ASSESSING DIETARY DIVERSITY OF FATHERS IN MANKESSIM IN THE MFANTSEMAN MUNICIPALITY

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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Item Type: Ghanaian Postgraduate Material  |  Attribute: 125 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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