The interrelations between nutrition, social and economic trajectories during adolescence among girls in Ghana

A dearth of data on the trends, efficacy, and timing (regarding menarche) of intervention impedes progress in the design of targeted policies and interventions that can holistically improve adolescents’ nutrition. This thesis primarily aims to examine the interrelations between nutrition, social, and economic trajectories during adolescence among girls in Ghana using a systematic narrative literature review on the socio-cultural and economic (SCE) determinants and consequences of adolescent undernutrition, analyses of secondary cross-sectional data in Ghana, and a randomised placebo-controlled trial among adolescent girls in north-eastern Ghana. Chapter 1 provides the background and rationale that informed the thesis and describes the specific research objectives for each chapter.In chapter 2, we undertook a systematic review of published literature to provide a narrative overview of the SCE determinants and consequences associated with undernutrition among adolescents in low and lower-middle-income countries. We identified 98 articles from PubMed, SCOPUS and CAB-Abstracts on determinants and consequences of undernutrition as defined by stunting, thinness, overweight and micronutrient deficiencies. At the individual level, significant determinants included age, sex, birth order, religion, ethnicity, educational and literacy level, working and marital status. At the household level, parental education and occupation, household size and composition, income, socio-economic status, and resources were associated with undernutrition. Few determinants were found at the broader community level, which included the residence, sanitation, school type, and seasonality. The sex-specific differences in undernutrition for adolescents were inconclusive. The consequences of adolescent undernutrition were mainly related to education and cognition. Most studies were cross-sectional in design, limiting inferences of causality to the description of associations, and very few studies were found for sub-Saharan Africa, indicating clear research gaps that informed the next parts of this study.In chapter 3, we describe a secondary data analysis of baseline data of an impact evaluation of the Ghana School Feeding Programme indicating that anaemia is a severe public health problem among rural school-aged children (6-9 years; n=323) and adolescents (10-17 years; n=319) in Ghana, irrespective of sex. The mean haemoglobin was 113.8 ± 13.1g/L and the overall prevalence of anaemia was 52.3%, being higher among school-aged children (55.1%) compared to adolescents (49.5%). Agro-ecological zone and age were independent predictors of anaemia, but the effect of age was only significant for girls and not boys.Chapter 4 examines the trends-over-time and the factors associated with malnutrition among adolescent girls in Ghana using cross-sectional data from 3 nationwide Ghana Demographic and Health Surveys (GDHS) conducted in 2003 (n=983), 2008 (n=955) and 2014 (n=857). Stunting was about 8% among the adolescent girls in 2003, declining by only 1.5% points in 2014. Although only 2% of the girls were thin in 2003, the prevalence decreased by