Sustained effects of small-quantity lipid-based nutrient supplements provided during the first 1000 days on child growth at 9-11 y in a randomized controlled trial in Ghana

BACKGROUND

There is limited research on whether nutritional supplementation in the first 1000 d affects long-term child outcomes. We previously demonstrated that pre- and postnatal small-quantity lipid-based nutrient supplements (SQ-LNS) increased birth weight and child length at 18 mo of age in Ghana.

OBJECTIVES

We aimed to investigate the effect of pre- and postnatal SQ-LNS on child growth and blood pressure at 9-11 y.

METHODS

In the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana trial, 1320 females ≤20 weeks of gestation were randomly assigned to receive daily: iron and folic acid (IFA) during pregnancy and placebo during 6 mo postpartum or multiple micronutrients (MMNs) during pregnancy and 6 mo postpartum, or SQ-LNS during pregnancy and 6 mo postpartum and for their children aged from 6 to 18 mo. We re-enrolled 966 children aged 9-11 y and assessed child blood pressure, height-for-age z-score (HAZ), body mass index (BMI)-for-age z-score, waist-to-height ratio, triceps skinfold, and midupper arm circumference. We compared SQ-LNS with control (IFA + MMN) groups adjusting for child's age.

RESULTS

Mean (standard deviation [SD]) HAZ in SQ-LNS and control group was -0.04 (0.96) and -0.16 (0.99); P = 0.060. There were no indications of group differences in the other outcomes (P > 0.10). Effects on HAZ varied by child sex (P-interaction = 0.075) and maternal prepregnancy BMI (kg/m2; P-interaction = 0.007). Among females, HAZ was higher in the SQ-LNS [0.08 (1.04)] than in the control group [-0.16 (1.01)] (P = 0.010); among males, SQ-LNS [-0.16 (0.85)] and control groups [-0.16 (0.96)] did not differ (P = 0.974). Among children of females with BMI of <25, HAZ was higher in the SQ-LNS [-0.04 (1.00)] than in the control group [-0.29 (0.94)] (P = 0.004); among females with BMI of ≥25, SQ-LNS [-0.04 (0.91)] and control groups [0.07 (1.00)] did not differ (P = 0.281).

CONCLUSIONS

There is a sustained impact of prenatal and postnatal SQ-LNS on linear growth among female children and children whose mothers were not overweight. This trial was registered at clinicaltrials.gov as NCT00970866 (https://clinicaltrials.gov/ct2/show/record/NCT00970866).

Prenatal and postnatal small-quantity lipid-based nutrient supplements and children's social-emotional difficulties at ages 9-11 y in Ghana: follow-up of a randomized controlled trial

BACKGROUND

Provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) during early life improves growth and development. In the International Lipid-Based Nutrient Supplements DYAD-Ghana trial, prenatal and postnatal SQ-LNS reduced social-emotional difficulties at age 5 y, with greater effects among children in less-enriched home environments.

OBJECTIVES

We aimed to investigate the effect of prenatal and postnatal SQ-LNS on children's social-emotional problems at age 9-11 y.

METHODS

In 2009-2011, 1320 pregnant women ≤20 wk gestation were randomly assigned to receive the following daily until 6 mo postpartum: 1) iron and folic acid until delivery, then placebo, 2) multiple micronutrients (MMNs), or 3) SQ-LNS (20 g/d). Children in group 3 received SQ-LNS from 6 to 18 mo. In 2021, we evaluated children's social-emotional outcomes with 6 assessment tools that used caregiver, teacher, and/or self-report to measure socioemotional difficulties, conduct problems, temperament, mood, anxiety, and emotion management.

RESULTS

We assessed outcomes in 966 children, comprising 79.4% of 1217 participants eligible for re-enrolment. No significant differences were found between the SQ-LNS and control (non-LNS groups combined) groups. Few children (<2%) experienced high parent-reported social-emotional difficulties at 9-11 y, in contrast to the high prevalence at age 5 in this cohort (25%). Among children in less-enriched early childhood home environments, the SQ-LNS group had 0.37 SD (-0.04 to 0.82) lower self-reported conduct problems than the control group (P-interaction = 0.047).

CONCLUSIONS

Overall positive effects of SQ-LNS on social-emotional development previously found at age 5 y are not sustained to age 9-11 y; however, there is some evidence of positive effects among children in less-enriched environments. The lack of effects may be owing to low prevalence of social-emotional problems at preadolescence, resulting in little potential to benefit from early nutritional intervention at this age in this outcome domain. Follow-up during adolescence, when social-emotional problems more typically onset, may yield further insights. This trial was registered at clinicaltrials.gov as NCT00970866. https://clinicaltrials.gov/ct2/show/record/NCT00970866.

Assessing psychosocial distress associated with homelessness in Ghana: A springboard for interventional policy design

This study investigated the causes of homelessness in Ghana and associated psychosocial distress. A sample of 86 homeless participants listed perceived causes of their homelessness and completed measures of psychosocial distress, and 97 non-homeless participants completed the same measures psychosocial distress. Causes of homelessness among the participants included poverty (30.1%), migration (10.4%), unemployment (2.2%), parental demise (2.2%), parental neglect (0.5%), and parental divorce (0.5%). Multivariate analysis revealed higher psychosocial distress among the homeless than the non-homeless. Homeless females reported higher levels of stress and suicidality than their male counterparts. The study demonstrates the need for timely and effective implementation of interventions such as provision of affordable housing, financial assistance, job-creation, and skill training for the homeless directly related to known causes of homelessness and accounting for gender differences.

A case-control and seven-year longitudinal neurocognitive study of adults with sickle cell disease in Ghana

Ageing in sickle cell disease (SCD) is associated with a myriad of end-organ complications, including cerebrovascular damage and cognitive impairment (CI). Although CI is very common in SCD, little is known about cognitive functioning and how it changes with age. This study examines cognitive patterns of 63 adults with SCD and 60 non-SCD, age- and education-matched controls in Ghana. Of those adults with SCD, 34 completed the neuropsychological battery at baseline and again seven years later. In cross-sectional data, adults with SCD performed worse than controls in all cognitive test domains (p < 0.01 for all). The seven-year follow-up data showed that the group exhibited a significant decline in visuospatial abilities (ranging from Cohen's d = 1.40 to 2.38), and to a lesser extent, in processing speed and executive functioning. Exploratory analyses showed a significant time-by-education interaction, indicating that education may be protective from decline in cognitive performance. These findings have implications for clinical practice. Early neuropsychological surveillance coupled with early assessment and remedial programmes will provide avenues for enhancing the quality of life of adults living with SCD in Ghana.

International Lipid-Based Nutrient Supplements (iLiNS) DYAD-Ghana Follow-Up Study: Effects on Social-Emotional Problems at Age 9–10 Years

Objectives

We aimed to investigate the effect of pre- and post-natal small-quantity lipid-based nutrient supplements (SQ-LNS) on child social-emotional problems at age 9–10 years in the context of children's home environments. As previously found in the 5-year follow-up study of the same trial, we expected that SQ-LNS would reduce social-emotional problems and that greater effects of SQ-LNS would be found among children from more disadvantaged home environments.

Methods

The International Lipid-Based Nutrient Supplements (iLiNS) DYAD-Ghana trial was a randomized controlled trial conducted in 2009–2014. 1320 pregnant women ≤ 20 weeks gestation were randomly assigned to receive daily (1) iron and folic acid (IFA) during pregnancy and placebo during 6 mo postpartum, (2) multiple (18) micronutrients (MMN) during pregnancy and 6 mo postpartum, or (3) SQ-LNS (20 g/d) for pregnant women during pregnancy and 6 mo postpartum and SQ-LNS for children from 6 to 18 mo of age. In 2021, we assessed child social-emotional problems at age 9–10 years by caregiver, child, and/or teacher report using the Strengths and Difficulties Questionnaire (SDQ), Brief Problem Monitor, Early Adolescent Temperament Questionnaire, Mood and Feelings Questionnaire, Screen for Child Anxiety Related Emotional Disorders, and Children's Emotion Management Scales.

Results

We re-enrolled and assessed outcomes in 966 children, 79.4% of the 1217 children eligible for re-enrollment (excluding those known not survived). At age 9–10 years, a very small percentage (<2%) of children had social-emotional difficulties scores in the abnormal range on the caregiver-reported SDQ, in contrast to the high prevalence previously found at age 5 years in the same cohort (25%). No significant differences were found between SQ-LNS and control groups. Early childhood home environment score did not modify the effect of SQ-LNS on any score.

Conclusions

Effects of pre- and post-natal SQ-LNS on social-emotional development previously found at age 5 y were not sustained to age 9–10 y in this cohort. This may have been due to the low prevalence of social-emotional problems at 10 y of age, such that there was little potential to benefit from early nutritional intervention at this age in this outcome domain.

Funding Sources

National Institutes of Health, Bill & Melinda Gates Foundation.

Dipo Rites of Passage and Psychological Well-being Among Krobo Adolescent Females in Ghana: A Preliminary Study

Dipo is a historical rites of passage among the Krobo in the Eastern Region of Ghana. The goal of Dipo is to assist pubertal girls in transitioning into adulthood by shaping moral values and social responsibilities, learning home management skills, and preventing risky sexual behavior. Differences in psychological distress among girls who had and had not participated in Dipo were examined in the current study. The sample included 145 adolescent females, 80 Dipo initiates and, 65 nonDipo initiates. Participants, 12 to 20 years of age, were recruited from junior and senior high schools, and administered a questionnaire with measures of psychological distress, a sex role inventory, and a measure of favorability of Dipo. Findings revealed that Dipo initiates reported significantly less psychological distress than noninitiates. Dipo initiates also reported more favorable attitudes about Dipo than noninitiates. Although this study is preliminary, findings suggest that Dipo may be useful for increasing psychological well-being. Recommendations for future research are provided.

Sources of perceived social support on resilience amongst parents raising children with special needs in Ghana

BACKGROUND

While parenting a child with special needs is burdensome, some parents do overcome through protective resources. Social support has been widely linked to this unique ability to overcome the challenges of raising a child with special needs. In spite of this, there is still paucity of research about the influence of the sources of perceived social support on this ability, known as resilience.

AIM

This study examined three sources of perceived social support-family, friends and significant other-on the resilience of Ghanaian parents raising children with special needs while adjusting for covariates (parental gender, marital status and educational level).

METHODS

One hundred and seven (107) biological parents were recruited from special schools and parents support groups in Accra, Ghana. They completed paper-and-pencil or online questionnaires on resilience and perceived social support.

RESULTS

Output from hierarchical multiple regression after adjusting for covariates showed that only support from significant others predicted resilience. Additionally, being married was positively and holding a higher education was inversely associated with resilience.

CONCLUSION AND IMPLICATION

These findings indicate the importance of support from significant others in the resiliency of parents but underscore the need to fully integrate and emphasize support from the other sources in resilience enhancing interventions.

Spirituality and subjective well-being of Ghanaian parents of children with special needs: The mediating role of resilience

The study explored the mediating role of resilience in the relationship between spirituality and subjective well-being of 107 Ghanaian biological parents raising children with special needs. Results from mediational analyses revealed that spirituality indirectly influenced life satisfaction, positive affect and negative affect through resilience. Specifically, greater levels of spirituality predicted greater resilience, which successively led to greater life satisfaction, greater positive affect and reduced negative affect. These findings emphasize the necessity of targeting parents' well-being through resilience to help them deal with the burden of providing care for their children with special needs.

Sex Differences in Visual-Spatial Performance among Ghanaian and Norwegian Adults

Sex differences in spatial ability among adults in Western cultures are widely acknowledged, but few studies have assessed visual-spatial ability in non-Western subjects with tests that show the largest sex differences, and little is known whether effect sizes for different spatial ability categories are the same across cultures. This issue was addressed by using four visual spatial ability tests (water level, surface development, PMA space, and Vandenberg-Kuse) to collect data from university students in Ghana (n = 197) and Norway (n = 220). Except for the Surface Development test, on which no sex difference appeared in either sample, males perforned significantly better than females in both samples, and the effect sizes (r) were about medium, with no significant between-nationality difference on individual tests. These results showed that patterns and magnitudes of sex differences in spatial abilities were simiilar across cultures. The test intercorrelation patterns in the two samples differed markedly, suggesting that the ability structure underlying spatial performance may be different in the two cultures.

Beyond the 'east-west' dichotomy: Global variation in cultural models of selfhood

Markus and Kitayama's (1991) theory of independent and interdependent self-construals had a major influence on social, personality, and developmental psychology by highlighting the role of culture in psychological processes. However, research has relied excessively on contrasts between North American and East Asian samples, and commonly used self-report measures of independence and interdependence frequently fail to show predicted cultural differences. We revisited the conceptualization and measurement of independent and interdependent self-construals in 2 large-scale multinational surveys, using improved methods for cross-cultural research. We developed (Study 1: N = 2924 students in 16 nations) and validated across cultures (Study 2: N = 7279 adults from 55 cultural groups in 33 nations) a new 7-dimensional model of self-reported ways of being independent or interdependent. Patterns of global variation support some of Markus and Kitayama's predictions, but a simple contrast between independence and interdependence does not adequately capture the diverse models of selfhood that prevail in different world regions. Cultural groups emphasize different ways of being both independent and interdependent, depending on individualism-collectivism, national socioeconomic development, and religious heritage. Our 7-dimensional model will allow future researchers to test more accurately the implications of cultural models of selfhood for psychological processes in diverse ecocultural contexts. (PsycINFO Database Record

Contextualism as an Important Facet of Individualism-Collectivism

Beliefs about personhood are understood to be a defining feature of individualism-collectivism (I-C), but they have been insufficiently explored, given the emphasis of research on values and self-construals. We propose the construct of contextualism, referring to beliefs about the importance of context in understanding people, as a facet of cultural collectivism. A brief measure was developed and refined across 19 nations (Study 1: N = 5,241), showing good psychometric properties for cross-cultural use and correlating well at the nation level with other supposed facets and indicators of I-C. In Study 2 ( N = 8,652), nation-level contextualism predicted ingroup favoritism, corruption, and differential trust of ingroup and outgroup members, while controlling for other facets of I-C, across 35 nations. We conclude that contextualism is an important part of cultural collectivism. This highlights the importance of beliefs alongside values and self-representations and contributes to a wider understanding of cultural processes.

Developing and Evaluating the Social Axioms Survey in Eleven Countries

Based on a deductive, culturally decentered approach, new items were generated to improve the reliability of the original Social Axioms Survey, which measures individuals’ general beliefs about the world. In Study 1, results from 11 countries support the original five-factor structure and achieve higher reliability for the axiom dimensions as measured by the new scale. Moreover, moderate but meaningful associations between axiom and Big-Five personality dimensions were found. Temporal change of social axioms at the culture level was examined and found to be moderate. In Study 2, additional new items were generated for social complexity and fate control, then assessed in Hong Kong and the United States. Reliability was further improved for both dimensions. Additionally, two subfactors of fate control were identified: fate determinism and fate alterability. Fate determinism, but not fate alterability, related positively to neuroticism. Other relationships between axiom and personality dimensions were similar to those reported in Study 1. The short forms of the axiom dimensions were generally reliable and correlated highly with the long forms. This research thus provides a stronger foundation for applying the construct of social axioms around the world.

A Comparison of Sex Differences in Visual-Spatial Performance from Preadolescence to Adulthood in Ghana and Norway

This study examined sex-related differences in visual-spatial performance from a cross-cultural perspective by comparing cross-sectional data on four visual-spatial tests (measuring three spatial ability categories) on four different age groups (9, 12, 16 and adults) in Ghana and Norway. Reliable sex differences in favor of males were present in all age groups and their effect size magnitudes were practically constant over age in the two cultures. There were significant differences in the test intercorrelations in the two samples, suggesting that different structures of abilities may underlie spatial task performance in the two cultures. The results do not support the notion that the development of sex differences in spatial abilities is dependent on maturational or psychosocial processes. The near adult effect size by age 9 and the stability of the magnitude across cultures, argue for a biologically-based explanation of the observed sex differences in spatial performance.

Directional biases in adults' performance on a multiple-choice water-level task

Performance data on the water-level task were collected on a multiple-choice test requiring 417 adult subjects to choose the one item that represented the waterline of still water in a tilted vessel. Except for the item showing the waterline horizontal, waterlines were drawn oriented +/- 8 degrees, +/- 16 degrees, +/- 24 degrees, and +/- 32 degrees referenced to the horizontal. Analyses of errors from 284 subjects who did not achieve a perfect test score showed that 73% of all errors were made on negatively signed items. Further, among subjects who erred on all trials (n = 128), the majority were remarkably systematic in making their errors, consistently (six out of six trials) choosing items with a negative sign (56%) or items with a positive sign (13%). The predominant negative directional bias suggests that most adult subjects who completely lack an adequate understanding of the invariant horizontality of water were basing their choices on the belief that water tends to climb obliquely towards the brim of the tilted vessel.