ABSTRACT
The evidence of nutritional problems in Ghana can be
seen in the numerous Diet Related Non-Communicable Diseases in the Ghanaian
population. Authors have deliberated on nutritional adequacies and the
importance of supplying a varied diet. A lot has been done on single nutrient
deficiencies, as well as child and maternal malnutrition. Women Dietary
Diversity Projects have also been carried out in other parts of the world. In
much the same way, we can study men’s diet and provide potential intervention
strategies needed to improve their health. Thus, using the descriptive design
mainly through questionnaire and interview, this study set out to assess
dietary diversity of fathers and find out which factors influence dietary
diversities of fathers. Two hundred and seventy-eight fathers in Mankessim were
sampled using the multi-staged sampling technique. The study pointed out a low
dietary diversity of fathers and their families as well as positive perception
of fathers on the importance of dietary diversity. However the Families’
dietary diversity significantly contributed to fathers’ dietary diversity but
not fathers’ perception. The money available, food prepared by wives or
homemakers, appetite for food, available food at home, nutritional information
in the media and fathers’ understanding of healthy diet, tend to influence the
dietary diversity of fathers to a large extent. Fathers’ dietary needs are met
by homemakers of fathers’ families, food vendors and fathers themselves.
Nutrition interventions that target fathers should include their homemakers as
well as food vendors.
CHAPTER ONE
INTRODUCTION
Background to the Study
Dietary patterns reflect adequate nutrition thereby making it
a key component in the socio-economic development of any nation that seeks to
achieve the Millennium Development Goals (MDGS) and primary healthcare (Parr
& Orr, 2013; Johnston, 2015). Adequate nutrition means stronger immune
system, fewer diseases, improved health and a more productive population
(Burchi, Fanzo & Frison, 2011). According to Maslow’s hierarchy of needs,
food is a basic requirement for humans to eat in order to live (Maslow, 1943).
In view of this assertion, Herbert and Subak-Sharpe (1995), proposed three key
words: moderation, variety and balance as vital ingredients in every food plan
which, could form part of the dietary guidelines indicated by the science of
nutrition to prevent diet related diseases.
Authors have argued that poor nutrition influences the
development of certain chronic diseases such as diabetes, hypertension, heart
disease, stroke, cancer, osteoporosis and Alzheimer’s disease (Brown, Isaacs,
Krinke, Lechtenberg, Murtaugh, Sharbaugh, Splett, Stang, & Wooldridge,
2011). According to the literature majority of developed countries suffer from
over-nutrition while developing countries such as Ghana have challenges with
both under-nutrition and over-nutrition (Government of Ghana, 2013; Ghana
Statistical Service & Ghana Health Service, 2015). It is therefore clear
that poor nutritional status in notwithstanding the situation
would lead to malnutrition.
Malnutrition is known to have devastating effects on the
human populace as stated by UNICEF (2006). Conditions that might explain the
prevalence of malnutrition include iron deficiency anemia, stunted growth
particularly in children, low birth weight, obesity and underweight,
cardiovascular diseases and inadequacies in food supply (World Health
Organization, 2013). All forms of malnutrition are associated with significant
morbidity, mortality and economic costs, particularly where both under and over
nutrition co-exist as happens in developing countries undergoing nutrition
transition (UNICEF, 2006).
Invariably, malnutrition in adults tends to occur from either
over nutrition and / or under nutrition. Over nutrition more likely would
result from decreased metabolic rate and activity levels not correlating
positively with the caloric intake, (Brown et al, 2011); this situation often
leads to Diet Related Non-Communicable Diseases (DRNCD), such as diabetes,
hypertension, heart attacks and stroke (Krause & Mahan, 1979). There are
indications that these diseases are on the increase in Ghana and accounts for
lots of deaths in adults, which after ranking showed hypertension as the
highest cause of deaths at the Saltpond Hospital, (Edusei-Boateng, 2014)
It is however, argued that cardiovascular diseases (CVDS)
occur more in males than in females (Calasanti, 2010). According to Harvard
Medical School (2014), men of all ages have more heart attacks than women and
generally experience heart related diseases 10 years earlier than women due to
hormonal changes (testosterone in the male sex hormone) which simultaneously raises the total cholesterol and lowers the
protective HDL cholesterol. The literature asserts that CVDs have their roots
in the diets consumed by individuals, (Brown et al, 2011; Ferrell & Cherne,
2009; Herbert Subak-Sharpe, 1995; Pamplona-Roger, 2011), and many
challenges created in part by nutrition such as cardiac disease, obesity, and
diabetes, are common to both men and women (Casey, 2004).
Generally, the absolute nutritional requirements in men are
greater than in women, simply because men as a population are larger and have
more muscle mass than women, (Tsang, 2013). The author continues that although
the biological demands of women at certain periods in life requires special
nutritional needs than men; the latter need more calories, protein and calcium
than women. Additionally, men need more calories and protein than women because
they have more weight, more lean muscle mass as well as more circulating blood cells
(Casey, 2004). In view of their possible eating habits which do not offer them
the required levels of fibre, they need to be supplied in their diets in order
to offset incidents of heart diseases (Tsang, 2013). The importance of taking a
critical look at the diet of individuals, particularly, men as a means to
achieving the required nutritional status therefore cannot be overlooked. This
is because the diet tends to be the basic medium, through which the human body
can receive its nutritional benefits for optimal health. Ferrell & Cherne,
(2009 p.29) highlights that, Ninety percent of all conditions other than acute infections,
contagious diseases, and traumatisms are traceable to diet. The food question
is infinitely the most important problem of the present day, and if properly
dealt with must result in the disappearance of the vast bulk of the disease,
misery and deaths According to Mortimer and Rockson (2014), all states of
ill-health tend to have a common cause; faulty nutrition that comes with or
without infection. The authors observed that of all the medicines created out
of the earth, food has the potential to act as a viable source of medication.
To this effect, sufferings that come about as a result of diseases are largely
the result of habitual diet related negligence (White, 2014). The basic
scientific knowledge of human nutrition is often not adhered to in the everyday
feeding of children, adolescents and adults (Marzola, Nasser, Hashim, Shih,
& Kaye, 2013).
In most cases the increasing levels of hypertension,
diabetes, stroke, cancers, kidney and other non-communicable diseases that
occur in Ghana are overlooked (Jafaru, 2016) because the trends are attributed
to poor eating habits that could be referred to as one of the major factors
which Ghanaians require to address appropriately. Bosu (2013) however argued
that to be able to address such health challenges, there was the need to
acknowledge that obesity reduces the overall mortality by two to four years
among persons with body mass index of 30–35 kg/m2 and by eight to 10 years at
40–45 kg/m2. This is because of the premise that the increasing prevalence
among
Ghanaians puts both men and women at risk of Diet, related
Non-Communicable Diseases, (Ghana Statistical Service & Ghana Health
Service, 2015). On the causes of prostate cancer, Obu (2015) found chemicalized
/ denatured / non-nutritious toxic foods, lack of vitamin D, too much
carbohydrate foods, late eating, less fruits and vegetable, and too much sugar
in foods among Ghanaian men. Western diets, which are high in energy, meat, and
fat, were also associated with higher incidence of prostate cancer whereas traditional Asian diets rich in vegetables and legumes were
associated with lower prostate cancer (Grant as cited in Mróz, Chapman, Oliffe,
& Bottorff, 2011). This gives the implication that diets have a greater influence
when it comes to health issues.
It is known that diet comprises a number of nutrient and
non-nutrient constituents that are often interacting (FAO & Agriculture and
Consumer Protection Department, 2010). This explains why nutrition research has
recently shifted towards studying inclusive food-based approaches that focus on
dietary patterns, (Ashigbie, 2015; Jayawardena, Byrne, Soares, Katulanda,
Yadav, & Hills, 2013; Arimond, Wiesmann, Becquey, Carriquiry, Daniels,
Deitchler, Fanou-Fogny, Joseph, Kennedy, Martin-Prevel & Torheim, 2010).
Diet refers to the food usually eaten by a person. For instance, the diets of
some people tend to be vegetarian while others eat to slim down.
According to Ashigbie (2015), information on dietary patterns
reflects the overall nutritional behaviour better than the information on
single foods or nutrients. Also, the analysis of dietary patterns gives a more
comprehensive quality impression of food consumption habits within a population
(Kettler, Kennedy, McNamara, Oberdörfer, O'Mahony, Schnabel, Smith, Sprong,
& Roland, 2015). Furthermore, the literature argues that varied diets or
diversified diet tend to be the healthiest ones (Mirmiran, Azadbakht,
Esmaillzadeh and Azizi (2004).
Dietary Diversity
Dietary diversity means the consumption of adequate amounts
of a variety of food groups or a number of biologically distinct foods eaten
over a given period of time (Mirmiran et al, 2004). Dietary patterns are
frameworks that people adopt when choosing what to eat. It is therefore
necessary to understand the level of influence various factors exert on the
individuals’ dietary practice when attempting to provide nutrition education
for a particular group of people (Ball, Timperio & Crawford, 2006). In other
words, diversity means that we choose to eat a mixture (variety) of foods
across the range of food groups such as the six food groups as outlined:
Animal foods and its products
Starchy roots and plantain
Fruits and vegetables
Cereals and grains
Legumes, Nuts and oily seeds
Fats and oils
Mirmiran et al (2004), assert that the provision of varied
meals contains all the nutrients that have the potential to support the
dimensions of human health like encouraging biodiversity and sustainability,
allowing for nutritional adequacy, minimizing the adverse consequences of food
on health, providing the interest in food for it to be eaten, and reducing the
prevalence of cancer, cardiovascular and other chronic diseases. The importance
of increasing dietary diversity as a way of improving health and preventing
diseases, however, is multidimensional and shaped by various factors, including
physiological, agricultural, historical, religious, socio-economic and
psychological ones (Gedrich as cited in Naska, Fouskakis, Oikonomou, Almeida,
Berg, Gedrich, Moreiras, Nelson, Trigg, Turrini, Remaut, Volatier &
Trichopoulou, 2006).
Family traditions, geographical locations, religious beliefs,
economic, technological advancement, foreign influence, education, peer
influence and mass media are also highlighted in the literature as factors that
influence dietary patterns of people (World Health Organization, 2015). In some
parts of the world, gender was found to influence food choices of people (Vabo
& Hansen, 2014). Some foods were labeled as masculine while some were seen
as feminine (McNelly, 2016). Consumption of meat for instance symbolized
masculine diet, while the consumption of vegetables and fruits represented
feminine diet, (Prattala, Paalanen, Grinberg, Helasoja, Kasmel &
Petkeviciene, 2006). This is because in most cases, the frequency of fruit and
vegetable intake was higher among women than men (Statistics Canada, 2016).
Additionally, women were identified with higher awareness,
better knowledge of nutrition, more concerns about their healthy eating habits
than men, (Kiefer, Rathmanner & Kunze, 2005; Prattala et al. 2006; Turrell,
1997; Missagia, Oliveira & Rezende, 2012). Although gender is a key
determinant of food choice, it has been shown that globally, the majority of
men consume diets that are different and often poorer than their women
counterparts (Pan American Health Organsation & World Health Organisation,
2012). This argument was confirmed in studies conducted in other areas: in
United States, (Oakes & Slotterback, 2001; Rappoport, Peters, Downey,
Mccann, & Huffcorzine, 1993), Finland (Roos et al., 1998) and in Australia
(Turrell, 1997; Dumbrell & Mathai, 2008).
In the United Kingdom, Gough & Conner (2006) found that
masculinity was associated with consumption of convenience foods, meat and
beer, whereas healthier behaviors such as vegetarianism and domestic cooking, increased consumption of fruits and vegetables
formed the eating pattern of females.
To this end, Mróz et al (2011) proposed that the interactions
between men and the women in their lives could have some impacts on the
consumption patterns and / or dietary choices of men. The authors argued that
because North American women tend to control family food provisions, this
contributed more to family dietary quality. However, they observed the opposite
in most cases and attributed it to traditional feminine ideals where, women
provide with their husbands their preferred choices of meals than healthy foods
(Calansati, 2010; Mróz et al. 2011). In support, Carlson & Neuberger (2017)
also argued that because women generally control family food provisions, it
enhances the dietary quality of the family.
For Mróz et al (2011) the concepts of masculine dominance and
female subordination influence women to allow to their husbands’ wishes and
preferences when planning the family menu. Several studies have been conducted
on single nutrient deficiencies among children, and women including expectant
mothers and lactating mothers (Allen, 2000). In spite of the nutritional
challenges within our population, people continue to overlook the principle of
variety when it comes to diet.
Notwithstanding this, a variety of biologically unique foods
for the human wellbeing are available for every part of the body: several foods
for the eye, others for the heart, respiratory system, reproductive system
whiles some food groups work on the arteries, and the blood (Pamplona-Roger,
2011). This means that individuals cannot achieve health and wellness when
certain food groups are not included in the various diets.
Additionally, the need for varied foods cannot be for just
some groups of people because all individuals have several organs in the body
that needs proper functioning for the sustenance of the body, (Insel &
Roth, 2010). The situation is not different in Ghana. Ashigbie (2015) conducted
a study in Hohoe in the Volta Region and found out that nearly two-thirds
(62.6%) of the female adolescents exceeds the DRI of calories/day whiles, 67.6%
of the sample’s protein intake was below the DRI/day. The intake of fruits and
vegetables was very low as no daily consumption of fruits was recorded among
the respondents and this is critical to health since it gives the implication
of loss of vitamins and minerals which are required for the prevention
protection against diseases.
A study by Agriculture and Consumer Protection Department
(FAO
Agriculture and Consumer Protection Department, 2010), concluded
that the Ghanaian diet largely relies on starchy roots (cassava, yam), fruits
(plantain) and cereals (maize, rice), making almost three quarters of the
dietary energy and diversity of the diet remains low. The lower the dietary
diversity of a population, the more compromised the health of the population
will be, (FAO & FHI 360, 2016).
Globally, poor diets pose a greater risk to our health than a
combination of alcohol, tobacco, drugs and unsafe sex, (Global Panel on
Agriculture and Food Systems for Nutrition (Glopan, 2016). It is further stated
that major risks factors driving the global burden of diseases are related to
diet (WHO, 2009; WHO, 2011). However, policy makers seem more concern about
reducing hunger and starvation other than ensuring people have a more
diversified diet. (Haddad as cited in Glopan, 2016). The Department of Health Department for Children, Schools and Families (2008)
therefore suggested a critical need for individual members of the family to
live healthy lives that could affect the health and well-being of the entire
family.
Mostly, the consequences of poor diet of any member of the
family affect the whole family and eventually the society at large (Irons,
2009). There is the possibility that fathers in the family, due to family
responsibilities and workload, might overlook the importance of consuming
healthy diets, (Hill, Hawkins, Martinson & Ferris, 2003; World Health
Organization, 2003).The management of diet related diseases have the potential
to cause financial burden to families and the state as a whole, (Gatt, Jan,
Mondraty, Horsfield, Hart, Russell, Laba & Beverley, 2014), and further
cause loss of working days and for that matter, economic losses to the nation.
Generally, men form a significant portion of the productive
part of the population (World Health Organization, 2003) and when they suffer
ill-health, have higher death rates for most major illnesses, and have shorter
life expectancies than women, it could affect the productive sector of
countries (WHO, 2011; WHO, 2017). It is known that, “worldwide, men live an
average of 3.9 years less than women … and are more likely to suffer and die
from the 12 leading causes of mortality” (Mróz et al, 2011, p, 179).
The authors argued that, in men’s health, masculinity is associated with
reluctance to seek help, and this is demonstrated by evidence that men are
generally poorer consumers of health care services and less likely to
acknowledge symptoms of illness than are women, as was seen in the health
facilities within Mfantseman Municipality.
According to the oral history and available hospital records
in the Saltpond Hospital and the Mfantseman Health Directorate more men die
from diet related non-communicable diseases such as hypertension, in their
outfit than women, because they (men) do not report to the health facility
early for treatment. The need to investigate men’s diet to promote healthy
principles such as variety, moderation and balance in order to prevent the emergence
of disease cannot be overemphasized.
Governments and other agencies often put measures in place to
ensure that new born babies and children are not malnourished, but healthy and
live longer. This study therefore asks whether same or similar measures are
possible for men to support their health and make them live healthier longer
lives in order to take care of their families.
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