Nutritional status and nutrient intake adequacy of Students of Nursing and Midwifery Training College, Bole, Ghana

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However, several studies revealed that the calorie and nutrient content of meals consumed at school frequently fall short of meeting the needs of schoolchildren in terms of nutrition. Methods The study estimated nutritional status and nutrient intake adequacy in a cross-sectional study consisting of 230 student nurses of Bole Nursing and Midwifery Training College-Ghana. Anthropometric measurements were used to determine students’ nutritional status while food frequency questionnaires and weighed food methods were used to assess dietary diversity and nutrient intake. HemoCue1 Hb 201+ was used to determine the haemoglobin concentration of the students. Results About 68% had BMIs within the range of acceptable body weight, whereas 4% and 27.8%, respectively, were underweight or overweight. There was a significant difference in BMI between males and females (p < .001) and among the program of study (p < .001). The anaemia prevalence in the study was 21.5% with the risk greater among females than males (p < .005). The waist-to-hip ratio was larger in 22 per cent of females than in 7.3 per cent of males (χ2 (1)= 6.086, p < .05). Conclusion The study found evidence of the triple burden of malnutrition in the school with undernutrition, overnutrition, and anaemia prevalence. More so, the college’s meals are not diversified and hence contribute less than the needed micronutrient requirements of students. 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F1000Research 2025, 14 :499 ( https://doi.org/10.12688/f1000research.158905.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Nutritional status and nutrient intake adequacy of Students of Nursing and Midwifery Training College, Bole, Ghana [version 1; peer review: awaiting peer review] Salahuddin Iddrisu https://orcid.org/0000-0002-9451-3426 1 , Wemakor Anthony 2 Salahuddin Iddrisu https://orcid.org/0000-0002-9451-3426 1 , Wemakor Anthony 2 PUBLISHED 19 May 2025 Author details Author details 1 Bole Nursing and Midwifery Training College, Bole, Savannah Region, NB, Ghana 2 Department of Nutritional Science, University for Development Studies, Tamale, Northern Region, NT, Ghana Salahuddin Iddrisu Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Visualization, Writing – Original Draft Preparation Wemakor Anthony Roles: Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW This article is included in the Agriculture, Food and Nutrition gateway. Abstract Background The provision of meals by colleges of nursing is geared towards meeting the nutrient requirements of students, thereby, improving their nutritional status. However, several studies revealed that the calorie and nutrient content of meals consumed at school frequently fall short of meeting the needs of schoolchildren in terms of nutrition. Methods The study estimated nutritional status and nutrient intake adequacy in a cross-sectional study consisting of 230 student nurses of Bole Nursing and Midwifery Training College-Ghana. Anthropometric measurements were used to determine students’ nutritional status while food frequency questionnaires and weighed food methods were used to assess dietary diversity and nutrient intake. HemoCue1 Hb 201+ was used to determine the haemoglobin concentration of the students. Results About 68% had BMIs within the range of acceptable body weight, whereas 4% and 27.8%, respectively, were underweight or overweight. There was a significant difference in BMI between males and females ( p < .001) and among the program of study ( p < .001). The anaemia prevalence in the study was 21.5% with the risk greater among females than males ( p < .005). The waist-to-hip ratio was larger in 22 per cent of females than in 7.3 per cent of males ( χ 2 (1) = 6.086, p < .05). Conclusion The study found evidence of the triple burden of malnutrition in the school with undernutrition, overnutrition, and anaemia prevalence. More so, the college’s meals are not diversified and hence contribute less than the needed micronutrient requirements of students. READ ALL READ LESS Keywords Mean Adequacy Ratio, Anaemia, Dietary Diversity, Student, Nutritional Status, Body Mass Index, Prevalence, Micronutrients, Meal Corresponding Author(s) Salahuddin Iddrisu ( [email protected] ) Close Corresponding author: Salahuddin Iddrisu Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Iddrisu S and Anthony W. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Iddrisu S and Anthony W. Nutritional status and nutrient intake adequacy of Students of Nursing and Midwifery Training College, Bole, Ghana [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :499 ( https://doi.org/10.12688/f1000research.158905.1 ) First published: 19 May 2025, 14 :499 ( https://doi.org/10.12688/f1000research.158905.1 ) Latest published: 19 May 2025, 14 :499 ( https://doi.org/10.12688/f1000research.158905.1 ) Introduction Energy and nutrient requirements vary throughout the life cycle according to age, sex, physiological state, and degree of physical activity. To maintain normal growth during adolescence and maturity, a daily calorie requirement of 1,850 kcal to 3,300 kcal 1 is needed, while the requirement for protein is roughly 46 g. For micronutrients, the Recommended Nutrient Intakes (RNIs) for thiamine is 1.1 mg for females and 1.2 mg for males for individuals 10 years of age and older, while the RNIs for riboflavin are 1.0 mg for female adolescents and 1.3 mg for male adolescents. Adults need 1.1 mg for females and 1.3 mg for males. Niacin needs for adults and adolescents are between 14 and 16 NE, 400 mg of folic acid, 2.4 mg of B12, 40–45 mg of vitamin C, 500–600 mg of vitamin A, 5 mg of vitamin D, 1000–1300 mg of calcium, 150 mg of iodine, 9.1–27.4 mg of iron for men and 19.6–58.8 mg for women, and 4.9–8.6 mg of zinc. 2 Adolescents need to be encouraged to adopt healthy habits to achieve these nutrient requirements. To promote healthy habits, it is necessary to consume the right amount of micronutrients, minimize consumption of trans-fat and saturated fat, sugar, salt, and processed foods, and engage in moderate levels of physical exercise. 3 Schoolchildren's diets should consist mostly of fruits, vegetables, whole grains, low-fat milk, beans, fish, and lean meat. 4 However, several studies revealed that the calorie and nutrient content of meals consumed at school frequently fall short of meeting the needs of schoolchildren in terms of nutrition. For instance, the average daily calorie intake for meals served in schools was 1501 kcal, with 88 per cent of the recommended daily intake for nutrients being satisfied. 3 It is the same in Ghana and many other emerging nations. A minimum of 664 kcal of energy, 16.3 g of protein, 11.1 g of fat, 22 mg of calcium, 3.7 mg of iron, 375 gRE of vitamin A, 0.19 mcg of thiamine, 0.10 mcg of riboflavin, 10.4 mcg of niacin, and 4 mcg of vitamin C are included in the Ghana School Feeding Program (GSFP) lunch box. 5 An evaluation of the nutritional content of meals served in three GSFP beneficiary schools in 2012 found that almost all of the RNI values for energy, protein, vitamin A, zinc, iron, and magnesium were met and that the values for vitamin C, riboflavin, and calcium were met to varying degrees (59 per cent, 25 per cent, and 22 per cent, respectively). 6 Large portion sizes with more energy and fat are served in private schools, but the micronutrient content is comparable to that in public schools. 7 Meals offered by schools to children are often viewed as a tool to combat malnutrition and unhealthful eating habits among students. 3 The meals served in nursing schools are designed to fulfil the nutritional needs of the students, consequently enhancing their nutritional status. School meal programs give students the chance to consume more calories and nutrients. 8 Therefore, providing nutritious food by Health Training Institutions (HTIs) could benefit students, especially those from poor backgrounds. Most college students don't have access to enough nutritious meal options through dining services. 9 They said that students who eat poorly every day run the risk of having lower intellectual and physical functioning. That is, school feeding programs (SFP) are unlikely to increase students' mental and academic capacities without nutritional gains. 8 The majority of students under the age of 12 are used in the impact evaluation of school meals. The quality, quantity, and compliance with nutrient requirements of the meals served to students at various HTIs are given little, if any, consideration. This study estimated the calorie and nutrient content of the meals offered at one of the HTIs that provide their meals to students on-site. The nutritional status of the students as well as the dietary diversity of the meals supplied were both evaluated. Finally, the study evaluated the trainee nurses' nutritional needs with the meals' nutrient adequacy. Methods Study design A cross-sectional design was used to carry out this study at one of the Nursing and Midwifery Training Colleges in the Savanna region of Ghana. The study concentrated on the nutritional status of students and nutrient intake adequacy as well as the dietary diversity of meals consumed. The Kwame Nkrumah University of Science and Technology, Kumasi's Committee on Human Research, Publications, and Ethics (CHRPE) granted its clearance for the study (Reference: CHRPE/AP/113/21). Additionally, permission was obtained from the Nursing and Midwifery Training College, Bole, management. Before conducting any evaluation or interview, each responder (staff or students) gave their written agreement. The informed consent form was explained to and signed by every participant who was chosen to participate in the study. Since the study document did not list the names of the participants, the anonymity of the data gathered was guaranteed. Participation in the study was entirely voluntary, and there were no financial incentives. Population and sampling The study population included Registered Nurse Assistant Preventive (RNAP) students, Post-NAP/NAC (PNNM) midwives, and Registered Community Nursing (RCN) students. A sample size of 231 was estimated using Yamane’s formula 10 for determining sample size as follows: n = N ( 1 + Ne 2 ) , Where n = sample size, N = population size = 423, and e = margin of error or required precision (5%) = 0.05. To cater for errors and missing data capture, an additional 10% contingency was applied. Based on the overall population of each class, a probability proportionate to size methodology was used to obtain the 231 numbers needed for the investigation. Each class was stratified according to sex, and the respective proportions were estimated ( Table 1 ). To get the proportion to be represented in the sample, Microsoft Excel was used to generate random numbers from the sampling frame of each class as shown in Table 2 . Table 1. Sampling frame of the study population. Class Male Female Total N % N % N % 2nd Year RNAP 32 25 94 75 126 30 1st Year RNAP 41 25 126 75 167 40 3rd Year RCN 11 48 12 52 23 5 2nd Year RCN 10 50 10 50 20 5 1st Year RCN 15 32 32 68 47 11 2nd Year PNNM 0 0 17 100 17 4 1st Year PNNM 0 0 20 100 20 5 TOTAL 109 311 420 100 Table 2. Proportion of students per class included in the sample. Class Male Female Total N N N 2nd Year RNAP 17 52 69 1st Year RNAP 23 69 92 3rd Year RCN 6 6 12 2nd Year RCN 6 6 12 1st Year RCN 8 18 26 2nd Year PNNM 0 10 10 1st Year PNNM 0 10 10 TOTAL 60 171 231 Data collection and measurements Semi-structured questionnaires were used to collect quantitative data for one month and two weeks (19th March 2021 to 3rd May 2021). Before collecting data, the field interviewers/anthropometrists underwent extensive training in questionnaire administration, anthropometric evaluations, and nutrition evaluation. The interviewers/anthropometrists were Diploma graduates in Community Nursing. The principal researcher continuously monitored the work of the field workers while collecting data, checking the questionnaire on the ground to guarantee that incomplete questionnaires and measurement errors were fixed the same day. Anthropometric measurements Recommended practices were used to measure the students’ weight, height, waist, and hip circumferences. 11 A microtoise (Bodymetre 208; Seca GmbH) was used to measure height to the nearest 0.1 cm, and an electronic scale (Uniscale; Seca GmbH) was used to measure weight to the nearest 0.1 kg. The scale was calibrated to measure a known mass (10 kg) every day. A tape measure was used to measure the waist and hip circumferences to the nearest 0.1 cm. All measurements were averaged over two measurements. The students' ages were calculated using their measurement dates and birth dates. To ensure that each participant had enough privacy, all physical assessments were carried out in an isolated location. The following procedures were used. Height measurement using microtoise Procedures 1. A microtoise was fixed on a levelled wall 2 metres above level ground 2. Every participant was requested to remove his/her: ▪ Footwear (shoes, slippers, sandals etc) ▪ Headgear (hat, cap, hair bows, comb, ribbons, etc) 3. Each participant was requested to stand against the wall facing the measurer with: ▪ Feet together ▪ Heels against the wall ▪ Knees straight 4. The participants were made to stand upright 5. The measurer made sure participants’ eyes were at the same level as their ears 6. The measuring arm (microtoise) was then gently moved down onto the head of the participant as they breathed in and stood upright 7. The height was read in centimetres at the precise point 8. The participant was asked to move away from the measuring wall 9. The height measurement in centimetres was then documented on the participant’s questionnaire Weight measurement using a Uniscale Set up requirements The scale was positioned on a firm, level surface and turned on to show 0.0. Procedures 1. The participants were requested to take off their footgear (shoes, slippers, sandals, etc) and socks 2. Each member was then requested to step onto the scale ensuring each foot was placed on each side of the scale 3. Each participant under measurement was requested to: ▪ stand still ▪ face forward ▪ place arms on the side and ▪ wait until asked to step off 4. The weight was finally documented in kilograms on the participant’s Tool Waist circumference measurement Procedure 1. Standing to the side of the participant, the inferior margin (lowest point) of the last rib and the crest of the ilium (top of the hip bone) were detected and marked with a fine pen 2. The centre was located and marked using a tape measure 3. A tension tape was applied over the marked midpoint and the participants were asked to wrap it around themselvesNote: It was ensured that the tape was horizontal across the back and front of the participant 4. The participants were asked to: ▪ stand with their feet together ▪ place their arms at their side with the palms of their hands facing inwards, and ▪ breathe out gently 5. The measurement of the waist circumference was read at a point closest to 0.1 cm and recorded on the participant’s Instrument Hip circumference measurement Procedure 1. Standing to the side of the participant, they were asked to assist in placing the tape around underneath their hips 2. The measurement tape was positioned around the greatest circumference of the buttocks as the participant: ▪ stood with their feet together ▪ placed their arms at their side with the palms of their hands facing inwards, and breathed out softly 3. It was ensured that the tape position was level all across the body 4. The waist circumference was measured with reading taken at the level of the tape to the closest 0.1 cm 5. The reading was then recorded on the instrument of the participant Measurement of haemoglobin concentration A HemoCue1 Hb 201+ was used to collect venous blood of about 1 ml to determine the haemoglobin concentration of the students. The blood sample was drawn from the fingertip of each participant into a pre-treated cuvette. The haemoglobin concentration value was displayed within 30 seconds on the device’s screen. Procedure 1. The instrument was turned on with the cuvette holder in its loading position. The display showed three flashing dashes and the HemoCue symbol. 2. Made sure the participant’s hand was warm and relaxed. The middle or ring finger was used for sampling and fingers with rings on were avoided. 3. The respective finger was cleaned with disinfectant and allowed to dry. 4. Using the thumb, the finger from the top of the knuckle was lightly pressed towards the tip. 5. Whilst pressing lightly towards the fingertip, a lancet was used to prick the finger. 6. The first two or three drops of blood were wiped away. Afterward, light pressure was re-applied towards the fingertip until another drop of blood appeared. 7. When the drop was large enough, the micro cuvette was filled in one continuous process, filling from the tip of the micro cuvette. 8. Excess blood was wiped off from the outside of the Cuvette. It was made sure that no blood was drawn out of the Cuvette during this procedure. 9. The filled microcuvette was placed in the cuvette holder. 10. The measurement began by pushing the Cuvette holder to its measuring position. 11. After 15-60 seconds the haemoglobin value of the sample was displayed. 12. Once the test was completed, the used microcuvette was discarded in the hazard bin. Weighed food record The school’s three (3) main meals were weighed every day from Sunday to Saturday for a total of one (1) week to assess the food and nutrient intakes. Using a digital electronic scale (MC-1001) to randomly weigh five (5) served meals at each meal time, the average was recorded down to the nearest 1g. All of the meal’s primary components were weighed and recorded separately throughout the weighing process, along with a description of the brands and information about how the food was prepared. The following procedure was used in weighing: i. First, the scale was standardized with a known weight of 1kg ii. An empty plate/bowl was weighed and the scale tarred to zero (0) iii. The meal component to be weighed was added to the empty plate/bowl on the scale iv. The weight of the food/various components was read and documented to the nearest 1g Dietary diversity assessment Using a semi-structured Food Frequency Questionnaire (FFQ), the college’s weekly menu was assessed, and a list of the ingredients needed to prepare it during a typical week was documented. Based on the FAO minimum dietary diversity index, the food products were divided into 10 groups. 12 Eight (8) frequency of intake categories, ranging from none (0) to seven (7) times per week, were available for each dietary item. Statistical analysis Data collected first went through cleaning daily during the data collection period to check for missing data. In case of missing data, the respective respondent was revisited. Data entry and analysis were done using SPSS version 23.0 (SPSS, Inc.) ( http://www.ibm.com/analytics/us/en/technology/predictive-analytics/#ibm-spss-stats-modeler-trials ). Continuous data distribution was checked by visual examination of normal-curved fitted histograms. The test of normality was done using the Kolmogorov-Smirnov test. Descriptive statistics were computed for the background characteristics of students. One sample t-test was used to test the differences in the nutrient content of foods served and actual requirements. The mean Adequacy Ratio was determined for some nutrients of interest using their nutrient adequacy ratios. A chi-square test of independence was performed to examine the relation between the background characteristics and nutritional status. An outcome with a p < 0.05 was considered statistically significant for all analyses. Results Demographic characteristics of the students The respondents’ mean age was 24.24±3.2 years ( Table 3 ). Approximately 13% of the interviewees said they were married, while 1.8% said they were engaged. The findings revealed that the majority (75.3%) of the students were females. Similarly, most (77%) of the students pursued a Nurse Assistant Preventive program and 59.6% were in their first year of study. Table 3. Socio-demographic Characteristics of Study Participants. Background Characteristics Frequency Per cent (%) Age (years ) 18-19 5 2.2 20-24 129 57.8 25-29 72 32.3 30-34 14 6.3 >34 3 1.3 Sex Male 55 24.7 Female 168 75.3 Program of study Registered Nurse Assistant Preventive (RNAP) 172 77.1 Registered Community Nursing (RCN) 33 14.8 Post-NAP/NAC Midwifery (PNNM) 18 8.1 Academic level 1st Year 133 59.6 2nd Year 83 37.2 3rd Year 7 3.1 Marital Status Single 191 85.7 Engaged 4 1.8 Married 28 12.6 Body mass index The mean weight, height, and BMI of students were 62.49 ± 11.1 kg, 1.6 ± 0.1 m, and 23.45 ± 4.1 kg/m 2 respectively. Out of the 223 students who were investigated, 152 (68.2%) had BMIs within the range for an acceptable body weight, whereas 4% and 27.8%, respectively, were underweight or overweight, as shown in Figure 1 . Table 4 shows that females were more likely than males to be overweight and obese. Likewise, students studying Post-NAP/NAC Midwifery (PNNM) were more prone to be overweight and obese whilst the risk of being underweight was significant among students in the Registered Nurse Assistant Preventive (RNAP) program ( χ 2 = 37.978, p < .001). Furthermore, the prevalence of underweight and overweight among first-year students was 4.5% and 18.6%, respectively, with 74.5% of them having a normal body weight and 7.5% being obese. Third-year students had lower odds of obesity and underweight than first-year students did ( χ 2 = 13.912, p < .05). Figure 1. Nutritional Status of Respondents. Table 4. Nutritional status by Program of Study, Academic Level, and Gender. Nutritional status of students Test statistics Underweight Normal Overweight Obese N % N % N % N % Program of study RNAP 9 5.2 122 70.9 32 18.6 9 5.2 χ 2 = 37.978, p < .001 RCN 0 0 27 81.8 5 15.2 1 3 PNNM 0 0 3 16.7 9 50 6 33.3 Academic level 1st Year 6 4.5 98 73.7 19 14.3 10 7.5 χ 2 = 13.912, p < .05 2nd Year 3 3.6 47 56.6 27 32.5 6 7.2 3rd Year 0 0 7 100 0 0 0 0 Gender Male 4 7.3 51 92.7 0 0.0 0 0.0 χ 2 = 28.657, p < .001 Female 5 3.0 101 60.1 46 27.4 16 9.5 Waist-to-hip Ratio (WHR) From the study, 74.9 ± 13.9 cm was the mean waist circumference and a mean WHR of 0.8 ± 0.9. Table 5 shows that the majority (81.6%) of students had a normal waist-to-hip ratio. However, the waist-to-hip ratio was larger in 22 per cent of females than in 7.3 per cent of males. ( χ 2 (1) = 6.086, p < .05). Additionally, 15.2 per cent of first-year students and 25.3 per cent of second-year students, respectively, exhibited high waist-to-hip ratios ( χ 2 (2) = 5.124 , p < .077) ( Table 5 ). Table 5. Waist-to-hip ratio by Program of Study, Academic Level, and Gender. Waist-to-hip ratio Test statistics Normal High N % N % Program of study RNAP 146 85.4 25 14.6 χ 2 = 23.660, p < .001 RCN 28 84.8 5 15.2 PNNM 7 38.9 11 61.1 Academic level 1st Year 112 84.8 20 15.2 χ 2 = 5.124, p = .077 2nd Year 62 74.7 21 25.3 3rd Year 7 100.0 0 0.0 Gender Male 51 92.7 4 7.3 χ 2 = 6.086, p = .014 Female 130 77.8 37 22.2 Anaemia status The mean haemoglobin level, shown in Table 6 , among students in the study, was 13.5 ± 2.1 g/dL. About 22 per cent of the 223 students who were studied were anaemic. Females were more likely than males to have anaemia ( χ 2 (1) = 8.779, p = .003). Additionally, 17.3% of first-year students had anaemia, compared to 30.1% of second-year students, who also had anaemia. Third-year students were at a lower risk than first-year and second-year students due to the large difference in prevalence ( χ 2 (2) = 6.960, p < .05). A highly significant association was identified between anaemia and the program of study. In comparison to 3.0% of students in the Registered Community Nursing (RCN) program and none (0.0%) in the Post NAP/NAC Midwifery (PNNM) program, students in the Registered Nurse Assistant Preventive (RNAP) program had a higher chance of developing anaemia (27.3%) ( χ 2 = 15.046, p = .001). Table 6. Anaemia Status by Program of Study, Academic Level, and Gender. Anaemia Status Test statistics Normal Anaemic N % N % Program of study RNAP 125 72.7 47 27.3 χ 2 = 15.046, p = .001 RCN 32 97.0 1 3.0 PNNM 18 100.0 0 0.0 Academic level 1st Year 110 82.7 23 17.3 χ 2 = 6.960, p = .031 2nd Year 58 69.9 25 30.1 3rd Year 7 100.0 0 0.0 Gender Male 51 92.7 4 7.3 χ 2 = 8.779, p = .003 Female 124 73.8 44 26.2 Meals served to students in the school The major ingredients of the meals provided to students by the school were corn, cassava, beans, and rice. Some of the meals provided were millet porridge, Tuo Zaafi (TZ) with dry okra soup, Banku with groundnut soup, Gari and beans, and plain rice with tomato stew. Details are displayed in Table 7 . Table 7. Daily meals served to students in the school. Day Breakfast Lunch Supper Sunday Millet porridge Gari and beans Banku with groundnut soup and meat Monday Fonio Kenkey with tomato stew and sardine Plain rice with groundnut soup Tuesday Millet porridge Rice and beans with tomato stew Tuo zaafi with dry okra soup Wednesday Maize porridge with bread Gari and beans Jollof rice with boiled egg Thursday Fonio Banku with groundnut soup and meat Plain rice with agushi stew Friday Millet porridge Rice and Beans with tomato stew Kenkey with tomato stew Saturday Millet porridge Jollof rice Tuo zaafi with dry okra soup Comparison of mean nutrient intakes with RDAs Table 8 contains the mean daily consumption of various nutrients in seven days matched with the Recommended Dietary Allowance (RDA). The mean energy in the form of calories provided by the school meals was 1951.77 ± 331.12 and those of protein, fat, carbohydrate, and fibre were 51.06 ± 17.09, 59.20 ± 28.45, 310.46 ± 31.14, and 25.62 ± 7.26 respectively. The percentages of two of the macronutrients, protein, and carbohydrates, provided in the school’s meals exceeded 100% of the daily requirements (RDA). The amount of cholesterol ( M = 46.41, SD = 81.37) and fat ( M = 59.20, SD = 28.45) met through the school diet was 15% and 61% respectively, whilst the total energy and fibre provided were 85% and 67% of the Recommended Dietary Allowance. Table 8. Differences in Nutrient Content of Foods Served and Actual Requirements. Nutrient Mean ± Std. Deviation RDA Mean Difference % of RDA Macronutrients Energy (Cal) 1951.77 ± 331.12 2300 348.23 85 Protein (g) 51.06 ± 17.09 50 1.06 102 Fat (g) 59.20 ± 28.45 97 37.80 61 Carbohydrate (g) 310.46 ± 31.14 130 180.46 239 Fibre (g) 25.62 ± 7.26 38 12.38 67 Cholesterol (mg) 46.41 ± 81.37 300 253.59 15 Vitamins Ascorbic acid (mg) 95.42 ± 57.51 45 50.42 212 Thiamine (mg) 1.22 ± 0.63 1.2 0.02 102 Riboflavin (mg) 0.62 ± 0.32 1.3 0.68 48 Niacin (mg) 13.38 ± 4.04 16 2.62 84 Vitamin B 6 (mg) 1.66 ± 0.26 1.3 0.36 128 Folate (μg) 484.12 ± 464.95 400 84.12 121 Vitamin B 12 (μg) 1.45 ± 1.80 2.4 -0.95 60 Vitamin A (μg RAE) 151.16 ± 100.35 600 448.84 25 Vitamin E (mg) 9.17 ± 4.51 10 0.83 92 Vitamin K (μg) 20.43 ± 14.89 65 44.57 31 Minerals Calcium (mg) 284.25 ± 104.55 1000 -715.75 28 Iron (mg) 12.96 ± 5.42 27 -14.04 48 Magnesium (mg) 408.48 ± 110.66 260 148.48 157 Potassium (mg) 2254.72 ± 895.55 3500 1245.28 64 Sodium (mg) 3686.83 ± 935.65 2400 1286.82 154 Zinc (mg) 8.78 ± 2.36 14 5.22 63 Selenium (mg) 67.66 ± 21.98 34 33.66 199 Essential Amino Acids Isoleucine (g) 1.88 ± 0.59 1.4 0.48 134 Tryptophan (g) 0.51 ± 0.19 0.28 0.23 181 Threonine (g) 1.73 ± 0.54 1.05 0.68 165 Leucine (g) 4.17 ± 1.03 2.73 1.44 153 Lysine (g) 2.22 ± 1.07 2.1 0.12 106 Phenylalanine (g) 2.53 ± 0.87 0.88 1.65 288 Histidine (g) 1.34 ± 0.46 0.7 0.64 191 Valine (g) 2.39 ± 0.65 0.75 1.64 319 Methionine (g) 0.91 ± 0.22 0.53 0.38 172 More than 100% of the Recommended Dietary Allowance (RDA) for Ascorbic Acid (212%), Thiamine (102%), Vitamin B 6 (128%), and Folate were provided by the school meals (121 per cent). The percentages of the RDA for riboflavin, vitamin B 12 , vitamin A, and vitamin K, on the other hand, were less than 66 per cent, while those for niacin and vitamin E were 84 and 92 per cent, respectively. In addition, while magnesium, sodium, and selenium provided over 100 per cent of the RDA, the amounts of calcium (M = 248.25, SD = 104.55), iron (M = 12.96, SD = 5.42), potassium (M = 2254.72, SD = 895.55), and zinc (M = 8.78, SD = 2.36) obtained from the meals contributed less than 66 per cent of the RDA. Additionally, the study found that the RDA for each essential amino acid was exceeded by more than 100%. In comparison to normal population means, the mean levels of tryptophan, threonine, leucine, phenylalanine, histidine, valine, and methionine in school meals were greater, t (6) = 3.158, p < .05; t (6) = 3.316, p < .05; t (6) = 3.710, p < .05; t (6) = 4.998, p < .005; t (6) = 3.677, p < .05; t (6) = 6.648, p < .005; t (6) = 4.478, p < .005. Mean Adequacy Ratio (MAR) of nutrients and dietary diversity of meals Figure 2 shows the Mean Adequacy Ratio (MAR) of several nutrients from the study. The macronutrient MAR was 1.2 and the micronutrient MAR was 1.3. The study's findings showed that the most often consumed food groups were grains, white roots and tubers, plantains, and other vegetables (every day of the week). Pulses were eaten four times as opposed to twice per week for dairy, meat, fish, and leafy green vegetables. There were no (0) fruits of any sort served on any day of the week, and dark green leafy vegetables earned a score of two on the nutritional scale. Meat, poultry, and fish had a score of 2 for dietary diversity. A total dietary diversity score of 28 was recorded for the meals in the school as shown in Table 9 . Figure 2. Mean Nutrient Adequacy Ratio of Macronutrients and Micronutrients. Table 9. Food Frequency Distribution. Food Category Sunday Monday Tuesday Wednesday Thursday Friday Saturday Total Grains, white roots and tubers, and plantains Yes Yes Yes Yes Yes Yes Yes 7 Pulses (beans, peas and lentils) Yes No Yes Yes No Yes No 4 Nuts and seeds Yes Yes No No Yes No No 3 Dairy No Yes No No Yes No No 2 Meat, poultry, and fish Yes No No No Yes No No 2 Eggs No No No Yes No No No 1 Dark green leafy vegetables No No Yes No No No Yes 2 Other vitamin A-rich fruits and vegetables No No No No No No No 0 Other vegetables Yes Yes Yes Yes Yes Yes Yes 7 Other fruits No No No No No No No 0 Sub-total 5 4 4 4 5 3 3 28 Condiments and seasonings Yes Yes Yes Yes Yes Yes Yes 7 Total 6 5 5 5 6 4 4 35 Discussion Anthropometric status The current study found that the obesity prevalence was 7.2%, the overweight prevalence was 20.6%, and the undernutrition prevalence was 4% which were all in contrast to other research works. 13 , 14 The reason for these variations in malnutrition prevalence may be because, in contrast to the current study, where the majority of participants were young adults in their twenties, their study populations focused on teenagers, a group at a stage with higher nutritional demands. However, the high prevalence of overweight and obesity among the Post-NAP/NAC Midwifery (PNNM) program could be because students pursuing that program are gainfully employed which may play a role in how and what they consume. The research also revealed that 25.1% of students had waist circumferences that were excessive for their respective genders. 15 This shows that roughly 25 out of every 100 research participants have an increased chance of having metabolic issues and non-communicable diseases linked to fat (NCDs). From the findings, metabolic issues are significantly more likely to emerge in 18.4% of students, with females being more at risk than males. The study's greater proportion of female participants who were overweight or obese may have contributed to their higher risk of developing metabolic problems than did their male counterparts. The majority of students with a high waist-to-hip ratio were second-year students, females, and students in the Post-NAP/NAC Midwifery (PNNM) program. The second-year students at the school might not participate in daily tasks like cleaning and maintenance. As a result, they become less active while eating the same amount of food as they did in the first year. Consequently, an increase in body fat will likely result from a decrease in activity. More specifically, the Post-NAP/NAC Midwifery (PNNM) program is mostly for females, and the program also has a greater prevalence of overweight among all the programs examined, which may be associated with the high prevalence of waist-to-hip ratio among females. Prevalence of anaemia Males were less likely to be anaemic than females contrast to a study in which more than 50 per cent of females were anaemic. 16 This may be because women lose more iron through menstruation regularly than men and since the majority of the study's participants were females, their need for iron is also higher. It might also be that most of the overweight and obese women in the study are females, and total body fat has been linked to anaemia. 17 Additionally, students enrolled in the Registered Nurse Assistant Preventive (RNAP) program had higher rates of anaemia. This may be the case given that the majority of RNAP participants have just graduated from high school and are in the transitional period between adolescence and early adulthood. Similar to this, a higher percentage of second-year students who were mostly female and of reproductive age had anaemia. The higher prevalence might be due to increased demand or loss, poor absorption, or parasitic infections 18 as well as other things, like a bad combination of foods rich in iron and foods high in nutrients that restrict growth (high calcium, phytates, and others). Nutrient Adequacy and Dietary Diversity of Meals According to the mean adequacy ratios, the amount of macronutrients and amino acids in school meals is generally sufficient for students’ needs, but the amount of minerals and vitamins is not. The micronutrient inadequacy could be ascribed to the limited provision of green leafy vegetables and the lack of fruits in the school’s meals. 19 However, the MAR for both macronutrients and a combined MAR for micronutrients (vitamins and minerals) in the college is adequate. The study findings revealed that the dietary diversity score of the meals served in the school is 28. This implies that the school’s meals served to students are not diversified, 12 thus reflecting micronutrient inadequacy. 20 , 21 Hence, it is not surprising that the study discovered that the meals served at the school lacked sufficient amounts of vitamins and minerals. Conclusion The study, in conclusion, found evidence of the triple burden of malnutrition in the school with undernutrition, overnutrition, and anaemia prevalence at 4 per cent, 27.8%, and 21.5% respectively. Also, the anaemia prevalence of 21.5% among students is a moderate public health problem. The school meals contributed adequate quantities of the carbohydrate, protein, and folate requirements of students. However, inadequacies were recorded for fat, cholesterol, and some micronutrients such as vitamin A, vitamin B 12 , iron, calcium, potassium, and zinc. More so, the college’s meals are not diversified and hence contribute less than the needed micronutrient requirements of students. Ethics and consent Ethical approval was gotten from the Committee on Human Research, Publications and Ethics (CHRPE) of the Kwame Nkrumah University of Science and Technology, Kumasi (Date: 18/03/2021; Reference: CHRPE/AP/113/21). Permission was also gotten from the management of the Nursing and Midwifery Training College, Bole (Date: 12/02/2021; Reference: MOH/NMTC/B/SF/14). Written consent was attained from each respondent (staff/students) before carrying out any assessment or interview. Each person selected to take part in the study was explained the informed consent and entreated to sign it before taking part. Names of participants were not written on the study document, hence, confidentiality regarding the information collected was ensured. Partaking in the study was voluntary and there were no monetary motivations attached. Data availability Figshare: Nutritional status and nutrient intake adequacy of nursing and midwifery students in Ghana. https://doi.org/10.6084/m9.figshare.24235513.v2 22 The project contains the following underlying data and Extended data: • Raw data • Questionnaire • Sample consent form • Participant information sheets Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgement We gratefully thank the Staff and students of Nursing Training College, Bole, for their support in participating in this study. More so, our sincere appreciation to the University for Development Studies, 23 and the Department of Nutritional Sciences. Lastly, our special thanks go to our family for their great support and encouragement in the successful accomplishment of this research project. References 1. FAO: Human energy requirements: report of a joint FAO/WHO/UNU Expert Consultation. Food Nutr. Bull. 2005; 26 (1): 166. 2. FAO: Human Vitamin and Mineral Requirements. Geneva: World Health Organization; 2001. Reference Source 3. Agbozo F, Atitto P, Abubakari A: Nutritional Status of Pupils Attending Public Schools with and without School Feeding Programme in Hohoe Municipality, Ghana. J. Food Nutr. Res. 2017; 5 (7): 467–474. 4. Osowski CP, Lindroos AK, Barbieri HE, et al. : The contribution of school meals to energy and nutrient intake of Swedish children in relation to dietary guidelines. Food Nutr. Res. 2015; 59 (November): 27563. Publisher Full Text 5. Fisher E: A Desk Review of the Ghana School Feeding Programme - World Food Programme’s Home Grown School Feeding Project.2007; 1–20. Reference Source 6. Danquah AO, Amoah AN, Steiner-Asiedu M, et al. : Nutritional Status of Participating and Non-participating Pupils in the Ghana School Feeding Programme. J. Food Res. 2012; 1 (3): 263. Publisher Full Text 7. 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BMC Public Health. 2014; 14 (14): 1471–2458. Publisher Full Text 14. Kumah DB, Akuffo KO, Abaka-Cann JE, et al. : Prevalence of overweight and obesity among students in the Kumasi metropolis. J. Nutr. Metab. 2015; 2015 : 1–4. Publisher Full Text 15. World Health Organisation (WHO): WHO|Waist Circumference and Waist–Hip Ratio. Report of a WHO Expert Consultation. Geneva, 8-11 December 2008.2008; 8–11. Reference Source 16. Al-Alimi AA, Bashanfer S, Morish MA: Prevalence of Iron Deficiency Anemia among University Students in Hodeida Province, Yemen. Anemia. 2018; 2018 : 1–7. PubMed Abstract | Publisher Full Text | Free Full Text 17. Al SH: Prevalence of overweight/obesity, anaemia and their associations among female university students in Dubai, United Arab Emirates: a cross-sectional study. J. Nutr. Sci. 2020; 9 : e26. Publisher Full Text 18. Shill KB, Karmakar P, Kibria MG, et al. : Prevalence of iron-deficiency anaemia among university students in Noakhali Region, Bangladesh. J. Health Popul. Nutr. 2014; 32 (1): 103–110. PubMed Abstract 19. Van den Berg VL, Abera BMM, Nel M, et al. : Nutritional status of undergraduate healthcare students at the University of the Free State. S. Afr. Fam. Pract. 2013; 55 (5): 445–452. Publisher Full Text 20. Acham H, Oldewage-theron WH, Egal AA: Dietary diversity, micronutrient intake and their variation among black women in informal settlements in South Africa: A cross-sectional study.2012; 4 (February): 24–39. 21. Verger EO, le Port A , Borderon A, et al. : Dietary Diversity Indicators and Their Associations with Dietary Adequacy and Health Outcomes: A Systematic Scoping Review. Adv. Nutr. 2021; 12 (5): 1659–1672. PubMed Abstract | Publisher Full Text | Free Full Text 22. Iddrisu S, Wemakor A: Dataset.zip. figshare. 2023 [cited 2025 Apr 25]. Reference Source 23. Iddrisu S: Nutritional status and nutrient intake adequacy of students of Nursing and Midwifery Training College, Bole, Ghana. University for Development Studies; 2022 [MSc thesis]. Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 19 May 2025 ADD YOUR COMMENT Comment Author details Author details 1 Bole Nursing and Midwifery Training College, Bole, Savannah Region, NB, Ghana 2 Department of Nutritional Science, University for Development Studies, Tamale, Northern Region, NT, Ghana Salahuddin Iddrisu Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Visualization, Writing – Original Draft Preparation Wemakor Anthony Roles: Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 19 May 2025, 14:499 https://doi.org/10.12688/f1000research.158905.1 Copyright © 2025 Iddrisu S and Anthony W. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Iddrisu S and Anthony W. Nutritional status and nutrient intake adequacy of Students of Nursing and Midwifery Training College, Bole, Ghana [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :499 ( https://doi.org/10.12688/f1000research.158905.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. 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