Anorexia nervosa among female secondary school students in Ghana.
BACKGROUND
We set out to determine whether anorexia nervosa exists in a culture where the pressure to be thin is less pervasive.


OBJECTIVE
To determine whether there were any cases of anorexia nervosa in female students attending two secondary schools in the north-east region of Ghana.


METHODS
The body mass index (BMI) of consenting students was calculated after measuring their height and weight. Those with a BMI </=19 kg/m(2) underwent a structured clinical assessment including mental state, physical examination and completion of the Eating Attitudes Test and the Bulimic Investigatory Test, Edinburgh. Participants nominated a best friend to serve as a comparison group, and these young women under went the same assessments.


RESULTS
Of the 668 students who were screened for BMI, 10 with a BMI <17.5 kg/m(2) appeared to have self-starvation as the only cause of their low weight. All 10 viewed their food restriction positively and in religious terms. The beliefs of these individuals included ideas of self-control and denial of hunger, without the typical anorexic concerns about weight or shape.


CONCLUSIONS
Morbid self-starvation may be the core feature of anorexia nervosa, with the attribution for the self-starvation behaviour varying between cultures.
South East Scotland Deanery, Edinburgh. Dinah.Bennett@lpct.scot.nhs.uk
Dinah
D
Bennett
Michael
M
Sharpe
Chris
C
Freeman
Alan
A
Carson
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000453:epidemiology*; D001294:Attitude to Health; D015992:Body Mass Index; D002032:Bulimia / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D015995:Prevalence