Abstract
We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. Countrywide, covering rural and urban areas in Ghana. Non-pregnant adolescent girls aged 15-19 years. Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.
Highlights
Population characteristics For all surveys (Table 1), the adolescent girls’ mean age was approximately 17 years; about half of the respondents were of Akan ethnicity and more than three-quarters of the adolescents professed Christianity
This study examined the trends over time and the factors associated with malnutrition among adolescent girls aged 15–19 years in Ghana using nationally representative data from the 2003, 2008 and 2014 Ghana demographic and health survey (GDHS)
Our analysis showed that the peak of anaemia in 2008 was highest in the forest zone, which was contrary to other studies in Ghana[15,54]
Summary
Study design We conducted secondary analyses of the national representative 2003, 2008 and 2014 GDHS data for non-pregnant adolescent girls aged 15–19 years. The GDHS contains data on individual demographic characteristics, household characteristics, fertility, women’s empowerment, nutrition and health of Ghanaian women aged 15–49 years. We did not use the 1993 and 1998 GDHS data due to the absence of Hb data and small sample sizes (see online Supplemental Table S1, for population selected for analysis). Details of the sample selection and data collection of the surveys are presented in the DHS Methodology report[40]. The datasets are accessed through the DHS MEASURE website[41]. The Ethical Review Committee of Ghana Health Service, Accra, Ghana, approved the GDHS, and no further ethical approval was required. We obtained permission from DHS MEASURE to download and analyse the data
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