A Study Of Community Perceptions And Strategies To Improve Women’s Dietary Quality In Savelugu-Nanton District, Ghana

ABSTRACT Background: The diets of women in reproductive age (WRA) are an important determinant of their health outcomes and quality of life especially in northern Ghana, where women’s diets remain persistently suboptimal. However, socio-cultural barriers, one of the multiple influences on WRA’s diets, are rarely addressed in existing interventions. This study identified the socio-cultural barriers to WRA achieving optimal diets, which, herein, represent beliefs, attitudes and actions that are derived from the existing native and emergent culture of the community and tested the feasibility of a community-based pilot intervention developed in consultation with the community to address these barriers. Methods: Socio-cultural barriers to women’s diets were identified and characterized through a qualitative study involving the exploration of the local food system, dietary knowledge, attitudes and practices at Yilkpene and Kpachilo. Data was collected through key informant interviews, focus group discussions, qualitative 24-hour dietary recalls with in-depth interviews and observations at the household and community levels. A 17- week attitudinal and behaviour change intervention was designed and implemented at Yilkpene in consultation with key community stakeholders. The first component, nutrition education, emphasized the importance of women’s diets and their reproductive health. The second component, advocacy, concerned empowering women to have more control over household food resources and modifying food taboos affecting women. Messages were delivered in the local language through participatory activities including community durbars, small group meetings, home-visits and food demonstration sessions. In the post-evaluation of the intervention, data was collected from 182 participants using the same tools used at baseline. The two sets of data were compared to assess the impact of the intervention at Yilkpene Results: Study participants, all aged at least 15 years, were mostly WRA (73%), married Muslims (87.4%) without formal education whose source of livelihood was farming (84.1%) and had households with sizes ranging between 6 and 40. At baseline, gender and socio-cultural factors significantly influenced all aspects of the food system, limiting women’s access to quality foods. Animal-source food taboos, which are mostly genderbased and affect the quality of women’s diets, were identified. At endline, these practices did not change but members of Yilkpene community were sensitized about them. Prior to the intervention, the dietary knowledge and attitudes among members of both communities were sub-optimal; but, at endline, improved knowledge and attitudes were observed in both communities even though the scope of improvements was more in the intervention community. There were also less reported beliefs about plant-source food restrictions at Yilkpene compared to Kpachilo. At baseline, close to half (45%) of women in either community could not meet their minimum dietary diversity but diversity deficit declined at endline (25% at Yilkpene and 10% at Kpachilo). Conclusion: Attitudinal and behavioural change communication interventions on entrenched socio-cultural issues pertaining to women’s diets need more prolonged and sustained durations to enhance their scopes of feasibility. Ghana Health Service and individuals should organize similar interventions.