**Background:** Magnesium is a critical cofactor in over 300 enzymatic reactions, including those regulating blood pressure, glycemic control, and lipid peroxidation. Low magnesium intake in women of reproductive age is associated with adverse pregnancy outcomes such as pre-eclampsia, gestational diabetes, preterm labor, restricted fetal growth, and intrauterine growth restriction. Despite magnesium's importance, few surveys have examined magnesium status in African women of reproductive age. Additionally, dietary analysis software varies across studies, and no consensus exists on which program provides more accurate estimates.
**Methods:** Between July and August 2019, a pilot cross-sectional study was conducted among 63 women aged 18–49 years living in Odumase Krobo, a peri-urban area in Ghana's Eastern Region. Women were non-pregnant, residents of the area, and able to speak Krobo, Twi, or English. Dietary magnesium intake was assessed using an interviewer-administered semiquantitative 150-item food frequency questionnaire (FFQ). Portion sizes were assigned using standard household measures and a Food Amounts Booklet. Frequency of consumption was recorded in six categories ranging from never to 2 or more times per day. Daily magnesium intake was estimated by multiplying frequency by magnesium content per portion. Dietary data were analyzed using two programs: Nutrient Data Software for Research 2018 (NDSR) and ESHA Food Processor Nutrition Analysis software, version 10.8. For composite dishes, recipes were added to both programs. The USDA dietary database was the primary reference; magnesium content of specific Ghanaian foods not available in either program was obtained from the FAO West African Food Composition table. The Wilcoxon signed rank test was used to compare mean differences between the two programs. Assuming a modest effect size of one-third of a standard deviation difference and a correlation of 0.60, the expected statistical power was 0.811.
**Key Results:** The mean age of participants was 29.5 ± 8.5 years; 56% were single, separated, or widowed; 98% were Ga-Dangme; 22% had completed senior high school or above; 62% were employed; 78% had been pregnant at least once; 62% had improved drinking water; 86% had unimproved sanitation; and 44% were overweight/obese (mean BMI 25.2 ± 5.1 kg/m²). There was a significant difference between the two dietary programs: ESHA estimated a mean magnesium intake of 200 ± 12 mg/day (median 185 mg/day), while NDSR estimated 168 ± 11 mg/day (median 145 mg/day), with a mean difference of 32.23 mg/day (95% CI: 16.80–47.65; p < 0.0001) and a Spearman correlation of 0.67. Using ESHA, 84.1% of women had intake below the RDA of 320 mg/day; using NDSR, 96.8% were below the RDA. Major dietary magnesium sources included banku (fermented corn), fufu and kokonte (cassava), koose (cowpeas), hausa koko (millet), light soup (eggplant), smoked tuna, plantain, yam, and orange.
**Clinical Implications:** The majority of Ghanaian women of reproductive age in this study had suboptimal magnesium intake, which is concerning given the increased risks of adverse pregnancy outcomes associated with low magnesium status at the start of pregnancy. The significant difference between ESHA and NDSR estimates highlights the need for standardized dietary analysis approaches in West Africa. ESHA was considered more accurate for this population due to its inclusion of specific ethnic foods and easier search functionality. The findings underscore the urgent need for magnesium supplementation programs, nutrition education, and the development of up-to-date national food composition databases across African countries. Currently, only 22 of 54 African countries have any food composition databases, and Ghana's last publications were in 1977 and 1983. Without accurate, region-specific databases, dietary assessments may misrepresent true nutrient intakes, potentially leading to misinformed public health interventions.