Title: Correlates and Barriers to Pediatric Nutrition in Two Orphanages in the Ashanti Region of Ghana: A Surprising Comparison
Study Location: Ghana
Type of Paper: Original Article, Observational
Purpose: To better understand the factors that most affect the nutritional health of children living in 2 regional children’s homes
Measures: Anthropometrics (weight, length/height), Illness Rates, Dietary Quality, Sanitation
Participants: Children and staff at 2 regional children’s homes. Kumasi Children’s Home: 38 children under 5 years, 44 staff; and Mampong Babies’ Home: 26 children under 5 years, 42 staff
Methods: Anthropometric data were recorded monthly by staff and nurses at the homes, and compared to WHO standards. Daily logs were used to study the frequency of illness. Principle investigators conducted interviews with home staff on issues central to children’s health. Interviews and observations were conducted over the course of 4 weeks at each site/home.
Dietary Quality: The Babies’ Home follows a 40-year-old menu of traditional Ghanaian foods. The menu is not always followed due to the seasonal availability of fruits, vegetables, legumes and nuts. The Children’s Home menu is constantly adjusted based on financial stability. Nutrient content of menus as each home is not possible to calculate due to lack of recipes and consistency in preparation. The standard weekly menu of the Mampong Babies’ Home includes: 6 servings of vegetables, 3.5 servings of fruits, 1 serving of legumes, 6 servings of meat or eggs, and 10 servings of fat-rich foods. In contrast, Kumasi Children’s Home weekly menu includes: 6 servings of vegetables, 7 servings of fruits, 2 servings of legumes, 16 servings of meat or eggs, and 9 servings of fat-rich foods. Children at the Kumasi home receive meals in their own bowls, whereas children at Mampong are fed in groups by caregivers’ hands. Often stronger, healthier children secure more food and weaker, more hesitant children are consistently underfed.
Sanitation: At the Mampong home, children wash their hands before every meal, compared to Kumasi where children wash their hands before half of the meals. However, hand washing at both homes consisted of children’s hands being dipped in a bowl of clean water. At Kumasi, children eat from their own bowls with their fingers (Ghanaian tradition). At Mampong, caregivers feed multiple children with their fingers from a single bowl. The worker-to-child ratio at Mampong was 1:13 and at Kumasi 1:5, indicating a greater strain on caregivers at Mampong to clean, feed and care for the children. Other unsanitary conditions observed include: children without clothes or shoes, puddles of urine or excrement, open sewer gutters in play areas, and rusty metals with sharp edges. The majority of staff at both homes lacks training and understanding on the importance of sanitary practices.
Illness: Over a 4 month period, the Kumasi Children’s Home had more illnesses across multiple categories compared to Mampong Babies’ Home. The Mampong home had an illness rate of .06 illnesses per child per month, and the Kumasi home had an illness rate of .3 illnesses per child per month (5 times the rate of the Mampong home).
Anthropometrics: 17.1% of children at Mampong and 34.6% of children at Kumasi were underweight; 17.1% of children at Mampong and 15.4% of children at Kumasi were stunted; and 2.9% of children at Mampong and 11.5% of children at Kumasi were wasted.
Conclusions and Implications: At Kumasi, the increased illness rates correspond with increased rates of malnutrition. Since illness was the only indicator observed as being an advantage of the Mampong Babies’ Home over Kumasi Children’s Home, the investigators suggest that illness rates may have the largest impact on the nutritional status of children over dietary quality and sanitation. Consequently, exposure to disease could be a result of crowding and poor sanitary conditions. However, there is not enough data to establish a causal relationship. Additionally, investigators recommend the Ghanaian ministry of health takes steps to improve nutrition and caregiver training at orphanages.
Limitations: Due to the lack of experimental design, no direct association can be drawn between illness and nutritional status. Since the studies focused on two specific orphanages, observations cannot be generalized to other child care institutions.
Citation/Reference: Ribeira, R., Brown, L.B., and Akuamoa-Boateng, A. Correlates and Barriers to Pediatric Nutrition in Two Orphanages in the Ashanti Region of Ghana: A Surprising Comparison. Journal of Nutrition and Dietetics; 2009, 3(1): 1-12. http://www.scientificjournals.org/journals2009/articles/1466.pdf