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Liu W, Wu Y, Sun Y, Florkowski WJ. Consumer Perception of the Performance of Online Catering Food Safety Regulations: The Case of Shanghai, China. Foods 2024; 13:2568. [PMID: 39200495 PMCID: PMC11353807 DOI: 10.3390/foods13162568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
To protect the safety of food bought from the online catering sector, the former State Food and Drug Administration of China issued two separate regulations in 2016 and 2017. Independently, the Shanghai government formulated local regulations, including the Shanghai Online Catering Service Supervision and Management Measures, to strengthen food safety supervision in this megacity with the largest catering sector in China. This study explored factors that influence consumer perceptions of the performance of online catering food safety regulations using survey data from 1050 respondents collected in 2019. The results indicate that consumers believe that Shanghai's online catering industry has improved by varying degrees in terms of food freshness, ingredient traceability, foreign matter control, food temperature control, internal packaging hygiene and environmental protection, and satisfaction with food safety. The factors that influenced the listed features include the number and effectiveness of government-issued regulations regarding the online catering sector, effectiveness of ordering platform food safety regulations, employee training frequency, employee food safety awareness, delivery box cleanliness and courier personal hygiene, consumer trust in ordering platform services, and consumer confidence in government supervision. These factors significantly and positively affected the consumers' perceptions of the performance of food safety regulations in the online catering sector.
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Affiliation(s)
- Weijun Liu
- College of Economics and Management, Shanghai Ocean University, 999 Huchenghuan Road, Shanghai 201306, China; (W.L.)
- Shanghai Social Survey Center, Shanghai Ocean University Branch, 999 Huchenghuan Road, Shanghai 201306, China
| | - Yige Wu
- College of Economics and Management, Shanghai Ocean University, 999 Huchenghuan Road, Shanghai 201306, China; (W.L.)
- Shanghai Social Survey Center, Shanghai Ocean University Branch, 999 Huchenghuan Road, Shanghai 201306, China
| | - Yue Sun
- College of Economics and Management, Shanghai Ocean University, 999 Huchenghuan Road, Shanghai 201306, China; (W.L.)
- Shanghai Social Survey Center, Shanghai Ocean University Branch, 999 Huchenghuan Road, Shanghai 201306, China
| | - Wojciech J. Florkowski
- Department of Agricultural & Applied Economics, University of Georgia, 1109 Experiment Street, 212 Stuckey, Griffin, GA 30223-1797, USA
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Tapsoba VA, Compaore EWR, Zeba AN, Some JW, Manga JS, Diouf A, Moubarac JC, Vandevijvere S, Dicko MH. Food environment in Burkina Faso: priority actions recommended to the government using Food-EPI tool. Front Nutr 2024; 11:1420323. [PMID: 39091684 PMCID: PMC11293057 DOI: 10.3389/fnut.2024.1420323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction The food environment is an important factor in the efforts of countries worldwide to achieve a transition to sustainable food systems. The objective of this study is to formulate and prioritize actions to be addressed to the government of Burkina Faso for the creation of a healthy food environment, which will contribute to reducing malnutrition in all its forms and non-communicable diseases. Methods National experts were brought together to identify and prioritize actions to fill the gaps identified through a multi-step assessment process following the methodology of the Healthy Food and Environment Policy Index (Food-EPI). Results Up to 20 priority policy actions were recommended to the Burkina Faso government. Actions in the policy component focused mainly on regulation of food promotion and marketing, particularly to children, and others in the infrastructure support component focused largely on political leadership, i.e., strong and visible political support from the government to improve the food environment, population nutrition, diet-related non-communicable diseases and their inequalities. Conclusion The priority actions to be recommended to the government will strengthen advocacy for government decisions to create a healthier food environment in the country.
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Affiliation(s)
- Viviane Aurelie Tapsoba
- Laboratory of Biochemistry, Biotechnology, Food Technology and Nutrition (LABIOTAN), Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | - Ella W. R. Compaore
- Laboratory of Biochemistry, Biotechnology, Food Technology and Nutrition (LABIOTAN), Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | | | | | | | - Adama Diouf
- Laboratory for Research into Human Nutrition and Food (LARNAH), Department of Animal Biology, Faculty of Science and Technology, Cheikh Anta Diop University (UCAD), Dakar, Senegal
| | | | | | - Mamoudou Hama Dicko
- Laboratory of Biochemistry, Biotechnology, Food Technology and Nutrition (LABIOTAN), Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
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Pineda E, Atanasova P, Wellappuli NT, Kusuma D, Herath H, Segal AB, Vandevijvere S, Anjana RM, Shamim AA, Afzal S, Akter F, Aziz F, Gupta A, Hanif AA, Hasan M, Jayatissa R, Jha S, Jha V, Katulanda P, Khawaja KI, Kumarendran B, Loomba M, Mahmood S, Mridha MK, Pradeepa R, Aarthi GR, Tyagi A, Kasturiratne A, Sassi F, Miraldo M. Policy implementation and recommended actions to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): a comparative analysis in South Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 26:100428. [PMID: 39040122 PMCID: PMC11260855 DOI: 10.1016/j.lansea.2024.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/28/2024] [Accepted: 05/10/2024] [Indexed: 07/24/2024]
Abstract
Background The increasing prevalence of diet-related non-communicable diseases (NCDs) in South Asia is concerning, with type 2 diabetes projected to rise to 68%, compared to the global increase of 44%. Encouraging healthy diets requires stronger policies for healthier food environments. Methods This study reviewed and assessed food environment policies in Bangladesh, India, Pakistan, and Sri Lanka from 2020 to 2022 using the Healthy Food Environment Policy Index (Food-EPI) and compared them with global best practices. Seven policy domains and six infrastructure support domains were considered, employing 47 good practice indicators to prevent NCDs. Stakeholders from government and non-governmental sectors in South Asia (n = 148) were invited to assess policy and infrastructure support implementation using the Delphi method. Findings Implementation of food environment policies and infrastructure support in these countries was predominantly weak. Labelling, monitoring, and leadership policies received a moderate rating, with a focus on food safety, hygiene, and quality rather than obesity prevention. Key policy gaps prioritized for attention included front-of-pack labelling, healthy food subsidies, unhealthy food taxation, restrictions on unhealthy food promotion, and improvements in school nutrition standards to combat NCDs. Interpretation Urgent action is required to expand food policies beyond hygiene and food security measures. Comprehensive strategies targeting NCD prevention are crucial to combat the escalating burden of NCDs in the region. Funding This research was funded by the NIHR (16/136/68 and 132960) with aid from the UK Government for global health research. Petya Atanasova also acknowledges funding from the Economic and Social Research Council (ESRC) (ES/P000703/1). The views expressed are those of the authors and not necessarily of the NIHR, the UK government or the ESRC.
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Affiliation(s)
- Elisa Pineda
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- The George Institute for Global Health UK, School of Public Health, Imperial College London, London, United Kingdom
| | - Petya Atanasova
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Dian Kusuma
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London, United Kingdom
| | - Himali Herath
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Ministry of Health, Colombo, Sri Lanka
| | - Alexa Blair Segal
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | | | | | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Saira Afzal
- King Edward Medical University, Lahore, Pakistan
| | - Fahmida Akter
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Faiza Aziz
- King Edward Medical University, Lahore, Pakistan
| | - Ananya Gupta
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
- Institute of Endocrinology, Diabetes & Metabolism, Max Super Speciality Hospital, New Delhi, India
| | - Abu Abdullah Hanif
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Renuka Jayatissa
- Nutrition Department, Medical Research Institute, Ministry of Health, Colombo, Sri Lanka
| | - Sujeet Jha
- Institute of Diabetes, Endocrinology & Metabolism, Max Super Speciality Hospital (A Unit of Devki Devi Foundation), New Delhi, India
| | - Vinitaa Jha
- Research & Academics, Clinical Directorate, Max Healthcare, New Delhi, India
| | | | - Khadija Irfan Khawaja
- Institute of Endocrinology & Metabolism, Services Institute of Medical Sciences (SIMS), Lahore, Pakistan
| | | | - Menka Loomba
- Office of Research, Max Super Speciality Hospital (A Unit of Devki Devi Foundation), New Delhi, India
| | - Sara Mahmood
- Institute of Endocrinology & Metabolism, Services Institute of Medical Sciences (SIMS), Lahore, Pakistan
| | - Malay Kanthi Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | - Akansha Tyagi
- Office of Research, Max Super Speciality Hospital (A Unit of Devki Devi Foundation), New Delhi, India
| | | | - Franco Sassi
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
| | - Marisa Miraldo
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
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Huayta VMR, Pradeilles R, Creed-Kanashiro HM, Rousham E, Delgado D, Pareja R, Landais E, Verdezoto N, Haycraft E, Holdsworth M. Identifying priority double-duty actions to tackle the double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national experts. PLoS One 2024; 19:e0303668. [PMID: 38768151 PMCID: PMC11104715 DOI: 10.1371/journal.pone.0303668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
Multiple forms of malnutrition coexist in infants and young children (IYC) in Peru. The World Health Organization has proposed double-duty actions (DDAs) to simultaneously address undernutrition and overweight/obesity. We assessed current implementation of- and priority for- government-level actions to tackle multiple forms of malnutrition in IYC in Peru. Mapping of current policy activity was undertaken against 47 indicators of good practice for five DDAs (exclusive breastfeeding, complementary feeding, food marketing, maternal nutrition, preschool nutrition; assessed by 27 indicators) and for the enabling policy environment, i.e., 'infrastructure support' (health in all policies, platforms for interactions, financing, monitoring, governance, leadership; assessed by 20 indicators). Interviews with 16 national experts explored views on the level of and barriers to implementation of DDAs and infrastructure support, as well as their prioritisation based on likely impact and feasibility. The level of implementation of actions was categorised into two groups (agenda setting/formulation vs. implementation/evaluation). Mean scores were generated for prioritisation of DDAs and infrastructure support. Deductive qualitative analysis was undertaken to identify barriers that influence policy implementation. Only 5/27 DDA indicators were reported as fully implemented by all national experts (international code that regulates the marketing of breastmilk substitutes, iron supplementation for IYC, micronutrient powders in IYC, iron/folic acid supplementation in pregnant women, paid maternity leave). Only 1/20 infrastructure support indicator (access to nutrition information) was rated as fully implemented by all experts. Barriers to implementing DDAs and infrastructure support included: legal feasibility or lack of regulations, inadequate monitoring/evaluation to ensure enforcement, commercial influences on policymakers, insufficient resources, shifting public health priorities with the COVID-19 pandemic and political instability. The experts prioritised 12 indicators across all five DDAs and eight infrastructure support indicators. Experts highlighted the need to improve implementation of all DDAs and identified ways to strengthen the enabling policy environment.
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Affiliation(s)
| | - Rebecca Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | | | - Emily Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Doris Delgado
- Facultad de Medicina, Departamento de Nutrición, Universidad Nacional Mayor de San Marcos (UNMSM), Lima, Perú
| | | | - Edwige Landais
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Nervo Verdezoto
- School of Computer Science and Informatics, Cardiff University, Cardiff, United Kingdom
| | - Emma Haycraft
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
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Pienaah CKA, Saaka SA, Yengnone HZ, Molle MN, Luginaah I. Does government food demonstration intervention influence household dietary diversity in the Upper West Region of Ghana? PLoS One 2024; 19:e0302869. [PMID: 38718020 PMCID: PMC11078389 DOI: 10.1371/journal.pone.0302869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Dietary diversity is crucial in ensuring food and nutrition security. In low-middle-income countries, people frequently prioritize the quantity of food they consume over its quality due to a lack of availability and financial limitations. As a result, achieving dietary diversity is often overlooked in favor of ensuring adequate caloric intake. Through a social cognitive theory perspective, our study examines the relationship between food demonstrations and household dietary diversity in Ghana's Upper West Region utilizing cross-sectional survey data from 517 smallholder farmer households. The results from ordered logistic regression presented in odds ratio (OR) show that participating in food demonstrations (OR: 2.585, p<0.01), engaging in home gardening (OR: 1.932, p<0.001), having access to credit (OR: 1.609, p<0.01), self-rated good nutritional status (OR: 1.747, p<0.01), and Waala ethnicity (OR: 3.686, p<0.001) were all positively associated with high household dietary diversity. Conversely, living in the Wa West district was associated with lower dietary diversity (OR: 0.326, p<0.001). Our research findings suggest that policymakers may want to consider implementing community-based educational programs, such as home and school visits for food demonstrations and sensitizations, promoting mother-to-mother support groups for dietary diversity education, nutrition counseling services, and using role-play and local media. In addition, strengthening local agricultural policies through food banks, indigenous seed development, and mobile food markets and enhancing public-private partnerships like the Ghana Schools Feeding Programme and National Food Buffer Stock company could improve the supply chain and distribution networks for diverse food items. Implementing these interventions in the Upper West Region of Ghana could improve health, well-being, food security, and nutritional outcomes.
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Affiliation(s)
- Cornelius K. A. Pienaah
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | - Sulemana Ansumah Saaka
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | - Herwin Ziemeh Yengnone
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | | | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
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Recine E, de Castro Junior PCP, Sugai A, Gentil PC, Feldenheimer da Silva AC. The INFORMAS healthy food environment policy index in Brazil: Benchmarking, current policies, and determining priorities for the future. Obes Rev 2024; 25:e13681. [PMID: 38123471 DOI: 10.1111/obr.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Obesity and non-communicable diseases are the most important cause of death and inability in Brazil and worldwide. Public policies are an important strategy to prevent obesity. This study analysed the scope of Brazilian public policies for preventing and controlling obesity using the INFORMAS/Food-EPI protocol. METHODS The public policies evaluation was conducted based on the INFORMAS/Food-EPI protocol. Experts from academia, civil society, and government assessed the level of implementation of food policies compared with international best practices and proposed new actions to be developed nationally. The protocol consisted of five phases: (1) A comprehensive review of the implementation of food environment-related public policies; (2) validation with experts; (3) comparison of the national actions with the international best practice and due to the level of implementation; (4) list a set of actions to improve the current policies; and (5) evaluation of the actions due to their importance and achievability. RESULTS Brazilian actions were focused on monitoring, leadership, governance, and resources and financing domains. CONCLUSION The results will provide elements to support and improve the national policies that aim at the promotion of a healthy food environment and obesity prevention.
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Affiliation(s)
- Elisabetta Recine
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Brasília, Brazil
| | | | - Andrea Sugai
- Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
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Abdulai PM, Sam K, Onyena AP, Ezejiofor AN, Frazzoli C, Ekhator OC, Udom GJ, Frimpong CK, Nriagu J, Orisakwe OE. Persistent organic pollutants and heavy metals in Ghanaian environment: a systematic review of food safety implications. ENVIRONMENTAL MONITORING AND ASSESSMENT 2024; 196:376. [PMID: 38492071 DOI: 10.1007/s10661-024-12500-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/24/2024] [Indexed: 03/18/2024]
Abstract
Advances in industrial and technological innovations have led to significant socio-economic benefits, but with overwhelming negative impacts on the environment. These impacts include the infiltration of organic contaminants into soil, water, and air, posing a threat to the environment and public health. Polybrominated diphenyl ethers (PBDEs), heavy metals, and polycyclic aromatic hydrocarbons (PAHs) are increasingly released as waste, endangering the environment. In countries like Ghana, where regulations are weakly enforced, industrial waste is released uncontrollably, posing threats to public health, environmental integrity, and food systems. This study systematically evaluated existing literature on PBDEs, heavy metals, PAHs, and organic contaminant exposure in Ghana and proposes a roadmap for achieving food safety and protecting the environment and human health. The research identified high mobility of specific heavy metals and risks associated with PBDEs and PAHs in sediments, dumpsites, and various food items. Unregulated dumping of electronic waste with PBDEs raised environmental concerns. An integrated approach is needed to address the multifaceted impact of organic pollutants on public health and ecosystems. Urgent implementation of effective environmental management strategies and regulatory measures is crucial. The study proposed short- to mid-term priorities emphasising the need to foster collaboration and implementing global measures. The mid- to long-term strategy includes a national information surveillance system, local monitoring capacity development, and integrating land contamination controls with food safety legislation. These measures would mitigate risks, ensure sustainable practices, and improve overall food safety management in Ghana, serving as a model for regions facing similar challenges with diverse pollutants.
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Affiliation(s)
- Prosper Manu Abdulai
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, Port Harcourt, Choba, 5323, Nigeria
| | - Kabari Sam
- Department of Marine Environment and Pollution Control, Nigeria Maritime University, Okerenkoko, Nigeria
- School of the Environment, Geography and Geoscience, University of Portsmouth, University House, Winston Churchill Ave, Portsmouth, PO1 2UP, UK
| | - Amarachi Paschaline Onyena
- Department of Marine Environment and Pollution Control, Nigeria Maritime University, Okerenkoko, Nigeria
| | - Anthoneth Ndidi Ezejiofor
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, Port Harcourt, Choba, 5323, Nigeria
| | - Chiara Frazzoli
- Department for Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore Di Sanità, Rome, Italy
| | - Osazuwa Clinton Ekhator
- Department of Science Laboratory Technology, Faculty of Science, University of Benin, Benin City, Nigeria
| | - Godswill J Udom
- Department of Pharmacology and Toxicology, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Caleb Kesse Frimpong
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jerome Nriagu
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Orish Ebere Orisakwe
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, Port Harcourt, Choba, 5323, Nigeria.
- Advanced Research Centre, European University of Lefke, Lefke, Northern Cyprus, TR-10 Mersin, Turkey.
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Li Z, Fang Y, Zhang N, Zhu W, Chang S, Zhou S, Zhang M, Ma G. Evaluating Childhood Overweight- and Obesity-Related Food Marketing Policies in China Using the Food-Environment Policy Index (Food-EPI). Nutrients 2024; 16:482. [PMID: 38398807 PMCID: PMC10893324 DOI: 10.3390/nu16040482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE Addressing the increasing global health issue of childhood obesity, exacerbated by pervasive food marketing, this study critically evaluated China's food marketing policies in comparison with international best practices, aiming to uncover policy content and implementation gaps and inform policy enhancement strategies. METHOD Three key indicators were utilized from the Healthy Food-Environment Policy Index (Food-EPI)'s food promotion domain. A panel of experts (n = 13) from academic institutions, China Centers for Disease Control and Prevention, and the food industry assessed the Chinese government's policy scores and implementation levels concerning food marketing. Benchmarked against international best practices using the Food-EPI process, this evaluation encompassed context analysis, data collection, evidence-based policy action, government validation, policy rating, scoring, and results translation for government and stakeholders. The three chosen indicators specifically addressed childhood overweight- and obesity-related food marketing in broadcast media (Indicator 1), non-broadcast media (Indicator 2), and child gathering settings (Indicator 3). RESULTS Specifically, Indicator 1, the Single Food Marketing Indicator Score was measured at 2.31 ± 0.38, with an accompanying Food Marketing Policy Implementation Percentage of 46.2%, and Low Implementation Level. For non-broadcast mediums (Indicator 2), these metrics were gauged at 1.77 ± 0.27, 35.4%, and Low Implementation Level, respectively. In child gathering settings (Indicator 3), for efforts curbing unhealthy food promotion, a score of 2.77 ± 0.27, an implementation percentage of 55.4%, and Medium Implementation Level was obtained. Cumulatively, the overarching efficacy of food marketing policy enforcement was determined to be suboptimal, with the consolidated figures being Total Food Marketing Score as 2.28 ± 0.97, Total Food Marketing Policy Implementation Percentage as 45.6%, and Total Food Marketing Policy Implementation Level as Low. CONCLUSION Like many countries, China's food marketing policies and implementation have room for improvement when compared to international best practices. Recommendations include emphasizing nutritional legislation, fostering stakeholder collaboration, bolstering public health campaigns, and leveraging technology for stringent enforcement.
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Affiliation(s)
- Zhenhui Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
| | - Yujie Fang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
| | - Na Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Wenli Zhu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Suying Chang
- Child Health Development Section, United Nations International Children’s Emergency Fund (UNICEF) Office for China, 12 Sanlitun Lu, Chaoyang District, Beijing 100600, China;
| | - Shuyi Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
| | - Man Zhang
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
- School of Nursing, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
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Salamandane A, Malfeito-Ferreira M, Brito L. The Socioeconomic Factors of Street Food Vending in Developing Countries and Its Implications for Public Health: A Systematic Review. Foods 2023; 12:3774. [PMID: 37893667 PMCID: PMC10606777 DOI: 10.3390/foods12203774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The sale of ready-to-eat (RTE) street food represents an important source of income in many developing countries. However, these foods are frequently implicated in outbreaks of gastrointestinal diseases. Street food vendors face several constraints that hamper improvement in the microbiological quality of their products. The aim of this review was to update knowledge about the main causes of foodborne illnesses in developing countries, including the growing concern with the microbial transmission of antibiotic resistance. Following PRISMA guidelines, this systematic review was conducted on original articles published from January 2010 to July 2023. The search was carried out using Scopus, PubMed, Web of Science, Food Science and Technology Abstracts (FSTA), the International Information System for Agricultural Sciences and Technology (AGRIS), as well as isolated searches of relevant articles from Google Scholar. The initial search identified 915 articles, 50 of which were included in this systematic review. The results indicate that, in the majority of the 15 countries examined, women constitute the predominant segment of street food vendors, representing more than 55% of the total number of these vendors. In 11 countries, street food vendors under the age of 18 were identified. Most vendors had a low level of education and, consequently, were unaware of good hygiene practices when handling food. The combination of factors such as poor hygiene practices on the part of food handlers and the lack of facilities, namely, the absence of available potable water, were frequently listed as the main causes of food contamination. Enterobacteriaceae such as Escherichia coli (61.9%), Salmonella (30.1%), and Shigella spp. (9.5%), as well as Staphylococcus aureus (30.1%) and Listeria monocytogenes (14.3%), were the most common pathogens found in RTE street foods. In 22 studies from 13 developing countries, 59% (13/22) reported high multidrug resistance in Enterobacteriaceae (40% to 86.4% in E. coli, 16.7 to 70% in Salmonella, and 31 to 76.4% in S. aureus). To address the challenges faced by street vendors and improve their economic activities, it is necessary for government entities, consumers, and vendors to work together collaboratively.
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Affiliation(s)
- Acácio Salamandane
- Linking Landscape, Environment, Agriculture and Food (LEAF) Research Centre, Associate Laboratory TERRA, Instituto Superior de Agronomia, Universidade de Lisboa, Tapada da Ajuda, 1349-017 Lisbon, Portugal; (M.M.-F.); (L.B.)
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Weil K, Coulibaly I, Fuelbert H, Herrmann A, Millogo RM, Danquah I. Dietary patterns and their socioeconomic factors of adherence among adults in urban Burkina Faso: a cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:107. [PMID: 37817202 PMCID: PMC10566033 DOI: 10.1186/s41043-023-00451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/03/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Sub-Saharan African populations undergo a nutrition transition towards diets associated with increased risk for metabolic and cardiovascular diseases. For targeted prevention, we aimed to characterize dietary patterns and determine their sociodemographic factors of adherence. METHODS We recruited 1,018 adults aged > = 25 years from two formal and three informal settlements within the Health and Demographic Surveillance System, Ouagadougou, Burkina Faso, between February and April 2021. In a cross-sectional sample, a culture-specific food-propensity questionnaire with 134 food items and a sociodemographic questionnaire were used to collect the data. Exploratory dietary patterns were derived using principal component analysis, and sociodemographic factors of adherence were calculated using multivariable linear regression models. RESULTS In this study population (median age: 42 years, interquartile range 21 years; male: 35.7%), the diet relied on starchy foods and other plant-based staples with rare consumption of animal-based products. We identified three dietary patterns, explaining 10.2%, 9.8%, and 8.9% of variation in food intake, respectively: a meat and egg-based pattern associated with younger age, male sex, better education, and economic situation; a fish-based pattern prevailed among women, higher educational levels, and better economic situation; and a starchy food-based was associated with younger age and sharing a home with other adults. CONCLUSIONS This study population is at an early stage of the nutrition transition and shows low intakes of health-beneficial food groups. Yet, progress along the nutrition transition varies according to age, educational attainment, and economic status. Particularly, younger and well-off people seem to adhere more strongly to diets high in animal-based products. These findings can inform strategies in public health nutrition for sub-Saharan African populations.
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Affiliation(s)
- Konstantin Weil
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
| | - Issa Coulibaly
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Hannah Fuelbert
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Alina Herrmann
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Roch Modeste Millogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
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Laar A, Amoah JM, Massawudu LM, Pereko KKA, Yeboah-Nkrumah A, Amevinya GS, Nanema S, Odame EA, Agyekum PA, Mpereh M, Sandaare S. Making food-related health taxes palatable in sub-Saharan Africa: lessons from Ghana. BMJ Glob Health 2023; 8:e012154. [PMID: 37813441 PMCID: PMC10565179 DOI: 10.1136/bmjgh-2023-012154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/05/2023] [Indexed: 10/13/2023] Open
Abstract
Amidst high burden of infectious diseases, undernutrition and micronutrient deficiencies, non-communicable diseases (NCDs) are predicted to become the leading cause of death in Ghana by 2030. NCDs are driven, to a large extent, by unhealthy food environments. Concerned, the Ghana Ministry of Health (MOH) has since 2012 sought to garner the support of all to address this challenge. We aimed to support the MOH to address the challenge through public health policy measures, but would soon be reminded that longstanding challenges to policy development such as data poverty, and policy inertia needed to be addressed. To do this, the we generated the needed evidence, curated the evidence, and availed the evidence to Ghanaian policymakers, researchers and civil society actors. Thus, we addressed the problem of data poverty using context-relevant research, and policy inertia through advocacy and scholar activism. In this paper, we share how a public interest coalition used context-relevant research, evidence-informed advocacy and scholar activism to valorise and increase demand for healthy food policy (including food-related health taxes) in Ghana.
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Affiliation(s)
- Amos Laar
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | | | | | | | - Annabel Yeboah-Nkrumah
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Gideon S Amevinya
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Silver Nanema
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Emmanuel Ankrah Odame
- Ghana Ministry of Health, Accra, Greater Accra, Ghana
- Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Mary Mpereh
- National Development Planning Commission, Accra, Greater Accra, Ghana
| | - Sebastian Sandaare
- Parliament of Ghana, Accra, Accra, Ghana
- Coalition of Actors for Public Health Advocacy, Accra, Ghana
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Tandoh A, Laar A, Pradeilles R, Le Port A, Osei-Kwasi H, Amevinya GS, Aryeetey RNO, Agyemang C, Holdsworth M. Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal. BMJ Open 2023; 13:e075166. [PMID: 37770260 PMCID: PMC10546112 DOI: 10.1136/bmjopen-2023-075166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE This study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4-15 years) in Greater Accra Region, the highly urbanised administrative capital of Ghana. DESIGN The community readiness model was used to conduct in-depth mixed methods interviews with stakeholders. Using predefined anchored rating statements, quantitative readiness scores ranging from 1 to 9 were generated. Thematic qualitative analysis was undertaken to understand barriers and facilitators that could influence the implementation of interventions. SETTING Greater Accra Region, Ghana. PARTICIPANTS 18 key informants from various school/education/citizen sectors, which together represented the 'school community' of Greater Accra Region. RESULTS The mean readiness scores indicated that the 'school community' was at the 'preplanning' stage of readiness (4.44±0.98) to address the marketing and availability of unhealthy food and beverages in and around schools. The mean readiness score for 'leadership' was the highest of all dimensions (5.36±1.60), corresponding to the 'preparation' stage. The lowest scores were found for 'community knowledge of efforts' (3.19±2.45) and 'resources for efforts' (3.64±0.87), both of which were at a 'vague awareness' stage. CONCLUSIONS The 'school community' recognised that the marketing and availability of unhealthy food and beverages was a problem. Additionally, current leadership was actively supportive of continuing/improving efforts that create healthier children's food environments. However, actions that aim to increase the 'school community's' knowledge of existing interventions and securing resources to sustain those interventions are needed before introducing readiness appropriate strategies.
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Affiliation(s)
- Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Rebecca Pradeilles
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Agnes Le Port
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Hibbah Osei-Kwasi
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Gideon Senyo Amevinya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Richmond Nii Okai Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
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Owusu MF, Adu J, Dortey BA. "I tell you, getting data for this is hell"-Exploring the use of evidence for noncommunicable disease policies in Ghana. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002308. [PMID: 37616207 PMCID: PMC10449463 DOI: 10.1371/journal.pgph.0002308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
After several years of over concentration on communicable diseases, Ghana has finally made notable strides in the prevention of NCDs by introducing key policies and programmes. Evident shows that there is limited NCD-related data on mortality and risk factors to inform NCD policy, planning, and implementation in Ghana. We explored the evidence base for noncommunicable disease policies in Ghana. A qualitative approach was adopted using key informant interviews and documents as data sources. An adaptation of the framework method for analysing qualitative data by Gale and colleagues' (2013) was used to analyse data. Our findings show that effort has been made in terms of institutions and systems to provide evidence for the policy process with the creation of the Centre for Health Information Management and the District Health Information Management System. Although there is overreliance on routine facility data, policies have also been framed using surveys, burden of disease estimates, monitoring reports, and systematic reviews. There is little emphasis on content analysis, key informant interviews, case studies, and implementation science techniques in the policy process of Ghana. Inadequate and poor data quality are key challenges that confront policymakers. Ghana has improved its information infrastructure but access to quality noncommunicable disease data remains a daunting challenge. A broader framework for the integration of different sources of data such as verbal autopsies and natural experiments is needed while strengthening existing systems. This, however, requires greater investments in personnel and logistics at national and district levels.
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Affiliation(s)
- Mark Fordjour Owusu
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Joseph Adu
- Department of Health and Rehabilitation, Western University, London, Ontario, Canada
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Pineda E, Poelman MP, Aaspõllu A, Bica M, Bouzas C, Carrano E, De Miguel-Etayo P, Djojosoeparto S, Blenkuš MG, Graca P, Geffert K, Hebestreit A, Helldan A, Henjum S, Huseby CS, Gregório MJ, Kamphuis C, Laatikainen T, Løvhaug AL, Leydon C, Luszczynska A, Mäki P, Martínez JA, Raulio S, Romaniuk P, Roos G, Salvador C, Sassi F, Silano M, Sotlar I, Specchia ML, de Arriaga MT, Terragni L, Torheim LE, Tur JA, von Philipsborn P, Harrington JM, Vandevijvere S. Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries. Lancet Reg Health Eur 2022; 23:100522. [PMID: 36405402 PMCID: PMC9673115 DOI: 10.1016/j.lanepe.2022.100522] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Food environments have been recognised as highly influential on population diets. Government policies have great potential to create healthy food environments to promote healthy diets. This study aimed to evaluate food environment policy implementation in European countries and identify priority actions for governments to create healthy food environments. Methods The Healthy Food Environment Policy Index (Food-EPI) was used to evaluate the level of food environment policy and infrastructure support implementation in Estonia, Finland, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Slovenia, and Spain in 2019–2021. Evidence of implementation of food environment policies was compiled in each country and validated by government officials. National experts evaluated the implementation of policies and identified priority recommendations. Findings Finland had the highest proportion (32%, n = 7/22) of policies shaping food environments with a “high” level of implementation. Slovenia and Poland had the highest proportion of policies rated at very low implementation (42%, n = 10/24 and 36%, n = 9/25 respectively). Policies regarding food provision, promotion, retail, funding, monitoring, and health in all policies were identified as the most important gaps across the European countries. Experts recommended immediate action on setting standards for nutrients of concern in processed foods, improvement of school food environments, fruit and vegetable subsidies, unhealthy food and beverage taxation, and restrictions on unhealthy food marketing to children. Interpretation Immediate implementation of policies and infrastructure support that prioritize action towards healthy food environments is urgently required to tackle the burden of obesity and diet-related non-communicable diseases in Europe. Funding This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative “A Healthy Diet for a Healthy Life”.
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Allen LN, Wild CEK, Loffreda G, Kak M, Aghilla M, Emahbes T, Bonyani A, Hatefi A, Herbst C, El Saeh HM. Non-communicable disease policy implementation in Libya: A mixed methods assessment. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000615. [PMID: 36962549 PMCID: PMC10021530 DOI: 10.1371/journal.pgph.0000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/09/2022] [Indexed: 11/12/2022]
Abstract
The Libyan Ministry of Health is keen to understand how it can introduce policies to protect its population from non-communicable diseases (NCDs). We aimed to perform an implementation research assessment of the current situation, including challenges and opportunities. We used an explanatory sequential mixed methods design. We started with a quantitative assessment of NCD policy performance based on review of the WHO NCD Progress Monitor Reports. Once we had identified Libya's NCD policy gaps we performed a systematic review to identify international lessons around barriers and successful strategies for the policies Libya has not yet implemented. Finally, we performed a series of key stakeholder interviews with senior policymakers to explore their perspectives around promising policy actions. We used a realist paradigm, methods triangulation, and a joint display to synthesise the interpretation of our findings and develop recommendations. Libya has not fully implemented any of the recommended policies for diet, physical activity, primary care guidelines & therapeutics, or data collection, targets & surveillance. It does not have robust tobacco policies in place. Evidence from the international literature and policymaker interviews emphasised the centrality of according strong political leadership, governance structures, multisectoral engagement, and adequate financing to policy development activities. Libya's complex political and security situation are major barriers for policy implementation. Whilst some policies will be very challenging to develop and deploy, there are a number of simple policy actions that could be implemented with minimum effort; from inviting WHO to conduct a second STEPS survey, to signing the international code on breast-milk substitutes. Like many other fragile and conflict-affected states, Libya has not accorded NCDs the policy attention they demand. Whilst strong high-level leadership is the ultimate key to providing adequate protections, there are a range of simple measures that can be implemented with relative ease.
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Affiliation(s)
- Luke N. Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cervantée E. K. Wild
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Giulia Loffreda
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - Mohini Kak
- World Bank Middle East and North Africa, Tunisia
| | | | | | | | - Arian Hatefi
- World Bank Middle East and North Africa, Washington, DC, United States of America
| | | | - Haider M. El Saeh
- Libya National Centre for Disease Control, Tajoura, Libya
- University of Tripoli, Tripoli, Libya
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Nanema S, Adjei A, Amevinya GS, Laar A. "Some are healthy and others not": Characterization of vended food products by Accra-based food retailers. Front Public Health 2022; 10:941919. [PMID: 36408024 PMCID: PMC9669954 DOI: 10.3389/fpubh.2022.941919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background and objectives Increasing the availability of healthy foods within food retail outlets can improve consumers' food environments. Such actions or inactions by food retailers may affect people's food purchasing and consumption behavior. This study explored Accra-based food retailers' perceptions and appreciation of "healthiness of food" as a concept. It also documented measures that food retailers adopt to encourage healthy food choices. Methods In-person semi-structured interviews were conducted with owners and managers of Accra-based supermarkets (n = 7) and corner stores (n = 13) in March 2021. The interviews were recorded, transcribed, coded, and analyzed thematically. Results The retailers' understanding of healthy food, or lack thereof, is exemplified by such expressions as "health, absence of disease, longevity, balanced diet, diversity, sanitation, and certification." A handful of retailers described what they sell as "products that meet consumer needs," "harmless," or "generally good." Very few retailers described the food they sell as "junk," high in sugar, fat, and salt, or energy-dense but nutrient poor foods, or as food that could pose some health risk to consumers. However, some retailers indicated that they advise their customers against the overconsumption of some foods. Conclusion Overall, Accra-based retailers have a fair understanding of what constitutes healthy food - exhibiting limited knowledge of the connection between very salty, very sugary, and very fatty foods and health outcomes. Retailers in Accra require interventions that improve their food, health, and nutrition literacy. Improving retailers' food and nutrition literacy may improve the availability of healthier options in food retail outlets in Accra.
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Affiliation(s)
| | | | | | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Tandoh A, Aryeetey R, Agyemang C, Holdsworth M, Asiki G, Zotor F, Mensah K, Laar ME, Laryea D, Sellen D, Vandevijvere S, Laar A. The Africa Food Environment Research Network (FERN): from concept to practice. Glob Health Promot 2022:17579759221126155. [DOI: 10.1177/17579759221126155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Africa is contending with unhealthy food environments that are, in part, driving increasing rates of overweight, obesity and diet-related non-communicable diseases, alongside persistent undernutrition. This current paradigm requires expanded efforts – both in the volume and nature of empirical research, as well as the tools and capacity of those who conduct it. High quality and context-relevant research supports the development and implementation of policies that create healthy food environments. Aim and approach: This paper sets out the concept of the Africa Food Environment Research Network (FERN) initiative recently established by the Measurement, Evaluation, Accountability, and Leadership Support for non-communicable diseases (NCDs) (MEALS4NCDs) prevention project. Central to the Africa FERN initiative are: 1) building research capacity for innovative food environment research in Africa; 2) improving South–South, South–North partnerships to stimulate robust food environment research and monitoring in Africa and 3) sustaining dialogue and focusing priorities around current and future needs for enhanced food environment research and monitoring in Africa. Conclusion: The FERN initiative presents an opportune platform for researchers in Africa and the global North to weave the threads of experience and expertise for research capacity building, collaboration and advocacy, to advance food environment research.
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Affiliation(s)
- Akua Tandoh
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Richmond Aryeetey
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-food systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, University of Ghana, Legon, Ghana
| | - Matilda E. Laar
- Department of Family and Consumer Sciences, School of Agriculture, University of Ghana, Legon, Ghana
| | - Dennis Laryea
- Non-Communicable Disease Control Programme, Ghana Health Service, Accra, Ghana
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Canada
| | | | - Amos Laar
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Zhang Z, Luo Y, Zhang Z, Robinson D, Wang X. Unraveling the Role of Objective Food Environment in Chinese Elderly's Diet-Related Diseases Epidemic: Considering Both Healthy Food Accessibility and Diversity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13924. [PMID: 36360812 PMCID: PMC9658263 DOI: 10.3390/ijerph192113924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
The essential role of the objective food environment in achieving healthy aging has been widely recognized worldwide. However, the existing empirical evidence is mostly based on Western cases, and how the objective food environment associates with health outcomes among Chinese elderly remains poorly understood. By merging nationally representative micro survey data with Baidu-based spatial data on the location of food outlets, this study develops accessibility and diversity indicators to explore the relationship between food environment and diet-related diseases among Chinese elderly and investigates how healthy lifestyles moderate this relationship. The results show that improvement in healthy food accessibility and diversity decreases both the probability and the number of diet-related diseases that the elderly suffer. Having more healthy lifestyle factors is associated with a lower risk of suffering from diet-related diseases and strengthens the negative effect of healthy food environment on suffered diet-related diseases. Heterogeneity effect analysis suggests that the relationship between objective food environment and diet-related diseases differs by city scale and income level. The findings of this study shed light on designing tailor-made policies for non-Western countries to promote healthy aging.
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Affiliation(s)
- Zhaohua Zhang
- School of Economics, Tianjin University of Commerce, Tianjin 300134, China
| | - Yuxi Luo
- School of Economics and Management, Guangxi Normal University, Guilin 541004, China
| | - Zhao Zhang
- College of Information and Electrical Engineering, China Agricultural University, Beijing 100083, China
| | - Derrick Robinson
- Aquaculture Economist, National Oceanic & Atmospheric Administration, San Diego, CA 92037, USA
| | - Xin Wang
- School of Economics, Tianjin University of Commerce, Tianjin 300134, China
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Liguori J, Pradeilles R, Laar A, Zotor F, Tandoh A, Klomegah S, Osei‐Kwasi HA, Le Port A, Bricas N, Aryeetey R, Akparibo R, Griffiths P, Holdsworth M. Individual-level drivers of dietary behaviour in adolescents and women through the reproductive life course in urban Ghana: A Photovoice study. MATERNAL & CHILD NUTRITION 2022; 18:e13412. [PMID: 35938776 PMCID: PMC9480960 DOI: 10.1111/mcn.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
Evidence on the individual-level drivers of dietary behaviours in deprived urban contexts in Africa is limited. Understanding how to best inform the development and delivery of interventions to promote healthy dietary behaviours is needed. As noncommunicable diseases account for over 40% of deaths in Ghana, the country has reached an advanced stage of nutrition transition. The aim of this study was to identify individual-level factors (biological, demographic, cognitive, practices) influencing dietary behaviours among adolescent girls and women at different stages of the reproductive life course in urban Ghana with the goal of building evidence to improve targeted interventions. Qualitative Photovoice interviews (n = 64) were conducted in two urban neighbourhoods in Accra and Ho with adolescent girls (13-14 years) and women of reproductive age (15-49 years). Data analysis was both theory- and data-driven to allow for emerging themes. Thirty-seven factors, across four domains within the individual-level, were identified as having an influence on dietary behaviours: biological (n = 5), demographic (n = 8), cognitions (n = 13) and practices (n = 11). Several factors emerged as facilitators or barriers to healthy eating, with income/wealth (demographic); nutrition knowledge/preferences/risk perception (cognitions); and cooking skills/eating at home/time constraints (practices) emerging most frequently. Pregnancy/lactating status (biological) influenced dietary behaviours mainly through medical advice, awareness and willingness to eat foods to support foetal/infant growth and development. Many of these factors were intertwined with the wider food environment, especially concerns about the cost of food and food safety, suggesting that interventions need to account for individual-level as well as wider environmental drivers of dietary behaviours.
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Affiliation(s)
- Julia Liguori
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems)CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRDMontpellierFrance
| | - Rebecca Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Amos Laar
- Department of Population, Family & Reproductive Health, School of Public HealthUniversity of GhanaAccraGhana
| | - Francis Zotor
- Department of Family and Community Health, School of Public HealthUniversity of Health and Allied SciencesHoGhana
| | - Akua Tandoh
- Department of Population, Family & Reproductive Health, School of Public HealthUniversity of GhanaAccraGhana
| | - Senam Klomegah
- Department of Family and Community Health, School of Public HealthUniversity of Health and Allied SciencesHoGhana
| | | | - Agnès Le Port
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems)CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRDMontpellierFrance
| | - Nicolas Bricas
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems)CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRDMontpellierFrance
| | - Richmond Aryeetey
- Department of Population, Family & Reproductive Health, School of Public HealthUniversity of GhanaAccraGhana
| | - Robert Akparibo
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Paula Griffiths
- Centre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems)CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRDMontpellierFrance
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Amevinya GS, Vandevijvere S, Kelly B, Afagbedzi SK, Aryeetey R, Adjei AP, Quarpong W, Tandoh A, Nanema S, Agyemang C, Zotor F, Laar ME, Mensah K, Laryea D, Asiki G, Holdsworth M, Laar A. Advertising of unhealthy foods and beverages around primary and junior high schools in Ghana's most urbanized and populous region. Front Public Health 2022; 10:917456. [PMID: 36211683 PMCID: PMC9539976 DOI: 10.3389/fpubh.2022.917456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/22/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively affects their food acquisition and consumption. We examined the extent and nature of food and beverage advertising around primary and junior high schools in Ghana's most populous and urbanized region, Greater Accra. Materials and methods Outdoor advertisements for foods and beverages within a 250 m road network distance of 200 randomly sampled schools were geocoded. For each food and beverage advertisement, information was collected on the setting, type, size, and number of product types featured in the advertisement. Promotional techniques (promotional characters and premium offers) used in advertisements were documented. Advertised foods and beverages were classified using the INFORMAS and NOVA food classification systems. Results A total of 5,887 advertisements were identified around the schools surveyed, 42% of which were for foods and beverages. Advertisements were most prevalent at food outlets (78% of all food advertisements), but also along roads and on non-food structures. Overall, 70% of food advertisements featured non-core/unhealthy products, while 12 and 14% had core/healthy and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra-processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most-69% were cartoons or manufacturer's characters), while 8% of all food advertisements had premium offers (including price discounts and gift/collectables). Conclusions There is an abundance of unhealthy food advertisements around primary and junior high schools in the Greater Accra Region. Policy actions such as restricting the promotion of unhealthy foods in children's settings are needed to protect pupils from such advertising practices.
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Affiliation(s)
- Gideon Senyo Amevinya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Seth Kwaku Afagbedzi
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Akosua Pokua Adjei
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Wilhemina Quarpong
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Silver Nanema
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Matilda E. Laar
- Department Family and Consumer Sciences, School of Agriculture, University of Ghana, Accra, Ghana
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, University of Ghana, Accra, Ghana
| | - Dennis Laryea
- Non-communicable Disease Programme, Ghana Health Service, Accra, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Trübswasser U, Candel J, Genye T, Bossuyt A, Holdsworth M, Baye K, Talsma E. Benchmarking policy goals and actions for healthy food environments in Ethiopia to prevent malnutrition in all its forms using document analysis. BMJ Open 2022; 12:e058480. [PMID: 35985782 PMCID: PMC9396152 DOI: 10.1136/bmjopen-2021-058480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Unhealthy diets resulting in overweight and obesity and diet-related non-communicable diseases are of increasing concern in Ethiopia, alongside persistent undernutrition, and have been linked to unhealthy food environments. Little is known about the policy response to unhealthy food environments in Ethiopia. The objective of this study was to assess how different food environment domains have been addressed in Ethiopian policy goals and action over time and how this compares with global good practice benchmarks. SETTING Ethiopia. PRIMARY AND SECONDARY OUTCOME MEASURES We analysed intentions and plans of the government to act, using policy documents (outputs of decision-making in the form of published strategies, plans or policies) related to improving diets and nutritional status through healthy food environments in Ethiopia between 2008 and 2020. Our coding framework was guided by the policy component (n=7 domains) of the Healthy Food-Environment Policy Index, which was modified to include food quality and safety as an eighth domain. RESULTS From the 127 policy outputs identified, 38 were retained, published by 9 different government ministries and institutions. Our results show that eight food environment domains have been addressed to some extent, but gaps remain compared with global best practice, especially in food promotion, processing, retail, price and trade. From 2018, policy began to embrace the wider food system, with more explicit food environment interventions becoming apparent. CONCLUSIONS Policy efforts achieved in food safety, food processing, marketing and labelling are important stepping stones to building future policy actions addressing the food environment domains of food retail, food provision and food trade. Benchmarking of food environment policy actions should also consider actions on food fortification, agro-processing and informal markets in the context of multiple forms of malnutrition.
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Affiliation(s)
- Ursula Trübswasser
- Division of Human Nutrition and Health, Chair Group Global Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - Jeroen Candel
- Public Administration and Policy Group, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Tirsit Genye
- Ethiopia NIPN Technical Assistance Project (ENTAP), International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Anne Bossuyt
- Ethiopia NIPN Technical Assistance Project (ENTAP), International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Center on Sustainable Agri-Food Systems), (Univ. Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Elise Talsma
- Division of Human Nutrition and Health, Chair Group Global Nutrition, Wageningen University & Research, Wageningen, The Netherlands
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Ahmed A, Lazo DPL, Alatinga KA, Gasparatos A. From Ampesie to French fries: systematising the characteristics, drivers and impacts of diet change in rapidly urbanising Accra. SUSTAINABILITY SCIENCE 2022:1-25. [PMID: 35990025 PMCID: PMC9379245 DOI: 10.1007/s11625-022-01195-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
Sub-Saharan Africa (SSA) is urbanising rapidly. One of the most visible outcomes of this urbanisation process is the change in the diets of urban residents. However, diet change in the context of rapid urbanisation is a complex and multi-dimensional phenomenon that encompasses multiple intersecting historical, environmental, socioeconomic, and political aspects. This study aims to unravel and systematise the characteristics, drivers and impacts of diet changes in Accra, through the interviews of multiple stakeholders and Causal Loop Diagrams. Diet change is characterised by the increased consumption of certain foodstuff such as rice, chicken, fish, vegetable oil, sugar, and ultra-processed food (UPF), and the decreased consumption of traditional foodstuff such as roots, tubers, and some cereals such as millet. These changes are driven by multiple factors, including among others, changes in income, sociocultural practices, energy access, and policy and trade regimes, as well as the proliferation of supermarkets and food vendors. Collectively, these diet changes have a series of environmental, socioeconomic, and health/nutrition-related impacts. Our results highlight the need to understand in a comprehensive manner the complex processes shaping diet change in the context of urbanisation, as a means of identifying effective interventions to promote healthy and sustainable urban diets in SSA. The development of such intervention should embrace a multi-stakeholder perspective, considering that the relevant urban actors have radically different perspectives and interests at this interface of urbanisation and diet change. Supplementary Information The online version contains supplementary material available at 10.1007/s11625-022-01195-y.
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Affiliation(s)
- Abubakari Ahmed
- Department of Planning, Faculty of Planning and Land Management, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Denise P. Lozano Lazo
- Graduate Program in Sustainability Science, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Kennedy A. Alatinga
- Department of Community Development, Faculty of Planning and Land Management, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana
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School Food Environment in Urban Zambia: A Qualitative Analysis of Drivers of Adolescent Food Choices and Their Policy Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127460. [PMID: 35742706 PMCID: PMC9224334 DOI: 10.3390/ijerph19127460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023]
Abstract
Identifying context specific points for reforming policy to promote healthier food environments and consumer behavior in critical life stages like adolescence is crucial in addressing the double burden of malnutrition. Using a qualitative study design, we conducted 20 focus group discussions with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into two domains—the external domain (availability, pricing, vendor and product properties, and marketing and regulation of food) and the internal domain (accessibility, affordability, convenience, and desirability of food)—was used to guide thematic data analysis and results interpretation. Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers. Adolescents felt their food choice is limited to ‘cheap junk foods’ which are affordable and readily available at school. Healthy foods like fruits were said to be inaccessible and unaffordable by the majority of adolescents. Some adolescents stated they were attracted to certain foods by adverts they see on TV and social media. School food environments in urban Lusaka do not support healthy food choices. Policy reforms are required to increase access to affordable healthy food options in schools, and to curb the indiscriminate marketing of unhealthy foods to adolescents.
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Manga JS, Diouf A, Vandevijvere S, Diagne M, Kwadjode K, Dossou N, Thiam EHM, Ndiaye NF, Moubarac JC. Evaluation and prioritization of actions on food environments to address the double burden of malnutrition in Senegal: perspectives from a national expert panel. Public Health Nutr 2022; 25:1-39. [PMID: 35321762 PMCID: PMC9991729 DOI: 10.1017/s1368980022000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/09/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the extent of implementation of public policies aimed at creating healthy eating environments in Senegal compared to international best practice and identity priority actions to address the double burden of malnutrition. DESIGN The Healthy Food Environment Policy Index (Food-EPI) was used by a local expert panel to assess the level of implementation of 43 good practice policy and infrastructure support indicators against international best practices using a Likert scale and identify priority actions to address the double burden of malnutrition in Senegal. SETTING Senegal, West Africa. PARTICIPANTS A national group of independent experts from academia, civil society, non-governmental organizations and United Nations bodies (n =15) and a group of government experts from various ministries (n =16) participated in the study. RESULTS Implementation of most indicators aimed at creating healthy eating environments were rated as "low" compared to best practice (31 on 43, or 72%). The Gwet AC2 inter-rater reliability was good at 0.75 (CI 0.70 - 0.80). In a prioritization workshop, experts identified forty-five actions, prioritizing ten as relatively most feasible and important and relatively most effective to reduce the double burden of malnutrition in Senegal (example: Develop and implement regional school menus based on local products (expand to 14 regions) and measure the extent of the promotion of unhealthy foods to children). CONCLUSIONS Significant efforts remain to be made by Senegal to improve food environments. This project allowed to establish an agenda of priority actions for the government to transform food environments in Senegal to tackle the double burden of malnutrition.
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Affiliation(s)
- Julien Soliba Manga
- Division de l’Alimentation et de la Nutrition, Direction de la Santé de la Mère et de l’Enfant (DSME) du Ministère de la Santé et de l’Action Sociale, Rue FN 20, Dakar, Sénégal
- Département de Nutrition, TRANSNUT (Centre collaborateur OMS) et CRESP (Centre de Recherche en Santé Publique), Université de Montréal, 2405 Chemin de la Côte-Sainte-Catherine, MontréalH3T 1A8, Canada
| | - Adama Diouf
- Laboratoire de Recherche en Nutrition et Alimentation Humaine (LARNAH), Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | | | - Maty Diagne
- Division de l’Alimentation et de la Nutrition, Direction de la Santé de la Mère et de l’Enfant (DSME) du Ministère de la Santé et de l’Action Sociale, Rue FN 20, Dakar, Sénégal
| | - Komlan Kwadjode
- Organisation des Nations Unies pour l’Alimentation et l’Agriculture, Bureau, Dakar, Sénégal
| | - Nicole Dossou
- Laboratoire de Recherche en Nutrition et Alimentation Humaine (LARNAH), Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | | | | | - Jean-Claude Moubarac
- Département de Nutrition, TRANSNUT (Centre collaborateur OMS) et CRESP (Centre de Recherche en Santé Publique), Université de Montréal, 2405 Chemin de la Côte-Sainte-Catherine, MontréalH3T 1A8, Canada
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Akparibo R, Aryeetey RNO, Asamane EA, Osei-Kwasi HA, Ioannou E, Infield Solar G, Cormie V, Pereko KK, Amagloh FK, Caton SJ, Cecil JE. Food Security in Ghanaian Urban Cities: A Scoping Review of the Literature. Nutrients 2021; 13:nu13103615. [PMID: 34684616 PMCID: PMC8540338 DOI: 10.3390/nu13103615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/27/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
Urbanisation in Ghana could be negatively impacting the state of food security, especially in economically vulnerable groups. Food supply, safety, and quality are all aspects of food security which could be impacted. We conducted a scoping literature review to understand the nature and magnitude of evidence available on the urban food security situation in Ghana. A literature search was conducted in Medline, CINAHL, Embase, Global Health, Scopus, Web of Science, Africa Wide Information and Google Scholar to identify relevant peer-reviewed and grey literature. 45 studies, mainly cross-sectional surveys/food samples analysis, met the inclusion criteria. The majority of studies were concentrated in the Greater Accra Region (n = 24). Most studies focused on food safety and quality (n = 31). Studies on supply and stability were, however, scarce. Qualitative research methods were uncommon in the included studies. The existing literature on food security are concentrated in two regions: The Greater Accra and Ashanti regions. Future studies exploring food security in urban Ghana should focus on exploring the lived experiences and perceptions of food insecurity and food stability by urban-dwellers using qualitative methods. The evidence suggesting that the safety/quality of foods sold in Ghanaian markets is poor should be a concern to consumers and policy makers.
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Affiliation(s)
- Robert Akparibo
- School of Health and Related Research, The University of Sheffield, Sheffield S10 2TN, UK; (E.I.); (S.J.C.)
- Correspondence: (R.A.); (J.E.C.)
| | | | - Evans Atiah Asamane
- Institute of Applied Health, University of Birmingham, Birmingham B15 2TT, UK;
| | | | - Elysa Ioannou
- School of Health and Related Research, The University of Sheffield, Sheffield S10 2TN, UK; (E.I.); (S.J.C.)
- Sports and Physical Activity Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK
| | | | - Vicki Cormie
- University Library, University of St Andrews, St Andrews KY16 9AJ, UK;
| | | | - Francis Kweku Amagloh
- Food Science and Technology Department, University for Development Studies, Tamale, Ghana;
| | - Samantha J. Caton
- School of Health and Related Research, The University of Sheffield, Sheffield S10 2TN, UK; (E.I.); (S.J.C.)
| | - Joanne E. Cecil
- School of Medicine, University of St Andrews, St Andrews KY16 9AJ, UK
- Correspondence: (R.A.); (J.E.C.)
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Laar A, Kelly B, Holdsworth M, Quarpong W, Aryeetey R, Amevinya GS, Tandoh A, Agyemang C, Zotor F, Laar ME, Mensah K, Laryea D, Asiki G, Pradeilles R, Sellen D, L'Abbe MR, Vandevijvere S. Providing Measurement, Evaluation, Accountability, and Leadership Support (MEALS) for Non-communicable Diseases Prevention in Ghana: Project Implementation Protocol. Front Nutr 2021; 8:644320. [PMID: 34485355 PMCID: PMC8416277 DOI: 10.3389/fnut.2021.644320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/12/2021] [Indexed: 01/22/2023] Open
Abstract
Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support public sector actions that create healthy food marketing, retail, and provisioning environments for Ghanaian children using adapted methods from the International Network for Food and Obesity/NCDs Research Monitoring and Action Support (INFORMAS). Methods: The protocol for this observational study draws substantially from the INFORMAS' Food Promotion and Food Provision Modules. However, to appraise the readiness of local communities to implement interventions with strong potential to improve food environments of Ghanaian children, the MEALS4NCDs protocol has innovatively integrated a local community participatory approach based on the community readiness model (CRM) into the INFORMAS approaches. The setting is Ghana, and the participants include health and nutrition policy-makers, nutrition and food service providers, consumers, school authorities, and pupils of Ghanaian basic schools. Results: The study establishes a standardized approach to providing implementation science evidence for the prevention of non-communicable diseases (NCDs) in Ghana. It demonstrates feasibility and the innovative application of the INFORMAS expanded food promotion and food provision modules, together with the integration of the CRM in a lower-middle income setting. Conclusion: The research will facilitate the understanding of the processes through which the INFORMAS approach is contextualized to a lower-middle income African context. The protocol could be adapted for similar country settings to monitor relevant aspects of food environments of children.
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Affiliation(s)
- Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Wilhemina Quarpong
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Gideon Senyo Amevinya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Matilda E Laar
- Department Family and Consumer Sciences, School of Agriculture, University of Ghana, Accra, Ghana
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, University of Ghana, Accra, Ghana
| | - Dennis Laryea
- Non-communicable Disease Programme, Ghana Health Service, Accra, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Mary R L'Abbe
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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Fears R, Abdullah KAB, Canales-Holzeis C, Caussy D, Haines A, Harper SL, McNeil JN, Mogwitz J, ter Meulen V. Evidence-informed policy for tackling adverse climate change effects on health: Linking regional and global assessments of science to catalyse action. PLoS Med 2021; 18:e1003719. [PMID: 34283834 PMCID: PMC8330928 DOI: 10.1371/journal.pmed.1003719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Robin Fears and co-authors discuss evidence-informed regional and global policy responses to health impacts of climate change.
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Affiliation(s)
| | | | | | - Deoraj Caussy
- Integrated Epidemiology Solutions, Ebene Reduit, Mauritius
| | - Andy Haines
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, United Kingdom
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Constantinides SV, Turner C, Frongillo EA, Bhandari S, Reyes LI, Blake CE. Using a global food environment framework to understand relationships with food choice in diverse low- and middle-income countries. GLOBAL FOOD SECURITY 2021. [DOI: 10.1016/j.gfs.2021.100511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Carducci B, Oh C, Roth DE, Neufeld LM, Frongillo EA, L'Abbe MR, Fanzo J, Herforth A, Sellen DW, Bhutta ZA. Gaps and priorities in assessment of food environments for children and adolescents in low- and middle-income countries. NATURE FOOD 2021; 2:396-403. [PMID: 37118231 DOI: 10.1038/s43016-021-00299-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/06/2021] [Indexed: 04/30/2023]
Abstract
School-aged children and adolescents have complex interactions with their food environments-the point of engagement of individuals with the food system-and are influenced by a diversity of individual, household and organizational factors. Although a wide range of methods have been proposed to define, monitor and evaluate food environments, few are tailored to school-aged children and adolescents. Here, we interrogate published literature on food metrics and methodologies for the characterization of food environments for school-aged children and adolescents living in low- and middle-income counties. We identify key priority actions and potential indicators for better monitoring and evaluation to galvanize policymaking to improve the healthiness of these interactions, which are so crucial to future adult well-being.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christina Oh
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel E Roth
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public, Health University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
| | | | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Mary R L'Abbe
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Fanzo
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Nitze School of Advanced International Studies, Johns Hopkins University, Washington DC, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Herforth
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Daniel W Sellen
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Peter Gilgan Centre for Research, Learning Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
- Dalla Lana School of Public, Health University of Toronto, Toronto, Ontario, Canada.
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan.
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Laar A. The role of food environment policies in making unhealthy foods unattractive and healthy foods available in Africa. EClinicalMedicine 2021; 36:100908. [PMID: 34041465 PMCID: PMC8144727 DOI: 10.1016/j.eclinm.2021.100908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
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Osei-Kwasi HA, Laar A, Zotor F, Pradeilles R, Aryeetey R, Green M, Griffiths P, Akparibo R, Wanjohi MN, Rousham E, Barnes A, Booth A, Mensah K, Asiki G, Kimani-Murage E, Bricas N, Holdsworth M. The African urban food environment framework for creating healthy nutrition policy and interventions in urban Africa. PLoS One 2021; 16:e0249621. [PMID: 33886599 PMCID: PMC8061920 DOI: 10.1371/journal.pone.0249621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/22/2021] [Indexed: 01/28/2023] Open
Abstract
This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and intervention development in Africa. A multi-component methodology, drawing on concept mapping, was employed to construct a framework of factors influencing dietary behaviours in urban Africa. The framework adapted a widely used socio-ecological model (developed in a high-income country context) and was developed using a mixed-methods research approach that comprised: i. Evidence synthesis consisting of a systematic review of 39 papers covering 14 African countries; ii. Qualitative interview data collected for adolescents and adults (n = 144) using photovoice in urban Ghana and Kenya; and iii. Consultation with interdisciplinary African experts (n = 71) from 27 countries, who contributed to at least one step of the framework (creation, validation/evaluation, finalisation). The final framework included 103 factors influencing dietary behaviours. Experts identified the factors influencing dietary behaviours across all the four levels of the food environment i.e. the individual, social, physical and macro levels. Nearly half (n = 48) were individual-level factors and just under a quarter (n = 26) were at the macro environmental level. Fewer factors associated with social (n = 15) and physical (14) environments were identified. At the macro level, the factors ranked as most important were food prices, cultural beliefs and seasonality. Factors ranked as important at the social level were household composition, family food habits and dietary practices. The type of food available in the neighbourhood and convenience were seen as important at the physical level, while individual food habits, food preferences and socioeconomic status were ranked highly at the individual level. About half of the factors (n = 54) overlap with those reported in an existing socio-ecological food environment framework developed in a high-income country context. A further 49 factors were identified that were not reported in the selected high-income country framework, underlining the importance of contextualisation. Our conceptual framework offers a useful tool for research to understand dietary transitions in urban African adolescents and adults, as well as identification of factors to intervene when promoting healthy nutritious diets to prevent multiple forms of malnutrition.
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Affiliation(s)
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Mark Green
- Department of Geography & Planning, University of Liverpool, Liverpool, United Kingdom
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Robert Akparibo
- School of Health and Related Research-ScHARR, University of Sheffield, Sheffield, United Kingdom
| | | | - Emily Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Amy Barnes
- School of Health and Related Research-ScHARR, University of Sheffield, Sheffield, United Kingdom
| | - Andrew Booth
- School of Health and Related Research-ScHARR, University of Sheffield, Sheffield, United Kingdom
| | - Kobby Mensah
- University of Ghana Business school, Accra, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Nicolas Bricas
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
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Bosu WK, Bosu DK. Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis. PLoS One 2021; 16:e0248137. [PMID: 33667277 PMCID: PMC7935309 DOI: 10.1371/journal.pone.0248137] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension is a major health problem in Ghana, being a leading cause of admissions and deaths in the country. In the context of a changing food and health policy environment, we undertook a systematic review (PROSPERO registration number: CRD42020177174) and a meta-analysis of the prevalence of adult hypertension, and its awareness and control in Ghana. METHODS We searched major databases including PubMed, Embase as well as Google Scholar and online digital collections of public universities of Ghana to locate relevant published and unpublished community-based articles up till April 2020. FINDINGS Eighty-five articles involving 82,045 apparently-healthy subjects aged 15-100 years were analyzed. In individual studies, the prevalence of hypertension, defined in most cases as blood pressure ≥ 140/90 mmHg, ranged from 2.8% to 67.5%. The pooled prevalence from the meta-analysis was 27.0% (95% CI 24.0%-30.0%), being twice as high in the coastal (28%, 95% CI: 24.0%-31.0%) and middle geo-ecological belts (29%, 95% CI: 25.0%-33.0%) as in the northern belt (13%, 95% CI: 7.0%-21.0%). The prevalence was similar by sex, urban-rural residence or peer-review status of the included studies. It did not appear to vary over the study year period 1976-2019. Of the subjects with hypertension, only 35% (95% CI: 29.0%-41.0%) were aware of it, 22% (95% CI: 16.0%-29.0%) were on treatment and 6.0% (95% CI: 3.0%-10.0%) had their blood pressure controlled. Sensitivity analyses corroborated the robust estimates. There was, however, high heterogeneity (I2 = 98.7%) across the studies which was partly explained by prevalent obesity in the subjects. CONCLUSION More than one in four adults in Ghana have hypertension. This high prevalence has persisted for decades and is similar in rural and urban populations. With the low awareness and poor control of hypertension, greater investments in cardiovascular health are required if Ghana is to meet the global target for hypertension.
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Affiliation(s)
- William Kofi Bosu
- Department of Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Burkina Faso
| | - Dary Kojo Bosu
- Department of Paediatrics, St Dominic’s Hospital, Akwatia, Ghana
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Hawkes C, Fox E, Downs SM, Fanzo J, Neve K. Child-centered food systems: Reorienting food systems towards healthy diets for children. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100414] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Menyanu E, Corso B, Minicuci N, Rocco I, Zandberg L, Baumgartner J, Russell J, Naidoo N, Biritwum R, Schutte AE, Kowal P, Charlton K. Salt-reduction strategies may compromise salt iodization programs: Learnings from South Africa and Ghana. Nutrition 2020; 84:111065. [PMID: 33450677 DOI: 10.1016/j.nut.2020.111065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Universal salt iodization has been adopted by many countries to address iodine deficiency. More recently, salt-reduction strategies have been widely implemented to meet global salt intake targets of <5 g/d. Compatibility of the two policies has yet to be demonstrated. This study compares urinary iodine excretion (UIE) according to 24-h urinary sodium excretion, between South Africa (SA) and Ghana; both countries have implemented universal salt iodization, but in Ghana no salt-reduction legislation has been implemented. METHODS Participants from the World Health Organization's Study on Global Ageing and Adult Health Wave 3, with survey and valid 24-h urinary data (Ghana, n = 495; SA, n = 707), comprised the sample. Median 24-h UIE was compared across salt intake categories of <5, 5-9 and >9 g/d. RESULTS In Ghana, median sodium excretion indicated a salt intake of 10.7 g/d (interquartile range [IQR] = 7.6), and median UIE was 182.4 µg/L (IQR = 162.5). In SA, both values were lower: median salt = 5.6 g/d (IQR = 5.0), median UIE = 100.2 µg/L (IQR = 129.6). UIE differed significantly across salt intake categories (P < 0.001) in both countries, with positive correlations observed in both-Ghana: r = 0.1501, P < 0.0011; South Africa: r = 0.4050, P < 0.0001. Participants with salt intakes <9 g/d in SA did not meet the World Health Organization's recommended iodine intake of 150 µg/d, but this was not the case in Ghana. CONCLUSIONS Monitoring and surveillance of iodine status is recommended in countries that have introduced salt-reduction strategies, in order to prevent reemergence of iodine deficiency.
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Affiliation(s)
- Elias Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Nadia Minicuci
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Ilaria Rocco
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Lizelle Zandberg
- Centre for Excellence in Nutrition, North West University, Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Centre for Excellence in Nutrition, North West University, Potchefstroom, South Africa; Human Nutrition Laboratory, Department of Health Sciences and Technology, Institute of Food, Nutrition and Health, Zurich, Switzerland
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nirmala Naidoo
- World Health Organization, Data, Analytics and Delivery for Impact Division, Geneva, Switzerland
| | | | - Aletta E Schutte
- School of Public Health and Community Medicine, University of New South Wales; The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Paul Kowal
- Chiang Mai University, Research Institute for Health Sciences, Chiang Mai, Thailand; World Health Organization, SAGE, Geneva, Switzerland
| | - Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.
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Holdsworth M, Pradeilles R, Tandoh A, Green M, Wanjohi M, Zotor F, Asiki G, Klomegah S, Abdul-Haq Z, Osei-Kwasi H, Akparibo R, Bricas N, Auma C, Griffiths P, Laar A. Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: Evidence for policy action from Ghana and Kenya. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2020; 26:100452. [PMID: 33324537 PMCID: PMC7726234 DOI: 10.1016/j.gfs.2020.100452] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/19/2020] [Accepted: 10/08/2020] [Indexed: 01/16/2023]
Abstract
Growing urbanisation in Africa is accompanied by rapid changes in food environments, with potential shifts towards unhealthy food/beverage consumption, including in socio-economically disadvantaged populations. This study investigated how unhealthy food and beverages are embedded in everyday life in deprived areas of two African countries, to identify levers for context relevant policy. Deprived neighbourhoods (Ghana: 2 cities, Kenya: 1 city) were investigated (total = 459 female/male, adolescents/adults aged ≥13 y). A qualitative 24hr dietary recall was used to assess the healthiness of food/beverages in relation to eating practices: time of day and frequency of eating episodes (periodicity), length of eating episodes (tempo), and who people eat with and where (synchronisation). Five measures of the healthiness of food/beverages in relation to promoting a nutrient-rich diet were developed: i. nutrients (energy-dense and nutrient-poor -EDNP/energy-dense and nutrient-rich -EDNR); and ii. unhealthy food types (fried foods, sweet foods, sugar sweetened beverages (SSBs). A structured meal pattern of three main meals a day with limited snacking was evident. There was widespread consumption of unhealthy food/beverages. SSBs were consumed at three-quarters of eating episodes in Kenya (78.5%) and over a third in Ghana (36.2%), with those in Kenya coming primarily from sweet tea/coffee. Consumption of sweet foods peaked at breakfast in both countries. When snacking occurred (more common in Kenya), it was in the afternoon and tended to be accompanied by a SSB. In both countries, fried food was an integral part of all mealtimes, particularly common with the evening meal in Kenya. This includes consumption of nutrient-rich traditional foods/dishes (associated with cultural heritage) that were also energy-dense: (>84% consumed EDNR foods in both countries). The lowest socio-economic groups were more likely to consume unhealthy foods/beverages. Most eating episodes were <30 min (87.1% Ghana; 72.4% Kenya). Families and the home environment were important: >77% of eating episodes were consumed at home and >46% with family, which tended to be energy dense. Eating alone was also common as >42% of eating episodes were taken alone. In these deprived settings, policy action to encourage nutrient-rich diets has the potential to prevent multiple forms of malnutrition, but action is required across several sectors: enhancing financial and physical access to healthier foods that are convenient (can be eaten quickly/alone) through, for example, subsidies and incentives/training for local food vendors. Actions to limit access to unhealthy foods through, for example, fiscal and advertising policies to dis-incentivise unhealthy food consumption and SSBs, especially in Ghana. Introducing or adapting food-based dietary guidelines to incorporate advice on reducing sugar and fat at mealtimes could be accompanied by cooking skills interventions focussing on reducing frying/oil used when preparing meals, including 'traditional' dishes and reducing the sugar content of breakfast.
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Affiliation(s)
- Michelle Holdsworth
- French National Research Institute for Sustainable Development (IRD), NUTRIPASS Unit: IRD-Univ Montpellier-SupAgro, Montpellier, France
- Corresponding author. Joint Research Unit on Food and Nutrition Research in the Global South (UMR NUTRIPASS), French National Research Institute for Sustainable Development (IRD), 911 av. Agropolis, 34394, Cedex 5, Montpellier, France.
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - Akua Tandoh
- School of Public Health, University of Ghana, Accra, Ghana
| | - Mark Green
- School of Environmental Sciences, University of Liverpool, Liverpool, UK
| | - Milkah Wanjohi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Gershim Asiki
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Zakia Abdul-Haq
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Robert Akparibo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nicolas Bricas
- French Agricultural Research Centre for International Development (CIRAD), Montpellier, France
| | - Carol Auma
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - Amos Laar
- School of Public Health, University of Ghana, Accra, Ghana
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Ogum-Alangea D, Aryeetey RNO, Gray HL, Laar AK, Adanu RMK. Basic school pupils' food purchases during mid-morning break in urban Ghanaian schools. PLoS One 2020; 15:e0238308. [PMID: 32870945 PMCID: PMC7462272 DOI: 10.1371/journal.pone.0238308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Unhealthy food vending can expose children to malnutrition and other diet related challenges such as obesity. This study sought to describe types and sources of food in basic schools in urban Accra, and to describe food purchases by pupils. METHODS This was a cross-sectional study of five basic schools (3 public; 2 private) and 644 pupils in the Ga-East Municipality in Ghana. Check-lists were used to document available sources of foods during school hours. Pupils were intercepted after making purchases during breaktime and the type, cost and sources of foods purchased documented. Energy content of foods were read from labels when available or estimated using the Ghana Food Composition database when unlabelled. Frequencies and crosstabs were used to compare food type by source and school type. RESULTS Foods were purchased from school canteen, school store, private stores, and 'table-top' vendors. Meals were most frequently purchased (38%) although single purchases were sweetened drinks, savoury snacks and confectioneries. About 53% of retailers located within the schools sold relatively healthier food options. Similar foods with comparable energy content were purchased within and outside of school. CONCLUSIONS Basic schools in urban Ghana provide ready access to energy dense food options, which are purchased by pupils both within and outside of school premises. Timely interventions inclusive of school food policies can encourage healthier diets among pupils.
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Affiliation(s)
- Deda Ogum-Alangea
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Legon, Ghana
| | - Richmond N. O. Aryeetey
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Legon, Ghana
| | - Heewon L. Gray
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Amos K. Laar
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Legon, Ghana
| | - Richard M. K. Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Legon, Ghana
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