Adolescents’ Knowledge of Diet-Related Chronic Diseases and Dietary Practices in Ghana ()
1. Introduction
Diet-related chronic diseases are long-term diseases that are not contagious and are largely preventable. They are diseases that result from poor eating habits. Examples include obesity, diabetes, cardiovascular diseases, cancer, osteoporosis, and dental diseases [1]. Diet-related chronic diseases require extensive care because most chronic diseases cannot be cured completely. Thus, people with chronic diseases may experience a lifetime discomfort, frequent doctor’s visits, medical tests, medications, therapies and sometimes surgery. According to World Health Organization [2], diet-related chronic diseases are now the major cause of death and disability worldwide. Cardiovascular diseases, diabetes, obesity, cancer and respiratory diseases, account for 59% of the 57 million deaths annually and 46% of the global burden of disease. A relationship exists between dietary habits and diet-related chronic diseases. A change in dietary habits and physical activity has been reported to have a major impact in reducing the rates of these diseases, often in a relatively short time. At the moment, advances in medicine and rehabilitation have made it possible for some chronic diseases sufferers to manage the disease without affecting other areas of their lives [2].
In Ghana diet-related chronic diseases constitute public health and developmental challenges requiring the same intellectual and financial commitment afforded to infectious diseases such as malaria. The Ghana Demographic and Health Survey [3] indicated that the national prevalence of diabetes was 11.6%. The survey recorded a national prevalence of 27.8% for hypertension. The report also indicated that 30% of women in Ghana were overweight and 9% obese. A regional comparison showed that 20% of women in the Upper West, Northern and Upper East regions (the three northern regions) were overweight/obese while women of the Greater Accra region had the highest proportion of 45%.
Adolescence is a developmental transition between childhood and adulthood that entails major interrelated physical, cognitive, and psychosocial changes in a person [4]. It is the second most critical period of physical growth in the life cycle after the first year and 25% of adult height is attained during this period. Nutritional needs are high for both male and female adolescents. The incidence of dietary inadequacies in adolescence is high. Substantial development and rates of growth combined with developmentally appropriate psychosocial changes, such as an increasing need for independence and a desire to make lifestyle choices that conform to peer ideals and differ from those of the family, place adolescents at risk of poor nutritional status [1]. Eating patterns established during adolescence may remain throughout the life cycle [5]. Adolescents increasingly seem to adopt lifestyles that negatively affect their nutritional and health status and therefore substantially increase their risk for premature development of diet-related diseases like cardiovascular diseases, diabetes and certain cancers. Poor dietary practices, sedentary leisure time spending and lack of physical activity are lifestyles that once instilled have a strong tendency to track from adolescence into adulthood and they become extremely resistant to modifications [6].
Adolescence is a unique intervention point in the life cycle. It offers a chance to acquire knowledge about optimal nutrition that could prevent, delay or hasten adultonset of diet-related chronic illnesses later in life. Understanding and promoting nutritional health, with appropriate assistance to adolescents, will help them improve their dietary habits and avoid diet-related chronic diseases such as diabetes, hypertension and obesity later in life. Since students in Day Second Cycle Institutions in Ghana are mainly adolescents who have much control over their dietary intakes, it is important to gain insight into their dietary habits, so as to offer appropriate interventions, to help them maintain optimal nutrition and health. This study, therefore, sought to assess adolescents’ knowledge of diet-related chronic diseases and its influence on their dietary practices. It was hypothesized that there was no relationship between knowledge of diet-related chronic diseases and the dietary practices of day SHS students.
2. Methodology
2.1. Study Design, Location and Population
A cross-sectional survey was used to investigate the influence of knowledge of diet-related chronic diseases on the dietary practices of Senior High School students in the Ghana. The study was conducted in the Ga-East Municipality of the Greater Accra Region of Ghana. The population comprised all day students in their second year in senior high schools who were within the ages of 14 - 18 years. First year students were not included in the study because they had just been admitted and were still adjusting to the senior high school curriculum. Third year students were also not included because they were preparing for their final West Africa Senior Secondary School Certificate Examination (WASSSCE).
2.2. Sample and Sampling Technique
In order to have a fair representation of all adolescents in the senior high schools in the municipality, 4 schools were selected using purposive sampling techniques based on their location in the Municipality. The study schools purposively selected were West Africa Senior High located in the east, Action Senior High located in the south, Pre-Modal Senior High located in the west and Elim Senior High located in the northern part of the municipality. The total number of students who qualified for the study and were willing to participate were 940. To determine the sampling frame (k), the method N/n = k, where N = Total population and n = sample size was used (k = 940/313). With a sampling frame of 3, a systematic random sampling technique was used to select every other 3rd person on each school’s list. Respondents who qualified for the study at the West Africa Senior High School, a public school, were 535. Out of this number, 178 were selected for the study. Students selected from the 3 private schools were 135. At Pre-Modal Senior High 150 qualified for the study and 50 were selected. At Action Senior High 180 qualified for the study and 60 were selected and at Elim Senior High 75 qualified for the study, of which 25 were selected for the study.
2.3. Instruments and Data Collection
The instruments used for data collection included a structured questionnaire and a food frequency questionnaire. A structured questionnaire was used to collect information on the background characteristics of respondents as well as their knowledge of diet-related chronic diseases and nutrition. A food frequency questionnaire consisting of food items from the 6 food groups in Ghana was used to assess frequency of consumption and dietary diversity of respondents. The food groups were starchy roots and plantain; cereals and grains; animal products; beans, nuts and oily seeds; fruits and vegetables; fats and oils. Respondents were required to tick the frequency of consumption of foods; whether on daily or weekly basis, occasionally or never. The data were collected between 2nd December, 2009 and 1st March 2010.
2.4. Data Analysis
2.4.1. Knowledge of Diseases
Knowledge of hypertension, diabetes and obesity were scored using a scoring system developed by the researchers (Table 1). The scoring was based on the responses for the definition, causes and prevention of each of the diseases assessed, namely hypertension, diabetes and obesity. A correct answer attracted 1 mark while an incorrect answer attracted zero.
Marks awarded for answering all questions correctly
Table 1. Scoring of knowledge of diet-related chronic diseases based on responses to questions related to the diseases.
on each disease was 3. Scoring and rating was as follows: 0 - 1 = Poor knowledge; 2 = Fair knowledge; 3 = Good knowledge. Knowledge of the three diseases was scored by adding all the responses together. The highest mark for the overall knowledge of the 3 diseases was 9. Individuals with scores between zero and 3 were classified as having poor knowledge; those with scores between 4 and 6 as having fair knowledge, and those with scores of 7 - 9 as having good knowledge of the diseases.
2.4.2. Dietary Data
Dietary diversity scores were generated from the food frequency questionnaire. The scores gave an indication of the number of different food groups that each respondent consumed throughout the day, thus, a picture of the actual diversity of the meal consumed by respondents. The highest attainable score by each respondent based on all food groups consumed was 6. Respondents with mean dietary diversity between 0 and 2 were classified as having low dietary diversity, 3 - 4 as fair diversity and 5 - 6 were classified as having high dietary diversity. All data collected were analyzed using The Statistical Package for Social Sciences (SPSS version 16.0). The chi-square test was used to ascertain the relationship between the knowledge of diet-related chronic diseases and the dietary practices of the high school students. Differences and associations were considered statistically significant for values of P < 0.05.
2.5. Ethical Consideration
Ethical approval was obtained from the Institutional Review Board of the Noguchi Memorial Institute for Medical Research, University of Ghana, Legon (Ethical Identification Number NMIMR-IRB CPN 003/10-11). Informed Consent was also obtained from the Heads and students of participating schools, after the purpose and significance of the study had been fully explained to them.
3. Results and Discussion
3.1. Background Characteristics of Respondents
The ages of the respondents ranged from 14 to 18 years. The mean ages for males and females were 16 years and 15 years respectively. Out of the 313 respondents, 52.1% of respondents’ parents worked in the private sector while the rest worked in the public sector. Major occupations of the parents included trading, banking, farming, teaching, nursing and social work. Even though it was not possible to document the financial capacities of respondents’ parents in terms of income, the occupational background gives a general view that their parents’ income cut across all the three economic levels; low, medium and high income earners.
3.2. Knowledge of Diet-Related Chronic Diseases
Table 2 shows respondents’ level of knowledge of the three diet-related chronic diseases. More than half (63.6%) of the respondents had poor knowledge of diabetes. This means that they did not have any understanding of the disease, did not know about its causes or prevention. Only 9.3% of the respondents had good knowledge of the disease. Data on the national prevalence of diabetes presented by the Ghana Demographic and Health Survey report [3] was 11.6%. Figures from the Centre for Disease Control and Prevention at the Korle-bu Teaching Hospital in Accra also showed that 1080 and 1055 adolescents were diagnosed with diabetes in 2008 and 2009, respectively. It is possible that with such prevalence, most of the respondents would not have heard any discussions about the disease. The results therefore imply that either the Regenerative Health Programme initiated by the Ghana Health Service to educate people on some of these chronic diseases is not empha-