Correction: Predictors of food variety and food consumption scores of adolescents living in a rural district in Ghana.

[This corrects the article DOI: 10.1371/journal.pone.0286477.].

Knowledge, prevalence and factors associated with anaemia among women of reproductive age in Tamale Metropolis, Ghana: A cross-sectional study.

INTRODUCTION: Anaemia is a global public health concern. Anaemia in women of reproductive age has negative outcomes on their health and reproduction. OBJECTIVE: This study assessed the knowledge, prevalence and associated factors of anaemia among non-pregnant and non-lactating women of reproductive age in Northern Ghana. DESIGN: This is a cross-sectional study. METHOD: A systematic random sampling was used to select 317 participants from the Tamale Metropolis. A semi-structured questionnaire was used to collect data on the sociodemographic, knowledge level of anaemia and iron foods. Haemoglobin levels were determined using URIT-12. Haemoglobin status was classified according to the World Health Organization standards. Descriptive statistics and chi-square were used in the statistical analysis. RESULTS: The mean age (SD) of participants was 26.4 ± 6.9. A large proportion (68.8%) of the women had knowledge about anaemia, and the source of information was mainly health professionals (56.4%). More than half of the participants knew of the symptoms (80%), causes (83.9%), prevention measures (81.2%), consequences of anaemia (64.2%) and iron-rich food sources (76%). A greater share of the participants, however, had no knowledge of both iron-enhancing foods (53.7%) and iron-inhibiting foods (51.8%). The prevalence of anaemia was high generally (63.1%) and was highest among females at the tertiary institutions (43%) and who were single (60.5%). A significant association existed between income status and haemoglobin status (χ2 = 6.3, p = 0.044). CONCLUSION: The majority of participants knew about anaemia; however, they had limited knowledge of iron-enhancing and inhibiting foods. The prevalence of anaemia was high among women of reproductive age. Integrating economic empowerment and nutrition education with the inclusion of iron-enhancing and iron-inhibiting foods could help to reduce the high prevalence of anaemia among women of reproductive age.

Predictors of food variety and food consumption scores of adolescents living in a rural district in Ghana.

INTRODUCTION: There is a dearth of information about the food variety and consumption scores of adolescents in Ghana. This study assessed predictors of food variety and consumption scores of adolescents living in a rural district in Ghana. METHOD: In this cross-sectional study, a multi-stage sampling method was used to select one hundred and thirty-seven (137) adolescents from the Asante-Akim South Municipality of Ghana. A structured questionnaire was used to collect data on sociodemographic, food practices and dietary intakes of study participants. Descriptive, chi-square, T-test, partial correlation and binary logistic regression were used for the data analysis. RESULTS: The mean food variety score was 25.8±6.4 (range 7-42) and food consumption score was 35±5.1 (range 18.6-49.9). Food variety score was significantly (p<0.05) associated with guardian income status. A significant and positive partial correlation existed between food variety score and calcium intake (r = 0.236, p<0.05). About 49% and 51% of adolescents were food insecure and food secure, respectively. Food consumption score had significant association (p<0.05) with gender (X2 = 6.1), residence (X2 = 7.0), frequency of meal (X2 = 6.8) and food variety score (X2 = 5.4). Adolescent male (AOR = 2.3, 95% CI (1.2-4.6), p = 0.017), peri-urban residency (AOR = 2.1, 95%CI (1.0-4.4), p = 0.036), having three or more meals per day (AOR = 4.2, 95% CI (1.3-13.6), p = 0.018), and a high food variety score (AOR = 2.1, 95%CI (1.0-4.2), p = 0.041) significantly predicted food consumption scores. CONCLUSION: Moderate income status was associated with food variety score in our study participants. Linear relationship existed between food variety and calcium intake. Adolescent males, peri-urban residency, frequency of meals and high food variety score were the predictors of food consumption score. Nutrition-specific and nutrition sensitive programmes aimed at promoting adolescent health should involve guardians.

Nutrition Education Improves Knowledge of Iron and Iron-Rich Food Intake Practices among Young Adolescents: A Nonrandomized Controlled Trial.

Introduction: Nutrition education targeting adolescents' health has the potential to enhance their well-being into adulthood. This study assessed the impact of nutrition education on the knowledge of iron and iron-rich food intake practices of adolescents living in rural communities in Ghana. Method: An intervention study was conducted among 137 adolescents; 69 were assigned to the intervention group and 68 to the control group. Participants and guardians in the intervention group were involved in the nutrition education programme for six months. Participants in both groups completed sociodemographic, knowledge of iron, and iron-rich food intake practice questionnaires at pre- and postintervention. Data were analyzed by chi-square and t-tests. Results: At postintervention, the mean knowledge score (p < 0.05) in the intervention group and control group was 5.3 ± 1.7 and 3.9 ± 1.9, respectively. Interventions (76%) and controls (46%) had good knowledge status. The mean knowledge score of participants with good knowledge status in the intervention group was 6.1 ± 0.8 (p < 0.05), and the control group was 5.6 ± 0.7 (p < 0.05). Forty-two percent of participants in the interventions and 26% in the controls had good food intake status. Participants with good food intake status had mean food intake scores of 3.2 ± 0.4 (p < 0.05) and 3.8 ± 0.7 (p < 0.05) for the intervention and control groups, respectively. Both groups increased and had the same mean food intake score (1.5 ± 1.4, p > 0.05), however, relatively higher in the intervention group. Conclusion: Nutrition education improved the knowledge of iron and iron-rich food intake practices of participants in the intervention group compared to the control group. Nutrition education should be a critical component in the management and prevention of micronutrient deficiency in adolescents.

Dietary Diversity and Nutritional Status of Adolescents in Rural Ghana.

Background: The rapid biological and physical changes during adolescence require adequate nutrient intake. This study assessed dietary diversity and nutritional status of adolescents living in selected rural areas in Ghana. Method: In this cross-sectional study, 137 young adolescents, aged 10 to 14 years were recruited. Structured questionnaire was used to collect data on sociodemographic, household size and food intake practices. A multiple past 24-hour recall was used to estimate the micronutrients intake. Haemoglobin and anthropometry data were assessed. Dietary diversity score was assessed with 10 food groups described by Food and Agricultural Organization. Descriptive, chi-square, binary regression and partial correlation were used in the data analysis. Results: The prevalence of underweight was 5.5%, overweight 5.8% and anaemia 29.9%. The mean dietary diversity score was 3.8 ± 0.8 and about 84.7% of participants had inadequate dietary diversity. Proportions of adolescents who consumed from the different food groups over a 24-hour period were: grains, white roots and tubers, plantain (100%); pulses (10.2%); nuts and seeds (34.1%); dairy (8%); meat, poultry and fish (86.9%); eggs (7.3%); dark green leafy vegetables (29.9%); other vitamin-A rich fruits and vegetables (2.2%); other vegetables (81%); other fruits (7.3%). Dietary diversity scores were positively and significantly correlated with intake of micronutrient, with correlation coefficients of .169, .186, .191, .173 and .175 for vitamin A, niacin, vitamin B6, iron and zinc, respectively. Meal skipping (AOR = 12.2, P < .001, 95% CI: 3.6-41.7) and snacking (AOR = 5.0, P = .007, 95% CI:1.6-16.7) increased odds of inadequate dietary diversity. Conclusion: The high prevalence of inadequate dietary diversity was positively related to meal skipping and snacking among adolescents. Dietary diversity score was significantly related to the intake of vitamin A, niacin, vitamin B6, iron and zinc. The prevalence of anaemia among our study participants is of public health concern. Adolescents should be encouraged both at home and school to eat from diverse food groups to promote adequate intake of micronutrients.

A Review of the Risk Factors for Iron Deficiency Anaemia among Adolescents in Developing Countries.

Introduction: Identifying the root causes of iron deficiency anaemia is a prerequisite for effective management and prevention in adolescents. This systematic review assessed risk factors of iron deficiency anaemia among adolescents living in developing countries. Method: Electronic databases such as PubMed, Cochrane Library, Science Direct, Google Scholar, and SCOPUS were comprehensively searched for studies published between 1990 and 2020 that involved risk factors of iron deficiency anaemia among adolescents living in developing countries. The quality of the included studies was assessed using the American Dietetic Association Quality Criteria Checklist. Results: A total of 2,252 publications were reviewed, and only fifteen cross-sectional studies were eligible for inclusion, eight of which focused on female adolescents and seven on both genders. Direct risk factors contributing to anaemia among adolescents included food intake practices (n = 10 studies), female adolescents (n = 8 studies), menstruation (n = 5 studies), and parasitic infection (n = 6 studies). Indirect risk factors found to be associated with anaemia among adolescents included low educational status (n = 4 studies) and low socioeconomic status (n = 3 studies). All fifteen studies were of good quality. Conclusion: Food intake practices, female adolescents, menstruation, parasitic infection, and low educational status were the leading risk factors of iron deficiency anaemia among adolescents. Further research should concentrate on assessing the effectiveness and efficacy of existing interventions aimed at preventing iron deficiency among vulnerable groups in developing countries.

Effectiveness of nutrition education and counselling programme on iron deficiency anaemia among adolescents: A study protocol of a randomized trial.

BACKGROUND: [GQ4]Adolescents tend to explore their dietary environment without prior consideration of their nutritional needs. This attitude is due to low nutrition knowledge and it contributes to micronutrient deficiency such as anaemia. The study aims to investigate the effect of nutrition education and counselling on dietary iron intake and iron status of early adolescents. METHODS/DESIGN: One hundred and twenty-six early adolescents will be recruited and randomized to receive nutrition education (intervention group) and no nutrition education (control group) in the Asante-Akim South Municipality of Ghana. Data on socio-demographics, dietary factors, dietary intake, knowledge of iron and anaemia will be collected at baseline and post-intervention. Blood samples will be collected for haemoglobin, ferritin and c-reactive protein analyses. The primary outcome measures include haemoglobin and ferritin levels, secondary outcomes such as dietary iron intake, dietary vitamin C intake and knowledge level of iron will be assessed at pre-and post-intervention (6 months). The study will comply with the Consolidated Standards of Reporting Trials (CONSORT) for randomized trials. DISCUSSION: The effectiveness of iron dietary guidelines developed will serve as a manual to aid, prevent and manage iron deficiency anaemia as well as reduce the prevalence of anaemia in the long term in Ghana.

Knowledge and practices of dietary iron and anemia among early adolescents in a rural district in Ghana.

The study assessed knowledge and practices of dietary iron intake and anemia among early adolescents in the Asante-Akim Municipality of Ghana. A cross-sectional study was conducted among 137 adolescents, aged 10-14 years. Structured questionnaire was used to collect data on sociodemographic, knowledge of iron, and anemia, and iron intake practices. Hemoglobin levels were determined using Hemocue 301. Data were analyzed using descriptive, chi-square test, and binary logistics regression. The mean age of participants was 11.5 years. About 40% had knowledge of iron deficiency anemia, 29.4% knew anemia causes, 86% knew symptoms of anemia, and 35% knew anemia consequences. Although 41.2% of participants knew its prevention as eating iron-rich foods, 31.4% knew the food sources of iron, and 4.4% mentioned animal-based foods as rich sources, with the bulk (27%) mentioning plant-based foods instead. Moreover, 18.2% knew iron enhancers, while 0.7% knew iron inhibitors. More chicken consumers (72.2%) than nonconsumers (56.6%) met the Estimated Average Requirement for dietary iron intake (Chi-square 3.4, p = .073), while more dried fish consumers (88%) than nonconsumers (66.7%) had normal hemoglobin levels (Chi-square 4.5, p = .050). Knowledge of food sources of iron and iron-rich foods was positively associated with intake of chicken, fresh fish, and dried fish. Moreover, lower knowledge of iron-based food sources (ß = -1.015, p = .020) and iron-rich foods (ß = -2.188, p = .015) was inversely associated with beef intake. Anemia was negatively associated with chicken (ß = -0.310, p = .416) and dried fish (ß = -1.299, p = .045) consumption. Majority of the adolescents had low knowledge of iron. Chicken and dried fish intake reduced the risk of anemia development. Our study may be the first to assess knowledge on iron, anemia, and its impact among young Ghanaian adolescents. Our findings provide insights into this topic, calling for to improve knowledge, and practices on anemia in Ghanaian adolescents.

Patterns of Dietary Iron Intake, Iron Status, and Predictors of Haemoglobin Levels among Early Adolescents in a Rural Ghanaian District.

INTRODUCTION: Early adolescents are vulnerable to anaemia due to lean body mass and menarche. The study assessed patterns of dietary iron intake, iron status, and predictors of anaemia among early adolescents. METHOD: One hundred and thirty-seven early adolescents were randomly selected in a rural district in Ghana. Multiple-pass 24-hour recall, iron food frequency questionnaire consisting of 27 food items, and semistructured questionnaire were administered. Variables include sociodemographics, dietary factors, and laboratory investigation including haemoglobin, ferritin, and C-reactive protein examination. Statistical Package for the Social Sciences (SPSS) software was used to calculate odds ratio and perform Mann-Whitney U test, chi-square (X2) test, exploratory factor analysis, and partial correlation (r) tests. RESULTS: Participants had mean age of 11.5 years. Three iron dietary patterns explaining 28.7% of the total variance were identified: iron dietary pattern 1 (11%) composed of iron-rich, iron-enhancing, and iron-inhibiting foods; iron dietary pattern 2 (9.9%) comprised of iron-rich, iron-enhancing, and non-iron-inhibiting foods; and iron dietary pattern 3 (7.1%) consisting of stinging nettle, iron-inhibiting foods, non-iron-enhancing foods, non-cocoyam leaves, and non-turkey berries. Meal skipping (X 2 = 5.7, p < 0.05), times of eating a day (X 2 = 12.6, p < 0.05), and guardian educational status (X 2 = 6.7, p < 0.05) significantly affected dietary iron intake. Anaemia was associated with meal skipping (ß = 0.367, p > 0.05), snacking (ß = 0.484, p > 0.05), and junior high school (JHS) education (ß = 0.544, p > 0.05). Partial correlation showed statistically significant relationship between iron dietary pattern 1 and dietary iron (r = -0.234, p < 0.01), iron dietary pattern 2 and dietary iron (r = -0.198, p < 0.05), iron dietary pattern 2 and vitamin C (r = -0.201, p < 0.05), and haemoglobin and ferritin (r = -0.178, p < 0.05). CONCLUSION: Meal skipping, guardian educational status, and number of times of eating a day were significantly associated with dietary iron intake. Meal skipping, snacking, and adolescents with JHS education were positively associated with anaemia.