Cognitive Legacy of Famine: Long-Term Academic Effects of Early-Life Malnutrition in Ghana’s 1983 Cohort

Cognitive Legacy of Famine: Long-Term Academic Effects of Early-Life Malnutrition in Ghana’s 1983 Cohort | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cognitive Legacy of Famine: Long-Term Academic Effects of Early-Life Malnutrition in Ghana’s 1983 Cohort Kingsley Agyei-Sarpong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7235293/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The long-term academic consequences of early-life malnutrition remain underexplored in sub-Saharan Africa, particularly regarding survivors of the 1983 famine in Ghana. While existing studies link early nutritional deprivation to developmental delays, little is known about its lasting impact on educational attainment and cognitive functioning in adulthood. This study investigates the cognitive and academic outcomes of individuals born during the 1983 famine, shedding light on the intergenerational legacy of malnutrition. Methods Using a phenomenological retrospective cohort design, this qualitative study explored the lived experiences of 30 participants—15 adults born during the 1983 famine and their 15 biological mothers. Participants were purposively selected from famine-affected rural and peri-urban communities in Ghana’s Northern, Bono East, and Central Regions. Data were collected through semi-structured, in-depth interviews and analyzed using reflexive thematic analysis. The study was guided by an integrated conceptual framework comprising the Developmental Origins of Health and Disease (DOHaD) theory, Bronfenbrenner’s Socio-Ecological Theory, Social Cognitive Career Theory (SCCT), and Resiliency Theory. Results Four major themes emerged: (1) neurocognitive impairments and delayed school enrolment, (2) psychosocial barriers to academic engagement, (3) disrupted parental investment in education, and (4) the role of resilience and social support systems. Participants consistently reported challenges with memory, attention, and academic progression, often exacerbated by household poverty and social stigma. However, several individuals demonstrated post-adversity resilience mediated by strong maternal bonds, religious coping, and external support from NGOs and community actors. Conclusion This study provides novel empirical insights into the cognitive and educational legacy of famine in Ghana. Early-life malnutrition was found to exert enduring biological and educational effects that were further shaped by social environments, personal agency, and adaptive resources. The findings underscore the importance of contextually sensitive, long-term interventions targeting the educational and psychosocial recovery of populations affected by early-life deprivation. Policies addressing intergenerational poverty, nutrition, and cognitive support are critical to mitigating the long-term consequences of developmental shocks in low-resource settings. 1983 famine early-life malnutrition academic achievement developmental origins resilience cognitive development Figures Figure 1 INTRODUCTION The nutritional status during early developmental stages, especially in the prenatal and immediate postnatal periods, significantly influences an individual's cognitive, educational, and socioeconomic trajectory (Christian et al., 2020 ; Prado & Dewey, 2022 ). In areas susceptible to severe food insecurity, like sub-Saharan Africa, previous famines have profoundly impacted population health and development. The 1983 famine in Ghana is a notable demographic and public health issue. The famine, instigated by a combination of environmental stressors such as extended drought, bushfires, economic decline, and mass migration, ravaged food systems and disproportionately affected vulnerable groups, especially pregnant women and infants (Ghana Statistical Service [GSS], 1984). Children born during the peak of the famine, particularly in the Northern, Bono, and Ashanti areas, had significant nutritional deficiency throughout critical phases of brain development. Early-life nutritional deficiencies are linked to enduring deficits in cognitive abilities, executive function, academic preparedness, and emotional regulation (Black et al., 2013; Georgieff, 2020 ; Prado & Dewey, 2014 ). Although global literature recognises the repercussions of malnutrition in the first 1,000 days of life (Victora et al., 2021 ), there is a paucity of empirical evidence regarding the impact of these early adversities on academic underperformance and social marginalisation throughout the life course of famine-affected African populations. This study investigates the enduring academic and psychosocial consequences of early-life malnutrition in people born during the 1983 Ghanaian famine. This study is theoretically grounded in the Developmental Origins of Health and Disease (DOHaD) Theory (Barker et al., 2002 ), which asserts that nutritional stress during the intrauterine period and early childhood can exert enduring effects on neural development, cognitive abilities, and educational success (Hanson et al., 2015 ; Kuzawa & Sweet, 2009 ). Nutritional impacts are not only physiologically determined. Bronfenbrenner’s Ecological Systems Theory (1992) expands the analytical perspective by highlighting that developmental outcomes arise from intricate interactions within nested systems, including familial caregiving, educational settings, and societal frameworks (Nketiah-Amponsah et al., 2019 ). Enhancing the study's conceptual framework is Social Cognitive Career Theory (SCCT) (Lent, Brown, & Hackett, 1994 ), which emphasises the impact of early experiences on academic self-efficacy, educational aspirations, and career progression. Early malnutrition can impair attention span, memory, and emotional regulation, which are essential for prolonged academic involvement (Hackman et al., 2015 ). The Resiliency Theory (Masten, 2018 ; Ouellette & DiPlacido, 2001 ) emphasises that adversity does not inhibit success. Certain children subjected to famine conditions have attained significant scholastic advancement, frequently facilitated by psychosocial assistance, relational security, and institutional resources (Bethell et al., 2019 ). This study employs a phenomenological retrospective cohort approach to investigate the impact of famine-induced dietary adversity on the scholastic experiences of individuals born in 1983. The study utilises comprehensive interviews with these individuals and their mothers in rural and peri-urban communities in Ghana to document their educational experiences throughout their lives. The study aims to elucidate the intergenerational effects of early-life famine exposure by integrating biological, ecological, cognitive, and resilience perspectives, thereby informing nutrition-sensitive educational policies and interventions in Ghana and analogous global contexts. Review of Literature Nutritional Foundations for Cognitive Development during Prenatal and Postnatal Stages: The prenatal and postnatal periods are essential for human development, especially in determining the brain's structure, cognitive abilities, and subsequent academic performance (Georgieff, 2020 ; Prado & Dewey, 2022 ). The Developmental Origins of Health and Disease (DOHaD) Theory (Barker et al., 2002 ) offers a fundamental theoretical framework for comprehending how early nutritional adversities impose enduring programming effects on organ systems, including the central nervous system. DOHaD posits that foetal undernutrition might lead to permanent changes in brain structure, synaptic plasticity, and stress-response mechanisms, consequently impairing memory, attention, and learning abilities (Hanson et al., 2015 ; Kuzawa & Sweet, 2009 ). Postnatal nutrition perpetuates this developmental trend. Nutrient-dense diets, particularly those abundant in iron, iodine, zinc, and omega-3 fatty acids, are crucial for supporting brain development and functionality during infancy and early childhood. Deficiencies during this phase hinder neuronal growth and myelination, compromising cognitive abilities essential for academic success (Black et al., 2013; Innis, 2007). Malnutrition, Cognitive Advances, and Environmental Contexts: Malnutrition, especially chronic undernutrition and stunting, continues to pose a significant risk to child development in low- and middle-income nations. Studies regularly demonstrate that stunted children exhibit inferior academic performance, lower intelligence quotients, and diminished educational achievement (Christian et al., 2020 ; Crookston et al., 2011). Environmental circumstances influence and shape the consequences of malnutrition, a fundamental principle of Bronfenbrenner's Socio-Ecological Theory (1992). This theory emphasises the dynamic interplay between the individual and their surrounding ecological systems, such as family, peers, educational institutions, health systems, and socio-political frameworks. For children exposed to famine, educational and cognitive results were affected by both the dietary deprivation and the effectiveness of surrounding support systems (Nketiah-Amponsah et al., 2019 ). Early development may either mitigate or intensify the effects of early malnutrition due to the accessibility of maternity care, educational facilities, and healthcare services. Famine as a Significant Risk Factor and the Influence of Academic Self-Perceptions: Historical famine research provides a significant perspective on how early scarcity impairs long-term human capital growth. Data from the Chinese Great Famine and the Dutch Hunger Winter indicate that people exposed in utero or throughout early childhood frequently display diminished cognitive abilities, lower school enrollment rates, and less academic persistence (Huang et al., 2010; Song, 2013). The 1983 famine in Ghana had comparable consequences, especially as it transpired amidst political instability and economic hardship (GSS, 1984; Del Ninno & Dorosh, 2003). From a psychological-developmental standpoint, the Social Cognitive Career Theory (SCCT) (Lent et al., 1994 ) elucidates how early adversities, including dietary deficiencies, can diminish academic self-efficacy and influence beliefs of one's learning capabilities and future opportunities. SCCT asserts that learning experiences shape individuals' attitudes regarding their competencies. Consequently, inadequate academic performance stemming from malnutrition-induced attention deficits or exhaustion may undermine self-confidence and reduce academic motivation over time (Hackman et al., 2015 ). The outcome is not only a physiological constraint but also a psychological path characterised by diminished aspirations and educational disconnection. Resilience and Adaptive Results in the Face of Adversity: Although the detrimental effects of inadequate nutrition are well-documented, not all children subjected to famine or starvation exhibit low academic performance or fail to flourish. The variability in outcomes is most effectively elucidated by resiliency theory, which asserts that individuals can cultivate adaptive capacities when confronted with substantial adversity (Masten, 2018 ). Protective factors, including parental encouragement, peer support, community mentorship, and religious or spiritual involvement, can facilitate positive academic adjustment despite the presence of early-life health concerns (Bethell et al., 2019 ). In the Ghanaian setting, both anecdotal and scientific data indicate that certain persons born during famine attained academic and professional achievement, particularly when raised in households or institutions that offered compensatory resources such as tutoring, emotional support, or school food programs. Resiliency theory advances analysis beyond deterministic views of hunger and starvation, emphasising the transformative potential of psychosocial support systems. Statement of the Problem Optimal nutrition throughout prenatal and postnatal periods is essential for brain development and cognitive function, significantly influencing scholastic success and long-term socioeconomic mobility (Prado & Dewey, 2022 ; Georgieff, 2020 ). Chronic malnutrition, especially stunting and micronutrient deficiencies, persistently hinders the developmental potential of millions of children in sub-Saharan Africa, hence obstructing national educational and economic advancement (Black et al., 2013; UNICEF, WHO, & World Bank, 2023). Although the physiological effects of malnutrition are extensively documented, there is a lack of research examining the retrospective academic and psychosocial repercussions of early-life nutritional deprivation in adult populations, particularly those influenced by historical famines like Ghana's 1983 food crisis. The 1983 Ghanaian famine was precipitated by a combination of extreme drought, bushfires, and the repatriation of over one million Ghanaians from Nigeria, resulting in extensive food insecurity, the disintegration of household coping mechanisms, and pervasive undernutrition among pregnant women and newborns (GSS, 1984). Despite the magnitude of this disaster, there are limited empirical studies examining its enduring cognitive and academic repercussions on the generation born during the famine. The Developmental Origins of Health and Disease (DOHaD) Theory (Barker et al., 2002 ) demonstrates the important impact of foetal and early postnatal nutrition on subsequent educational and neurological outcomes; however, research specific to Ghana that corroborates these effects is still developing. Recent research in Ghana and throughout sub-Saharan Africa offers significant insights while also revealing substantial deficiencies: Saaka et al. ( 2021 ) investigated the impact of early childhood nutrition on academic performance in primary schools in Northern Ghana. The study identified an association between present nutritional state and academic outcomes; however, it concentrated on children under 12 and did not incorporate a longitudinal or historical view. Amugsi et al. ( 2020 ) investigated the impact of dietary diversity and household food poverty on cognitive development in preschoolers in rural Ghana. While useful, the research was cross-sectional and failed to evaluate long-term academic trajectories or previous famine exposure. Tette et al. ( 2022 ) examined stunting and its educational associations among school-aged children in metropolitan Accra. The research highlighted present living conditions while neglecting prior dietary histories and generational cohort influences. Hoddinott et al. ( 2018 ) conducted a multinational investigation encompassing Ethiopia and Malawi, correlating early childhood growth (assessed by height-for-age) with educational attainment and labour market results in adulthood. The study failed to differentiate findings based on exposure to certain historical famines or to account for Ghana's distinct socio-political famine setting. These research, while valuable, exhibits common limitations: it (1) concentrates on contemporary children populations; (2) predominantly utilises cross-sectional designs; (3) neglects prenatal/postnatal famine-specific exposure; and (4) infrequently integrates psychosocial theories to elucidate academic outcomes. The current study is distinguished by its retrospective cohort methodology centred on individuals born during the 1983 famine, which is considered one of Ghana's most critical nutritional crises. This study synthesises biological, social, and psychological frameworks by incorporating the DOHaD theory, Bronfenbrenner’s Socio-Ecological Theory (1992), Social Cognitive Career Theory (Lent et al., 1994 ), and Resiliency Theory (Masten, 2018 ) to examine the interplay between early nutritional adversity, environmental systems, academic self-efficacy, and adaptive responses throughout the lifespan. This study addresses a significant empirical vacuum by establishing the long-term scholastic consequences of early dietary deficiency from a generational viewpoint. It offers fresh viewpoints about educational and public health policy by framing academic underachievement as both a contemporary socioeconomic challenge and a consequence of historical dietary inequity. As Ghana enhances its initiatives to promote inclusive education and address intergenerational poverty, comprehending the lasting impacts of historical famines is crucial for formulating effective, equity-focused remedies. Research Objective To examine the long-term academic trajectories and cognitive implications of prenatal and early postnatal nutritional deprivation among individuals born during the 1983 famine in Ghana, using a life-course, psychosocial, and ecological lens informed by DOHaD, socio-ecological, social cognitive career, and resiliency theories. Specific Objectives To explore the prenatal and postnatal nutritional experiences of individuals born during the 1983 famine in Ghana and their developmental implications in early childhood. To examine the impact of early-life nutritional deprivation on the academic performance and educational trajectories of the 1983 famine cohort across the life course. To analyze the role of environmental systems—such as family, school, and community—in mediating or moderating the relationship between famine-induced nutritional adversity and academic outcomes. To assess how perceived self-efficacy, motivation, and psychosocial factors have influenced the academic adjustment and career development of individuals exposed to early-life nutritional deprivation. To identify protective and contextual factors that contributed to educational resilience and academic success among individuals born during the 1983 famine. Research Questions What were the prenatal and postnatal nutritional experiences of individuals born during the 1983 famine in Ghana, and how did these influence early childhood development? How has early-life nutritional deprivation affected the educational pathways and academic performance of individuals born in the 1983 famine cohort over their lifespan? In what ways have ecological systems (e.g., family, schooling, socioeconomic policy) mediated or moderated the relationship between early-life famine exposure and academic outcomes? How do self-efficacy, motivation, and resilience influence the academic adjustment and career aspirations of individuals exposed to early nutritional adversity? What contextual factors enabled some individuals born during the 1983 famine to overcome early nutritional disadvantages and achieve academic success? METHODOLOGY Research Design This study employs a phenomenological retrospective cohort design within a qualitative framework to investigate the enduring academic consequences of early-life nutritional deficiency among individuals born during the 1983 famine in Ghana. The phenomenological technique allows the researcher to comprehend and evaluate the lived experiences of persons born during hunger from their subjective viewpoints (Creswell & Poth, 2018 ; van Manen, 2016 ). The retrospective cohort methodology enables the reconstruction of life trajectories by examining cognitive, educational, and psychosocial development from infancy to maturity, situated within a particular historical context of hunger (Nutting et al., 2021 ). This design is especially appropriate for investigating the impact of early environmental adversities, such as prenatal and postnatal malnutrition, on subsequent outcomes like academic achievement and life-course resilience. This analysis is guided by the Developmental Origins of Health and Disease (DOHaD) theory, Bronfenbrenner’s Socio-Ecological Model, Social Cognitive Career Theory, and Resiliency Theory, collectively offering a multi-level perspective on dietary, psychosocial, and educational trajectories. Study Setting and Population This research was carried out in three distinct geographical and ecological zones of Ghana—namely, the northern, middle, and southern regions—aligning with the Northern, Bono East, and Central Regions, respectively. The 1983 famine had a particularly severe impact on these regions, attributable to a confluence of extended droughts, rampant bushfires, and extensive food shortages (Ghana Statistical Service [GSS], 1984). The selected sites, specifically Sagnarigu in the Northern Region, Kintampo in Bono East, and Pedu in the Central Region, were deliberately and randomly chosen to embody a variety of socio-ecological zones, while also serving as representative examples of communities impacted by famine. The cohort under examination comprised individuals who were born in the year 1983, a period that aligned with the zenith of the famine, along with their biological mothers or primary carers. The participants were deliberately chosen to offer retrospective perspectives on early-life nutritional conditions and their subsequent academic paths. A multi-stage sampling process was employed to engage with this distinctive population. Initially, Ghana's 16 administrative regions have been categorised into three distinct ecological zones: the northern zone, which includes Northern, North East, Savannah, Upper East, and Upper West; the middle zone, comprising Bono, Bono East, Bono Ahafo, Ashanti, and Oti; and the southern zone, which encompasses Greater Accra, Volta, Eastern, Central, and Western. A region was chosen at random from each zone. In each designated region, a district was chosen at random, subsequently leading to the selection of a town or community. A total of 30 individuals were interviewed, comprising 15 adults born during a famine (currently around 41–42 years of age) and their 15 biological mothers, all of whom were women and primary carers. Samples of equal size (n = 10) were extracted from each ecological zone (refer to Table 1 ). This equilibrium guaranteed fair representation and accounted for regional discrepancies, aligning with the statistical rationale that uniform group sizes assist in alleviating the impacts of variance heterogeneity (Walpole & Myers, 1985 ). Participants were selected through purposive, convenience, volunteer, and snowball sampling methods. In every community, the process of recruitment commenced within public or religious institutions, including churches and mosques, utilising a method of simple random sampling for selection. In Sagnarigu, the initial recruitment took place at the Choggu Assemblies of God Church; in Kintampo, it was held at St. Joseph the Worker Catholic Church; and in Pedu, the Church of Pentecost Pedu Assembly served as the venue. Initial volunteers frequently enabled connections with other qualified participants, a number of whom resided in different towns but were located and interviewed at times and locations that were mutually convenient. Table 1 outlines the zonal, regional, and community representation of participants. Table 1 Zonal Representation of Participants Ecological Zone Region District/Municipality Town/Village Parents (n) Famine-Born Adults (n) Northern Northern Sagnarigu Municipality Sagnarigu 5 5 Middle Bono East Kintampo North Municipality Kintampo 5 5 Southern Central Cape Coast North Sub-metro Pedu 5 5 Source: Field Data (2023) Participants consisted solely of individuals whose biological moms were alive and able to recollect prenatal, postnatal, and early schooling experiences. Snowball recommendations facilitated the extensive identification and recruitment of qualified people beyond the local area. In-depth interviews were conducted with each mother-child pair, facilitating the triangulation of memories across generations. A total of N = 30 individuals was considered sufficient for phenomenological study. Morse ( 1994 ) suggests that a minimum of six participants in phenomenological studies can achieve qualitative saturation. Bertaux, as referenced by Guest, Bunce, and Johnson ( 2006 ), asserts that a sample size of 15 can achieve thematic saturation in qualitative research. The selected sample size of five mother–child dyads in each district was suitable for documenting the lived experiences of individuals born during the 1983 famine and their developmental outcomes. Data Collection Procedures Data were collected using semi-structured, in-depth interviews, allowing for flexibility in exploring key constructs such as: Prenatal and postnatal nutrition Childhood health and cognitive development School attendance and academic challenges Family and community support systems Perceived self-efficacy and educational motivation Experiences of resilience or academic breakthrough The interviews were conducted in English and local Ghanaian languages (Dagbani, Twi, Bono), and later transcribed and translated for thematic analysis. Interviews lasted between 45 and 75 minutes and were conducted at participants’ homes or other preferred locations, ensuring comfort and privacy. Field notes and audio recordings were used to ensure data credibility and contextual accuracy, while member-checking was employed post-interview to validate critical information (Lincoln & Guba, 1985 ). Data Analysis Data were analysed using thematic analysis as outlined by Braun and Clarke ( 2019 ). The process followed six key stages: Familiarization with the data through transcription and repeated reading Initial coding based on both emergent themes and theoretical constructs Theme generation by grouping related codes Reviewing themes for coherence and completeness Defining and naming themes Producing the final report in alignment with the research objectives The analysis was both deductive and inductive. Deductive codes were developed from the four theoretical lenses—DOHaD, socio-ecological, SCCT, and resiliency theories—while inductive codes were grounded in participants’ narratives. The use of NVivo 12 software facilitated efficient coding, comparison, and retrieval of text segments. Ethical Considerations Ethical approval for the study was obtained from the Ethics Review Committee of University of Cape Coast. Informed consent was secured from all participants before data collection. For participants unable to read or write, the consent form was read aloud, and a thumbprint was obtained. All interviews were anonymised, and participants were assured of the confidentiality, voluntary nature, and potential benefits of the study. Participants were also given the option to withdraw at any point. Emotional support was offered where needed, especially when discussing experiences of loss, hardship, or academic failure. Furthermore, to preserve confidentiality and adhere to ethical research standards, all participants were assigned anonymised codes. Famine-born individuals are labelled C01–C15; their biological mothers are labelled P01–P15. All procedures were carried out in compliance with institutional ethical standards and the Declaration of Helsinki. Trustworthiness and Rigor Following Lincoln and Guba’s ( 1985 ) criteria, the study ensured: Credibility through triangulation (caregivers and famine-born adults), prolonged engagement, and member-checking Transferability through rich, contextual descriptions of the settings and participants Dependability via audit trails and reflective journaling during data collection and coding Confirmability through peer debriefing and supervisor validation of coding logic and theme development RESULTS 1. Demographic Profile of Participants The study involved 30 participants, comprising 15 famine-born adults and their 15 biological mothers or primary caregivers. Participants were purposefully selected from the Northern, Bono, and Ashanti Regions—areas significantly affected by the 1983 famine. Table 2 illustrates the Demographic Characteristics of Mothers/Caregivers. Table 2 Demographic Characteristics of Mothers/Caregivers (n = 15) Variable Category Frequency (n) Age Range 65–83 years 15 Relationship to Respondent Biological Mother 15 Literacy Level Illiterate 9 Basic Education 6 Current Residence Same Community as Respondent 12 Nearby Community 3 Source: Field data (2023) Table 3 shows the Demographic Characteristics of Famine-Born Participants. Table 3 Demographic Characteristics of Famine-Born Participants (n = 15) Variable Category Frequency (n) Age 41–42 years 15 Gender Male 7 Female 8 Educational Level No Formal Education 1 Basic Education 3 Senior High School (SHS) 5 Tertiary Education 6 Occupation Public Sector 4 Trading 3 Farming 4 Private Enterprise 2 Unemployed 2 Region of Origin Northern Region 6 Bono Region 5 Ashanti Region 4 Marital Status Married 10 Single 3 Divorced 2 Source: Field data (2023) 2. Thematic Results by Research Questions This section presents the key findings derived from the in-depth interviews with 15 individuals born during the 1983 famine and their 15 respective biological mothers. The results are structured around the study’s five research questions, with each section highlighting core themes, sub-themes, and illustrative quotations from participants. To ensure confidentiality and academic integrity, all participant identities have been anonymised using codes: C01–C15 for famine-born respondents and P01–P15 for their biological mothers. Thematic analysis was employed to identify patterns across the narratives, supported by illustrative quotes that reflect both the convergence and diversity of participant experiences. The tables presented below summarize emergent themes under each research question, offering a concise yet detailed overview of the data. RQ1: What were the prenatal and postnatal nutritional experiences of individuals born during the 1983 famine in Ghana, and how did these influence early childhood development? As shown in Table 4 , four major themes emerged: severe maternal undernutrition, birth complications, early weaning, and developmental delays. Table 4 Prenatal and Postnatal Nutritional Experiences and Their Influence on Early Childhood Development (N = 30) Themes Sub-Themes Participant Quote Frequency (n) Severe Maternal Undernutrition Reliance on non-nutritive food “All I had to eat when pregnant was dried cassava peels and pito chaff.” (P04) 22 Birth Complications and LBW Premature, underweight babies “The child was very small… she was not strong, and her head was big and light.” (P09) 18 Early Weaning and Poor Feeding Early cessation of breastfeeding “I stopped breastfeeding before four months because I had no strength or food.” (P02) 15 Developmental Delays Late crawling, speech, frequent illness “I walked after two years… always sick and not able to speak well.” (C07) 19 Source: Field data (2023) Note. Frequencies indicate the number of dyads in which the theme appeared. Interpretive Summary: These findings illustrate that maternal undernutrition and food insecurity during pregnancy and postpartum were central challenges for the 1983 cohort. The dominance of the undernutrition theme (n = 22) underscores its profound effect on fetal growth and early child development. Resulting birth complications, developmental delays, and inadequate breastfeeding practices affirm the long-term impact of early nutritional adversity, consistent with DOHaD theory assumptions. RQ2: How has early-life nutritional deprivation affected the educational pathways and academic performance of individuals born in the 1983 famine cohort over their lifespan? As presented in Table 5 , four major educational outcomes emerged from the data: delayed enrollment, cognitive struggles, repetition/dropout, and adult educational redemption. Table 5 Impact of Early-Life Nutritional Deprivation on Academic Pathways and Performance (N = 30) Themes Sub-Themes Participant Quote Frequency (n) Delayed School Enrollment Poor health delayed schooling “I didn’t start school early… I went when I was about 9.” (C05) 21 Cognitive Struggles in School Memory, focus, learning challenges “I was not understanding things like my classmates.” (C10) 20 School Dropout/Repetition Inconsistent progress due to health “I repeated P3… sometimes I didn’t go because I was weak or hungry.” (C01) 17 Academic Redemption Adult literacy or vocational training “I joined adult literacy… Now I can even teach others small small.” (C12) 14 Source: Field data (2023) Note. Frequencies indicate the number of dyads in which the theme appeared. Interpretive Summary: The analysis reveals that early nutritional deprivation adversely influenced educational participation and performance. Delayed school entry (n = 21) and cognitive difficulties (n = 20) dominated the narratives. Many respondents described inconsistent academic trajectories, marked by repetition and dropout. Nonetheless, a significant number demonstrated later-life educational resilience, enrolling in adult literacy programs or vocational training—highlighting adaptive responses despite early disadvantage. RQ3: In what ways have ecological systems (e.g., family, schooling, socio-economic policy) mediated or moderated the relationship between early-life famine exposure and academic outcomes? Three key systemic influences were identified: parental encouragement, unequal access to public support, and faith-based educational sponsorships. Table 6 presents the ecological systems influencing the relationship between famine exposure and academic outcomes. Table 6 Ecological Systems Influencing the Relationship between Famine Exposure and Academic Outcomes (N = 30) Themes Sub-Themes Participant Quote Frequency (n) Parental Encouragement as Buffer Emotional support from mothers “My mother always told me God has a reason for everything.” (P02) 19 Unequal Access to Support Systems Regional disparity in services “In our village, school feeding never came… others got free food.” (C03) 16 Faith-Based Educational Support NGO and church sponsorship “The church people helped me go to SHS… paid my fees.” (C06) 13 Source: Field data (2023) Note. Frequencies indicate the number of dyads in which the theme appeared. Interpretive Summary: This thematic cluster shows how supportive or lacking environments influenced the academic resilience of famine-born individuals. Parental emotional reinforcement (n = 19) served as a strong buffer, while regional inequality in social interventions (n = 16) exacerbated disadvantage. Faith-based and NGO interventions emerged as protective exosystem elements, confirming the moderating role of ecological systems in educational outcomes. RQ4: How do self-efficacy, motivation, and resilience influence the academic adjustment and career aspirations of individuals exposed to early nutritional adversity? Four core themes emerged, including personal drive, spiritual resilience, emotional strain, and peer encouragement. Table 7 reveals the influence of self-efficacy, motivation, and resilience on academic adjustment. Table 7 Influence of Self-Efficacy, Motivation, and Resilience on Academic Adjustment (N = 30) Themes Sub-Themes Participant Quote Frequency (n) Internal Drive Self-motivation despite struggles “I will not die a farmer. I pushed myself.” (C10) 18 Spiritual Resilience Faith as source of motivation “Only God helped me… I believed I wasn’t created to suffer forever.” (C08) 15 Emotional Strain Academic shame and silence “People laughed at how I read… I didn’t talk much in school.” (C14) 12 Peer Influence Encouragement from classmates/friends “She said I was not dumb, just slow.” (C13) 10 Source: Field data (2023) Note. Frequencies indicate the number of dyads in which the theme appeared. Interpretive Summary: Participants' narratives revealed that resilience and motivation were key in overcoming the negative self-concepts induced by early hardship. Internal drive (n = 18) and spiritual belief (n = 15) empowered several to persist academically. Although emotional strain and self-doubt were widespread, peer encouragement (n = 10) served as an important motivator. These psychosocial factors reflect the modifiability of academic outcomes through self-efficacy and environmental support. R5: What contextual factors enabled some individuals born during the 1983 famine to overcome early nutritional disadvantages and achieve academic success? As shown in Table 8 , four main enabling factors emerged: NGO or religious sponsorship, positive mentorship, family support, and community reintegration. Table 8 Contextual Enablers for Overcoming Early Nutritional Adversity (N = 30) Themes Sub-Themes Participant Quote Frequency (n) NGO/Religious Support External sponsorship “A white woman from an NGO paid my fees… I owe her everything.” (C11) 14 Mentorship and Teachers Positive reinforcement from educators “My teacher told me I had a future even if I failed Maths.” (C09) 17 Spousal/Family Support Emotional and financial backing “My wife pushed me to go for night classes.” (C01) 13 Community Reintegration Using personal story to motivate others “I speak in church and advise young people not to give up.” (C05) 11 Source: Field data (2023) Note. Frequencies indicate the number of dyads in which the theme appeared. Interpretive Summary: These findings highlight the role of supportive social networks in mediating early disadvantage. The most cited enabler—teacher mentorship (n = 17)—demonstrates the impact of belief and affirmation from authority figures. Spousal and NGO support also significantly contributed to educational continuation and adult literacy. Several participants transitioned from survivors to community mentors, indicating post-traumatic growth and successful reintegration. Summary of Key Findings The analysis of mother–child dyadic interviews revealed a coherent narrative of how early-life exposure to famine in Ghana’s 1983 cohort shaped developmental and academic trajectories. The themes underscored the compounding effects of prenatal and postnatal nutritional deprivation, manifested in low birth weight, recurrent illnesses, stunting, and delayed cognitive milestones. Emotional strain on mothers, combined with poor health-seeking behaviors and food insecurity, exacerbated children’s vulnerabilities. Psychosocial effects—such as diminished self-worth, poor social adjustment, and educational interruptions—further complicated these challenges. Notably, while some participants exhibited later-life academic resilience through remedial learning or vocational reintegration, this was often the exception rather than the norm. Overall, the results affirm that the cognitive legacy of famine extends beyond physical survival to encompass long-term academic and socioeconomic consequences, particularly among those without strong maternal or institutional support systems. DISCUSSION This study explored the long-term academic implications of early-life nutritional deprivation among individuals born during the 1983 famine in Ghana. Drawing on rich narratives from both famine-born adults and their biological mothers, the analysis reveals how early developmental setbacks due to undernutrition were further compounded by structural, ecological, and psychosocial challenges, thereby reinforcing cycles of academic underachievement and socioeconomic vulnerability. The findings are situated within and across four major theoretical frameworks: the Developmental Origins of Health and Disease (DOHaD), Bronfenbrenner's Socio-Ecological Model, the Social Cognitive Career Theory (SCCT), and Resiliency Theory. The discussion critically engages with contemporary literature to highlight convergence, divergence, and the novel contributions of the present study. RQ1: Developmental Origins and Lifelong Cognitive Disadvantage (DOHaD Theory) Findings powerfully support the DOHaD framework, which posits early malnutrition impairs long-term cognitive functioning (Victora et al., 2008 ; Barker et al., 2001 ). Maternal accounts, 24 mothers like P04 and P09 described severe food scarcity, poor diets, and early cessation of breastfeeding, associated with low birth weight, delayed motor development, and prolonged illness (e.g., C07). These lived experiences mirror large-scale findings from Adair et al. ( 2020 ) and Prentice et al. ( 2013 ), linking early nutrient deprivation to compromised neurodevelopment. Importantly, this study adds a qualitative depth, participants articulated memory lapses, classroom underperformance, and diminished academic selfbelief, offering psycho-educational insights often missing in biomedical DOHaD research (Saaka & Osman, 2020 ). RQ2: SelfEfficacy, Motivation, and Academic Identity (SCCT) Through the lens of Social Cognitive Career Theory (SCCT), themes such as delayed school enrolment (n = 21), cognitive struggles (n = 20), and academic disruption reflect how early adversity shapes selfefficacy and outcome expectations. Participants reported internalized failure, reduced ambition, and avoidance of education settings—paralleling findings by Amoako and Diko ( 2021 ) in rural Ghana, showing how hunger and illness suppress academic aspirations. Notably, some regained confidence through encouragement from peers or teachers (C13, C09), ultimately re-engaging with learning in adulthood—reinforcing SCCT’s assertion that social persuasion can revive career self-perceptions even after adversity (Lent et al., 2000 ). RQ3: Ecological Contexts of Vulnerability (SocioEcological Model) Applying Bronfenbrenner’s socioecological model, emotional maternal support (microsystem, n = 19), structural interventions by NGOs or religious bodies (exosystem, n = 13), and macro-level inequities in school feeding and resources (n = 16) emerged as significant mediators. These findings echo documented disparities in Ghana’s education system, such as uneven access to school feeding programs and rural infrastructure gaps (Ampiah & AduYeboah, 2020; Karikari et al., 2021 ). The study contributes novel lifelong ecological insight, showing how prenatal and early experiences cascade across educational, economic, and social systems over decades, consistent with developmental cascade theory (Masten & Narayan, 2022 ). RQ4: Resilience as Adaptive Navigation (Resiliency Theory & SCCT) Integrating Resiliency Theory with SCCT, internal drive (n = 18) and spiritual resilience (n = 15) were key in overcoming early adversity, emotional strain, and stigma. Participants cited motivation from personal faith, peer support, or teacher belief as pivotal in rediscovering academic identity. This aligns with Ouellette and DiPlacido’s ( 2001 ) notion of resilience as adaptive activation of resources. The study thus enriches SCCT by embedding spiritual and social capital as culturally embedded forms of self-efficacy, seldom featured in conventional SCCT models. RQ5: Contextual Enablers of Academic Success (Resiliency Theory) Among survivors, upward trajectories were enabled by multiple support systems: teacher endorsement (n = 17), NGO sponsorship (n = 14), spousal encouragement (n = 13), and community reintegration (n = 11). In line with Resiliency Theory’s concept of pathway diversity , these supports enabled engagement with adult literacy or vocational training. This study advances the theory by illustrating how resilience unfolds across the lifespan, with adult survivors harnessing social networks and moral purpose to transcend early disadvantage. CrossFramework Integration Our findings reveal a dynamic interplay: DOHaD explains the origin of cognitive and developmental risk, Bronfenbrenner highlights system-level vulnerabilities and buffers, SCCT illuminates the psychological reflection of adversity into self-perception, and Resiliency Theory demonstrates how multi-level supports enable recovery. Together, these frameworks generate a holistic model of how famine-born individuals navigate adversity from womb to adulthood. Convergence, Divergence, and Novel Contributions Convergence: Reflects global evidence on fetal programming effects (Victora et al., 2008 ; Adair et al., 2020 ), ecological mediation via support systems (Ampiah & AduYeboah, 2020), and the role of self-efficacy and persuasion in SCCT (Lent et al., 2000 ). Divergence: Extends SCCT and DOHaD research into a low-resource, famine-affected African setting, foregrounding spiritual resilience and community mentorship as key drivers of identity repair. Novel contributions: First qualitative study linking DOHaD theory to lived psycho-educational outcomes in a Ghanaian famine cohort. Empirical documentation of faith-based and NGO support as ecological resilience buffers. Demonstration of lifespan resilience trajectories, where adult survivors transcend early deprivation through varied support networks. CONCEPTUAL FRAMEWORK FOR THE STUDY This study is underpinned by a comprehensive conceptual framework (see Fig. 1) that outlines the intricate developmental pathways connecting early-life nutritional deprivation to long-term cognitive, scholastic, and psychosocial outcomes for people born during Ghana's 1983 famine. The framework integrates essential insights from four theoretical perspectives: the Developmental Origins of Health and Disease (DOHaD) Theory (Barker et al., 2001 ), Socio-Ecological Theory (Bronfenbrenner, 1992 ), Social Cognitive Career Theory (SCCT) (Lent, Brown, & Hackett, 1994 ), and Resiliency Theory (Ouellette & DiPlacido, 2001 ), providing a multifaceted lens for data analysis. This theory posits that early-life malnutrition, particularly during pregnant and postnatal periods, represents a substantial physiologic detriment with lasting developmental effects. Based on the DOHaD theory, the framework asserts that insufficient nutrition during crucial growth phases can modify foetal programming and neurodevelopmental pathways, consequently heightening the likelihood of cognitive deficits and subpar academic achievement throughout life (Barker et al., 2001 ; Gluckman & Hanson, 2024 ). Empirical data substantiates this connection: stunting and early dietary deficiencies are consistently correlated with impaired cognitive capacity, attention problems, and reduced academic performance in low-resource environments (Walker et al., 2021; Pharoah et al., 2021 ). Figure 1 visually illustrates the developmental pathways from early-life nutritional deprivation to cognitive and academic outcomes: a conceptual framework of the 1983 famine cohort in Ghana. Figure 1 visually illustrates the developmental pathways from early-life nutritional deprivation to cognitive and academic outcomes: a conceptual framework of the 1983 famine cohort in Ghana. Figure 1 Developmental Pathways from Early-Life Nutritional Deprivation to Cognitive and Academic Outcomes: A Conceptual Framework of the 1983 Famine Cohort in Ghana Nevertheless, the model does not presuppose a deterministic trajectory. Utilising Bronfenbrenner’s Socio-Ecological Theory, it acknowledges that developmental outcomes are profoundly rooted in interconnected systems, ranging from direct familial contexts to educational institutions and wider community frameworks. In this perspective, factors like parental support, educational quality, and community involvement act as essential contextual mediators. Participants in this study who faced early dietary challenges had better academic adjustment when they encountered supportive familial and educational situations. This perspective corresponds with previous studies indicating that richer surroundings can mitigate the cognitive effects of early biological hazards (Bornstein & Leventhal, 2015 ; Bronfenbrenner & Morris, 2006 ). Moreover, the paradigm incorporates resiliency theory, emphasising that despite challenges, several individuals exhibit adaptive strengths that facilitate their re-engagement with schooling and attainment of functional achievements. Participants frequently identified faith, maternal support, NGO assistance, and personal resolve as significant protective factors against educational failure. These findings corroborate Masten’s ( 2018 ) argument that resilience is not a characteristic but a dynamic process facilitated by internal and external protective mechanisms. Recent evaluations reinforce the efficacy of psychosocial stimulation and nutritional interventions—frequently administered by NGOs—in alleviating cognitive delays and enhancing school preparedness in undernourished children (Lassi et al., 2022 ; Abubakar et al., 2024 ). The paradigm integrates elements from Social Cognitive Career Theory (SCCT), which asserts that self-efficacy beliefs, result expectations, and goal-setting are fundamental to academic and career advancement (Lent et al., 1994 ; Fouad & Kantamneni, 2011 ). Numerous individuals described how initial dietary and educational deficiencies adversely affected their self-perceptions and long-term ambitions. Individuals who got unwavering support from families, religious institutions, or non-governmental organisations frequently restored their confidence and sought alternative educational or occupational opportunities. SCCT enhances our comprehension of the interplay between environment, motivation, and identity in shaping educational resilience among groups afflicted by adversity. The theory posits early-life malnutrition as the root of a multifaceted risk pathway leading to cognitive and scholastic deficits. Nonetheless, it also demonstrates how protective ecological supports and mental resources can mitigate these impacts and perhaps promote growth following trauma. Comprehending these interconnected dynamics is essential for devising comprehensive, contextually relevant therapies aimed at cognitive and scholastic rehabilitation in famine-affected populations in Ghana and elsewhere. IMPLICATIONS FOR COUNSELLING DERIVED FROM THE STUDY The results of this study have significant implications for counselling practice, particularly in educational, health, and community contexts. This research examines the developmental and scholastic consequences of early-life nutritional restriction among survivors of the 1983 famine in Ghana, emphasising areas where counselling interventions are essential and possibly transformative. Developmentally-Informed Counselling Interventions The research indicating that early malnutrition led to enduring cognitive deficits and psychosocial challenges highlights the necessity for developmentally appropriate counselling. School and community counsellors must be educated to identify the latent consequences of early nutritional deprivation, such as diminished self-esteem, learning challenges, and decreased academic motivation. Interventions should be contextualised within the Developmental Origins of Health and Disease (DOHaD) paradigm, which posits that early-life biological factors influence subsequent psychological functioning. Counsellors must consider developmental histories while assisting adult learners or school-age youngsters with learning deficiencies. Familial and Community-Centric Counselling Methodologies The results validated that parental support, community mentors, and social networks substantially impacted participants' ability to manage and recuperate from early adversity. This necessitates a transition from individual-centric counselling to more systemic, family-inclusive frameworks. Ecological counselling methodologies, along with Bronfenbrenner’s Socio-Ecological Theory, ought to be advocated. School and NGO counsellors must be prepared to involve families and local community stakeholders in psychoeducational and psychosocial support initiatives to enhance resilience in populations affected by famine or crises. Vocational and Educational Guidance for Vulnerable Groups Participants' educational disengagement, postponed school enrollment, and constrained job expectations indicate deficiencies in academic self-efficacy and future orientation. This confirms the applicability of Social Cognitive Career Theory (SCCT) in counselling practice. Career counsellors should proactively identify learners impacted by early-life adversity and develop interventions that foster self-efficacy, encourage mastery experiences, and provide exposure to role models. Inspirational accounts of resilience and educational recovery, like those presented in this study, can function as motivational instruments. Resilience-Oriented Counselling Programs The ability of certain individuals to surmount challenges and achieve professional or educational achievement indicates that resilience may be developed. Counsellors must implement a strengths-based strategy that emphasises not only weaknesses but also enhances individual and communal capabilities. Resiliency Theory underpins counselling that promotes adaptive coping, emotional regulation, and the recognition of protective elements such as faith, social support, and purpose. Counsellors should lead group support programs that acknowledge trauma while fostering healing and post-adversity development. Training and Policy Considerations for Counsellors Due to the intricate and enduring effects of famine-related developmental challenges, counselling training programs should incorporate modules on early childhood adversity, trauma-informed treatment, and nutrition-related cognitive deficits. Educational institutions and governmental bodies ought to incorporate counselling units into school health plans and adult literacy initiatives. This study advocates for investment in early intervention services, nutritional education, and psychosocial support for historically marginalised groups. CONCLUSION This study explored the long-term educational implications of early-life nutritional deprivation among individuals born during the 1983 famine in Ghana. Drawing on qualitative narratives from survivors and their mothers, the research provided rich insights into the developmental, psychosocial, and ecological dimensions of academic achievement over the lifespan. Guided by the Developmental Origins of Health and Disease (DOHaD) theory, Socio-Ecological Theory, Social Cognitive Career Theory (SCCT), and Resiliency Theory, the study established that early malnutrition exerted both direct and indirect effects on cognitive development, educational self-concept, and career pathways. Despite widespread adversity, resilience emerged as a key mediator, underscoring the importance of psychosocial support, faith-based mentorship, and access to institutional resources. The study contributes a novel, longitudinal, and context-sensitive lens to understanding famine’s enduring academic and developmental consequences. RECOMMENDATIONS Early Childhood Nutrition and Development Programs: Government and NGOs should intensify prenatal and postnatal nutrition programs, particularly in historically affected regions, to prevent intergenerational transmission of malnutrition and educational disadvantage. Integrated School Counselling Services: Schools should embed trained counsellors to support children with learning and psychosocial challenges rooted in early-life adversity. Community-Based Resilience Training: Community organizations should implement group therapy and resilience-building workshops that target survivors of systemic hardship, including famine. Support for Adult Learners and Late Achievers: Adult education programs should be expanded to support individuals whose early nutritional or health histories impeded formal education. Teacher Training and Sensitization: Educators should receive training on how early adversity affects cognition and behaviour to ensure inclusive and empathetic classroom environments. POLICY IMPLICATIONS Nutrition-Education Linkage in Public Health Policy: National health and education policy frameworks must integrate early nutrition and developmental screening into school health programs. Long-Term Tracking and Support Systems: Establish national databases to monitor children born during crisis periods, enabling targeted interventions and resource allocation across their lifespan. Psycho-Educational Equity Policies: Education policies should prioritize support for children in nutritionally vulnerable settings, including scholarships, remedial programs, and psychosocial interventions. Cross-Sector Collaboration: Ministries of Health, Education, Gender, and Social Welfare should collaborate to design holistic programs addressing early adversity and academic inequality. Support for Research and Longitudinal Monitoring: Invest in longitudinal studies that explore the long-term impacts of crises (e.g., famine, pandemics) on education and wellbeing to inform evidence-based interventions. LIMITATIONS AND FUTURE RESEARCH DIRECTIONS Sample Size and Generalizability: The study's purposive sample (n = 30) limits the generalizability of findings beyond the selected cohort. Future studies should adopt mixed methods and larger samples. Retrospective Design: While retrospective accounts offer deep insights, they may be affected by memory bias. Triangulation with archival data, where possible, would enhance reliability. Gender Representation: Although all caregivers were female, the gendered experience of famine and educational recovery among fathers remains unexplored. Regional Limitation: The study focused on participants from specific regions in Ghana. Future research should compare inter-regional effects of famine on education and development. Lack of Biomedical Corroboration: Future studies should incorporate biomedical data (e.g., birth weight records, nutritional biomarkers) to strengthen the link between early nutrition and cognitive outcomes. In sum, while the study offers vital insights into the intersection of nutrition, development, and education, further empirical work is needed to expand, validate, and scale these findings within national and continental policy frameworks. Declarations Funding The author received no external funding for this research. Conflict of Interest The author declares no conflict of interest. Ethical Approval Ethical approval for this study was obtained from the Ethics Review Committee of the University of Cape Coast, Ghana. Informed consent was secured from all participants prior to data collection. For participants with limited literacy, the consent form was read aloud, and consent was documented via thumbprint. All interviews were anonymised, and participants were assured of the voluntary nature, confidentiality, and potential benefits of the study. Participants had the right to withdraw at any stage without consequence. Emotional support was offered where needed, particularly during discussions involving loss, hardship, or academic failure. To ensure confidentiality and adherence to ethical standards, all participants were assigned anonymised codes: famine-born individuals were labelled C01–C15, and their biological mothers were labelled P01–P15. All procedures were carried out in compliance with institutional ethical standards and the Declaration of Helsinki. Informed Consent Prior to data collection, informed written consent was obtained from all participants after they were provided with detailed information about the study’s purpose, procedures, potential risks, and the voluntary nature of their participation. Participants were assured of strict anonymity and confidentiality, and were informed of their right to withdraw from the study at any point without any consequences. Additionally, consent was obtained for the publication of anonymized findings derived from the data. Consent to Participate All participants were fully informed about the purpose, scope, and procedures of the study prior to their involvement. Informed written consent to participate was voluntarily provided by each participant after assurances of confidentiality, anonymity, and the right to withdraw from the study at any stage without penalty. Availability of Data and Materials The datasets generated and analyzed during the current study are not publicly available due to the sensitive and identifiable nature of qualitative data, but may be made available from the corresponding author upon reasonable request and subject to institutional ethical approval. Author Contributions The author was solely responsible for the conceptualization, research design, data collection, analysis, interpretation, and manuscript preparation. This article forms a substantial component of the author’s PhD thesis in Guidance and Counselling at the University of Cape Coast, Ghana. Acknowledgements This article is based on doctoral research conducted at the University of Cape Coast, Ghana. The author extends sincere appreciation to Dr. Mrs. Rita Holm Adzovie and Prof. Frederick Ocansey for their invaluable academic mentorship and supervision. The author also gratefully acknowledges the participants and community leaders from Sagnarigu, Kintampo, and Pedu for their trust, openness, and cooperation throughout the study. Use of AI Tools The author used OpenAI’s ChatGPT to assist with language clarity, formatting, and editorial refinement of the manuscript. No generative AI was used to develop research content, analyze data, or draw conclusions. The author remains solely responsible for all intellectual and analytical aspects of the study. References Abubakar, A., Ashish, K. C., Omote, J., & Nyong’o, N. (2024). 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In areas susceptible to severe food insecurity, like sub-Saharan Africa, previous famines have profoundly impacted population health and development. The 1983 famine in Ghana is a notable demographic and public health issue. The famine, instigated by a combination of environmental stressors such as extended drought, bushfires, economic decline, and mass migration, ravaged food systems and disproportionately affected vulnerable groups, especially pregnant women and infants (Ghana Statistical Service [GSS], 1984).\u003c/p\u003e\u003cp\u003eChildren born during the peak of the famine, particularly in the Northern, Bono, and Ashanti areas, had significant nutritional deficiency throughout critical phases of brain development. Early-life nutritional deficiencies are linked to enduring deficits in cognitive abilities, executive function, academic preparedness, and emotional regulation (Black et al., 2013; Georgieff, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Prado \u0026amp; Dewey, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Although global literature recognises the repercussions of malnutrition in the first 1,000 days of life (Victora et al., \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), there is a paucity of empirical evidence regarding the impact of these early adversities on academic underperformance and social marginalisation throughout the life course of famine-affected African populations.\u003c/p\u003e\u003cp\u003eThis study investigates the enduring academic and psychosocial consequences of early-life malnutrition in people born during the 1983 Ghanaian famine. This study is theoretically grounded in the Developmental Origins of Health and Disease (DOHaD) Theory (Barker et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2002\u003c/span\u003e), which asserts that nutritional stress during the intrauterine period and early childhood can exert enduring effects on neural development, cognitive abilities, and educational success (Hanson et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Kuzawa \u0026amp; Sweet, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Nutritional impacts are not only physiologically determined. Bronfenbrenner\u0026rsquo;s Ecological Systems Theory (1992) expands the analytical perspective by highlighting that developmental outcomes arise from intricate interactions within nested systems, including familial caregiving, educational settings, and societal frameworks (Nketiah-Amponsah et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEnhancing the study's conceptual framework is Social Cognitive Career Theory (SCCT) (Lent, Brown, \u0026amp; Hackett, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e1994\u003c/span\u003e), which emphasises the impact of early experiences on academic self-efficacy, educational aspirations, and career progression. Early malnutrition can impair attention span, memory, and emotional regulation, which are essential for prolonged academic involvement (Hackman et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The Resiliency Theory (Masten, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Ouellette \u0026amp; DiPlacido, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) emphasises that adversity does not inhibit success. Certain children subjected to famine conditions have attained significant scholastic advancement, frequently facilitated by psychosocial assistance, relational security, and institutional resources (Bethell et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study employs a phenomenological retrospective cohort approach to investigate the impact of famine-induced dietary adversity on the scholastic experiences of individuals born in 1983. The study utilises comprehensive interviews with these individuals and their mothers in rural and peri-urban communities in Ghana to document their educational experiences throughout their lives. The study aims to elucidate the intergenerational effects of early-life famine exposure by integrating biological, ecological, cognitive, and resilience perspectives, thereby informing nutrition-sensitive educational policies and interventions in Ghana and analogous global contexts.\u003c/p\u003e"},{"header":"Review of Literature","content":"\u003cp\u003eNutritional Foundations for Cognitive Development during Prenatal and Postnatal Stages: The prenatal and postnatal periods are essential for human development, especially in determining the brain's structure, cognitive abilities, and subsequent academic performance (Georgieff, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Prado \u0026amp; Dewey, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The Developmental Origins of Health and Disease (DOHaD) Theory (Barker et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) offers a fundamental theoretical framework for comprehending how early nutritional adversities impose enduring programming effects on organ systems, including the central nervous system. DOHaD posits that foetal undernutrition might lead to permanent changes in brain structure, synaptic plasticity, and stress-response mechanisms, consequently impairing memory, attention, and learning abilities (Hanson et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Kuzawa \u0026amp; Sweet, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePostnatal nutrition perpetuates this developmental trend. Nutrient-dense diets, particularly those abundant in iron, iodine, zinc, and omega-3 fatty acids, are crucial for supporting brain development and functionality during infancy and early childhood. Deficiencies during this phase hinder neuronal growth and myelination, compromising cognitive abilities essential for academic success (Black et al., 2013; Innis, 2007). Malnutrition, Cognitive Advances, and Environmental Contexts: Malnutrition, especially chronic undernutrition and stunting, continues to pose a significant risk to child development in low- and middle-income nations. Studies regularly demonstrate that stunted children exhibit inferior academic performance, lower intelligence quotients, and diminished educational achievement (Christian et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Crookston et al., 2011). Environmental circumstances influence and shape the consequences of malnutrition, a fundamental principle of Bronfenbrenner's Socio-Ecological Theory (1992).\u003c/p\u003e\u003cp\u003eThis theory emphasises the dynamic interplay between the individual and their surrounding ecological systems, such as family, peers, educational institutions, health systems, and socio-political frameworks. For children exposed to famine, educational and cognitive results were affected by both the dietary deprivation and the effectiveness of surrounding support systems (Nketiah-Amponsah et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Early development may either mitigate or intensify the effects of early malnutrition due to the accessibility of maternity care, educational facilities, and healthcare services.\u003c/p\u003e\u003cp\u003eFamine as a Significant Risk Factor and the Influence of Academic Self-Perceptions: Historical famine research provides a significant perspective on how early scarcity impairs long-term human capital growth. Data from the Chinese Great Famine and the Dutch Hunger Winter indicate that people exposed in utero or throughout early childhood frequently display diminished cognitive abilities, lower school enrollment rates, and less academic persistence (Huang et al., 2010; Song, 2013). The 1983 famine in Ghana had comparable consequences, especially as it transpired amidst political instability and economic hardship (GSS, 1984; Del Ninno \u0026amp; Dorosh, 2003).\u003c/p\u003e\u003cp\u003eFrom a psychological-developmental standpoint, the Social Cognitive Career Theory (SCCT) (Lent et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e1994\u003c/span\u003e) elucidates how early adversities, including dietary deficiencies, can diminish academic self-efficacy and influence beliefs of one's learning capabilities and future opportunities. SCCT asserts that learning experiences shape individuals' attitudes regarding their competencies. Consequently, inadequate academic performance stemming from malnutrition-induced attention deficits or exhaustion may undermine self-confidence and reduce academic motivation over time (Hackman et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The outcome is not only a physiological constraint but also a psychological path characterised by diminished aspirations and educational disconnection.\u003c/p\u003e\u003cp\u003eResilience and Adaptive Results in the Face of Adversity: Although the detrimental effects of inadequate nutrition are well-documented, not all children subjected to famine or starvation exhibit low academic performance or fail to flourish. The variability in outcomes is most effectively elucidated by resiliency theory, which asserts that individuals can cultivate adaptive capacities when confronted with substantial adversity (Masten, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Protective factors, including parental encouragement, peer support, community mentorship, and religious or spiritual involvement, can facilitate positive academic adjustment despite the presence of early-life health concerns (Bethell et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the Ghanaian setting, both anecdotal and scientific data indicate that certain persons born during famine attained academic and professional achievement, particularly when raised in households or institutions that offered compensatory resources such as tutoring, emotional support, or school food programs. Resiliency theory advances analysis beyond deterministic views of hunger and starvation, emphasising the transformative potential of psychosocial support systems.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatement of the Problem\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOptimal nutrition throughout prenatal and postnatal periods is essential for brain development and cognitive function, significantly influencing scholastic success and long-term socioeconomic mobility (Prado \u0026amp; Dewey, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Georgieff, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Chronic malnutrition, especially stunting and micronutrient deficiencies, persistently hinders the developmental potential of millions of children in sub-Saharan Africa, hence obstructing national educational and economic advancement (Black et al., 2013; UNICEF, WHO, \u0026amp; World Bank, 2023). Although the physiological effects of malnutrition are extensively documented, there is a lack of research examining the retrospective academic and psychosocial repercussions of early-life nutritional deprivation in adult populations, particularly those influenced by historical famines like Ghana's 1983 food crisis.\u003c/p\u003e\u003cp\u003eThe 1983 Ghanaian famine was precipitated by a combination of extreme drought, bushfires, and the repatriation of over one million Ghanaians from Nigeria, resulting in extensive food insecurity, the disintegration of household coping mechanisms, and pervasive undernutrition among pregnant women and newborns (GSS, 1984). Despite the magnitude of this disaster, there are limited empirical studies examining its enduring cognitive and academic repercussions on the generation born during the famine. The Developmental Origins of Health and Disease (DOHaD) Theory (Barker et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) demonstrates the important impact of foetal and early postnatal nutrition on subsequent educational and neurological outcomes; however, research specific to Ghana that corroborates these effects is still developing.\u003c/p\u003e\u003cp\u003eRecent research in Ghana and throughout sub-Saharan Africa offers significant insights while also revealing substantial deficiencies: Saaka et al. (\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) investigated the impact of early childhood nutrition on academic performance in primary schools in Northern Ghana. The study identified an association between present nutritional state and academic outcomes; however, it concentrated on children under 12 and did not incorporate a longitudinal or historical view. Amugsi et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) investigated the impact of dietary diversity and household food poverty on cognitive development in preschoolers in rural Ghana. While useful, the research was cross-sectional and failed to evaluate long-term academic trajectories or previous famine exposure. Tette et al. (\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) examined stunting and its educational associations among school-aged children in metropolitan Accra. The research highlighted present living conditions while neglecting prior dietary histories and generational cohort influences. Hoddinott et al. (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) conducted a multinational investigation encompassing Ethiopia and Malawi, correlating early childhood growth (assessed by height-for-age) with educational attainment and labour market results in adulthood. The study failed to differentiate findings based on exposure to certain historical famines or to account for Ghana's distinct socio-political famine setting.\u003c/p\u003e\u003cp\u003eThese research, while valuable, exhibits common limitations: it (1) concentrates on contemporary children populations; (2) predominantly utilises cross-sectional designs; (3) neglects prenatal/postnatal famine-specific exposure; and (4) infrequently integrates psychosocial theories to elucidate academic outcomes. The current study is distinguished by its retrospective cohort methodology centred on individuals born during the 1983 famine, which is considered one of Ghana's most critical nutritional crises. This study synthesises biological, social, and psychological frameworks by incorporating the DOHaD theory, Bronfenbrenner\u0026rsquo;s Socio-Ecological Theory (1992), Social Cognitive Career Theory (Lent et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e1994\u003c/span\u003e), and Resiliency Theory (Masten, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) to examine the interplay between early nutritional adversity, environmental systems, academic self-efficacy, and adaptive responses throughout the lifespan.\u003c/p\u003e\u003cp\u003eThis study addresses a significant empirical vacuum by establishing the long-term scholastic consequences of early dietary deficiency from a generational viewpoint. It offers fresh viewpoints about educational and public health policy by framing academic underachievement as both a contemporary socioeconomic challenge and a consequence of historical dietary inequity. As Ghana enhances its initiatives to promote inclusive education and address intergenerational poverty, comprehending the lasting impacts of historical famines is crucial for formulating effective, equity-focused remedies.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResearch Objective\u003c/b\u003e\u003c/p\u003e\u003cp\u003e To examine the long-term academic trajectories and cognitive implications of prenatal and early postnatal nutritional deprivation among individuals born during the 1983 famine in Ghana, using a life-course, psychosocial, and ecological lens informed by DOHaD, socio-ecological, social cognitive career, and resiliency theories.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSpecific Objectives\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo explore the prenatal and postnatal nutritional experiences of individuals born during the 1983 famine in Ghana and their developmental implications in early childhood.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo examine the impact of early-life nutritional deprivation on the academic performance and educational trajectories of the 1983 famine cohort across the life course.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo analyze the role of environmental systems\u0026mdash;such as family, school, and community\u0026mdash;in mediating or moderating the relationship between famine-induced nutritional adversity and academic outcomes.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo assess how perceived self-efficacy, motivation, and psychosocial factors have influenced the academic adjustment and career development of individuals exposed to early-life nutritional deprivation.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo identify protective and contextual factors that contributed to educational resilience and academic success among individuals born during the 1983 famine.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eResearch Questions\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat were the prenatal and postnatal nutritional experiences of individuals born during the 1983 famine in Ghana, and how did these influence early childhood development?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow has early-life nutritional deprivation affected the educational pathways and academic performance of individuals born in the 1983 famine cohort over their lifespan?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIn what ways have ecological systems (e.g., family, schooling, socioeconomic policy) mediated or moderated the relationship between early-life famine exposure and academic outcomes?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow do self-efficacy, motivation, and resilience influence the academic adjustment and career aspirations of individuals exposed to early nutritional adversity?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat contextual factors enabled some individuals born during the 1983 famine to overcome early nutritional disadvantages and achieve academic success?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e\u003cb\u003eResearch Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study employs a phenomenological retrospective cohort design within a qualitative framework to investigate the enduring academic consequences of early-life nutritional deficiency among individuals born during the 1983 famine in Ghana. The phenomenological technique allows the researcher to comprehend and evaluate the lived experiences of persons born during hunger from their subjective viewpoints (Creswell \u0026amp; Poth, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; van Manen, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The retrospective cohort methodology enables the reconstruction of life trajectories by examining cognitive, educational, and psychosocial development from infancy to maturity, situated within a particular historical context of hunger (Nutting et al., \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis design is especially appropriate for investigating the impact of early environmental adversities, such as prenatal and postnatal malnutrition, on subsequent outcomes like academic achievement and life-course resilience. This analysis is guided by the Developmental Origins of Health and Disease (DOHaD) theory, Bronfenbrenner\u0026rsquo;s Socio-Ecological Model, Social Cognitive Career Theory, and Resiliency Theory, collectively offering a multi-level perspective on dietary, psychosocial, and educational trajectories.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Setting and Population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis research was carried out in three distinct geographical and ecological zones of Ghana\u0026mdash;namely, the northern, middle, and southern regions\u0026mdash;aligning with the Northern, Bono East, and Central Regions, respectively. The 1983 famine had a particularly severe impact on these regions, attributable to a confluence of extended droughts, rampant bushfires, and extensive food shortages (Ghana Statistical Service [GSS], 1984). The selected sites, specifically Sagnarigu in the Northern Region, Kintampo in Bono East, and Pedu in the Central Region, were deliberately and randomly chosen to embody a variety of socio-ecological zones, while also serving as representative examples of communities impacted by famine.\u003c/p\u003e\u003cp\u003eThe cohort under examination comprised individuals who were born in the year 1983, a period that aligned with the zenith of the famine, along with their biological mothers or primary carers. The participants were deliberately chosen to offer retrospective perspectives on early-life nutritional conditions and their subsequent academic paths. A multi-stage sampling process was employed to engage with this distinctive population. Initially, Ghana's 16 administrative regions have been categorised into three distinct ecological zones: the northern zone, which includes Northern, North East, Savannah, Upper East, and Upper West; the middle zone, comprising Bono, Bono East, Bono Ahafo, Ashanti, and Oti; and the southern zone, which encompasses Greater Accra, Volta, Eastern, Central, and Western. A region was chosen at random from each zone. In each designated region, a district was chosen at random, subsequently leading to the selection of a town or community.\u003c/p\u003e\u003cp\u003eA total of 30 individuals were interviewed, comprising 15 adults born during a famine (currently around 41\u0026ndash;42 years of age) and their 15 biological mothers, all of whom were women and primary carers. Samples of equal size (n\u0026thinsp;=\u0026thinsp;10) were extracted from each ecological zone (refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This equilibrium guaranteed fair representation and accounted for regional discrepancies, aligning with the statistical rationale that uniform group sizes assist in alleviating the impacts of variance heterogeneity (Walpole \u0026amp; Myers, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e1985\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eParticipants were selected through purposive, convenience, volunteer, and snowball sampling methods. In every community, the process of recruitment commenced within public or religious institutions, including churches and mosques, utilising a method of simple random sampling for selection. In Sagnarigu, the initial recruitment took place at the Choggu Assemblies of God Church; in Kintampo, it was held at St. Joseph the Worker Catholic Church; and in Pedu, the Church of Pentecost Pedu Assembly served as the venue. Initial volunteers frequently enabled connections with other qualified participants, a number of whom resided in different towns but were located and interviewed at times and locations that were mutually convenient. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the zonal, regional, and community representation of participants.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eZonal Representation of Participants\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEcological Zone\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDistrict/Municipality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTown/Village\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eParents (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFamine-Born Adults (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNorthern\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNorthern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSagnarigu Municipality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSagnarigu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMiddle\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBono East\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKintampo North Municipality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKintampo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSouthern\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCentral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCape Coast North Sub-metro\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePedu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eSource: Field Data (2023)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eParticipants consisted solely of individuals whose biological moms were alive and able to recollect prenatal, postnatal, and early schooling experiences. Snowball recommendations facilitated the extensive identification and recruitment of qualified people beyond the local area. In-depth interviews were conducted with each mother-child pair, facilitating the triangulation of memories across generations.\u003c/p\u003e\u003cp\u003eA total of N\u0026thinsp;=\u0026thinsp;30 individuals was considered sufficient for phenomenological study. Morse (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e1994\u003c/span\u003e) suggests that a minimum of six participants in phenomenological studies can achieve qualitative saturation. Bertaux, as referenced by Guest, Bunce, and Johnson (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), asserts that a sample size of 15 can achieve thematic saturation in qualitative research. The selected sample size of five mother\u0026ndash;child dyads in each district was suitable for documenting the lived experiences of individuals born during the 1983 famine and their developmental outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection Procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData were collected using semi-structured, in-depth interviews, allowing for flexibility in exploring key constructs such as:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePrenatal and postnatal nutrition\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eChildhood health and cognitive development\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSchool attendance and academic challenges\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFamily and community support systems\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePerceived self-efficacy and educational motivation\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eExperiences of resilience or academic breakthrough\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe interviews were conducted in English and local Ghanaian languages (Dagbani, Twi, Bono), and later transcribed and translated for thematic analysis. Interviews lasted between 45 and 75 minutes and were conducted at participants\u0026rsquo; homes or other preferred locations, ensuring comfort and privacy. Field notes and audio recordings were used to ensure data credibility and contextual accuracy, while member-checking was employed post-interview to validate critical information (Lincoln \u0026amp; Guba, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e1985\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were analysed using thematic analysis as outlined by Braun and Clarke (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The process followed six key stages:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFamiliarization with the data through transcription and repeated reading\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eInitial coding based on both emergent themes and theoretical constructs\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTheme generation by grouping related codes\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eReviewing themes for coherence and completeness\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDefining and naming themes\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eProducing the final report in alignment with the research objectives\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eThe analysis was both deductive and inductive. Deductive codes were developed from the four theoretical lenses\u0026mdash;DOHaD, socio-ecological, SCCT, and resiliency theories\u0026mdash;while inductive codes were grounded in participants\u0026rsquo; narratives. The use of NVivo 12 software facilitated efficient coding, comparison, and retrieval of text segments.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e for the study was obtained from the Ethics Review Committee of University of Cape Coast. Informed consent was secured from all participants before data collection. For participants unable to read or write, the consent form was read aloud, and a thumbprint was obtained. All interviews were anonymised, and participants were assured of the confidentiality, voluntary nature, and potential benefits of the study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eParticipants were also given the option to withdraw at any point. Emotional support was offered where needed, especially when discussing experiences of loss, hardship, or academic failure. Furthermore, to preserve confidentiality and adhere to ethical research standards, all participants were assigned anonymised codes. Famine-born individuals are labelled C01\u0026ndash;C15; their biological mothers are labelled P01\u0026ndash;P15. All procedures were carried out in compliance with institutional ethical standards and the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrustworthiness and Rigor\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFollowing Lincoln and Guba\u0026rsquo;s (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e1985\u003c/span\u003e) criteria, the study ensured:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCredibility through triangulation (caregivers and famine-born adults), prolonged engagement, and member-checking\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTransferability through rich, contextual descriptions of the settings and participants\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDependability via audit trails and reflective journaling during data collection and coding\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConfirmability through peer debriefing and supervisor validation of coding logic and theme development\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cb\u003e1. Demographic Profile of Participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study involved 30 participants, comprising 15 famine-born adults and their 15 biological mothers or primary caregivers. Participants were purposefully selected from the Northern, Bono, and Ashanti Regions\u0026mdash;areas significantly affected by the 1983 famine.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the Demographic Characteristics of Mothers/Caregivers.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eDemographic Characteristics of Mothers/Caregivers (n\u0026thinsp;=\u0026thinsp;15)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge Range\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65\u0026ndash;83 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRelationship to Respondent\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBiological Mother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiteracy Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBasic Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCurrent Residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSame Community as Respondent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNearby Community\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eSource: Field data (2023)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the Demographic Characteristics of Famine-Born Participants.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eDemographic Characteristics of Famine-Born Participants (n\u0026thinsp;=\u0026thinsp;15)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u0026ndash;42 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo Formal Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBasic Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenior High School (SHS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic Sector\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrading\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarming\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate Enterprise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRegion of Origin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNorthern Region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBono Region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAshanti Region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eSource: Field data (2023)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003e2. Thematic Results by Research Questions\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis section presents the key findings derived from the in-depth interviews with 15 individuals born during the 1983 famine and their 15 respective biological mothers. The results are structured around the study\u0026rsquo;s five research questions, with each section highlighting core themes, sub-themes, and illustrative quotations from participants. To ensure confidentiality and academic integrity, all participant identities have been anonymised using codes: C01\u0026ndash;C15 for famine-born respondents and P01\u0026ndash;P15 for their biological mothers.\u003c/p\u003e\u003cp\u003eThematic analysis was employed to identify patterns across the narratives, supported by illustrative quotes that reflect both the convergence and diversity of participant experiences. The tables presented below summarize emergent themes under each research question, offering a concise yet detailed overview of the data.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRQ1: What were the prenatal and postnatal nutritional experiences of individuals born during the 1983 famine in Ghana, and how did these influence early childhood development?\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, four major themes emerged: severe maternal undernutrition, birth complications, early weaning, and developmental delays.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003ePrenatal and Postnatal Nutritional Experiences and Their Influence on Early Childhood Development (N\u0026thinsp;=\u0026thinsp;30)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant Quote\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere Maternal Undernutrition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReliance on non-nutritive food\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;All I had to eat when pregnant was dried cassava peels and pito chaff.\u0026rdquo; (P04)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth Complications and LBW\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePremature, underweight babies\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;The child was very small\u0026hellip; she was not strong, and her head was big and light.\u0026rdquo; (P09)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly Weaning and Poor Feeding\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly cessation of breastfeeding\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I stopped breastfeeding before four months because I had no strength or food.\u0026rdquo; (P02)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevelopmental Delays\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLate crawling, speech, frequent illness\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I walked after two years\u0026hellip; always sick and not able to speak well.\u0026rdquo; (C07)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"1\"\u003eSource: Field data (2023)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"1\"\u003e\u003cem\u003eNote. Frequencies indicate the number of dyads in which the theme appeared.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInterpretive Summary: These findings illustrate that maternal undernutrition and food insecurity during pregnancy and postpartum were central challenges for the 1983 cohort. The dominance of the undernutrition theme (n\u0026thinsp;=\u0026thinsp;22) underscores its profound effect on fetal growth and early child development. Resulting birth complications, developmental delays, and inadequate breastfeeding practices affirm the long-term impact of early nutritional adversity, consistent with DOHaD theory assumptions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRQ2: How has early-life nutritional deprivation affected the educational pathways and academic performance of individuals born in the 1983 famine cohort over their lifespan?\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, four major educational outcomes emerged from the data: delayed enrollment, cognitive struggles, repetition/dropout, and adult educational redemption.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eImpact of Early-Life Nutritional Deprivation on Academic Pathways and Performance (N\u0026thinsp;=\u0026thinsp;30)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant Quote\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelayed School Enrollment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor health delayed schooling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I didn\u0026rsquo;t start school early\u0026hellip; I went when I was about 9.\u0026rdquo; (C05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCognitive Struggles in School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMemory, focus, learning challenges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I was not understanding things like my classmates.\u0026rdquo; (C10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSchool Dropout/Repetition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInconsistent progress due to health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I repeated P3\u0026hellip; sometimes I didn\u0026rsquo;t go because I was weak or hungry.\u0026rdquo; (C01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Redemption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdult literacy or vocational training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I joined adult literacy\u0026hellip; Now I can even teach others small small.\u0026rdquo; (C12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSource: Field data (2023)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote. Frequencies indicate the number of dyads in which the theme appeared.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInterpretive Summary: The analysis reveals that early nutritional deprivation adversely influenced educational participation and performance. Delayed school entry (n\u0026thinsp;=\u0026thinsp;21) and cognitive difficulties (n\u0026thinsp;=\u0026thinsp;20) dominated the narratives. Many respondents described inconsistent academic trajectories, marked by repetition and dropout. Nonetheless, a significant number demonstrated later-life educational resilience, enrolling in adult literacy programs or vocational training\u0026mdash;highlighting adaptive responses despite early disadvantage.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRQ3: In what ways have ecological systems (e.g., family, schooling, socio-economic policy) mediated or moderated the relationship between early-life famine exposure and academic outcomes?\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThree key systemic influences were identified: parental encouragement, unequal access to public support, and faith-based educational sponsorships. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e presents the ecological systems influencing the relationship between famine exposure and academic outcomes.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eEcological Systems Influencing the Relationship between Famine Exposure and Academic Outcomes (N\u0026thinsp;=\u0026thinsp;30)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant Quote\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParental Encouragement as Buffer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional support from mothers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;My mother always told me God has a reason for everything.\u0026rdquo; (P02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnequal Access to Support Systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegional disparity in services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;In our village, school feeding never came\u0026hellip; others got free food.\u0026rdquo; (C03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFaith-Based Educational Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNGO and church sponsorship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;The church people helped me go to SHS\u0026hellip; paid my fees.\u0026rdquo; (C06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSource: Field data (2023)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote. Frequencies indicate the number of dyads in which the theme appeared.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInterpretive Summary: This thematic cluster shows how supportive or lacking environments influenced the academic resilience of famine-born individuals. Parental emotional reinforcement (n\u0026thinsp;=\u0026thinsp;19) served as a strong buffer, while regional inequality in social interventions (n\u0026thinsp;=\u0026thinsp;16) exacerbated disadvantage. Faith-based and NGO interventions emerged as protective exosystem elements, confirming the moderating role of ecological systems in educational outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRQ4: How do self-efficacy, motivation, and resilience influence the academic adjustment and career aspirations of individuals exposed to early nutritional adversity?\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFour core themes emerged, including personal drive, spiritual resilience, emotional strain, and peer encouragement. Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e reveals the influence of self-efficacy, motivation, and resilience on academic adjustment.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eInfluence of Self-Efficacy, Motivation, and Resilience on Academic Adjustment (N\u0026thinsp;=\u0026thinsp;30)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant Quote\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternal Drive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-motivation despite struggles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I will not die a farmer. I pushed myself.\u0026rdquo; (C10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpiritual Resilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFaith as source of motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Only God helped me\u0026hellip; I believed I wasn\u0026rsquo;t created to suffer forever.\u0026rdquo; (C08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Strain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcademic shame and silence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;People laughed at how I read\u0026hellip; I didn\u0026rsquo;t talk much in school.\u0026rdquo; (C14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeer Influence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEncouragement from classmates/friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;She said I was not dumb, just slow.\u0026rdquo; (C13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSource: Field data (2023)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote. Frequencies indicate the number of dyads in which the theme appeared.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInterpretive Summary: Participants' narratives revealed that resilience and motivation were key in overcoming the negative self-concepts induced by early hardship. Internal drive (n\u0026thinsp;=\u0026thinsp;18) and spiritual belief (n\u0026thinsp;=\u0026thinsp;15) empowered several to persist academically. Although emotional strain and self-doubt were widespread, peer encouragement (n\u0026thinsp;=\u0026thinsp;10) served as an important motivator. These psychosocial factors reflect the modifiability of academic outcomes through self-efficacy and environmental support.\u003c/p\u003e\u003cp\u003e\u003cb\u003eR5: What contextual factors enabled some individuals born during the 1983 famine to overcome early nutritional disadvantages and achieve academic success?\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, four main enabling factors emerged: NGO or religious sponsorship, positive mentorship, family support, and community reintegration.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eContextual Enablers for Overcoming Early Nutritional Adversity (N\u0026thinsp;=\u0026thinsp;30)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipant Quote\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNGO/Religious Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExternal sponsorship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;A white woman from an NGO paid my fees\u0026hellip; I owe her everything.\u0026rdquo; (C11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMentorship and Teachers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive reinforcement from educators\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;My teacher told me I had a future even if I failed Maths.\u0026rdquo; (C09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpousal/Family Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional and financial backing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;My wife pushed me to go for night classes.\u0026rdquo; (C01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity Reintegration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUsing personal story to motivate others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I speak in church and advise young people not to give up.\u0026rdquo; (C05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSource: Field data (2023)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote. Frequencies indicate the number of dyads in which the theme appeared.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInterpretive Summary: These findings highlight the role of supportive social networks in mediating early disadvantage. The most cited enabler\u0026mdash;teacher mentorship (n\u0026thinsp;=\u0026thinsp;17)\u0026mdash;demonstrates the impact of belief and affirmation from authority figures. Spousal and NGO support also significantly contributed to educational continuation and adult literacy. Several participants transitioned from survivors to community mentors, indicating post-traumatic growth and successful reintegration.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSummary of Key Findings\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe analysis of mother\u0026ndash;child dyadic interviews revealed a coherent narrative of how early-life exposure to famine in Ghana\u0026rsquo;s 1983 cohort shaped developmental and academic trajectories. The themes underscored the compounding effects of prenatal and postnatal nutritional deprivation, manifested in low birth weight, recurrent illnesses, stunting, and delayed cognitive milestones. Emotional strain on mothers, combined with poor health-seeking behaviors and food insecurity, exacerbated children\u0026rsquo;s vulnerabilities. Psychosocial effects\u0026mdash;such as diminished self-worth, poor social adjustment, and educational interruptions\u0026mdash;further complicated these challenges. Notably, while some participants exhibited later-life academic resilience through remedial learning or vocational reintegration, this was often the exception rather than the norm. Overall, the results affirm that the cognitive legacy of famine extends beyond physical survival to encompass long-term academic and socioeconomic consequences, particularly among those without strong maternal or institutional support systems.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study explored the long-term academic implications of early-life nutritional deprivation among individuals born during the 1983 famine in Ghana. Drawing on rich narratives from both famine-born adults and their biological mothers, the analysis reveals how early developmental setbacks due to undernutrition were further compounded by structural, ecological, and psychosocial challenges, thereby reinforcing cycles of academic underachievement and socioeconomic vulnerability. The findings are situated within and across four major theoretical frameworks: the Developmental Origins of Health and Disease (DOHaD), Bronfenbrenner\u0026apos;s Socio-Ecological Model, the Social Cognitive Career Theory (SCCT), and Resiliency Theory. The discussion critically engages with contemporary literature to highlight convergence, divergence, and the novel contributions of the present study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRQ1: Developmental Origins and Lifelong Cognitive Disadvantage (DOHaD Theory)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings powerfully support the DOHaD framework, which posits early malnutrition impairs long-term cognitive functioning (Victora et al., \u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e; Barker et al., \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e). Maternal accounts, 24 mothers like P04 and P09 described severe food scarcity, poor diets, and early cessation of breastfeeding, associated with low birth weight, delayed motor development, and prolonged illness (e.g., C07). These lived experiences mirror large-scale findings from Adair et al. (\u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e) and Prentice et al. (\u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e), linking early nutrient deprivation to compromised neurodevelopment. Importantly, this study adds a qualitative depth, participants articulated memory lapses, classroom underperformance, and diminished academic selfbelief, offering psycho-educational insights often missing in biomedical DOHaD research (Saaka \u0026amp; Osman, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRQ2: SelfEfficacy, Motivation, and Academic Identity (SCCT)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThrough the lens of Social Cognitive Career Theory (SCCT), themes such as delayed school enrolment (n\u0026thinsp;=\u0026thinsp;21), cognitive struggles (n\u0026thinsp;=\u0026thinsp;20), and academic disruption reflect how early adversity shapes selfefficacy and outcome expectations. Participants reported internalized failure, reduced ambition, and avoidance of education settings\u0026mdash;paralleling findings by Amoako and Diko (\u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) in rural Ghana, showing how hunger and illness suppress academic aspirations. Notably, some regained confidence through encouragement from peers or teachers (C13, C09), ultimately re-engaging with learning in adulthood\u0026mdash;reinforcing SCCT\u0026rsquo;s assertion that social persuasion can revive career self-perceptions even after adversity (Lent et al., \u003cspan class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRQ3: Ecological Contexts of Vulnerability (SocioEcological Model)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApplying Bronfenbrenner\u0026rsquo;s socioecological model, emotional maternal support (microsystem, n\u0026thinsp;=\u0026thinsp;19), structural interventions by NGOs or religious bodies (exosystem, n\u0026thinsp;=\u0026thinsp;13), and macro-level inequities in school feeding and resources (n\u0026thinsp;=\u0026thinsp;16) emerged as significant mediators. These findings echo documented disparities in Ghana\u0026rsquo;s education system, such as uneven access to school feeding programs and rural infrastructure gaps (Ampiah \u0026amp; AduYeboah, 2020; Karikari et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). The study contributes novel lifelong ecological insight, showing how prenatal and early experiences cascade across educational, economic, and social systems over decades, consistent with developmental cascade theory (Masten \u0026amp; Narayan, \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRQ4: Resilience as Adaptive Navigation (Resiliency Theory \u0026amp; SCCT)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntegrating Resiliency Theory with SCCT, internal drive (n\u0026thinsp;=\u0026thinsp;18) and spiritual resilience (n\u0026thinsp;=\u0026thinsp;15) were key in overcoming early adversity, emotional strain, and stigma. Participants cited motivation from personal faith, peer support, or teacher belief as pivotal in rediscovering academic identity. This aligns with Ouellette and DiPlacido\u0026rsquo;s (\u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e) notion of resilience as adaptive activation of resources. The study thus enriches SCCT by embedding spiritual and social capital as culturally embedded forms of self-efficacy, seldom featured in conventional SCCT models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRQ5: Contextual Enablers of Academic Success (Resiliency Theory)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong survivors, upward trajectories were enabled by multiple support systems: teacher endorsement (n\u0026thinsp;=\u0026thinsp;17), NGO sponsorship (n\u0026thinsp;=\u0026thinsp;14), spousal encouragement (n\u0026thinsp;=\u0026thinsp;13), and community reintegration (n\u0026thinsp;=\u0026thinsp;11). In line with Resiliency Theory\u0026rsquo;s concept of \u003cstrong\u003epathway diversity\u003c/strong\u003e, these supports enabled engagement with adult literacy or vocational training. This study advances the theory by illustrating how resilience unfolds across the lifespan, with adult survivors harnessing social networks and moral purpose to transcend early disadvantage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCrossFramework Integration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings reveal a dynamic interplay: DOHaD explains the origin of cognitive and developmental risk, Bronfenbrenner highlights system-level vulnerabilities and buffers, SCCT illuminates the psychological reflection of adversity into self-perception, and Resiliency Theory demonstrates how multi-level supports enable recovery. Together, these frameworks generate a holistic model of how famine-born individuals navigate adversity from womb to adulthood.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConvergence, Divergence, and Novel Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eConvergence: Reflects global evidence on fetal programming effects (Victora et al., \u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e; Adair et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e), ecological mediation via support systems (Ampiah \u0026amp; AduYeboah, 2020), and the role of self-efficacy and persuasion in SCCT (Lent et al., \u003cspan class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eDivergence: Extends SCCT and DOHaD research into a low-resource, famine-affected African setting, foregrounding spiritual resilience and community mentorship as key drivers of identity repair.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNovel contributions:\u003c/p\u003e\n \u003col\u003e\n \u003cli\u003eFirst qualitative study linking DOHaD theory to lived psycho-educational outcomes in a Ghanaian famine cohort.\u003c/li\u003e\n \u003cli\u003eEmpirical documentation of faith-based and NGO support as ecological resilience buffers.\u003c/li\u003e\n \u003cli\u003eDemonstration of lifespan resilience trajectories, where adult survivors transcend early deprivation through varied support networks.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eCONCEPTUAL FRAMEWORK FOR THE STUDY\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is underpinned by a comprehensive conceptual framework (see Fig. 1) that outlines the intricate developmental pathways connecting early-life nutritional deprivation to long-term cognitive, scholastic, and psychosocial outcomes for people born during Ghana\u0026apos;s 1983 famine. The framework integrates essential insights from four theoretical perspectives: the Developmental Origins of Health and Disease (DOHaD) Theory (Barker et al., \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e), Socio-Ecological Theory (Bronfenbrenner, \u003cspan class=\"CitationRef\"\u003e1992\u003c/span\u003e), Social Cognitive Career Theory (SCCT) (Lent, Brown, \u0026amp; Hackett, \u003cspan class=\"CitationRef\"\u003e1994\u003c/span\u003e), and Resiliency Theory (Ouellette \u0026amp; DiPlacido, \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e), providing a multifaceted lens for data analysis.\u003c/p\u003e\n\u003cp\u003eThis theory posits that early-life malnutrition, particularly during pregnant and postnatal periods, represents a substantial physiologic detriment with lasting developmental effects. Based on the DOHaD theory, the framework asserts that insufficient nutrition during crucial growth phases can modify foetal programming and neurodevelopmental pathways, consequently heightening the likelihood of cognitive deficits and subpar academic achievement throughout life (Barker et al., \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e; Gluckman \u0026amp; Hanson, \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e). Empirical data substantiates this connection: stunting and early dietary deficiencies are consistently correlated with impaired cognitive capacity, attention problems, and reduced academic performance in low-resource environments (Walker et al., 2021; Pharoah et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). Figure\u0026nbsp;1 visually illustrates the developmental pathways from early-life nutritional deprivation to cognitive and academic outcomes: a conceptual framework of the 1983 famine cohort in Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFigure 1\u003c/em\u003e visually illustrates the developmental pathways from early-life nutritional deprivation to cognitive and academic outcomes: a conceptual framework of the 1983 famine cohort in Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDevelopmental Pathways from Early-Life Nutritional Deprivation to Cognitive and Academic Outcomes: A Conceptual Framework of the 1983 Famine Cohort in Ghana\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNevertheless, the model does not presuppose a deterministic trajectory. Utilising Bronfenbrenner\u0026rsquo;s Socio-Ecological Theory, it acknowledges that developmental outcomes are profoundly rooted in interconnected systems, ranging from direct familial contexts to educational institutions and wider community frameworks.\u003c/p\u003e\n\u003cp\u003eIn this perspective, factors like parental support, educational quality, and community involvement act as essential contextual mediators. Participants in this study who faced early dietary challenges had better academic adjustment when they encountered supportive familial and educational situations. This perspective corresponds with previous studies indicating that richer surroundings can mitigate the cognitive effects of early biological hazards (Bornstein \u0026amp; Leventhal, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Bronfenbrenner \u0026amp; Morris, \u003cspan class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eMoreover, the paradigm incorporates resiliency theory, emphasising that despite challenges, several individuals exhibit adaptive strengths that facilitate their re-engagement with schooling and attainment of functional achievements. Participants frequently identified faith, maternal support, NGO assistance, and personal resolve as significant protective factors against educational failure. These findings corroborate Masten\u0026rsquo;s (\u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e) argument that resilience is not a characteristic but a dynamic process facilitated by internal and external protective mechanisms.\u003c/p\u003e\n\u003cp\u003eRecent evaluations reinforce the efficacy of psychosocial stimulation and nutritional interventions\u0026mdash;frequently administered by NGOs\u0026mdash;in alleviating cognitive delays and enhancing school preparedness in undernourished children (Lassi et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e; Abubakar et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe paradigm integrates elements from Social Cognitive Career Theory (SCCT), which asserts that self-efficacy beliefs, result expectations, and goal-setting are fundamental to academic and career advancement (Lent et al., \u003cspan class=\"CitationRef\"\u003e1994\u003c/span\u003e; Fouad \u0026amp; Kantamneni, \u003cspan class=\"CitationRef\"\u003e2011\u003c/span\u003e). Numerous individuals described how initial dietary and educational deficiencies adversely affected their self-perceptions and long-term ambitions. Individuals who got unwavering support from families, religious institutions, or non-governmental organisations frequently restored their confidence and sought alternative educational or occupational opportunities. SCCT enhances our comprehension of the interplay between environment, motivation, and identity in shaping educational resilience among groups afflicted by adversity.\u003c/p\u003e\n\u003cp\u003eThe theory posits early-life malnutrition as the root of a multifaceted risk pathway leading to cognitive and scholastic deficits. Nonetheless, it also demonstrates how protective ecological supports and mental resources can mitigate these impacts and perhaps promote growth following trauma. Comprehending these interconnected dynamics is essential for devising comprehensive, contextually relevant therapies aimed at cognitive and scholastic rehabilitation in famine-affected populations in Ghana and elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIMPLICATIONS FOR COUNSELLING DERIVED FROM THE STUDY\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study have significant implications for counselling practice, particularly in educational, health, and community contexts. This research examines the developmental and scholastic consequences of early-life nutritional restriction among survivors of the 1983 famine in Ghana, emphasising areas where counselling interventions are essential and possibly transformative.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDevelopmentally-Informed Counselling Interventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe research indicating that early malnutrition led to enduring cognitive deficits and psychosocial challenges highlights the necessity for developmentally appropriate counselling. School and community counsellors must be educated to identify the latent consequences of early nutritional deprivation, such as diminished self-esteem, learning challenges, and decreased academic motivation. Interventions should be contextualised within the Developmental Origins of Health and Disease (DOHaD) paradigm, which posits that early-life biological factors influence subsequent psychological functioning. Counsellors must consider developmental histories while assisting adult learners or school-age youngsters with learning deficiencies.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003eFamilial and Community-Centric Counselling Methodologies\u003c/strong\u003e\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003eThe results validated that parental support, community mentors, and social networks substantially impacted participants\u0026apos; ability to manage and recuperate from early adversity. This necessitates a transition from individual-centric counselling to more systemic, family-inclusive frameworks. Ecological counselling methodologies, along with Bronfenbrenner\u0026rsquo;s Socio-Ecological Theory, ought to be advocated. School and NGO counsellors must be prepared to involve families and local community stakeholders in psychoeducational and psychosocial support initiatives to enhance resilience in populations affected by famine or crises.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003eVocational and Educational Guidance for Vulnerable Groups\u003c/strong\u003e\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003eParticipants\u0026apos; educational disengagement, postponed school enrollment, and constrained job expectations indicate deficiencies in academic self-efficacy and future orientation. This confirms the applicability of Social Cognitive Career Theory (SCCT) in counselling practice. Career counsellors should proactively identify learners impacted by early-life adversity and develop interventions that foster self-efficacy, encourage mastery experiences, and provide exposure to role models. Inspirational accounts of resilience and educational recovery, like those presented in this study, can function as motivational instruments.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003eResilience-Oriented Counselling Programs\u003c/strong\u003e\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003eThe ability of certain individuals to surmount challenges and achieve professional or educational achievement indicates that resilience may be developed. Counsellors must implement a strengths-based strategy that emphasises not only weaknesses but also enhances individual and communal capabilities. Resiliency Theory underpins counselling that promotes adaptive coping, emotional regulation, and the recognition of protective elements such as faith, social support, and purpose. Counsellors should lead group support programs that acknowledge trauma while fostering healing and post-adversity development.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003eTraining and Policy Considerations for Counsellors\u003c/strong\u003e\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003eDue to the intricate and enduring effects of famine-related developmental challenges, counselling training programs should incorporate modules on early childhood adversity, trauma-informed treatment, and nutrition-related cognitive deficits. Educational institutions and governmental bodies ought to incorporate counselling units into school health plans and adult literacy initiatives. This study advocates for investment in early intervention services, nutritional education, and psychosocial support for historically marginalised groups.\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study explored the long-term educational implications of early-life nutritional deprivation among individuals born during the 1983 famine in Ghana. Drawing on qualitative narratives from survivors and their mothers, the research provided rich insights into the developmental, psychosocial, and ecological dimensions of academic achievement over the lifespan. Guided by the Developmental Origins of Health and Disease (DOHaD) theory, Socio-Ecological Theory, Social Cognitive Career Theory (SCCT), and Resiliency Theory, the study established that early malnutrition exerted both direct and indirect effects on cognitive development, educational self-concept, and career pathways. Despite widespread adversity, resilience emerged as a key mediator, underscoring the importance of psychosocial support, faith-based mentorship, and access to institutional resources. The study contributes a novel, longitudinal, and context-sensitive lens to understanding famine\u0026rsquo;s enduring academic and developmental consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRECOMMENDATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eEarly Childhood Nutrition and Development Programs:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eGovernment and NGOs should intensify prenatal and postnatal nutrition programs, particularly in historically affected regions, to prevent intergenerational transmission of malnutrition and educational disadvantage.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIntegrated School Counselling Services:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eSchools should embed trained counsellors to support children with learning and psychosocial challenges rooted in early-life adversity.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCommunity-Based Resilience Training:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eCommunity organizations should implement group therapy and resilience-building workshops that target survivors of systemic hardship, including famine.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSupport for Adult Learners and Late Achievers:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eAdult education programs should be expanded to support individuals whose early nutritional or health histories impeded formal education.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTeacher Training and Sensitization:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eEducators should receive training on how early adversity affects cognition and behaviour to ensure inclusive and empathetic classroom environments.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003ePOLICY IMPLICATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eNutrition-Education Linkage in Public Health Policy:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eNational health and education policy frameworks must integrate early nutrition and developmental screening into school health programs.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLong-Term Tracking and Support Systems:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eEstablish national databases to monitor children born during crisis periods, enabling targeted interventions and resource allocation across their lifespan.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePsycho-Educational Equity Policies:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eEducation policies should prioritize support for children in nutritionally vulnerable settings, including scholarships, remedial programs, and psychosocial interventions.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCross-Sector Collaboration:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eMinistries of Health, Education, Gender, and Social Welfare should collaborate to design holistic programs addressing early adversity and academic inequality.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSupport for Research and Longitudinal Monitoring:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eInvest in longitudinal studies that explore the long-term impacts of crises (e.g., famine, pandemics) on education and wellbeing to inform evidence-based interventions.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eLIMITATIONS AND FUTURE RESEARCH DIRECTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eSample Size and Generalizability:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eThe study\u0026apos;s purposive sample (n = 30) limits the generalizability of findings beyond the selected cohort. Future studies should adopt mixed methods and larger samples.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRetrospective Design:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eWhile retrospective accounts offer deep insights, they may be affected by memory bias. Triangulation with archival data, where possible, would enhance reliability.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eGender Representation:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eAlthough all caregivers were female, the gendered experience of famine and educational recovery among fathers remains unexplored.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRegional Limitation:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eThe study focused on participants from specific regions in Ghana. Future research should compare inter-regional effects of famine on education and development.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLack of Biomedical Corroboration:\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eFuture studies should incorporate biomedical data (e.g., birth weight records, nutritional biomarkers) to strengthen the link between early nutrition and cognitive outcomes.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eIn sum, while the study offers vital insights into the intersection of nutrition, development, and education, further empirical work is needed to expand, validate, and scale these findings within national and continental policy frameworks.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The author received no external funding for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The author declares no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Ethics Review Committee of the University of Cape Coast, Ghana. Informed consent was secured from all participants prior to data collection. For participants with limited literacy, the consent form was read aloud, and consent was documented via thumbprint. All interviews were anonymised, and participants were assured of the voluntary nature, confidentiality, and potential benefits of the study. Participants had the right to withdraw at any stage without consequence. Emotional support was offered where needed, particularly during discussions involving loss, hardship, or academic failure. To ensure confidentiality and adherence to ethical standards, all participants were assigned anonymised codes: famine-born individuals were labelled C01\u0026ndash;C15, and their biological mothers were labelled P01\u0026ndash;P15. All procedures were carried out in compliance with institutional ethical standards and the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to data collection, informed written consent was obtained from all participants after they were provided with detailed information about the study\u0026rsquo;s purpose, procedures, potential risks, and the voluntary nature of their participation. Participants were assured of strict anonymity and confidentiality, and were informed of their right to withdraw from the study at any point without any consequences. Additionally, consent was obtained for the publication of anonymized findings derived from the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants were fully informed about the purpose, scope, and procedures of the study prior to their involvement. Informed written consent to participate was voluntarily provided by each participant after assurances of confidentiality, anonymity, and the right to withdraw from the study at any stage without penalty.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are\u0026nbsp;\u003cstrong\u003enot publicly available\u003c/strong\u003e due to the sensitive and identifiable nature of qualitative data, but \u003cstrong\u003emay be made available\u003c/strong\u003e from the corresponding author upon\u0026nbsp;\u003cstrong\u003ereasonable request\u003c/strong\u003e and subject to institutional ethical approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author was solely responsible for the conceptualization, research design, data collection, analysis, interpretation, and manuscript preparation. This article forms a substantial component of the author\u0026rsquo;s PhD thesis in Guidance and Counselling at the University of Cape Coast, Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is based on doctoral research conducted at the University of Cape Coast, Ghana. The author extends sincere appreciation to Dr. Mrs. Rita Holm Adzovie and Prof. Frederick Ocansey for their invaluable academic mentorship and supervision. The author also gratefully acknowledges the participants and community leaders from Sagnarigu, Kintampo, and Pedu for their trust, openness, and cooperation throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUse of AI Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author used OpenAI\u0026rsquo;s ChatGPT to assist with language clarity, formatting, and editorial refinement of the manuscript. No generative AI was used to develop research content, analyze data, or draw conclusions. The author remains solely responsible for all intellectual and analytical aspects of the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbubakar, A., Ashish, K. C., Omote, J., \u0026amp; Nyong\u0026rsquo;o, N. (2024). Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania. \u003cem\u003ePLOS ONE, 19\u003c/em\u003e(5), e0285240. https://doi.org/10.1371/journal.pone.0285240\u003c/li\u003e\n\u003cli\u003eAdair, L. S., Fall, C. H., Osmond, C., et al. (2020). 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Macmillan Publishing Company.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"1983 famine, early-life malnutrition, academic achievement, developmental origins, resilience, cognitive development","lastPublishedDoi":"10.21203/rs.3.rs-7235293/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7235293/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe long-term academic consequences of early-life malnutrition remain underexplored in sub-Saharan Africa, particularly regarding survivors of the 1983 famine in Ghana. While existing studies link early nutritional deprivation to developmental delays, little is known about its lasting impact on educational attainment and cognitive functioning in adulthood. This study investigates the cognitive and academic outcomes of individuals born during the 1983 famine, shedding light on the intergenerational legacy of malnutrition.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eUsing a phenomenological retrospective cohort design, this qualitative study explored the lived experiences of 30 participants\u0026mdash;15 adults born during the 1983 famine and their 15 biological mothers. Participants were purposively selected from famine-affected rural and peri-urban communities in Ghana\u0026rsquo;s Northern, Bono East, and Central Regions. Data were collected through semi-structured, in-depth interviews and analyzed using reflexive thematic analysis. The study was guided by an integrated conceptual framework comprising the Developmental Origins of Health and Disease (DOHaD) theory, Bronfenbrenner\u0026rsquo;s Socio-Ecological Theory, Social Cognitive Career Theory (SCCT), and Resiliency Theory.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFour major themes emerged: (1) neurocognitive impairments and delayed school enrolment, (2) psychosocial barriers to academic engagement, (3) disrupted parental investment in education, and (4) the role of resilience and social support systems. Participants consistently reported challenges with memory, attention, and academic progression, often exacerbated by household poverty and social stigma. However, several individuals demonstrated post-adversity resilience mediated by strong maternal bonds, religious coping, and external support from NGOs and community actors.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study provides novel empirical insights into the cognitive and educational legacy of famine in Ghana. Early-life malnutrition was found to exert enduring biological and educational effects that were further shaped by social environments, personal agency, and adaptive resources. The findings underscore the importance of contextually sensitive, long-term interventions targeting the educational and psychosocial recovery of populations affected by early-life deprivation. Policies addressing intergenerational poverty, nutrition, and cognitive support are critical to mitigating the long-term consequences of developmental shocks in low-resource settings.\u003c/p\u003e","manuscriptTitle":"Cognitive Legacy of Famine: Long-Term Academic Effects of Early-Life Malnutrition in Ghana’s 1983 Cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 06:00:16","doi":"10.21203/rs.3.rs-7235293/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d295fe48-5124-4bf9-a2a1-ae2dae66d653","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T07:21:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 06:00:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7235293","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7235293","identity":"rs-7235293","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}