Dietary transitions in African cities to promote nutritious diets
Africa is experiencing increasing levels of obesity in its cities, particularly in women. This change is partly driven by the increasing migration of individuals to cities but dietary habits are also changing. Consumption of food that is high in calories and low in nutrients is on the rise.
The rise in obesity is associated with an increased prevalence of diet-related non-communicable diseases (NDCs) such as type 2 diabetes, coronary heart disease, stroke and several cancers. Mortality from NCDs is increasing and is likely to hinder future economic development through increasing costs of healthcare.
Prior to this project, policy responses to the rise in obesity in Africa have had limited success. This is because they were mostly influenced by experiences in higher income countries which are less relevant to African cities.
There is insufficient understanding of the factors that drive food consumption in Africa, particularly the role that people’s social networks play (e.g. family or peer groups) and the neighbourhoods that individuals live in (e.g. access to fast food outlets). Without this understanding, effective strategies to promote healthier food consumption in African cities cannot be devised.
Two sister projects were funded by the MRC and the Drivers of Food Choice Program from 2017 to 2019 and were implemented in two African countries as case studies: Kenya and Ghana. Both countries, in consultation with their Ministries of Health, had identified the need for national food-based dietary guidelines and context-specific interventions that prevent diet-related NCDs.
We collaborated with in-country academic partners at the University of Ghana, University of Health and Allied Sciences (Ghana) and the African Population and Health Research Center (Kenya), as well as partners from the Universities of Liverpool and Loughborough and the Montpellier Interdisciplinary Centre on Sustainable Agri-food systems in France. Together we explored the factors that are associated with what people eat, as well as how, where, when and with whom they eat within 3 cities: Nairobi in Kenya, and Accra and Ho in Ghana.
We did this by:
- Interviewing people about what kinds of food they eat and how they eat it (e.g. in a hurry, alone or with others) and using photography with local people to explore the factors that influence these decisions.
- Mapping the food environment in people’s neighbourhoods (e.g. location and type of food outlets available) to explore how characteristics/features in the environment might influence people’s food consumption and practices.
- Reviewing the state of knowledge throughout existing published research and analysing existing information on dietary behaviours.
We are using the data we collected to support the development of country-specific guidelines for encouraging healthy diets in Ghana and Kenya. The data is also being used to review national NCD policies and implementation strategies. For example, the Ghanaian Government, through its Ministry of Health, has revised its NCD policy and implementation strategy using evidence from the project. Our researchers, alongside Ghanaian colleagues, have been invited to support the policy and strategy revision.
Part of the project was also to identify local evidence that will inform the development of food-based dietary guidelines for Sub-saharan Africa. Currently, the development of these guidelines is ongoing, led by the Food and Agricultural Organisation, and facilitated by one of our Ghanaian colleagues who collaborated in these projects.
Finally, we have developed and validated an Africa Food Environment Framework using findings from the project, which will be published this year (2021). It will help African researchers and practitioners with their work to improve the food environment. And, it will mean that future research and policies can be based on frameworks appropriate for use in the African context.
This project and its continued impact is important for the future health of the populations of Ghana and Kenya; particularly among socio-economically disadvantaged groups, which are experiencing the greatest increase in obesity. There are also longer-term wider economic benefits for the participating counties, as improved nutrition across population groups can lead to gains in educational achievement and economic productivity.
It is hoped that the learning from this project can be used in other African countries that are following similar trajectories of rapid urbanisation and dietary change.