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There is limited information on the magnitude and determinants of household food insecurity (HFI) and how it relates to the nutritional status of pregnant women in Northern Ghana. The magnitude, determinants of HFI, and how it relates to the nutritional status of pregnant women were evaluated in the Africa RISING West Africa project intervention communities in Northern Ghana. The prevalence of moderate and severe household hunger was 25.9% (95% CI: 19.0, 34.3) and 6.8% (95% CI: 4.2, 10.9) respectively. The independent predictors of maternal thinness were region of residence, gestational age and maternal age. Compared to women in the first trimester, women in the third trimester were 2.2 times more likely of being underweight adjusted odds ratio (AOR = 2.19, CI: 1.02, 4.70). Women who were under 20 years of age were 11.9 times more likely of being thin compared to women aged more than 35 years (AOR = 11.97, CI: 2.55, 5. 67). Food insecurity was highly prevalent but it was not associated with maternal thinness of pregnant women. The risk of maternal thinness increased as the gestational age increased and this has a great potential of adversely influencing pregnancy outcomes and overall quality of life.
The study covered 25 communities located in five districts of Northern Ghana. The International Institute of Tropical Agriculture is currently operating in these districts, namely Nadowli, Wa West in the Upper West Region (UWR), Tolon and Savelugu in the Northern Region (NR), and Kassena‐Nankana in the Upper East Region (UER). The study area is characterized by high poverty and recurrent droughts and floods which predispose communities to increased vulnerability to food insecurity and malnutrition. The Ghana Living Standards Survey Round 6 Report showed that the three study regions have high proportions of households in the lowest quintile than in the highest quintile. The UWR has the highest proportion of households in the lowest quintile (55.7%) and the NR recorded the lowest proportion in the highest quintile (10.2%; GSS, 2014). These are indication that poverty is more prevalent in the three NR, particularly in the UWR. The three regions share some boundaries with each other. The UER shares its northern boundary with Burkina Faso and its eastern boundary with the Republic of Togo. The UWR on the other hand has a northern boundary with Burkina Faso and a western boundary with La Cote d’Ivoire. The UER and UWR share their southern boundaries with the NR which also has la Cote d’Ivoire to the west and Togo to the east. Majority of the people have agriculture as their main occupation while some are involved in trading. The main staple foods including maize, sorghum, millet and yam are usually harvested from October through December. Although the food security situation is usually good during the harvesting time, child care tends to suffer because of lack of time on the part of rural mothers. A high proportion of rural women work daily away from home, and therefore frequently face challenges to the care of children. The rainfall pattern is unimodal and the period is usually short and lasts from May to August, followed by a long dry season (September–April) with dry harmattan winds. This study was an analytical cross sectional survey involving pregnant women in different stages of gestation. The basic primary sampling unit was the household in which there was a pregnant woman. In each community, a complete list of all households was compiled and were serially numbered. Systematic random sampling was then used in selecting study households. To get the sampling interval, the total number of households in a cluster was divided by the cluster size. The first household was randomly selected by picking any number within the sample interval. Subsequent selections were made by adding the sampling interval to the selected number in order to locate the next household to visit. If the selected household does not have a target respondent, then next household was selected using the systematic sampling procedure. The sample size of 400 was determined on the assumption that 50% of the pregnant mothers experienced food insecurity with 5% marginal error and 95% confidence level and a none response rate of 5%. Based on this assumption, the actual sample size for the study was determined using the formula for one‐point sample estimation: where n = required sample size, t = confidence level at 95% (standard value of 1.96), p = estimated prevalence of food insecurity in the domain area (50.0%) and m = margin of error at 5% (standard value of .05). The data were collected using predesigned and pretested semi‐structured questionnaire. Targeted eligible women were interviewed in the local language in their homes. Data collected included socio‐demographic information including marital status, maternal occupation, nutritional status, and household food security. Mid upper arm circumference (MUAC) tape was used to measure arm circumference and Seca electronic adult scale for maternal weight. Information on gestational age was retrieved from Maternal Health Record Books antenatal care (ANC cards). In order to ensure reliability and validity of data collected, all field assistants with a minimum qualification of Senior High School were given training for 3 days. The content of the training included objectives and methodology, standard measurement procedures, data recording, recruitment, administration of questionnaires and supervision. The HFI was quantified using the HFI access scale (HFIAS). The HFIAS was developed for use in developing country settings, and it is quantified by asking respondents about three domains of food insecurity: (1) experiencing anxiety and uncertainty about the household food supply; (2) altering quality of the diet and (3) reducing quantity of food consumed (Ozaltin, Hill, & Subramanian, 2010). In arriving at the domains of food access, nine occurrence questions were asked about changes households made in their diet or food consumption patterns due to limited resources to acquire food in the preceding 30 days. A household was classified as “food secure” if the responses was “never” to all of the nine items; as “food insecure” if the response were “sometimes” or “always” to one or more of the nine occurrence questions. Based on the responses given to the nine questions and frequency of occurrence over the past 30 days, households were assigned a score that ranges from 0 to 27. A higher HFIAS score is indicative of poorer access to food and greater household food insecurity. Food insecure households were further classified into two groups based on overall distribution of the HFIAS in the sample. The lower the score, the most food secured a household was. HFIAS allows assessment of food poverty (i.e., the inability to obtain healthy affordable food). Though data was collected based on the HFIAS, the household hunger scale (HHS) was used in most of the analyses because of easy comparison of results across different cultures and greater reliability of responses from respondents. The HHS comprises three subset questions from the HFIAS that pertain to insufficient food quantities (Deitchler et al., 2011; Silventoinen, 2003). Scores of 0–1 are classified as “little to no household hunger”; 2–3 as “moderate household hunger” and 4–6 “severe household hunger” (Silventoinen, 2003). Women with scores 2–6 are therefore classified as experiencing “moderate or severe household hunger.” For logistic regression analyses, the three classes were regrouped into two (none/mild and moderate/severe household food insecurity). The reduced coping strategy index (CSI) is considered a proxy indicator of the food access component of food security and it is calculated on the basis of a specific set of behaviors each with its own universal severity weighting (Maxwell & Caldwell, 2008; Maxwell et al., 2003). The five standard coping strategies and their severity weightings are: Answers to the simple question “In the past 7 days, if there have been times when you did not have enough food or enough money to buy food, how many days has your household had to adopt a particular food‐based coping strategy” were used to create the CSI. For each household, a score was given to each coping strategy. The score = (frequency with which coping strategy is used) × (severity weight). The scores for each coping strategy are added together to give a composite score for each household. Higher values of the index indicate more severe food insecurity. Mid upper arm circumference was used to assess the nutritional status of the pregnant women. MUAC was used as a proxy for body weight, since it is not affected by gestational age (Krasovec & Anderson, 1991). MUAC was measured to the nearest 0.1 cm, and values below 25.0 cm were classified in the analyses as an indicator of low body weight. A household wealth index based on household assets and housing quality was used as a proxy indicator for socio‐economic status (SES) of households. Principal component analysis was used to determine household wealth index from information collected on housing quality (floor, walls, and roof material), source of drinking water, type of toilet facility, the presence of electricity, type of cooking fuel, and ownership of modern household durable goods and livestock (e.g., bicycle, television, radio, motorcycle, sewing machine, telephone, cars, refrigerator, mattress, bed, computer, and mobile phone; Filmer & Pritchett, 2001; Howe, Hargreaves, & Huttly, 2008; Rutstein & Johnson, 2004; Vyas & Kumaranayake, 2006). These facilities or durable goods are often regarded as modern goods that have been shown to reflect household wealth. A household of zero index score for example means that household had not a single modern good. The scores were thus added up to give the proxy household wealth index. The main aim of creating the index was to categorize households into SES groupings in order that we could compare the difference in the prevalence of HFI between the groups of lowest and highest SES. The data were coded for statistical analysis using SPSS for windows 21.0 (SPSS Inc, Chicago). For continuous outcomes, statistical significance was assessed using analysis of variance. For categorical and dichotomous outcomes, chi square tests were performed to assess statistical significance. Multiple regression analysis was used to identify the independent contributors to food insecurity and maternal nutritional status, controlling for potential confounding factors. A p value of <.05 was considered statistically significant. Ethical clearance was obtained from the Institutional Review Board of the Tamale Teaching Hospital (ref no. TTH/10/11/15/01). Participation in the study was voluntary and no incentives were provided. Verbal informed consent was sought from all the study participants before the commencement of any interview. The study was not harmful to any study participant. Study participants were free to withdraw from the study at any time without any penalty.
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