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Huayta VMR, Pradeilles R, Creed-Kanashiro HM, Rousham E, Delgado D, Pareja R, Landais E, Verdezoto N, Haycraft E, Holdsworth M. Identifying priority double-duty actions to tackle the double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national experts. PLoS One 2024; 19:e0303668. [PMID: 38768151 PMCID: PMC11104715 DOI: 10.1371/journal.pone.0303668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
Multiple forms of malnutrition coexist in infants and young children (IYC) in Peru. The World Health Organization has proposed double-duty actions (DDAs) to simultaneously address undernutrition and overweight/obesity. We assessed current implementation of- and priority for- government-level actions to tackle multiple forms of malnutrition in IYC in Peru. Mapping of current policy activity was undertaken against 47 indicators of good practice for five DDAs (exclusive breastfeeding, complementary feeding, food marketing, maternal nutrition, preschool nutrition; assessed by 27 indicators) and for the enabling policy environment, i.e., 'infrastructure support' (health in all policies, platforms for interactions, financing, monitoring, governance, leadership; assessed by 20 indicators). Interviews with 16 national experts explored views on the level of and barriers to implementation of DDAs and infrastructure support, as well as their prioritisation based on likely impact and feasibility. The level of implementation of actions was categorised into two groups (agenda setting/formulation vs. implementation/evaluation). Mean scores were generated for prioritisation of DDAs and infrastructure support. Deductive qualitative analysis was undertaken to identify barriers that influence policy implementation. Only 5/27 DDA indicators were reported as fully implemented by all national experts (international code that regulates the marketing of breastmilk substitutes, iron supplementation for IYC, micronutrient powders in IYC, iron/folic acid supplementation in pregnant women, paid maternity leave). Only 1/20 infrastructure support indicator (access to nutrition information) was rated as fully implemented by all experts. Barriers to implementing DDAs and infrastructure support included: legal feasibility or lack of regulations, inadequate monitoring/evaluation to ensure enforcement, commercial influences on policymakers, insufficient resources, shifting public health priorities with the COVID-19 pandemic and political instability. The experts prioritised 12 indicators across all five DDAs and eight infrastructure support indicators. Experts highlighted the need to improve implementation of all DDAs and identified ways to strengthen the enabling policy environment.
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Affiliation(s)
| | - Rebecca Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | | | - Emily Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Doris Delgado
- Facultad de Medicina, Departamento de Nutrición, Universidad Nacional Mayor de San Marcos (UNMSM), Lima, Perú
| | | | - Edwige Landais
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Nervo Verdezoto
- School of Computer Science and Informatics, Cardiff University, Cardiff, United Kingdom
| | - Emma Haycraft
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
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Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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Rousham E, Pareja RG, Creed-Kanashiro HM, Bartolini R, Pradeilles R, Ortega-Roman D, Holdsworth M, Griffiths P, Verdezoto N. Designing intervention prototypes to improve infant and young child nutrition in Peru: a participatory design study protocol. BMJ Open 2023; 13:e071280. [PMID: 38070935 PMCID: PMC10729018 DOI: 10.1136/bmjopen-2022-071280] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Nutrition during the complementary feeding period (6-23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and middle-income countries, including Peru. This study aims to co-design and develop prototypes for interventions to address the multiple forms of malnutrition in IYC in urban Peru, using a participatory design approach. METHODS AND ANALYSIS The study will be based within peri-urban communities in two areas of Peru (Lima and Huánuco city). Following the identification of key nutritional challenges for IYC aged 6-23 months through formative research (phase I), we will conduct a series of workshops bringing together healthcare professionals from government health centres and caregivers of IYC aged 6-23 months. Workshops (on idea generation; creating future scenarios; storyboarding and early implementation and feedback) will take place in parallel in the two study areas. Through these workshops, we will engage with community participants to explore, experiment, co-design and iteratively validate new design ideas to address the challenges around IYC complementary feeding from phase I. Workshop outputs and transcripts will be analysed qualitatively using affinity diagramming and thematic analyses. The intervention prototypes will be evaluated qualitatively and piloted with the participating communities. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Ethical Review Committee of the Instituto de Investigación Nutricional (IIN) Peru (388-2019/CIEI-IIN), Loughborough University (C19-87) and confirmed by Cardiff University. Findings of the participatory design process will be disseminated through a deliberative workshop in Lima, Peru with national and regional government stakeholders, as well as participants and researchers involved in the design process. Further dissemination will take place through policy briefs, conferences and academic publications.
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Azizi F, Bacopoulou F, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Baretić M, Barrera L, Basit A, Batieha AM, Batista AP, Baur LA, Belavendra A, Ben Romdhane H, Benet M, Berkinbayev S, Bernabe-Ortiz A, Berrios Carrasola X, Bettiol H, Beybey AF, Bhargava SK, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boggia JG, Bonaccio M, Bonilla-Vargas A, Borghs H, Bovet P, Brajkovich I, Brenner H, Brewster LM, Brian GR, Briceño Y, Brito M, Bugge A, Buntinx F, Cabrera de León A, Caixeta RB, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardoso VC, Carlsson AC, Casanueva FF, Censi L, Cervantes‐Loaiza M, Chamnan P, Chamukuttan S, Chan Q, Charchar FJ, Chaturvedi N, Chen H, Cheraghian B, Chirlaque MD, Chudek J, Cifkova R, Cirillo M, Claessens F, Cohen E, Concin H, Cooper C, Costanzo S, Cowell C, Crujeiras AB, Cruz JJ, Cureau FV, Cuschieri S, 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Jokelainen JJ, Jonas JB, Joshi P, Josipović J, Joukar F, Jóźwiak J, Kafatos A, Kajantie EO, Kalmatayeva Z, Karki KB, Katibeh M, Kauhanen J, Kazakbaeva GM, Kaze FF, Ke C, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kersting M, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Kingston A, Klakk H, Klanova J, Knoflach M, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kowlessur S, Koziel S, Kriemler S, Kristensen PL, Kromhout D, Kubinova R, Kujala UM, Kulimbet M, Kurjata P, Kyobutungi C, La QN, Labadarios D, Lachat C, Laid Y, Lall L, Lankila T, Lanska V, Lappas G, Larijani B, Latt TS, Laurenzi M, Lehmann N, Lehtimäki T, Lemogoum D, Leung GM, Li Y, Lima-Costa MF, Lin HH, Lind L, Lissner L, Liu X, Lopez-Garcia E, Lopez T, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lustigová M, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maestre GE, Maggi S, Magliano DJ, Magriplis E, 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F, Námešná J, Nangia VB, Naseri T, Neelapaichit N, Nejatizadeh A, Nenko I, Nervi F, Ng TP, Nguyen CT, Nguyen QN, Ni MY, Nie P, Nieto-Martínez RE, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, Odili AN, Oh K, Ohtsuka R, Omar MA, Onat A, Ong SK, Onodugo O, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostovar A, Otero JA, Ottendahl CB, Otu A, Owusu-Dabo E, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Park S, Parsaeian M, Patel ND, Pechlaner R, Pećin I, Pedro JM, Peixoto SV, Peltonen M, Pereira AC, Pessôa dos Prazeres TM, Peykari N, Phall MC, Pham ST, Phan HH, Pichardo RN, Pikhart H, Pilav A, Piler P, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Providencia R, Puder JJ, Puhakka S, Punab M, Qorbani M, Quintana HK, Quoc Bao T, Rahimikazerooni S, Raitakari O, Ramirez-Zea M, Ramke J, Ramos R, Rampal L, Rampal S, Rangel Reina DA, Rashidi MM, Redon J, Renner JDP, Reuter CP, Revilla L, Rezaei N, Rezaianzadeh A, Rigo F, Roa RG, Robinson L, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Romeo EL, Rosengren A, Rubinstein A, Rust P, Rutkowski M, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Salonen JT, Salvetti M, Sánchez-Abanto J, Santos DA, Santos LC, Santos MP, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Sbaraini M, Scazufca M, Schaan BD, Scheidt-Nave C, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sedaghattalab M, Sein AA, Sepanlou SG, Sewpaul R, Shamah-Levy T, Shamshirgaran SM, Sharafkhah M, Sharma SK, Sharman A, Shayanrad A, Shayesteh AA, Shimizu-Furusawa H, Shiri R, Shrestha N, Si-Ramlee K, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Soumaré A, Sousa-Poza A, Sparrenberger K, Staessen JA, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stokwiszewski J, Stronks K, Suarez-Ortegón MF, Suebsamran P, Sundström J, Suriyawongpaisal P, Sylva RC, Szklo M, Tamosiunas A, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thrift AG, Timmermans EJ, Tjandrarini DH, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Torres-Collado L, Traissac P, Triantafyllou A, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tuomainen TP, Tzala E, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Uusitalo HMT, Valdivia G, van den Born BJ, Van der Heyden J, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Vasan SK, Vega T, Velasquez-Melendez G, Verstraeten R, Viet L, Villalpando S, Vioque J, Virtanen JK, Viswanathan B, Voutilainen A, Wan Bebakar WM, Wan Mohamud WN, Wang C, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Webster-Kerr K, Wedderkopp N, Wei W, Westbury LD, Whincup PH, Widhalm K, Widyahening IS, Więcek A, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong A, Wong EB, Woodward M, Wu FC, Xu H, Xu L, Yaacob NA, Yan L, Yan W, Yoosefi M, Yoshihara A, Younger-Coleman NO, Yu YL, Yu Y, Yusoff AF, Zainuddin AA, Zamani F, Zambon S, Zampelas A, Zaw KK, Zeljkovic Vrkic T, Zeng Y, Zhang ZY, Zholdin B, Zimmet P, Zitt E, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c. Nat Med 2023; 29:2885-2901. [PMID: 37946056 PMCID: PMC10667106 DOI: 10.1038/s41591-023-02610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
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Pradeilles R, Landais E, Pareja R, Eymard‐Duvernay S, Markey O, Holdsworth M, Rousham EK, M. Creed‐Kanashiro H. Exploring the magnitude and drivers of the double burden of malnutrition at maternal and dyad levels in peri-urban Peru: A cross-sectional study of low-income mothers, infants and young children. Matern Child Nutr 2023; 19:e13549. [PMID: 37485734 PMCID: PMC10483951 DOI: 10.1111/mcn.13549] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
Multiple forms of malnutrition coexist in Peru, especially in peri-urban areas and poor households. We investigated the magnitude of, and the contribution of, dietary and socio-demographic factors to the double burden of malnutrition (DBM) at maternal (i.e., maternal overweight/obesity with anaemia) and dyad (i.e., maternal overweight/obesity with child anaemia) levels. A cross-sectional survey was conducted among low-income mother-child (6-23 months) dyads (n = 244) from peri-urban communities in Peru. Dietary clusters and the minimum dietary diversity score (MDD) were generated for mothers and infants, respectively. A composite indicator using the maternal dietary clusters and the MDD was created to relate to dyad level DBM. Two dietary clusters were found: (i) the 'high variety (i.e., animal-source foods, fruit and vegetables), high sugary foods/beverages' (cluster 1) and (ii) the 'high potato, low fruit and vegetables, low red meat' (cluster 2). DBM prevalence among mothers and dyads was 19.9% and 36.3%, respectively. Logistic regression analyses revealed that the only socio-demographic factor positively associated with maternal DBM was maternal age (aOR/5 years: 1.35 [1.07, 1.71]). Mothers belonging to diet cluster 1 were less likely to experience the DBM (aOR = 0.52 [0.26, 1.03]), although CIs straddled the null. Socio-demographic factors positively associated with dyad level DBM included maternal age (aOR/5 years: 1.41 [1.15, 1.73]), and having ≥ two children under 5 years (aOR = 2.44 [1.23, 4.84]). Diet was not associated with dyad-level DBM. Double-duty actions that tackle the DBM are needed given that one-third of dyads and a fifth of mothers had concurrent overweight/obesity and anaemia.
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Affiliation(s)
- Rebecca Pradeilles
- Centre for Global Health and Human Development School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | - Edwige Landais
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | | | - Sabrina Eymard‐Duvernay
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | - Oonagh Markey
- Centre for Global Health and Human Development School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | - Emily K. Rousham
- Centre for Global Health and Human Development School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
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Tandoh A, Laar A, Pradeilles R, Le Port A, Osei-Kwasi H, Amevinya GS, Aryeetey RNO, Agyemang C, Holdsworth M. Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal. BMJ Open 2023; 13:e075166. [PMID: 37770260 PMCID: PMC10546112 DOI: 10.1136/bmjopen-2023-075166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE This study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4-15 years) in Greater Accra Region, the highly urbanised administrative capital of Ghana. DESIGN The community readiness model was used to conduct in-depth mixed methods interviews with stakeholders. Using predefined anchored rating statements, quantitative readiness scores ranging from 1 to 9 were generated. Thematic qualitative analysis was undertaken to understand barriers and facilitators that could influence the implementation of interventions. SETTING Greater Accra Region, Ghana. PARTICIPANTS 18 key informants from various school/education/citizen sectors, which together represented the 'school community' of Greater Accra Region. RESULTS The mean readiness scores indicated that the 'school community' was at the 'preplanning' stage of readiness (4.44±0.98) to address the marketing and availability of unhealthy food and beverages in and around schools. The mean readiness score for 'leadership' was the highest of all dimensions (5.36±1.60), corresponding to the 'preparation' stage. The lowest scores were found for 'community knowledge of efforts' (3.19±2.45) and 'resources for efforts' (3.64±0.87), both of which were at a 'vague awareness' stage. CONCLUSIONS The 'school community' recognised that the marketing and availability of unhealthy food and beverages was a problem. Additionally, current leadership was actively supportive of continuing/improving efforts that create healthier children's food environments. However, actions that aim to increase the 'school community's' knowledge of existing interventions and securing resources to sustain those interventions are needed before introducing readiness appropriate strategies.
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Affiliation(s)
- Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Rebecca Pradeilles
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Agnes Le Port
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Hibbah Osei-Kwasi
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Gideon Senyo Amevinya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Richmond Nii Okai Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
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Moustier P, Holdsworth M, Anh DT, Seck PA, Renting H, Caron P, Bricas N. Corrigendum to: "The diverse and complementary components of urban food systems in the global South: Characterization and policy implications". Global Food Security 2023. [DOI: 10.1016/j.gfs.2023.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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Mishra A, Zhou B, Rodriguez-Martinez A, Bixby H, Singleton RK, Carrillo-Larco RM, Sheffer KE, Paciorek CJ, Bennett JE, Lhoste V, Iurilli MLC, Di Cesare M, Bentham J, Phelps NH, Sophiea MK, Stevens GA, Danaei G, Cowan MJ, Savin S, Riley LM, Gregg EW, Aekplakorn W, Ahmad NA, Baker JL, Chirita-Emandi A, Farzadfar F, Fink G, Heinen M, Ikeda N, Kengne AP, Khang YH, Laatikainen T, Laxmaiah A, Ma J, Monroy-Valle M, Mridha MK, Padez CP, Reynolds A, Sorić M, Starc G, Wirth JP, Abarca-Gómez L, Abdeen ZA, Abdrakhmanova S, Ghaffar SA, Abdul Rahim HF, Abdurrahmonova Z, Abu-Rmeileh NM, Garba JA, Acosta-Cazares B, Adam I, Adamczyk M, Adams RJ, Adu-Afarwuah S, Afsana K, Afzal S, Agbor VN, Agdeppa IA, Aghazadeh-Attari J, Aguenaou H, Aguilar-Salinas CA, Agyemang C, Ahmad MH, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed I, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Lahou B, Al-Raddadi R, Al Hourani HM, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Alexius S, Ali MM, Alkandari A, Alkerwi A, Alkhatib BM, Allin K, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Etxezarreta PA, Amoah J, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Androutsos O, Ängquist L, Anjana RM, Ansari-Moghaddam A, Anufrieva E, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aseffa N, Aspelund T, Assah FK, Assembekov B, Assunção MCF, Aung MS, Auvinen J, Avdičová M, Avi S, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Jørgensen MB, Baharudin A, Bahijri S, Bakacs M, Balakrishna N, Balanova Y, Bamoshmoosh M, Banach M, Banegas JR, Baran J, Baran R, Barbagallo CM, Filho VB, Barceló A, Baretić M, Barkat A, Barnoya J, Barrera L, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JLD, Bata I, Batieha AM, Batista AP, Batista RL, Battakova Z, Baur LA, Bayauli PM, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedics J, Benet M, Rolandi GEB, Bere E, Bergh IH, Berhane Y, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Carrasola XB, Bettiol H, Beutel ME, Beybey AF, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi H, Bi Y, Bia D, Biasch K, Lele ECB, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard AA, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Magnazu MB, Bo S, Bobak M, Boddy LM, Boehm BO, Boer JMA, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Boymatova K, Braeckevelt L, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Briceño Y, Brinduse L, Brito M, Brophy S, Brug J, Bruno G, Bugge A, Buntinx F, Buoncristiano M, Burazeri G, Burns C, de León AC, Cacciottolo J, Cai H, Caixeta RB, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Casas M, Celikcan E, Censi L, Cervantes‐Loaiza M, Cesar JA, Chamukuttan S, Chan A, Chan Q, Chaturvedi HK, Chaturvedi N, Rahim NCA, Chee ML, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheng YJ, Cheraghian B, Chetrit A, Chikova-Iscener E, Chinapaw MJM, Chinnock A, Chiolero A, Chiou ST, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Cirillo M, Claessens F, Clarke J, Clays E, Cohen E, Compañ-Gabucio LM, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Cortés LY, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Cross AJ, Crujeiras AB, Cruz JJ, Csányi T, Csilla S, Cucu AM, Cui L, Cureau FV, Cuschieri S, Czenczek-Lewandowska E, D’Arrigo G, d’Orsi E, Dacica L, Dallongeville J, Damasceno A, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, de Assis MAA, De Backer G, De Bacquer D, De Curtis A, de Fragas Hinnig P, de Gaetano G, De Henauw S, De Miguel-Etayo P, de Oliveira PD, De Ridder D, De Ridder K, de Rooij SR, De Smedt D, Deepa M, Deev AD, DeGennaro V, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Dhimal M, Di Castelnuovo A, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Fernández PD, Ripollés MPD, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Dominguez L, Donati MB, Donfrancesco C, Dong G, Dong Y, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Doua K, Dragano N, Drygas W, Duan JL, Duante CA, Duboz P, Duleva VL, Dulskiene V, Dumith SC, Dushpanova A, Dyussupova A, Dzerve V, Dziankowska-Zaborszczyk E, Echeverría G, Eddie R, Eftekhar E, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ammari L, El Ati J, Eldemire-Shearer D, Eliasen M, Elliott P, Endevelt R, Engle-Stone R, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhradiyev I, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Sant’Angelo VF, Fattahi MR, Fawwad A, Fawzi WW, Feigl E, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari G, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fisberg M, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, do Carmo Franco M, Fras Z, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furdela V, Furusawa T, Gaciong Z, Gafencu M, Cuesta MG, Galbarczyk A, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, Mérida MJG, Solano MG, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, George R, Ghaderi E, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Gialluisi A, Giampaoli S, Gianfagna F, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Glushkova N, Gluškova N, Godara R, Godos J, Gogen S, Goldberg M, Goltzman D, Gómez G, Gómez JHG, Gomez LF, Gómez SF, Gomula A, da Silva BGC, Gonçalves H, Gonçalves M, González-Alvarez AD, Gonzalez-Chica DA, González-Gil EM, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Gregório MJ, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Guajardo V, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, González EG, Gutierrez L, Gutzwiller F, Gwee X, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Kumar RH, Lassen TH, Harooni J, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, He Y, Heidinger-Felső R, Heier M, Hejgaard T, Hendriks ME, dos Santos Henrique R, Henriques A, Cadena LH, Herrala S, Herrera-Cuenca M, Herrera VM, Herter-Aeberli I, Herzig KH, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Höfelmann DA, Holdsworth M, Homayounfar R, Homs C, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Petrescu CH, Huisman M, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Iakupova EM, Ibarluzea JM, Ibrahim MM, Wong NI, Ikram MA, Iñiguez C, Iotova V, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Islek D, Ivanova-Pandourska IY, Iwasaki M, Jääskeläinen T, Jackson RT, Jacobs JM, Jadoul M, Jafar T, Jallow B, James K, Jamil KM, Jamrozik K, Jansson A, Janszky I, Janus E, Jarani J, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jonnagaddala J, Jørgensen T, Joshi P, Josipović J, Joukar F, Jóźwiak JJ, Judge DS, Juolevi A, Jurak G, Simina IJ, Juresa V, Kaaks R, Kaducu FO, Kafatos A, Kaj M, Kajantie EO, Kakutia N, Kállayová D, Kalmatayeva Z, Kalter-Leibovici O, Kameli Y, Kampmann FB, 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KM, Malyutina SK, Maniego LV, Manios Y, Manix MI, Mann JI, Mansour-Ghanaei F, Manyanga T, Manzato E, Marcil A, Margozzini P, Mariño J, Markaki A, Markey O, Ioannidou EM, Marques-Vidal P, Marques LP, Marrugat J, Martin-Prevel Y, Martin R, Martorell R, Martos E, Maruszczak K, Marventano S, Masala G, Mascarenhas LP, Masoodi SR, Mathiesen EB, Mathur P, Matijasevich A, Matłosz P, Matsha TE, Matsudo V, Mavrogianni C, Mazur A, Mbanya JCN, McFarlane SR, McGarvey ST, McKee M, McLachlan S, McLean RM, McLean SB, McNairy ML, McNulty BA, Benchekor SM, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisfjord J, Meisinger C, Melgarejo JD, Melkumova M, Mello J, Méndez F, Mendivil CO, Menezes AMB, Menon GR, Mensink GBM, Menzano MT, Meshram II, Meto DT, Mi J, Michaelsen KF, Michels N, Mikkel K, Miłkowska K, Miller JC, Milushkina O, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Duraković M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Yusoff MFM, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Mopa HT, Moradpour F, Moreira LB, Morejon A, Moreno LA, Morey F, Morgan K, Morin SN, Mortensen EL, Moschonis G, Moslem A, Mossakowska M, Mostafa A, Mostafavi SA, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Movsesyan Y, Msyamboza KP, Mu TT, Muc M, Muca F, Mugoša B, Muiesan ML, Müller-Nurasyid M, Münzel T, Mursu J, Murtagh EM, Musa KI, Milanović SM, Musil V, Musinguzi G, Muyer MTMC, Nabipour I, Naderimagham S, Nagel G, Najafi F, Nakamura H, Nalecz H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Nardone P, Naseri T, Nauck M, Neal WA, Nejatizadeh A, Nekkantti C, Nelis K, Nenko I, Neovius M, Nervi F, Ng TP, Nguyen CT, Nguyen ND, Nguyen QN, Ni MY, Nicolescu R, Nie P, Nieto-Martínez RE, Nikitin YP, Ning G, Ninomiya T, Nishi N, Nishtar S, Noale M, Noboa OA, Nogueira H, Nordendahl M, Nordestgaard BG, Noto D, Nowak-Szczepanska N, Nsour MA, Nuhoğlu I, Nunes B, Nurk E, Nuwaha F, Nyirenda M, O’Neill TW, O’Reilly D, Obreja G, Ochimana C, Ochoa-Avilés AM, Oda E, Odili AN, Oh K, Ohara K, Ohlsson C, Ohtsuka R, Olafsson Ö, Olinto MTA, Oliveira IO, Omar MA, Omar SM, Onat A, Ong SK, Onland-Moret NC, Ono LM, Ordunez P, Ornelas R, Ortiz AP, Ortiz PJ, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Pagkalos I, Pahomova E, de Paiva KM, Pająk A, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Pérez CM, Peterkova V, Peters A, Petersmann A, Petkeviciene J, Petrauskiene A, Kovtun OP, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Pichardo RN, Pierannunzio D, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Bao TQ, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Rao SR, Ramachandran A, Ramadan OPC, Ramires VV, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Richter A, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Robitaille C, Roccaldo R, Rodrigues D, Rodríguez-Artalejo F, del Cristo Rodriguez-Perez M, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Moreno ER, Rusakova IA, Jonsson KR, Russo P, Rust P, Rutkowski M, Saamel M, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Martinez ES, Saleva C, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Rodríguez IS, Sandjaja, Sans S, Marina LS, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Rosario AS, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, de Moura Silva CR, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina NA, Skodje G, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Jérome CS, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suka M, Sun CA, Sun L, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szklo M, Szponar L, Tabone L, Tai ES, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Braunerová RT, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thuesen BH, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Mądry R, Torheim LE, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tsao YH, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Voutilainen A, Vrijheid M, Vrijkotte TGM, Wade AN, Waldhör T, Walton J, Wambiya EOA, Bebakar WMW, Mohamud WNW, de Souza Wanderley Júnior R, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Webster-Kerr K, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wojciech R, Wojtyniak B, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, García MY, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Cisneros JZ, Zuziak M, Bhutta ZA, Black RE, Ezzati M. Diminishing benefits of urban living for children and adolescents' growth and development. Nature 2023; 615:874-883. [PMID: 36991188 PMCID: PMC10060164 DOI: 10.1038/s41586-023-05772-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Abstract
Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
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Isanovic S, Constantinides SV, Frongillo EA, Bhandari S, Samin S, Kenney E, Wertheim-Heck S, Nordhagen S, Holdsworth M, Dominguez-Salas P, Ambikapathi R, Laar A, Patil CL, Kulkarni B, Bukachi SA, Ngutu M, Blake CE. How Perspectives on Food Safety of Vendors and Consumers Translate into Food-Choice Behaviors in 6 African and Asian Countries. Curr Dev Nutr 2023; 7:100015. [PMID: 37181131 PMCID: PMC10100931 DOI: 10.1016/j.cdnut.2022.100015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/30/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Consumption of unsafe foods increases morbidity and mortality and is currently an issue, particularly in low- and middle-income countries. Policy actions to ensure food safety are dominated by mitigation of biological and chemical hazards through supply-side risk management, lessening the degree to which consumer perspectives of food safety are considered. Objectives This study aimed to provide an in-depth understanding, from vendor and consumer perspectives, of how food-safety concerns of consumers translate into their subsequent food-choice behaviors in 6 diverse low- and middle-income countries. Methods Six Drivers of Food Choice projects (2016-2022) provided transcripts from 17 focus group discussions and 343 interviews conducted in Ghana, Guinea, India, Kenya, Tanzania, and Vietnam. Qualitative thematic analysis was used to identify emerging themes important to food safety. Results The analysis suggests that consumers constructed meaning about food safety through personal lived experience and social influences. Community and family members contributed knowledge about food safety. Concerns about food safety were influenced by reputations of and relationships with food vendors. Consumers' mistrust of food vendors was amplified by purposeful adulteration or unsafe selling practices and new methods used to produce food. Moreover, consumers were reassured of food safety by positive relationships with vendors; meals cooked at home; implementation of policies and following regulations; vendor adherence to environmental sanitation and food-hygiene practices; cleanliness of vendors' appearance; and vendors' or producers' agency to use risk mitigation strategies in production, processing, and distribution of food. Conclusions Consumers integrated their meanings, knowledge, and concerns about food safety to achieve assurance about the safety of their foods when making food-choice decisions. The success of food-safety policies hinges on consideration of consumers' food-safety concerns in their design and implementation, alongside actions to reduce risk in food supply.
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Affiliation(s)
- Sejla Isanovic
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shilpa V. Constantinides
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shiva Bhandari
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sharraf Samin
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Emma Kenney
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sigrid Wertheim-Heck
- Environmental Policy Group, Department of Social Sciences, Wageningen University, Wageningen, the Netherlands
| | | | - Michelle Holdsworth
- Montpellier Interdisciplinary Center on Sustainable Agri-food Systems, University of Montpellier, French Agricultural Research Centre for International Development, International Center for Advanced Mediterranean Agronomic Studies, Mediterranean Agronomic Institute of Montpellier, French National Institute for Agricultural Research, Institut Agro, French National Research Institute for Sustainable Development, Montpellier, France
| | - Paula Dominguez-Salas
- Natural Resources Institute, University of Greenwich, London, United Kingdom
- International Livestock Research Institute, Nairobi, Kenya
| | - Ramya Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, USA
- Department of Global Development, Cornell University, Ithaca, NY, USA
| | - Amos Laar
- University of Ghana, Department of Population, Family and Reproductive Health, School of Public Health, Accra, Ghana
| | - Crystal L. Patil
- Department of Human Development Nursing Science, University of Illinois–Chicago, Chicago, IL, USA
| | - Bharati Kulkarni
- Division of Reproductive Biology, Maternal and Child Health and Nutrition, Indian Council of Medical Research, V. Ramalingaswami Bhawan, New Delhi, India
| | - Salome A. Bukachi
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Mariah Ngutu
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Christine E. Blake
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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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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11
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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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12
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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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13
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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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14
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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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15
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Trübswasser U, Candel J, Genye T, Bossuyt A, Holdsworth M, Baye K, Talsma E. Benchmarking policy goals and actions for healthy food environments in Ethiopia to prevent malnutrition in all its forms using document analysis. BMJ Open 2022; 12:e058480. [PMID: 35985782 PMCID: PMC9396152 DOI: 10.1136/bmjopen-2021-058480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 11/07/2022] Open
Abstract
OBJECTIVE Unhealthy diets resulting in overweight and obesity and diet-related non-communicable diseases are of increasing concern in Ethiopia, alongside persistent undernutrition, and have been linked to unhealthy food environments. Little is known about the policy response to unhealthy food environments in Ethiopia. The objective of this study was to assess how different food environment domains have been addressed in Ethiopian policy goals and action over time and how this compares with global good practice benchmarks. SETTING Ethiopia. PRIMARY AND SECONDARY OUTCOME MEASURES We analysed intentions and plans of the government to act, using policy documents (outputs of decision-making in the form of published strategies, plans or policies) related to improving diets and nutritional status through healthy food environments in Ethiopia between 2008 and 2020. Our coding framework was guided by the policy component (n=7 domains) of the Healthy Food-Environment Policy Index, which was modified to include food quality and safety as an eighth domain. RESULTS From the 127 policy outputs identified, 38 were retained, published by 9 different government ministries and institutions. Our results show that eight food environment domains have been addressed to some extent, but gaps remain compared with global best practice, especially in food promotion, processing, retail, price and trade. From 2018, policy began to embrace the wider food system, with more explicit food environment interventions becoming apparent. CONCLUSIONS Policy efforts achieved in food safety, food processing, marketing and labelling are important stepping stones to building future policy actions addressing the food environment domains of food retail, food provision and food trade. Benchmarking of food environment policy actions should also consider actions on food fortification, agro-processing and informal markets in the context of multiple forms of malnutrition.
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Affiliation(s)
- Ursula Trübswasser
- Division of Human Nutrition and Health, Chair Group Global Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - Jeroen Candel
- Public Administration and Policy Group, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Tirsit Genye
- Ethiopia NIPN Technical Assistance Project (ENTAP), International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Anne Bossuyt
- Ethiopia NIPN Technical Assistance Project (ENTAP), International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Center on Sustainable Agri-Food Systems), (Univ. Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Elise Talsma
- Division of Human Nutrition and Health, Chair Group Global Nutrition, Wageningen University & Research, Wageningen, The Netherlands
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Pradeilles R, Pareja R, Creed‐Kanashiro HM, Griffiths PL, Holdsworth M, Verdezoto N, Eymard‐Duvernay S, Landais E, Stanley M, Rousham EK. Diet and food insecurity among mothers, infants, and young children in Peru before and during COVID‐19: A panel survey. Maternal & Child Nutrition 2022; 18:e13343. [PMID: 35274825 PMCID: PMC9115223 DOI: 10.1111/mcn.13343] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 12/26/2022]
Abstract
The COVID‐19 pandemic may impact diet and nutrition through increased household food insecurity, lack of access to health services, and poorer quality diets. The primary aim of this study is to assess the impact of the pandemic on dietary outcomes of mothers and their infants and young children (IYC) in low‐income urban areas of Peru. We conducted a panel study, with one survey prepandemic (n = 244) and one survey 9 months after the onset of COVID‐19 (n = 254). We assessed breastfeeding and complementary feeding indicators and maternal dietary diversity in both surveys. During COVID‐19, we assessed household food insecurity experience and economic impacts of the pandemic on livelihoods; receipt of financial or food assistance, and uptake of health services. Almost all respondents (98.0%) reported adverse economic impacts due to the pandemic and 46.9% of households were at risk of moderate or severe household food insecurity. The proportion of households receiving government food assistance nearly doubled between the two surveys (36.5%–59.5%). Dietary indicators, however, did not worsen in mothers or IYC. Positive changes included an increase in exclusive breastfeeding <6 months (24.2%–39.0%, p < 0.008) and a decrease in sweet food consumption by IYC (33.1%–18.1%, p = 0.001) and mothers (34.0%–14.6%, p < 0.001). The prevalence of sugar‐sweetened beverage consumption remained high in both mothers (97%) and IYC (78%). In sum, we found dietary indicators had not significantly worsened 9 months into the COVID‐19 pandemic. However, several indicators remain suboptimal and should be targeted in future interventions. Almost all respondents (98.0%) reported negative economic impacts on their households from the pandemic. During the pandemic, almost half of households (46.9%) were at risk of moderate or severe household food insecurity. During the pandemic, 66.9% of households received cash transfers, and 59.4% received food assistance from the government. Nine months into the pandemic, positive changes included an increased prevalence of exclusive breastfeeding <6 months, a decreased proportion of mothers and infants and young children (IYC) consuming sweet foods, and stable dietary indicators for IYC and women. Consumption of sugar‐sweetened beverages and unhealthy foods remained high across the two time periods for mothers and IYC and should be targeted in future interventions.
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Affiliation(s)
- Rebecca Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | | | | | - Paula L. Griffiths
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
- School of Clinical Medicine University of the Witwatersrand Johannesburg South Africa
| | - Michelle Holdsworth
- Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRD (UMR MoISA) Montpellier France
| | - Nervo Verdezoto
- School of Computer Science and Informatics Cardiff University Cardiff UK
| | - Sabrina Eymard‐Duvernay
- Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRD (UMR MoISA) Montpellier France
| | - Edwige Landais
- Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRD (UMR MoISA) Montpellier France
| | - Megan Stanley
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Emily K. Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
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Trübswasser U, Talsma EF, Ekubay S, Poelman MP, Holdsworth M, Feskens EJM, Baye K. Factors Influencing Adolescents' Dietary Behaviors in the School and Home Environment in Addis Ababa, Ethiopia. Front Public Health 2022; 10:861463. [PMID: 35462798 PMCID: PMC9024113 DOI: 10.3389/fpubh.2022.861463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Malnutrition affects many adolescents in Ethiopia. Over one-third of adolescent girls and two-thirds of boys are thin. Overweight and obesity in Ethiopia is mostly a concern in urban populations of higher wealth quintiles. Urbanization and globalization of diets is shifting food environments. The objective of this study was to assess whether food environments in and around schools in urban Ethiopia influence dietary diversity, quality, BMI status or perceptions of adolescents. Methods Twelve high schools were selected in Addis Ababa (private/government). From each school, 20 pupils aged 15–19 years were randomly selected (n = 217) and interviewed about assets in their households, their diets (categorized into 10 food groups of the Minimum Dietary Diversity, the Global Dietary Recommendations scores and four categories of the NOVA classification based on level of processing) and their use of pocket money. In addition, food environment audits were conducted within the school compound and a 0.5 km radius around each school and types of food outlets. Results On average there were 436 food outlets and 246 food or drink advertisements around each school. The majority of the advertisements (89.9%) were of ultra-processed foods, mostly sugar-sweetened beverages (SSBs). Most were positioned on food outlets (89.1%). SSBs or sweets were visibly on display in 26.3% of the outlets and fresh fruits and vegetables in 17.9% of outlets. Dietary diversity of adolescents was poor with an average of 3.6 food groups out of 10 consumed in the last 24 h. Ultra-processed foods and beverages were consumed by 23.5% of adolescents. The majority of adolescents spent their pocket money on SSBs, sweets or fried foods. Our analysis found that higher assets in adolescents' households were associated with higher dietary diversity and consumption of healthy food groups. We found no association between the food environment and dietary indicators or the BMI-z-score. Conclusion While the school food environments investigated were not conducive with promoting healthy dietary behaviors, we cannot conclude that these environmental factors directly influence adolescents' diets. The pervasive advertising and availability of unhealthy foods and beverages requires policy action for healthy school food environments.
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Affiliation(s)
- Ursula Trübswasser
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- *Correspondence: Ursula Trübswasser
| | - Elise F. Talsma
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Selamawit Ekubay
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maartje P. Poelman
- Department of Social Sciences, Chair Group Consumption and Healthy Lifestyles, Wageningen University, Wageningen, Netherlands
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
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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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Pradeilles R, Holdsworth M, Olaitan O, Irache A, Osei-Kwasi HA, Ngandu CB, Cohen E. Body size preferences for women and adolescent girls living in Africa: a mixed-methods systematic review. Public Health Nutr 2022; 25:738-759. [PMID: 33593472 PMCID: PMC9991778 DOI: 10.1017/s1368980021000768] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To synthesise evidence on body size preferences for females living in Africa and the factors influencing these. DESIGN Mixed-methods systematic review including searches on Medline, CINHAL, ASSIA, Web of Science and PsycINFO (PROSPERO CRD42015020509). A sequential-explanatory approach was used to integrate quantitative and qualitative findings. SETTING Urban and rural Africa. PARTICIPANTS Studies of both sexes providing data on body size preferences for adolescent girls and women aged ≥10 years. RESULTS Seventy-three articles from twenty-one countries were included: fifty quantitative, fifteen qualitative and eight mixed methods. Most studies reported a preference for normal or overweight body sizes. Some studies of adolescent girls/young women indicated a preference for underweight. Factors influencing preferences for large(r) body sizes included: socio-demographic (e.g. education, rural residency), health-related (e.g. current BMI, pubertal status), psycho-social (e.g. avoiding HIV stigma) and socio-cultural factors (e.g. spouse's preference, social standing, cultural norms). Factors influencing preferences for slim(mer) body sizes included: socio-demographic (e.g. higher socioeconomic status, urban residency, younger age), health-related (e.g. health knowledge, being nulliparous), psycho-social (e.g. appearance, body size perception as overweight/obese) and socio-cultural factors (e.g. peer pressure, media). CONCLUSIONS Preference for overweight (not obese) body sizes among some African females means that interventions need to account for the array of factors that maintain these preferences. The widespread preference for normal weight is positive in public health terms, but the valorisation of underweight in adolescent girls/young women may lead to an increase in body dissatisfaction. Emphasis needs to be placed on education to prevent all forms of malnutrition.
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Affiliation(s)
- Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences (SSEHS), Loughborough University, LoughboroughLE11 3TU, UK
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | | | - Ana Irache
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Christian B Ngandu
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Emmanuel Cohen
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- UMR CNRS-MNHN 7206 « Eco-anthropologie », Musée de l’Homme, Paris, France
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Reyes LI, Constantinides SV, Bhandari S, Frongillo EA, Schreinemachers P, Wertheim-Heck S, Walls H, Holdsworth M, Laar A, Nguyen T, Turner C, Wellard K, Blake CE. Actions in global nutrition initiatives to promote sustainable healthy diets. Global Food Security 2021. [DOI: 10.1016/j.gfs.2021.100585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, Gregg EW, Bennett JE, Solomon B, Singleton RK, Sophiea MK, Iurilli MLC, Lhoste VPF, Cowan MJ, Savin S, Woodward M, Balanova Y, Cifkova R, Damasceno A, Elliott P, Farzadfar F, He J, Ikeda N, Kengne AP, Khang YH, Kim HC, Laxmaiah A, Lin HH, Margozzini Maira P, Miranda JJ, Neuhauser H, Sundström J, Varghese C, Widyahening IS, Zdrojewski T, Abarca-Gómez L, Abdeen ZA, Abdul Rahim HF, Abu-Rmeileh NM, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad NA, Ahmadi A, Ahmadi N, Ahmadi N, Ahmadizar F, Ahmed SH, Ahrens W, Ajlouni K, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Aly E, Amarapurkar DN, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Anjana RM, Ansari-Moghaddam A, Ansong D, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Auvinen J, Avdićová M, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Bahijri S, Balakrishna N, Bamoshmoosh M, Banach M, Banadinović M, Bandosz P, Banegas JR, Baran J, Barbagallo CM, Barceló A, Barkat A, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JLD, Bata I, Batieha AM, Batyrbek A, Baur LA, Beaglehole R, Belavendra A, Ben Romdhane H, Benet M, Benson LS, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bezerra J, Bhagyalaxmi A, Bhargava SK, Bia D, Biasch K, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boeing H, Boggia JG, Boissonnet CP, Bojesen SE, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Boyer CB, Braeckman L, Brajkovich I, Branca F, Breckenkamp J, Brenner H, Brewster LM, Briceño Y, Brito M, Bruno G, Bueno-de-Mesquita HB, Bueno G, Bugge A, Burns C, Bursztyn M, Cabrera de León A, Cacciottolo J, Cameron C, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano V, Cardoso VC, Carlsson AC, Carvalho J, Casanueva FF, Censi L, Cervantes-Loaiza M, Chadjigeorgiou CA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chee ML, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheraghian B, Cherkaoui Dekkaki I, Chetrit A, Chien KL, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cinteza E, Claessens F, Clarke J, Clays E, Cohen E, Concin H, Cooper C, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Crujeiras AB, Cruz JJ, Csilla S, Cui L, Cureau FV, Cuschieri S, D'Arrigo G, d'Orsi E, Dallongeville J, Dankner R, Dantoft TM, Dauchet L, Davletov K, De Backer G, De Bacquer D, De Curtis A, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Delisle H, Demarest S, Dennison E, Deschamps V, Dhimal M, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Dickerson TT, Dika Z, Djalalinia S, Do HTP, Dobson AJ, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dörr M, Doua K, Dragano N, Drygas W, Duante CA, Duboz P, Duda RB, Dulskiene V, Dushpanova A, Džakula A, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ati J, Eldemire-Shearer D, Eliasen M, Elosua R, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Fattahi MR, Fawwad A, Felix-Redondo FJ, Felix SB, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fink G, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, Franco MDC, Frikke-Schmidt R, Frontera G, Fuchs FD, Fuchs SC, Fujita Y, Fumihiko M, Furdela V, Furer A, Furusawa T, Gaciong Z, Galbarczyk A, Galenkamp H, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, Garcia P, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gazzinelli A, Gehring U, Geleijnse JM, George R, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Goldberg M, Goldsmith RA, Gomez LF, Gomula A, Gonçalves H, Gonçalves M, Gonçalves Cordeiro da Silva B, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gorbea MB, Gottrand F, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Grodzicki T, Grosso G, Gruden G, Gu D, Guan OP, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Gupta PC, Gupta R, Gureje O, Gurzkowska B, Gutierrez L, Gutzwiller F, Ha S, Hadaegh F, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Hari Kumar R, Hashemi-Shahri SM, Hata J, Haugsgjerd T, Hayes AJ, He Y, Heier M, Hendriks ME, Henrique RDS, Henriques A, Hernandez Cadena L, Herqutanto, Herrala S, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Holdsworth M, Homayounfar R, Horasan Dinc G, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Huisman M, Husseini AS, Huybrechts I, Hwalla N, Iacoviello L, Iannone AG, Ibrahim MM, Ibrahim Wong N, Ikram MA, Iotova V, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Iwasaki M, Jackson RT, Jacobs JM, Jaddou HY, Jafar T, James K, Jamrozik K, Janszky I, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Johansson M, Jokelainen JJ, Jonas JB, Jørgensen T, Joshi P, Joukar F, Jóżwiak J, Juolevi A, Jurak G, Jureša V, Kaaks R, Kafatos A, Kajantie EO, Kalmatayeva Z, Kalpourtzi N, Kalter-Leibovici O, Kampmann FB, Kannan S, Karaglani E, Kårhus LL, Karki KB, Katibeh M, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Keil U, Keinan Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khalili D, Khaw KT, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl S, Killewo J, Kim DW, Kim J, Klakk H, Klimek M, Klumbiene J, Knoflach M, Kolle E, Kolsteren P, Kontto JP, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kouda K, Kowlessur S, Koziel S, Kratenova J, Kriaucioniene V, Kristensen PL, Krokstad S, Kromhout D, Kruger HS, Kubinova R, Kuciene R, Kujala UM, Kulaga Z, Kumar RK, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, Laatikainen T, Lachat C, Laid Y, Lam TH, Landrove O, Lanska V, Lappas G, Larijani B, Latt TS, Le Coroller G, Le Nguyen Bao K, Le TD, Lee J, Lee J, Lehmann N, Lehtimäki T, Lemogoum D, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin X, Lin YT, Lind L, Lingam V, Linneberg A, Lissner L, Litwin M, Lo WC, Loit HM, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukačević Lovrenčić I, Lukrafka JL, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Lustigová M, Luszczki E, Ma G, Ma J, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Malekzadeh F, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malyutina SK, Maniego LV, Manios Y, Mann JI, Mansour-Ghanaei F, Manzato E, Marcil A, Mårild SB, Marinović Glavić M, Marques-Vidal P, Marques LP, Marrugat J, Martorell R, Mascarenhas LP, Matasin M, Mathiesen EB, Mathur P, Matijasevich A, Matlosz P, Matsha TE, Mavrogianni C, Mbanya JCN, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene Benchekor S, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisinger C, Mendoza Montano C, Menezes AMB, Menon GR, Mereke A, Meshram II, Metspalu A, Meyer HE, Mi J, Michels N, Mikkel K, Milkowska K, Miller JC, Minderico CS, Mini GK, Mirjalili MR, Mirrakhimov E, Mišigoj-Duraković M, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Molnár D, Momenan A, Mondo CK, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Moreira LB, Morejon A, Moreno LA, Morgan K, Moschonis G, Mossakowska M, Mostafa A, Mostafavi SA, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Mridha MK, Msyamboza KP, Mu TT, Muhihi AJ, Muiesan ML, Müller-Nurasyid M, Murphy N, Mursu J, Musa KI, Musić Milanović S, Musil V, Mustafa N, Nabipour I, Naderimagham S, Nagel G, Naidu BM, Najafi F, Nakamura H, Námešná J, Nang EEK, Nangia VB, Narake S, Ndiaye NC, Neal WA, Nejatizadeh A, Nenko I, Neovius M, Nguyen CT, Nguyen ND, Nguyen QV, Nguyen QN, Nieto-Martínez RE, Niiranen TJ, Nikitin YP, Ninomiya T, Nishtar S, Njelekela MA, Noale M, Noboa OA, Noorbala AA, Norat T, Nordendahl M, Nordestgaard BG, Noto D, Nowak-Szczepanska N, Nsour MA, Nunes B, O'Neill TW, O'Reilly D, Ochimana C, Oda E, Odili AN, Oh K, Ohara K, Ohtsuka R, Olié V, Olinto MTA, Oliveira IO, Omar MA, Onat A, Ong SK, Ono LM, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Padez C, Pahomova E, Paiva KMD, Pająk A, Palli D, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Papandreou D, Park SW, Park S, Parnell WR, Parsaeian M, Pasquet P, Patel ND, Pavlyshyn H, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres KGDA, Peres MA, Peters A, Petkeviciene J, Peykari N, Pham ST, Pichardo RN, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Polašek O, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Price AJ, Price JF, Providencia R, Puhakka SE, Puiu M, Punab M, Qasrawi RF, Qorbani M, Queiroz D, Quoc Bao T, Radić I, Radisauskas R, Rahimikazerooni S, Rahman M, Raitakari O, Raj M, Rakhimova EM, Ramachandra Rao S, Ramachandran A, Ramos E, Rampal L, Rampal S, Rangel Reina DA, Rarra V, Rech CR, Redon J, Reganit PFM, Regecová V, Revilla L, Rezaianzadeh A, Ribeiro R, Riboli E, Richter A, Rigo F, Rinke de Wit TF, Ritti-Dias RM, Robitaille C, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Roggenbuck U, Rojas-Martinez R, Romaguera D, Romeo EL, Rosengren A, Roy JGR, Rubinstein A, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Rusakova IA, Russo P, Rutkowski M, Sabanayagam C, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saidi O, Sakarya S, Saki N, Salanave B, Salazar Martinez E, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sans S, Santos DA, Santos IS, Santos LC, Santos MP, Santos R, Saramies JL, Sardinha LB, Sarganas G, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schargrodsky H, Schipf S, Schmidt CO, Schnohr P, Schöttker B, Schramm S, Schultsz C, Schutte AE, Sebert S, Sein AA, Sen A, Senbanjo IO, Sepanlou SG, Servais J, Shalnova SA, Shamah-Levy T, Shamshirgaran M, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shi Z, Shibuya K, Shimizu-Furusawa H, Shin DW, Shirani M, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Silva CRDM, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Sørensen TIA, Sørgjerd EP, Sorić M, Sossa Jérome C, Soumaré A, Sparboe-Nilsen B, Sparrenberger K, Staessen JA, Starc G, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stronks K, Strufaldi MW, Suka M, Sun CA, Sung YT, Suriyawongpaisal P, Sy RG, Syddall HE, Sylva RC, Szklo M, Tai ES, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thijs L, Thinggaard M, Thomas N, Thorand B, Thuesen BH, Timmermans EJ, Tjandrarini DH, Tjonneland A, Toft U, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Touloumi G, Traissac P, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsugane S, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzourio C, Ueda P, Ugel E, Ulmer H, Uusitalo HMT, Valdivia G, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Minh H, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Varbo A, Vasan SK, Vega T, Veidebaum T, Velasquez-Melendez G, Veronesi G, Verschuren WMM, Verstraeten R, Victora CG, Viet L, Villalpando S, Vineis P, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Voutilainen A, Wade AN, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wei W, Weres A, Werner B, Whincup PH, Widhalm K, Wiecek A, Wilks RJ, Willeit J, Willeit P, Williams EA, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong A, Wong TY, Woo J, Wu FC, Wu S, Wyszynska J, Xu H, Xu L, Yaacob NA, Yan W, Yang L, Yang X, Yang Y, Yasuharu T, Ye X, Yiallouros PK, Yoosefi M, Yoshihara A, You SL, Younger-Coleman NO, Yusoff AF, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zapata ME, Zaw KK, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhen S, Zheng Y, Zholdin B, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 938] [Impact Index Per Article: 312.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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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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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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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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25
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Trübswasser U, Verstraeten R, Salm L, Holdsworth M, Baye K, Booth A, Feskens EJM, Gillespie S, Talsma EF. Factors influencing obesogenic behaviours of adolescent girls and women in low- and middle-income countries: A qualitative evidence synthesis. Obes Rev 2021; 22:e13163. [PMID: 33283419 PMCID: PMC7988604 DOI: 10.1111/obr.13163] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/20/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
This systematic review synthesized the qualitative evidence on factors influencing obesogenic behaviours in adolescent girls and women of reproductive age in low- and middle-income countries (LMICs). This qualitative evidence synthesis followed the framework synthesis approach to extract, analyse and synthesize data. Electronic searches were conducted in the Web of Science, SCOPUS, CABI Abstracts, MEDLINE, PsycINFO and Google Scholar. Studies were eligible if they were conducted in LMICs, of qualitative nature, and reported obesogenic behaviours of female adolescents (10-19 years of age) or women of reproductive age (15-49 years of age). The review resulted in 71 included studies from 27 different countries. Thirty-two studies focused on dietary behaviours, 17 on physical activity and 22 on both behaviours. Gender norms and failures to recognize the importance of healthy behaviours across the life cycle were important factors. The abundance and promotion of affordable but unhealthy food, food safety concerns, taste preferences and social desirability of foods drive consumption of unhealthy foods. Busy lives and limited exercise spaces keep girls and women from being physically active. Obesogenic behaviours of adolescent girls and women of reproductive age are influenced by factors at individual, social, physical and environmental levels and require diverse solutions to address these factors in LMICs.
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Affiliation(s)
- Ursula Trübswasser
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Roos Verstraeten
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Leah Salm
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Dakar, Senegal.,Institute for Development Studies (IDS), Brighton, UK
| | - Michelle Holdsworth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Food and Nutrition in the Global South Research Unit (NUTRIPASS), Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Stuart Gillespie
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Brighton, UK
| | - Elise F Talsma
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Ko Zaw K, Zdrojewski T, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Cisneros JZ, Zuziak M, Ezzati M, Filippi S. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLife 2021; 10:e60060. [PMID: 33685583 PMCID: PMC7943191 DOI: 10.7554/elife.60060] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 06/17/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023] Open
Abstract
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nayu Ikeda
- National Institutes of Biomedical Innovation, Health and Nutrition
| | | | | | | | - Jing Liu
- Capital Medical University Beijing An Zhen Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shoaib Afzal
- University of Copenhagen
- Copenhagen University Hospital
| | | | | | | | | | | | | | - Ali Ahmadi
- Shahrekord University of Medical Sciences
| | | | | | | | | | - Kamel Ajlouni
- National Center for Diabetes, Endocrinology and Genetics
| | | | | | | | | | | | | | | | | | | | | | | | - Eman Aly
- World Health Organization Regional Office for the Eastern Mediterranean
| | | | - Parisa Amiri
- Research Center for Social Determinants of Health
| | | | | | | | | | | | | | | | | | - Joana Araújo
- Institute of Public Health of the University of Porto
| | | | | | | | | | | | | | | | | | | | | | | | - Shina Avi
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Abdul Basit
- Baqai Institute of Diabetology and Endocrinology
| | | | | | | | | | | | | | | | | | | | | | | | - Judith Benedics
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | - Hongsheng Bi
- Shandong University of Traditional Chinese Medicine
| | - Yufang Bi
- Shanghai Jiao-Tong University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - João Breda
- World Health Organization Regional Office for Europe
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Laura Censi
- Council for Agricultural Research and Economics
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Angela Chetrit
- The Gertner Institute for Epidemiology and Health Policy Research
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cora L Craig
- Canadian Fitness and Lifestyle Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachel Dankner
- The Gertner Institute for Epidemiology and Health Policy Research
| | | | | | | | - Luc Dauchet
- University of Lille
- Lille University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jia Li Duan
- Beijing Center for Disease Prevention and Control
| | | | | | | | | | | | | | - Anar Dushpanova
- Scuola Superiore Sant'Anna
- Al-Farabi Kazakh National University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute
- University of Basel
| | | | | | | | - Heba M Fouad
- World Health Organization Regional Office for the Eastern Mediterranean
| | | | | | | | | | | | | | | | | | | | | | | | - Mihai Gafencu
- Victor Babes University of Medicine and Pharmacy Timisoara
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marcel Goldberg
- Institut National de la Santé et de la Recherche Médicale
- Paris University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yin Guo
- Capital Medical University Beijing Tongren Hospital
| | | | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute
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- Beijing Institute of Ophthalmology
| | | | | | | | | | | | | | - Yuan He
- National Research Institute for Health and Family Planning
| | - Yuna He
- Chinese Center for Disease Control and Prevention
| | | | | | | | | | | | - Ana Henriques
- Institute of Public Health of the University of Porto
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- Institute of Molecular and Clinical Ophthalmology Basel
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- French National Research Institute for Sustainable Development
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- Johns Hopkins Bloomberg School of Public Health
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- Research Institute for Primordial Prevention of Non-communicable Disease
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Slawomir Koziel
- PASs Hirszfeld Institute of Immunology and Experimental Therapy
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- French National Research Institute for Sustainable Development
| | - Vera Lanska
- Institute for Clinical and Experimental Medicine
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- University of Chinese Academy of Sciences
| | | | | | | | | | | | - Lijuan Liu
- Capital Medical University Beijing Tongren Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xu Ma
- National Research Institute for Health and Family Planning
| | | | | | | | | | - Stefania Maggi
- Institute of Neuroscience of the National Research Council
| | | | | | | | | | - Bernard Maire
- French National Research Institute for Sustainable Development
| | | | | | - Päivi Mäki
- Finnish Institute for Health and Welfare
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jaume Marrugat
- CIBERCV
- Institut Hospital del Mar d'Investigacions Mèdiques
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jie Mi
- Capital Institute of Pediatrics
| | | | | | | | | | | | | | - GK Mini
- Women’s Social and Health Studies Foundation
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marie Moitry
- University of Strasbourg
- Strasbourg University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jorge Motta
- Instituto Conmemorativo Gorgas de Estudios de la Salud
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jana Námešná
- Banska Bystrica Regional Authority of Public Health
| | | | | | | | | | | | | | | | | | | | - Keiu Nelis
- National Institute for Health Development
| | - Liis Nelis
- National Institute for Health Development
| | | | | | | | | | | | | | | | - Yury P Nikitin
- SB RAS Federal Research Center Institute of Cytology and Genetics
| | - Guang Ning
- Shanghai Jiao-Tong University School of Medicine
| | | | | | - Marianna Noale
- Institute of Neuroscience of the National Research Council
| | | | | | | | | | | | | | | | | | | | - Eha Nurk
- National Institute for Health Development
| | | | | | | | | | | | | | - Kyungwon Oh
- Korea Centers for Disease Control and Prevention
| | | | - Claes Ohlsson
- University of Gothenburg
- Sahlgrenska University Hospital
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- Institute for Cancer Research, Prevention and Clinical Network
| | | | | | | | | | | | - Francesco Panza
- IRCCS Ente Ospedaliero Specializzato in Gastroenterologia S. de Bellis
| | | | | | - Suyeon Park
- Korea Centers for Disease Control and Prevention
| | | | | | - Ionela M Pascanu
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS
| | | | | | | | | | | | | | | | | | | | | | - Raluca M Pop
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
| | | | - Miquel Porta
- Institut Hospital del Mar d'Investigacions Mèdiques
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Puiu
- Victor Babes University of Medicine and Pharmacy Timisoara
| | | | | | | | | | | | | | | | | | | | | | - Manu Raj
- Amrita Institute of Medical Sciences
| | | | | | - Ivo Rakovac
- World Health Organization Regional Office for Europe
| | | | | | | | | | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Rito
- National Institute of Health Doutor Ricardo Jorge
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paola Russo
- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | - Nader Saki
- Ahvaz Jundishapur University of Medical Sciences
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Savvas Savva
- Research and Education Institute of Child Health
| | - Mathilde Savy
- French National Research Institute for Sustainable Development
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aletta E Schutte
- University of New South Wales
- The George Institute for Global Health
| | | | | | | | - Abhijit Sen
- Center for Oral Health Services and Research Mid-Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfonso Siani
- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | | | | | | | | | - Liam Smeeth
- London School of Hygiene & Tropical Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Igor Spiroski
- Institute of Public Health
- Ss. Cyril and Methodius University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lela Sturua
- National Center for Disease Control and Public Health
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lucjan Szponar
- National Institute of Public Health – National Institute of Hygiene
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Traissac
- French National Research Institute for Sustainable Development
| | | | | | | | - Oanh TH Trinh
- University of Medicine and Pharmacy at Ho Chi Minh City
| | | | | | | | | | | | | | | | | | | | | | - Gilad Twig
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | - Eunice Ugel
- Universidad Centro-Occidental Lisandro Alvarado
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anette Varbo
- Copenhagen University Hospital
- University of Copenhagen
| | | | | | | | - Tomas Vega
- Consejería de Sanidad Junta de Castilla y León
| | | | | | | | | | | | | | | | - Lucie Viet
- National Institute for Public Health and the Environment
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ningli Wang
- Capital Medical University Beijing Tongren Hospital
| | | | | | | | | | | | | | - Adelheid Weber
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bogdan Wojtyniak
- National Institute of Public Health - National Institute of Hygiene
| | | | | | | | | | - Jean Woo
- The Chinese University of Hong Kong
| | | | | | - Jianfeng Wu
- Shandong University of Traditional Chinese Medicine
| | | | | | - Haiquan Xu
- Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs
| | - Liang Xu
- Beijing Institute of Ophthalmology
| | | | | | - Weili Yan
- Children's Hospital of Fudan University
| | | | | | - Yang Yang
- Shanghai Educational Development Co. Ltd
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yi Zeng
- Peking University
- Duke University
| | | | | | - Dong Zhao
- Capital Medical University Beijing An Zhen Hospital
| | | | - Wenhua Zhao
- Chinese Center for Disease Control and Prevention
| | - Shiqi Zhen
- Jiangsu Provincial Center for Disease Control and Prevention
| | | | | | | | - Maigeng Zhou
- Chinese Center for Disease Control and Prevention
| | - Dan Zhu
- Inner Mongolia Medical University
| | - Marie Zins
- Institut National de la Santé et de la Recherche Médicale
- Paris University
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Booth A, Barnes A, Laar A, Akparibo R, Graham F, Bash K, Asiki G, Holdsworth M. Policy Action Within Urban African Food Systems to Promote Healthy Food Consumption: A Realist Synthesis in Ghana and Kenya. Int J Health Policy Manag 2021; 10:828-844. [PMID: 33619936 PMCID: PMC9309963 DOI: 10.34172/ijhpm.2020.255] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/12/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa, driven by urbanisation and changing food environments. Policy action has been limited - and influenced by high income countries. Socio-economic/political environments of African food systems must be considered in order to understand what policy might work to prevent NR-NCDs, for whom, and under what circumstances.
Methods: A realist synthesis of five policy areas to support healthier food consumption in urban Africa: regulating trade/foreign investment; regulating health/nutrition claims/labels; setting composition standards for processed foods; restricting unhealthy food marketing; and school food policy. We drew upon Ghana and Kenya to contextualise the evidence base. Programme theories were generated by stakeholders in Ghana/Kenya. A two-stage search interrogated MEDLINE, Web of Science and Scopus. Programme theories were tested and refined to produce a synthesised model.
Results: The five policies operate through complex, inter-connected pathways moderated by global-, national- and local contexts. Consumers and the food environment interact to enable/disable food accessibility, affordability and availability. Consumer relationships with each other and retailers are important contextual influences, along with political/ economic interests, stakeholder alliances and globalized trade. Coherent laws/regulatory frameworks and government capacities are fundamental across all policies. The increasing importance of convenience is shaped by demographic and sociocultural drivers. Awareness of healthy diets mediates food consumption through comprehension, education, literacy and beliefs. Contextualised data (especially food composition data) and inter-sectoral collaboration are critical to policy implementation.
Conclusion: Evidence indicates that coherent action across the five policy areas could positively influence the healthiness of food environments and consumption in urban Africa. However, drivers of (un)healthy food environments and consumption reflect the complex interplay of socio-economic and political drivers acting at diverse geographical levels. Stakeholders at local, national, and global levels have important, yet differing, roles to play in ensuring healthy food environments and consumption in urban Africa.
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Affiliation(s)
- Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Amy Barnes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Amos Laar
- School of Public Health, University of Ghana, Accra, Ghana
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Fiona Graham
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kristin Bash
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Gershim Asiki
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Michelle Holdsworth
- French National Research Institute for Sustainable Development (IRD), NUTRIPASS Unit, IRD-Univ Montpellier, Montpellier, France
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Graham F, Barker M, Menon M, Holdsworth M. Acceptability and feasibility of a café-based sustainable food intervention in the UK. Health Promot Int 2020; 35:1507-1518. [PMID: 32243498 DOI: 10.1093/heapro/daaa027] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dietary change is needed to improve health and reduce the environmental burden of food production and consumption. Using an Intervention Mapping approach, this study aimed to explore the views caterers and customers held towards point-of-choice interventions that promote healthy and environmentally friendly (EF) food and beverage choices at the University of Sheffield. Intervention options proposed during focus groups were devised using the Nuffield Bioethics ladder of intervention. Ten focus groups were held involving caterers (n = 16) and customers (n = 45). Thematic analysis was conducted on the transcripts of caterer and customer focus groups seperately, and then comparisons were made to identify concerns about the acceptability and feasibility of intervention options. Attitudes towards intervention options varied considerably amongst stakeholders, with the greatest disparity of opinion in the acceptability of interventions that restrict or limit personal choice, particularly with regards to meat consumption. Information provision was favoured as an acceptable intervention by both customers and caterers. However, labelling products in terms of their environmental impact was considered practically unfeasible. Social norms around eating also emerged as influencing the acceptability and feasibility of interventions with concerns raised about: shaming customers who chose meat, the exclusivity of vegan choices and the limited availability and appeal of meatless café options. Financial considerations were the main priority of caterers when discussing point-of-choice interventions. An acceptable and feasible café-based intervention ought to increase awareness and understanding of healthy and EF food choices, protect customer choice and avoid additional costs.
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Affiliation(s)
- Fiona Graham
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.,Population Health Sciences Institute, Baddiley-Clark, Building Richardson Road, Newcastle NE2 4AX, UK
| | - Margo Barker
- Food and Nutrition Group, Sheffield Business School, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Manoj Menon
- Department of Geography, University of Sheffield, Sheffield S3 7HQ, UK
| | - Michelle Holdsworth
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.,NUTRIPASS Unit (IRD-SupAgro-University of Montpellier), IRD, 911 avenue d'agropolis, Montpellier 34394, France
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29
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Auma CI, Pradeilles R, Blake MK, Musoke D, Holdsworth M. Factors influencing dietary practices in a transitioning food environment: a cross-sectional exploration of four dietary typologies among rural and urban Ugandan women using Photovoice. Nutr J 2020; 19:127. [PMID: 33238992 PMCID: PMC7690007 DOI: 10.1186/s12937-020-00634-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/04/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Healthy and sustainable dietary practices offer a possible solution to competing tensions between health and environmental sustainability, particularly as global food systems transition. To encourage such dietary practices, it is imperative to understand existing dietary practices and factors influencing these dietary practices. The aim of this study was to identify multi-level factors in lived rural and urban Ugandan food environments that influence existing dietary practices among women of reproductive age (WRA). METHODS A mixed methods study was conducted. Multiple correspondence analysis followed by hierarchical cluster analysis were performed on dietary data collected among a sample (n = 73) of Ugandan WRA in Kampala (urban) and Wakiso (rural) districts to elicit dietary clusters. Dietary clusters, which were labelled as dietary typologies based on environmental impact and nutrition transition considerations, were reflective of dietary practices. Following this, a smaller sample of WRA (n = 18) participated in a Photovoice exercise and in-depth interviews to identify factors in their social, physical, socio-cultural and macro-level environments influencing their enactment of the identified dietary typologies, and therefore dietary practices. RESULTS Four dietary typologies emerged: 'urban, low-impact, early-stage transitioners', 'urban, medium-impact, mid-stage transitioners', 'rural, low-impact, early-stage transitioners' and 'rural, low-impact, traditionalists'. Although experienced somewhat differently, the physical environment (access, availability and cost), social networks (parents, other family members and friends) and socio-cultural environment (dietary norms) were cross-cutting influences among both urban and rural dietary typologies. Seasonality (macro-environment) directly influenced consumption of healthier and lower environmental impact, plant-based foods among the two rural dietary typology participants, while seasonality and transportation intersected to influence consumption of healthier and lower environmental impact, plant-based foods among participants in the two urban dietary typologies. CONCLUSION Participants displayed a range of dietary typologies, and therefore dietary practices. Family provides an avenue through which interventions aimed at encouraging healthier and lower environmental impact dietary practices can be targeted. Home gardens, urban farming and improved transportation could address challenges in availability and access to healthier, lower environmental impact plant-based foods among urban WRA.
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Affiliation(s)
- Carolyn I Auma
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Sheffield, LE11 3TU, UK
| | - Megan K Blake
- Department of Geography, University of Sheffield, Winter Street, Sheffield, S3 7ND, UK
| | - David Musoke
- School of Public Health, Makerere University, New Mulago Hill Road, Kampala, Uganda
| | - Michelle Holdsworth
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.,UMR NUTRIPASS: Institute of Research for Development- IRDUM, SupAgro Montpellier, Montpellier, France
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30
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Rodriguez-Martinez A, Zhou B, Sophiea MK, Bentham J, Paciorek CJ, Iurilli MLC, Carrillo-Larco RM, Bennett JE, Di Cesare M, Taddei C, Bixby H, Stevens GA, Riley LM, Cowan MJ, Savin S, Danaei G, Chirita-Emandi A, Kengne AP, Khang YH, Laxmaiah A, Malekzadeh R, Miranda JJ, Moon JS, Popovic SR, Sørensen TIA, Soric M, Starc G, Zainuddin AA, Gregg EW, Bhutta ZA, Black R, Abarca-Gómez L, Abdeen ZA, Abdrakhmanova S, Abdul Ghaffar S, Abdul Rahim HF, Abu-Rmeileh NM, Abubakar Garba J, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad MH, Ahmad NA, Ahmadi A, Ahmadi N, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Othman AR, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amiri P, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Ängquist L, Anjana RM, Ansari-Moghaddam A, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Aung MS, Auvinen J, Avdicová M, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Bæksgaard Jørgensen M, Baharudin A, Bahijri S, Baker JL, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Baran J, Barbagallo CM, Barceló A, Barkat A, Barros AJD, Barros MVG, Basit A, Bastos JLD, Bata I, Batieha AM, Batista RL, Battakova Z, Batyrbek A, Baur LA, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedics J, Benet M, Bennett JE, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bhutta ZA, Bi H, Bi Y, Bia D, Bika Lele EC, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boddy LM, Boehm BO, Boeing H, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Braeckevelt L, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Brinduse L, Brophy S, Bruno G, Bueno-de-Mesquita HB, Bugge A, Buoncristiano M, Burazeri G, Burns C, Cabrera de León A, Cacciottolo J, Cai H, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Capková N, Capuano E, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Celikcan E, Censi L, Cervantes-Loaiza M, Cesar JA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Che Abdul Rahim N, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheraghian B, Chetrit A, Chikova-Iscener E, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Claessens F, Clarke J, Clays E, Cohen E, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Crujeiras AB, Csilla S, Cucu AM, Cui L, Cureau FV, D'Arrigo G, d'Orsi E, Dacica L, 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X, Yiallouros PK, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zdrojewski T, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zocalo Y, Zuñiga Cisneros J, Zuziak M, Ezzati M. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. Lancet 2020; 396:1511-1524. [PMID: 33160572 PMCID: PMC7658740 DOI: 10.1016/s0140-6736(20)31859-6] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. METHODS For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5-19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. FINDINGS We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9-10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes-gaining too little height, too much weight for their height compared with children in other countries, or both-occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. INTERPRETATION The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. FUNDING Wellcome Trust, AstraZeneca Young Health Programme, EU.
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Mutisya M, Markey O, Rousham EK, Chintsanya JMN, Pradeilles R, Kimani-Murage EW, Madise NJ, Munthali AC, Kalimbira A, Holdsworth M, Griffiths PL, Haycraft E. Improving nutritional status among urban poor children in sub-Saharan Africa: An evidence-informed Delphi-based consultation. Matern Child Nutr 2020; 17:e13099. [PMID: 33145974 PMCID: PMC7988854 DOI: 10.1111/mcn.13099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 01/26/2023]
Abstract
In sub‐Saharan Africa (SSA), rapid urbanisation coupled with the high prevalence of infant and young child (IYC) undernutrition in low‐income settings means that interventions to support IYC nutrition are a priority. Little is known about how urbanisation influences IYC feeding (IYCF) practices, and evidence‐based interventions to improve IYC health/nutrition in the urban poor are lacking. Therefore, this research aimed to (a) systematically review evidence on interventions for improving the nutritional status of IYC aged 6–23 months living in urban poor areas (PROSPERO CRD42018091265) and (b) engage stakeholders to identify the highest ranking evidence gaps for improving IYCF programmes/policies. First, a rapid systematic review was conducted. This focused on the literature published regarding nutrition‐specific and nutrition‐sensitive complementary feeding interventions in urban poor areas, specifically low‐income informal settlements, in low‐ and middle‐income countries (LMICs). Six intervention studies met the review inclusion criteria. Intervention adherence was generally high, and indicators of maternal knowledge and IYC nutritional intake typically increased because of the interventions, but the impact on anthropometric status was small. Second, stakeholders working across SSA were engaged via a Delphi‐based approach to identify priority areas for future intervention. Stakeholders reported that a situational analysis was required to better understand IYCF in urban poor areas, particularly the causes of IYC undernutrition, and highlighted the need to involve local communities in defining how future work should proceed. Together, these findings indicate a need for more evidence regarding IYCF and the factors that drive it in urban poor areas across LMIC settings, but particularly in SSA.
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Affiliation(s)
- Maurice Mutisya
- African Population and Health Research Center, Nairobi, Kenya
| | - Oonagh Markey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jesman M N Chintsanya
- Department of Population Studies, Chancellor College, University of Malawi, Zomba, Malawi
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Alister C Munthali
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | | | - Michelle Holdsworth
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,UMR NUTRIPASS, Research Institute for Development, Montpellier, France
| | - Paula L Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Cohen E, Ndao A, Bernard JY, Gueye A, Duboz P, Macia E, Boëtsch G, Pasquet P, Holdsworth M, Gradidge PJL. Development and validation of the body shape scale (BOSHAS) for assessing body shape perception in African populations. BMC Public Health 2020; 20:1562. [PMID: 33066748 PMCID: PMC7566052 DOI: 10.1186/s12889-020-09654-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/05/2019] [Accepted: 10/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background As a consequence of ‘Western’ acculturation, eating disorders and body image disturbances, such as fatness phobia and body dysmorphic disorders towards musculature and body shape, are emerging in Africa, with young people the most affected. It is therefore important to accurately assess perceptions of body shape. However, the existing body image assessment scales lack sufficient accuracy and validity testing to compare body shape perception across different African populations. The purpose of this study was to develop and validate the Body Shape Scale (BOSHAS) to evaluate body shape perceptions related body image disorders in African populations. Methods To develop the BOSHAS, anthropometric measures of 80 Cameroonians and 81 Senegalese (both sexes included; 40.1% females overall) were taken for three body shape criteria: somatotype components, body mass index (BMI) and waist-to-hip ratio. Subjects were selected to cover a wide variability in body shape and were photographed in full face and profile positions. To validate the BOSHAS, the scale was administered twice (2 weeks apart) to 106 participants (aged 31.2 ± 12.6 years) to assess its reliability. In addition, a questionnaire measuring different aspects of body shape (e.g. musculature) was also administered (n = 597; aged 36.7 ± 15.6 years) to assess its convergent validity. Results The BOSHAS includes two sex-specific subscales of 10 photographs each. Most participants were able to repeat their BOSHAS preference order. Test-retest reliability was also consistent in estimating Current Body Shape (CBS), Desired Body Shape and Ideal Body Shape for participants and their partners. CBS was correlated with BMI, and different BOSHAS indices were consistent with declarations obtained by questionnaire. Conclusions The BOSHAS is the first sex-specific scale of real African models photographed in face and profile, including large body shape variability. The validation protocol showed good validity and reliability for evaluating body shape perceptions and dissatisfaction of Africans.
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Affiliation(s)
- Emmanuel Cohen
- CNRS, UMR 7206 « Eco-anthropologie », Muséum National d'Histoire Naturelle, Paris, France. .,CNRS, UMR 7178 « Institut Pluridisciplinaire Hubert CURIEN », Université de Strasbourg, Strasbourg, France. .,MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Amadou Ndao
- CNRS, UMR 8177, IIAC-LAIOS, Ecole des Hautes Etudes en Sciences Sociales (EHESS), Paris, France.,Raum IG 551, Université de Francfort sur le Main, Institut Ethnologie, Frankfurt/Main, Germany
| | - Jonathan Y Bernard
- Inserm, UMR 1153, Centre of research Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Early Determinants of Children's Health and Development (ORCHAD) team, Villejuif, France.,Paris Descartes University, Paris, France
| | - Amadoune Gueye
- CNRS, UMI 3189 « Environnement, Santé, Société », Faculté de Médecine, UCAD, Dakar, Sénégal
| | - Priscilla Duboz
- CNRS, UMI 3189 « Environnement, Santé, Société », Faculté de Médecine, UCAD, Dakar, Sénégal
| | - Enguerran Macia
- CNRS, UMI 3189 « Environnement, Santé, Société », Faculté de Médecine, UCAD, Dakar, Sénégal
| | - Gilles Boëtsch
- CNRS, UMI 3189 « Environnement, Santé, Société », Faculté de Médecine, UCAD, Dakar, Sénégal
| | - Patrick Pasquet
- CNRS, UMR 7206 « Eco-anthropologie », Muséum National d'Histoire Naturelle, Paris, France
| | | | - Philippe Jean-Luc Gradidge
- Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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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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Asiki G, Wanjohi MN, Barnes A, Bash K, Muthuri S, Amugsi D, Doughman D, Kimani E, Vandevijvere S, Holdsworth M. Benchmarking food environment policies for the prevention of diet-related non-communicable diseases in Kenya: National expert panel's assessment and priority recommendations. PLoS One 2020; 15:e0236699. [PMID: 32760079 PMCID: PMC7410300 DOI: 10.1371/journal.pone.0236699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/08/2019] [Accepted: 07/12/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Unhealthy food environments drive the increase of diet-related non-communicable diseases (NCDs). Objective We aimed to examine healthy food environment policies in Kenya and identify priorities for future action. Methods Using the Healthy Food Environment Policy Index (Food-EPI) we collected evidence on the extent of government action to create healthy food environments across 13 policy and infrastructure support domains and 43 related good practice indicators between 2017 and 2018. A panel of 15 national experts rated the extent of government action on each indicator compared to the policy development cycle and international best practice respectively. Based on gaps found, actions to improve food environments in Kenya were identified and prioritized. Results In the policy development cycle, 16/43 (37%) of good practice policy indicators were judged to be in ‘implementation’ phase, including: food composition targets, packaged foods’ ingredient lists/nutrient declarations; systems regulating health claims; restrictions on marketing breast milk substitutes; and school nutrition policies. Infrastructure support actions in ‘implementation’ phase included: food-based dietary guidelines; strong political support to reduce NCDs; comprehensive NCD action plan; transparency in developing food policies; and surveys monitoring nutritional status. Half (22/43) of the indicators were judged to be ‘in development’. Compared to international best practice, the Kenyan Government was judged to be performing relatively well (‘medium’ implementation) in one policy (restrictions on marketing breast milk substitutes) and three infrastructure support areas (political leadership; comprehensive implementation plan; and ensuring all food policies are sensitive to nutrition). Implementation for 36 (83.7%) indicators were rated as ‘low’ or ‘very little’. Taking into account importance and feasibility, seven actions within the areas of leadership, food composition, labelling, promotion, prices and health-in-all-policies were prioritized. Conclusion This baseline assessment is important in creating awareness to address gaps in food environment policy. Regular monitoring using Food-EPI may contribute to addressing the burden of diet-related NCDs in Kenya.
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Affiliation(s)
- Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
- * E-mail:
| | | | - Amy Barnes
- Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Kristin Bash
- Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Stella Muthuri
- African Population and Health Research Center, Nairobi, Kenya
| | - Dickson Amugsi
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | | - Michelle Holdsworth
- French National Research Institute for Sustainable Development (IRD), NUTRIPASS Unit: IRD-Univ Montpellier-SupAgro, Montpellier, France
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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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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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Osei-Kwasi HA, Boateng D, Danquah I, Holdsworth M, Mejean C, Terragni L, Powell K, Schulze MB, Owusu-Dabo E, Meeks K, Beune E, Agyemang C, Klipstein-Grobusch K, Stronks K, Galbete C, Nicolaou M. Acculturation and Food Intake Among Ghanaian Migrants in Europe: Findings From the RODAM Study. J Nutr Educ Behav 2020; 52:114-125. [PMID: 31601528 DOI: 10.1016/j.jneb.2019.09.004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study examined the role of migration and acculturation in the diet of Ghanaian migrants in Europe by (1) comparing food intake of Ghanaian migrants in Europe with that of Ghanaians living in Ghana and (2) assessing the association between acculturation and food intake. DESIGN Data from the cross-sectional multicenter study Research on Obesity and Diabetes among African Migrants were used. Food intake was assessed using a Ghana-specific food propensity questionnaire (134 items and 14 food groups); foods were grouped based on a model of dietary change proposed by Koctürk-Runefors. SETTING Ghana, London, Amsterdam, and Berlin. PARTICIPANTS A total of 4,534 Ghanaian adults living in Ghana and Europe, with complete dietary data. Of these, 1,773 Ghanaian migrants had complete acculturation data. MAIN OUTCOME MEASURE Food intake (the weighted intake frequency per week of food categories). ANALYSIS Linear regression. RESULTS Food intake differed between Ghanaians living in Ghana and Europe. Among Ghanaian migrants in Europe, there were inconsistent and small associations between acculturation and food intake, except for ethnic identity, which was consistently associated with intake only of traditional staples. CONCLUSIONS AND IMPLICATIONS Findings indicate that migration is associated with dietary changes that cannot be fully explained by ethnic, cultural, and social acculturation. The study provides limited support to the differential changes in diet suggested by the Koctürk-Runefors' model of dietary change.
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Affiliation(s)
- Hibbah Araba Osei-Kwasi
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom; Department of Clinical Sciences and Nutrition, University of Chester, Parkgate Road, Tower Building, United Kingdom.
| | - Daniel Boateng
- Julius, Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands; School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom; Institute of Research for Development, UMR Nutripass IRD, UM, SupAgro, Montpellier, France
| | - Caroline Mejean
- MOISA, University of Montpellier, INRA, CIRAD, CIHEAM-IAMM, Montpellier SupAgro, Montpellier, France
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Katie Powell
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany; Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, KNUST, Kumasi, Ghana
| | - Karlijn Meeks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Erik Beune
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius, Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karien Stronks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Cecilia Galbete
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Mary Nicolaou
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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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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Osei-Kwasi HA, Nicolaou M, Powell K, Holdsworth M. "I cannot sit here and eat alone when I know a fellow Ghanaian is suffering": Perceptions of food insecurity among Ghanaian migrants. Appetite 2019; 140:190-196. [PMID: 31103443 DOI: 10.1016/j.appet.2019.05.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 04/04/2019] [Accepted: 05/14/2019] [Indexed: 11/26/2022]
Abstract
In the UK, ethnic minority groups tend to have higher levels of poverty than the white British population and therefore may be at high risk of food insecurity. Ghanaians, living in Ghana or as migrants are thought to have a high level of social support in their communities, but the role of this resource in relation to food security is unknown. We explored participants' perceptions of social and economic factors influencing food security among Ghanaian migrants in Greater Manchester. Participants aged ≥25 years (n = 31) of Ghanaian ancestry living in Greater Manchester were interviewed using a semi-structured interview guide developed by the researchers. Participants varied in socioeconomic status (SES), gender and migration status. Interviews were transcribed verbatim and analysed thematically using a framework approach. Participants offered similar accounts of the social and economic factors influencing food security. Accounts were based on participants' perceptions and/or personal experiences of food insecurity within the community. Participants indicated that they and their fellow Ghanaians can 'manage' even when they described quite challenging food access environments. This has negative implications on their food choices in the UK. Participants reported food insecure households may be reluctant to make use of food banks for fear of 'gossip' and 'pride'. Paradoxically, this reluctance does not extend to close network. Many participants described the church and other social groups as a trusted base in which people operate; support given through these channels is more acceptable than through the 'official context'. Government assisted food banks could partner with the social groups within this community given that these are more trusted. Keywords: food insecurity; food choice; social networks; Ghanaians; healthy eating; migrants.
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Affiliation(s)
- Hibbah Araba Osei-Kwasi
- Public Health Section, School of Health and Related Research-ScHARR, University of Sheffield, Sheffield, UK; Department of Clinical Science and Nutrition, University of Chester, Parkgate Road, Chester, UK.
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Katie Powell
- Public Health Section, School of Health and Related Research-ScHARR, University of Sheffield, Sheffield, UK
| | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research-ScHARR, University of Sheffield, Sheffield, UK
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40
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Auma CI, Pradeilles R, Blake MK, Holdsworth M. What Can Dietary Patterns Tell Us about the Nutrition Transition and Environmental Sustainability of Diets in Uganda? Nutrients 2019; 11:nu11020342. [PMID: 30764586 PMCID: PMC6412986 DOI: 10.3390/nu11020342] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 11/16/2022] Open
Abstract
Uganda is undergoing dietary transition, with possible environmental sustainability and health implications, particularly for women. To explore evidence for dietary transitions and identify how environmentally sustainable women's dietary patterns are, principal component analysis was performed on dietary data collected using a 24 h recall during the Uganda Food Consumption Survey (n = 957). Four dietary patterns explained 23.6% of the variance. The "traditional, high-fat, medium environmental impact" pattern was characterized by high intakes of nuts/seeds, fats, oils and spreads, fish and boiled vegetables. High intakes of bread and buns, rice and pasta, tea and sugar characterized the "transitioning, processed, low environmental impact' pattern. The 'plant-based, low environmental impact" pattern was associated with high intakes of legumes, boiled roots/tubers, boiled traditional vegetables, fresh fruit and fried traditional cereals. High intakes of red/organ meats, chicken, and soups characterized the "animal-based high environmental impact" pattern. Urban residence was positively associated with "transitioning, processed, low environmental impact" (β = 1.19; 1.06, 1.32) and "animal-based high environmental impact" (β = 0.45; 0.28, 0.61) patterns; but negatively associated with the "plant-based low environmental impact" pattern (β= -0.49; -0.62, -0.37). A traditional, high-fat dietary pattern with medium environmental impact persists in both contexts. These findings provide some evidence that urban women's diets are transitioning.
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Affiliation(s)
- Carolyn Imelda Auma
- Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK.
| | - Rebecca Pradeilles
- Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK.
| | - Megan K Blake
- Department of Geography, University of Sheffield, Sheffield S10 2TN, UK.
| | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK.
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41
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Bissell P, Peacock M, Holdsworth M, Powell K, Wilcox J, Clonan A. Introducing the idea of 'assumed shared food narratives' in the context of social networks: reflections from a qualitative study conducted in Nottingham, England. Sociol Health Illn 2018; 40:1142-1155. [PMID: 29916556 DOI: 10.1111/1467-9566.12746] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study explores the ways in which social networks might shape accounts about food practices. Drawing on insights from the work of Christakis and Fowler () whose claims about the linkages between obesity and social networks have been the subject of vigorous debate in the sociological literature, we present qualitative data from a study of women's' accounts of social networks and food practices, conducted in Nottingham, England. We tentatively suggest that whilst social networks in their broadest sense, might shape what was perceived to be normal and acceptable in relation to food practices (and provide everyday discursive resources which normalise practice), the relationship between the two is more complex than the linear relationship proposed by Christakis and Fowler. Here, we introduce the idea of assumed shared food narratives (ASFNs), which, we propose, sheds light on motive talk about food practices, and which also provide practical and discursive resources to actors seeking to protect and defend against 'untoward' behaviour, in the context of public health messages around food and eating. We suggest that understanding ASFNs and the ways in which they are embedded in social networks represents a novel way of understanding food and eating practices from a sociological perspective.
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Affiliation(s)
- Paul Bissell
- University of Huddersfield School of Human and Health Sciences, Huddersfield, UK
- ScHARR, University of Sheffield, Sheffield, UK
| | - Marian Peacock
- Faculty of Health and Social Care, Edge Hill University, Lancashire, UK
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Roos G, Langøien L, Terragni L, Rugseth G, Nicolaou M, Holdsworth M, Stronks K, Lien N. 5.10-P1Systematic mapping review of factors influencing physical activity and sedentary behaviour in ethnic minority groups in Europe: a DEDIPAC study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Roos
- Consumption Research Norway, Oslo and Akershus University College of Applied Sciences, Norway
| | - L Langøien
- Norwegian School of Sport Sciences, Norway
| | - L Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Norway
| | - G Rugseth
- Norwegian School of Sport Sciences, Norway
| | - M Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - M Holdsworth
- Public Health Section, School of Health and Related Research, University of Sheffield, United Kingdom
| | - K Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - N Lien
- Department of Nutrition, University of Oslo, Norway
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43
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Diaz E, Ortiz-Barreda G, Ben-Shlomo Y, Holdsworth M, Salami B, Rammohan A, Chung RYN, Padmadas SS, Krafft T. Interventions to improve immigrant health. A scoping review. Eur J Public Health 2018; 27:433-439. [PMID: 28339883 PMCID: PMC5445720 DOI: 10.1093/eurpub/ckx001] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Disparities in health between immigrants and their host populations have been described across countries and continents. Hence, interventions for improving health targeting general populations are not necessarily effective for immigrants. Aims: To conduct a systematic search of the literature evaluating health interventions for immigrants; to map the characteristics of identified studies including range of interventions, immigrant populations and their host countries, clinical areas targeted and reported evaluations, challenges and limitations of the interventions identified. Following the results, to develop recommendations for research in the field. Methods: A scoping review approach was chosen to provide an overview of the type, extent and quantity of research available. Studies were included if they empirically evaluated health interventions targeting immigrants and/or their descendants, included a control group, and were published in English (PubMed and Embase from 1990 to 2015). Results: Most of the 83 studies included were conducted in the USA, encompassed few immigrant groups and used a randomized controlled trial (RCT) or cluster RCT design. Most interventions addressed chronic and non-communicable diseases and attendance at cancer screening services, used individual targeted approaches, targeted adult women and recruited participants from health centres. Outcome measures were often subjective, with the exception of interventions for cardiovascular risk and diabetes. Generally, authors claimed that interventions were beneficial, despite a number of reported limitations. Conclusions: Recommendations for enhancing interventions to improve immigrant health are provided to help researchers, funders and health care commissioners when deciding upon the scope, nature and design of future research in this area.
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Affiliation(s)
- Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Gaby Ortiz-Barreda
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Michelle Holdsworth
- School of Health and Related Research- ScHARR, University of Sheffield, Sheffield, UK
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Alberta, Canada
| | - Anu Rammohan
- Discipline of Economics, University of Western Australia, Perth, Australia
| | - Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | | | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
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44
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Roberts K, Cade J, Dawson J, Holdsworth M. Empirically Derived Dietary Patterns in UK Adults Are Associated with Sociodemographic Characteristics, Lifestyle, and Diet Quality. Nutrients 2018; 10:nu10020177. [PMID: 29415478 PMCID: PMC5852753 DOI: 10.3390/nu10020177] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 01/10/2018] [Revised: 01/28/2018] [Accepted: 02/02/2018] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to examine empirical dietary patterns in UK adults and their association with sociodemographic characteristics, lifestyle factors, self-reported nutrient intake, nutrient biomarkers, and the Nutrient-based Diet Quality Score (NDQS) using National Diet and Nutrition Survey data 2008–2012 (n = 2083; mean age 49 years; 43.3% male). Four patterns explained 13.6% of the total variance: ‘Snacks, fast food, fizzy drinks’ (SFFFD), ‘Fruit, vegetables, oily fish’ (FVOF), ‘Meat, potatoes, beer’ (MPB), and ‘Sugary foods, dairy’ (SFD). ‘SFFFD’ was associated positively with: being male; smoking; body mass index (BMI); urinary sodium; intake of non-milk extrinsic sugars (NMES), fat and starch; and negatively with: age; plasma carotenoids; and NDQS. ‘FVOF’ was associated positively with: being non-white; age; income; socioeconomic classification (National Statistics Socio-economic Classifications; NSSEC); plasma carotenoids; intake of non-starch polysaccharides and polyunsaturated fatty acids. It was negatively associated with: being male, smoking, BMI, urinary sodium, intake of saturated fat; and NMES and NDQS. Whilst the patterns explained only 13.6% of the total variance, they were associated with self-reported nutrient intake, biomarkers of nutrient intake, sociodemographic and lifestyle variables, and the NDQS. These findings provide support for dietary patterns analyses as a means of exploring dietary intake in the UK population to inform public health nutrition policy and guidance.
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Affiliation(s)
- Katharine Roberts
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
- Health Improvement Directorate, Public Health England, London SE1 6LH, UK.
| | - Janet Cade
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK.
| | - Jeremy Dawson
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
| | - Michelle Holdsworth
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
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45
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Holdsworth M, Nicolaou M, Langøien LJ, Osei-Kwasi HA, Chastin SFM, Stok FM, Capranica L, Lien N, Terragni L, Monsivais P, Mazzocchi M, Maes L, Roos G, Mejean C, Powell K, Stronks K. Developing a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe - a DEDIPAC study. Int J Behav Nutr Phys Act 2017; 14:154. [PMID: 29115995 PMCID: PMC5678802 DOI: 10.1186/s12966-017-0608-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 02/05/2017] [Accepted: 10/24/2017] [Indexed: 12/20/2022] Open
Abstract
Background Some ethnic minority populations have a higher risk of non-communicable diseases than the majority European population. Diet and physical activity behaviours contribute to this risk, shaped by a system of inter-related factors. This study mapped a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe, to inform research prioritisation and intervention development. Methods A concept mapping approach guided by systems thinking was used: i. Preparation (protocol and terminology); ii. Generating a list of factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe from evidence (systematic mapping reviews) and ‘eminence’ (89 participants from 24 academic disciplines via brainstorming, an international symposium and expert review) and; iii. Seeking consensus on structuring, rating and clustering factors, based on how they relate to each other; and iv. Interpreting/utilising the framework for research and interventions. Similar steps were undertaken for frameworks developed for the majority European population. Results Seven distinct clusters emerged for dietary behaviour (containing 85 factors) and 8 for physical activity behaviours (containing 183 factors). Four clusters were similar across behaviours: Social and cultural environment; Social and material resources; Psychosocial; and Migration context. Similar clusters of factors emerged in the frameworks for diet and physical activity behaviours of the majority European population, except for ‘migration context’. The importance of factors across all clusters was acknowledged, but their relative importance differed for ethnic minority populations compared with the majority population. Conclusions This systems-based framework integrates evidence from both expert opinion and published literature, to map the factors influencing dietary and physical activity behaviours in ethnic minority groups. Our findings illustrate that innovative research and complex interventions need to be developed that are sensitive to the needs of ethnic minority populations. A systems approach that encompasses the complexity of the inter-related factors that drive behaviours may inform a more holistic public health paradigm to more effectively reach ethnic minorities living in Europe, as well as the majority host population. Electronic supplementary material The online version of this article (10.1186/s12966-017-0608-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Holdsworth
- Public Health Section, School of Health and Related Research-ScHARR, The University of Sheffield, Sheffield, UK.
| | - Mary Nicolaou
- Academic Medical Centre, University of Amsterdam, Department of Public Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands
| | - Lars Jørun Langøien
- Department of Physical Education, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hibbah Araba Osei-Kwasi
- Public Health Section, School of Health and Related Research-ScHARR, The University of Sheffield, Sheffield, UK
| | - Sebastien F M Chastin
- Institute for Applied Health Research, School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - F Marijn Stok
- Department of Psychological Assessment and Health Psychology, University of Konstanz, Constance, Germany
| | - Laura Capranica
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Laura Terragni
- Department of Nursing and Health Promotion Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Pablo Monsivais
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Present address: Department of Nutrition and Exercise Physiology, Elson S Floyd College of Medicine, Washington State University, Spokane, WA 99210-1495, USA
| | - Mario Mazzocchi
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Lea Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Gun Roos
- Consumption Research Norway SIFO, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Caroline Mejean
- UMR MOISA, Campus INRA-SupAgro de la Gaillarde, Montpellier, France
| | - Katie Powell
- Public Health Section, School of Health and Related Research-ScHARR, The University of Sheffield, Sheffield, UK
| | - Karien Stronks
- Academic Medical Centre, University of Amsterdam, Department of Public Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands
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Méjean C, Si Hassen W, Gojard S, Ducrot P, Lampuré A, Brug H, Lien N, Nicolaou M, Holdsworth M, Terragni L, Hercberg S, Castetbon K. Social disparities in food preparation behaviours: a DEDIPAC study. Nutr J 2017; 16:62. [PMID: 28931416 PMCID: PMC5607511 DOI: 10.1186/s12937-017-0281-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 09/05/2017] [Indexed: 11/29/2022] Open
Abstract
Background The specific role of major socio-economic indicators in influencing food preparation behaviours could reveal distinct socio-economic patterns, thus enabling mechanisms to be understood that contribute to social inequalities in health. This study investigated whether there was an independent association of each socio-economic indicator (education, occupation, income) with food preparation behaviours. Methods A total of 62,373 adults participating in the web-based NutriNet-Santé cohort study were included in our cross-sectional analyses. Cooking skills, preparation from scratch and kitchen equipment were assessed using a 0–10-point score; frequency of meal preparation, enjoyment of cooking and willingness to cook better/more frequently were categorical variables. Independent associations between socio-economic factors (education, income and occupation) and food preparation behaviours were assessed using analysis of covariance and logistic regression models stratified by sex. The models simultaneously included the three socio-economic indicators, adjusting for age, household composition and whether or not they were the main cook in the household. Results Participants with the lowest education, the lowest income group and female manual and office workers spent more time preparing food daily than participants with the highest education, those with the highest income and managerial staff (P < 0.0001). The lowest educated individuals were more likely to be non-cooks than those with the highest education level (Women: OR = 3.36 (1.69;6.69); Men: OR = 1.83 (1.07;3.16)) while female manual and office workers and the never-employed were less likely to be non-cooks (OR = 0.52 (0.28;0.97); OR = 0.30 (0.11;0.77)). Female manual and office workers had lower scores of preparation from scratch and were less likely to want to cook more frequently than managerial staff (P < 0.001 and P < 0.001). Women belonging to the lowest income group had a lower score of kitchen equipment (P < 0.0001) and were less likely to enjoy cooking meal daily (OR = 0.68 (0.45;0.86)) than those with the highest income. Conclusion Lowest socio-economic groups, particularly women, spend more time preparing food than high socioeconomic groups. However, female manual and office workers used less raw or fresh ingredients to prepare meals than managerial staff. In the unfavourable context in France with reduced time spent preparing meals over last decades, our findings showed socioeconomic disparities in food preparation behaviours in women, whereas few differences were observed in men. Electronic supplementary material The online version of this article (10.1186/s12937-017-0281-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline Méjean
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologies et Biostatistiques, Inserm (U1153), Inra (U1125), Cnam, F-93017, Bobigny, France. .,INRA, UMR 1110 MOISA, F-34000, Montpellier, France.
| | - Wendy Si Hassen
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologies et Biostatistiques, Inserm (U1153), Inra (U1125), Cnam, F-93017, Bobigny, France
| | - Séverine Gojard
- INRA, UR1303 ALISS, 65 Boulevard de Brandebourg, F-94205, Ivry sur Seine Cedex, France
| | - Pauline Ducrot
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologies et Biostatistiques, Inserm (U1153), Inra (U1125), Cnam, F-93017, Bobigny, France
| | - Aurélie Lampuré
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologies et Biostatistiques, Inserm (U1153), Inra (U1125), Cnam, F-93017, Bobigny, France
| | - Hans Brug
- Department of Epidemiology & Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, P.O. Box 1046 Blindern, -0316, Oslo, NO, Norway
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Michelle Holdsworth
- School of Health and Related Research (ScHARR), Public Health section, The University of Sheffield, Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Serge Hercberg
- Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologies et Biostatistiques, Inserm (U1153), Inra (U1125), Cnam, F-93017, Bobigny, France
| | - Katia Castetbon
- Université Libre de Bruxelles (ULB), Ecole de Santé Publique, Route de Lennik 808, B-1070, CP 598, Bruxelles, Belgium
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Langøien LJ, Terragni L, Rugseth G, Nicolaou M, Holdsworth M, Stronks K, Lien N, Roos G. Systematic mapping review of the factors influencing physical activity and sedentary behaviour in ethnic minority groups in Europe: a DEDIPAC study. Int J Behav Nutr Phys Act 2017; 14:99. [PMID: 28738832 PMCID: PMC5525226 DOI: 10.1186/s12966-017-0554-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 12/05/2016] [Accepted: 07/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Physical activity and sedentary behaviour are associated with health and wellbeing. Studies indicate that ethnic minority groups are both less active and more sedentary than the majority population and that factors influencing these behaviours may differ. Mapping the factors influencing physical activity and sedentary behaviour among ethnic minority groups living in Europe can help to identify determinants of physical activity and sedentary behaviour, research gaps and guide future research. Methods A systematic mapping review was conducted to map the factors associated with physical activity and sedentary behaviour among ethnic minority groups living in Europe (protocol PROSPERO ID = CRD42014014575). Six databases were searched for quantitative and qualitative research published between 1999 and 2014. In synthesizing the findings, all factors were sorted and structured into clusters following a data driven approach and concept mapping. Results Sixty-three articles were identified out of 7794 returned by the systematic search. These included 41 quantitative and 22 qualitative studies. Of these 58 focused on physical activity, 5 on both physical activity and sedentary behaviour and none focused on sedentary behaviour. The factors associated with physical activity and sedentary behaviour were grouped into eight clusters. Social & cultural environment (n = 55) and Psychosocial (39) were the clusters containing most factors, followed by Physical environment & accessibility (33), Migration context (15), Institutional environment (14), Social & material resources (12), Health and health communication (12), Political environment (3). An important finding was that cultural and religious issues, in particular those related to gender issues, were recurring factors across the clusters. Conclusion Physical activity and sedentary behaviour among ethnic minority groups living in Europe are influenced by a wide variety of factors, especially informed by qualitative studies. More comparative studies are needed as well as inclusion of a wider spectrum of the diverse ethnic minority groups resettled in different European countries. Few studies have investigated factors influencing sedentary behaviour. It is important in the future to address specific factors influencing physical activity and sedentary behaviour among different ethnic minority groups in order to plan and implement effective interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0554-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Gro Rugseth
- Norwegian School of Sport Sciences, Oslo, Norway
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Gun Roos
- Consumption Research Norway - SIFO, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
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Cohen E, Amougou N, Ponty A, Loinger-Beck J, Nkuintchua T, Monteillet N, Bernard JY, Saïd-Mohamed R, Holdsworth M, Pasquet P. Nutrition Transition and Biocultural Determinants of Obesity among Cameroonian Migrants in Urban Cameroon and France. Int J Environ Res Public Health 2017; 14:E696. [PMID: 28661463 PMCID: PMC5551134 DOI: 10.3390/ijerph14070696] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/07/2017] [Accepted: 06/27/2017] [Indexed: 01/19/2023]
Abstract
Native of rural West Cameroon, the Bamiléké population is traditionally predisposed to obesity. Bamiléké who migrated to urban areas additionally experience the nutrition transition. We investigated the biocultural determinants of obesity in Bamiléké who migrated to urban Cameroon (Yaoundé), or urban France (Paris). We conducted qualitative interviews (n = 36; 18 men) and a quantitative survey (n = 627; 266 men) of adults using two-stage sampling strategy, to determine the association of dietary intake, physical activity and body weight norms with obesity of Bamiléké populations in these three socio-ecological areas (rural Cameroon: n = 258; urban Cameroon: n = 319; urban France: n = 50). The Bamiléké valued overweight and traditional energy-dense diets in rural and urban Cameroon. Physical activity levels were lower, consumption of processed energy-dense food was frequent and obesity levels higher in new migrants living in urban Cameroon and France. Female sex, age, duration of residence in urban areas, lower physical activity and valorisation of overweight were independently associated with obesity status. This work argues in favour of local and global health policies that account for the origin and the migration trajectories to prevent obesity in migrants.
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Affiliation(s)
- Emmanuel Cohen
- Centre National de la Recherche Scientifique, Unité Mixte Internationale 3189, Environnement, Santé, Société, Faculté de Médecine-Nord, 51 bd Pierre Dramard, 13344 Marseille CEDEX 15, France.
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa.
| | - Norbert Amougou
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.
| | - Amandine Ponty
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.
| | - Juliette Loinger-Beck
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.
| | - Téodyl Nkuintchua
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.
| | - Nicolas Monteillet
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.
| | - Jonathan Y Bernard
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.
| | - Rihlat Saïd-Mohamed
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa.
| | - Michelle Holdsworth
- School of Health and Related Research, Public Health section, The University of Sheffield, Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
| | - Patrick Pasquet
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7206, Eco-Anthropologie et Ethnobiologie, Musée de l'Homme, Muséum National d'Histoire Naturelle, 17 place du Trocadéro, 75016 Paris, France.
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Osei-Kwasi HA, Powell K, Nicolaou M, Holdsworth M. The influence of migration on dietary practices of Ghanaians living in the United Kingdom: a qualitative study. Ann Hum Biol 2017; 44:454-463. [PMID: 28535737 DOI: 10.1080/03014460.2017.1333148] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 10/19/2022]
Abstract
BACKGROUND Previous studies have identified a process of dietary acculturation when migrant groups adopt the food patterns of the host country. AIM The aim of this study was to explore the influence of migration on dietary practices and the process of dietary acculturation amongst Ghanaians living in the UK. SUBJECT AND METHODS A qualitative study of adults aged ≥25 years (n = 31) of Ghanaian ancestry living in Greater Manchester using face-to-face interviews. Participants varied in socioeconomic status, gender and migration status. Interviews were transcribed verbatim and analysed thematically. RESULTS Three distinct dietary practice typologies were discernible that differed in terms of typical meal formats, meal contexts, structure and patterning of meals, food preparation and purchasing behaviours: (i) continuity practices; (ii) flexible practices; and (iii) changed practices. The identified practices were shaped by interrelating factors that fell into four main clusters: social and cultural environment; accessibility of foods; migration context; and food beliefs/perceptions. CONCLUSION Participants retained, to a varying degree, some aspects of Ghanaian dietary practices, whilst adopting key features of UK food culture. This study demonstrates the complexity of dietary change, indicating that it is not a linear process and it is dependent on several factors.
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Affiliation(s)
- Hibbah Araba Osei-Kwasi
- a Public Health Section, School of Health and Related Research-ScHARR , University of Sheffield , Sheffield , UK
| | - Katie Powell
- a Public Health Section, School of Health and Related Research-ScHARR , University of Sheffield , Sheffield , UK
| | - Mary Nicolaou
- b Department of Public Health , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
| | - Michelle Holdsworth
- a Public Health Section, School of Health and Related Research-ScHARR , University of Sheffield , Sheffield , UK
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Horton P, Banwart SA, Brockington D, Brown GW, Bruce R, Cameron D, Holdsworth M, Lenny Koh SC, Ton J, Jackson P. An agenda for integrated system-wide interdisciplinary agri-food research. Food Secur 2017. [DOI: 10.1007/s12571-017-0648-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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