Food beliefs and practices in urban poor communities in Accra: implications for health interventions

Perceptions and self-management of a healthy diet among middle-aged adults with risk of stroke in North China: a qualitative exploration

OBJECTIVE

Although stroke is prevalent among older people, there is a rising incidence among the younger subpopulations, particularly middle-aged adults. A healthy diet is one of the key modifiable factors to primary prevention of stroke among these subpopulations, yet there is limited understanding of the dietary habits among middle agers who have the risk factor(s) but no occurrence of stroke. This study aims to explore the views on perceptions and the self-management of middle-aged adults at risk of stroke on a healthy diet and to identify the enablers and barriers that could inform the future development of dietary interventions.

DESIGN

This study used an interpretive descriptive qualitative design, employing semistructured purposive sampling for focus group discussions. Thematic analysis was conducted on the transcribed interviews and field notes, facilitated by NVivo 12.0 Plus software.

SETTING

Community settings in Zhengzhou City, Henan Province.

PARTICIPANTS

Middle-aged adults (aged 45-59) were identified as at risk of stroke due to the presence of one or more modifiable risk factors.

RESULT

A total of seven focus group discussions were audio recorded. Four main themes emerged, which were: (1) cognitive understanding of a healthy diet; (2) dietary practices; (3) knowledge acquisition and (4) barriers to dietary adherence.

CONCLUSIONS

The middle-aged adults at risk of stroke were generally aware of the risk and attempted to practise healthy eating. The existing educational programmes on following a healthy diet in the prevention of disease need to be made more comprehensible, accessible and equitable, especially for those from socioeconomically disadvantaged communities.

Dietary patterns among adults in three low-income urban communities in Accra, Ghana

OBJECTIVE

Dietary patterns describe the dietary behaviour and habits of individuals. Unhealthy dietary patterns provide individuals with limited nutrients while increasing the risk of nutrition-related diseases. Unhealthy dietary patterns are high in urban areas, especially among low-income urban residents. This study examined dietary patterns in three low-income urban communities in Accra, Ghana, between 2011 and 2013.

METHODS

This study used Wave 2 and 3 data from the Urban Health and Poverty Survey (EDULINK 2011 and 2013). The sample size was 960 in 2011 and 782 in 2013. Dietary pattern was examined using factor analysis and the NOVA food classification system. Summary statistics were computed for sociodemographic characteristics and diet frequency and pattern. Differences in dietary behaviours between 2011 and 2013 were also estimated. Three logistic regression models were computed to determine the predictors of dietary patterns.

RESULTS

The frequency of consumption of animal-source foods (ASF) and fruits was higher in 2013 compared with 2011. The intake of processed culinary ingredients (NOVA Group 2), processed foods (NOVA Group 3) and ultra-processed foods (NOVA Group 4) was higher in 2013 versus 2011. In 2013, 29% consumed ultra-processed foods compared to 21% in 2011. Three dietary patterns (rice-based, snack-based, and staple and stew/soup) were identified. About two out of every five participants consumed the food items in the rice (43%) and staple and sauce patterns (40%). The proportion of participants who consumed the food items in the snack pattern was 35% in 2011 but 41% in 2013. Respondents aged 25-34 and those with higher education often consumed the snack-based and rice-based dietary patterns. In 2013, participants in Ussher Town had a higher probability of consuming food items in the snack pattern than those living in Agbogbloshie.

CONCLUSIONS

This study found that between 2011 and 2013, more participants consumed ASFs, fruits, and processed foods. A complex interplay of personal and socio-cultural factors influenced dietary intake. The findings of this study mirror global changes in diet and food systems, with important implications for the primary and secondary prevention of NCDs. Health promotion programs at the community level are needed to address the increasing levels of processed food consumption.

Food availability and food habits among Ghanaians: Tracking the dietary transition in Ghana

Background: Although extreme hunger has reduced significantly, people are eating nutrient-poor cheap foods that are unhealthy and environmentally unsustainable. Even though dietary practices are changing in Ghana, there is minimal national-level analysis of the changes and their implication for population health. Aim: This study describes shifts in food availability and consumption in Ghana from 1983-2013. Methods: Data from the Food and Agriculture Organisation (FAO) food balance sheets and a scoping review were used. Descriptive analysis was conducted in excel for the FAO data, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews recommendation was followed for the scoping review. Results: The availability of total calories increased from 1527 kcal in 1983 to 3016 kcal in 2013, representing 608 kcal above the daily recommended allowance for women. Sugar and sweeteners was the food group with the highest increase of 1075%. Vegetables contributed the least to food availability, with less than 40 kcal a day. Rice contributed the most to food availability among cereals (56 kcal in 1983 to 304 kcal in 2013), replacing maise as the primary cereal. Conclusion: After the 1983 famine, there were significant increases in food availability in Ghana. The provision of rice, sugars and tubers meant to end hunger, changed dietary patterns and has resulted in low dietary diversity, high energy intake and overweight/obesity. Therefore, there is a need to intervene and increase the availability of other food groups.

Community perceptions on the factors in the social food environment that influence dietary behaviour in cities of Kenya and Ghana: a Photovoice study

OBJECTIVE

To explore communities' perspectives on the factors in the social food environment that influence dietary behaviours in African cities.

DESIGN

A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary behaviours. Follow-up in-depth interviews allowed participants to tell the 'stories' of their photographs. Thematic analysis was conducted, using data-driven and theory-driven (based on the socio-ecological model) approaches.

SETTING

Three low-income areas of Nairobi (n 48) in Kenya and Accra (n 62) and Ho (n 32) in Ghana.

PARTICIPANTS

Adolescents and adults, male and female aged ≥13 years.

RESULTS

The 'people' who were most commonly reported as influencers of dietary behaviours within the social food environment included family members, friends, health workers and food vendors. They mainly influenced food purchase, preparation and consumption, through (1) considerations for family members' food preferences, (2) considerations for family members' health and nutrition needs, (3) social support by family and friends, (4) provision of nutritional advice and modelling food behaviour by parents and health professionals, (5) food vendors' services and social qualities.

CONCLUSIONS

The family presents an opportunity for promoting healthy dietary behaviours among family members. Peer groups could be harnessed to promote healthy dietary behaviours among adolescents and youth. Empowering food vendors to provide healthier and safer food options could enhance healthier food sourcing, purchasing and consumption in African low-income urban communities.

Individual‐level drivers of dietary behaviour in adolescents and women through the reproductive life course in urban Ghana: A Photovoice study

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.

Time constraints, eating at home, eating out, cooking skills, food preferences and food safety concerns were identified as key factors influencing dietary behaviours at the individual level in urban Ghana.

Ability to eat nutritious, safe food was largely mediated by income and wealth.

Biological factors, such as pregnancy/lactating status influenced behaviours through medical advice, nutrition knowledge and willingness to promote foetal/infant development.

Many individual‐level factors were intertwined with the wider food environment.

Factors influencing dietary behaviour at different levels need to be considered together when developing interventions/policies for healthier diets.

Factors Associated with Improved Knowledge of Metabolic Syndrome in Female Market Traders

Metabolic syndrome (MetS) is considered to be a clustering of cardiometabolic diseases and is emerging as a public health concern. There is little evidence of this disease in market traders, and so the aim of this study was to determine the prevalence and knowledge of MetS. In this cross-sectional study, anthropometry, blood pressure and bloods were collected using standardized methods to detect the prevalence of MetS using the harmonized method in a cohort of female Ghanaian market traders (n = 338). A questionnaire documented the knowledge of MetS. Linear regression was used to investigate the factors associated with knowledge and was reported as adjusted β values. Forty-two percent (n = 142) had MetS. The overall knowledge of MetS was low, driven by education (β = 0.22, p = 0.0001), low levels of high-density lipoprotein-cholesterol (β = -0.15, p = 0.018) and affiliation with the Ewe cultural group (β = -0.19, p = 0.0004). As females working in a sedentary occupation, market traders are vulnerable to MetS. Our findings indicate the urgent need for culturally sensitive education to promote healthy behaviours.

From Ampesie to French fries: systematising the characteristics, drivers and impacts of diet change in rapidly urbanising Accra

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.

Perceptions of community members on contextual factors driving cardiovascular disease behavioural risk in Ghana: a qualitative study

Background

There is clear evidence that lifestyle interventions are effective towards reducing cardiovascular risk. However, implementing these interventions in real-world setting has been suboptimal, especially in sub-Saharan Africa, thus creating ‘evidence to practice gap.’ We explore perceptions of community members on contextual factors driving cardiovascular disease (CVD) behavioural risk (alcohol consumption, smoking, physical (in)activity and fruits and vegetables consumption) in Ghana.

Methods

This was a cross-sectional study. Thirty (30) focus group discussions (FGDs) were carried out in five communities in Ghana (Ga Mashie, Tafo, Gyegyeano, Chanshegu and Agorve) between October and November 2017, and these were analysed using a thematic approach.

Results

Five main factors were raised by participants as contextual factors driving alcohol consumption and smoking and these include economic (poverty, unemployment, loss of jobs), psycho-social (worries, hardships, anxieties), medical (pain suppression, illness management), sexual (sexual performance boost), and socio-cultural (curse invocation, quest for supernatural powers) factors. Personal/social factors (time constraints, personal dislike, lack of knowledge of the benefits of exercise), economic factors (poverty, economic hardship), and negative health effects (getting tired easily, medical conditions) were cited as reasons why community members did not engage in physical activity. Consumption of fruits and vegetables in the five communities were determined by availability, cost, personal (dis)like, lack of knowledge about benefits, and cultural taboo. Participants’ narratives revealed that the symbolic functions of some of these behavioural risk factors and the built environment were important determining factors that have sustained these behaviours in these communities over the years.

Conclusions

This study showed that successful implementation of CVD interventions in Ghana needs to address the perceptions of community members on factors driving CVD behavioural risk factors. Future policies and interventions should be developed based on these contextual factors taking into consideration the age, sex and ethnic variations especially with interventions seeking to address CVD risk factors at the primary health care level. These findings should urge local policy makers and health managers to incorporate the roles of these contextual factors in new programs targeting cardiovascular health. Closing the ‘evidence to practice’ gap as far as CVD interventions are concerned may be impossible without this.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13646-3.

Lay knowledge of cardiovascular disease and risk factors in three communities in Accra, Ghana: a cross-sectional survey

OBJECTIVES

Cardiovascular disease is a major cause of morbidity and mortality in Ghana, and urban poor communities are disproportionately affected. Research has shown that knowledge of cardiovascular disease (CVD) is the first step to risk reduction. This study examines knowledge of CVD and risk factors and determinants of CVD knowledge in three urban poor communities in Accra, Ghana.

METHODS

Using the Cardiovascular Disease Risk Factors Knowledge Level Scale, which has been validated in Ghana, we conducted a cross-sectional survey with 775 respondents aged 15-59 years. CVD knowledge was computed as a continuous variable based on correct answers to 27 questions, and each correct response was assigned one point. Linear regression was used to determine the factors associated with CVD knowledge.

RESULTS

The mean age of the participants was 30.3±10.8 years and the mean knowledge score was 19.3±4.8. About one-fifth of participants were living with chronic diseases. Overall, 71.1% had good CVD knowledge, and 28.9% had moderate or poor CVD knowledge. CVD knowledge was low in the symptoms and risk factor domains. A larger proportion received CVD knowledge from radio and television. The determinants of CVD knowledge included ethnicity, alcohol consumption, self-reported health and sources of CVD knowledge. CVD knowledge was highest among a minority Akan ethnic group, those who were current alcohol consumers and those who rated their health as very good/excellent, compared with their respective counterparts. CVD knowledge was significantly lower among those who received information from health workers and multiple sources.

CONCLUSION

This study underscores the need for health education programmes to promote practical knowledge on CVD symptoms, risks and treatment. We outline health systems and community-level barriers to good CVD knowledge and discuss the implications for developing context-specific and culturally congruent CVD primary prevention interventions.

Metabolic syndrome among individuals living with hypertension in Accra, Ghana

Metabolic syndrome (MetS) is a major risk factor to cardiovascular diseases. In this study, we investigate the prevalence and associated risky behaviour of MetS in resource-poor urban communities in Accra, Ghana. We analysed data on 111 persons with hypertension, screened and recruited for a therapeutic lifestyle intervention program in August 2015. MetS was measured using the International Diabetes Federation (IDF) and the World Health Organization definitions. The prevalence of MetS was 58.4% and 16.8% by the IDF and WHO definitions respectively. More women (61.8%) compared to men (31.8%) had MetS (p = 0.011). Approximately 31% of the hypertensive patients were engaged in moderate-intensity physical activity; 9.0% were current smokers, 42.0% consumed excess alcohol over the past month prior to the interview and 41.0% discontinued taking their antihypertensive medications without consulting with a doctor. About 42.0% and 37.0% of respondents always consumed fruits and vegetables respectively at least two times a day. The binary logistic regression showed that compared to women, men had lower odds of consuming two or more servings of vegetable in a day (OR: 0.2; 95% CI; 0.1, 0.8). Increase in age was associated with higher odds of consuming fruits at least twice a day (1.0; 1.0, 1.1) but with lower odds of engaging in moderate intensity physical activity (0.9; 0.8, 1.0). Being married was associated with higher odds of engaging in moderate physical activity (2.8; 1.0, 8.2). Therapeutic methods essential for the management of patients with hypertension and MetS should include non-pharmacological remedies targeting the promotion of medication adherence, Dietary Approaches to Stop Hypertension (DASH) and physical activities; these are vital to changing unhealthy lifestyle which worsens the underlying pathology.

Institutional mortality rate and cause of death at health facilities in Ghana between 2014 and 2018

BACKGROUND

The epidemiological transition, touted as occurring in Ghana, requires research that tracks the changing patterns of diseases in order to capture the trend and improve healthcare delivery. This study examines national trends in mortality rate and cause of death at health facilities in Ghana between 2014 and 2018.

METHODS

Institutional mortality data and cause of death from 2014-2018 were sourced from the Ghana Health Service's District Health Information Management System. The latter collates healthcare service data routinely from government and non-governmental health institutions in Ghana yearly. The institutional mortality rate was estimated using guidelines from the Ghana Health Service. Percent change in mortality was examined for 2014 and 2018. In addition, cause of death data were available for 2017 and 2018. The World Health Organisation's 11th International Classification for Diseases (ICD-11) was used to group the cause of death.

RESULTS

Institutional mortality decreased by 7% nationally over the study period. However, four out of ten regions (Greater Accra, Volta, Upper East, and Upper West) recorded increases in institutional mortality. The Upper East (17%) and Volta regions (13%) recorded the highest increase. Chronic non-communicable diseases (NCDs) were the leading cause of death in 2017 (25%) and 2018 (20%). This was followed by certain infectious and parasitic diseases (15% for both years) and respiratory infections (10% in 2017 and 13% in 2018). Among the NCDs, hypertension was the leading cause of death with 2,243 and 2,472 cases in 2017 and 2018. Other (non-ischemic) heart diseases and diabetes were the second and third leading NCDs. Septicaemia, tuberculosis and pneumonia were the predominant infectious diseases. Regional variations existed in the cause of death. NCDs showed more urban-region bias while infectious diseases presented more rural-region bias.

CONCLUSIONS

This study examined national trends in mortality rate and cause of death at health facilities in Ghana. Ghana recorded a decrease in institutional mortality throughout the study. NCDs and infections were the leading causes of death, giving a double-burden of diseases. There is a need to enhance efforts towards healthcare and health promotion programmes for NCDs and infectious diseases at facility and community levels as outlined in the 2020 National Health Policy of Ghana.

Barriers to healthy eating among nurses working in hospitals: A meta-synthesis

AIM

To explore the barriers to healthy eating among nurses working in hospitals.

DESIGN

Meta-synthesis.

DATA SOURCES

Published and unpublished papers were identified through electronic searches on PubMed, CINAHL, PsycINFO, Embase, Scopus, COCHRANE Library, Food Science and Technology Abstract, ProQuest Dissertations and Theses and OpenGrey from inception until 6 September 2020. English-language primary qualitative or mixed-method studies on barriers to healthy eating among hospital nurses were included. Mixed-method studies were eligible if their qualitative data were distinguishable. Studies on nursing assistants, enrolled nurses, nursing students, and patient-care assistants were excluded, as well as studies without full-texts, correlational studies, quantitative surveys, exploratory studies, conference abstracts and reviews.

METHODS

The studies were appraised using Critical Appraisal Skills Programme checklist. Qualitative data were extracted using Joanna Briggs Institute Qualitative Data Extraction Tool. Data synthesis followed two stages, meta-summary and meta-synthesis, proposed by Sandelowski & Barroso.

RESULTS

Twelve studies published from 2008 to 2020 involving 618 hospital nurses were included. The meta-summary generated 10 themes, which were meta-synthesized into three interrelated themes: personal barriers (e.g. nonchalance towards unhealthy eating), interprofessional and patient-related barriers (e.g. sharing unhealthy food), and organizational barriers (e.g. overwhelming work demands).

CONCLUSION

Insufficient self-control and self-confidence, nonchalance and negligence towards healthy eating and cultural beliefs that oppose the practice of healthy eating (personal barriers), exposure of unhealthy food practices in wards (interprofessional and patient-related barriers) and hospital cafeterias, overwhelming work exigencies and institutional constraints (organizational barriers) hindered nurses to achieve wholesome healthy eating.

IMPACT

Many hospital nurses' encountered challenges in healthy eating, thereby potentially jeopardizing their health and work performance. The findings emphasized the need of a joint effort by hospital nurses, families and colleagues, and hospital institutions to overcome the barriers to healthy eating faced by the hospital nurses.

Urban physical food environments drive dietary behaviours in Ghana and Kenya: A photovoice study

We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Economic access was perceived as a major barrier to accessing nutritionally safe and healthy foods. Home gardening supplemented household nutritional needs, particularly in Nairobi. Policies to enhance food safety in neighbourhood environments are required. Home gardening, food pricing policies and social protection schemes could reduce financial barriers to safe and healthy diets.

Determinants of energy intake in Central African populations experiencing nutrition transition

Central Africa is experiencing rapid urbanisation, and this situation comes along with changes in food habits and an increased prevalence of obesity and associated health risks. Factors influencing dietary intake among the diverse African populations are not well understood. Our objective was to characterise the dietary intake and their determinants in the two main ethnic groups experiencing nutrition transition in Cameroon, the Bamiléké and the Béti. We sampled Bamiléké (381) and Béti (347) adults living in both rural and urban, collected socio-demographic variables, assessed dietary patterns by using a food portion photographs book to administrate a FFQ and a 24-h dietary recall technique and derived their BMI from measured weight and height. The dietary patterns of Bamiléké people were composed of more energy-dense foods than the Béti people, regardless of the living area. The energy intake (13·8 (sd 4·6)-15·4 (sd 4·8) MJ v. 9·7 (sd 3·5)-11·2 (sd 3·9 MJ) and the obesity (15-29 % v. 5-8 %) were therefore higher in Bamiléké than in Béti, respectively. Multivariable linear regression analyses showed strong associations of both ethnicities (4·02 MJ; P < 0·001), living area (0·21 MJ; P < 0·001) and education (0·59 MJ; P < 0·048) with energy intake, independently of each other and other socio-demographic factors. The ethnicity factor has been characterised as the more important determinant of diet. Our findings provide new insights and perspectives highlighting the importance of anthropological factors when building prevention campaigns against obesity in Central Africa.

Income Level but Not Nutrition Knowledge Is Associated with Dietary Diversity of Rural Pregnant Women from Northern Ghana

Essential nutrients are necessary for reducing the risk of maternal mortality, prenatal mortality, and low-birthweight infants. Dietary diversity can play an important role in supplying essential nutrients to both the mother and the foetus. We evaluated nutrition knowledge, attitudes, and dietary diversity of pregnant women. In addition, we investigated the sociodemographic determinants of dietary diversity among pregnant women from a rural district in Ghana. Participants were pregnant women receiving antenatal care from a rural district hospital in Ghana. Dietary diversity was measured using a 24-hour dietary recall questionnaire. Multiple linear regression was used to determine the sociodemographic characteristics of dietary diversity. About 85% of the pregnant women knew that they should eat more in comparison to nonpregnant women, and only 16.9% knew the importance of folic acid supplementation during pregnancy. Mean (SD) dietary diversity score of the participants was 5.27 (1.35), 85.4% did not consume any fruits, and 82.3% did not take milk and milk products. Almost all participants took at least one food item in the starchy staples and green leafy vegetables food groups. Moreover, 53% consumed vitamin A-rich fruits, vegetables, and tubers; 7.7% organ meats; and 30.8% eggs. Those who earned a monthly income of ≥GHC 500 or US$ 87 (B = 1.82; 0.90-2.73; p < 0.001) significantly had higher dietary diversity scores compared to those who earned less. Dietary diversity of the pregnant women was suboptimal. The consumption of vitamin A- and iron-rich foods was inadequate. Income was an important determinant of the dietary diversity of pregnant women from Northern rural Ghana.

Dietary health perceptions and sources of nutritional knowledge in an urban food environment: a qualitative study from Indonesia

OBJECTIVE

To investigate dietary health understandings, healthy foods access perceptions and the main sources of nutritional knowledge of residents in three urban communities of varying socio-economic make-up.

DESIGN

An ethnographic approach to primary qualitative data collection, involving frequent visits to study areas over 4 months and in-depth interviews. Interviews were recorded, transcribed verbatim and analysed through an iterative approach.

SETTING

Yogyakarta, Indonesia.

PARTICIPANTS

A purposive sample of 45 participants divided equally among the 3 communities. Participants were mostly female (93 %), aged between 27 and 75 years (mean 47·7) and largely identified as the person responsible for household food-related decisions (93 %).

RESULTS

Three overarching themes emerged: (i) dietary health understandings; (ii) healthy foods access perceptions and (iii) sources of nutritional knowledge. Participants employed multifaceted conceptualisation of dietary health. Most identified healthy foods with traditional plant-based foods, inexpensive and locally available from multiple sources. Thus, all participants perceived healthy foods as highly available in the local environment and most (80 %) as affordable. Reported affordability issues referred to specific foods (particularly animal source products) and were independent of income levels. Participants acquired nutritional knowledge from multiple sources, including many community-based initiatives. These were overall perceived as useful, but also as presenting some limitations.

CONCLUSIONS

The variety in dietary health understandings reported by study participants, and their high perceptions of healthy foods availability in the local environment reinforce the idea that individual- and food environment-level determinants of nutritional behaviours are highly contextual.

The landscape of nutri-informatics: a review of current resources and challenges for integrative nutrition research

Informatics has become an essential component of research in the past few decades, capitalizing on the efficiency and power of computation to improve the knowledge gained from increasing quantities and types of data. While other fields of research such as genomics are well represented in informatics resources, nutrition remains underrepresented. Nutrition is one of the most integral components of human life, and it impacts individuals far beyond just nutrient provisions. For example, nutrition plays a role in cultural practices, interpersonal relationships and body image. Despite this, integrated computational investigations have been limited due to challenges within nutrition informatics (nutri-informatics) and nutrition data. The purpose of this review is to describe the landscape of nutri-informatics resources available for use in computational nutrition research and clinical utilization. In particular, we will focus on the application of biomedical ontologies and their potential to improve the standardization and interoperability of nutrition terminologies and relationships between nutrition and other biomedical disciplines such as disease and phenomics. Additionally, we will highlight challenges currently faced by the nutri-informatics community including experimental design, data aggregation and the roles scientific journals and primary nutrition researchers play in facilitating data reuse and successful computational research. Finally, we will conclude with a call to action to create and follow community standards regarding standardization of language, documentation specifications and requirements for data reuse. With the continued movement toward community standards of this kind, the entire nutrition research community can transition toward greater usage of Findability, Accessibility, Interoperability and Reusability principles and in turn more transparent science.

Factors influencing dietary practices in a transitioning food environment: a cross-sectional exploration of four dietary typologies among rural and urban Ugandan women using Photovoice

BACKGROUND

Healthy and sustainable dietary practices offer a possible solution to competing tensions between health and environmental sustainability, particularly as global food systems transition. To encourage such dietary practices, it is imperative to understand existing dietary practices and factors influencing these dietary practices. The aim of this study was to identify multi-level factors in lived rural and urban Ugandan food environments that influence existing dietary practices among women of reproductive age (WRA).

METHODS

A mixed methods study was conducted. Multiple correspondence analysis followed by hierarchical cluster analysis were performed on dietary data collected among a sample (n = 73) of Ugandan WRA in Kampala (urban) and Wakiso (rural) districts to elicit dietary clusters. Dietary clusters, which were labelled as dietary typologies based on environmental impact and nutrition transition considerations, were reflective of dietary practices. Following this, a smaller sample of WRA (n = 18) participated in a Photovoice exercise and in-depth interviews to identify factors in their social, physical, socio-cultural and macro-level environments influencing their enactment of the identified dietary typologies, and therefore dietary practices.

RESULTS

Four dietary typologies emerged: 'urban, low-impact, early-stage transitioners', 'urban, medium-impact, mid-stage transitioners', 'rural, low-impact, early-stage transitioners' and 'rural, low-impact, traditionalists'. Although experienced somewhat differently, the physical environment (access, availability and cost), social networks (parents, other family members and friends) and socio-cultural environment (dietary norms) were cross-cutting influences among both urban and rural dietary typologies. Seasonality (macro-environment) directly influenced consumption of healthier and lower environmental impact, plant-based foods among the two rural dietary typology participants, while seasonality and transportation intersected to influence consumption of healthier and lower environmental impact, plant-based foods among participants in the two urban dietary typologies.

CONCLUSION

Participants displayed a range of dietary typologies, and therefore dietary practices. Family provides an avenue through which interventions aimed at encouraging healthier and lower environmental impact dietary practices can be targeted. Home gardens, urban farming and improved transportation could address challenges in availability and access to healthier, lower environmental impact plant-based foods among urban WRA.

Determinants of dietary and physical activity behaviours among women of reproductive age in urban Uganda, a qualitative study

OBJECTIVE

To explore determinants of dietary and physical activity behaviours among women of reproductive age.

DESIGN

Data were collected through focus group discussions (FGD). The FGD guide was based on a modified theoretical framework; theory of planned behaviour was incorporated with constructs of health belief model, precaution adoption process model, social cognitive and social support theory. Discussions were audio recorded, transcribed verbatim and analysed thematically.

SETTING

Kampala, Uganda.

PARTICIPANTS

Women were categorised into young adults; 18-34 years and adults; 35-45 years.

RESULTS

Separate FGD with independent participants were conducted for dietary and physical activity behaviours until data saturation was achieved. Six FGD were conducted per behaviour. Determinants of dietary behaviours at intra-individual level included gaps in food skills, knowledge and self-efficacy, food safety concerns, convenience, finances and physiological satisfaction. The social-cultural norms were relationship between vegetable consumption and low social status, consideration of fruits as a snack for children and not food and habitual orientation towards carbohydrate foods. At environment level, social networks and increased availability of energy-dense, nutrient poor, street and processed foods influence dietary behaviour. For physical activity, intra-individual determinants were knowledge gaps and self-efficacy, while socio-cultural norms included gender stereotypes. Home (limited space and sedentary entertainment like social media and TV) and physical environment (cheap motorised transportation) influence physical activity.

CONCLUSION

The existing cultural beliefs promote dietary and physical activity behaviours which are divergent from healthy recommendations. Therefore, a comprehensive intervention is needed to address socio-cultural misconceptions, financial and time limitations in urban Uganda.

Towards Population Salt Reduction to Control High Blood Pressure in Ghana: A Policy Direction

Although population salt reduction is considered a "best buy" in addressing hypertension and cardiovascular disease, Ghana shares a high hypertension burden with a seemingly high salt consumption. This article discusses best practices in reducing population salt intake and provides preliminary data on salt and potassium intake, as well as the process to develop a road map and identification of actions needed to support the development of a strategic national document towards salt reduction in Ghana. In February 2019, a 2-d stakeholder meeting was held with government agencies, researchers, nongovernmental organizations, civil society organizations, and international partners to deliberate on salt reduction strategies and interventions needed in the face of rising hypertension and other noncommunicable diseases (NCDs) in Ghana. Recommendations were developed from the stakeholder meeting and are being considered for inclusion in the revision of Ghana's national NCD policy.

Meat, fruit, and vegetable consumption in sub-Saharan Africa: a systematic review and meta-regression analysis

CONTEXT

The dietary choices people make affect personal health and have consequences for the environment, both of which have serious implications for the 2030 Sustainable Development Agenda. In global reviews, the literature on meat, fruit, and vegetable consumption in sub-Saharan Africa (SSA) is limited.

OBJECTIVE

This systematic review set out to quantify meat, fruit, and vegetable consumption in SSA populations and to answer the following question: How much meat, fruit, and/or vegetables are being consumed daily by which individuals in SSA over the years?

DATA SOURCES

Following the PRISMA guidelines, the authors systematically searched the MEDLINE, EMBASE, ASSIA CINAHL, Web of Science, POPLINE, and Google Scholar databases to identify 47 (out of 5922 search results) studies reporting meat, fruit, and/or vegetable consumption in SSA populations.

DATA EXTRACTION

Three independent investigators extracted data on year of data collection, study country, study population and geographical context, and population intake of meat, fruit, and/or vegetables.

DATA ANALYSIS

Using STATA SE version 15 software, random-effects meta-regression analyses were used to test the effect of year of data collection and method of data collection on population meat, fruit, and vegetable consumption. The analyses also tested any association between age, sex, rural/urban residence, or a country's economic development and population intake of meat, fruits, and/or vegetables. The review was started in 2017 and completed in 2019.

RESULTS

Richer SSA countries were likely to consume more meat (ß = 36.76, P = 0.04) and vegetables (ß =43.49, P  = 0.00) than poorer countries. Vegetable intake has increased dramatically over the last 3 decades from ≈10 g to ≈110 g (ß = 4.43, P  = 0.00). Vegetable (ß= -25.48, P  = 0.00) consumption was higher in rural than in urban residents. Although the trend of meat consumption has risen (≈25 g to ≈75 g), the trend is nonsignificant (ß = 0.63, N.S.). Daily average per capita meat consumption was 98 g - above the 70 g recommendation - while fruit and vegetable intake (268 g) remain below the World Health Organization's recommendation (400 g).

CONCLUSIONS

Given the low intake of plant-based foods, it is likely that SSA populations may be deficient in high-quality protein and micronutrients as suggested by the EAT-Lancet Commission. There is a need to promote both an adequate supply and demand of plant-based protein and micronutrients, including fruit, vegetables, nuts, seeds, and legumes, in SSA countries. While dietary changes in SSA may offer large absolute benefits, consideration of the magnitude of dietary change, particularly increasing or reducing meat consumption, will need to occur in a way that ensures that policy and interventions support the reduction of undernutrition and micronutrient deficiencies without worsening the prevalence and environmental impacts of noncommunicable diseases. There is also the need for preventive action that ensures that SSA populations do not increase their meat consumption as disposable incomes increase and countries' economic development rises, as is seen in most countries undergoing economic transformation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42018090497.

Determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa: a systematic review

Urban sub-Saharan Africa is in a nutrition transition shifting towards consumption of energy-dense nutrient-poor diets and decreasing physical activity. Determinants of nutrition transition in sub-Saharan Africa are presently not well understood. The objective of this review was to synthesise available data on determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa according to the socio-ecological framework. We searched MEDLINE, Embase, Scopus, Web of Science and bibliographies of included articles for qualitative, observational and randomised controlled studies published in English from January 2000 to September 2018. Studies conducted within general populations of women aged 18–49 years were included. Searches were according to a predefined protocol published on PROSPERO (ID = CRD42018108532). Two reviewers independently screened identified studies. From a total of 9853 unique references, twenty-three studies were retained and were mainly from South and West Africa. No rigorous designed quantitative study was identified. Hence, data synthesis was narrative. Notable determinants of dietary behaviour included: convenience, finances, social network, food skills and knowledge gaps, food deserts and culture. Cultural beliefs include strong relationship between high social status and weight gain, energy-dense confectionery, salt or fat-rich foods. Physical activity is influenced by the fast-changing transport environment and cultural beliefs which instigate unfavourable gender stereotypes. Studies with rigorous qualitative and quantitative designs are required to validate and develop the proposed frameworks further, especially within East Africa. Nevertheless, available insights suggest a need for comprehensive skill-based interventions focusing on socio-cultural misconceptions and financial limitations.

Factors influencing dietary behaviours in urban food environments in Africa: a systematic mapping review

Objective:

To identify factors influencing dietary behaviours in urban food environments in Africa and identify areas for future research.

Design:

We systematically reviewed published/grey literature (protocol CRD4201706893). Findings were compiled into a map using a socio-ecological model on four environmental levels: individual, social, physical and macro.

Setting:

Urban food environments in Africa.

Participants:

Studies involving adolescents and adults (11–70 years, male/female).

Results:

Thirty-nine studies were included (six adolescent, fifteen adolescent/adult combined and eighteen adult). Quantitative methods were most common (twenty-eight quantitative, nine qualitative and two mixed methods). Studies were from fifteen African countries. Seventy-seven factors influencing dietary behaviours were identified, with two-thirds at the individual level (45/77). Factors in the social (11/77), physical (12/77) and macro (9/77) environments were investigated less. Individual-level factors that specifically emerged for adolescents included self-esteem, body satisfaction, dieting, spoken language, school attendance, gender, body composition, pubertal development, BMI and fat mass. Studies involving adolescents investigated social environment-level factors more, for example, sharing food with friends. The physical food environment was more commonly explored in adults, for example, convenience/availability of food. Macro-level factors associated with dietary behaviours were food/drink advertising, religion and food prices. Factors associated with dietary behaviour were broadly similar for men and women.

Conclusions:

The dominance of studies exploring individual-level factors suggests a need for research to explore how social, physical and macro-level environments drive dietary behaviours of adolescents and adults in urban Africa. More studies are needed for adolescents and men, and studies widening the geographical scope to encompass all African countries.

Microbial Contamination, an Increasing Threat to the Consumption of Fresh Fruits and Vegetables in Today's World

Microbes are found all over the globe with some few exceptions, including sterilized surfaces. They include normal flora that is nonpathogenic, which contribute to the larger percentage, and pathogenic species which are few. Hence, the activities of humans cannot be completely separated from microbes. Thus, many pathogenic microbes have found their way into fresh fruits and vegetables which are a great source of a healthy diet for humans. The growing demand for fresh fruits and vegetables has necessitated larger production. The larger production of vegetables within the shortest possible time to meet the growing demand has placed them at a higher risk of contamination with the pathogenic microbes, making the safety of consumers uncertain. Study of sources of contamination and type of pathogenic etiological agents isolated from fresh fruits and vegetables includes Bacillus cereus, Campylobacter jejuni, Clostridium botulinum, E. coli O157: H7, Listeria monocytogenes, Salmonella spp., Shigella, Staphylococcus, and Vibrio cholera. Several measures have proven to be effective in controlling contamination of microbes and they include the establishment of surveillance systems to monitor the production chain and thoroughly washing vegetables with vinegar water. Saltwater and other washing techniques are effective but caution should be taken to make sure one does not use one cycle of water for washing all vegetables. The consumption of fresh fruits and vegetables is still encouraged by this review but significant measures must be taken to check the safety of these products before consumption.

Rapidly increasing prevalence of overweight and obesity in older Ghanaian adults from 2007-2015: Evidence from WHO-SAGE Waves 1 & 2

BACKGROUND

Studies on changes in the prevalence and determinants of obesity in older adults living in sub-Saharan Africa are scarce. We examined recent changes in obesity prevalence and associated factors for older adults in Ghana between 2007/08 and 2014/15.

METHODS

Data on adults aged 50 years and older in Ghana were drawn from the WHO SAGE 2007/08 (Wave 1; n = 4158) and 2014/15 (Wave 2; n = 1663). The weighted prevalence of obesity, overweight, normal weight and underweight, and of high central adiposity were compared in 2007/08 and 2014/15. Multinomial and binomial logistic regressions were used to examine whether the determinants of weight status based on objectively measured body mass index and waist circumference changed between the two time periods.

RESULTS

The prevalence of overweight (2007/08 = 19.6%, 95% CI: 18.0-21.4%; 2014/15 = 24.5%, 95% CI: 21.7-27.5%) and obesity (2007/08 = 10.2%, 95% CI: 8.9-11.7%; 2014/15 = 15.0%, 95% CI: 12.6-17.7%) was higher in 2014/15 than 2007/08 and more than half of the population had high central adiposity (2007/08 = 57.7%, 95% CI: 55.4-60.1%; 2014/15 = 66.9%, 95% CI: 63.7-70.0%) in both study periods. While the prevalence of overweight increased in both sexes, obesity prevalence was 16% lower in males and 55% higher in females comparing 2007/08 to 2014/15. Female sex, urban residence, and high household wealth were associated with higher odds of overweight/obesity and high central adiposity. Those aged 70+ years had lower odds of obesity in both study waves. In 2014/15, females who did not meet the recommended physical activity were more likely to be obese.

CONCLUSION

Over the 7-year period between the surveys, the prevalence of underweight decreased and overweight increased in both sexes, while obesity decreased in males but increased in females. The difference in obesity prevalence may point to differential impacts of past initiatives to reduce overweight and obesity, potential high-risk groups in Ghana, and the need to increase surveillance.

Determinants of systemic hypertension in older adults in Africa: a systematic review

BACKGROUND

An estimated 55% of older adults in Africa have systemic hypertension, a major risk factor for stroke, heart failure and dementia in the region. The risk factors associated with hypertension in this population group in Africa have not been systematically evaluated. We, therefore, undertook a systematic review to identify these risk factors.

METHODS

We searched for population-based studies of adults aged ≥50 years living in Africa and reporting an estimate of hypertension and associated risk factors. We included articles published in any language between January 1980 and May 2018 using a comprehensive search strategy. We extracted data including the sample characteristics, prevalence of hypertension and risk factors with their effect sizes.

RESULTS

From an initial 10,719 records, we retained 63 eligible full text articles for review out of which we analyzed 23 studies made up of 19 primary and four multiple publications which had data on risk factors from bivariate or multivariable analysis. The primary studies, published from 2010 to 2018, involved a total of 30,500 participants in 12 different countries with mean ages ranging from 62.7 ± 9 years to 76.9 ± 8.4 years. Through narrative synthesis, we found consistent determinants of hypertension (overweight/obesity and history of stroke), less consistent but frequent determinants (including older age group, female sex and urban residence), inconsistent determinants (including education, wealth index, alcohol intake and physical activity) and nonsignificant covariates (marital status and having health insurance). Overall, the highest adjusted odds ratios were those associated with obesity and history of stroke.

CONCLUSION

The key determinants of systemic hypertension in older adults in Africa are older age group, overweight/obesity, history of stroke and female sex. Health programmes should promote weight reduction throughout the life course, including during the middle and older age of African adults.

The role of intergenerational educational mobility and household wealth in adult obesity: Evidence from Wave 2 of the World Health Organization's Study on global AGEing and adult health

BACKGROUND

Obesity has emerged as a major risk factor for non-communicable diseases in low and middle-income countries but may not follow typical socioeconomic status (SES)-related gradients seen in higher income countries. This study examines the associations between current and lifetime markers of SES and BMI categories (underweight, normal weight, overweight, obese) and central adiposity in Ghanaian adults.

METHODS

Data from 4,464 adults (2,610 women) who participated in the World Health Organization's Study on global AGEing and adult health (SAGE) Wave 2 were examined. Multilevel multinomial and binomial logistic regression models were used to examine associations. SES markers included parental education, individual education, intergenerational educational mobility and household wealth. Intergenerational educational mobility was classified: stable-low (low parental and low individual education), stable-high (high parental and high individual education), upwardly (low parental and high individual education), or downwardly mobile (high parental and low individual education).

RESULTS

The prevalence of obesity (12.9%) exceeded the prevalence of underweight (7.2%) in the population. High parental and individual education were significantly associated with higher odds of obesity and central adiposity in women. Compared to the stable low pattern, stable high (obesity: OR = 3.15; 95% CI: 1.96, 5.05; central adiposity: OR = 1.75; 95% CI: 1.03, 2.98) and upwardly (obesity: OR = 1.71; 95% CI: 11.13, 2.60; central adiposity: OR = 1.60; 95% CI: 1.08, 2.37) mobile education patterns were associated with higher odds of obesity and central adiposity in women, while stable high pattern was associated with higher odds of overweight (OR = 1.88; 95% CI: 1.11, 3.19) in men. Additionally, high compared to the lowest household wealth was associated with high odds of obesity and central adiposity in both sexes.

CONCLUSION

Stable high and upwardly mobile education patterns are associated with higher odds of obesity and central adiposity in women while the stable high pattern was associated with higher odds of overweight in men.

The more critical murderer of atherosclerosis than lipid metabolism: chronic stress

BACKGROUND

The mortality of atherosclerotic cerebrovascular disease is on the rise, and changes in intimal and media thickness are a leading cause of cerebral ischemia-related death. Levels of low density lipoprotein cholesterol (LDLC), total cholesterol (TC), and chronic stress (CS) are all recognized risk factors for atherosclerosis (AS). However, the leading independent risk factor is indistinct. This study explored the effects of chronic stress, LDLC, and TC on AS and intimal and media thickness, preliminarily explored the main risk factor of AS, and analyzed the related histocyte mechanisms for macrophages and endothelial cells.

METHODS

Conditions include normal, high-fat diet (HF), and HF plus CS. The correlations between intimal and media thickness and general risk factors were analyzed using χ2, Spearman's rho test, and multiple linear regression. Univariate Cox regression was used to identify potential factors that affect the non-depression time (NDT). We performed a ROC curve to determine the ability of this condition to predict the thickness. Immunohistochemistry was implemented to detect macrophagocytes and endotheliocytes.

RESULTS

Based on χ2 and Spearman's rho test, LDLC, TC, and CS are all related with intimal and media thickness (P < 0.05). However, in multiple linear regression, CS is still a risk factor of thickness (P < 0.05) but LDLC and TC are not. High levels of LDLC, TC, and CS were correlated with poor NDT (P < 0.05). This condition can predict the thickness sensitively. The endarterium is richest in macrophagocytes, and the arrangement of endotheliocytes is disordered and cracked under CS.

CONCLUSION

CS is the main independent risk factor for AS and intimal (and media) thickness, rather than LDLC or TC.