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Objective: The study aimed to highlight the determinants of overnutrition (overweight plus obesity) in fishing communities and establish if these were the same as reported elsewhere in Ghana. Design: Cross-sectional study. Setting: The study was conducted in Idun, Ola and Duakor fishing communities in Cape Coast, Ghana. Subjects: Adults (n 252) aged 20 to 50 years. Results: Results showed that 32 % of participants were overweight/obese (BMI $ 25?0 kg/m 2 ). Participants' mean age was 31?7 (SD 1?0) years, they had 13?7 (SD 8?1) mean years of formal education, their median monthly income was $US 7?4 (interquartile range $US 3?3, 20?0) and their median daily energy intake was 7?3 (interquartile range 5?3, 9?8) MJ. Significant associations (P , 0?05) were found between BMI and gender, age, years of education, fat intake and marital status. Females were almost eight times more likely to be overweight/obese than males (adjusted OR 5 7?7; 95 % CI 3?6, 16?4). Persons aged $40 years were about six times more likely to be overweight/obese than those aged 20-29 years (adjusted OR 5 6?1; 95 % CI 2?6, 14?1). Married people were nearly three times more likely to be overweight/obese than singles (adjusted OR 5 2?8; 95 % Cl 1?4, 5?7). People with more than 13 years of formal education (adjusted OR 5 0?3; 95 % CI 0?1, 0?9) and people with .30 % fat contribution to daily energy intake (adjusted OR 5 0?3; 95 % CI 0?1, 0?6) had reduced odds of being overweight/obese. Conclusions: Overnutrition was prevalent in the fishing communities and associated with factors such as age, gender, marital status, educational status and fat intake.

Background Gestational iron deficiency (ID) can be deleterious to mother and fetus. However, iron status is not routinely measured during pregnancy in Ghana. Therefore, the scope of ID in this population is unknown. Objective To determine the prevalence of anemia and ID across pregnancy in the Central Region of Ghana. Methods Women were recruited during their 1st trimester of pregnancy (< 13 weeks; n = 116) and followed through to their 2nd (n = 71) and 3rd (n = 71) trimesters. Data on socio-demographic variables, weekly intake of iron-rich foods and vitamin C-rich fruits were collected. Blood samples were drawn and the concentrations of hemoglobin (Hb), ferritin (Ft), serum iron (sFe), total iron binding capacity (TIBC), were measured; transferrin saturation (TSAT) was calculated. Repeated measures ANOVA was used to determine change in anemia and iron variables over time with groups categorized by 1st trimester iron status. Results Participants were 27.1 ± 5.2 years, on average. Prevalence of anemia (Hb <11.0 g/dL) was 37%, 63%, 58%; ID (Ft <15 μg/L) was 16%, 20%, 38%; and iron deficiency anemia (IDA; based on low Ft and Hb) was 6%, 12%, 25% in 1st, 2nd and 3rd trimesters, respectively. Significant changes in Hb, Ft and TIBC occurred across time. Iron status at 1st trimester had a significant effect on 2nd but not 3rd trimester iron status. Conclusions ID is prevalent in pregnant Ghanaian women, especially during the 3rd trimester. Anemia is a major public health problem during pregnancy in Ghana with a significant proportion due to factors other than ID.

Background Significant rates of anxiety, depressive symptoms, and low quality of life (QoL) have been found among pregnant women in developed countries. These psychosocial disturbances have not been adequately assessed during pregnancy in many developing countries. Methods Women were recruited in their first trimester of pregnancy (< 13 weeks; n = 116) and followed through to their 2nd (n = 71) and 3rd (n = 71) trimesters. Questionnaires were used to collect data on anxiety symptoms (Beck Anxiety Inventory; BAI), depressive symptoms (Center for Epidemiological Studies-Depression Inventory; CES-D), and quality of life (RAND SF-36; QoL). Psychometric analyses were used to determine the reliability of the questionnaires in this context. The proportion of pregnant women with psychosocial disturbances at each trimester was determined. Repeated measures ANOVA were used to examine changes in psychosocial outcomes over time; and generalized estimating equation to determine if gestational age predicted the psychosocial outcomes whilst controlling for sociodemographic variables. Results Participants were aged 27.1 ± 5.2 years, on average. Psychometric analyses revealed a 4-factor solution for BAI (18 items), 1-factor solution for CES-D (13 items) and 4-factor solution for RAND SF-36 (26 items). The prevalence estimate of psychosocial disturbances was 34%, 10%, 2% (anxiety), 49%, 31%, 34% (depressive symptoms), and 46%, 37%, 59% (low QoL) for 1st, 2nd and 3rd trimesters, respectively. Gestational age and food insecurity were significant predictors of depressive symptoms, anxiety symptoms and QoL. Conclusions In this population of Ghanaian women, the levels of depressive symptoms and low QoL observed across pregnancy should be recognized as major public health problems and efforts to address these should be put in place. Addressing food insecurity may be a major step to solve not only the physical needs of the pregnant woman but also the psychological needs.

Background and aims: Malnutrition is common among patients with end stage liver disease including liver cirrhosis and liver cancer. Optimal nutrition is important to reduce morbidity and mortality of these patients. There is limited qualitative data on nutritional status and management of chronic liver disease patients. We aimed to explore the knowledge, opinions and practices of cirrhosis patients and health workers in nutritional management of cirrhosis in Ghana, in order to determine whether there is a need to improve nutritional care for cirrhosis patients. Methods: We conducted a qualitative study using semi-structured interviews of cirrhotic patients (n ¼ 16) and healthcare providers (n ¼ 27) in three academic centers in Accra, Kumasi and Cape Coast (Ghana). Recruitment was by purposive sampling of patients attending specialist liver disease clinics. The recorded data were analyzed using NVivo 11 software, with generation of codes, themes and subthemes. Results: The major themes that emerged from the data included nutrition as part of care delivery during the hospital visit, nutritional recommendations, dietary changes and long-term practice improvement. The results showed that patients and health workers felt dietary recommendations for patients were frequently addressed, but could be significantly improved. We found that in the opinion of study participants, local guidelines are important and necessary in nutritional management of cirrhosis patients, and that participants felt it was difficult to change dietary habits following cirrhosis diagnosis. Conclusions: These results suggest that nutritional management of cirrhosis patients in Ghana requires improvement. Strategies to improve this could include a multidisciplinary approach to nutritional management, development of local guidelines and continued nutritional assessment, monitoring and follow-up.

Anaemia among women is a major public health concern globally. In developing countries, nutritional anaemia may be due to poor bioavailability of dietary iron, haemoglobinopathies, or intestinal parasites. The study objectives were to determine the prevalence of anaemia and current nutrient intakes essential to erythropoiesis among women of reproductive age (WRA) in peri-urban settlements in the Ga-East Municipality, Accra, Ghana. This cross-sectional study assessed the nutrient intake, sickling and haemoglobin levels of 134 women aged 15-49 years enrolled in a peanutbased field trial at baseline. A pretested semi-quantitative food frequency questionnaire was used to assess energy and nutrient intake using the Food Processor (ESHA) software. Whole blood was used to determine full blood count using the haematology automated analyser. Sickling was determined by blood staining. Anaemia was classified based on recommended cutoffs. Chi-square analysis was used as a test of independence between anaemia and age groups. Linear regression was used to determine predictors of haemoglobin concentration. The mean age of the women was 29 ± 8 years. The mean total caloric intake was 2315 ± 915 kcal, whilst protein and fat intakes were 67 ± 27g and 68± 30g, respectively. Almost three-quarters of the women met the recommended dietary allowance (RDA) for iron and vitamin C. However, only a third met the RDA for fat, and about two-thirds met their needs for energy and protein. None of the women met the RDA for folate which is integral for haem formation. Also 17% (23/134) of the women were sickle cell anaemia positive. Mean haemoglobin concentration was 12.1 ± 1.8 g/dL. Mild, moderate and severe anaemia due to iron deficiency was present in 35.8%, 6.7% and 1.5%, of the women respectively. All categories of anaemia was present in 44% of the women. Anaemia, prevalence increased during the early stages of the reproductive age (15-29 years) and declined towards the end of the reproductive age period (40-49 years). An increase in age of one year was significantly associated with a 0.056 g/dL rise in haemoglobin level (p=0.014). Anaemia due to iron deficiency exists as a public health problem among women in peri-urban settlements in the Ga-East Municipality, Accra, Ghana. Dietary diversity to include green leafy vegetables which are rich in folate and pro-vitamin A may reduce the current level of prevalence.

Introduction Headache is a common and sometimes debilitating medical condition. Patients presenting with no neurologic anomaly, nontraumatic primary headache require careful evaluation before neuroimaging. National Guidelines standardizing exploitation of Computed Tomography (CT), the most utilized imaging modality in this clinical scenario, has not been established in Ghana, a developing country with limited healthcare resources. The country has not also adopted existing guidelines such as the National Institute for Health and Care Excellence (NICE) of the United Kingdom or the Appropriateness Criteria (AC) of the American College of Radiologists (ACR). The purpose of this review was to analyze the propensity of CT utilization for diagnosing headaches against the AC of the ACR and discuss some of the socio-economic inferences thereof. Methods This study retrospectively reviewed CT imaging records and clinical data of all patients referred for head CT scans between 1 st January 2016 and 31 st December 2018 at five major health facilities (four tertiary government hospitals and one private hospital) across Ghana. We isolated all head CT scans performed for the diagnosis of headache for analysis. We analyzed the type of presenting headache, CT findings, gender distribution, pattern of referrals, and head CT appropriateness against the AC of the ACR. Results A total of 44,218 patients were referred to the five facilities for head CT secondary to diverse indications for the period. All non-trauma cases were 41.7%; trauma cases were 31.6%, the majority (72.3%) were from road traffic accidents. The majority (64.9%) of trauma casualties were males. A total of 11,806 (26.7%) patients were referred for a head CT scan for the diagnosis of headache. The private hospital recorded the highest referrals for head CT scan for diagnosis of headache. The gender distribution of all headache patients was 57.6% females, and 42.4% were males. The age distribution showed 19.3% were children, 71.2% were adults, and the aged constituted 9.4%. The results showed 2.8% significant cranial CT findings of all reviewed headache patients. Pathological findings among the cohort of children were 0.6%. The sources and pattern of referrals showed 57.3% were from the Outpatient Department, 26.6% from the Emergency Department, in-patients’ referrals were 9.4%, and specialist consultation was 7.1%. Analysis of CT scans performed against the AC of the ACR, showed 69.0% of headache patients were likely scanned inappropriately. Conclusions There is a need to implement international best practice guidelines or develop a national neuroimaging policy to protect patients. Unjustified CT utilization for diagnosis of headaches exposes patients to unnecessary ionizing radiation that can instigate cancer and unnecessary expenditure. Head CT scan for some headache patients with normal neurologi...

Non-alcoholic fatty liver disease (NAFLD) is a burgeoning health problem worldwide. NAFLD is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol Different methods are employed in the diagnosis of NAFLD. Certain drugs, genetics, lifestyle factors have been implicated in the development of NAFLD. NAFLD symptoms are asymptomatic but indicated when there is unexplained persistent elevation of liver enzyme levels. Nutrition and lifestyle modifications are widely prescribed as helpful in the prevention and treatment of Non-Alcoholic Fatty Liver disease (NAFLD). Dietary and lifestyle modifications are apparent measures considering the disease association with obesity, diabetes, and cardiovascular disease which many reviews have linked to the condition. Reduction in body weight, involvement in both aerobic and anaerobic exercises, conscious intake in the types of fat and carbohydrates are helpful in the management of NAFLD. This chapter highlights the various theories and principles underlying nutrition and lifestyle modifications in the prevention and treatment of NAFLDs.