Foodscapes, finance, and faith: Multi-sectoral stakeholder perspectives on the local population health and wellbeing in an urbanizing area in Kenya

Introduction

Rapid urbanization (growth of cities) can upset the local population's health and wellbeing by creating obesogenic environments which increase the burden of non-communicable diseases (NCDs). It is important to understand how stakeholders perceive the impact of urbanizing interventions (such as the construction of a new hypermarket) on the health and wellbeing of local populations. Because low- and middle-income countries (LMICs) lack the reliable infrastructure to mitigate the effects of obesogenic environments, so engaging stakeholders who influence dietary habits is one population-level strategy for reducing the burden of NCDs caused by newly built developments.

Methods

We conducted key informant interviews with 36 stakeholders (25 regulatory and 11 local community stakeholders) from Kisumu and Homa Bay Counties of Western Kenya in June 2019. We collected stakeholders' perspectives on the impacts of a new Mall and supermarket in Kisumu, and existing supermarkets in Homa Bay on the health and wellbeing of local populations.

Results

Through thematic discourse analysis, we noted that some stakeholders thought supermarkets enabled access to unhealthy food items despite these outlets being also reliable food sources for discerning shoppers. Others linked the changing physical environment to both an increase in pollution and different types of diseases. Stakeholders were unsure if the pricing and convenience of supermarkets would stop local populations from buying from their usual small-scale food vendors. The key finding of this study was that engaging relevant stakeholders as part of population health impact assessments of new developments in cities are important as it directs focus on health equity and prevention in instances of resource constraints. The findings highlight, also, that community members have a strong awareness of the potential for interventions that would improve the health and wellbeing of local populations.

Navigating the local foodscape: qualitative investigation of food retail and dietary preferences in Kisumu and Homa Bay Counties, western Kenya

Introduction

Non-communicable diseases have risen markedly over the last decade. A phenomenon that was mainly endemic in high-income countries has now visibly encroached on low and middle-income settings. A major contributor to this is a shift towards unhealthy dietary behavior. This study aimed to examine the complex interplay between people’s characteristics and the environment to understand how these influenced food choices and practices in Western Kenya.

Methods

This study used semi-structured guides to conduct in-depth interviews and focus group discussions with both male and female members of the community, across various socioeconomic groups, from Kisumu and Homa Bay Counties to further understand their perspectives on the influences of dietary behavior. Voice data was captured using digital voice recorders, transcribed verbatim, and translated to English. Data analysis adopted an exploratory and inductive analysis approach. Coded responses were analyzed using NVIVO 12 PRO software.

Results

Intrapersonal levels of influence included: Age, the nutritional value of food, occupation, perceived satiety of some foods as opposed to others, religion, and medical reasons. The majority of the participants mentioned location as the main source of influence at the community level reflected by the regional staple foodscape. Others include seasonality of produce, social pressure, and availability of food in the market. Pricing of food and distance to food markets was mentioned as the major macro-level influence. This was followed by an increase in population and road infrastructure.

Conclusion

This study demonstrated that understanding dietary preferences are complex. Future interventions should not only consider intrapersonal and interpersonal influences when aiming to promote healthy eating among communities but also need to target the community and macro environments. This means that nutrition promotion strategies should focus on multiple levels of influence that broaden options for interventions. However, government interventions in addressing food access, affordability, and marketing remain essential to any significant change.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13580-4.

Cross-Sectional Association of Food Source with Food Insecurity, Dietary Diversity and Body Mass Index in Western Kenya

The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption (‘own livestock’) had lower odds of moderate or severe household food insecurity (odds ratio (OR) = 0.29 (95% CI: 0.09, 0.96)) and those that reported buying food from supermarkets had lower odds of moderate or severe household food insecurity (borderline significant, OR = 0.37 (95% CI: 0.14, 1.00)), increased dietary diversity scores (Poisson coefficient = 0.17 (95% CI: 0.10, 0.24)) and higher odds of achieving minimum dietary diversity (OR = 2.84 (95% CI: 1.79, 4.49)). Our findings provide insight into the relationship between food environments, dietary patterns and nutrition in Kenya, and suggest that interventions that influence household food source may impact the malnutrition burden in this context.

Impacts of a New Supermarket on Dietary Behavior and the Local Foodscape in Kisumu, Kenya: Protocol for a Mixed Methods, Natural Experimental Study

Background

Access to healthy food is considered a key determinant of dietary behavior, and there is mixed evidence that living near a supermarket is associated with a healthier diet. In Africa, supermarkets may contribute to the nutrition transition by offering both healthy and unhealthy foods and by replacing traditional food sellers. In Kisumu, Kenya, a planned hypermarket (ie, a supermarket combined with a department store) will form the basis for a natural experimental evaluation.

Objective

The aim of this study is to explore the impacts of a new hypermarket on food shopping practices, dietary behaviors, physical activity patterns, and body composition among local residents and to identify concurrent changes in the local foodscape. We also aim to explore how impacts and associations vary by socioeconomic status.

Methods

We employ a mixed methods, longitudinal study design. Two study areas were defined: the hypermarket intervention area (ie, Kisumu) and a comparison area with no hypermarket (ie, Homabay). The study is comprised of 4 pieces of primary data collection: a quantitative household survey with local residents, a qualitative study consisting of focus group discussions with local residents and semistructured interviews with government and private sector stakeholders, an audit of the local foodscape using on-the-ground data collection, and an intercept survey of shoppers in the hypermarket. Assessments will be undertaken at baseline and approximately 1 year after the hypermarket opens.

Results

Baseline assessments were conducted from March 2019 to June 2019. From a total sampling frame of 400 households, we recruited 376 of these households, giving an overall response rate of 94.0%. The household survey was completed by 516 individuals within these households. Across the two study areas, 8 focus groups and 44 stakeholder interviews were conducted, and 1920 food outlets were geocoded.

Conclusions

This study aims to further the understanding of the relationship between food retail and dietary behaviors in Kenya. Baseline assessments for the study have been completed.

International Registered Report Identifier (IRRID)

DERR1-10.2196/17814

Revised Method for Aflatoxins in Cottonseed Products, and Comparison of Thin Layer and High Performance Liquid Chromatography Determinative Steps: Collaborative Study

Modifications to save analyst time and reagents have been made in the rapid method for separation and quantitation of aflatoxins in cottonseed products. A collaborative study of the revised method, including optional high performance liquid chromatography (HPLC) in addition to thin layer chromatography for the determinative step, showed no change in the method precision or accuracy due to the modifications and no significant difference in the values obtained by either determinative procedure. The HPLC technique provided no significant difference in analysis repeatability, but did reduce the betweenlaboratory error component. The method has been adopted as official first action.

Structural approaches to knowledge exchange: comparing practices across five centres of excellence in public health

Background

In 2008, five UKCRC Public Health Research Centres of Excellence were created to develop a coordinated approach to policy and practice engagement and knowledge exchange. The five Centres have developed their own models and practices for achieving these aims, which have not been compared in detail to date.

Methods

We applied an extended version of Saner's model for the interface between science and policy to compare five case studies of knowledge exchanges, one from each centre. We compared these practices on three dimensions within our model (focus, function and type/scale) to identify barriers and facilitators for knowledge exchange.

Results

The case studies shared commonalities in their range of activities (type) but illustrated different ways of linking these activities (function). The Centres' approaches ranged from structural to more organic, and varied in the extent that they engaged internal audiences (focus). Each centre addressed policymakers at different geographical levels and scale.

Conclusions

This article emphasizes the importance of linking a range of activities that engage policymakers at different levels, intensities and points in their decision-making processes to build relationships. Developing a structural approach to knowledge exchange activities in different contexts presents challenges of resource, implementation and evaluation.

What principles should guide interactions between population health researchers and the food industry? Systematic scoping review of peer-reviewed and grey literature

There is no explicit consensus amongst population health researchers regarding what constitutes acceptable or effective interactions with the food industry. This has led to confusion and disagreements over conflicts of interest, which can undermine the integrity of science. To clarify this issue, we aimed to systematically identify the key principles developed by population health researchers to prevent or minimize conflicts of interest when interacting with the food industry. Databases of peer-reviewed literature were searched. In addition, an advanced Google search, a request to experts seeking related documents, and hand searching of references were undertaken. Thematic analysis of the extracted data was undertaken. We examined 54 eligible documents describing guidelines for population health researchers when interacting with the food industry. Fifty-six principles were identified and synthesized in five themes. There were high levels of agreement in themes relating to research governance, transparency, and publication but less agreement and guidance on how principles should be applied in relation to funding and risk assessment. There is agreement on some of the general principles for preventing and minimizing conflicts of interests for population health researchers when interacting with the food industry. However, for issues such as assessing the appropriateness of an industry partner, greater clarity and consensus are required.

Correction: Data visualisation to support obesity policy: case studies of data tools for planning and transport policy in the UK

The financial support for this Article was not fully acknowledged. The Acknowledgements should have included the following: "This work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research [Grant Number ES/G007462/1], and the Wellcome Trust [Grant Number 087636/Z/08/Z], under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged."

Data visualisation to support obesity policy: case studies of data tools for planning and transport policy in the UK

Data visualisation is becoming an established way to drive discovery and develop theory and hypotheses among researchers. Data visualisations can also serve as tools for knowledge translation with policy makers, who are increasingly using data and evidence to inform and implement policy. For obesity policy, data visualisation tools can help policy makers and other professionals understand the socio-spatial distribution of risk factors and quantify social and environmental conditions that are recognised upstream determinants of diet, activity and obesity. The demand for and use of data visualisation tools can be driven by an identified policy need, which can be met by researchers and data scientists. Alternatively, researchers are developing and testing data visualisations, which may be subsequently adapted for, and adopted by policy users.Two recently-released interactive data visualisation tools in the UK illustrate these points. The Propensity to Cycle Tool (PCT) was developed with funding from the UK government to inform the investment of cycling infrastructure in England. The Food environment assessment tool (Feat) evolved as a translational output from a programme of epidemiological research. This article uses PCT and Feat as case studies, drawing parallels and contrasts between them. We discuss these two tools from policy context and scientific underpinnings, to product launch and evaluation. We review challenges inherent in the development and dissemination of data tools for policy, including the need for technical expertise, feedback integration, long-term sustainability, and provision of training and user support. Finally, we attempt to derive learning points that may help overcome challenges associated with the creation, dissemination and sustaining of data tools for policy. We contend that, despite a number of challenges, data tools provide a novel gateway between researchers and a range of stakeholders, who are seeking ways of accessing and using evidence to inform obesity programs and policies.

Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury

BACKGROUND

Type 2 myocardial infarction and myocardial injury are common in clinical practice, but long-term consequences are uncertain. We aimed to define long-term outcomes and explore risk stratification in patients with type 2 myocardial infarction and myocardial injury.

METHODS

We identified consecutive patients (n=2122) with elevated cardiac troponin I concentrations (≥0.05 µg/L) at a tertiary cardiac center. All diagnoses were adjudicated as per the universal definition of myocardial infarction. The primary outcome was all-cause death. Secondary outcomes included major adverse cardiovascular events (eg, nonfatal myocardial infarction or cardiovascular death) and noncardiovascular death. To explore competing risks, cause-specific hazard ratios were obtained using Cox regression models.

RESULTS

The adjudicated index diagnosis was type 1 or 2 myocardial infarction or myocardial injury in 1171 (55.2%), 429 (20.2%), and 522 (24.6%) patients, respectively. At 5 years, all-cause death rates were higher in those with type 2 myocardial infarction (62.5%) or myocardial injury (72.4%) compared with type 1 myocardial infarction (36.7%). The majority of excess deaths in those with type 2 myocardial infarction or myocardial injury were because of noncardiovascular causes (hazard ratio, 2.32; 95% confidence interval, 1.92-2.81 versus type 1 myocardial infarction). Despite this finding, the observed crude major adverse cardiovascular event rates were similar between groups (30.6% versus 32.6%), with differences apparent after adjustment for covariates (hazard ratio, 0.82; 95% confidence interval, 0.69-0.96). Coronary heart disease was an independent predictor of major adverse cardiovascular events in those with type 2 myocardial infarction or myocardial injury (hazard ratio, 1.71; 95% confidence interval, 1.31-2.24).

CONCLUSIONS

Despite an excess in noncardiovascular death, patients with type 2 myocardial infarction or myocardial injury have a similar crude rate of major adverse cardiovascular events as those with type 1 myocardial infarction. Identifying underlying coronary heart disease in this vulnerable population may help target therapies that could modify future risk.

A hot topic--heat waves and stroke

Following a heat wave in January 2014 in Adelaide, state capital of South Australia, we asked the question whether extreme heat was associated with an increase in stroke incidence. We found in the literature that the association between stroke presentation to hospital and meteorological factors has long been a topic of debate and subject to numerous studies. The literature indicated that an association between heat waves and an increase in admissions for stroke was unlikely in Australia and the United States. We suggest that it may be inappropriate to generalize this conclusion to other countries and rural areas. In view of the global climate change debate, we suggest that prospective studies be focused in developing countries and rural areas to assess the real impact of extreme heat on respective populations to better inform stroke physicians and health policy makers.

Gas chromatographic determination of deoxynivalenol in wheat with electron capture detection

A method is described for the determination of deoxynivalenol (DON) in wheat. The method involves sample extraction with chloroform-ethanol (8 + 2), column chromatographic cleanup on silica gel of small particle size, and derivatization with heptafluorobutyric acid anhydride using 4-dimethylaminopyridine as a catalyst. The derivative DON tris-heptafluorobutyrate is determined by gas chromatography using an electron capture detector. Recoveries of DON added to wheat at levels of 118-1184 ng/g averaged 88% with a coefficient of variation of 8.6%.