M ICRONUTRIENT I NTAKE AMONG C HILDREN

Micronutrient deficiency is a major contributor to childhood morbidity and mortality. Micro-nutrients are available in foods and can also be provided through direct supplementation. Breastfeeding children benefit from supplements given to the mother. In Ghana the prevailing levels of micronutrient deficiency levels related to anaemia, vitamin A, and iodine are considered high and of major public health significance by World Health Organisation standards.

Iron deficiency is one of the primary causes of anaemia, which has serious health consequences for both women and children. Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye damage and is the leading cause of childhood blindness. VAD also increases the severity of infections such as measles and diarrhoeal disease in children and slows recovery from illness. VAD is common in dry environments where fresh fruits and vegetables are not readily available. Vitamin A supplementation is an important tool in preventing VAD among young children. Iodine is an important trace element essential for the normal function of the thyroid gland. Iodine deficiency is most frequently caused by inadequate iodine intake and has serious effects on growth and mental development. The deficiency is the leading cause of preventable mental impairment worldwide.

Information was collected on food consumption during the day and night preceding the interview among the youngest children under age 2 living with their mothers; these data are useful in assessing the extent to which children are consuming food groups rich in two key micronutrients—vitamin A and iron—

in their daily diet. In addition, the GDHS included questions designed to ascertain whether young children had received vitamin A supplements or deworming medication in the six months preceding the survey or iron supplements in the seven days preceding the survey.

76

23

47

6 78

23

48

7 66

27

37

2 Percent

2003 GHDS 2008 GDHS 2014 GDHS

Any anaemia Mild Moderate Severe

Table 11.8 shows the intake of key micronutrients among children and shows the extent to which young children consumed adequate amounts of foods rich in vitamin A and iron by background characteristics. The results show that among the youngest children age 6-23 months living with their mother, 67 percent consumed foods rich in vitamin A on the day or night preceding the survey. There are very slight differences in consumption of vitamin A-rich foods by sex and residence. Nonbreastfeeding children are more likely to consume vitamin A-rich foods (92 percent) compared with breastfeeding children (62 percent). Mother’s education shows slight association with the consumption of vitamin A-rich foods: 63 percent of children of mothers with primary education consume vitamin A-rich foods, compared with 78 percent of children of mothers with a secondary or higher education. Regional variations are evident in the consumption of vitamin A-rich foods by children, with the highest proportion being in the Central region (82 percent) and the lowest being in the Northern region (56 percent).

Nearly 7 out of 10 children age 6-23 months living with the mother consumed foods rich in iron in the 24 hours preceding the survey (67 percent). Variations by most background characteristics are similar to those observed for vitamin A-rich foods. By region, the consumption of iron-rich foods among children is highest in Central (78 percent) and lowest in Upper East (36 percent).

Table 11.8 also shows information on vitamin A and iron supplementation. Among all children age 6-59 months, 65 percent received vitamin A supplements in the six months immediately preceding the survey. Vitamin A supplementation is higher among children age 6-23 months than among older children.

Breastfeeding children are more likely than nonbreastfeeding children to have received a vitamin A supplement in the last six months (72 percent and 62 percent, respectively). Children in urban areas are slightly less likely to receive a vitamin A supplement than children in rural areas (63 percent versus 68 percent). The proportion of children who received a vitamin A supplement is highest in the Central region (79 percent) and lowest in the Northern region (44 percent). There are no consistent patterns in percentage of children receiving a vitamin A supplement by mothers’ education and age at birth, or by household wealth.

Regarding iron supplementation, only 24 percent of children age 6-59 months received an iron supplement in the seven days preceding the survey. There are no notable variations by most background characteristics, except for regions and household wealth. The percentage of children age 6-59 months who received an iron supplement in the seven days preceding the survey ranges from 9 percent in the Upper West to 37 percent in Western. Children from the poorest households are the least likely to have received iron supplementation in the past seven days (19 percent).

Looking at trends, the proportion of children age 6-59 months who received vitamin A supplementation in the preceding six months increased from 56 percent in 2008 to 65 percent in 2014, and the proportion who received an iron supplement in the seven days preceding the survey decreased somewhat, from 28 percent in 2008 to 24 percent in 2014.

Intestinal parasites such as helminthes can contribute to anaemia, and periodic deworming to control such organisms can improve children’s health and growth. The 2014 GDHS collected information on whether children age 6-59 months had been given deworming medication in the six months before the survey. Results shown in Table 11.8 indicate that 38 percent of children age 6-59 months received deworming medication in the six months preceding the survey. Children in urban areas are more likely than those in rural areas to receive deworming medication (43 percent and 35 percent, respectively). The regional coverage of deworming medication among children ranges from a low of 13 percent in Upper West to 49 percent in Ashanti. Nonbreastfeeding children, children whose mothers have a secondary or higher education, and those from the wealthiest households are the most likely to be given deworming medication. For example, 52 percent of children who belong to the wealthiest households received deworming medication compared with only 19 percent of children from the poorest households.

Nutrition of Children and Women • 171

Table 11.8 Micronutrient intake among children

Among youngest children age 6-23 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night preceding the survey, among all children 6-59 months, the percentages given vitamin A supplements in the six months preceding the survey, the percentages given iron supplements in the past seven days, and the percentages given deworming medication in the six months preceding the survey; and among all children age 6-59 months who live in households tested for iodised salt, the percentage who live in households with iodised salt, by background characteristics, Ghana 2014

Among youngest children age 6-23

months living with the mother: Among all children age 6-59 months:

Among children age 6-59 Note: Information on vitamin A is based on both mother’s recall and the immunisation card (where available). Information on iron supplements and deworming medication is based on the mother’s recall. Total includes four children with missing information on breastfeeding status.

na = Not applicable

1 Includes meat (including organ meat), fish, poultry, eggs, pumpkin, carrots, squash or sweet potatoes, dark green leafy vegetables, mangoes, paw paw, and other locally grown fruits and vegetables that are rich in vitamin A.

2 Includes meat (including organ meat), fish, poultry, and eggs

3 Deworming for intestinal parasites is commonly done for helminthes and for schistosomiasis.

4 Excludes children in households in which salt was not tested.

Ghana has adopted a national programme for universal salt iodisation (USI) to iodise salt as the main approach for the prevention of iodine deficiency. This is backed by the Food and Drugs Law Amendment Act (Act 523) passed in 1996, making provision for the mandatory fortification of all refined and unrefined edible salt with potassium iodate. To generate data on household use or consumption of iodised salt a semi-quantitative rapid test kit was used to measure iodine content of the salt used for cooking in a selected household subsample.

Table 11.8 shows that 62 percent of children live in households that use iodised salt. Children in urban areas (69 percent) are more likely to live in households that use iodised salt than their rural counterparts (56 percent). The percentage of children living in households that use iodised salt is lowest in the Eastern region (39 percent) and highest in the Western region (80 percent). Almost 8 in 10 children who are born to mothers with a secondary or higher education and who belong to the highest wealth quintile live in households with iodised salt.

Table 11.9 shows the proportion of households with iodised salt according to background characteristics. Overall, salt was tested in 87 percent of the households and two-thirds (66 percent) of the tested households had iodised salt. Although the presence of any iodine is most commonly accepted to define iodised salt, the test kits allow classification as to whether the salt contains at least 15 parts per million (ppm) of iodine, which constitutes the adequate amount of iodisation. Using this criterion, only 4 in 10 of the tested households (39 percent) had adequately iodised salt. Although Ghana is far from the 90 percent USI target, these results show substantial improvements in the percentage of households that use any iodised salt and that use adequately iodised salt from 42 percent and 28 percent, respectively, in the 2003 GDHS to 66 percent and 39 percent, respectively, in the 2014 GDHS.

The percentage of households using any iodised salt is far greater in urban (72 percent) than rural areas (58 percent). Western region has the highest proportion of households using iodised salt (84 percent), while Volta and Eastern regions have the lowest proportions (42 percent each). The proportion of households using iodised salt rises steadily from 54 percent in the poorest households to 84 percent in the wealthiest households.

Table 11.9 Presence of iodised salt in household

Among all households, the percentage with salt tested for iodine content and the percentage with no salt in the household; and among households with salt tested, the percent distribution by level of iodine in salt (parts per million or ppm) and percentage with iodised salt, according to background characteristics, Ghana 2014

Among all households, the percentage Among households with tested salt:

Background