What is the Accra urban adolescent nutrition study?

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Adolescence is the period between childhood and adulthood. This age group (between 10 and 19 years) is an important health-determining stage of life. Optimal health and nutrition during adolescence can have lasting impacts on the adolescent, and even generations after them. This is particularly important for adolescent girls who have a high risk of transmitting malnutrition and poor health to their children, and grandchildren, and thereby perpetuate a vicious cycle of malnutrition and poor health outcomes.

Unfortunately, globally, adolescent nutrition is not given the attention it deserves in policies and programs. Usually, the focus is on women and children, because malnutrition among infants and young children as well as women in fertile age can easily result in death. However, in the case of adolescents, malnutrition is more likely to lead to loss of human capital (e.g. poor cognitive and learning ability), disability (such as blindness from vitamin A deficiency, short stature), impaired health status (such as anemia, poor immunity), and loss of quality of life (e.g. low earning capacity).

In Ghana, focus on adolescents has been on reproductive health, until recently in 2017 when the nation started investing in supplementation interventions to address anemia in school girls by providing iron and folate supplements, through the school system. There is also a new program to promote a global concept of nutrition-friendly schools. However, there is very little that we know about the school food environment. If children are spending most of their waking hours in school or on the way to and from school, we should understand what foods and beverages are being provided/sold to children. Some preliminary studies that we have done at the University of Ghana have shown that our children are exposed unhealthy inappropriate food advertisement and food that is not good for our health. These foods are usually highly processed foods that are excessively packed with sugar, fat, and salt. Continuous consumption of such foods is the reason why between 12% and 20% of our adolescents are either overweight or obese.

It is to understand and unpack these issues, through empirical research, that the University of Ghana and the International Food Policy Research Institute has teamed up to implement the Accra Urban Adolescent Nutrition Study. The Accra Urban Adolescent Nutrition Study is being implemented to understand the nutrition status of about one thousand adolescents in 10 randomly selected neighbourhoods between ages 12 and 19 years. The communities are Chorkor, Abelemkpe, South La, New Mamprobi, Achimota, Old Nungua, West Legon, Kokomlemle, New Town, and Nungua. The study is being led by experienced local and international nutrition and public health experts. The study has four main components: household food security and adolescent diet (including eating patterns and amounts), physical activity and the opportunities for physical activity, biomarkers of malnutrition using laboratory indicators, and description of food environments (to determine what situations and vendors in and around the school are driving what children are eating when they are in school).

The study has been approved and is supported by the Noguchi memorial Institute for Medical Research’s Institutional Review Board, the Ghana Health Service, and the Ghana Education Service. Within each selected community, we are selecting 96 children. Every child who participates must have the parent or caregiver give informed consent, that is their permission. Thereafter, they are interviewed. They are also invited to wear an accelerometer and a GPS device to measure their physical activity as well as determine which places they spend their time over the course of a 7-day period, to determine if they are exposed to obesity-promoting food environments.

Unfortunately, this aspect of the study (that is the wearing of the devices) has created significant uncertainty and fear among a section of the population. Of course, is not every day that you see children wearing such devices such as the ones we as using in our research. Therefore, we understand why some people are asking questions and we are using this article to explain the procedures of the study. The researchers would like to use this opportunity to inform and educate the public that there is no harm from wearing these devices as they are the same devices we already have in our smart phones to give us direction on google maps, and to measure our steps for physical activity. These devices cannot tell us anything beyond where the child has been and their steps. What we advice against is creating the impression that the study is trying to harm the children. That is not true. The researchers are professionals and do care about the children and will not do anything that can harm them.

The researchers are also working with MDS Lancet to take laboratory samples for assessing nutrients in their blood. We do this on Saturdays and Sundays. Because the children are asked to come in before they eat breakfast, we give them a nice breakfast after the sample taking. Several adolescents have done this test already without any problems and we count on the public’s cooperation to help us carry out this important project, successfully. Ultimately, our aim is to make sure we know and understand more about our children’s diets and to use the information we are gathering for improved policies and programs for children at this critical life stage.

By Richmond Aryeetey , Co-investigator of the Adolescent nutrition Study, University of Ghana School of Public Health