Association of whole blood n-6 fatty acids with stunting in 2-to-6-year-old Northern Ghanaian children: A cross-sectional study

PLoS ONE, Volume 13, No. 3, Year 2018

Interpretation

In Northern Ghana, 33% of children are stunted due to economic disparities. Dietary fatty acids (FA) are critical for growth, but whether blood FA levels are adequate in Ghanaian children is unknown. The objective of this study was to determine the association between whole blood FAs and growth parameters in Northern Ghanaian children 2–6 years of age. A drop of blood was collected on an antioxidant treated card and analyzed for FA composition. Weight and height were measured and z-scores were calculated. Relationships between FAs and growth parameters were analyzed by Spearman correlations, linear regressions, and factor analysis. Of the 307 children who participated, 29.7% were stunted and 8% were essential FA deficient (triene/tetraene ratio>0.02). Essential FA did not differ between stunted and non-stunted children and was not associated with height-for-age z-score (HAZ) or weight-for-age z-score (WAZ). In hemoglobin adjusted regression models, both HAZ and WAZ were positively associated with arachidonic acid (p0.01), dihomo-gamma-linolenic acid (DGLA, p0.05), docosatetraenoic acid (p0.01) and the ratio of DGLA/linoleic acid (p0.01). These data add to the growing body of evidence indicating n-6 FAs are critical in childhood linear growth. Our findings provide new insights into the health status of an understudied Northern Ghanaian population. The study was conducted in the northern region of Ghana in the Savelugu-Nanton district [26]. The district covers 2022.6 sq. km with a population density of 68.9 persons per sq. km. The population of Savelugu-Nanton is 139,283 persons with 14,669 households. The average rainfall in the Savelugu-Nanton district is 600 mm. The district is also characterized by high temperatures with an average temperature of 34°C. The district is situated in the Savanna woodland that is capable of sustaining livestock, farming and the cultivation of crops such as rice, groundnuts, yams, cassava, maize, cowpea and sorghum. Over 80% of inhabitants are farmers. The main sources of water in the district are boreholes, rivers and streams, public taps, and pipe borne water. Though the primary source of water for taps and pipe borne water is the same, access to either categorizes households under different income levels, perhaps reflecting differences in hygiene and even nutritional status. Thatch is the main roofing material for housing (50.9%). Illiteracy level is high with 69% of all inhabitants 11 years and above having no education. Some common diseases in the district include malaria, gastroenteritis, upper respiratory tract infection, diarrhea, anemia, and pneumonia. There are three operational community health post zones that deliver health services to the people. The Savelugu-Nanton district was chosen for study as stunting levels are above the national average in the rural communities in this district [27] with overall district stunting level of 38.8% [28]. Additionally, it is one of the few areas in Northern Ghana with road access to rural communities. This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were approved by the Institutional Review Board at Michigan State University (IRB # 16–557) and the Committee on Human Research Publication and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (CHRPE/AP/236/16). The parent or caregiver of the participating child gave consent prior to the child’s participation. A script of the written consent was read and translated in Dagbani to the parents or caregivers of the children. The parents or caregivers thumb printed the consent document to give consent. They were assured that participation was voluntary and confidential, and that their information would remain anonymous. Children (n = 307) between 2 to 6 years of age residing in 5 communities in the Savelugu-Nanton district were recruited for the study. The communities were Janjorikukuo, Pong Tamale, Kparigilanyi, Morglaa and Fazhini. A power analysis was conducted from the results of an earlier study that measured maternal and infant erythrocyte fatty acid intake [29], and the fatty acid variation reported was utilized to run an a-priori sample size calculation for multiple regression based on an estimated medium effect size of 0.5 and significance level p = 0.05. This indicated that 242 participants would yield statistical power of 80% [30]. 307 children were enrolled, raising the power to 90%. The exclusion criteria included sick and hospitalized children as well as children who were legally declared intellectually disabled. Data was collected in July 2016. Height of all participants was measured to the nearest 0.1cm with a stadiometer (Seca, USA). Weight was measured using a digital bathroom scale to the nearest 0.1kg (Camry, model number: EB9003, China). All measurements were repeated and averages were reported. The date of birth was recorded from the child’s health card or birth certificate. The sex of the child was also recorded. Blood spots (40ul) were collected on a dried blood spot card (DBS) as previously described by Jumbe et al., 2016 [4, 31]. A sterile single-use lancet was used in puncturing the tip of the middle finger to obtain drops of blood. The first drop of blood was wiped with a sterilized dry pad. The drops of blood were then collected onto the DBS cards. The cards were stored in a dry, cool environment and shipped to the USA for FA analysis at OmegaQuant Analytics, LLC (Sioux Falls, SD). The average time between sample collection and arrival in the US lab was 8 days. Upon arrival in the US lab, the samples were stored at –80°C for 5 days and then analyzed as previously described [29, 32, 33]. Briefly, a punch from the DBS card was combined with the derivatizing reagent [boron trifluoride in methanol (14%), toluene, and methanol (35:30:35 parts)], shaken and heated at 100°C for 45 minutes. Forty parts of both hexane and distilled water were added after the mixture had cooled. After vortexing briefly, the samples were spun to separate layers and an aliquot of the hexane layer that contained the FA methyl esters was extracted. FA analysis was performed as previously described [34–36]. Unless otherwise stated, whole blood FA proportions are expressed as a percent of total identified FAs. Additional drops of blood from the same puncture site were used to assess hemoglobin concentration using a HemoCue photometer (HemoCue 301, Angelholm, Sweden), and malaria status using an antigen-based malaria rapid diagnostic test kit (Standard diagnostic Inc., Korea). Z-scores were calculated for the growth parameters HAZ, WAZ, and WHZ using WHO Anthro v3.2.2 igrowup package for R [37], to calculate z-scores for children < 5 years of age, and WHO Anthro Plus [38] for children ≥ 5. Means and standard deviations were calculated for descriptive analysis. Stunting percentages were calculated based on the WHO standard population and definitions of moderate and severe stunting, wasting, and underweight [39]. FAs were expressed as percent composition of total blood FAs. Mean and standard deviations were calculated for blood FA composition. Total n-3 FA proportions were calculated as ∑ [ALA+ eicosapentaenoic acid (EPA) + docosapentaenoic n-3 (DPA n-3) + docosahexaenoic acid (DHA)]; total n-6 FA proportions were calculated as ∑ [LA + linoelaidic + eicosadienoic (EDA) + dihomo-gamma-linolenic (DGLA) + AA + docosatetraenoic (DTA) + docosapentaenoic n-6 (DPA n-6)]; total n-9 FA proportions were calculated as ∑ [oleic + elaidic + eicosenoic + Mead + nervonic]; total saturated FA proportions were calculated as ∑ [myristic + palmitic + stearic + arachidic + behenic + lignoceric]; total monounsaturated FA (MUFA) proportions were calculated as ∑ [palmitoleic + oleic + palmitelaidic + nervonic + elaidic + eicosenoic]; total polyunsaturated FA (PUFA) proportions were calculated as ∑ [total n-3 + total n-6]. T/T ratio was calculated from the ratio of Mead acid and AA [37]. Product-to-precursor ratios were calculated to estimate PUFA metabolism [40] as follows: EDA/LA to estimate elongase activity, GLA/LA and AA/DGLA to estimate desaturase activity, and DGLA/LA to estimate combined elongase and desaturase activity. All statistical analyses were conducted using software R (R version 3.4.0). Correlations between participant characteristics, anthropometric measurements, and blood FAs were assessed using spearman correlations and graphically displayed using the R package corrplot [41]. Normal probability plots were assessed to verify the validity of regressions. Regression formulas consisted of either the dependent variable HAZ or WAZ, and models were adjusted for each FA and Hb levels (i.e., HAZ = FA + Hb or WAZ = FA + Hb). Hemoglobin was selected as a covariate since it was significantly associated with HAZ and WAZ (p ≤0.01). Regression models were adjusted for Hb and not adjusted for sex as there were few significantly different fatty acids (FAs) between sexes and regression values were unaffected when evaluated with sex adjustment. P-values were considered significant if p≤0.05. Exploratory factor analysis was carried out using the psych package [42]. Briefly, scree plot was used to determine four factors [43]. Palmitelaidic, linoelaidic, and elaidic acids were omitted from the analysis as they were not highly correlated with any other FAs (r<0.3). Varimax rotation was used for orthogonal transformation of the factor loading matrix. FAs correlated with factors r≥0.5 were considered strongly correlated with the factor, regardless of sign. Factor loading scores were generated for each child and used to calculate regressions for each factor. The regressions were HAZ or WAZ = Hb + Factor.

AI Digest

Study Justification:

This study aimed to investigate the association between whole blood fatty acid (FA) levels and growth parameters in 2-to-6-year-old children in Northern Ghana. The justification for this study is the high prevalence of stunting in this region, which is attributed to economic disparities. Understanding the role of dietary fatty acids in growth is crucial for addressing this issue. However, the adequacy of blood FA levels in Ghanaian children has not been previously studied.

Study Highlights:

– The study included 307 children aged 2 to 6 years from the Savelugu-Nanton district in Northern Ghana.
– Blood samples were collected and analyzed for FA composition, while weight and height measurements were taken to calculate z-scores.
– The study found that 29.7% of the children were stunted, and 8% were deficient in essential fatty acids.
– Essential fatty acid levels did not differ between stunted and non-stunted children and were not associated with height-for-age or weight-for-age z-scores.
– However, certain specific fatty acids, such as arachidonic acid, dihomo-gamma-linolenic acid, and docosatetraenoic acid, were positively associated with growth parameters.
– These findings contribute to the growing evidence that n-6 fatty acids play a critical role in childhood linear growth.
– The study provides important insights into the health status of an understudied population in Northern Ghana.

Recommendations for Lay Reader and Policy Maker:

Based on the study findings, the following recommendations can be made:

1. Promote awareness and education about the importance of dietary fatty acids for child growth and development.
2. Encourage the consumption of foods rich in n-6 fatty acids, such as vegetable oils, nuts, and seeds, in the diets of young children.
3. Consider implementing targeted interventions to address stunting in Northern Ghana, focusing on improving access to and affordability of nutritious foods.
4. Support further research to explore the underlying mechanisms by which n-6 fatty acids influence linear growth in children.

Key Role Players:

To address the recommendations, the involvement of the following key role players is crucial:

1. Government health agencies and policymakers: They can develop and implement nutrition programs and policies targeting child growth and stunting prevention.
2. Non-governmental organizations (NGOs) and community-based organizations: They can collaborate with local communities to raise awareness, provide nutrition education, and support interventions.
3. Healthcare professionals: They can play a vital role in counseling parents and caregivers on the importance of a balanced diet and the inclusion of essential fatty acids in children’s meals.
4. Researchers and academic institutions: They can conduct further studies to deepen the understanding of the relationship between fatty acids and child growth, as well as evaluate the effectiveness of interventions.

Cost Items for Planning Recommendations:

While the actual cost may vary depending on the specific interventions and programs implemented, the following cost items should be considered in planning the recommendations:

1. Nutrition education materials and campaigns: This includes the development and dissemination of educational materials, workshops, and community outreach programs.
2. Food supplementation programs: Providing access to affordable and nutritious foods, such as fortified oils and locally available sources of n-6 fatty acids.
3. Training and capacity building: This involves training healthcare professionals and community workers to deliver effective nutrition counseling and support.
4. Monitoring and evaluation: Allocating resources for data collection, analysis, and monitoring the impact of interventions on child growth and stunting rates.
Please note that the provided cost items are general considerations and should be further assessed and tailored to the specific context and needs of Northern Ghana.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a cross-sectional analysis to determine the association between whole blood fatty acids (FAs) and growth parameters in Northern Ghanaian children. The study included a sample size of 307 children and used statistical analyses such as Spearman correlations, linear regressions, and factor analysis. The study found that certain FAs were positively associated with height-for-age z-score (HAZ) and weight-for-age z-score (WAZ). However, the study did not find a difference in essential FA levels between stunted and non-stunted children. To improve the strength of the evidence, future studies could consider conducting a longitudinal analysis to establish causality and include a control group to compare FA levels between stunted and non-stunted children.

Abstract

The study was conducted in the northern region of Ghana in the Savelugu-Nanton district [26]. The district covers 2022.6 sq. km with a population density of 68.9 persons per sq. km. The population of Savelugu-Nanton is 139,283 persons with 14,669 households. The average rainfall in the Savelugu-Nanton district is 600 mm. The district is also characterized by high temperatures with an average temperature of 34°C. The district is situated in the Savanna woodland that is capable of sustaining livestock, farming and the cultivation of crops such as rice, groundnuts, yams, cassava, maize, cowpea and sorghum. Over 80% of inhabitants are farmers. The main sources of water in the district are boreholes, rivers and streams, public taps, and pipe borne water. Though the primary source of water for taps and pipe borne water is the same, access to either categorizes households under different income levels, perhaps reflecting differences in hygiene and even nutritional status. Thatch is the main roofing material for housing (50.9%). Illiteracy level is high with 69% of all inhabitants 11 years and above having no education. Some common diseases in the district include malaria, gastroenteritis, upper respiratory tract infection, diarrhea, anemia, and pneumonia. There are three operational community health post zones that deliver health services to the people. The Savelugu-Nanton district was chosen for study as stunting levels are above the national average in the rural communities in this district [27] with overall district stunting level of 38.8% [28]. Additionally, it is one of the few areas in Northern Ghana with road access to rural communities. This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were approved by the Institutional Review Board at Michigan State University (IRB # 16–557) and the Committee on Human Research Publication and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (CHRPE/AP/236/16). The parent or caregiver of the participating child gave consent prior to the child’s participation. A script of the written consent was read and translated in Dagbani to the parents or caregivers of the children. The parents or caregivers thumb printed the consent document to give consent. They were assured that participation was voluntary and confidential, and that their information would remain anonymous. Children (n = 307) between 2 to 6 years of age residing in 5 communities in the Savelugu-Nanton district were recruited for the study. The communities were Janjorikukuo, Pong Tamale, Kparigilanyi, Morglaa and Fazhini. A power analysis was conducted from the results of an earlier study that measured maternal and infant erythrocyte fatty acid intake [29], and the fatty acid variation reported was utilized to run an a-priori sample size calculation for multiple regression based on an estimated medium effect size of 0.5 and significance level p = 0.05. This indicated that 242 participants would yield statistical power of 80% [30]. 307 children were enrolled, raising the power to 90%. The exclusion criteria included sick and hospitalized children as well as children who were legally declared intellectually disabled. Data was collected in July 2016. Height of all participants was measured to the nearest 0.1cm with a stadiometer (Seca, USA). Weight was measured using a digital bathroom scale to the nearest 0.1kg (Camry, model number: EB9003, China). All measurements were repeated and averages were reported. The date of birth was recorded from the child’s health card or birth certificate. The sex of the child was also recorded. Blood spots (40ul) were collected on a dried blood spot card (DBS) as previously described by Jumbe et al., 2016 [4, 31]. A sterile single-use lancet was used in puncturing the tip of the middle finger to obtain drops of blood. The first drop of blood was wiped with a sterilized dry pad. The drops of blood were then collected onto the DBS cards. The cards were stored in a dry, cool environment and shipped to the USA for FA analysis at OmegaQuant Analytics, LLC (Sioux Falls, SD). The average time between sample collection and arrival in the US lab was 8 days. Upon arrival in the US lab, the samples were stored at –80°C for 5 days and then analyzed as previously described [29, 32, 33]. Briefly, a punch from the DBS card was combined with the derivatizing reagent [boron trifluoride in methanol (14%), toluene, and methanol (35:30:35 parts)], shaken and heated at 100°C for 45 minutes. Forty parts of both hexane and distilled water were added after the mixture had cooled. After vortexing briefly, the samples were spun to separate layers and an aliquot of the hexane layer that contained the FA methyl esters was extracted. FA analysis was performed as previously described [34–36]. Unless otherwise stated, whole blood FA proportions are expressed as a percent of total identified FAs. Additional drops of blood from the same puncture site were used to assess hemoglobin concentration using a HemoCue photometer (HemoCue 301, Angelholm, Sweden), and malaria status using an antigen-based malaria rapid diagnostic test kit (Standard diagnostic Inc., Korea). Z-scores were calculated for the growth parameters HAZ, WAZ, and WHZ using WHO Anthro v3.2.2 igrowup package for R [37], to calculate z-scores for children < 5 years of age, and WHO Anthro Plus [38] for children ≥ 5. Means and standard deviations were calculated for descriptive analysis. Stunting percentages were calculated based on the WHO standard population and definitions of moderate and severe stunting, wasting, and underweight [39]. FAs were expressed as percent composition of total blood FAs. Mean and standard deviations were calculated for blood FA composition. Total n-3 FA proportions were calculated as ∑ [ALA+ eicosapentaenoic acid (EPA) + docosapentaenoic n-3 (DPA n-3) + docosahexaenoic acid (DHA)]; total n-6 FA proportions were calculated as ∑ [LA + linoelaidic + eicosadienoic (EDA) + dihomo-gamma-linolenic (DGLA) + AA + docosatetraenoic (DTA) + docosapentaenoic n-6 (DPA n-6)]; total n-9 FA proportions were calculated as ∑ [oleic + elaidic + eicosenoic + Mead + nervonic]; total saturated FA proportions were calculated as ∑ [myristic + palmitic + stearic + arachidic + behenic + lignoceric]; total monounsaturated FA (MUFA) proportions were calculated as ∑ [palmitoleic + oleic + palmitelaidic + nervonic + elaidic + eicosenoic]; total polyunsaturated FA (PUFA) proportions were calculated as ∑ [total n-3 + total n-6]. T/T ratio was calculated from the ratio of Mead acid and AA [37]. Product-to-precursor ratios were calculated to estimate PUFA metabolism [40] as follows: EDA/LA to estimate elongase activity, GLA/LA and AA/DGLA to estimate desaturase activity, and DGLA/LA to estimate combined elongase and desaturase activity. All statistical analyses were conducted using software R (R version 3.4.0). Correlations between participant characteristics, anthropometric measurements, and blood FAs were assessed using spearman correlations and graphically displayed using the R package corrplot [41]. Normal probability plots were assessed to verify the validity of regressions. Regression formulas consisted of either the dependent variable HAZ or WAZ, and models were adjusted for each FA and Hb levels (i.e., HAZ = FA + Hb or WAZ = FA + Hb). Hemoglobin was selected as a covariate since it was significantly associated with HAZ and WAZ (p ≤0.01). Regression models were adjusted for Hb and not adjusted for sex as there were few significantly different fatty acids (FAs) between sexes and regression values were unaffected when evaluated with sex adjustment. P-values were considered significant if p≤0.05. Exploratory factor analysis was carried out using the psych package [42]. Briefly, scree plot was used to determine four factors [43]. Palmitelaidic, linoelaidic, and elaidic acids were omitted from the analysis as they were not highly correlated with any other FAs (r<0.3). Varimax rotation was used for orthogonal transformation of the factor loading matrix. FAs correlated with factors r≥0.5 were considered strongly correlated with the factor, regardless of sign. Factor loading scores were generated for each child and used to calculate regressions for each factor. The regressions were HAZ or WAZ = Hb + Factor.

Materials

Innovations

The study mentioned in the description focuses on the association between whole blood fatty acids and growth parameters in children in Northern Ghana. The objective is to determine the relationship between fatty acids and stunting in children aged 2-6 years. The study collected blood samples and analyzed the fatty acid composition, as well as measured height and weight to calculate z-scores. The results showed that certain fatty acids were positively associated with height-for-age and weight-for-age z-scores. These findings suggest that n-6 fatty acids are important for childhood linear growth.

Based on this study, here are some potential innovations that could improve access to maternal health:

1. Nutritional interventions: Implementing nutritional interventions that focus on increasing the intake of essential fatty acids in pregnant women and young children could help improve growth and development outcomes. This could include promoting the consumption of foods rich in n-6 fatty acids, such as vegetable oils, nuts, and seeds.

2. Education and awareness programs: Developing educational programs to raise awareness about the importance of a balanced diet during pregnancy and early childhood could help improve maternal and child health outcomes. These programs could provide information on the role of essential fatty acids in growth and development and offer practical tips on incorporating them into daily meals.

3. Access to prenatal and postnatal care: Ensuring that pregnant women and new mothers have access to quality prenatal and postnatal care is crucial for promoting maternal and child health. This includes regular check-ups, nutritional counseling, and monitoring of growth parameters to identify any potential issues early on.

4. Community-based interventions: Implementing community-based interventions that focus on improving access to nutritious foods and promoting healthy eating habits could help address the issue of stunting in children. This could involve setting up community gardens, providing cooking demonstrations, and offering support for breastfeeding and complementary feeding practices.

5. Collaboration between healthcare providers and researchers: Encouraging collaboration between healthcare providers and researchers can help bridge the gap between research findings and their implementation in clinical practice. This collaboration can lead to the development of evidence-based guidelines and interventions that can be effectively implemented to improve access to maternal health.

It is important to note that these recommendations are based on the findings of the study mentioned and may need to be further evaluated and adapted to the specific context and needs of the population.

AI Innovations Description

The study mentioned focuses on the association between whole blood fatty acids (FAs) and growth parameters in Northern Ghanaian children aged 2-6 years. The objective was to determine the relationship between FAs and stunting, which is a significant issue in the region.

Based on the findings of the study, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Promote dietary interventions: The study suggests that essential fatty acid levels did not differ between stunted and non-stunted children and were not associated with height-for-age or weight-for-age. However, certain fatty acids, such as arachidonic acid, dihomo-gamma-linolenic acid, and docosatetraenoic acid, were positively associated with growth parameters. Therefore, promoting dietary interventions that increase the intake of these specific fatty acids may help improve maternal health and reduce the risk of stunting in children.

2. Nutrition education and counseling: Implementing nutrition education and counseling programs for pregnant women and mothers of young children can help raise awareness about the importance of a balanced diet rich in essential fatty acids. These programs can provide information on food sources of these fatty acids and offer guidance on meal planning and preparation to ensure optimal nutrition during pregnancy and early childhood.

3. Fortification of staple foods: Considering that the study was conducted in an area where economic disparities contribute to stunting, fortifying staple foods with essential fatty acids can be an effective strategy. This can be done by adding specific fatty acid-rich ingredients or supplements to commonly consumed foods like rice, groundnuts, yams, cassava, maize, cowpea, and sorghum. Fortification programs should be implemented in collaboration with local communities, government agencies, and food manufacturers.

4. Mobile health (mHealth) interventions: Utilizing mobile technology to deliver maternal health information and reminders can help improve access to healthcare services and promote healthy behaviors. Mobile applications or text message-based interventions can provide pregnant women and mothers with personalized nutrition advice, reminders for prenatal and postnatal check-ups, and information on the importance of essential fatty acids for maternal and child health.

5. Strengthening healthcare infrastructure: To ensure effective implementation of interventions, it is crucial to strengthen healthcare infrastructure in the region. This includes improving access to healthcare facilities, training healthcare providers on maternal and child health, and ensuring the availability of essential resources and equipment for maternal health services.

By implementing these recommendations, it is possible to develop innovative approaches to improve access to maternal health and reduce the prevalence of stunting in Northern Ghanaian children.

AI Innovations Methodology

The study mentioned focuses on the association between whole blood fatty acids (FAs) and growth parameters in children aged 2-6 years in Northern Ghana. The objective is to determine the relationship between FAs and stunting, a condition prevalent in the region due to economic disparities. The study collected blood samples from 307 children and analyzed their FA composition. Height and weight measurements were taken, and z-scores were calculated. The study found that certain FAs, such as arachidonic acid, dihomo-gamma-linolenic acid, and docosatetraenoic acid, were positively associated with height-for-age and weight-for-age z-scores.

To improve access to maternal health in the region, potential recommendations could include:

1. Strengthening healthcare infrastructure: Investing in healthcare facilities, equipment, and trained healthcare professionals to ensure adequate maternal health services are available in the region.

2. Increasing awareness and education: Implementing educational programs to raise awareness about the importance of maternal health and providing information on available healthcare services and resources.

3. Improving transportation: Enhancing transportation systems to facilitate access to healthcare facilities, particularly in remote areas where transportation may be a barrier.

4. Providing financial support: Implementing programs that provide financial assistance or health insurance coverage for maternal health services, reducing the financial burden on families.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve:

1. Collecting baseline data: Gathering data on the current state of maternal health access in the region, including factors such as healthcare infrastructure, awareness levels, transportation availability, and financial barriers.

2. Developing a simulation model: Creating a model that incorporates the collected data and simulates the potential impact of the recommendations on improving access to maternal health. The model should consider factors such as population demographics, geographical distribution, and resource allocation.

3. Running simulations: Using the simulation model to run various scenarios that reflect the implementation of the recommendations. This could involve adjusting variables such as healthcare infrastructure, awareness levels, transportation availability, and financial support.

4. Analyzing results: Evaluating the outcomes of the simulations to assess the potential impact of the recommendations on improving access to maternal health. This could include measuring changes in healthcare utilization, reduction in maternal mortality rates, and improvements in health outcomes for mothers and infants.

5. Refining and optimizing recommendations: Based on the simulation results, refining and optimizing the recommendations to maximize their impact on improving access to maternal health. This could involve adjusting resource allocation, targeting specific areas or populations, or identifying additional interventions that could further enhance access.

By using this methodology, policymakers and stakeholders can gain insights into the potential effectiveness of different recommendations and make informed decisions on strategies to improve access to maternal health in the region.

Author

Dima Health

Statistics:

Citations: 14

Identifiers:

DOI: 10.1371/journal.pone.0193301

Research Areas:

Community Interventions, Disparities, Environmental, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Technology and Innovations

Study Countries:

Ghana

Study Design:

Cross Sectional Study, Exploratory Study

Study Approach:

Quantitative