There is increased emphasis on the quality of food and the overall pattern of micronutrient intake as an integral consideration for food security particularly among people living with HIV/AIDS (PLWHA). However, limited data exist on food consumption and nutrient intakes for populations in sub-Saharan Africa. The study examined dietary patterns and their relationship with nutrient intakes in HIV uninfected (HIV-) and infected (HIV+) adults in North-West Province, South Africa. In this cross-sectional study, dietary and nutrient intakes were assessed with Quantitative Food Frequency Questionnaire (QFFQ) and FoodFinder software, respectively. Dietary patterns were determined using Principal Component Analysis. Participants’ scores for the dietary patterns were related to nutrient intakes using Spearman Rank correlation and Generalised Linear Modelling (GENLIN). Four main dietary patterns were found in each population. The first three patterns were similar between the HIV- and HIV+ populations: “animal-based”, associated with intake of foods of animal origin; “recommended” associated with a varied diet; and “staple-based”. The fourth pattern was described as either ‘eggs-and-breakfast-cereals’ for the HIV- group or ‘legumesand-vegetables’ for HIV+ group. Scores for animal-based pattern showed strongest correlations(r) with nutrient intakes for both populations, notably zinc (r=0.54), calcium (r=0.5), potassium (r=0.54), vitamin A (r=0.5), and vitamin C (r=0.5), (p<0.001 for all). In the HIV+ group, the legumes-and-vegetables pattern was strongly associated with energy (r=0.64), vitamins D (r=0.51), E (0.51) and B1 (r=0.55) (p<0.001 for all). Compared with the other patterns, the Staple-based and the recommended patterns showed the weakest associations with nutrient intakes. Generalised Linear Modelling confirmed stronger positive linear associations between scores of the animal-based diet and nutrients intake, compared with the other patterns. The findings suggest that the animal-based pattern was strongly associated with nutrients intake in both HIV + and HIV- populations. This raises the need for studies into dietary recommendations for promoting nutritional wellbeing for PLWHA in sub-Saharan Africa.

Food-Based Dietary Guidelines (FBDG) provide culturally-appropriate and actionable recommendations based on which populations can make healthy food choices. Food systems sustainability, from production to consumption, and disposal of food and food-related items, should be a critical consideration for developing such guidelines. This rapid review assesses Ghana's food systems to determine the level of sustainability to inform the FBDG recommendations. Peer-reviewed articles, documents and reports of relevance to Ghana were included in this rapid review. A hundred and eight papers, answering different questions on food system sustainability were reviewed. Bread, cereals, fish and indigenous vegetables are the most frequently consumed food groups. Sugar-Sweetened Beverages are the most consumed imported foods. In rural areas, 53% of dietary protein comes from plant sources. Fish is the main the source of animal protein for most Ghanaian households. There is intensive exploitation of marine and fresh water resources. Most livestock are raised by smallholder farmers using free-range system. Poultry is frequently kept on deep litter system and only a few are large-scale. Crop production for household consumption and small-scale animal rearing are predominant, especially in Northern Ghana. By weight, fruits and vegetables are the least cultivated and consumed crops at the household level. Wood is the commonest source of fuel for cooking, especially in rural areas. Single use plastic is the most used and preferred material for food packaging. Indiscriminate and poor management of waste and pesticide misuse is commonly reported. The findings suggest the need for promoting production diversification, use of clean fuel and reusable food packaging as part of FBDGs to enhance sustainability of Ghana’s food systems. Key words: sustainability, food system, Ghana, Food-based Dietary Guidelines, production, diversification

Food environments exert a significant effect on population dietary choices and health outcomes. Policies that influence the food environment, can have a significant impact on individual and population dietary choices. This rapid review assessed the nature and interaction within the Ghanaian food environment, and the impact that existing school, workplace, and national food policies have on dietary intake and nutritional outcomes. Online databases and university repositories were searched for relevant articles and documents. A total of forty articles and documents were included in the review. Majority of the reviewed papers (85%) used a cross-sectional design. The findings show that traditional outlets (open markets) constitute the main food source among the Ghanaian populace, while convenience stores serve as an important source of processed foods. Prepared local foods are often consumed outside the home and are mainly sourced from street food vendors. Street foods are perceived as less expensive, convenient, and delicious. The food environment was found to influence dietary acquisition, intake, and nutritional outcomes. Although most nutrients provided by the School Feeding Programme (SFP) are below recommended intake standards, the SFP contributes positively to improved diets and nutrition status of school-age children. Children attending SFP-implementing schools experience higher intakes of protein, iron, zinc, calcium, vitamin A, folate, and have higher haemoglobin, and lower prevalence of stunting, underweight, and thinness than children in non-SFP implementing schools. Availability of a private room for breastfeeding mothers improved breastfeeding frequency. Ghana’s fatty meat restriction policy has reduced the availability and sale of fatty meat on the Ghanaian market. Reported drivers and barriers to healthy foods consumption include socio-economic factors, media information, food storage facilities, cultural perception, fruit seasonality, knowledge on the nutrient value of fruits and vegetables, safety profile of fruits and vegetables, and contribution of household production to dietary intake. In conclusion, the food environment review reveals the drivers of availability, barriers to healthy food access, and impact of interventions and policies on the Ghanaian food environment. Key words: Ghana, Food environment, policies, nutritional impact, health impact

Micronutrients are important for improving the physical growth and cognition of school-aged children. Food fortification strategies using locally available and consumed micronutrient rich foods such as edible insects can be cost effective and sustainable in improving nutritional and cognitive outcomes in school children. The study evaluated the impact of biscuits fortified with palm weevil larvae and orange-fleshed sweet potato on cognitive performance and nutritional status of school children from low income families in an urban setting in Ghana. A 12-week randomized, blinded controlled trial was conducted. 102 school children aged 6-11 years were assigned to consume either the fortified biscuits or non-fortified biscuits. Raven’s cognition test, anthropometrics, hematological and biochemical parameters were assessed at baseline and at the end of the study. After 12 weeks of intervention, there were no statistically significant differences in the means of the nutritional outcomes and cognitive performance between the treatment and control groups (p>0.05). However, significant increase in mean levels of serum ferritin (Baseline: 26.15 ± 18.42 µg/L, Endline: 42.63 ± 19.54 µg/L, mean increase: +16.48 µg/L, p=0.001), weight-for-age (Baseline: -0.37 ± 0.97, Endline: -0.11 ± 0.91, mean increase: +0.26, p<0.0001), and Raven’s cognition test score (Baseline: 14.22 ± 4.93, Endline: 16.35 ± 4.40, mean increase: +2.13, p<0.0001) were observed within the treatment group compared to the control group where significant increase was observed in only the Ravens cognition test score (Baseline: 14.79 ± 4.57, Endline: 15.95 ± 5.32, mean increase: +1.16, p<0.029). Moreover, the mean increase in cognition score was higher in intervention (+2.13) than control (+1.16) children. Results from binary logistic regression showed that although statistically insignificant, children in the treatment group had lower odds of iron deficiency (AOR= 0.7, p = 0.545, 95%CI= 0.2-2.4). In conclusion, consumption of the fortified biscuit significantly improved serum ferritin and weight-for-age in the school-aged children within the treatment group. Improvement in cognitive test score was also higher in the treatment group than the control group. Key words: Fortified biscuit, cognition, micronutrients, school children, palm weevil larvae, insects