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Ghana Systematic Map to guide decision-making on the current landscape of research on World Health Assembly indicators in West Africa
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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.
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Ghana Systematic Map to guide decision-making on the current landscape of research on World Health Assembly indicators in West Africa
- 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 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
- 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
- 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
- Results – Ghana
- Analysis General characteristics Characteristics of WHA indicators Characteristics of focus of research Results
- 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
- 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
- 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
- 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
- Analysis General characteristics Characteristics of WHA indicators Characteristics of focus of research Results
- Publications per indicator category grouping in focal countries 16 24 23 5 21 18 20 5 7 33 61 2 1 4 7 2 8 20 50 3 9 13 20 4 0 20 40 60 80 100 120 140 160 180 200 Burkina Faso Ghana Nigeria Senegal U5 Stunting U5 Wasting LBW U5 Overweight Anaemia WRA EBF
- Publications reporting on Ghana per indicator category 45% 13% 18% 24% Percent of publications per indicator category (n=86) U5NS EBF Anaemia WRA More than 1 WHA indicator 20% 8% 67% 5% Breakdown of publications within U5NS (n=137) U5 Stunting U5 Wasting LBW U5 Overweight
- Analysis General characteristics Characteristics of WHA indicators Characteristics of focus of research Results
- 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
- 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
- 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
Editor's Notes
- 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.
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