Understanding the burden and contextual risk factors is critical for developing appropriate interventions to control undernutrition. This study used data from the 2014 Ghana Demographic and Health Survey to estimate the prevalence of underweight, stunting, and wasting. Single multiple logistic regressions were used to identify the factors associated with underweight, wasting and stunting. The study involved 2720 children aged 0–59 months old and mother pairs. All analyses were done in STATA/IC version 15.0. Statistical significance was set at p<0.05. The prevalence of underweight, wasting and stunting were 10.4%, 5.3%, and 18.4% respectively. The age of the child was associated with underweight, wasting and stunting, whereas the sex was associated with wasting and stunting. Normal or overweight/obese maternal body mass index category, high woman’s autonomy and middle-class wealth index were associated with a lower odds of undernutrition. The factors that were associated with a higher odds of child undernutrition included: low birth weight (<2.5 kg), minimum dietary diversity score (MDDS), a higher (≥4^th) birth order number of child, primary educational level of husband/partner and domicile in the northern region of Ghana. There is still a high burden of child undernutrition in Ghana. The age, sex, birth weight, birth order and the MDDS of the child were the immediate factors associated with child undernutrition. The intermediate factors that were associated with child undernutrition were mainly maternal related factors and included maternal nutritional status and autonomy. Distal level factors which were associated with a higher odds of child undernutrition were the wealth index of the household, paternal educational status and region of residence. We recommend that interventions and policies for undernutrition should address socioeconomic inequalities at the community level while factoring in women empowerment programmes.

Dietary diversity score (DDS) is relatively easy to measure and is shown to be a very useful indicator of the probability of adequate micronutrient intake. Dietary diversity, however, is usually assessed during a single period and little is known about the effect of seasonality on it. This study investigates whether dietary diversity is influenced by seasonality. Two cross-sectional surveys were conducted in two different seasons—dry season (October 2010) and rainy season (May 2011) among the same school-age children (SAC) in two rural schools in northern Ghana. The study population consisted of 228 school-age children. A qualitative 24-hour dietary recall was conducted in both seasons. Based on 13 food groups, a score of 1 was given if a child consumed a food item belonging to a particular food group, else 0. Individual scores were aggregated into DDS for each child. Differences in mean DDS between seasons were compared using linear mixed model analysis. The dietary pattern of the SAC was commonly plant foods with poor consumption of animal source foods. The mean DDS was significantly higher (P < 0.001) in the rainy season (6.95 ± 0.55) compared to the dry season (6.44 ± 0.55) after adjusting for potential confounders such as age, sex, occupation (household head and mother) and education of household head. The difference in mean DDS between dry and rainy seasons was mainly due to the difference in the consumption of Vitamin A-rich fruits and vegetables between the seasons. While vitamin A-rich fruits (64.0% vs. 0.9%; P < 0.0001) and vitamin A rich dark green leafy vegetables (52.6% vs. 23.3%, P < .0001) were consumed more during the rainy season than the dry season, more children consumed vitamin A-rich deep yellow, orange and red vegetables during the dry season than during the rainy season (73.7% vs. 36.4%, P <0.001). Seasonality has an effect on DDS and may affect the quality of dietary intake of SAC; in such a context, it would be useful to measure DDS in different seasons. Since DDS is a proxy indicator of micronutrient intake, the difference in DDS may reflect in seasonal differences in dietary adequacy and further studies are needed to establish this.

Adolescent undernutrition is a persisting public health problem in low and lower middle income countries (LLMICs). Nutritional trajectories are complexly interrelated with socio‐cultural and economic (SCE) trajectories. However, a synthesis of the SCE determinants or consequences of undernutrition in adolescents is lacking. We undertook a narrative review of published literature to provide a narrative overview of the SCE determinants and consequences associated with undernutrition among adolescents in LLMICs. We identified 98 articles from PubMed, SCOPUS, and CAB‐Abstracts on determinants and consequences of undernutrition as defined by stunting, underweight, thinness, and micronutrient deficiencies. At the individual level, significant determinants included age, sex, birth order, religion, ethnicity, educational and literacy level, working status, and marital status. At the household level, parental education and occupation, household size and composition, income, socioeconomic status, and resources were associated with undernutrition. Only a few determinants at the community/environmental level, including residence, sanitation, school type, and seasonality, were identified. The consequences of adolescent undernutrition were mostly related to education and cognition. This review underscores the importance of the broad range of context‐specific SCE factors at several levels that influence adolescent nutritional status and shows that further research on SCE consequences of undernutrition is needed.

The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes.

Objective Household food insecurity is positively associated with depression; however, the association among adolescents is not well known. We examined the association between household food insecurity and depression among adolescent girls in Northern Ghana. Methods We analysed data from the Ten2Twenty-Ghana randomised controlled trial end-line for adolescent girls aged 10–17 years (n=582). The girls were chosen at random from 19 primary schools in the Mion District of Ghana’s northern region. The children’s depression inventory and the Food Insecurity Experience Scale were used in face-to-face interviews to assess depression and household food insecurity. Hierarchical survey binary logistic regression and linear mixed models were used to examine the association between household food insecurity and depressive symptoms. We took into account a number of potential confounders in the analysis, such as life satisfaction, self-efficacy, self-esteem, health complaints, child’s age, menarche status, pubertal development, anaemia, stunting, frequency of consuming fruits and vegetables, frequency of consuming animal-sourced foods, maternal age, household wealth index and size, and the intervention group the girl was assigned to in the trial. Results About 20.1% of adolescent girls were classified as likely depressed, and 70.3% of their households were food insecure, with 22.9% and 18.0% being moderately and severely food insecure, respectively. Compared with girls from food-secure households, those from moderately (adjusted OR (AOR) 2.63, 95% CI (1.35 to 5.12)) and severely (AOR 3.28, 95% CI (1.66 to 6.49)) food insecure households had about three times the odds of being classified as depressed, after controlling for potential confounders. The odds of being likely depressed were about twice for adolescent girls from food-insecure households compared with their peers from food-secure households in both the crude and final adjusted model. Conclusion The study discovered high levels of household food insecurity and depression in adolescent girls in Northern Ghana, with a dose-response association between the two.

Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school‐aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6–9 years;n= 323) and adolescents (10–17 years;n= 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21,P < 0.001); farm diversity score (β = 0.59,P = 0.036); and agro‐ecological zone (Ptrend <0.001) as the main predictors of Hb of SAC. Household asset index (Ptrend = 0.042) and agro‐ecological zone (Ptrend <0.001) were predictors of Hb in adolescents. Agro‐ecological zone and age were predictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59,P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro‐ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.