Seasonality and nutrition-sensitive farming in rural Northern Ghana.

In rural sub-Saharan Africa, where malnutrition in all its forms is rife, the greatest gap between the availability of foods and the foods needed for a nutritious diet are faced during the 'hunger season'. We investigated what rural households in Northern Ghana would need to grow to ensure year-round availability of a nutrient adequate diet or the income required to fulfil their dietary needs. We applied linear programming to model different scenarios and interventions. Our results provide three major insights. First, considering seasonality is crucial in nutrition-sensitive farming. Ensuring a nutritious diet year-round requires enhanced availability of vegetables and fruits throughout the year. Second, although staple crops do not provide the full range of essential nutrients, increasing their yields allows for a reduction of field size, freeing up space for the production of other foods belonging to a nutritious diet, such as vegetables. Third, small farms are unable to produce sufficient food to cover their needs. They depend on income both from agriculture and other sources, and the availability of types of foods on markets to meet their dietary needs. Our study shows the value of modelling the range of dietary effects from agricultural interventions in a specific context, using a local feasible nutritious diet as a starting point and taking seasonality into account. Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-022-01325-5.

PROTOCOL: Measuring diet-related consumer behaviours relevant to low- and middle-income countries to advance food systems research: An evidence and gap map.

This is the protocol for a evidence and gap map. The main objective of this evidence and gap map is to provide access to a systematic overview of available indicators for diet-related consumer behaviours relevant to LMICs, to support policy makers and researchers to develop, monitor and revise food policies and programmes to leverage food systems transformations for healthier and more sustainable diets.

Current and potential role of grain legumes on protein and micronutrient adequacy of the diet of rural Ghanaian infants and young children: using linear programming.

BACKGROUND: Grain legumes are appreciated for their contribution to dietary protein and micronutrient intake in addition to their benefits in providing income and replenishing soil fertility. They offer potential benefits in developing countries where future food demand is increasing and both undernutrition and overweight co-exist. We studied the current and potential role of grain legumes on protein, both quantity and quality, and micronutrient adequacy in the diet of rural Ghanaian infants and young children. METHODS: Energy and nutrient (including amino acids) intakes of breastfed children of 6-8 months (n=97), 9-11 months (n=97), 12-23 months (n=114), and non-breastfed children of 12-23 months (n=29) from Karaga district in Northern Ghana were assessed using a repeated quantitative multi-pass 24-hour recall method. Food-based dietary guidelines that cover nutrient adequacy within the constraints of local current dietary patterns were designed using the linear programming software Optifood (version 4.0.9, Optifood©). Optifood was also used to evaluate whether additional legumes would further improve nutrient adequacy. RESULTS: We found that 60% of the children currently consumed legumes with an average portion size of 20 g per day (cooked) contributing more than 10% of their total protein, folate, iron and niacin intake. The final sets of food-based recommendations included legumes and provided adequate protein and essential amino acids but insufficient calcium, iron, niacin and/or zinc among breastfed children and insufficient calcium, vitamin C, vitamin B12 and vitamin A among non-breastfed children. The sets of food-based recommendations combined with extra legumes on top of the current dietary pattern improved adequacy of calcium, iron, niacin and zinc but only reached sufficient amounts for calcium among breastfed children of 6-8 months old. CONCLUSIONS: Although legumes are often said to be the 'meat of the poor' and current grain legume consumption among rural children contribute to protein intake, the main nutritional benefit of increased legume consumption is improvement of micronutrient adequacy. Besides food-based recommendations, other interventions are needed such as food-based approaches and/or fortification or supplementation strategies to improve micronutrient adequacy of infants and young children in rural Ghana. TRIAL REGISTRATION: Noguchi Memorial Institute for Medical Research Institutional Review Board (NMIMR-IRB CPN 087/13-14).

Food and nutrient gaps in rural Northern Ghana: Does production of smallholder farming households support adoption of food-based dietary guidelines?

Food-based dietary guidelines (FBDGs) provide guidance to policy makers, the private sector and consumers to redesign food systems and to improve diets of vulnerable populations. As appropriate FBDGs are based on the actual dietary patterns and their costs, it is assumed that the recommended foods are available, affordable and acceptable for the population under study. Using quantitative dietary intake data of young children in rural Northern Ghana, we developed local FBDGs and studied whether these are supported by the diversity and quantity of the production of a household among 329 households. We found that 40% of rural Northern Ghanaian infants and young children were stunted and their nutrient intakes were far below the recommendations: the probability of adequacy for most nutrient intakes was less than 50%. At household level, the developed FBDGs were, on average, unable to sufficiently cover the household requirements for fat (60.4% of recommended nutrient intake (RNI)), calcium (34.3% RNI), iron (60.3% RNI), vitamin A (39.1% RNI), vitamin B12 (2.3% RNI) and vitamin C (54.6% RNI). This implies that even when these FBDGs are fully adopted the requirements for these nutrients will not be met. In addition, the nutrient needs and food needs (according to the developed FBDGs) of a household were only marginally covered by their own food production. The food production of over half the households supplied insufficient calcium (75.7%), vitamin A (100%), vitamin B12 (100%) and vitamin C (77.5%) to cover their needs. The food production of about 60% of the households did not cover their required quantities of grains and legumes and none covered their required quantities of vegetables. Further analysis of the food gaps at district and national level showed that sufficient grains were available at both levels (267% and 148%, respectively) to meet requirements; availability of legumes was sufficient at district level (268%) but not at national level (52%); and vegetables were insufficient at both levels (2% and 49%, respectively). Diversifying household food production is often proposed as a means to increase the diversity of foods available and thereby increasing dietary diversity of rural populations. We found that the diversity of the production of a household was indeed positively related with their food and nutrient coverage. However, the diversity of the production of a household and their food and nutrient coverage were not related with children's dietary diversity and nutrient adequacy. Our results show that the production of a households does not support the adoption of FBDGs in rural Northern Ghana, especially for vegetables. This suggests that the promotion of FBDGs through nutrition education or behaviour change communications activities alone is insufficient to lead to improvements in diets. Additional strategies are needed to increase the food availability and accessibility of the households, especially that of fruits and vegetables, such as diversification of the crops grown, increased production of specific crops and market-based strategies.

Grain legume cultivation and children's dietary diversity in smallholder farming households in rural Ghana and Kenya.

Boosting smallholder food production can potentially improve children's nutrition in rural Sub-Saharan Africa through a production-own consumption pathway and an income-food purchase pathway. Rigorously designed studies are needed to provide evidence for nutrition impact, but are often difficult to implement in agricultural projects.Within the framework of a large agricultural development project supporting legume production (N2Africa), we studied the potential to improve children's dietary diversity by comparing N2Africa and non-N2Africa households in a cross-sectional quasi-experimental design, followed by structural equation modelling (SEM) and focus group discussions in rural Ghana and Kenya. Comparing N2Africa and non-N2Africa households, we found that participating in N2Africa was not associated with improved dietary diversity of children. However, for soybean, SEM indicated a relatively good fit to the posteriori model in Kenya but not in Ghana, and in Kenya only the production-own consumption pathway was fully supported, with no effect through the income-food purchase pathway. Results are possibly related to differences in the food environment between the two countries, related to attribution of positive characteristics to soybean, the variety of local soybean-based dishes, being a new crop or not, women's involvement in soybean cultivation, the presence of markets, and being treated as a food or cash crop. These findings confirm the importance of the food environment for translation of enhanced crop production into improved human nutrition. This study also shows that in a situation where rigorous study designs cannot be implemented, SEM is a useful option to analyse whether agriculture projects have the potential to improve nutrition.