Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Debbie L. Humphries

Second Advisor

Michael Cappello


Background: Because human and animal cross-sectional studies cannot assess temporality, a longitudinal study is needed to assess the association between protein intake and hookworm infection susceptibility. Cultural preferences and belief systems have been noted to affect the intake of food in some African societies but extensive research has not been conducted to characterize them.

Methods: Children (n=274) 7-13 years of age who attended school in the Kintampo North Municipality of Ghana were screened for participation in a longitudinal study assessing the relationship between protein intake and hookworm infection susceptibility. Protein intake was calculated by 24-hour recalls. A qualitative sub-study recruited mothers (n=32), whose children were part of the longitudinal study, to participate in 45-60 minute in-depth semi-structured interviews and assess their beliefs, attitudes, and behaviors around child nutrition, particularly protein-rich foods. Three focus groups were also conducted (two with mothers and one with children).

Principal Findings: After adjusting for covariates, no significant association was found between weight-adjusted protein intake in January 2013 and hookworm infection status in June 2013 (OR: 0.93, 95% CI 0.78, 1.12; P = 0.455). The sub-study showed that staple foods were the most important and nutritious foods to give to children in this community. Contributions of food from friends and family were also noted.

Conclusion: Higher protein intake levels were not observed to protect against future hookworm infection in children with adequate protein intake, although more research is warranted. The qualitative findings were consistent with previous qualitative work in other African communities, but future research is needed to determine similarities between belief systems and behaviors in other African populations, especially those burdening with protein deficiency, and identify sociocultural mechanisms that explain protein intake in school-age children.


This is an Open Access Thesis.

Open Access

This Article is Open Access