Relationship between home garden ownership and the consumption of fruits and vegetables

**Background:** Fruits and vegetables (FV) are essential for preventing diet-related diseases such as diabetes, cancer, coronary heart disease, stroke, and cataract formation. The WHO recommends at least 400 g (five servings) of FV per person daily. In low- and middle-income countries, FV consumption is often low due to poverty, limited availability, and high prices. Home gardens have been proposed as a sustainable means to improve household food and nutrition security by increasing access to nutrient-dense foods. However, evidence on the nutritional impact of home gardens is mixed. This study aimed to assess the association between home garden ownership and the frequency of FV consumption in rural households in Northern Ghana, a region with prevalent food insecurity and micronutrient deficiencies.

**Methods:** A community-based comparative analytical cross-sectional study was conducted in February 2021 during the lean dry season in 50 rural communities across five districts in Northern Ghana. A sample of 847 households with children under 5 years was selected using multistage sampling: simple random sampling of districts, cluster sampling of communities, and systematic random sampling of households. Data were collected via face-to-face interviews using a structured questionnaire administered by trained enumerators on smartphones. The primary outcome was frequency of FV consumption in the past 7 days, categorized as low (<3 days/week) or high (≥3 days/week). The key exposure was home garden ownership (growing FV in or around the home). Mothers' attitudes toward FV consumption were assessed using 12 positive statements on a three-point Likert scale, with scores classified as positive (≥ median) or negative. Socioeconomic status was measured via a wealth index based on durable asset ownership, categorized into quintiles. Multivariable logistic regression was used to adjust for confounders including household size, nutrition education, employment, education, wealth, region, maternal attitudes, and father's involvement in childcare. The complex samples module of SPSS accounted for cluster sampling.

**Key Results:** The mean age of mothers was 29.4 ± 6.2 years; 55.5% had no formal education, and 26.1% were in the highest wealth quintile. Home garden ownership was reported by 40.4% of households. Overall, 47.1% of households consumed FV at least 3 days per week. In bivariate analysis, home garden ownership was significantly associated with higher FV consumption (55.0% vs. 41.8%, χ²=14.2, p<0.001). After adjusting for confounders, home garden ownership remained a significant predictor: adjusted odds ratio (AOR)=1.46 (95% CI 1.06–2.0, p=0.020). Mothers with a positive attitude toward FV were 1.63 times more likely to consume FV at least 3 days/week (AOR=1.63, 95% CI 1.17–2.27, p=0.004). Households in the Upper East region had higher odds compared to Upper West (AOR=3.46, 95% CI 2.23–5.36, p<0.001). Richer households (third wealth tertile) were more likely to consume FV than the poorest (AOR=2.39, 95% CI 1.19–4.79, p=0.04). The model explained 19.0% of the variation in FV consumption (Nagelkerke R²=0.190). Main barriers to regular FV consumption were high prices (44.4%) and non-availability year-round (53.7%).

**Clinical Implications:** This study provides evidence that home garden ownership is positively associated with more frequent FV consumption in rural Northern Ghana, supporting the use of home gardens as a nutrition-sensitive agricultural intervention. The findings also highlight the importance of maternal attitudes and household wealth as determinants of FV intake. Nutrition behavior change communication campaigns that promote positive attitudes toward FV, especially among lower-income households, may further enhance consumption. The low overall FV intake (only 47.1% consuming at least 3 days/week) underscores the need for multifaceted strategies combining home garden promotion, education, and economic support to improve dietary diversity and reduce micronutrient deficiencies in vulnerable populations.