Introduction: The overarching empirical question of this study is this: how are children
growing in Ghana and how is childcare related to child growth?
Child health is a fundamental public health issue, for children's sake AND because good
child health sets one up for life long health and functioning, and well-being. In sub-Saharan
Africa (SSA), child physical health is of particular concern due the high rates of illness and
mortality in this region. The leading causes of child morbidity and mortality in SSA include
but are not limited to measles, diarrheal infections, respiratory infections, malaria, HIV and
nutritional deficiencies. In Ghana, the focus of this study, respiratory infections, diarrheal
infections, malaria and nutritional deficiencies (malnutrition) remain the major diseases
plaguing children less than 5 years of age. Malnutrition is the underlying cause of 40% of all
deaths among children less than 5 years in Ghana and almost three out of every ten children
in Ghana are stunted. There have been major interventions by the government of Ghana and
her partners such as WHO and UNICEF to combat childhood diseases in the country.
However, a lot needs to be done as yet, especially research on long term trends in child
health within social segments in the country, that have yet to be elucidated well enough. This
is important to help guide better national and local health promotion policy-making and
practice. Further, while home care is understood to be of vital importance to child health, too
little is yet known about childcare practices and how these influence child health in Ghana.
The present study therefore set out to address the following questions: What are the trends
over time in child malnutrition prevalence in socio-demographic subgroups within the 10
Ghana geographic regions (provinces)? What are the relationships of dietary diversity to
childhood wasting in urban and in rural Ghana, when control variables related to maternal,
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child and household characteristics are accounted for? What influence do childcare practices
have on children’s height-for-age z-scores, controlling for factors at child, maternal,
household and community levels? Do some children in Ghana benefit more from care than
others?
Methodology: This dissertation uses data from the Ghana Demographic and Health Surveys
(DHS), conducted in Ghana in 1993, 1998, 2003 and 2008. The main indicators of child
growth were height-for-age, weight-for-age and weight-for-height Z-scores. Children with
height-for-age, weight-for-age and weight-for-height Z-scores less than -2 standard
deviations (SD) of the WHO reference population were defined as stunted (chronically
malnourished), underweight, and/or wasted (acutely malnourished), respectively. In the
present study, the indicators were used both as continuous and categorical variables. The
study employs three main analytical methodologies: trend analysis—examines the time
trends of child malnutrition over time, logistic regression analysis— examines the
relationship between dietary diversity and child nutritional status, and multiple regression
analysis—examines the association between childcare practices (CCP) score and height-forage
z-scores (HAZ).
Main results: The results of the time trends analysis at the national level showed
statistically significant declining trends for stunting (F (1, 7204) = 7.89, p < .005) and
underweight (F (1, 7441) = 44.87, p<.001). The declining trends for wasting were also
statistically significant (F (1, 7130) = 6.19, p < .013). In the rural/urban place of residence
data, there was a stable and statistically insignificant trend in stunting for urban males and
females and rural females, while the declining trend for rural males was statistically
significant. Analysis by maternal education show a significant increasing trend in stunting
for males (F (1, 2004) = 3.92, p < .048) and for females (F (1, 2004) = 4.34, p < .037) whose
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mothers had higher than primary education, while the trends decreased significantly for male
and females whose mothers had no education. The logistic regression results showed that
high dietary diversity score (DDS) was associated with improved growth outcomes in rural
settings. A unit increase in DDS was associated with an 11% reduced odds of being wasted
(OR = 0.89, 95%, C.I 0.80-0.99). In the multiple regression analysis, CCP was a significant
predictor of HAZ, after controlling for covariates/confounders at child, maternal and
household levels. Children with higher CCP scores had higher HAZ scores. Statistical
interaction analyses revealed no subgroup differences in the CCP/HAZ relationship, such
that no subgroup benefited less from good care than other subgroups.
Conclusions: Overall, national malnutrition trends have declined significantly, but this
decline did not benefit all segments of society, as there were static to worsening trends in
some socio-demographic subgroups. Also, dietary diversity has a modest but statistically
significant association with acute malnutrition in rural but not in urban Ghana. Intervention
research to combat acute malnutrition in rural settings should include efforts to promote the
consumption of a variety of food groups.