Community interventions to improve iron and iodine status in mother and child dyads in Northern Ghana

ABSTRACTCOMMUNITY INTERVENTIONS TO IMPROVE IRON AND IODINE STATUS IN MOTHER AND CHILD DYADS IN NORTHERN GHANABYClement Kubreziga KubugaHigh prevalence of micronutrients deficiencies exist in Ghana especially northern Ghana which are worst during the dry/lean season for diverse reasons. Our current research is focused on trace minerals (iron and iodine). In Ghana, the prevalence of ID is also the highest among children along with high rate of stunting and in women of childbearing age. During the dry/lean season (7-8 months/year), food insecurity peaks in northern Ghana as agricultural production becomes very difficult for the majority peasant farmers. Iodine deficiency is the worldwide leading cause of intellectual deficiency. A 2014 survey indicates that 39% of households in Ghana used adequately iodized salt, to date no monitoring of iodine status indicators for women have been reported at the national. In Ghana, the three northern regions far from the ocean have the longest dry/lean season and the highest unmet food security needs. Estimated iodine deficiency prevalence and role of iodized salt in improving iodine status of the population is urgently needed for public health interventions. Four hypotheses of this research are: 1) dietary diversity score (DDS) and/or dietary patterns (DP) can predict the risk of iron and iodine deficiencies in women and their toddlers; 2) native iron-rich Hibiscus Sabdariffa leaves meal (HSLM) is efficacious in improving iron status of mother-child dyads with time during dry/lean season; 3) weekly household iodized salt supply can improve mother-child dyads iodine status; and 4) Container gardening can be used to cultivate Hibiscus Sabdariffa (HS) and cabbage during the dry/lean season, produce adequate amount of HS for mother-child dyads consumption and economic gains from cash crop cabbage for purchase of iodized salt and dry fish. For testing hypothesis 1, multivariable logistic regression models were used to examine the relationship between DDS (DDS<4 & DDS≥4)/dietary pattern tertiles and the risk of iron and iodine deficiencies in a cross-sectional study (Women: n=118; children: n=121). In hypothesis 2 we had a quasi-experimental community-based feeding trial for 12 weeks. Groups were compared using chi-square statistics and student’s t-test for categorical and continuous variables, respectively. Multiple logistic regression was conducted using GENMOD to compare groups’ iron status. In hypothesis 3, chi-square test was used to test distributions of sociodemographic characteristics. UICs of both groups were compared. In hypothesis 4, two women groups farmed 40 wooden containers to grow HS for consumption and 15 containers for cash crop cabbage in the dry/lean season. Participants’ characteristics, yields, and consumption were examined using descriptive statistics. We found that DDS and DP respectively predicted the risk of iron and iodine deficiencies in women but not in their toddlers. We further found that HSLM was efficacious in improving iron status of women with time and protected toddlers from stunting. Weekly household iodized salt supply improved dyads iodine status. Finally, we demonstrated that containers can be used to cultivate HS and cabbage during the dry/lean season, produce adequate amount of HS for dyads consumption and provide economic gains from cabbage production for purchase of iodized salt and dry fish. These findings provide scientific bases to guide recommendations and policy making on programs targeted at reducing the risk of iron and iodine deficiencies in northern Ghana.