The Magnitude of Hidden Hunger and Cognitive Deficits among Children Living in Orphanages in Kumasi, Ghana

Tandoh, Marina; Asamoah, Mary

doi:https://doi.org/10.1155/2022/9684785

Advances in Public Health

On this page

Abstract Introduction Methods Results Discussion Conclusions Data Availability Ethical Approval Conflicts of Interest References Copyright Related Articles

Research Article | Open Access

Volume 2022 | Article ID 9684785 | https://doi.org/10.1155/2022/9684785

The Magnitude of Hidden Hunger and Cognitive Deficits among Children Living in Orphanages in Kumasi, Ghana

Marina Tandoh¹and Mary Asamoah¹

Academic Editor: Carol J. Burns

Received21 Jun 2022

Accepted28 Aug 2022

Published28 Sept 2022

Abstract

This study assessed the magnitude of hidden hunger (micronutrient deficiencies) and cognitive deficits of 130 school-aged children (6–13 years old) living in three selected orphanages in Kumasi, Ghana. Sociodemographic data assessment, anthropometric assessment (BMI for age and height for age), dietary assessment (3-day repeated 24-hour dietary recall), urinary iodine level assessment, and cognitive performance assessment (Raven’s Coloured Progressive Matrices) were performed. Boys formed 50.8% of the study population, while girls formed 49.2%. The median age of participants was 10.50 years. About 12.3%, 7%, and 10.0% of participants were stunted, thin, and overweight/obese, respectively. The prevalence of mild iodine deficiency (i.e., 50–99 μg/L) was 16.2%. Iodine deficiency was significantly higher (23.6%) in participants who had lived for at least 7 years in the orphanage compared to those who had lived less than 7 years (10.7%) (). About 17% of the participants performed poorly (<50%) on the cognition test. Mean cognition test scores were significantly different among the orphanages (). The majority of participants, 89.2%, 54.6%, 76.9%, and 77.7%, had adequate intake of iron, zinc, vitamin C, and folate, respectively, whereas intake of vitamins A and B₁₂ was inadequate for the majority of participants (90.8% and 50.8%, respectively). There was no significant correlation between micronutrient intake and cognitive performance. However, mean cognition test scores were significantly different between participants with adequate and inadequate iron and vitamin A intake ( and , respectively). The findings of this study warrant a closer look at nutritional intakes in orphanages to improve hidden hunger and cognitive performance.

1. Introduction

Hidden hunger refers to deficiencies of vitamins and minerals, commonly called micronutrient malnutrition [1]. Hidden hunger is called so because the signs are subtle and not always obvious in those who suffer it [2]. Women of reproductive age and young children living in developing countries are most susceptible to deficiencies of vitamins and minerals (micronutrients) [2]. Deficiencies of iron, vitamin A, and iodine are the most prevalent micronutrient deficiencies globally [3]. Also, of significant public health importance are deficiencies of zinc, folate, vitamin B_12, and vitamin D [3]. It has been estimated that about 2 million people suffer chronic micronutrient deficiencies worldwide [4]. Hidden hunger is said to be responsible for about 7% of the annual global disease burden [2]. Key findings from the Hidden Hunger Index showed that among the 20 countries with the highest occurrence of multiple micronutrient deficiencies, Ghana ranked tenth [2]. Usually, the aetiologies of the deficiencies of various micronutrients are common, (mostly resulting from inadequate consumption of vegetables and fruits, foods of animal origin, or nutrient losses secondary to frequent infections); thus, they tend to occur together in the same population [2].

Iodine deficiency, usually caused by inadequate dietary intake of iodine, is also a public health issue of concern globally [5]. Severe iodine deficiency in a population can lead to a 13.5 point loss in mean intelligence quotient that can impair intellectual abilities in school or at work and as much as up to 15% of the population can suffer cretinism (severe physical and mental stunting) [5, 6]. Though on the verge of being eliminated, iodine deficiency is still the world’s leading, albeit easily preventable, cause of impaired neurocognitive development in children [5].

It is estimated that more than 153 million children are orphans globally [7]. Research has shown that compared to their family-reared counterparts, institutionalized children and those who are adopted after early institutional care exhibit retarded physical growth [8–10]. Being orphaned also makes a child more vulnerable to undernutrition [11, 12]. The overall nutritional status, including micronutrient status, of children, plays a critical role in their health, cognition, and consequently their educational attainment [13]. Thus, micronutrient deficiencies can affect neurocognitive development. Research has shown that children institutionalized in orphanages experience language delays and lower intelligence quotient (IQ) [10, 14, 15].

Many studies have assessed the magnitude of mixed micronutrient deficiencies or individual micronutrient deficiencies among children under 5 years, women of reproductive age (15–49 years old), and pregnant women [16]. However, the same attention has not been given to vulnerable children living in various orphanages [17]. This study, therefore, sought to assess the prevalence of hidden hunger (micronutrient deficiency) and cognitive deficits among children living in selected orphanages in Kumasi, Ghana.

2. Methods

2.1. Study Design, Study Site, and Study Population

An analytical cross-sectional study was conducted among randomly selected orphans living in the Kumasi Children’s Home, a state-run institution, All Nations Orphanage Home, a privately run institution, and Cherubs Children’s Home, another privately run institution, all located in the Kumasi Metropolis, Ashanti Region from April to June, 2021.

2.2. Sample Size Calculation

Minimum sample size was obtained based on the sample size calculation using Cochran’s formula:where n = sample size, z = confidence level 95% (1.96), p = estimated population proportion of malnourished children living in an orphanage in Accra is 5.9% [18], q = predefined (1 − p), and e = margin of error at 5%.

However, a total sample size of 130 was obtained for the study.

2.3. Inclusion and Exclusion Criteria

Children aged 6–13 years who had lived in the orphanage for a minimum of 12 months were included in the study, while children suffering from neurological disorders such as cerebral palsy or other chronic ailments such as type 1 diabetes and sickle cell anaemia were excluded.

2.4. Data Collection

A structured questionnaire was used to elicit information from participants. Prior to the start of the data collection, research assistants underwent training in the administration of the questionnaire and in how to properly conduct anthropometric and dietary assessments as well as the cognition test.

The heights of the participants were measured using a stadiometer (Seca 213 mobile stadiometer, Germany) to the nearest 0.1 cm. Weight was measured using a digital bathroom scale (Tanita digital bathroom scale) to the nearest 0.1 kg with participants wearing light clothing. BMI-for-age Z-scores (BAZ) and height-for-age Z-scores (HAZ) were computed and interpreted based on the WHO child growth standards [19] for determination of the nutritional status of the participants.

A three-day repeated (two weekdays and one weekend) 24-hour dietary recall method was employed to elicit information about participants’ dietary intake. Participants were requested to recollect all meals, including drinks and snacks, eaten the previous day. Common household measures were used to estimate the actual quantities (grams/mL) of foods and drinks consumed by the participants. The nutritional composition of foods eaten was then analysed using the nutrient analysis template [20].

A sterile urine container with a screw cap was given to each participant to provide about 5 mL of their first urine of the morning. The samples were placed into cold boxes kept at eight degree celsius and transported quickly to the Clinical Analyses Laboratory, KNUST for analysis. The determination of urinary iodine concentration was done using the manual spectrophotometric measurement of the Sandell–Kolthoff reduction reaction. Iodine status for school-aged children (SAC) was defined according to the guidelines of the WHO [21] which categorizes urinary iodine levels of <20 μg/L as severe iodine deficiency, 20–49 μg/L as moderate iodine deficiency, 50–99 μg/L as mild iodine deficiency, 100–199 μg/L as adequate iodine nutrition, 200–299 μg/L more than adequate intake of iodine and finally, ≥300 μg/L as excessive intake of iodine.

The Raven’s coloured progressive matrices (RCPM) for non-verbal reasoning ability were adapted and used to assess the cognitive ability of the children. This assessment tool had previously been used in a population of Ghanaian school-aged children [22]. The test has 36 questions or problems divided into three sets of 12 questions each that increases progressively in difficulty. Each question involves a geometric pattern or design with a missing piece which participants have to provide from the list of six options. The first question of the test was used as a demonstration for the participants to help them understand the concept of the test. Cognition status was defined as follows: <50% poor cognitive performance, 50% to 69.99% good cognitive performance, and ≥70% excellent cognitive performance.

2.5. Statistical Analysis

Data were entered into Microsoft Excel and analysed with the Statistical Package for the Social Sciences (SPSS) version 25. Data were checked for normal distribution using the Shapiro–Wilk test. Dietary intakes of macronutrients and micronutrients were analysed with the Nutrient Analysis Template Software. Sociodemographic characteristics, anthropometric measurements, and other sections of the data obtained were analysed using descriptive statistical analysis. Pearson’s correlation and chi-square tests were conducted to analyse associations between various variables. Mean differences in cognitive test scores were compared with the independent-sample t-test and oneway analysis of variance test. was considered to be statistically significant for all analyses performed.

3. Results

3.1. Sociodemographic and Anthropometric Characteristics, Iodine, and Cognition Status of Participants

Table 1 presents the sociodemographic and other characteristics of participants. Median age of 10.50 years was recorded, with the majority (71.5%) of participants aged 9 to 13 years. The study had just over half of the participants being boys (50.8%). The majority of the participants reported no challenges with their stay in the orphanage (78.5%), and desired no change in their livelihood (66.2%). The combined prevalence of stunting and severe stunting was 12.3%. The combined prevalence of severe thinness and thinness was 2.3%. Overall, close to half of the participants (49.2%) had excellent cognitive performance. With respect to iodine status, 16.2% of all participants recorded mild iodine deficiency.

3.2. Association between Nutritional Status and Sociodemographic and Cognition Status

Table 2 presents prevalence of nutritional deficiencies based on participants’ age, gender, length of stay in the orphanage and cognition status. The prevalence of iodine deficiency was significantly higher in participants who had lived in the orphanage for 7 years or more compared to those who had lived in the orphanage for 6 years or less (23.6% vs 10.7%, ). The girls demonstrated better nutrition outcomes than the boys though the differences in prevalence of stunting, thinness and iodine deficiency were not statistically significant.

3.3. Micronutrient Intake of Participants

The adequacy of participants’ dietary intake of various micronutrients was assessed, and results are presented in Table 3. Overall, micronutrient deficiency status was significantly different between the three orphanages (). Overall, majority of the participants, 89.2%, 54.6%, 76.9%, and 77.7%, had adequate micronutrient intakes for iron, zinc, vitamin C, and folate, respectively. Intake of vitamins A and B₁₂ was inadequate for majority of participants (90.8% and 50.8%, respectively).

3.4. Comparing Differences in Cognition Test Scores

The mean cognition test scores of participants were compared by sociodemographic characteristics, nutritional status, micronutrient intake adequacy, and intake deficiency status (Table 4). The average cognition test score for participants aged 9–13 years was significantly higher than those aged 6–8 years (). Among participants in the three orphanages, the mean differences in cognition test scores were significant only between O2 and O3 () after a post hoc analysis. The differences in mean cognition scores between those who had adequate and inadequate iron and vitamin A intakes were significant ( and , respectively), as well as for those who had no micronutrient intake deficiencies and those who had deficiencies (). Again, the mean cognition test score was significantly higher for participants who had a single micronutrient intake deficiency compared to those who had multiple micronutrient intake deficiencies ().

3.5. Association between Micronutrient Intake, Urinary Iodine Levels, and Cognition Test Scores

A weak negative association was observed between the number of micronutrient intake inadequacies and cognition test scores. However, the association was not significant. Similarly, no significant association was recorded between any of the other variables and cognition test scores (Table 5).

4. Discussion

The aetiologies of micronutrient deficiencies, thus hidden hunger, are common, primarily resulting from inadequate consumption of micronutrient-rich foods including vegetables, fruits, and foods of animal origin or nutrient losses secondary to frequent infection [2, 5, 19]. It is of utmost importance that recommended quantities of micronutrients are consumed daily to avert deficiencies. Inadequate intakes were recorded for all six micronutrients assessed in this study, with as high as a 90.8% inadequate intake prevalence for vitamin A. Annan et al. [23] similarly observed inadequate intakes in all six micronutrients they assessed, with vitamin A recording the highest inadequate intake prevalence of 61.3% among SAC in the Kumasi Metropolis. It appears the issue of the high prevalence of vitamin A deficiency seems not to get better as previous studies in Ghana among SAC have also reported high levels of vitamin A deficiency [24–26]. More needs to be done for SAC in Ghana to improve their vitamin A status.

Multiple micronutrient deficiencies do occur in vulnerable populations like SAC [2, 27], and there is substantial evidence of the role of the micronutrients iodine, iron, zinc, and vitamins A and B₁₂ in the brain and cognitive development [23]. It may therefore come as little surprise that in this study population of orphans, the average cognition test scores for people with multiple inadequate micronutrient intakes were significantly lower () than those who had only one deficiency (Table 4). Similarly, Annan et al. [23] also found that SAC with an adequate intake of 5 to 6 out of 6 micronutrients had higher cognition scores than those who had an adequate intake of 0 to 2 micronutrients. This suggests that the coexistence of multiple micronutrient deficiencies more adversely impacts cognitive ability. Overall, the prevalence of poor cognition was 16.9% in this study compared to a higher prevalence (36.2%) reported by Annan et al. [23] and a much higher prevalence (84.8%) reported among SAC in fishing and farming communities in Kwahu Afram Plains South District [22]. It thus appears that the orphans in this present study have better cognitive performance than their non-orphaned counterparts in Kumasi and Kwahu Afram Plains South District.

Iodine deficiency is a public health concern in developing countries, and indeed, Ghana is situated in the iodine deficiency belt, as reported by Gyamfi et al. [28]. The prevalence of iodine deficiency in this study population of school-aged orphans was 16.2%, the same as the prevalence recorded by Gyamfi et al. [28] among 6 to 12 year old non-orphaned SAC in the Ejura-Sekyere-Dumase district in the Ashanti region of Ghana but much lower than the 57% prevalence reported among SAC in Southeast Ethiopia [29]. However, another study among SAC in Eastern Nepal recorded a lower prevalence of 9.8% [30]. Iodine is critical in the production of thyroid hormones, which are involved in brain and neurocognitive development [31]. Thus, iodine deficiency can impair cognitive performance. In Ghana, it has been estimated that about 120,000 children who are born each year stand the risk of developing intellectual deficits due to iodine deficiency, with a majority of these affected children growing with reduced intelligence and mental problems that impair academic achievement and negatively impact the educational system in Ghana [32, 33]. This study observed that the prevalence of iodine deficiency was highest among participants with poor cognition and lowest among those with excellent cognition, though the comparison was not statistically significant. It can greatly benefit the cognitive abilities and subsequent academic performance of SAC (the orphans or non-orphans) if interventions to ensure adequate iodine intake like the universal salt iodization, which Ghana implemented in 1996, are ramped up. Indeed, the Ghana Health Service has previously indicated that iodine deficiency diseases persist in the country [34].

It was also observed among this study population that there was no record of the above-mentioned adequate or excessive intake of iodine, i.e., 200–299 μg/L or ≥300 μg/L, respectively. The risk of goiter, hypothyroidism, and hyperthyroidism, as well as autoimmune thyroid disease, are linked to excessive iodine intake [35]. A systematic review and meta-analysis by Xiu et al. [36] reported that among school-aged children, excessive iodine intake could lead to elevated goiter risk. In contrast to the absence of excessive iodine intake in this population of SAC, Gyamfi et al. [28] reported a prevalence of 34% and 28% among male and female SAC, respectively. While seeking to increase iodine consumption to prevent iodine deficiency diseases, care must be taken alongside effective monitoring to prevent excessive consumption, which can also be detrimental.

The stunting and thinness prevalence of 12.3% and 2.3%, respectively, reported in this study are lower than the 13.8% and 7.5% reported by Tandoh et al. [22] among non-orphaned children, and much lower than the 98% reported among orphans in Nairobi, Kenya [37]. Kamath et al. [38] also reported a thinness prevalence of 25.7% and a stunting prevalence of 31.4% among orphans in Mangalore, India. The better nutritional status of orphans in this current study may be attributed to better general care, as is quite evidenced by the fact that a vast majority of them reported no challenges in the orphanage and also did not desire any livelihood changes. Although the livelihood of orphans is typically troubled by low availability of food or food insecurity, reduced access to economic and educational opportunities, maltreatment, and discrimination, among others [39]. About two-thirds of orphans in this study did not desire any changes in their livelihoods. However, about 18% also desired the provision of educational and play materials and opportunities. Other livelihood changes that were desired included financial support, completion of accommodation facilities, and an increase in food provision.

4.1. Limitations

Firstly, due to the relatively small sample size, the findings may not be generalizable to the general orphan population in Ghana. The 24-hour dietary recall method of assessing dietary intake, especially from young children, may have introduced some over- or underestimation bias, but this has been proven to provide reliable estimates.

5. Conclusions

A high prevalence of inadequate intake of multiple micronutrients persists in the study population for which reason, a closer look needs to be taken at the nutritional intakes in orphanages. Although the occurrence of thinness was low, stunting occurrence and mild iodine deficiency were of notable concern. Cognitive performance was generally good in this population of school-aged orphans.

Data Availability

The dataset of this study will be available upon request from Dr. Marina Aferiba Tandoh ([email protected]).

Ethical Approval

The Committee on Human Research Publications and Ethics of Kwame Nkrumah University of Science and Technology, School of Medical Sciences, and Komfo Anokye Teaching Hospital granted approval for this study (Ref: CHRPE/AP/080/21). Approvals to conduct the study were also granted by the Management of the Orphanages and the Department of Social Welfare. Participants who agreed to partake in the study appended their thumbprints to the consent form under the supervision of their caretakers at the orphanages.

Conflicts of Interest

The authors declare no conflicts of interest.

References

J. Hodge, “Hidden hunger: approaches to tackling micronutrient deficiencies,” Nourishing Millions: Stories of Change in Nutrition, International Food Policy Research Institute (IFPRI), Washington, DC, USA, 2016.
View at: Publisher Site | Google Scholar
S. Muthayya, J. H. Rah, J. D. Sugimoto, F. F. Roos, K. Kraemer, and R. E. Black, “The global hidden hunger indices and maps: an advocacy tool for action,” PLoS One, vol. 8, no. 6, Article ID e67860, 2013.
View at: Publisher Site | Google Scholar
B. Thompson and L. Amoroso, Combating Micronutrient Deficiencies: Food- Based Approaches, Food and Agriculture Organization of the United Nations, Rome, Italy, 2010.
Micronutrient Initiative, Investing in the Future: A United Call to Action on Vitamin and Mineral Deficiencies–Global Report 2009, Micronutrient Initiative, Ottawa, Canada, 2009.
https://www.who.int/nutrition/topics/idd/en/.
Regional Committee for Africa 58, “Iodine deficiency disorders in the WHO african region: situation analysis and the way forward,” 2008, https://apps.who.int/iris/handle/10665/19986.
View at: Google Scholar
S. Routray, B. K. Meher, R. Tripathy, S. N. Parida, N. Mahilary, and D. D. Pradhan, “Growth and development among children living in orphanages of Odisha, an eastern Indian state,” IOSR Journal of Dental and Medical Science, vol. 14, no. 4, pp. 38–41, 2015.
View at: Google Scholar
N. A. Dobrova-Krol, M. H. Van IJzendoorn, M. J. Bakermans-Kranenburg, C. Cyr, and F. Juffer, “Physical growth delays and stress dysregulation in stunted and non-stunted Ukrainian institution-reared children,” Infant Behavior and Development, vol. 31, no. 3, pp. 539–553, 2008.
View at: Publisher Site | Google Scholar
E. J. Sonuga-Barke, W. Schlotz, and M. Rutter, “Physical growth and maturation following early severe institutional deprivation: do they mediate specific psychopathological effects?” Monographs of the Society for Research in Child Development, vol. 75, no. 1, pp. 143–166, 2010.
View at: Publisher Site | Google Scholar
P. Vorria, Z. Papaligoura, J. Dunn et al., “Early experiences and attachment relationships of Greek infants raised in residential group care,” Journal of Child Psychology and Psychiatry, vol. 44, no. 8, pp. 1208–1220, 2003.
View at: Publisher Site | Google Scholar
K. A. Lindblade, F. Odhiambo, D. H. Rosen, and K. M. Decock, “Health and nutritional status of orphans <6 years old cared for by relatives in Western Kenya,” Tropical Medicine and International Health, vol. 8, no. 1, pp. 67–72, 2003.
View at: Publisher Site | Google Scholar
M. Sarker, C. Neckermann, and O. Müller, “Assessing the health status of young AIDS and other orphans in Kampala, Uganda,” Tropical Medicine and International Health, vol. 10, no. 3, pp. 210–215, 2005.
View at: Publisher Site | Google Scholar
S. P. S. Chajhlana, R. N. Mahabhasyam, and M. S. M. Varaprasada, “Nutritional deficiencies among school children in urban areas of Hyderabad, Telangana, India,” International Journal of Community Medicine and Public Health, vol. 4, no. 2, pp. 607–612, 2017.
View at: Publisher Site | Google Scholar
M. H. Van IJzendoorn, M. Luijk, and F. Juffer, “IQ of children growing up in children’s homes: a meta-analysis on IQ delays in orphanages,” Merrill-Palmer Quarterly, vol. 54, no. 3, pp. 341–366, 2008.
View at: Publisher Site | Google Scholar
C. H. Zeanah, A. T. Smyke, S. F. Koga, and E. Carlson, “Attachment in institutionalized and community children in Romania,” Child Development, vol. 76, no. 5, pp. 1015–1028, 2005.
View at: Publisher Site | Google Scholar
SPRING and Ghana Health Service, “Ghana: landscape analysis of anemia and anemia programming,” Strengthening Partnerships, Results, and Innovations in Nutrition Globally, SPRING Project, Accra, Ghana, 2016.
View at: Google Scholar
Z. Ali, N. Abu, I. A. Ankamah, E. A. Gyinde, A. S. Seidu, and A. R. Abizari, “Nutritional status and dietary diversity of orphan and non-orphan children under five years: a comparative study in the Brong Ahafo region of Ghana,” BMC Nutrition, vol. 4, no. 1, p. 32, 2018.
View at: Publisher Site | Google Scholar
K. O. Duedu, E. Peprah, I. Anim- Baidoo, and P. F. Ayeh- Kumi, “Prevalence of intestinal parasites and association with malnutrition at a Ghanaian Orphanage,” Human Parasitic Diseases, vol. 7, pp. 5–9, 2015.
View at: Publisher Site | Google Scholar
https://www.who.int/tools/growth-reference-data-for-5to19-years.
Food Science and Nutrition Department University of Ghana, “The nutrient analysis template software excel spreadsheet,” 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766589/.
View at: Google Scholar
WHO, “Urinary iodine concentrations for determining iodine status deficiency in populations,” Vitamin and Mineral Nutrition Information System, World Health Organization, Geneva, Switzerland, 2013.
View at: Google Scholar
M. A. Tandoh, F. C. Mill- Robertson, M. D. Wilson, and A. K. Anderson, “Nutritional and cognitive deficits in school-age children: a study in helminth- endemic fishing and farming communities in Ghana,” Nutrition & Food Science, vol. 50, no. 3, pp. 443–462, 2019.
View at: Google Scholar
R. A. Annan, C. Apprey, O. Asamoah‐Boakye, S. Okonogi, T. Yamauchi, and T. Sakurai, “The relationship between dietary micronutrients intake and cognition test performance among school‐aged children in government‐owned primary schools in Kumasi metropolis, Ghana,” Food Sciences and Nutrition, vol. 7, no. 9, pp. 3042–3051, 2019.
View at: Publisher Site | Google Scholar
M. Alicke, J. K. Boakye-Appiah, I. Abdul-Jalil et al., “Adolescent health in rural Ghana: a cross-sectional study on the co-occurrence of infectious diseases, malnutrition and cardio-metabolic risk factors,” PLoS One, vol. 12, no. 7, Article ID e0180436, 2017.
View at: Publisher Site | Google Scholar
G. Egbi, “Prevalance of vitamin A, zinc, iodine deficiency and anaemia among 2–10 year-old Ghanaian children,” African Journal of Food, Agriculture, Nutrition and Development, vol. 12, no. 50, pp. 5946–5958, 2012.
View at: Publisher Site | Google Scholar
E. Godfred, G. A. Alatiah, I. Ayi, and M. Steiner‐Asiedu, “Red palm oil bean‐stew improved serum vitamin A and haemoglobin concentrations and anthropometric indicators of school children with low vitamin A concentrations in a malaria‐endemic setting,” African Journal of Food, Agriculture, Nutrition and Development, vol. 17, no. 4, pp. 12817–12836, 2017.
View at: Publisher Site | Google Scholar
L. H. Allen, J. M. Peerson, and D. K. Olney, “Provision of multiple rather than two or fewer micronutrients more effectively improves growth and other outcomes in micronutrient deficient children and adults,” Journal of Nutrition, vol. 139, no. 5, pp. 1022–1030, 2009.
View at: Publisher Site | Google Scholar
D. Gyamfi, Y. A. Wiafe, E. Ofori Awuah, E. A. Adu, and E. K. Boadi, “Goitre prevalence and urinary iodine concentration in school-aged children in the Ashanti region of Ghana,” International Journal of Endocrinology, vol. 2020, Article ID 3759786, 8 pages, 2020.
View at: Publisher Site | Google Scholar
S. Hailu, M. Wubshet, H. Woldie, and A. Tariku, “Iodine deficiency and associated factors among school children: a cross-sectional study in Ethiopia,” Archives of Public Health, vol. 74, no. 1, p. 46, 2016.
View at: Publisher Site | Google Scholar
M. K. Tamang, B. Gelal, B. Tamang, M. Lamsal, D. Brodie, and N. Baral, “Excess urinary iodine concentration and thyroid dysfunction among school age children of eastern Nepal: a matter of concern,” BMC Research Notes, vol. 12, no. 1, p. 294, 2019.
View at: Publisher Site | Google Scholar
I. Velasco, S. C. Bath, and M. P. Rayman, “Iodine as essential nutrient during the first 1000 days of life,” Nutrients, vol. 10, no. 3, p. 290, 2018.
View at: Publisher Site | Google Scholar
C. Buxton and B. Baguune, “Knowledge and practices of people in Bia district, Ghana, with regard to iodine deficiency disorders and intake of iodized salt,” Archives of Public Health, vol. 70, no. 1, p. 5, 2012.
View at: Publisher Site | Google Scholar
H. R. Chung, S. Apanga, and J. Addah, “Assessing iodized salt use in rural northern Ghana: a mixed method approach,” Annals of Pediatric Endocrinology & Metabolism, vol. 5, no. 3, pp. 70–76, 2015.
View at: Google Scholar
Ghana Health Service, Health Annual Report, Ghana Health Service, Accra, Ghana, 2014.
H. R. Chung, “Iodine and thyroid function,” Annals of Pediatric Endocrinology and Metabolism, vol. 19, no. 1, pp. 8–2, 2014.
View at: Publisher Site | Google Scholar
L. Xiu, G. Zhong, and X. Ma, “Urinary iodine concentration (UIC) could be a promising biomarker for predicting goiter among school-age children: a systematic review and meta-analysis,” PLoS One, vol. 12, no. 3, Article ID e0174095, 2017.
View at: Publisher Site | Google Scholar
E. W. Mwaniki, A. N. Makokha, and J. N. Muttunga, “Nutrition status and associated morbidity risk factors among orphanage and non-orphanage children in selected public primary schools within Dagoretti Nairobi, Kenya,” East African Medical Journal, vol. 91, no. 9, pp. 289–297, 2014.
View at: Google Scholar
S. M. Kamath, K. G. Venkatappa, and E. M. Sparshadeep, “Impact of nutritional status on cognition in institutionalized orphans: a pilot study,” Journal of Clinical and Diagnostic Research, vol. 11, no. 3, pp. CC01–CC04, 2017.
View at: Publisher Site | Google Scholar
L. Z. Gilborn, R. Nyonyintono, R. Kabumbuli, and G. Jagwe-Wadda, Making a Difference for Children Affected by AIDS: Baseline Findings from Operations Research in Uganda, Population Council, New York, NY, USA, 2001.

Copyright

Copyright © 2022 Marina Tandoh and Mary Asamoah. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation

Download other formats

Order printed copies

Views

679

Downloads

489

Citations