Making ‘akitibogɛ’ unfashionable: Ghana’s nutrition story of change and challenge

By Richmond Aryeetey, University of Ghana

Growing up in the city of Accra, it was common to see young children who looked much smaller than their age mates. In fact, there was a nickname for such children: akitibogɛ. This literally means ‘small and fashionable’. It was not until I focused my research on child nutrition, that I realized those children were likely survivors of chronic undernutrition, otherwise known as stunted growth. Children who have experienced stunted growth, have a deficit in their height compared to well-nourished children of similar age. Even more important, stunting is not only a physical deficit. It is also an important pointer to other adverse outcomes of undernutrition, including cognitive and behavioral deficits that occur during childhood, as well as nutrition-related non-communicable diseases, such as diabetes.

Sadly, chronic undernutrition is very common around the world. Although there is evidence of the technology and resources needed to prevent child stunting, one in every five young children below five years are stunted. Stunting has, therefore, become a global development issue. The World Health Assembly has set a target to reduce, by 40%, the number of children under 5 years old who are stunted, by 2025. The Sustainable Development Goal two also has a target of significantly reducing stunting among young children.

As recently as 2008, Ghana was classified among the 36 countries with the highest burden of childhood stunting, by the Lancet series on maternal and child undernutrition. However, there has been a big sea change on this issue.. In 2008, an estimated 28% of children were stunted[1]. However, in 2017, the proportion of stunted children had declined to 19%[2]. On the other hand, there are unusually high rates (>60%) of childhood anemia, a condition in which the child does not have enough functional red blood cells. Although stunting and anemia share common drivers, over the same period, there has been significant reduction in stunting but not in anemia rates. From a program implementation perspective, this puzzle is important and warrants investigating to explain this seemingly divergent outcome.

In response to this, the Stories of Change in Nutrition study was started in Ghana between 2017 and 2019 as part of the Transform Nutrition West Africa initiative (TNWA). The methods and findings of the study have been summarized and presented in a research brief and presentation. In summary, the study used multiple data gathering approaches consistent with the Stories of Change in nutrition methodology to identify the key strands that explain why in Ghana, stunting declined but not anemia in the past decade. The study points to the key changes in policy, programs, capacity, leadership, and service coverage in Ghana during the period. These changes are categorized under three main themes:

1)Framing, generation, and communication of knowledge and evidence;
2) Political economy of stakeholders, ideas, and interests; and
3) Capacity and financial resources.

Within each of these themes, the stories of success or challenge have been highlighted. The findings of the Stories of Change in Nutrition study, provide the government of Ghana with empirical evidence to guide its decision making into the future. A future where there should be no akitibogɛ’s, or at worst, much fewer than today.

[1] GSS et al. 2009. Ghana Demographic and Health Survey 2008

[2] GSS et al. 2017. Multiple Indicator Cluster Survey, Ghana