Effect of Nutrition Education on Vegetable and Legume Intake Among Households in Accra

NCT07012473 | Completed DMC

• 1 other identifier: CBAS 004/21-22
• Study Type: interventional
• Target: 360
• Locations: 1 country
• Sites: 1

Brief Summary

The main purpose of this observational study is to determine the effect of nutrition education on the knowledge and behaviour of households towards the consumption of green leafy vegetables, legumes and vitamin C-rich fruits and its influence on haemoglobin levels of (households) mothers, fathers and children. The questions it aimed to answer are:

• What is the effect of nutrition education on knowledge, attitude and practice towards the consumption of green leafy vegetables and legumes among households in Ayawso Central Municipality?
• What are the consumption patterns of green leafy vegetables, legumes and vitamin C -rich fruits among households in Ayawso Central Municipality?
• What is the iron, β-carotene, vitamin C and antinutritional contents of the commonly consumed green leafy vegetables and legumes in Ayawso Central Municipality?
• Is iron bioaccessible in the commonly consumed green leafy vegetables and legumes in Ayawso Central Municipality?
• What is the haemoglobin level of participants at baseline and end line in Ayawso Central Municipality? The study will address knowledge, attitude and the low intake of these nutrient-rich foods and the high prevalence of iron deficiency anaemia/ anaemia among women, children and men through nutrition education and also examine the iron content and iron bioaccessibility in the indigenous green leafy vegetables and legumes that participants consume. Participants are aware of indigenous green leafy vegetables, legumes and vitamin C-rich fruits in their environment; however, they do not consume them frequently. They will answer questions on knowledge, attitude and practices towards these foods during the six months study and have their haemoglobin levels determine.

Conditions

Iron Deficiency Anemia

Keywords

Nutrition education; Green leafy vegetables; Legumes; haemoglobin levels; iron-bioaccessibity; parents-child pair; Ghana

Outcome Measures

Primary Outcomes (4)

• Change in mean Nutritional Knowledge from baseline to endline

  Nutritional Knowledge will be meansured using questionnaire. An adapted knowledge score scale (0, 1: where 0 is the least and 1 highest) will be used in scoring the participants knowledge. Participants score 1 if the answer knowledge question correctly and will score zero if they get the question wrong. There will be 11 questions on nutritional knowledge, if participants answer 9 and above questions correctly (80% and above) , they will be described as having good knowledge, 6-8 correct answers (50-70%) will be moderate knowledge while 0-5 (\< 50%) correct answers will be poor knowledge. Data will be collected three times (baseline, midline and endline). The mean difference will be established based on p-value \< 0.05 using repeated ANOVA

  From enrollment to end of intervention at 6 months

• Change in mean Nutritional Attitude will be measuered from baseline to end line 6 months

  A questionnaire will be used collect data on Nutritional Attitude at baseline, midline and endline. To measure change in nutritional attitude towards the consumption of green leafy vegetables, legumes and vitamin C rich fruits, two categories will be created: good attitude and poor attitude. A median score will be used to measure change in attitude based on seven (7) attitudinal questions. Participants who surpased the median score of the 7 questions will be described as having good attitude while those who score below the median will be described as having poor attidude. The mean difference will be established based on p-value \< 0.05 in repeated measures using ANOVA

  From enrollment to the end of the intervention at 6 months

• Change in mean will be measured for Nutritional Practice from baseline to end line at 6 months

  A questionnaire will be used to measure the change in Nutritional Practice of participants. The measurement will be done using an adapted nutritional practice scale of 0 and 1, with 1 for a correct answer and 0 for a wrong answer. There will be 23 nutritional practice questions divided into 7 sections, and there will be two categorie; good or poor practice. Participants who score 16 out of 23 questions correctly (70%) and above will be classified as having good practice while those who score less than 16 out of the 23 questions correctly will be classified as having poor practice. Data will be collected at three time points: baseline, midline and endline. Mean difference will be established using repeated ANOVA and p-value \< 0.05

  From enrollment to the end of the intervention at 6 months

• Differences in the mean of chemical compositions of the indigenous green leafy vegetables and legumes will be measured during the study

  The commonly consumed green leafy vegetables and legumes consumed by intervention group participants will be analysed in the laboratory to determine their chemical composition and iron bioaccessibity in them. The quantities of nutrients and iron bioaccessibility will be measure in mg/ 100g.One way ANOVA will be used to establish the mean differences in the vegetables and legumes at p-value \< 0.005.

  This will be done at the end of the nutrition education intervention at 6 months

Secondary Outcomes (2)

• Change in the frequency of consumption of green leafy vegetables and legumes will be measured from baseline to end line at 6 months

  From enrollment to end line at 6 months

• Change in mean haemoglobin levels will be measured at baseline and endline at 6 months

  At enrollment and endline at 6 months

Study Arms (2)

Intervention Group

ACTIVE COMPARATOR

Intervention Group: Will receive Nutrition Education Intervention for 6 months

Behavioral: Nutrition education on green leafy vegetables and legumes

Control Group

NO INTERVENTION

Control Group: This group will not be given any form of Nutrition Education from the researcher for 6 months period

Interventions

Nutrition education on green leafy vegetables and legumes BEHAVIORAL

The nutrition education intervention will be based on the Theory of Reasoned Action, Social Cognitive Theory, and the Health Belief Model to influence key behaviour change factors such as knowledge, attitudes, practices, and beliefs. Educational materials will include stickers featuring indigenous green leafy vegetables, legumes, and vitamin C-rich fruits, with information on their benefits, storage, preparation, and the importance of combining them for enhanced iron absorption. Other materials include videos, messages, and affirmative words on iron deficiency and its prevention. The intervention will be delivered to selected households in the intervention community through biweekly meetings and phone calls over six months. The control community will not receive any intervention from the researcher.

Intervention Group

Eligibility Criteria

• Age: 6 Years - 49 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Couples with a child between 6-10 years'
• The woman is between ages 15-49 years.
• Couples will be staying within the selected community for at least 6 months after the recruitment.

You may not qualify if:

• Single parents in the study community
• Bachelors and spinsters
• Couples without children.
• Married women 14 years or below and 50 years or more
• Couples with children below or above the ages of 6-10 years.

Sponsors & Collaborators

• University of Ghana: lead
• Société des Produits Nestlé (SPN): collaborator

Study Sites (1)

University of Ghana, Legon, Department of Nutrition and Food Science

Accra, +233, Ghana

Location

Related Publications (29)

• Zelalem, A., Endeshaw, M., Ayenew, M., Shiferaw, S., & Yirgu, R. (2017). Effect of nutrition education on pregnancy specific nutrition knowledge and healthy dietary practice among pregnant women in Addis Ababa. Clinics in Mother and Child Health, 14(3), 265.

  BACKGROUND

• Yetnayet, M., Henry, C. J., Berhanu, G., Whiting, S. J., & Regassa, N. (2017). Nutrition education promoted consumption of pulse based foods among rural women of reproductive age in Sidama Zone, Southern Ethiopia. African Journal of Food, Agriculture, Nutrition and Development, 17(3), 12377-12395.

  BACKGROUND

• World Health, O. (2011). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity.

  BACKGROUND

• WHO. (2019). Healthy diet / World Health Organization. Regional Office for the Eastern Mediterranean. https://apps.who.int/iris/bitstream/handle/10665/325828/EMROPUB_2019_en_23536.pdf

  BACKGROUND

• WHO. (2020). WHO guidance helps detect iron deficiency and protect brain development; April 2020

  BACKGROUND

• Wagner MG, Rhee Y, Honrath K, Blodgett Salafia EH, Terbizan D. Nutrition education effective in increasing fruit and vegetable consumption among overweight and obese adults. Appetite. 2016 May 1;100:94-101. doi: 10.1016/j.appet.2016.02.002. Epub 2016 Feb 2.

  PMID: 26850310 BACKGROUND

• Van Jaarsveld, P., Faber, M., Van Heerden, I., Wenhold, F., van Rensburg, W. J., & Van Averbeke, W. (2014). Nutrient content of eight African leafy vegetables and their potential contribution to dietary reference intakes. Journal of Food Composition and Analysis, 33(1), 77-84.

  BACKGROUND

• Marías, Y. F., & Glasauer, P. (2014). Guidelines for assessing nutrition-related knowledge, attitudes and practices: Food and Agriculture Organization of the United Nations (FAO).

  BACKGROUND

• Umeobika, U. C., Nwali, D. C., & Ekwueme, I. J. (2015). Quantitative evaluation of anti-nutritional factors in mango (Mangifera indica) fruit. Int. J. Appl. Sci. Math, 2(5), 2394-2894.

  BACKGROUND

• Tuli, R. T., Rahman, M. M., Abdullah, A. T., Akhtauzzaman, M., & Islam, S. N. (2016). Phytochemicals-Tannins in some Leafy Vegetables of Bangladesh. J. Nutr, 3, 150.

  BACKGROUND

• Stuetz W, Gowele V, Kinabo J, Bundala N, Mbwana H, Rybak C, Eleraky L, Lambert C, Biesalski HK. Consumption of Dark Green Leafy Vegetables Predicts Vitamin A and Iron Intake and Status among Female Small-Scale Farmers in Tanzania. Nutrients. 2019 May 7;11(5):1025. doi: 10.3390/nu11051025.

  PMID: 31067775 BACKGROUND

• Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, Pena-Rosas JP, Bhutta ZA, Ezzati M; Nutrition Impact Model Study Group (Anaemia). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013 Jul;1(1):e16-25. doi: 10.1016/S2214-109X(13)70001-9. Epub 2013 Jun 25.

  PMID: 25103581 BACKGROUND

• Santos WPC, Ribeiro NM, Santos DCMB, Korn MGA, Lopes MV. Bioaccessibility assessment of toxic and essential elements in produced pulses, Bahia, Brazil. Food Chem. 2018 Feb 1;240:112-122. doi: 10.1016/j.foodchem.2017.07.051. Epub 2017 Jul 11.

  PMID: 28946232 BACKGROUND

• Rosi A, Paolella G, Biasini B, Scazzina F; SINU Working Group on Nutritional Surveillance in Adolescents. Dietary habits of adolescents living in North America, Europe or Oceania: A review on fruit, vegetable and legume consumption, sodium intake, and adherence to the Mediterranean Diet. Nutr Metab Cardiovasc Dis. 2019 Jun;29(6):544-560. doi: 10.1016/j.numecd.2019.03.003. Epub 2019 Mar 14.

  PMID: 31078365 BACKGROUND

• Rosenstock IM. Why people use health services. Milbank Mem Fund Q. 1966 Jul;44(3):Suppl:94-127. No abstract available.

  PMID: 5967464 BACKGROUND

• Nomkong, R. F., Ejoh, R. A., Dibanda, R. F., Gabriel, M. N. J. F., & Sciences, N. (2019). Bioavailability of Iron and Related Components in Cooked Green Leafy Vegetables Consumed in Cameroon. 10(9), 1096-1111.

  BACKGROUND

• Murty, P., Rao, M. V., & Bamji, M. S. (2016). Impact of enriching the diet of women and children through health and nutrition education, introduction of homestead gardens and backyard poultry in rural India. Agricultural Research, 5, 210-217.

  BACKGROUND

• Lion R, Arulogun O, Titiloye M, Shaver D, Jain A, Godwin B, Sidibe M, Adejumo M, Rosseel Y, Schmidt P. The effect of the "Follow in my Green Food Steps" programme on cooking behaviours for improved iron intake: a quasi-experimental randomized community study. Int J Behav Nutr Phys Act. 2018 Aug 16;15(1):79. doi: 10.1186/s12966-018-0710-4.

  PMID: 30115087 BACKGROUND

• Leafy green crops to improve diets on Pacific islands. Bull World Health Organ. 2018 Sep 1;96(9):595-596. doi: 10.2471/BLT.18.020918.

  PMID: 30262939 BACKGROUND

• Holdsworth M, Pradeilles R, Tandoh A, Green M, Wanjohi M, Zotor F, Asiki G, Klomegah S, Abdul-Haq Z, Osei-Kwasi H, Akparibo R, Bricas N, Auma C, Griffiths P, Laar A. Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: Evidence for policy action from Ghana and Kenya. Glob Food Sec. 2020 Sep;26:100452. doi: 10.1016/j.gfs.2020.100452.

  PMID: 33324537 BACKGROUND

• Fallah F, Pourabbas A, Delpisheh A, Veisani Y, Shadnoush M. Effects of nutrition education on levels of nutritional awareness of pregnant women in Western iran. Int J Endocrinol Metab. 2013 Summer;11(3):175-8. doi: 10.5812/ijem.9122. Epub 2013 Jul 1.

  PMID: 24348589 BACKGROUND

• de Jager I, Borgonjen-van den Berg KJ, Giller KE, Brouwer ID. Current and potential role of grain legumes on protein and micronutrient adequacy of the diet of rural Ghanaian infants and young children: using linear programming. Nutr J. 2019 Feb 21;18(1):12. doi: 10.1186/s12937-019-0435-5.

  PMID: 30791898 BACKGROUND

• Dahanayake DN, Castillejos AG, Chodosh J, Vavvas DG. Visual restoration with KPro after face allotransplantation with a grade III phthisical eye. Digit J Ophthalmol. 2024 Jun 24;30(2):45-47. doi: 10.5693/djo.02.2024.03.003. eCollection 2024.

  PMID: 38962671 BACKGROUND

• Coomson JB, Aryeetey R. Perception and practice of breastfeeding in public in an urban community in Accra, Ghana. Int Breastfeed J. 2018 May 18;13:18. doi: 10.1186/s13006-018-0161-1. eCollection 2018.

  PMID: 29796057 BACKGROUND

• Bundala N, Kinabo J, Jumbe T, Bonatti M, Rybak C, Sieber S. Gaps in knowledge and practice on dietary consumption among rural farming households; a call for nutrition education training in Tanzania. Int J Food Sci Nutr. 2020 May;71(3):341-351. doi: 10.1080/09637486.2019.1655533. Epub 2019 Aug 21.

  PMID: 31433686 BACKGROUND

• Arasaretnam, S., Kiruthika, A., & Mahendran, T. (2018). Nutritional and mineral composition of selected green leafy vegetables. Ceylon Journal of Science, 47(1), 35-41.

  BACKGROUND

• Amagloh FK, Atuna RA, McBride R, Carey EE, Christides T. Nutrient and Total Polyphenol Contents of Dark Green Leafy Vegetables, and Estimation of Their Iron Bioaccessibility Using the In Vitro Digestion/Caco-2 Cell Model. Foods. 2017 Jul 22;6(7):54. doi: 10.3390/foods6070054.

  PMID: 28737681 BACKGROUND

• Aggarwal M, Devries S, Freeman AM, Ostfeld R, Gaggin H, Taub P, Rzeszut AK, Allen K, Conti RC. The Deficit of Nutrition Education of Physicians. Am J Med. 2018 Apr;131(4):339-345. doi: 10.1016/j.amjmed.2017.11.036. Epub 2017 Dec 18.

  PMID: 29269228 BACKGROUND

• Abu-Baker NN, Eyadat AM, Khamaiseh AM. The impact of nutrition education on knowledge, attitude, and practice regarding iron deficiency anemia among female adolescent students in Jordan. Heliyon. 2021 Feb 27;7(2):e06348. doi: 10.1016/j.heliyon.2021.e06348. eCollection 2021 Feb.

  PMID: 33718648 BACKGROUND

MeSH Terms

Conditions

Anemia, Iron-Deficiency

Condition Hierarchy (Ancestors)

Anemia, Hypochromic; Anemia; Hematologic Diseases; Hemic and Lymphatic Diseases; Iron Deficiencies; Iron Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases

Study Officials

• John Anoku, PhD, MSc

  University of Ghana

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: There will be two groups but only one group ( the interventiongroup) will receive the intervention while the second group will not receive the intervention

Study Record Dates

• First Submitted: May 24, 2025
• First Posted: June 10, 2025
• Study Start: April 28, 2022
• Primary Completion: November 28, 2022
• Study Completion: December 10, 2022
• Last Updated: June 10, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR
• Time Frame: Beginning 3 months and ending 3 years after publication of results
• Access Criteria: IPD will be shared upon request with researchers in the field of Nutrition and Public Health who will submit data sharing agreement plan which will be reviewed by study Chair and Directors

Locations

GH (1)