A new study by Transform Nutrition West Africa identifies the trends and gaps in research that cover the World Health Assembly indicators across West Africa. These are potentially valuable insights for nutrition decision makers in the region. This presentation is to be used as a freely accessible resource for decision-makers at all levels.
HMCS Vancouver Pre-Deployment Brief - May 2024 (Web Version).pptx
Ghana Systematic Map to guide decision-making on the current landscape of research on World Health Assembly indicators in West Africa
1. Ghana
International Food Policy Research Institute
The Current Landscape of Research on World Health
Assembly Indicators in West Africa: A Systematic Map
to Guide Decision-Making
2. 2
The West Africa (WA) Region has been one of the slowest in
reducing its many burdens of malnutrition. The World Health
Assembly’s (WHA) 2025 nutrition targets were developed to track
countries’ nutritional situations, and measure progress in reducing
malnutrition. These indicators are therefore essential to guide
decision making. Understanding the regional and in-country
dynamics are an essential first step to highlight gaps and trends in
evidence in the region.
Introduction
This study aimed to identify and catalogue peer-reviewed research
on the WHA indicators in West Africa, and create a map of recent
research evidence to inform decision-making for nutrition policies
and programs in the region.
Objective
3. Data were extracted at abstract level.
No quality appraisal of publications was undertaken.
A systematic approach was applied to literature searches, developing inclusion
criteria, screening, coding, taxonomy, data extraction, and study synthesis
The MEDLINE database was searched for research published on World Health
Assembly (WHA) indicators from 2010 to April 2018
Search terms were developed to capture evidence
on the prevalence, drivers, programs (Randomized
Controlled Trials), and policies relating to the WHA
indicators. These include stunting, wasting and
overweight in children under 5, low birth weight
(LBW), exclusive breastfeeding (EBF) up to 6
months, and anemia in women of reproductive age
(WRA)
Methods
4. References identified through
systematic search (n=6,630)
References excluded (n=2,581)
- Not WA region (n=130)
- Not target population (n=172)
- Disease specific/not nutrition related
(n=1729)
- Nutrition related but not WHA specific
(n=337)
- Additional program studies (n=75)
- RCT Protocol (n=9)
- Other (n=129)
Duplicates removed
(n=3,669)
References retrieved after title
and abstract screening
(n=380)
- Primary studies (n=359)
- Reviews (n=21)
References retrieved for title
and abstract screening
(n=2,961)
References included in mapping
(n=363)
Primary Studies (n=340)
Reviews (n=23)
Excluded at extraction level (n=17)
Flow chart of
search
approach
7. 21
39
4
12
10
86
5
5
5
15
18
147
14
8
2
1
Benin
Burkina Faso
Cape Verde
Cote d'Ivoire
Gambia
Ghana
Guinea
Guinea- Bassau
Liberia
Mali
Niger
Nigeria
Senegal
Sierre Leone
Togo
WA region
Number of publications per country
A quarter of publications
report on Ghana
78 publications focus only
on Ghana and 8
publications are on multi-
country studies that
include Ghana
8. Publications per year in four focal countries
0
2
4
6
8
10
12
14
16
18
20
22
24
26
2010 2011 2012 2013 2014 2015 2016 2017
Nrofpublications
Nigeria
Ghana
Burkina Faso
Senegal
9. Publications reporting on Ghana by study setting
28
8
9
3
27
11
0 5 10 15 20 25 30
Not specified
National
District
Community
Hospital
Health facility
Nr of publications
10. Publications reporting on Ghana by study design
1%
21%
2%
54%
12%
9%
1%
Percent of publications per study
design (n=86)
Other Not specified
Case-control Case series
Cross-sectional Cohort
RCT Review
67%
9%
Hierarchy of evidence
15. Publications reporting on Ghana per indicator category and research focus
22
17
29
4
12
16
2
4
1
4
1
2
3
3
1
0
5
10
15
20
25
30
35
40
U5 Stunting U5 Wasting LBW U5 Overweight EBF Anaemia WRA
Problem Program Policy
16. Program studies by intervention type and outcome
18
8
4
1
0
5
10
15
20
Burkina Faso Ghana Nigeria Senegal
Nrofprogramstudies
Ghana’s programs
Intervention description U5NS (n=5) EBF (n=1) Anaemia (n=4)
Supplementation 2 0 2
Counseling/ Health promotion 1 1 0
Screening/Treatment Malaria 2 0 2
17. Key Messages
Most publications were conducted within health facilities
The majority of publications reported on the prevalence
and drivers of indicator categories, and very few report on
policy and programs
The majority of research studies report on under 5
nutritional status. Within this, the majority of studies
report on low birth weight and very few report on under 5
overweight
25% of the publications were conducted in Ghana
Notes de l'éditeur
Note: Only primary studies are included in the analysis (n=340)
23 reviews have been recorded for use at a later stage
Note:
Each bar in this graph includes publications that reports on one country only (eg. Ghana), as well as publications that report on multiple countries (Burkina Faso and Nigeria and Ghana). We include all of these because we want to capture all evidence that incorporates that specific country (eg. Ghana). This is why the total is greater than 340 (the number of publications included in this study) because they may be counted twice if it reports on more than 1 country.
There are 17 publications that report on more than 1 country
Key message: Ghana has the second largest share of publications (after Nigeria). Ghana represents 25% of publications in the West Africa region
Note: This graph includes publications that report on one specific focal country only (eg. Ghana), as well as publications that report on multiple countries, that include the focal country (eg. Burkina Faso, Nigeria and Ghana). We include all of these because we want to capture all evidence that incorporates each focal country
Key messages:
Overall the volume of literature has increased over the years, with a slight decline in 2016 within the focal countries.
Ghana has increased it’s volume of publications since 2010.
Note: This graph includes publications that report on Ghana only, as well as publications that report on multiple countries, that include Ghana (86 studies in total). We include all of these because we want to capture all evidence that incorporates Ghana
Key messages:
Most publications do not report the setting at abstract level (n=28). Of those that do, the majority were conducted within a health setting (hospital (n=27) and health facility (n=11)).
Other publications specified the geographic coverage of the study including national coverage (8 publications), district coverage (9 publications), and community (3 publications).
Note: This graph includes publications that were reporting only in Ghana, as well as studies that were reporting on multiple countries, that include Ghana (86 studies in total). We include all of these because we want to capture all evidence that incorporates Ghana
Key message:
The majority (67%) of studies reporting on Ghana are observational in design (cross-sectional studies, cohort, case-control) (n=58).
Experimental studies (Randomized control trial (RCT)) only account only for 9% (n=8).
The remaining are either not specified at abstract level or are of an alternative design
Majority of publications are towards the bottom of the evidence pyramid in terms of evidence quality
Note:
Each bar in this graph includes publications that report on one specific focal country only (eg Ghana), as well as publications that report on multiple countries, that include the focal country (eg. Ghana, Burkina Faso and Senegal). We include all of these because we want to capture all evidence that incorporates each focal country
Also, this graph includes publications reporting on one indicator category alone (Eg. EBF), as well as multi-indicator publications (eg. EBF and stunting). Therefore publications can be counted twice – Both in the EBF category and the stunting category. This is why the total for Senegal is higher than 86 (total number of publication reporting on Ghana).
Key Messages:
Most of the studies among the four focal countries report on U5 stunting, U5 wasting, LBW and Anaemia WRA.
In Ghana:
The majority of studies report on LBW (n=33) followed by U5 stunting (n=24), Anaemia WRA (n=20) and U5 wasting (n=18).
Ghana has more studies reporting on U5 stunting (n=24).
The least reported are U5 Overweight (n=4) followed by EBF (n=13)
Note: These pie charts includes publications that report on Ghana only, as well as publications that report on multiple countries, that include Ghana.
The left pie chart includes publications reporting on one indicator alone (Eg. EBF). Studies that report on more that one indicator have been brought together into the ‘more than 1 indicator’ category (n=21)
The right side pie chart includes studies that report on single indicators only (eg. Stunting). Studies reporting on more than one indicator (eg. Stunting and wasting) have not been included here.
U5NS = Under 5 nutritional status including: stunting, wasting, LBW, overweight
Key Messages:
The majority of publications report on U5NS (n=39), followed by Anaemia WRA (n=15), and EBF (n=11). There are 21 publications that report in more than 1 indicator.
Within U5SN, there is an uneven breakdown between studies. The majority of studies report on low birth weight (n=26), followed by U5 stunting (n=8) and very few report on overweight (n=2) or wasting (n=3).
Note:
These charts includes publications that report on Ghana only, as well as publications that report on multiple countries, that include Ghana. We include all of these because we want to capture all evidence that incorporates Ghana.
Also, this graph includes publications reporting on one indicator category alone (Eg. EBF), as well as multi-indicator publications (eg. EBF and stunting). Therefore publications can be counted twice – Both in the EBF category and the stunting category. This is why the total for Ghana is higher than 86 (total number of publications reporting on Ghana).
This graph includes publications reporting on one area of research only (eg. Policy) as well as multi-areas of research (eg. Policy and problem), therefore publications can be counted twice (when reporting for instance on two research areas, Problem and Program); and this is why the total number of publications on indicator category can be higher than the number of publications for that indicator category.
Key messages:
The majority of publications across all indicator categories in Ghana report on the problem (n=100) (in terms of prevalence and drivers), with fewer studies reporting on policy (n=10) or program (n=11).
There are no program studies for wasting and overweight and no policy studies for Anaemia WRA.
The most amount of program studies have been conducted on Anaemia WRA and LBW (n=4 each).
There is a clear research gap in terms of programs and policy across all indicators categories
Note:
For each country, we included publications that report on that specific focal country only (eg Ghana), as well as publications that report on multiple countries, that include the focal country (eg. Ghana, Burkina Faso and Senegal). We include all of these because we want to capture all evidence that incorporates each focal country
In the table we includes program studies reporting on one indicator category alone (Eg. EBF), as well as multi-indicator publications (eg. EBF and stunting). Therefore publications can be counted twice – Both in the EBF category and the U5NS category. This is why the total for Ghana is higher than 8 (total number of publications reporting on programs).
This table includes program studies reporting on one program type only (eg. Supplementation to address U5NS) as well as multi-program types (eg. Supplementation and counseling to address U5NS), therefore program studies can be counted twice (when reporting for instance on more than one type of program); and this is why the total number of program studies can be higher than the number of program studies for specific WHA indicator
Key Messages:
The majority of interventions focus on supplementation and screening/treatment malaria (n=4 each) to address U5NS related outcomes and Anaemia WRA. This is followed by counseling/health promotion interventions (n=2) to address U5NS and EBF.