Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: National experts’ assessment of government action

Laar, Amos; Barnes, Amy; Aryeetey, Richmond; Tandoh, Akua; Bash, Kristin; Mensah, Kobby; Zotor, Francis; Vandevijvere, Stefanie; Holdsworth, Michelle

doi:10.1016/j.foodpol.2020.101907

Cited by 80 publications

(97 citation statements)

References 21 publications

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“…The combination of the enabling factors of high prevalence, low awareness and poor control of hypertension calls for an urgent response in line with Ghana’s strategies to prioritize cardiovascular health through investments in risk reduction dietary and lifestyle behaviour [ 154 , 155 ]. In a recent evaluation, local experts in Ghana gave a low rating to the implementation of three-quarters of 43 indicators of health food environment [ 156 ]. Other experts cite inadequate resources and a focus on clinical rather than preventive actions as the major challenges hindering the implementation of diabetes and hypertension policies in Ghana [ 157 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis

Bosu

Bosu²

2021

PLoS ONE

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Background Hypertension is a major health problem in Ghana, being a leading cause of admissions and deaths in the country. In the context of a changing food and health policy environment, we undertook a systematic review (PROSPERO registration number: CRD42020177174) and a meta-analysis of the prevalence of adult hypertension, and its awareness and control in Ghana. Methods We searched major databases including PubMed, Embase as well as Google Scholar and online digital collections of public universities of Ghana to locate relevant published and unpublished community-based articles up till April 2020. Findings Eighty-five articles involving 82,045 apparently-healthy subjects aged 15–100 years were analyzed. In individual studies, the prevalence of hypertension, defined in most cases as blood pressure ≥ 140/90 mmHg, ranged from 2.8% to 67.5%. The pooled prevalence from the meta-analysis was 27.0% (95% CI 24.0%-30.0%), being twice as high in the coastal (28%, 95% CI: 24.0%-31.0%) and middle geo-ecological belts (29%, 95% CI: 25.0%-33.0%) as in the northern belt (13%, 95% CI: 7.0%-21.0%). The prevalence was similar by sex, urban-rural residence or peer-review status of the included studies. It did not appear to vary over the study year period 1976–2019. Of the subjects with hypertension, only 35% (95% CI: 29.0%-41.0%) were aware of it, 22% (95% CI: 16.0%-29.0%) were on treatment and 6.0% (95% CI: 3.0%-10.0%) had their blood pressure controlled. Sensitivity analyses corroborated the robust estimates. There was, however, high heterogeneity (I2 = 98.7%) across the studies which was partly explained by prevalent obesity in the subjects. Conclusion More than one in four adults in Ghana have hypertension. This high prevalence has persisted for decades and is similar in rural and urban populations. With the low awareness and poor control of hypertension, greater investments in cardiovascular health are required if Ghana is to meet the global target for hypertension.

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Section: Discussionmentioning

confidence: 99%

Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis

Bosu

Bosu²

2021

PLoS ONE

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“…This is beyond the scope of this worked example, but there are indications of challenges. For example, Ghana has very low implementation of food environment policies (Laar et al, 2020) and a recent study showed there is low community readiness to accept them (Pradeilles et al, 2019). A study by Hartley and Arndt (2018) indicates that the groundnut value chain has high potential to improve diets, but would generate relatively little economic growth compared to other foods.. *Based on information in Box 2.…”

Section: Boxmentioning

confidence: 99%

Child-centered food systems: Reorienting food systems towards healthy diets for children

Hawkes

Fox

Downs

et al. 2020

Global Food Security

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Current food systems are failing to guide children towards healthy diets. This paper presents a tool to identify the actions needed to reorient food systems to become more child-centred from a nutrition perspective. To connect the dots between children's lives, their food environments and food supply systems, the tool takes a childcentred, food systems approach. Comprising six methodological steps, the tool starts by measuring and understanding children's realities and then working back up into the system to identify how food environments and supply systems could make relevant foods more or less available, affordable, appealing and aspirational in the contexts of children's lives. The paper spells out the mix of methods needed to make this assessment, gives examples of the data and studies already available and type of insights they provide, and discusses the methodological challenges and gaps. It presents a worked example that shows how following these steps in sequence enables the identification of a package of actions that can act coherently to reorient food systems in the way most likely to have impact on child malnutrition.

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“…We also know from wider research that advertising is an important driver of food choice. We also know from policy appraisals with national stakeholders in Ghana and Kenya that food advertising controls are a priority for action ( Laar et al, 2020 ; Asiki et al, 2020 ). We recommend actions to dis-incentivise unhealthy food consumption because we found widespread consumption of unhealthy foods and beverages, including at mealtimes.…”

Section: Recommendations For Policy Action and Conclusionmentioning

confidence: 99%

“…Therefore, FBDGs need to acknowledge these directly, for example, making recommendations for a lower sugar breakfast by reducing sugar in tea in Kenya and sweet food consumption in both countries; and reducing fat in meals, including those consumed at home, including ‘traditional’ foods and dishes that are associated with cultural identity. In Ghana there are no interpretive, evidence-informed FBDGs despite political support ( Laar et al, 2020 ). However, Dietary and Physical Activity Guidelines have been adopted by the Ghana Dietetic Association ( MoH 2009 ), which provide information on making healthy choices and planning meals based on the nutrient content of foods.…”

Section: Recommendations For Policy Action and Conclusionmentioning

confidence: 99%

Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: Evidence for policy action from Ghana and Kenya

Holdsworth

Pradeilles

Tandoh

et al. 2020

Global Food Security

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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 ...

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Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: National experts’ assessment of government action

Cited by 80 publications

References 21 publications

Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis

Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis

Child-centered food systems: Reorienting food systems towards healthy diets for children

Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: Evidence for policy action from Ghana and Kenya

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