identifying and assessing adaptation options are key pre-requisite steps to adaptation prioritization and effective adaptation planning. In this paper, we presented a systematic approach for adaptation stocktaking, combining a systematic mapping and an outcome-oriented and evidence-based assessment, illustrated using the case of The Gambia. This study systematically mapped 24 adaptation options that can potentially inform adaptation planning in The Gambia agriculture and food systems and assessed how the identified options contribute to the pillars of Climate-Smart Agriculture. Because of the paucity of evidence sources from The Gambia, we collated evidence from both The Gambia and the West Africa region. We found that many of the documented options, such as climate-resilient crop varieties, crop diversification, climate information use, and weather indexed-based insurance have the potential to increase agricultural productivity and income while building resilience to climate change...
Facilitating dietary change is pivotal to improving population health, increasing food system res... more Facilitating dietary change is pivotal to improving population health, increasing food system resilience, and minimizing adverse impacts on the environment, but assessment of the current ‘status-quo’ and identification of bottlenecks for improvement has been lacking to date. We assessed deviation of the Gambian diet from the EAT-Lancet guidelines for healthy and sustainable diets and identified leverage points to improve nutritional and planetary health. We analysed the 2015/16 Gambian Integrated Household Survey dataset comprising food consumption data from 12 713 households. Consumption of different food groups was compared against the EAT-Lancet reference diet targets to assess deviation from the guidelines. We computed a ‘sustainable and healthy diet index (SHDI)’ based on deviation of different food groups from the EAT-Lancet recommendations and modelled the socio-economic and geographic determinants of households that achieved higher scores on this index, using multivariable m...
Objectives We assessed deviation of the Gambian diet from the EAT-Lancet guidelines for healthy a... more Objectives We assessed deviation of the Gambian diet from the EAT-Lancet guidelines for healthy and sustainable diets and identified leverage points to improve nutritional and planetary health. Methods We performed secondary analyses using the recent Integrated Household Survey dataset comprising food consumption data from 12,713 households. Consumption of different food groups were compared against EAT-Lancet reference diet targets to assess deviation from the guidelines. We computed a “sustainable and healthy diet index” based on deviation of different food groups from the EAT-Lancet recommendations and modelled the socio-economic and geographic determinants of households that achieved higher scores on this index, using multivariable mixed effects regression. Results The average Gambian diet had very low adherence to EAT-Lancet recommendations. The diet was dominated by refined grains and added sugars consumption which exceed the recommendations. Consumption of important food grou...
Background: School feeding offers an excellent opportunity for targeted intervention to students ... more Background: School feeding offers an excellent opportunity for targeted intervention to students not only as means for improving educational outcomes but also enhancing nutritional outcomes. The Government of Ghana introduced the free lunch feeding policy for nonresidential students in senior high schools (SHS) in 2018. Objective: We assessed unintended benefits of the free lunch program to dietary improvement. Methods: This was an analytical cross-sectional study among 403 (202 beneficiary and 201 non-beneficiary) students in SHS. The Food and Agriculture Organization’s standard procedure for measuring dietary diversity score (DDS) was followed. A 3-day dietary recall was used to assess school day DDS, while a 24-hour recall was used to assess weekend DDS of students. Differences in DDS and food group consumption were determined using student t test and χ2 test, respectively. Results: Nearly all (98.5%) beneficiary students consumed the free school lunch and 7 (70%) in 10 of them c...
Background: Middle childhood and adolescence are critical times for the growth, development, and ... more Background: Middle childhood and adolescence are critical times for the growth, development, and establishment of healthy eating habits. The Europe and Central Asia (ECA) region has been through economic and nutrition transitions over the past 20 years, which are likely to have affected the nutritional status of this group. Objective: This review aimed to collate data on the nutritional status and dietary patterns of school-aged children (SAC) and adolescents (5-19 years) across the ECA region in order to inform policy and programming decisions. Methods: A systematic search of the literature in Pubmed, Cochrane, and ScienceDirect databases was conducted (April 2019), complemented by a systematic review of nationally representative surveys. Inclusion criteria were any data on micronutrient deficiencies, overweight, stunting, wasting, thinness, or dietary patterns in SAC and adolescents in the 21 UNICEF-defined countries of ECA, published since the year 2000. Results: Results included 134 published papers and 6 sources of survey data. The majority of studies were conducted in Turkey (56%), with all other countries having fewer than 10 studies each; 8 countries in the region having no studies on this age group at all. The most significant nutrition issue was overweight and obesity. Micronutrient deficiencies, particularly anemia, emerge as a further challenge. Dietary patterns were worse in urban areas and boys. Conclusions: The findings of this review suggest that there are 3 critical areas that need immediate attention: the promotion of healthy diets and physical activity to address high levels of overweight/obesity, anemia prevention efforts, and addressing the considerable data gaps for SAC and adolescent nutrition.
Agriculture in West Africa faces the challenge of meeting the rising demand for food as national ... more Agriculture in West Africa faces the challenge of meeting the rising demand for food as national incomes and populations increase while production becomes more uncertain due to climate change. Crop production models can provide helpful information on agricultural yields under a range of climate change scenarios and on the impact of adaptation strategies. Here, we report a systematic review of the impact of climate change on the yield of major staple crops in West Africa. Unlike earlier reviews we pay particular attention to the potential of common agricultural adaptation strategies (such as optimised planting dates, use of fertilisers and climate-resilient crop varieties) to mitigate the effects of climate change on crop yields. We systematically searched two databases for literature published between 2005 and 2020 and identified 35 relevant studies. We analysed yield changes of major staple crops (maize, sorghum, rice, millet, yam, cassava and groundnuts) caused by different climate change and field management scenarios. Yields declined by a median of 6% (−8% to +2% depending on the crop) due to climate change in all scenarios analysed. We show that the common adaptation strategies could increase crop yields affected by climate change by 13% (−4% to +19% depending on the strategy) as compared to business-as-usual field management practices, and that optimised planting dates and cultivars with longer crop cycle duration could in fact offset the negative effects of climate change on crop yields. Increased fertiliser use has not mitigated the impact of climate change on crops but could substantially increase yields now and in the future. Our results suggest that a combination of increased fertiliser use and adopting cropping practices that take advantage of favourable climate conditions have great potential to protect and enhance future crop production in West Africa.
Introduction Despite the gains on exclusive breastfeeding (EBF), recent nationwide surveys have c... more Introduction Despite the gains on exclusive breastfeeding (EBF), recent nationwide surveys have consistently revealed a decline in EBF rates in Ghana. The World Food Programme implemented an intervention for Enhanced Nutrition and Value Chain (ENVAC) which was based on three pillars including pregnant women, lactating women, adolescent and children under two years old being beneficiaries of the third pillar since the first 1000 days are critical for averting malnutrition. The social behavior change communication (SBCC) interventions implemented as part of this project have a potential to increase EBF among beneficiaries but this has not been measured. Therefore, this study assessed the prevalence of EBF practice among mothers with children under two years old who were beneficiaries of the ENVAC project and its associated factors in northern Ghana. Methods This was a cross-sectional study involving 339 mother-child pairs in two districts of the northern region of Ghana. Participants ...
Purpose A lack of data, intervention studies, policies, and targets for nutrition in school-age c... more Purpose A lack of data, intervention studies, policies, and targets for nutrition in school-age children (SAC) and adolescents (5-19 years) is hampering progress towards tackling malnutrition. To stimulate and guide further research, this study generated a list of research priorities. Methods Using the Child Health and Nutrition Research Initiative (CHNRI) method, a list of 48 research questions was compiled and questions were scored against defined criteria using a stakeholder survey. Questions covered all forms of malnutrition, including micronutrient deficiencies, thinness, stunting, overweight/obesity, and suboptimal dietary quality. The context was defined as research focused on SAC and adolescents, 5 to 19 years old, in low-and middle-income countries, that could achieve measurable results in reducing the prevalence of malnutrition in the next 10 years. Results Between 85 and 101 stakeholders responded per question. Respondents covered a broad geographical distribution across ...
BackgroundThe coexistence of under- and overnutrition is of increasing public health concern in T... more BackgroundThe coexistence of under- and overnutrition is of increasing public health concern in The Gambia. Fruits, vegetables and pulses are essential to healthy and sustainable diets, preventing micronutrient deficiencies and non-communicable diseases, while cereals significantly contribute to energy intake. However, environmental changes are predicted to intensify, reducing future yields of these crops if agricultural productivity and resilience are not improved. The Gambia is highly climate-vulnerable and import-dependent, but the extent of its reliance on other climate-vulnerable countries for its supply of nutritionally important crops is currently unknown.MethodsWe used United Nations Food and Agriculture Organization data, with novel origin-tracing algorithms applied, to analyse The Gambia's supply of cereals, fruits, vegetables and pulses between 1988 and 2018. The climate vulnerability of countries was assessed using Notre Dame Global Adaptation Initiative (ND-GAIN) in...
Identifying and assessing adaptation options are key pre-requisite steps to adaptation prioritiza... more Identifying and assessing adaptation options are key pre-requisite steps to adaptation prioritization and effective adaptation planning. In this paper, we presented a systematic approach for adaptation stocktaking, combining a systematic mapping and an outcome-oriented and evidence-based assessment, illustrated using the case of The Gambia. This study systematically mapped 24 adaptation options that can potentially inform adaptation planning in The Gambia agriculture and food systems and assessed how the identified options contribute to the pillars of Climate-Smart Agriculture. Because of the paucity of evidence sources from The Gambia, we collated evidence from both The Gambia and the West Africa region. We found that many of the documented options, such as climate-resilient crop varieties, crop diversification, climate information use, and weather indexed-based insurance have the potential to increase agricultural productivity and income while building resilience to climate change...
Facilitating dietary change is pivotal to improving population health, increasing food system res... more Facilitating dietary change is pivotal to improving population health, increasing food system resilience, and minimizing adverse impacts on the environment, but assessment of the current ‘status-quo’ and identification of bottlenecks for improvement has been lacking to date. We assessed deviation of the Gambian diet from the EAT-Lancet guidelines for healthy and sustainable diets and identified leverage points to improve nutritional and planetary health. We analysed the 2015/16 Gambian Integrated Household Survey dataset comprising food consumption data from 12 713 households. Consumption of different food groups was compared against the EAT-Lancet reference diet targets to assess deviation from the guidelines. We computed a ‘sustainable and healthy diet index (SHDI)’ based on deviation of different food groups from the EAT-Lancet recommendations and modelled the socio-economic and geographic determinants of households that achieved higher scores on this index, using multivariable m...
Objectives We assessed deviation of the Gambian diet from the EAT-Lancet guidelines for healthy a... more Objectives We assessed deviation of the Gambian diet from the EAT-Lancet guidelines for healthy and sustainable diets and identified leverage points to improve nutritional and planetary health. Methods We performed secondary analyses using the recent Integrated Household Survey dataset comprising food consumption data from 12,713 households. Consumption of different food groups were compared against EAT-Lancet reference diet targets to assess deviation from the guidelines. We computed a “sustainable and healthy diet index” based on deviation of different food groups from the EAT-Lancet recommendations and modelled the socio-economic and geographic determinants of households that achieved higher scores on this index, using multivariable mixed effects regression. Results The average Gambian diet had very low adherence to EAT-Lancet recommendations. The diet was dominated by refined grains and added sugars consumption which exceed the recommendations. Consumption of important food grou...
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