Community Interventions to Improve Iron and Iodine Status in Mother and Child Dyads in Northern Ghana
Condition: Iron Deficiency (ID); General Anemia; Iron Deficiency Anemia (IDA)
MeSH terms: Anemia; Anemia, Iron-Deficiency; Iron Deficiencies
Study type: Interventional

Summary: 
      BACKGROUND Ghana has reduced food insecurity prevalence by 49.2% in two decades. However,
      prevalence of malnutrition especially stunting (in <children5yr) has not matched the changes
      in food security levels. Of several key nutritional factors that lead to stunting,
      nutritional status of such trace minerals as iodine, iron and zinc has not been studied.
      Nutritional inadequacy of these trace minerals may be detected by estimation of dietary
      intake, and time-consuming and costly biochemical measurements of respective biomarkers.
      Since there is no means to estimate dietary intake of the trace minerals in Ghana, due to
      incomplete food composition data of the nutrients, identifying validated non-invasive,
      dietary approaches to predict the biomarker status of these trace minerals are critical in
      counteracting the challenges surrounding the persistent stunting due to micronutrient
      deficiencies in Ghana. Additionally, exploring alternative approaches to providing access to
      foods rich in trace minerals at household level is crucial.

      STUDY AIMS AND HYPOTHESIS The ultimate goal of this research is to increase knowledge base on
      improving trace mineral status in mother-child (6-23 mo) dyads through a sustainable
      community-based interventions in northern Ghana. Investigators will begin with iron and
      iodine that impair mothers and young children's growth and cognitive development most with
      three aims: 1) to develop dietary screening tools that are validated by biomarkers for early
      detection of deficiencies, 2) to determine efficacy (dose responses) of feeding indigenous
      nutrient-rich meals in preventing deficiencies and improving iron and iodine status, and 3)
      to demonstrate sustainable and scalable improvement of food systems through a container
      gardening project for iron-rich Hibiscus sabdarifa for consumption and income by empowering
      women during the dry/lean season in northern Ghana.

      • Aims 1: To develop dietary screening tools that are validated by biomarkers for early
      detection of deficiencies among children 6-23 months and their mothers H1.1: Dietary
      diversity score can predict iron deficiency among children 6-23 months and their mothers.

      H1.2: Dietary diversity score can predict iodine status deficiency among children 6-23 months
      and their mothers.

        -  Aims 2: Indigenous nutrient-rich meals of hibiscus sabdarifa improves iron and iodine
           status of dyads H2.1: Indigenous nutrient-rich meals of hibiscus sabdarifa improves iron
           status of dyads H2.2: Indigenous nutrient-rich meals of hibiscus sabdarifa improves
           iodine status of dyads

        -  Aims 3: to demonstrate that container gardening can provide sustainable and scalable
           improvement of food systems for iron-rich Hibiscus sabdarifa for consumption and income
           during the dry/lean season in northern Ghana H3.1: Container gardening can provide
           adequate amounts of vegetables for mother and child dyad during the dry season H3.2:
           Container gardening can provide adequate income to purchase iodized salt and Amani for
           mother and child dyad during the dry season

      SIGNIFICANCE This project addresses the gap in our knowledge and practices pertaining to
      serious and persisting trace mineral deficiencies that result in stunting and cognitive
      impairment in northern Ghana. Early detection of iron and iodine deficiencies with validated
      non-invasive dietary screening tools (aim 1), effective indigenous nutrient-rich meal-based
      programs (aim 2) and sustainable/scalable and women-led community-based food-system changing
      agricultural project (aim 3) are expected to be the most creative approach to counteract iron
      and iodine deficiencies in northern Ghana. This project will utilize science and education to
      change practices, environments and policies to reduce the prevalence of trace mineral
      deficiencies at the local, regional, national and global levels.
    


Intervention name(s): Intervention Group
Intervention type(s): Behavioral
Intervention description(s): The participating dyads in intervention communities were invited to consume veo soup/meal (HSM) three times a week and provided weekly supply of iodized salt (450 g) for the household usage as well as being engaged in dry season container gardening. The veo soup/meal is a local Ghanaian soup/meal mainly made of Hibiscus Sabdarifa leaves. It is a soup when prepared a bit watery and consumed with 'tou zaafi' (millet or corn based cooked paste). It is also a meal when prepared thick and eaten by itself. The Hibiscus Sabdariffa leaves meal (HSM) used in the present study was made of 18 kg Hibiscus Sabdariffa leaves, 8 kg groundnut, 1.1 kg dawadawa (fermented African locust beans), 3 kg dried fish plus 0.045 kg iodized salt, cooked with about 23 L (23 kg) water to yield 52.5 kg HSM. In each community, groups of ten women took turns to share the cooking activities, washing of bowls, and making water available for cooking. No treatment provided in our control communities.
Allocation: Non-Randomized
Intervention model: Sequential Assignment
Intervention model description: Quasi experimental
Masking: None (Open Label)
Primary purpose: Prevention