Journal of Food Security. 2023, 11(2), 43-55
DOI: 10.12691/JFS-11-2-2
Original Research

Dietary Diversity and Nutritional Adequacy of Children by Agro-ecological Zones of Ghana

Isaac Anane1, 2, , Nie Fengying1 and Huang Jiaqi1, 3

1Agricultural Information Institute, Chinese Academy of Agricultural Sciences, Beijing 100081, P.R China

2Yancheng Foreign Language School, No.2 Lushan Road, Yancheng Economic Development Zone

3Urban Economics Group, Department of Social Sciences, Wageningen University, 6706 KN Wageningen, The Netherlands

Pub. Date: September 08, 2023

Cite this paper

Isaac Anane, Nie Fengying and Huang Jiaqi. Dietary Diversity and Nutritional Adequacy of Children by Agro-ecological Zones of Ghana. Journal of Food Security. 2023; 11(2):43-55. doi: 10.12691/JFS-11-2-2

Abstract

Children’s early year’s life is essential. Those who receive inadequate nutrition are more likely to suffer from sickness and death in the short term, contributing to behavioral disorders, poor cognitive development, and poor education performance. This paper assesses children’s dietary diversity, food groups, and nutrition adequacy with agro-ecological zone potentials. We used the 24-hour recall method, the newest national representative, a cross-sectional dataset from Ghana’s Demographic and health survey with broad coverage in all agro-ecological zones, and 2451 children aged 6-59 months old for the final analysis. Multivariate logistic regression models were used to examine the relationship between food groups, adequate dietary diversity intake, and marginal effects were applied to estimate the magnitude of nutritional adequacy between different agro-ecological zones. We found that the average dietary diversity score for all food groups was low, 2.23 out of 7. Out of the total food consumed daily, the food group which constitutes the highest proportion are grains, roots, and tubers, with an average daily intake (45.6% to 49.6%), and the least are vitamin A-rich fruits and vegetables (2.6% to 10.0%). The main results were that adequate dietary diversity intake decreased from the least affected climatic zone (12.7%) to the most vulnerable zones (1.7%). There is also a relationship between food groups, adequate dietary diversity, and agro-ecological zones. Implementing climate-smart agriculture, especially in areas prone to extreme climatic stress, will help reduce climate change effects, enhance sustainable food production, and provide adequate food supply and nutrition.

Keywords

Agro-ecological zones, nutritional adequacy, dietary diversity, food groups, Ghana

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Kirkpatrick, S.I., McIntyre, L. and Potestio, M.L. 2010. Child hunger and long-term adverse consequences for health. Archives of pediatrics & adolescent medicine, 164, 754-762.
 
[2]  Strauss J., Thomas D. 1998. Health, nutrition, and economic development. Journal of economic literature, 36, 766-817.
 
[3]  Godfray, H. C. J., & Garnett, T. 2014. Food security and sustainable intensification. Philosophical transactions of the Royal Society B: biological sciences, 369(1639), 20120273.
 
[4]  Pinstrup-Andersen P., Pandya-Lorch R., Rosegrant M. W. 1999. World food prospects: Critical issues for the early twenty-first century (No. 585-2016-39757).
 
[5]  Thrupp L. A. 2000. Linking agricultural biodiversity and food security: the valuable role of agrobiodiversity for sustainable agriculture. International affairs, 76, 265-281.
 
[6]  Fanzo J. 2012. The nutrition challenge in sub-Saharan Africa (No. 2012-012). United Nations Development Programme, Regional Bureau for Africa, Addis Ababa, Ethiopia.
 
[7]  Akombi B. J., Agho K. E., Merom D., Renzaho A. M., Hall J. J. 2017. Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016). PloS one, 12, e0177338.
 
[8]  Pomati, M., & Nandy, S. (2020). Assessing Progress towards SDG2: Trends and patterns of multiple malnutrition in young children under 5 in west and Central Africa. Child Indicators Research, 13(5), 1847-1873.
 
[9]  Chakona G., Shackleton C. 2017. Minimum dietary diversity scores for women indicate micronutrient adequacy and food insecurity status in South African towns. Nutrients, 9, 812.
 
[10]  WHO, FAO. 2006. Evaluating the public health significance of micronutrient malnutrition. Guidelines on food fortification with micronutrients. Geneva: World Health Organization, 39-92.
 
[11]  World Health Organization, 2019. The state of food security and nutrition in the world 2019: safeguarding against economic slowdowns and downturns, FAO, Rome.
 
[12]  FAO, IFAD, UNICEF, WFP, WHO. 2020. The State of Food Security and Nutrition in the World 2020. Transforming food systems for affordable healthy diets. Rome, Italy.
 
[13]  De Groot R., Handa S., Ragno L. P., Spadafora T., Ghana LEAP1000 Evaluation Team. 2020. Child malnutrition, consumption growth, maternal care and price shocks: new evidence from Northern Ghana. Development Studies Research, 7, 18-30.
 
[14]  UNICEF-Ghana. 2016. National nutrition policy document. Retrieved from https://www.unicef.org/ghana/media/1311/file/UN712528.pdf (Accessed 5th March 2021).
 
[15]  Wutz Anja 2019. Pediatric Malnutrition: A Global Health Threat. All Graduate Plan B and other Reports 1370. Utah State University. Retrieved from https://digitalcommons.usu.edu/gradreports/1370. (Accessed 9th March 2021).
 
[16]  Miah, R., Apanga, P. and Abdul-Haq, Z., 2016. Risk factors for undernutrition in children under five years old: evidence from the 2011 Ghana multiple indicator cluster Survey. Journal of AIDS & Clinical Research, 7, 585.
 
[17]  UNICEF/WHO/World Bank. 2020. Joint Child Malnutrition Estimates Expanded Database: (Stunting, Wasting, and Overweight) New York. Retrieved from https://data.unicef.org/resources/dataset/malnutrition-data. (Accessed: 9th March 2021).
 
[18]  UNICEF. 2019. The State of the World’s Children 2019. Children, Food and Nutrition: Growing well in a changing world. UNICEF, New York.
 
[19]  Mkhize M., Sibanda M. 2020. A review of selected studies on the factors associated with the nutrition status of children under the age of five years in South Africa. International Journal of Environmental Research and Public Health, 17, 7973.
 
[20]  Ijarotimi O. S. 2013. Determinants of childhood malnutrition and consequences in developing countries. Current Nutrition Reports, 2, 129-133.
 
[21]  Müller O., Krawinkel M. 2005. Malnutrition and health in developing countries. Canadian medical association journal, 173, 279-286.
 
[22]  De Jager I., Giller K. E., Brouwer I. D. 2018. Food and nutrient gaps in rural Northern Ghana: Does production of smallholder farming households support adoption of food-based dietary guidelines? PloS one, 13, e0204014.
 
[23]  Ghana Statistical Service (GSS). 2007. Pattern and Trends of Poverty in Ghana, 1991-2006. Ghana Statistical Service –Accra Ghana.
 
[24]  Danquah I., Galbete C., Meeks K., Nicolaou M., Klipstein-Grobusch K., Addo J. & Schulze M. B. 2018. Food variety, dietary diversity, and type 2 diabetes in a multi-center cross-sectional study among Ghanaian migrants in Europe and their compatriots in Ghana: the RODAM study. European journal of nutrition, 57, 2723-2733.
 
[25]  Kenkhuis M.F. 2016. Nutritional status among cocoa farming families and underlying causes in Ghana. Student Nutrition and Health at Wageningen University, intern at GAIN. Global Alliance for Improved Nutrition.
 
[26]  Wemakor A., Laari J. 2018. Association between household dietary diversity and nutritional status of children (6–36 months) in Wenchi Municipality, Brong Ahafo Region, Ghana. Nutrire, 43, 1-10.
 
[27]  Kerr R. B., Madsen S., Stüber M., Liebert J., Enloe S., Borghino N., Wezel A. 2021. Can agroecology improve food security and nutrition? A review. Global Food Security, 29, 100540.
 
[28]  Ndirangu S. N., Mbogoh S. G., Mbatia O. L 2017. An Analysis of the Impact of Agro-Ecological Zones on the Influence of the Key Factors That Affect Food Security: The Case of the Embu County in Kenya. World Journal of Research and Review, 5, 64-72.
 
[29]  Azupogo F., Aurino E., Gelli A., Bosompem K. M., Ayi I., Osendarp S. J., Folson, G. 2019. Agro‐ecological zone and farm diversity are factors associated with hemoglobin and anemia among rural school‐aged children and adolescents in Ghana. Maternal & child nutrition, 15, e12643.
 
[30]  Kerr R. B., Kangmennaang J., Dakishoni L., Nyantakyi-Frimpong H., Lupafya E., Shumba L., Luginaah I. 2019. Participatory agro-ecological research on climate change adaptation improves smallholder farmer household food security and dietary diversity in Malawi. Agriculture, Ecosystems & Environment, 279, 109-121.
 
[31]  Altieri M.A.1991. ‘Traditional farming in Latin America,’ The Ecologist, 21, 93–96.
 
[32]  Altieri M. A. 1999. Applying agroecology to enhance the productivity of peasant farming systems in Latin America. Environment, Development and Sustainability, 1, 197-217.
 
[33]  Food and Agriculture Organization (2017). The future of food and agriculture–trends and challenges. Annual Report. Rome, Italy. Retrieved from http://www.fao.org/3/i6583e/i6583e.pdf (Accessed 11th March 2021)
 
[34]  Food and Agriculture Organization. 1996. Agro-ecological zoning Guidelines, FAO soil Bulletin (No. 73). Soil Resources, Management, Conservation Service, Land, & Water Development Division. Food and Agriculture Organization of the United Nations, Rome, Italy
 
[35]  Fischer G., Nachtergaele F. O., Van Velthuizen H., Chiozza F., Francheschini G., Henry M., Tramberend S. 2021. Global Agro-ecological Zones (GAEZ v4)-Model Documentation. Rome, FAO. Retrieved from.
 
[36]  De la Rosa D., Mayol F., Diaz-Pereira E., Fernandez M., De la Rosa Jr D. (2004). A land evaluation decision support system (MicroLEIS DSS) for agricultural soil protection: With special reference to the Mediterranean region. Environmental Modelling & Software, 19, 929-942.
 
[37]  Pingault N., Caron P., Kolmans A., Lemke S., Kalafatic C., Zikel, S., QIN, Y. J. 2020. Moving beyond the opposition of diverse knowledge systems for food security and nutrition. Journal of Integrative Agriculture, 19, 291-293.
 
[38]  Sivakumar M. V. K., Valentin C. 1997. Agro-ecological zones and the assessment of crop production potential. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 352, 907-916.
 
[39]  Qiu G. Y., Jin Y., Geng S. 2012. Impact of climate and land-use changes on water security for agriculture in Northern China. Journal of Integrative Agriculture, 11, 144-150.
 
[40]  Kennedy G. L. 2009. Evaluation of dietary diversity scores for assessment of micronutrient intake and food security in developing countries. Ph.D. Thesis, Wageningen University.
 
[41]  Nair M. K., Augustine L. F., Konapur A. 2016. Food-based interventions to modify diet quality and diversity to address multiple micronutrient deficiency. Frontiers in public health, 3, 277.
 
[42]  Hoddinott J., Yohannes Y. 2002. Dietary Diversity as a Food Security Indicator. International Food Policy Research Institute; Washington, DC, USA: Food Consumption and Nutrition Division
 
[43]  Nti C. A. 2011. Dietary diversity is associated with nutrient intakes and nutritional status of children in Ghana. Asian Journal of Medical Sciences, 2, 105-109.
 
[44]  Warren E., Hawkesworth S., Knai C. 2015. Investigating the association between urban agriculture and food security, dietary diversity, and nutritional status: A systematic literature review. Food Policy, 53, 54-66.
 
[45]  Zhang Q., Chen X., Liu Z., Varma D. S., Wan R., Zhao S. 2017. Diet diversity and nutritional status among adults in southwest China. PloS one, 12, e0172406.
 
[46]  Rah J. H., Akhter N., Semba R. D., De Pee S., Bloem M. W., Campbell A. A., Kraemer K. 2010. Low dietary diversity is a predictor of child stunting in rural Bangladesh. European journal of clinical nutrition, 64, 1393-1398.
 
[47]  Novignon J., Aboagye E., Agyemang O. S., Aryeetey G. 2015. Socioeconomic-related inequalities in child malnutrition: evidence from the Ghana multiple indicator cluster survey. Health economics review, 5, 1-11.
 
[48]  Jonah C. M., Sambu W. C., May J. D. 2018. A comparative analysis of socioeconomic inequities in stunting: a case of three middle-income African countries. Archives of Public Health, 76, 1-15.
 
[49]  Ewusie J. E., Beyene J., Ahiadeke C., Hamid J. S. 2017. Malnutrition in pre-school children across different geographic areas and socio-demographic groups in Ghana. Maternal and child health journal, 21, 797-808.
 
[50]  Cost of Hunger Africa –COHA. 2016. The Cost of Hunger in Ghana: Social and Economic Impact of Child Undernutrition on Ghana’s Long-Term Development, WFP, Retrieved from https://docs.wfp.org/api/documents/WFP-0000119786/download/ (Accessed 8th March 2021).
 
[51]  Abbam T., Johnson F. A., Dash J., Padmadas S. S. 2018. Spatiotemporal variations in rainfall and temperature in Ghana over the twentieth century, 1900–2014. Earth and Space Science, 5, 120-132.
 
[52]  UNDP. 2008. Climate Change Country Profile: Ghana. Retrieved from https://web.archive.org/web/20130921055503/http://ncsp.undp.org/document/undp-climate-change-country-profile-11 (Accessed 18th March 2021).
 
[53]  Aniah P., Kaunza-Nu-Dem M. K., Ayembilla J. A. 2019. Smallholder farmers’ livelihood adaptation to climate variability and ecological changes in the savanna agro-ecological zone of Ghana. Heliyon, 5, e01492.
 
[54]  Kyei-Mensah C., Kyerematen R., Adu-Acheampong S. 2019. Impact of rainfall variability on crop production within the Worobong Ecological Area of Fanteakwa District, Ghana. Advances in Agriculture, 2019, 7.
 
[55]  Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF International. 2015. Ghana Demographic and Health Survey 2014. Rockville, Maryland, USA.
 
[56]  Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF International (2015). 2014 Ghana Demographic and Health Survey (DHS) Key Findings. Rockville, Maryland, USA.
 
[57]  World Health Organization. 2010. Indicators for Assessing Infant and Young Child Feeding Practices 2010: Part 2: Measurement. World Health Organization; Geneva, Switzerland.
 
[58]  World Health Organization. 2008. Indicators for Assessing Infant and Young Child Feeding Practices: Part 1: Definitions: Conclusions of a Consensus Meeting held 6–8 November 2007 in Washington, DC, USA. World Health Organization; Geneva, Switzerland.
 
[59]  Ministry of Food and Agriculture (MOFA): Agriculture in Ghana. Available on http://www.srid-mofaghana.com/stories (Accessed 15th March 2021).
 
[60]  Owusu-Ansah F., Smardon R. C. 2015. Mining and agriculture in Ghana: A contested terrain. International Journal of Environment and Sustainable Development, 14, 371-397.
 
[61]  Quezada‐Sánchez A. D., Shamah‐Levy T., Mundo‐Rosas V. 2020. Socioeconomic characteristics of mothers and their relationship with dietary diversity and food group consumption of their children. Nutrition & Dietetics, 77, 467-476.
 
[62]  Agrawal S., Kim R., Gausman J., Sharma S., Sankar R., Joe W., Subramanian S. V. 2019. Socioeconomic patterning of food consumption and dietary diversity among Indian children: evidence from NFHS-4. European journal of clinical nutrition, 73, 1361-1372.
 
[63]  Ali N. B., Tahsina T., Hoque D. M. E., Hasan M. M., Iqbal A., Huda T. M., El Arifeen S. 2019. Association of food security and other socio-economic factors with dietary diversity and nutritional statuses of children aged 6-59 months in rural Bangladesh. PloS one, 8, p.e0221929
 
[64]  Howe L. D., Hargreaves J. R., Gabrysch S., Huttly S. R. 2009. Is the wealth index a proxy for consumption expenditure? A systematic review. Journal of Epidemiology & Community Health, 63, 871-877.
 
[65]  Córdova A. (2009). Methodological note: Measuring relative wealth using household asset indicators. AmericasBarometer Insights, 6, 1-9.
 
[66]  Rutstein S.O., Johnson K. 2004. The DHS Wealth Index. DHS Comparative Reports no.6. ORC Macro; Calverton, NY, USA
 
[67]  Rutstein S. O., Staveteig S. 2014. Making the demographic and health surveys wealth index comparable (Vol. 9). Rockville, MD: ICF International.
 
[68]  Hosmer DW, Lemeshow S.1989. Applied Logistic Regression. New York, NY, USA: John Wiley & Sons
 
[69]  Jann B. 2013. Predictive Margins and Marginal Effects in Stata 11th German Stata Users Group Meeting; University of Potsdam: Potsdam, Germany.
 
[70]  Williams R. 2012. Using the margins command to estimate and interpret adjusted predictions and marginal effects. The Stata Journal, 12, 308-331.
 
[71]  Bartus T. 2005. Estimation of marginal effects using margeff. The Stata Journal, 5, 309-329.
 
[72]  Long J.S., Freese J. Regression 2006. Models for Categorical Dependent Variables Using Stata; Stata Press: College Station, TX, USA.
 
[73]  Bursac Z., Gauss C. H., Williams D. K., Hosmer D. W. 2008. Purposeful selection of variables in logistic regression. Source code for biology and medicine, 3, 1-8.
 
[74]  Kim J. H. 2019. Multicollinearity and misleading statistical results. Korean Journal of anesthesiology, 72, 558.
 
[75]  Tamura R., Kobayashi K., Takano Y., Miyashiro R., Nakata K., Matsui T. 2019. Mixed integer quadratic optimization formulations for eliminating multicollinearity based on variance inflation factor. Journal of Global Optimization, 73, 431-446.
 
[76]  Ruel M. T. 2003. Is dietary diversity an indicator of food security or dietary quality? A review of measurement issues and research needs. Food and nutrition bulletin, 24, 231-232.
 
[77]  Torheim L. E., Ouattara F., Diarra M. M., Thiam F. D., Barikmo I., Hatløy A., Oshaug A. 2004. Nutrient adequacy and dietary diversity in rural Mali: association and determinants. European journal of clinical nutrition, 58, 594-604.
 
[78]  Habte T. Y., Krawinkel M. 2016. Dietary diversity score: A measure of nutritional adequacy or an indicator of healthy diet. J Nutr Health Sci, 3, 303.
 
[79]  Bandoh D. A., Kenu E. 2017. Dietary diversity and nutritional adequacy of under-fives in a fishing community in the central region of Ghana. BMC Nutrition, 3, 1-6.
 
[80]  Gyampoh S., Otoo G. E., Aryeetey R. N. O. 2014. Child feeding knowledge and practices among women participating in growth monitoring and promotion in Accra, Ghana. BMC pregnancy and childbirth, 14, 1-7.
 
[81]  Roba K. T., O’Connor T. P., Belachew T., O’Brien N. M. 2015. Seasonal variation in nutritional status and anemia among lactating mothers in two agro-ecological zones of rural Ethiopia: A longitudinal study. Nutrition, 31, 1213-1218.
 
[82]  Gidding, S. S., Dennison, B. A., Birch, L. L., Daniels, S. R., Gilman, M. W., Lichtenstein, A. H., & Van Horn, L. (2006). Dietary recommendations for children and adolescents: a guide practitioners. Pediatrics, 117 (2), 544-559.
 
[83]  Fanzo J., Davis C., McLaren R., Choufani J. 2018. The effect of climate change across food systems: Implications for nutrition outcomes. Global Food Security, 18, 12-19.
 
[84]  Dulal B., Mundy G., Sawal R., Rana P. P., Cunningham K. 2017. Homestead food production and maternal and child dietary diversity in Nepal: variations in association by season and agro-ecological zone. Food and nutrition bulletin, 38, 338-353.
 
[85]  Fischer G., Van Velthuizen H.T., Nachtergaele F.O. 2000. Global Agro-Ecological Zones Assessment: Methodology and Results. IIASA Interim Report. IIASA, Laxenburg, Austria: IR-00-064
 
[86]  Owusu V., Ma W., Emuah D., Renwick A. 2021. Perceptions and vulnerability of farming households to climate change in three agro-ecological zones of Ghana. Journal of Cleaner Production, 293, 126-154.
 
[87]  Buri M. M., Iassaka R. N., Fujii H., Wakatsuki T. 2010. Comparison of soil nutrient status of some rice-growing environments in the major agro-ecological zones of Ghana. Journal of Food, Agriculture & Environment, 8, 384-388.
 
[88]  Devendra C., Thomas D. 2002. Crop–animal systems in Asia: importance of livestock and characterization of agro-ecological zones. Agricultural Systems, 71, 5-15.
 
[89]  Khan N. P., Akhtar J. 2006. Competitiveness and policy analysis of potato production in different agro-ecological zones of Northern Areas: Implications for food security and poverty alleviation. The Pakistan development review, 45, 1137-1154.
 
[90]  Fischer G., Shah M., Van Velthuizen H., Nachtergaele F. 2006. Agro-ecological zones assessments. Encyclopedia of land use, land cover, and soil sciences, vol. 3, Eolss publishing, oxford, U.K.
 
[91]  Amugsi D. A., Mittelmark M. B., Oduro A. 2015. Association between maternal and child dietary diversity: an analysis of the Ghana demographic and health survey. PloS one, 10, e0136748.
 
[92]  Ogechi U. P., Chilezie O. V. 2017. Assessment of Dietary Diversity Score, Nutritional Status and Socio-demographic Characteristics of Under-5 Children in Some Rural Areas of Imo State, Nigeria. Malaysian Journal of Nutrition, 23, 425 - 435.
 
[93]  Altieri M. A., Nicholls C. I., Henao A., Lana, M. A. 2015. Agro-ecology and the design of climate change-resilient farming systems. Agronomy for sustainable development, 35, 869-890.
 
[94]  Estaquio C., Druesne-Pecollo N., Latino-Martel P., Dauchet L., Hercberg S., Bertrais S. 2008. Socioeconomic differences in fruit and vegetable consumption among middle-aged French adults: adherence to the 5 A Day recommendation. Journal of the AmericanDietetic Association, 108, 2021-2030.
 
[95]  Deshmukh-Taskar P., Nicklas T. A., Yang S. J., Berenson G. S. 2007. Does food group consumption vary by differences in socioeconomic, demographic, and lifestyle factors in young adults? The Bogalusa Heart Study. Journal of the American Dietetic Association, 107, 223-234.
 
[96]  Gupta A., Mishra D. K. 2014. Food consumption pattern in rural India: A regional perspective. Journal of Economic and Social Development, 9, 1-16.
 
[97]  Subramanian S., Deaton A. 1990. Gender effects in Indian food consumption patterns, Research Programme in Development studies. Discussion Paper 147, Princeton University.
 
[98]  Kossioni A., Bellou O. 2011. Eating habits in older people in Greece: The role of age, dental status and chewing difficulties. Archives of gerontology and geriatrics, 52, 197-201.
 
[99]  Waibel A. Ruth 2011 Religion and Dietary Practices, Available at: http://www.faqs.org/nutrition/PreSma/Religion-and-Dietary-Practices.html (accessed 18th April 2021).