Growing Healthy Food, Growing Healthy Children

Families gather under a mango tree in Beposo to learn how to enroll in the nutrition intervention on February 23, 2018.

Self-Help International has been instrumental in starting feeding programs in primary schools in rural villages in the Ashanti Region of Ghana. The schools report increased enrollment, daily attendance, and test scores when children have this breakfast to start the school day. Over the past two years, Self-Help staff have weighed and measured the students who are receiving the breakfast porridge through our school feeding program on mornings when school is in session, and found that a number of children who start to come to school at 4 – 5 years old are already stunted. Children who are stunted are not only short in stature, but their brains have been impacted in ways that cannot be overcome by better feeding later in childhood or adulthood. Stunting affects their ability to learn and long-term productivity for the rest of their lives. In some of the village schools we serve, more than 1 in 4 children were stunted, slightly above than the national average for rural Ghana (22%).

In 2016, I traveled to Ghana to see the school feeding programs first hand. What I observed was that the children,  parents, and teachers loved the school feeding program. But they could see for themselves that their children needed more nutrients, and asked us how they could better fortify the porridge? So as increased funding became available, we introduced intercropping to the school farms, and schools began to plant groundnuts or cowpea in the rows between the QPM, which was then added to further enhance the caloric and protein content of the porridge. Fresh in my mind on that trip was Roger Thurow’s recently published book, The First 1,000 Days, which focused on improving nutritional and health status of pregnant and lactating women, and their children, with case studies of how to make things better in the U.S. and around the world. No matter where in the world a child is born, to prevent stunting, there are three critical findings: 1) calorie and protein requirements must be met during prenatal development, during the first six months of breast feeding, and weaning; 2) nutritional health is important during pregnancy and lactation; 3) it is very important that babies are exclusively breastfed for the first six months.

While nearly all babies in rural Ghana are breastfed for a while, the data collected by an Iowa State University nutritional science student intern last summer found that only 36% of mothers practiced exclusive breastfeeding for the first six months. Mothers often feed water or fufu to their infants, thereby diluting the nutrients obtained by breastfeeding by offering replacements. The results of our monitoring and evaluation coupled with the reading and research all led to this question: is it possible to grow foods in these villages that mothers would use as a weaning supplement that would be more nutritional for the child to prevent stunting? Self-Help’s mission is to end hunger by helping people help themselves. Over recent years in the food, agriculture, and international development community there has been a new understanding that ending hunger means not just feeding people, but going further to fuel growth and development of individuals and communities. With that in mind, I returned to Ghana in January 2018 to work with our staff nutritionists to answer that question. We began the trip with a consultation with nutritionists Drs. Grace Marquis and Esi Colecraft, of McGill University and the University of Ghana, Accra respectively. Through her 20 years of research with mothers and infants in Ghana, Dr. Marquis is convinced that some animal protein is needed in the diet of weaning children to prevent the nutritional damage to health status.

Based on consultations with nursing and lactating mothers in the villages we serve, nutritionists and researchers working in Ghana, our staff specialists, and hospital and community health workers in the districts we serve, we’ve designed an intervention to working with farmers to grow foods locally that would improve the weaning foods for infants, as well as provide a more adequate diet for pregnant and lactating women. Based on growth data from the schools and demonstrated commitment of the community members, we plan to launch this pilot intervention in the village of Beposo. Self-Help nutritionist, Jesse Jackson Sarkodie, will be working extensively with the village of Beposo, beginning in March to enroll up to 50 pregnant women in the program, providing supplemental food packets for porridge for them during pregnancy and lactation since it’s difficult to farm as an expectant or new mother, monitoring weight gain in pregnancy, and length and weight measurements of the babies. We’ll track the quality of their dietary intake, and food security of their home situation.

At the same time, our agriculture training team will teach intercropping of QPM with cowpeas or groundnuts to increase the protein content of the porridge, and will partner with regional experts to teach farmers to grow orange-flesh sweet potatoes which are high in Vitamin A to add to the weaning food. After participants are able to grow cowpeas, groundnuts and orange-flesh sweet potatoes, the next step will be to introduce poultry production in the village using accepted methods for both family food and income generation through our micro-credit and farm input loan mechanism, which Self-Help is already doing. Raising poultry for family consumption (or larger scale as a business) will enable the inclusion of 3 hard cooked egg yolks per week in the diet for the weaning infants. In order to enroll, the mother (and father when possible) must commit to both the farming and nutrition counseling and education components of the program. Although much of the one-on-one counseling and group nutrition education sessions with the Self-Help nutritionist with the mothers, we will be working to gain buy-in from the fathers and the whole community.

Babies born in Beposo will be followed until 2 years of age. The goal: no child is stunted by the time they reach 24 months old. Similar interventions in other parts of Ghana and across Africa that combine nutrition education and means of growing nutrient-dense foods have found that this intensive support for a mother with one child will improve health for all her future children, even after the intervention has ended. Our in-country director, Benjamin Kusi, has been working to make the connections to gain the trust and necessary permissions to be able to try such an intervention. The community leadership and assigned community health worker have already expressed their eagerness to partner with Self-Help on this endeavor to improve the growth and health of their children. Budget estimates of the cost of the program were calculated with the Ghana staff. To do this will require an upfront investment, but the intervention is designed to be continued in the village beyond the time of the intervention.

The Rev. Dr. Mary Jane Oakland is an emeritus professor of Food Science and Human Nutrition at Iowa State University, and retired Episcopal priest. She has served on the Self-Help International Board of Directors since 2006.

This intervention will cost an estimated $10,000 in year 1 to serve 50 women and their 50 babies ($4 per person per week) including securing a motorbike for regular transportation to Beposo, fuel, nutrition education and supplements, and ag inputs and training. If you would like to be responsible for ending stunting and chronic malnutrition for dozens of mothers and children in Beposo, please make a donation below to help us reach our goal.