Stories of Change in Nutrition in Ghana: a focus on stunting and anemia among children under-five years (2009 – 2018)

Abstract

The current study aimed to understand why child stunting and anemia (CS&A) rates declined in Ghana between 2009 and 2018, and which priority policies and programs will further improve nutrition outcomes. Trends and potential drivers of stunting (height-for-age z-score < -2.0 SD) and anemia (hemoglobin < 11.0 g/dL), and decomposition analysis of DHS data (2003 to 2014) were conducted. The quantitative evidence was triangulated with Net-Map analysis of nutrition stakeholder relationships and influence, desk review of policies and programs 2009–2019, and in-depth interviews with 25 stakeholders who provided additional insights to explain CS&A trends. Declines in stunting (29.6%) and anemia (14.1%) in children were observed at the national level, but with important subgroup variations. Decomposition analyses identified changes in the household, maternal, and child characteristics (including wealth, use of antenatal services, maternal education, and immunization) as correlates of anemia reduction. Stunting reduction was linked with changes in bed-net utilization, household wealth, and pregnancy care service utilization. Additionally, multiple policies and programs initiated/implemented across multiple sectors were considered potentially relevant to CS&A reduction over time, including those focused on infant and young child feeding, water and sanitation, social protection, and health care access. Initiation/strengthening of these interventions was stimulated by awareness creation and subsequently increased prioritization of stunting. However, program delivery was limited by deficits in government funding, perceived low priority of child anemia, low implementation capacity and coverage, and weak coherence across sectors. Reduced CS&A resulted from improved access to services implemented across multiple sectors, albeit limited by implementation scale and capacity. Further reduction in CS&A requires enhanced multi-sectorally coordinated actions and capacity.

Changes in Nigeria’s enabling environment for nutrition from 2008 to 2019 and challenges for reducing malnutrition

“…org/). 2 Other Stories of Change studies carried out under TNWA were in Burkina Faso and Ghana (Aryeetey et al, 2022;Becquey et al, 2022). political economy and governance; and capacity and resources -that are necessary features of enabling environments.…”

“… 2 Other Stories of Change studies carried out under TNWA were in Burkina Faso and Ghana (Aryeetey et al, 2022 ; Becquey et al, 2022 ). …”

Revisiting food security in 2021: an overview of the past year

“…In the introductory article, Gillespie et al ( 2021 ) lay out the rationale for combining clear qualitative and quantitative evidence with compelling narratives to catalyse action on multiple forms of malnutrition in Africa and Asia. Two articles have been published in this series so far: Harris et al ( 2021 ) look at the history and policy drivers of malnutrition among different ethnic groups in Vietnam; and Aryeetey et al ( 2021 ) analyse the policy and programmatic drivers of reductions in child stunting and anaemia in Ghana. This series will continue into 2022 with several more articles.…”

Association of maternal characteristics with child feeding indicators and nutritional status of children under-two years in Rural Ghana

“…Each of these 5 questions were given three response options -no/never, yes/some of the time and yes/ all the time which were coded as 0, 1 and 2 respectively. The total scores ranged between 0 and 17 and were categorised into low (0-8), medium/average (9-12) and high (13)(14)(15)(16)(17) financial independence similar to the coding of levels in related studies [24,26].…”

“…Furthermore, most of the previous studies that were conducted to assess the determinants of the nutritional status of children in Ghana focused on children underfive years [11][12][13][14] and these relationships are yet to be determined among children under two (2) years. Again, these previous studies did not focus on some maternal variables (parity, financial independence and participation in decision-making at the household level) and how they influence feeding practices and nutritional status of children under two (2) years.…”