Agro‐ecological zone and farm diversity are factors associated with haemoglobin and anaemia among rural school‐aged children and adolescents in Ghana

Abstract

Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school-aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6-9 years; n = 323) and adolescents (10-17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro-ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro-ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro-ecological zone and age were predictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro-ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.

Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient–Fortified Biscuits among Adolescent Girls in Northeastern Ghana

“…Hence, data on nutrition and health in the district are scanty. Moreover, the district is mainly rural (∼91%), and our secondary analysis ( 30 ) suggests a very high prevalence (64.6%) of anemia among adolescent girls in the rural northern savannah agro-ecological zone. Last, the district capital is only ∼1 h drive from Tamale, the regional capital and location of the University for Development Studies (UDS), which coordinated the fieldwork.…”

“…The RCT sample size calculation was based on 80% power, a 1-sided hypothesis at 5% significance level for 3 variables: hemoglobin (Hb), serum ferritin (SF), and serum retinol. The SD for Hb in this population was 12.9 g/L (for both anemic and nonanemic girls) and 8.4 g/L (for only anemic girls) ( 30 ). Therefore, to detect a difference in mean Hb of 3.83 g/L between the MMB and UB groups required 141 girls per group for a nontargeted approach and 122 girls per group for only anemic girls.…”

“…For ethical reasons, a nontargeted approach that did not distinguish anemic and nonanemic girls was used to include a random subsample ( n = 620) of girls from the RCT survey. The nontargeted approach was also justified by the high prevalence of anemia (64.6%) among female adolescents in the rural northern savannah agro-ecological zone of Ghana ( 30 ). The nontargeted approach was previously used in similar efficacy trials and proved to be effective ( 43 , 73 , 74 ).…”

“…Also, there is increasing evidence of inadequate micronutrient status among girls ( 27 , 28 ), and particularly iron deficiency anemia (IDA) ( 17 ), a result of the increased iron needs during periods of rapid growth and blood loss during menstruation after menarche ( 17 , 29 ). In a recent analysis, ∼64.6% of rural adolescent girls were anemic in the northern savannah agro-ecological zone of Ghana ( 30 ). Despite the increasing evidence of inadequate micronutrient status among adolescent girls, nutrition intervention programs in Ghana, like in other developing contexts, have commonly focused on infants, young children, and pregnant and lactating women, and generally neglected adolescents.…”

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003–2014 Ghana demographic and health survey (GDHS) data

“…for girls (12,13) . The 2014 Ghana demographic and health survey (GDHS) (14) indicates that 14•0 % of 15-19-year-old female adolescents are thin, and 9•0 % are overweight; other studies show that 44•0 % of rural Ghanaian adolescent girls aged 10-19 years are anaemic, being higher than 60•0 % in the northern and coastal savannah agro-ecological zones (15) . This confirms the presence of the double burden of malnutrition among adolescents in Ghana, which has adverse effects on attained height (16) , productivity later in life (17) and cardiovascular risk (18) .…”