Browsing by Author "Tandoh, A."

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Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal
(BMJ Open, 2023) Tandoh, A.; Laar, A.; Pradeilles, R.; et al.
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 urbanized the 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 schools/ 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’ recognized that the marketing and availability of unhealthy food and beverages was a problem. Additionally, the 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.
The Africa Food Environment Research Network (FERN): from concept to practice
(Sage, 2022) Tandoh, A.; Aryeetey, R.; et al.
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.
Factors associated with health insurance enrolment among ghanaian children under the fve years. Analysis of secondary data from a national survey
(BMC Health Services Research, 2022) Anaba, E.A.; Tandoh, A.; Sesay, F.R.; Fokukora, T.
Background: Health insurance enrolment provides financial access to health care and reduces the risk of catastrophic healthcare expenditure. Therefore, the objective of this study was to assess the prevalence and correlates of health insurance enrolment among Ghanaian children under five years. Methods: We analyzed secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. The survey was a nationally representative weighted sample comprising 8,874 children under fve years and employed Computer Assisted Personal Interviewing to collect data from the participants. In addition, Chi-square and Logistic Regression analyses were conducted to determine factors associated with health insurance enrolment. Results: The results showed that a majority (58.4%) of the participants were insured. Health insurance enrollment was associated with child age, maternal educational status, wealth index, place of residence and geographical region (p<0.05). Children born to mothers with higher educational status (AOR=2.14; 95% CI: 1.39–3.30) and mothers in the richest wealth quintile (AOR=2.82; 95% CI: 2.00–3.98) had a higher likelihood of being insured compared with their counterparts. Also, children residing in rural areas (AOR=0.75; 95% CI: 0.61–0.91) were less likely to be insured than children in urban areas. Conclusion: This study revealed that more than half of the participants were insured. Health insurance enrolment was influenced by the child’s age, mother’s educational status, wealth index, residence, ethnicity and geographical region. Therefore, interventions aimed at increasing health insurance coverage among children should focus on children from low socio-economic backgrounds. Stakeholders can leverage these findings to help improve health insurance coverage among Ghanaian children under five years.
How ready are communities to implement actions to improve diets of adolescent girls and women in urban Ghana?
(BMC Public Health, 2019-05-15) Laar, A.; Pradeilles, R.; Marr, C.; Holdsworth, M.; Zotor, F.; Tandoh, A.; Klomegah, S.; Coleman, N.; Bash, K.; Green, M.; Griffiths, P.L.
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 recognizing 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.
Implementation of healthy food environment policies to prevent nutritionrelated non-communicable diseases in Ghana: National experts’ assessment of government action
(Food Policy, 2020-05-19) Laar, A.; Barnes, A.; Aryeetey, R.; Tandoh, A.; Bash, K.; Mensah, K.; Zotor, F.; Vandevijvere, S.; Holdsworth, M.
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 nationallyrelevant 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.
Nutrition-Sensitive Education And Social Protection Policies Have Implications For Food-Based Dietary Guidelines For Ghana
(ajfand, 2022) Tandoh, A.; Amevinya, G.S.; Addo, P.; Laar, A.
Ghana continues to address persistent malnutrition through political action and programme development. Government-led efforts have included the formulation of multi-sectoral policies and programmes to improve the diet and nutritional status of various at-risk population groups. Globally, an important tool for promoting healthy diets are Food-Based Dietary Guidelines (FDBGs). To achieve and sustain the desired goal of promoting healthy eating habits and lifestyles, FBDGs require, among many factors, supportive national policies and programmes. When coherently incorporated in relevant nutrition-related policies and programmes, FBDGs enhance their impact on shaping and sustaining healthier dietary habits. In this context, it is essential to understand the national policy and programme environment and its potential contribution during the formulation of FBDGs. The present review aimed to identify existing nutrition-related education and social protection policies and programmes in Ghana and their relevance to the development and implementation of FBDGs. Previously conducted scoping reviews, gap analyses, and a benchmarking report of Ghana’s public health nutrition policies were used as information sources to identify relevant policies and programmes. Additionally, websites of relevant government ministries, departments and agencies were searched to retrieve applicable policies or actions that were not included in previous reviews. Nutrition-related education policies that were identified primarily support school health services, whereas social protection policies broadly target social assistance, social welfare, social equity and insurancebased policies and programmes. Specific ways these policies and programmes could support the development and implementation of Ghana’s dietary guidelines include embedding FBDGs in the school nutrition curriculum to motivate healthier food choices by schoolchildren and using FBDGs to plan meals provided as part of the country’s school feeding programme. Regarding social protection, existing instruments such as food transfers, social pensions and conditional cash transfers could be aligned with FBDGs to ensure vulnerable households can access foods and follow recommended guidelines. Although some nutrition actions are incorporated in existing policies and programmes, there are opportunities to improve their nutrition sensitivity.
Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: Evidence for policy action from Ghana and Kenya
(Global Food Security, 2020) Holdsworth, M.; Pradeilles, R.; Tandoh, A.; et al.
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 di etary 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.