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Laar A, Baye K, Zotor F, Asiki G, Lartey A. Editorial: The African food environments. Front Public Health 2023; 11:1181096. [PMID: 37397772 PMCID: PMC10313380 DOI: 10.3389/fpubh.2023.1181096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/11/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kaleab Baye
- Research Center for Inclusive Development in Africa (RIDA), Nutrition and Food Systems Division, Addis Ababa, Ethiopia
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Francis Zotor
- Fred Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
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Adjei AP, Amevinya GS, Quarpong W, Tandoh A, Aryeetey R, Holdsworth M, Agyemang C, Zotor F, Laar ME, Mensah K, Addo P, Laryea D, Asiki G, Sellen D, Vandevijvere S, Laar A. Availability of healthy and unhealthy foods in modern retail outlets located in selected districts of Greater Accra Region, Ghana. Front Public Health 2022; 10:922447. [PMID: 36438248 PMCID: PMC9682120 DOI: 10.3389/fpubh.2022.922447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background Intake of unhealthy foods is linked to the onset of obesity and diet-related non-communicable diseases (NCDs). Availability of unhealthy (nutritionally poor) foods can influence preference, purchasing and consumption of such foods. This study determined the healthiness of foods sold at modern retail outlets- supermarkets and mini-marts in the Greater Accra Region of Ghana. Methods All modern retail outlets located in six districts of Greater Accra were eligible. Those < 200 m2 of floor area and with permanent structures were categorized as mini-marts; and those ≥200 m2 as supermarkets. Shelf length of all available foods were measured. Healthiness of food was determined using two criteria - the NOVA classification and energy density of foods. Thus, ultra-processed foods or food items with >225 kcal/100 g were classified as unhealthy. The ratio of the area occupied by unhealthy to healthy foods was used to determine the healthiness of modern retail outlets. Results Of 67 retail outlets assessed, 86.6% were mini-marts. 85.0% of the total SHELF area was occupied by foods categorized as unhealthy (ranging from 9,262 m2 in Ashiaman Municipality to 41,892 m2 in Accra Metropolis). Refined grains/grain products were the most available, occupying 30.0% of the total food shelf space, followed by sugar-sweetened beverages (20.1% of total shelf space). The least available food group-unprocessed staples, was found in only one high income district, and occupied 0.1% of the total food shelf space. Retail outlets in two districts did not sell fresh fruits or fresh/unsalted canned vegetables. About two-thirds of food products available (n = 3,952) were ultra-processed. Overall, the ratio of ultra-processed-to-unprocessed foods ranged from 3 to 7 with an average (SD) of 5(2). Thus, for every healthy food, there were five ultra-processed ones in the studied retail outlets. Conclusion This study reveals widespread availability of ultra-processed foods in modern retail outlets within the selected districts. Toward a healthier food retail environment, public health and food regulators, in partnership with other stakeholders need to institute measures that improve availability of healthy foods within supermarkets and mini-marts.
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Affiliation(s)
- Akosua Pokua Adjei
- 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
| | - 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
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam 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
| | - Phyllis Addo
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Dennis Laryea
- Non-Communicable Disease Programme, Ghana Health Service, Accra, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana,*Correspondence: Amos Laar
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wanjohi MN, Pradeilles R, Asiki G, Holdsworth M, Kimani-Murage EW, Muthuri SK, Irache A, Laar A, Zotor F, Tandoh A, Klomegah S, Graham F, Osei-Kwasi HA, Green MA, Coleman N, Mensah K, Akparibo R, Aryeteey R, Rousham EK, Bricas N, Bohr M, Griffiths P. Community perceptions on the factors in the social food environment that influence dietary behaviour in cities of Kenya and Ghana: a Photovoice study. Public Health Nutr 2022; 26:1-13. [PMID: 36305344 PMCID: PMC9989710 DOI: 10.1017/s1368980022002270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/08/2022] [Accepted: 10/04/2022] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Milkah N Wanjohi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, P.O Box 01787-00100, Nairobi, Kenya
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, Loughborough, UK
| | - Gershim Asiki
- Health and Systems for Health Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-food systems), (Université Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institute Agro, IRD), Montpellier, France
| | - Elizabeth W Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, P.O Box 01787-00100, Nairobi, Kenya
| | - Stella K Muthuri
- Population Dynamics and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ana Irache
- Warwick Center for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Fiona Graham
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Mark A Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Nathaniel Coleman
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle Bu, Accra, Ghana
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, Legon, Accra, Ghana
| | - Robert Akparibo
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Richmond Aryeteey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, Loughborough, UK
| | - Nicolas Bricas
- French Agricultural Research Centre for International Development (CIRAD), Montpellier Cedex 5, France
| | - Marco Bohr
- School of Art and Design, Nottingham Trent University, Nottingham, UK
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, Loughborough, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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. 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.
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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, IRD Montpellier France
| | - Rebecca Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Amos Laar
- Department of Population, Family & 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
| | - Akua Tandoh
- Department of Population, Family & Reproductive Health, School of Public Health University of Ghana Accra Ghana
| | - Senam Klomegah
- Department of Family and Community Health, School of Public Health University of Health and Allied Sciences Ho Ghana
| | | | - Agnès Le Port
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems) CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRD Montpellier France
| | - Nicolas Bricas
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems) CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRD Montpellier France
| | - Richmond Aryeetey
- Department of Population, Family & Reproductive Health, School of Public Health University of Ghana Accra Ghana
| | - Robert Akparibo
- School of Health and Related Research University of Sheffield Sheffield UK
| | - Paula Griffiths
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems) CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRD Montpellier France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Laar AK, Addo P, Aryeetey R, Agyemang C, Zotor F, Asiki G, Rampalli KK, Amevinya GS, Tandoh A, Nanema S, Adjei AP, Laar ME, Mensah K, Laryea D, Sellen D, Vandevijvere S, Turner C, Osei-Kwasi H, Spires M, Blake C, Rowland D, Kadiyala S, Madzorera I, Diouf A, Covic N, Dzudzor IM, Annan R, Milani P, Nortey J, Bricas N, Mphumuzi S, Anchang KY, Jafri A, Dhall M, Lee A, Mackay S, Oti SO, Hofman K, Frongillo EA, Holdsworth M. Perspective: Food Environment Research Priorities for Africa-Lessons from the Africa Food Environment Research Network. Adv Nutr 2022; 13:739-747. [PMID: 35254411 PMCID: PMC9156374 DOI: 10.1093/advances/nmac019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/07/2022] [Accepted: 02/18/2022] [Indexed: 02/03/2023] Open
Abstract
Over the last 2 decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization, and development. These changes have altered African food environments and, subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition-obesity and other diet-related noncommunicable diseases (DR-NCDs)-along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and offer energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food environments. However, in Africa, the necessary research and policy action have received insufficient attention. Contextual evidence to motivate, enable, and create supportive food environments in Africa for better population health is urgently needed. In November 2020, the Measurement, Evaluation, Accountability, and Leadership Support for Noncommunicable Diseases Prevention Project (MEALS4NCDs) convened the first Africa Food Environment Research Network Meeting (FERN2020). This 3-d virtual meeting brought researchers from around the world to deliberate on future directions and research priorities related to improving food environments and nutrition across the African continent. The stakeholders shared experiences, best practices, challenges, and opportunities for improving the healthfulness of food environments and related policies in low- and middle-income countries. In this article, we summarize the proceedings and research priorities identified in the meeting to advance the food environment research agenda in Africa, and thus contribute to the promotion of healthier food environments to prevent DR-NCDs, and other forms of malnutrition.
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Affiliation(s)
| | - Phyllis Addo
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Richmond Aryeetey
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Krystal K Rampalli
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Gideon S Amevinya
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Akua Tandoh
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Silver Nanema
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Akosua Pokua Adjei
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Matilda E Laar
- Department of 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, Legon, Accra, Ghana
| | - Dennis Laryea
- Non-Communicable Disease Programme, Ghana Health Service, Accra, Ghana
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | | | - Christopher Turner
- Department of Food and Markets, University of Greenwich, Greenwich, United Kingdom
| | - Hibbah Osei-Kwasi
- Geography Department, University of Sheffield, Sheffield, United Kingdom
| | - Mark Spires
- Centre for Food Policy, City University of London, London, United Kingdom
| | - Christine Blake
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dominic Rowland
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Isabel Madzorera
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Adama Diouf
- Nutrition Laboratory, Department of Animal Biology, Faculty of Science and Technology, University Cheikh Anta Diop, Dakar, Senegal
| | - Namukolo Covic
- International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Isaac M Dzudzor
- Center for Development Research (ZEF), University of Bonn, Bonn, Germany
| | - Reginald Annan
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - John Nortey
- Statistics, Research, and Information Directorate, Ministry of Food and Agriculture, Accra, Ghana
| | - Nicholas Bricas
- UMR MoISA (Montpellier Interdisciplinary Center on Sustainable Agri-food Systems), CIRAD, University of Montpellier, Montpellier, France
| | | | | | - Ali Jafri
- Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Meenal Dhall
- Department of Anthropology, University of Delhi, Delhi, India
| | - Amanda Lee
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Samuel O Oti
- International Development Research Center, Nairobi, Kenya
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Sciences - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Center on Sustainable Agri-food Systems), University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, French National Research Institute for Sustainable Development (IRD), Montpellier, France
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Pradeilles R, Irache A, Wanjohi MN, Holdsworth M, Laar A, Zotor F, Tandoh A, Klomegah S, Graham F, Muthuri SK, Kimani-Murage EW, Coleman N, Green MA, Osei-Kwasi HA, Bohr M, Rousham EK, Asiki G, Akparibo R, Mensah K, Aryeetey R, Bricas N, Griffiths P. Urban physical food environments drive dietary behaviours in Ghana and Kenya: A photovoice study. Health Place 2021; 71:102647. [PMID: 34375838 PMCID: PMC8520917 DOI: 10.1016/j.healthplace.2021.102647] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/20/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom.
| | - Ana Irache
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Michelle Holdsworth
- IRD (French National Research Institute for Sustainable Development), NUTRIPASS Unit, Université de Montpellier-IRD, Montpellier, France
| | - Amos Laar
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Akua Tandoh
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Fiona Graham
- Population Health Sciences Institute, Newcastle University, United Kingdom
| | | | | | - Nathaniel Coleman
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana; Department of Obstetrics and Gynaecology, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Mark A Green
- Department of Geography and Planning, University of Liverpool, UK
| | | | - Marco Bohr
- School of Art & Design, Nottingham Trent University, UK
| | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Robert Akparibo
- Public Health Section, School of Health and Related Research, University of Sheffield, United Kingdom
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, Accra, Ghana
| | - Richmond Aryeetey
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Nicolas Bricas
- UMR MOISA, CIRAD- Agricultural Research & International Cooperation Organization, Montpellier, France
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
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10
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Martínez-González MA, Kim HS, Prakash V, Ramos-Lopez O, Zotor F, Martinez JA. Personalised, population and planetary nutrition for precision health. BMJ Nutr Prev Health 2021; 4:355-358. [PMID: 34308147 PMCID: PMC8258037 DOI: 10.1136/bmjnph-2021-000235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Hyun-Sook Kim
- Department of Food and Nutrition, Sookmyung Women's University, Yongsan-gu, Seoul, The Republic of Korea
| | - Vish Prakash
- Nutritional and Nutraceutical Research Centre, Ramaiah University of Applied Sciences, Bangalore, India
| | - Omar Ramos-Lopez
- Medicine and Psychology School, Autonomous University of Baja California, Tijuana, Mexico
| | - Francis Zotor
- School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - J Alfredo Martinez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute, Madrid, Spain.,Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
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11
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Agbozo F, Abubakari A, Zotor F, Jahn A. Gestational Diabetes Mellitus per Different Diagnostic Criteria, Risk Factors, Obstetric Outcomes and Postpartum Glycemia: A Prospective Study in Ghana. Clin Pract 2021; 11:257-271. [PMID: 34066909 PMCID: PMC8161461 DOI: 10.3390/clinpract11020039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
The surge in gestational diabetes mellitus (GDM) globally requires a health system tailored approach towards prevention, detection and management. We estimated the prevalence of GDM using diverse recommended tests and diagnostic thresholds, and also assessed the risk factors and obstetric outcomes, including postpartum glycemia. Using a prospective cohort design, 446 singleton pregnant women without pre-existing diabetes did GDM tests in five hospitals in Ghana from 20–34 weeks using fasting plasma glucose (FPG), one-hour and 2-h oral glucose tolerance test (OGTT). Birth outcomes of 403 were assessed. GDM was diagnosed using six international diagnostic criteria. At 12 weeks postpartum, impaired fasting glucose (6.1–6.9 mmol/L) and diabetes (FPG ≥7.0 mmol/L) were measured for 100 women. Per FPG and 2-h OGTT cut-offs, GDM prevalence ranged between 8.3–23.8% and 4.4–14.3%, respectively. Risk factors included overweight (OR = 2.13, 95% CI: 1.13–4.03), previous miscarriage (OR = 4.01, 95% CI: 1.09–14.76) and high caloric intake (OR = 2.91, 95% CI: 1.05–8.07). Perineal tear (RR = 2.91, 95% CI: 1.08–5.57) and birth asphyxia (RR = 3.24, 95% CI: 1.01–10.45) were the associated perinatal outcomes. At 12 weeks postpartum, 15% had impaired fasting glucose, and 5% had diabetes. Tackling modifiable risk factors is crucial for prevention. Glycemic monitoring needs to be integral in postpartum and well-child reviews.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Ho, Ghana, Private Mail Bag 31 Ho, Ghana;
- Heidelberg Institute of Global Health, University Hospital Heidelberg Germany, Im Neuenheimer Feld 130.3, 60120 Heidelberg, Germany;
- Correspondence:
| | - Abdulai Abubakari
- Public Health Department, University for Development Studies, Tamale Ghana, Tamale P.O. Box TL 1350, Ghana;
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Ho, Ghana, Private Mail Bag 31 Ho, Ghana;
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, University Hospital Heidelberg Germany, Im Neuenheimer Feld 130.3, 60120 Heidelberg, Germany;
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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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. Glob Food Sec 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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Ayanore MA, Adjuik M, Ameko A, Kugbey N, Asampong R, Mensah D, Alhassan RK, Afaya A, Aviisah M, Manu E, Zotor F. Self-reported breast and cervical cancer screening practices among women in Ghana: predictive factors and reproductive health policy implications from the WHO study on global AGEing and adult health. BMC Womens Health 2020; 20:158. [PMID: 32723342 PMCID: PMC7388217 DOI: 10.1186/s12905-020-01022-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Breast and cervical cancers constitute the two leading causes of cancer deaths among women in Ghana. This study examined breast and cervical screening practices among adult and older women in Ghana. METHODS Data from a population-based cross-sectional study with a sample of 2749 women were analyzed from the study on global AGEing and adult health conducted in Ghana between 2007 and 2008. Binary and multivariable ordinal logistic regression analyses were performed to assess the association between socio-demographic factors, breast and cervical screening practices. RESULTS We found that 12.0 and 3.4% of adult women had ever had pelvic screening and mammography respectively. Also, 12.0% of adult women had either one of the screenings while only 1.8% had both screening practices. Age, ever schooled, ethnicity, income quantile, father's education, mother's employment and chronic disease status were associated with the uptake of both screening practices. CONCLUSION Nationwide cancer awareness campaigns and education should target women to improve health seeking behaviours regarding cancer screening, diagnosis and treatment. Incorporating cancer screening as a benefit package under the National Health Insurance Scheme can reduce financial barriers for breast and cervical screening.
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Affiliation(s)
- Martin Amogre Ayanore
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana.
| | - Martin Adjuik
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Asiwome Ameko
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Nuworza Kugbey
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Asampong
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Derrick Mensah
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Agani Afaya
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Mark Aviisah
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Emmanuel Manu
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Francis Zotor
- School of Public Health, University of Health and Allied Sciences, University of Health and Allied Sciences, Ho, Ghana
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15
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Green MA, Pradeilles R, Laar A, Osei-Kwasi H, Bricas N, Coleman N, Klomegah S, Wanjohi MN, Tandoh A, Akparibo R, Aryeetey RNO, Griffiths P, Kimani-Murage EW, Mensah K, Muthuri S, Zotor F, Holdsworth M. Investigating foods and beverages sold and advertised in deprived urban neighbourhoods in Ghana and Kenya: a cross-sectional study. BMJ Open 2020; 10:e035680. [PMID: 32595155 PMCID: PMC7322322 DOI: 10.1136/bmjopen-2019-035680] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods. DESIGN Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability. SETTING Three deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya). MAIN OUTCOME MEASURE Types of foods and beverages sold and/or advertised. RESULTS Jamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets. CONCLUSION Our study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.
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Affiliation(s)
- Mark Alan Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Amos Laar
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Nathaniel Coleman
- Department of Population, Family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Milka Njeri Wanjohi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | | | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Kobby Mensah
- Business School, University of Ghana, Legon, Ghana
| | | | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Michelle Holdsworth
- NUTRIPASS Unit, French Research Institute for Sustainable Development (IRD), Montpellier, France
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Agbemafle I, Hadzi D, Amagloh F, Zotor F, Reddy M. Nutritional Content and Microbial Quality of Complementary Foods Produced from Blends of Orange-Fleshed Sweet Potato and Edible Insects. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa052_001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Improved formulations of complementary foods (CFs) with animal-source foods (ASFs) is an eminent strategy to improve infant nutrition, but they are expensive and not readily available in many food insecure settings which are a haven of edible insects. Hence, we developed orange-fleshed sweet potato (OFSP) based CFs supplemented with Cricket or palm weevil larvae (PWL), examined its nutritional content and microbial quality for infant feeding.
Methods
OFSP roots were sourced from local farmers, peeled, sliced, steam cooked and mechanically dried into OFSP flour. Cricket powder and PWL paste were obtained from commercial producers, steam cooked, and mechanically dried into Cricket/PWL flours. OFSP flour was mixed with either Cricket/PWL flours in the ratios of 100:0 (control), 85:15, 70:30, and 50:50 and used to produce ready-to-eat CFs. The CFs were evaluated for nutrient composition and microbial contamination using standard methods. ANOVA followed by Dunnett's test was used to compare all the formulations to the control.
Results
There were increase in protein (4.80 to 36.75%), iron (1.26 to 4.38 mg/100 g), zinc (0.69 to 10.65 mg/100 g) and calcium (45.54 to 152.77 mg/100 g) contents of the OFSP-based CFs with increased supplementation with Cricket/PWL flour. The carbohydrate and β-carotene content decreased but the energy content increased with increased supplementation with cricket/PWL flour from 344.52 Kcal/100 g in 100% OFSP CF to 541.09 Kcal/100 g in 50:50 CFs (OFSP: PWL) (P = 0.001). Aerobic mesophilic count (AMC) of the OFSP: Cricket CFs was 60 cfu/g as compared to 1300 cfu/g for the OFSP: PWL CFs. Comparing the OFSP-based Cricket/PWL CFs to the commercial Cricket or PWL, there was 35–331-fold reduction in AMC. Bacillus cereus (BC), aerobic (APC) and anaerobic plate count (NPC) was 0 cfu/g for the OFSP: Cricket CFs. BC, APC and NPC were 100, 260 and 130 cfu/g respectively for the OFSP: PWL CFs.
Conclusions
Steam cooking, then mechanical drying significantly reduced microbial concentrations in commercial Cricket and PWL to below minimum limits set by the Ghana Standards Authority for CFs requiring heating to boiling before consumption. OFSP-based Cricket/PWL composite flours could be safe viable alternatives as nutritious CFs in countries where they are culturally accepted as food.
Funding Sources
Nutritional Sciences Council at Iowa State University.
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Agbozo F, Abubakari A, Zotor F, Jahn A. Counselling as a Complementary Maternal and Child Health Intervention in Ghana: The Effect on Pregnancy Outcomes. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa059_002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To identify the main issues midwives reportedly counsel pregnant women on, the influence of counseling on pregnancy outcomes and the implementation gaps.
Methods
Mixed method design was used. Quantitative data included interviews with 299 pregnant women above 27 gestational weeks randomly recruited from five hospitals in Ghana who had four or more antenatal care (ANC) visits. Their maternal health record books were reviewed for documented counseling sessions. Where half of the recommended topics were discussed, it was considered as adequate counseling (AC). Binary logistic regression was modeled in STATA to estimate the unadjusted odds ratio (OR) of AC on pregnancy outcomes. For the qualitative data, in-depth were conducted with 15 midwives and exit interviews with all the women and analyzed thematically.
Results
According to the women, the most discussed topics were usage of insecticide-treated nets (60.5%), personal/environmental hygiene (57.5%) and breastfeeding (52.3%). Conversely, the midwives documented discussing mostly nutrition/anaemia (37.6%), danger signs in pregnancy (30.1%) and birth preparedness/complication readiness (29.9%). Most women disliked group counseling and cited non-tailoring of advice. Main implementation gaps were heavy work schedules, inadequate staff, limited time for counseling and hefty documentation. The 45% who were adequately counseled significantly reduced their likelihood for poor dietary intake (OR: 0.54, 95% CI: 0.32–0.90), incidence of malaria (OR: 0.22, 95% CI: 0.06–0.78), preeclampsia (OR: 0.25 CI: 0.06–0.99) and need for neonatal intensive care (OR: 0.29 CI: 0.09–0.94) while increasing the newborn's birth weight (OR: 1.85 CI: 1.08–3.19).
Conclusions
Strengthening ANC, training midwives to counsel effectively using different skills in varying situations and adopting peer counsellors would facilitate client-centred nutrition education and empower women to take healthier actions, thus promoting behaviour change.
Funding Sources
None.
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Affiliation(s)
| | | | - Francis Zotor
- University of Health and Allied Sciences, Family and Community Health Department
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University
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18
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Laar A, Barnes A, Aryeetey R, Tandoh A, Bash K, Mensah K, Zotor F, Vandevijvere S, Holdsworth M. Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: National experts' assessment of government action. Food Policy 2020; 93:101907. [PMID: 32565610 PMCID: PMC7299075 DOI: 10.1016/j.foodpol.2020.101907] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 05/15/2023]
Abstract
Nutrition-related non-communicable diseases (NR-NCDs) are a global health problem, increasingly recognised as driven by unhealthy food environments. Yet little is known about government action to implement food environment-relevant policies, particularly in low-and lower-middle income countries. This study assessed government action, implementation gaps, and priorities to improve the food environment in Ghana. Using the Healthy Food-Environment Policy Index (Food-EPI), a panel comprising government and independent experts (n = 19) rated government action to improve the healthiness of food environment in Ghana against international best practices and according to steps within a policy cycle. Forty-three good practice indicators of food environment policy and infrastructure support were used, with ratings informed by systematically collected evidence of action validated by government officials. Following the rating exercise, the expert panel proposed and prioritized actions for government implementation. Three-quarters of all good practice indicators were rated at 'low'/'very little' implementation. Restricting the marketing of breast milk substitutes was the only indicator rated "very high". Of ten policy actions prioritized for implementation, restricting unhealthy food marketing in children's settings and in the media were ranked the highest priority. Providing sufficient funds for nationally-relevant research on nutrition and NCDs was the highest priority infrastructure-support action. Other priority infrastructure-support actions related to leadership, monitoring and evaluation. This study identified gaps in Ghana's implementation of internationally-recommended policies to promote healthy food environments. National stakeholders recommended actions, which will require legislation and leadership. The findings provide a baseline for measuring government progress towards implementing effective policies to prevent NR-NCDs.
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Affiliation(s)
- Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Amy Barnes
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richmond Aryeetey
- 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
| | - Kristin Bash
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, Accra, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public health, University of Health and Allied Sciences Ho, Ghana
| | | | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
- UMR NUTRIPASS, French National Research Institute for Sustainable Development- IRD, Montpellier, France
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19
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Aglago EK, Bray F, Zotor F, Slimani N, Chajès V, Huybrechts I, Ferrari P, Gunter MJ. Temporal trends in food group availability and cancer incidence in Africa: an ecological analysis. Public Health Nutr 2019; 22:2569-2580. [PMID: 31124766 PMCID: PMC10260536 DOI: 10.1017/s1368980019000831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/28/2019] [Accepted: 02/19/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We evaluated the relationship between food availability, as the only dietary exposure data available across Africa, and age-standardised cancer incidence rates (ASR) in eighteen countries. DESIGN Ecological study. SETTING Availability of food groups and dietary energy was considered for five hypothetical time points: years of collection of ASR (T0) and 5, 10, 15 and 20 preceding years (T-5, T-10, T-15, T-20). Ecological correlations adjusted for human development index, smoking and obesity rates were calculated to evaluate the relationship between food availability and ASR of breast, prostate, colorectal, oesophageal, pancreatic, stomach and thyroid cancer. RESULTS Red meat was positively correlated with pancreatic cancer in men (T-20: r-20 = 0·61, P < 0·05), stomach cancer in women (T0: r0 = 0·58, P < 0·05), and colorectal cancer in men (T0: r0 = 0·53, P < 0·05) and women (T-20: r-20 = 0·58, P < 0·05). Animal products including meat, animal fats and higher animal-sourced energy supply tended to be positively correlated with breast, colorectal, pancreatic, stomach and thyroid cancer. Alcoholic beverages were positively correlated to oesophageal cancer in men (r0 = 0·69, P < 0·001) and women (r-20 = 0·72, P < 0·001). CONCLUSIONS The present analysis provides initial insights into the impact of alcoholic beverages, and increasing use of animal over plant products, on the incidence of specific cancers in Africa. The findings support the need for epidemiological studies to investigate the role of diet in cancer development in Africa.
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Affiliation(s)
- Elom K Aglago
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Francis Zotor
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Nadia Slimani
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Veronique Chajès
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Inge Huybrechts
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Pietro Ferrari
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
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20
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Pradeilles R, Marr C, Laar A, Holdsworth M, Zotor F, Tandoh A, Klomegah S, Coleman N, Bash K, Green M, Griffiths PL. How ready are communities to implement actions to improve diets of adolescent girls and women in urban Ghana? BMC Public Health 2019; 19:646. [PMID: 31138180 PMCID: PMC6537223 DOI: 10.1186/s12889-019-6989-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022] Open
Abstract
Background Ghana has reached an advanced stage of nutrition transition, contributing to an increase in nutrition-related non-communicable diseases, particularly amongst urban women. Community involvement is an important factor in the success of efforts to promote healthy eating. The readiness of populations to accept a range of interventions needs to be understood before appropriate interventions can be implemented. Therefore, this study assessed how ready urban communities are to improve diets of women of reproductive age in Ghana. Methods Using the Community Readiness Model (CRM), in-depth interviews were conducted with 24 key informants from various sectors in low income communities across two cities in Ghana: Accra and Ho. The CRM consists of 36 open questions addressing five readiness dimensions (community knowledge of efforts, leadership, community climate, knowledge of the issue and resources). Interviews were scored using the CRM protocol with a maximum of 9 points per dimension (from 1 = no awareness to 9 = high level of community ownership). Thematic analysis was undertaken to gain insights of community factors that could affect the implementation of interventions to improve diets. Results The mean community readiness scores indicated that both communities were in the “vague awareness stage” (3.35 ± 0.54 (Accra) and 3.94 ± 0.41 (Ho)). CRM scores across the five dimensions ranged from 2.65–4.38/9, ranging from denial/resistance to pre-planning. In both communities, the mean readiness score for ‘knowledge of the issue’ was the highest of all dimensions (4.10 ± 1.61 (Accra); 4.38 ± 1.81 (Ho)), but was still only at the pre-planning phase. The lowest scores were found for community knowledge of efforts (denial/resistance; 2.65 ± 2.49 (Accra)) and resources (vague awareness; 3.35 ± 1.03 (Ho)). The lack of knowledge of the consequences of unhealthy diets, misconceptions of the issue partly from low education, as well as challenges faced from a lack of resources to initiate/sustain programmes explained the low readiness. Conclusions Despite recognising that unhealthy diets are a public health issue in these urban Ghanaian communities, it is not seen as a priority. The low community readiness ratings highlight the need to increase awareness of the issue prior to intervening to improve diets. Electronic supplementary material The online version of this article (10.1186/s12889-019-6989-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Pradeilles
- Public Health Section, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK.
| | - Colette Marr
- Public Health Section, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK
| | - Amos Laar
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Akua Tandoh
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Nathaniel Coleman
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kristin Bash
- Public Health Section, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK
| | - Mark Green
- School of Environmental Sciences, University of Liverpool, Liverpool, UK
| | - Paula L Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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21
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Forsyth S, Calder PC, Zotor F, Amuna P, Meyer B, Holub B. Dietary Docosahexaenoic Acid and Arachidonic Acid in Early Life: What Is the Best Evidence for Policymakers? Ann Nutr Metab 2018; 72:210-222. [PMID: 29518776 PMCID: PMC6067655 DOI: 10.1159/000487271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/28/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND A wealth of information on the functional roles of docosahexaenoic acid (DHA) and arachidonic acid (ARA) from cellular, animal, and human studies is available. Yet, there remains a lack of cohesion in policymaking for recommended dietary intakes of DHA and ARA in early life. This is predominantly driven by inconsistent findings from a relatively small number of randomised clinical trials (RCTs), which vary in design, methodology, and outcome measures, all of which were conducted in high-income countries. It is proposed that this selective evidence base may not fully represent the biological importance of DHA and ARA during early and later life and the aim of this paper is to consider a more inclusive and pragmatic approach to evidence assessment of DHA and ARA requirements in infants and young children, which will allow policymaking to reflect the marked diversity of need worldwide. SUMMARY Data from clinical RCTs is considered in the context of the extensive evidence from experimental, animal and human observational studies. Although the RCT data shows evidence of beneficial effects on visual function and in specific cognitive domains, early methodological approaches do not reflect current thinking and this undermines the strength of evidence. An outline of a framework for an inclusive and pragmatic approach to policy development on dietary DHA and ARA in early life is described. CONCLUSION High-quality RCTs that will determine long-term health outcomes in appropriate real-world settings need to be undertaken. In the meantime, a collective pragmatic approach to evidence assessment, may allow public health policymakers to make comprehensive reasoned judgements on the merits, costs, and expediency of dietary DHA and ARA interventions.
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Affiliation(s)
| | - Philip C. Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Paul Amuna
- Research Section, Department of Clinical Affairs, Primary Health Care Corporation, Doha, Qatar
| | - Barbara Meyer
- Lipid Research Centre, School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bruce Holub
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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Aglago EK, Landais E, Zotor F, Nicolas G, Gunter MJ, Amuna P, Slimani N. Optimising design and cost-effective implementation of future pan-African dietary studies: a review of existing economic integration and nutritional indicators for scenario-based profiling and clustering of countries. Proc Nutr Soc 2018; 77:84-93. [PMID: 29241474 DOI: 10.1017/s0029665117004141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most of the African countries are undergoing a complex nutrition and epidemiologic transition associated with a rapid increase in the prevalence of diverse non-communicable diseases. Despite this alarming situation, the still limited and fragmented resources available in Africa impede the implementation of effective action plans to tackle the current and projected diet-disease burden. In order to address these common needs and challenges, the African Union is increasingly supporting continental approaches and strategies as reflected in the launching of the Agenda 2063 and the African regional nutrition strategy 2015-2025, among others. To assure the successful implementation of pan-African nutritional and health initiatives, cost-effective approaches considering similarities/disparities in economy, regional integration, development and nutritional aspects between countries are needed. In the absence of pre-existing models, we reviewed regional economic integration and nutritional indicators (n 13) available in international organisations databases or governmental agencies websites, for fifty-two African countries. These indicators were used to map the countries according to common languages (e.g. Arabic, English, French, Portuguese), development status (e.g. human development index), malnutrition status (e.g. obesity) and diet (e.g. staples predominantly based on either cereals or tubers). The review of the indicators showed that there exist similarities between African countries that can be exploited to benefit the continent with cross-national experiences in order to avoid duplication of efforts in the implementation of future pan-African health studies. In addition, including present and future nutrition surveillance programmes in Africa into national statistical systems might be cost-effective and sustainable in the longer term.
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Affiliation(s)
- Elom K Aglago
- International Agency for Research on Cancer (IARC/WHO),Lyon,France
| | - Edwige Landais
- UMR 204 'Nutripass' IRD,University of Montpellier,SupAgro,Montpellier,France
| | - Francis Zotor
- University of Health and Allied Sciences,Ho,Volta Region,Ghana
| | | | - Marc J Gunter
- International Agency for Research on Cancer (IARC/WHO),Lyon,France
| | - Paul Amuna
- Research Section,Primary Health Care Corporation,Doha,Qatar
| | - Nadia Slimani
- International Agency for Research on Cancer (IARC/WHO),Lyon,France
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Kwabla MP, Gyan C, Zotor F. Nutritional status of in-school children and its associated factors in Denkyembour District, eastern region, Ghana: comparing schools with feeding and non-school feeding policies. Nutr J 2018; 17:8. [PMID: 29329533 PMCID: PMC5767048 DOI: 10.1186/s12937-018-0321-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 01/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Childhood malnutrition still remains a major public health problem impacting negatively on the academic aptitude of school-aged children (SAC) particularly in limited resource countries. The Government of Ghana in collaboration with the Dutch Government introduced the school feeding programme (SFP) to boost the nutritional status of SAC in the country. This study sought to compare the nutritional status of SAC enrolled in schools with the SFP and SAC enrolled in schools without the SFP in place for the purpose of identifying which group has the higher rate of malnutrition. Methods A multi-stage sampling was used to select 359 SAC between 5 and 12 years who are enrolled in primary one to six. Twelve public schools were selected, of which 6 schools benefit from the SFP and the other six do not. Anthropometric measurements were conducted for the subjects and SPSS version 20.0 was used for data entry and analysis. Chi square test was carried out to determine the difference between the two groups of schools. Results Of the total of 359 subjects, 55.1% were from schools that do not implement the SFP and 44.9% were from schools that implement the SFP. The prevalence of stunting among children in schools on the SFP was 16.2% compared with 17.2% among children in schools that do not implement the SFP. The prevalence of thinness was two times higher (9.3%) among children in schools on the SFP than in children in schools that do not implement the SFP (4.6%) (p = 0.028). The prevalence of overweight among children in schools on the SFP was 1.9% and 0.0% for children in schools that do not implement the SFP. Sub district, sex, age of pupil, area of residence and community type were significantly associated with stunting (p = 0.002), (p = 0.008), (p = 0.008), (p < 0.001) and (p = 0.007) respectively. Conclusion Overweight and thinness were higher among children in schools on SFP than in children in schools without SFP. An evaluation of the implementation of the school feeding programme is recommended for future studies.
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Affiliation(s)
- Mavis Pearl Kwabla
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.
| | - Charlotte Gyan
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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24
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Agboli E, Egu E, Kweku M, Cham M, Zotor F, Binka F. Assessment of Some Physico-chemical Properties and Bacteriological Status of Sachet Water Consumed in the Hohoe Municipality, Ghana. ACTA ACUST UNITED AC 2018. [DOI: 10.9734/ijtdh/2017/37744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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25
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Aglago EK, Landais E, Nicolas G, Margetts B, Leclercq C, Allemand P, Aderibigbe O, Agueh VD, Amuna P, Annor GA, El Ati J, Coates J, Colaiezzi B, Compaore E, Delisle H, Faber M, Fungo R, Gouado I, El Hamdouchi A, Hounkpatin WA, Konan AG, Labzizi S, Ledo J, Mahachi C, Maruapula SD, Mathe N, Mbabazi M, Mirembe MW, Mizéhoun-Adissoda C, Nzi CD, Pisa PT, El Rhazi K, Zotor F, Slimani N. Evaluation of the international standardized 24-h dietary recall methodology (GloboDiet) for potential application in research and surveillance within African settings. Global Health 2017; 13:35. [PMID: 28629424 PMCID: PMC5477249 DOI: 10.1186/s12992-017-0260-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/11/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Collection of reliable and comparable individual food consumption data is of primary importance to better understand, control and monitor malnutrition and its related comorbidities in low- and middle-income countries (LMICs), including in Africa. The lack of standardised dietary tools and their related research support infrastructure remains a major obstacle to implement concerted and region-specific research and action plans worldwide. Citing the magnitude and importance of this challenge, the International Agency for Research on Cancer (IARC/WHO) launched the "Global Nutrition Surveillance initiative" to pilot test the use of a standardized 24-h dietary recall research tool (GloboDiet), validated in Europe, in other regions. In this regard, the development of the GloboDiet-Africa can be optimised by better understanding of the local specific methodological needs, barriers and opportunities. The study aimed to evaluate the standardized 24-h dietary recall research tool (GloboDiet) as a possible common methodology for research and surveillance across Africa. METHODS A consultative panel of African and international experts in dietary assessment participated in six e-workshop sessions. They completed an in-depth e-questionnaire to evaluate the GloboDiet dietary methodology before and after participating in the e-workshop. RESULTS The 29 experts expressed their satisfaction on the potential of the software to address local specific needs when evaluating the main structure of the software, the stepwise approach for data collection and standardisation concept. Nevertheless, additional information to better describe local foods and recipes, as well as particular culinary patterns (e.g. mortar pounding), were proposed. Furthermore, food quantification in shared-plates and -bowls eating situations and interviewing of populations with low literacy skills, especially in rural settings, were acknowledged as requiring further specific considerations and appropriate solutions. CONCLUSIONS An overall positive evaluation of the GloboDiet methodology by both African and international experts, supports the flexibility and potential applicability of this tool in diverse African settings and sets a positive platform for improved dietary monitoring and surveillance. Following this evaluation, prerequisite for future implementation and/or adaptation of GloboDiet in Africa, rigorous and robust capacity building as well as knowledge transfer will be required to roadmap a stepwise approach to implement this methodology across pilot African countries/regions.
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Affiliation(s)
- Elom Kouassivi Aglago
- Nutrition and Metabolism Section (NME), International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, 69372 Lyon, France
| | | | - Geneviève Nicolas
- Nutrition and Metabolism Section (NME), International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, 69372 Lyon, France
| | - Barrie Margetts
- Institute of Human Nutrition, University of Southampton, Southampton, UK
| | - Catherine Leclercq
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Pauline Allemand
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | | | | | - Paul Amuna
- Research Section, Primary Health Care Corporation, Doha, Qatar
| | | | | | - Jennifer Coates
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Brooke Colaiezzi
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Ella Compaore
- Department of Biochemistry-Microbiology, UFR-SVT, CRSBAN/University of Ouagadougou I Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Hélène Delisle
- TRANSNUT, Centre Collaborateur OMS sur la transition nutritionnelle et le développement, Département de Nutrition, Faculté of Médecine, Université de Montréal, Montréal, Canada
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Robert Fungo
- School of Food Technology, Nutrition & Bio-Engineering, Makerere University, Kampala, Uganda
| | - Inocent Gouado
- Faculty of Science, University of Douala, Douala, Cameroon
| | - Asmaa El Hamdouchi
- Unité mixte de recherche en Nutrition et alimentation; URAC 39; RDC-Nutrition associé à l’AFRA/AIEA (CNESTEN-Université Ibn Tofail), Rabat, Morocco
| | - Waliou Amoussa Hounkpatin
- Department of Food Science and Nutrition, Faculty of Agricultural Science, University of Abomey-Calavi, Cotonou, Benin
| | | | - Saloua Labzizi
- Unité mixte de recherche en Nutrition et alimentation; URAC 39; RDC-Nutrition associé à l’AFRA/AIEA (CNESTEN-Université Ibn Tofail), Rabat, Morocco
- Ministry of Health, Rabat, Morocco
| | | | - Carol Mahachi
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | | | - Nonsikelelo Mathe
- Faculty of Health Disciplines, Athabasca University, School of Public Health, University of Alberta, Edmonton, Canada
| | - Muniirah Mbabazi
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham, UK
| | - Mandy Wilja Mirembe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Karima El Rhazi
- Department of Epidemiology and Public Health, Faculty of Medicine of Fez, Fez, Morocco
| | - Francis Zotor
- University of Health and Allied Sciences, Ho, Volta Region Ghana
| | - Nadia Slimani
- Nutrition and Metabolism Section (NME), International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, 69372 Lyon, France
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Pisa PT, Landais E, Margetts B, Vorster HH, Friedenreich CM, Huybrechts I, Martin-Prevel Y, Branca F, Lee WTK, Leclercq C, Jerling J, Zotor F, Amuna P, Al Jawaldeh A, Aderibigbe OR, Amoussa WH, Anderson CAM, Aounallah-Skhiri H, Atek M, Benhura C, Chifamba J, Covic N, Dary O, Delisle H, El Ati J, El Hamdouchi A, El Rhazi K, Faber M, Kalimbira A, Korkalo L, Kruger A, Ledo J, Machiweni T, Mahachi C, Mathe N, Mokori A, Mouquet-Rivier C, Mutie C, Nashandi HL, Norris SA, Onabanjo OO, Rambeloson Z, Saha FBU, Ubaoji KI, Zaghloul S, Slimani N. Inventory on the dietary assessment tools available and needed in africa: a prerequisite for setting up a common methodological research infrastructure for nutritional surveillance, research, and prevention of diet-related non-communicable diseases. Crit Rev Food Sci Nutr 2017; 58:37-61. [PMID: 25486107 DOI: 10.1080/10408398.2014.981630] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To carry out an inventory on the availability, challenges, and needs of dietary assessment (DA) methods in Africa as a pre-requisite to provide evidence, and set directions (strategies) for implementing common dietary methods and support web-research infrastructure across countries. METHODS The inventory was performed within the framework of the "Africa's Study on Physical Activity and Dietary Assessment Methods" (AS-PADAM) project. It involves international institutional and African networks. An inventory questionnaire was developed and disseminated through the networks. Eighteen countries responded to the dietary inventory questionnaire. RESULTS Various DA tools were reported in Africa; 24-Hour Dietary Recall and Food Frequency Questionnaire were the most commonly used tools. Few tools were validated and tested for reliability. Face-to-face interview was the common method of administration. No computerized software or other new (web) technologies were reported. No tools were standardized across countries. CONCLUSIONS The lack of comparable DA methods across represented countries is a major obstacle to implement comprehensive and joint nutrition-related programmes for surveillance, programme evaluation, research, and prevention. There is a need to develop new or adapt existing DA methods across countries by employing related research infrastructure that has been validated and standardized in other settings, with the view to standardizing methods for wider use.
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Affiliation(s)
- Pedro T Pisa
- a Dietary Exposure Assessment Group, International Agency for Research on Cancer (IARC-WHO) , Lyon , France
| | - Edwige Landais
- a Dietary Exposure Assessment Group, International Agency for Research on Cancer (IARC-WHO) , Lyon , France.,b Institut de Recherche pour le Développement (IRD), UMR 204 Nutripass, IRD-UM2-UM1 , Montpellier , France
| | - Barrie Margetts
- c Institute of Human Nutrition, University of Southampton , Southampton , UK , and World Public Health Nutrition
| | - Hester H Vorster
- d Centre of Excellence for Nutrition (CEN), North-West University , Potchefstroom , South Africa , and African Nutrition Leadership Programme
| | - Christine M Friedenreich
- e Department of Population Health Research, Cancer Control Alberta, Alberta Health Services , and Departments of Oncology and Community Health Sciences, Faculty of Medicine , University of Calgary , Calgary, Alberta , Canada
| | - Inge Huybrechts
- a Dietary Exposure Assessment Group, International Agency for Research on Cancer (IARC-WHO) , Lyon , France
| | - Yves Martin-Prevel
- b Institut de Recherche pour le Développement (IRD), UMR 204 Nutripass, IRD-UM2-UM1 , Montpellier , France
| | - Francesco Branca
- f Department of Nutrition for Health and Development, World Health Organization (WHO) Headquarter , Geneva , Switzerland
| | - Warren T K Lee
- g Nutrition Division, Food and Agriculture Organization (FAO) of the United Nations , Rome , Italy
| | - Catherine Leclercq
- g Nutrition Division, Food and Agriculture Organization (FAO) of the United Nations , Rome , Italy
| | - Johann Jerling
- d Centre of Excellence for Nutrition (CEN), North-West University , Potchefstroom , South Africa , and African Nutrition Leadership Programme
| | - Francis Zotor
- h University of Health and Allied Sciences, Hohoe, and African Nutrition Society (ANS) , Accra , Ghana
| | - Paul Amuna
- i Department of Life Sciences , University of Greenwich , Kent , UK , and African Nutrition Society (ANS), Accra, Ghana
| | - Ayoub Al Jawaldeh
- j Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO) , Cairo , Egypt
| | | | - Waliou Hounkpatin Amoussa
- l Département de Nutrition et de Sciences Alimentaires , Faculté des Sciences Agronomiques, Université d'Abomey-Calavi , Cotonou , Bénin
| | - Cheryl A M Anderson
- m Department of Family and Preventive Medicine , San Diego School of Medicine, University of California , San Diego , CA , USA
| | - Hajer Aounallah-Skhiri
- n National Institute of Public Health, and Research Laboratory SURVEN (Nutritional Surveillance and Epidemiology in Tunisia) , Tunis , Tunisia
| | - Madjid Atek
- o National Institute of Public Health (INSP) , Algiers , Algeria
| | - Chakare Benhura
- p Institute of Food, Nutrition and Family Sciences, University of Zimbabwe , Harare , Zimbabwe
| | - Jephat Chifamba
- q Physiology Department, College of Health Sciences , University of Zimbabwe , Harare , Zimbabwe
| | - Namukolo Covic
- r Centre of Excellence for Nutrition (CEN), School of Physiology, Nutrition and Consumer Sciences, North-West University , Potchefstroom , South Africa
| | - Omar Dary
- s Abt Associates , Cambridge , Uganda
| | - Hélène Delisle
- t TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition , University of Montreal , Montreal , Canada
| | - Jalila El Ati
- u National Institute of Nutrition and Food Technology (INNTA), and Research Laboratory SURVEN (Nutritional Surveillance and Epidemiology in Tunisia) , Tunis , Tunisia
| | - Asmaa El Hamdouchi
- v Unité Mixte de Recherche en Nutrition et Alimentation (URAC 39), Université Ibn Tofaïl - CNESTEN , Rabat-Kénitra , Morocco
| | - Karima El Rhazi
- w Faculté de Médecine et de Pharmacie de Fès, Laboratoire d'Epidémiologie , Recherche Clinique et Santé Communautaire , Fès , Morocco
| | - Mieke Faber
- x Non-Communicable Diseases Research Unit, Medical Research Council , Cape Town , South Africa
| | - Alexander Kalimbira
- y Lilongwe University of Agriculture and Natural Resources , Lilongwe , Malawi
| | - Liisa Korkalo
- z Department of Food and Environmental Sciences , University of Helsinki , Finland
| | - Annamarie Kruger
- aa Africa Unit for Transdisciplinary Health Research (AUTHeR), Faculty of Health Sciences, North-West University , Potchefstroom , South Africa
| | | | - Tatenda Machiweni
- q Physiology Department, College of Health Sciences , University of Zimbabwe , Harare , Zimbabwe
| | - Carol Mahachi
- q Physiology Department, College of Health Sciences , University of Zimbabwe , Harare , Zimbabwe
| | - Nonsikelelo Mathe
- ac Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, University of Alberta , Edmonton , Canada
| | - Alex Mokori
- ad John Snow Inc. (JSI), Research and Training Institute , Kampala , Uganda
| | - Claire Mouquet-Rivier
- b Institut de Recherche pour le Développement (IRD), UMR 204 Nutripass, IRD-UM2-UM1 , Montpellier , France
| | - Catherine Mutie
- ae Ministry of Education, Science and Technology , Nairobi , Kenya
| | - Hilde Liisa Nashandi
- af Ministry of Health and Social Services, Non-Communicable Diet-Related Diseases and Nutrition in HIV, Food and Nutrition Subdivision , Windhoek , Namibia
| | - Shane A Norris
- ag MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Oluseye Olusegun Onabanjo
- ah Department of Human Nutrition & Dietetics , Federal University of Agriculture , Abeokuta , Ogun State , Nigeria
| | | | - Foudjo Brice U Saha
- aj Department of Biochemistry, Faculty of Science , University of Yaoundé I , Yaoundé , Cameroon
| | - Kingsley Ikechukwu Ubaoji
- ak Department of Applied Biochemistry, Faculty of Biosciences , Nnamdi Azikiwe University , Awka , Anambra State , Nigeria
| | | | - Nadia Slimani
- a Dietary Exposure Assessment Group, International Agency for Research on Cancer (IARC-WHO) , Lyon , France
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Al Lenjawi B, Mohamed H, Amuna P, Zotor F, Ziki MDA. Nurse-led theory-based educational intervention improves glycemic and metabolic parameters in South Asian patients with type II diabetes: a randomized controlled trial. Diabetol Int 2017; 8:95-103. [PMID: 30603312 PMCID: PMC6224927 DOI: 10.1007/s13340-016-0286-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study assessed whether a structured nurse-led diabetes educational program underpinned by the theories of the health belief model, change in locus of control, and patient empowerment is effective in improving glycemic and metabolic parameters among South Asians with type II diabetes compared to regular outpatient care. METHODS This was a parallel-group randomized trial in South Asian adult patients with type II diabetes living in Qatar. 460 subjects were randomized to a nurse-led, group-based diabetes educational program (n = 230) or to usual care (n = 230). The primary outcome was the improvement in HbA1c and other metabolic parameters, including lipid profile, albumin/creatinine ratio, blood pressure, and body mass index. Patients in the intervention group were invited to attend four 2-h sessions of self-efficacy improvement education once weekly. Outcomes were assessed at baseline and 12 months later. An intention-to-treat analysis was performed using repeated measures ANOVA (analysis of variance) for each of the clinical outcome variables. RESULTS After 12 months, 290 patients completed the study. Subjects in the intervention group had statistically significant improvements in HbA1c (-0.55 %, p = 0.012), fasting blood sugar (-16.6 mg/dl, p = 0.022), albumin/creatinine ratio (-3.09, p < 0.001), and HDL cholesterol (+6.08 mg/dl, p < 0.0001). CONCLUSION The inclusion of South Asian patients with type II diabetes in a structured, theory-based diabetes educational program that is led by nurses improves glycemic and metabolic parameters after 12 months.
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Affiliation(s)
| | - Hashim Mohamed
- Department of Nursing, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Paul Amuna
- School of Science, University of Greenwich, Kent, UK
| | - Francis Zotor
- School of Science, University of Greenwich, Kent, UK
| | - Maen D. Abou Ziki
- Department of Medicine, Weill Cornell Medical College in Qatar, Doha, Qatar
- Depatment of Genetic Medicine, Weill Cornell Medical College in Qatar, Doha, Qatar
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Egbi G, Ayi I, Saalia FK, Zotor F, Adom T, Harrison E, Ahorlu CK, Steiner-Asiedu M. Impact of Cowpea-Based Food Containing Fish Meal Served With Vitamin C-Rich Drink on Iron Stores and Hemoglobin Concentrations in Ghanaian Schoolchildren in a Malaria Endemic Area. Food Nutr Bull 2015; 36:264-75. [PMID: 26385950 DOI: 10.1177/0379572115596253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nutritional anemia is a public health problem among Ghanaian schoolchildren. There is need to employ dietary modification strategies to solve this problem through school and household feeding programs. OBJECTIVE To evaluate the effectiveness of cowpea-based food containing fish meal served with vitamin C-rich drink to improve iron stores and hemoglobin concentrations in Ghanaian schoolchildren. METHODS The study involved cross-sectional baseline and nutrition intervention phases. There were 150 participants of age 6 to 12 years. They were randomly assigned to 3 groups, fish meal -vitamin C (n = 50), vitamin C (n = 50), and control (n = 50), and given different cowpea-based diets for a 6-month period. Height and weight measurements were done according to the standard procedures, dietary data were obtained by 24-hour recall and food frequency questionnaire, hemoglobin concentrations were determined by Hemocue Hemoglobinometer, and serum ferritin and complement-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. Participants' blood samples were examined for malaria parasitemia and stools for helminthes using Giemsa stain and Kato-Katz techniques, respectively. RESULTS Mean ferritin concentration was not significantly different among groups. End line mean or change in hemoglobin concentrations between fish meal-vitamin C group (128.4 ± 7.2/8.3 ± 10.6 g/L) and control (123.1 ± 6.6/4.2 ± 10.4 g/L) were different, P < .05. Change in prevalence of anemia in fish meal-vitamin C group (19.5%) was different compared to those of vitamin C group (9.3%) and the control (12.2%). Levels of malaria parasitemia and high CRP among study participants at baseline and end line were 58% and 80% then 55% and 79%, respectively. Level of hookworm infestation was 13%. CONCLUSION Cowpea-based food containing 3% fish meal and served with vitamin C-rich drink improved hemoglobin concentration and minimized the prevalence of anemia among the study participants.
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Affiliation(s)
- Godfred Egbi
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Irene Ayi
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Firibu Kwesi Saalia
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | | | | | - Eric Harrison
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Collins K Ahorlu
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Matilda Steiner-Asiedu
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
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Mohamed H, Al-Lenjawi B, Amuna P, Zotor F, Elmahdi H. Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial. Prim Care Diabetes 2013; 7:199-206. [PMID: 23830727 DOI: 10.1016/j.pcd.2013.05.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 04/22/2013] [Accepted: 05/30/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the effectiveness of a culturally sensitive, structured education programme (CSSEP) on biomedical, knowledge, attitude and practice measures among Arabs with type two diabetes. RESEARCH DESIGNS AND METHODS A total of 430 patients with type II diabetes mellitus living in Doha, Qatar were enrolled in the study. They were randomized to either intervention (n = 215) or a control group (n = 215). A baseline and one-year interval levels of biomedical variables including HbA1C, lipid profile, urine for microalbuminuria; in addition to knowledge, attitude and practice (KAP) scores were prospectively measured. The intervention was based on theory of empowerment, health belief models and was culturally sensitive in relation to language (Arabic), food habits and health beliefs. It consisted of four educational sessions for each group of patients (10-20 patients per session), lasting for 3-4 h. The first session discussed diabetes pathophysiology and complications; while the second session discussed healthy life style incorporating the Idaho plate method; and the third session dealt with exercise benefits and goal setting and the fourth session concentrated enhancing attitude and practice using counselling techniques. Outcomes were assessed at base line and 12 months after intervention. RESULTS After 12 months participation in the intervention was shown to have led to a statistically significant reduction in HbA1C in the (CSSEP) group (-0.55 mmol/L, P = 0.012), fasting blood sugar (-0.92 mmol/L, P = 0.022), body mass index (1.70, P = 0.001) and albumin/creatinine ratio (-3.09, P < 0.0001) but not in the control group. The intervention group also had improvement in Diabetes knowledge (5.9%, P < 0.0001), attitude (6.56%, P < 0.0001), and practice (6.52%, P = 0.0001). CONCLUSION This study demonstrates the effectiveness of culturally sensitive, structured, group-based diabetes education in enhancing biomedical and behavioural outcomes in Diabetic patients.
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Affiliation(s)
- Hashim Mohamed
- Weill Cornell Medical College - Qatar, Qatar; Family Medicine, Primary Health Care Corporation, P.O. Box 7452, Doha, Qatar.
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Zotor F, Sheehy T, Lupu M, Kolahdooz F, Corriveau A, Sharma S. Frequency of consumption of foods and beverages by Inuvialuit adults in Northwest Territories, Arctic Canada. Int J Food Sci Nutr 2012; 63:782-9. [DOI: 10.3109/09637486.2012.676029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Amuna P, Zotor F, Tewfik I. Human and economic development in developing countries: a public health dimension employing the food multimix concept. ACTA ACUST UNITED AC 2004. [DOI: 10.1504/wrstsd.2004.005510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Amuna P, Zotor F, Sumar S, Tswelelo Chinyanga Y. The role of traditional cereal/legume/fruit‐based multimixes in weaning in developing countries. ACTA ACUST UNITED AC 2000. [DOI: 10.1108/00346650010319688] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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