Methodology for developing and evaluating food-based dietary guidelines and a Healthy Eating Index for Ethiopia: a study protocol

Abstract

IntroductionFood-based dietary guidelines (FBDGs) are used to promote and maintain healthy eating in a population, by providing country-specific guidance. However, many African countries like Ethiopia do not have FBDGs. This paper describes the methodology for the development of Ethiopian FBDGs and for creating and evaluating a Healthy Eating Index and a scoring tool that can be used to monitor the adherence of the population to FBDGs.Methods and analysisA multidisciplinary technical working group will be tasked to develop FBDGs for the general population above 2 years of age based on identification of priority diet-related public health problems and risk factors, and a systematic review of dietary patterns in relation to the identified priority health outcomes, following a multistep process. FBDGs will be translated into daily food choices for specific subpopulations by applying linear programming using data from the National Food Consumption Survey (NFCS) of 2011. FBDGs will be evaluated for cultural appropriateness, acceptability, consumer understanding and practicality. A dietary gap assessment will be conducted by comparing the national food supply with the country’s food demand. In addition an Ethiopian Healthy Eating Index (EHEI) will be developed based on the FBDGs using the NFCS data. The EHEI will be evaluated by comparing the EHEI Score based on 24 hours diet recall with that of the EHEI Score based on a Food Frequency Questionnaire, by analysing the association of the EHEI Score with population characteristics and micronutrient intake with or without additional adjustment for energy intake. Finally, a brief Food Quality Screening tool scoring for the important EHEI components will be developed to enable evaluation for counselling.Ethics and disseminationEthical approval is received from the Scientific and Ethical Review Office of the Ethiopian Public Health Institute. The findings will be disseminated through peer-reviewed publications.A dissemination workshop will be organised with key implementing sectors of the food system for a healthier diet (http://a4nh.cgiar.org/our-research/research-flagships/) and with key public and private partners. The findings from this study will be translated into FBDGs and shared through conferences, reports and the mass media (TV and radio).Trial registration numberNCT03394963; Pre-results.

Factors Influencing Adolescents' Dietary Behaviors in the School and Home Environment in Addis Ababa, Ethiopia

“…In addition, the currently widespread unhealthy choices in the school food environment need to be regulated. Advertising of unhealthy food and beverages in and around schools should be restricted and food and beverages offered in school cafeterias should follow food-based dietary guidelines (41), which are currently being drafted and validated in Ethiopia (42).…”

Assessing factors influencing adolescents’ dietary behaviours in urban Ethiopia using participatory photography

“…Restricting energy-dense nutrient-poor snack foods from school compounds could help reduce consumption of such foods (48) . In addition, the national food-based dietary guidelines that are currently under development could be another opportunity to improve adolescent diets (50) . Offering individual pieces of fruit or vegetables around schools has been shown to increase fruit consumption as well as sales of fruit for the vendors (51) and should be considered more widely with free or subsidised schemes within schools.…”

Changes and challenges in markets for animal source foods: a qualitative study among market vendors in Addis Ababa, Ethiopia

“…For example, among Orthodox Christians, dietary diversification efforts may need to promote plant-based sources of protein (e.g., legumes and nuts) more heavily than ASFs, or engage the clergy to help reduce the stigma associated with consuming ASFs during fasting periods in order to encourage ASF consumption among pregnant women and children. In addition, our findings can help inform Ethiopia's national food-based dietary guidelines, which are currently under development (Bekele et al 2019). They shed light on whether global dietary recommendations and guidelines focused on protein intake, similar to those made by the EAT-Lancet Commission (Willett et al 2019), can realistically be adopted to promote healthy and sustainable urban diets in Ethiopia.…”