Study setting
Ekumfi Narkwa is located along the coastline of the Central region. It is one of the nine fishing communities in the district. It has a population of 4169 with 506 children under-five [16]. The community has a Community based Health Planning and Services (CHPS) compound with health workers residing in the facility. The major economic activity in the community is fishing and selling of the fresh or smoked fish. Every year, during the lean fishing season, most of the fishermen migrate to the Western region of the country to continue their fishing activities. Their wives and children go along with them to facilitate the handling and selling of the fish.
Sample size
The sample size was determined with the following assumptions: confidence interval of 95%, a proportion of 20.2% for children under five in the Central region who are undernourished. This proportion is according to the 2014 Ghana Demographic and Health Survey [17]. The total of 250 caregiver and child pairs consented, and were recruited.
Sampling method
We selected respondents from all the suburbs in the community namely Asemasa- Esikado, Ahenbrom, Kokodo and Adukrom. Respondents were selected proportionate to the size of the suburb. In each suburb, at least forty-five (45) respondents were selected. The proportions selected from each suburb were; Ahembrom (35%), Adukrom (25%), Esikado-Asemasa (22%) and Kokodo (18%). This was used because the community had no proper housing list [18]. Sampling of respondents from their households was done by the modified random walk method.
In the modified random walk, we identified and listed key land marks in each suburb. These included the taxi rank, clinic outreach points, schools, churches, information center, mosque, and CHPS compound. In each suburb, a listed landmark was randomly selected as the starting point for sampling of respondents. Field workers identified the house closest to the landmark and started selection of respondents from there. They continued in a clockwise manner till the sample size for the suburb was met. This procedure was repeated in each suburb till the total sample size was obtained.
In each house, we asked for caregivers with children under-five years. Every household in each sampled house with a child aged 6–59 months was given the opportunity to be part of the study. In places where a household had more than one child under five, names of both children were written on pieces of paper and the mother randomly selected one. The selected child was taken as part of the study.
The study was explained to the caregivers of these children and they were taken through the consent procedure. Caregivers who agreed signed the informed consent document before the questionnaire was administered and measurements of the child taken. In cases were the mother was less than 18 years, permission was sort form her guardian to allow her take part in the study. Again, we ensured that the guardian was present during the consent procedure and all her questions were answered. Both the mother and her guardian signed before the interviews were conducted. Participation in the study was voluntary and based on caregiver’s willingness to give full consent and the availability of the child during the study period.
Data collection
Data was collected by interview administered questionnaires. Research assistants interviewed mothers and caregivers on their demographic characteristics, general practices, the major food groups the child had eaten in the past week and also took the child’s anthropometric measurements. Interviews and anthropometric measurements were done in the home of the caregiver.
General practices were defined as the community’s accepted way of doing things. General practices assessed were; those normally involved in childcare (who acts as caregivers), and nature of economic activities the community engages in (type of activity, nature of activity).
For the assessment of major food groups the under-five had eaten, caregivers recalled the number of times in the week the child had eaten staples (cereals, roots, tubers and plantain) and the number of times the child had taken fish products. The instrument used for food recall was adopted from the Food and Nutrition Technical Assistance (FANTA) project [19].
Anthropometric measurements
Anthropometric measures (weight and height) were taken twice with a calibrated infantometer, ShorrBoard brand, Weigh and Measure, LLC brand and weighing scale, Seca 803 brand respectively. All measurements were recorded. All children were clothed in only underwear or light clothing during measurements. The measurements were taken using WHO standard procedure [20].
Each measurement was taken by two skilled field workers who had been trained in taking various anthropometric measurements of children under five years.
Data analysis
Data was entered in Microsoft Excel Office 2010, cleaned and exported to STATA Software, Texas, USA, version 13 for analysis. Data collected on demographic characteristics and their general practices were presented in tables as frequencies and percentages. Means were calculated for weight and height in Microsoft Excel and were exported to WHO ANTHRO software for calculation of the nutritional indices; Height-for-age, (HA), Weight-for-age (WA) and Weight-for-Height (WH)) and their respective Z-scores. The nutritional status was assessed by the three commonly used indicators of nutritional status; height for age, weight for height and weight for age [16]. According to the WHO, child whose height for age, weight for height or weight Z-scores fell below − 2 of the mean standard deviation of the Z-score of the population was classified as stunted, wasted or underweight respectively [21]. The overall nutritional status was also determined as those whose who had Z-scores below − 2 of the population mean for any of the three nutritional indices assessed.
The anthropometric data was presented by age and sex since growth failure varies from age to age and within sexes. Age was categorized in months as: 6–11, 12–17, 18–23, 24–35, 36–47, and 48–59 respectively.
A simple logistic regression was run to assess the significant association between the nutritional status of the under-fives and the various factors assessed. Significant association was determined at 95% confidence interval and p-value < 0.05.