Browsing by Author "Zotor, F."

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The African urban food environment framework for creating healthy nutrition policy and interventions in urban Africa
(PLOS ONE, 2021) Osei-Kwasi, H.A.; Laar, A.; Zotor, F.; Pradeilles, R.; Aryeetey, R.; Green, M.; Griffiths, P.; Akparibo, R.; Wanjohi, M.N.; Rousham, E.; Barnes, A.; Booth, A.; Mensah, K.; Asiki, G.; Kimani-Murage, E.; Bricas, N.; Holdsworth, M.
This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and inter vention development in Africa. A multi-component methodology, drawing on concept map ping, was employed to construct a framework of factors influencing dietary behaviours in urban Africa. The framework adapted a widely used socio-ecological model (developed in a high-income country context) and was developed using a mixed-methods research approach that comprised: i. Evidence synthesis consisting of a systematic review of 39 papers covering 14 African countries; ii. Qualitative interview data collected for adolescents and adults (n = 144) using photovoice in urban Ghana and Kenya; and iii. Consultation with interdisciplinary African experts (n = 71) from 27 countries, who contributed to at least one step of the framework (creation, validation/evaluation, finalisation). The final framework included 103 factors influencing dietary behaviours. Experts identified the factors influencing dietary behaviours across all the four levels of the food environment i.e. the individual, social, physical and macro levels. Nearly half (n = 48) were individual-level factors and just under a quarter (n = 26) were at the macro environmental level. Fewer factors associated with social (n = 15) and physical (14) environments were identified. At the macro level, the factors ranked as most important were food prices, cultural beliefs and seasonality. Factors ranked as important at the social level were household composition, family food habits and dietary practices. The type of food available in the neighbourhood and convenience were seen as important at the physical level, while individual food habits, food preferences and socioeconomic status were ranked highly at the individual level. About half of the factors (n = 54) overlap with those reported in an existing socio-ecological food environment framework developed in a high-income country context. A further 49 factors were identified that were not reported in the selected high-income country framework, underlining the importance of contextualisation. Our conceptual framework offers a useful tool for research to understand dietary transitions in urban African adolescents and adults, as well as identification of factors to intervene when promoting healthy nutritious diets to prevent multiple forms of malnutrition.
Capacity for scaling up nutrition: a focus on pre-service training in West Africa and a Ghanaian case study.
(Proceedings of the Nutrition Society, 2015-11) Aryeetey, R.N.O.; Laar, A.; Zotor, F.; Ghana SUN Academic Platform
The 2013 Lancet series on maternal and child nutrition is identified and advocated for improved institutional and human capacity in nutrition towards scaling up nutrition (SUN) in countries with high stunting rates. Of the fifty-four countries with high burden of child undernutrition who have committed to the SUN movement, thirty-six are in Africa. In the present paper, the academic platform of the SUN movement in Ghana presents an overview of nutrition pre-service capacity in West Africa with a focus on Ghana. The present paper is based on the findings of a sub-region-wide assessment of degree programmes in nutrition in West Africa, plus another report on pre-service nutrition capacity in diploma awarding nursing and nutrition programmes in Ghana. Although there is inadequate evidence on pre-service nutrition training in the sub-region, the two reports provide useful evidence for action, including inadequate number and distribution of pre-service nutrition training programmes, low nutrition graduate output, poor quality of the programme curriculum and instruction, and sub-optimal capital investment. The present paper calls for urgent action to improve pre-service nutrition capacity building as a critical step towards SUN in West Africa.
Editorial: The African food environments
(Frontiers in Public Health, 2023) Laar, A.; Baye, K.; Zotor, F.; Asiki, G.; Lartey, A.
Evaluation of the international standardized 24-h dietary recall methodology (GloboDiet) for potential application in research and surveillance within African settings
(Globalization and Health, 2017) Aglago, E.K.; Landais, E.; Nicolas, G.; Margetts, B.; Annor, G.A.; El Ati, J.; Coates, J.; Colaiezzi, B.; Compaore, E.; Delisle, H.; Faber, M.; Fungo, R.; El Hamdouchi, A.; Hounkpatin, W.A.; Konan, A.G.; Labzizi, S.; Ledo, J.; Mahachi, C.; Maruapula, S.D.; Mathe, N.; Mbabazi, M.; Mirembe, M.W.; Mizéhoun-Adissoda, C.; Nzi, C.D.; Pisa, P.T.; El Rhazi, K.; Zotor, F.; Slimani, N.
Background: Collection of reliable and comparable individual food consumption data is of primary importance to better understand, control and monitor malnutrition and its related comorbidities in low- and middle-income countries (LMICs), including in Africa. The lack of standardised dietary tools and their related research support infrastructure remains a major obstacle to implement concerted and region-specific research and action plans worldwide. Citing the magnitude and importance of this challenge, the International Agency for Research on Cancer (IARC/WHO) launched the "Global Nutrition Surveillance initiative" to pilot test the use of a standardized 24-h dietary recall research tool (GloboDiet), validated in Europe, in other regions. In this regard, the development of the GloboDiet-Africa can be optimised by better understanding of the local specific methodological needs, barriers and opportunities. The study aimed to evaluate the standardized 24-h dietary recall research tool (GloboDiet) as a possible common methodology for research and surveillance across Africa. Methods: A consultative panel of African and international experts in dietary assessment participated in six e-workshop sessions. They completed an in-depth e-questionnaire to evaluate the GloboDiet dietary methodology before and after participating in the e-workshop. Results: The 29 experts expressed their satisfaction on the potential of the software to address local specific needs when evaluating the main structure of the software, the stepwise approach for data collection and standardisation concept. Nevertheless, additional information to better describe local foods and recipes, as well as particular culinary patterns (e.g. mortar pounding), were proposed. Furthermore, food quantification in shared-plates and -bowls eating situations and interviewing of populations with low literacy skills, especially in rural settings, were acknowledged as requiring further specific considerations and appropriate solutions. Conclusions: An overall positive evaluation of the GloboDiet methodology by both African and international experts, supports the flexibility and potential applicability of this tool in diverse African settings and sets a positive platform for improved dietary monitoring and surveillance. Following this evaluation, prerequisite for future implementation and/or adaptation of GloboDiet in Africa, rigorous and robust capacity building as well as knowledge transfer will be required to roadmap a stepwise approach to implement this methodology across pilot African countries/regions. © 2017 The Author(s).
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.
Impact of Cowpea-Based Food Containing Fish Meal Served With Vitamin C–Rich Drink on Iron Stores and Hemoglobin Concentrations in Ghanaian Schoolchildren in a Malaria Endemic Area
(Food and nutrition bulletin, 2015-09) Egbi, G.; Ayi, I.; Saalia, F.K.; Zotor, F.; Adom, T.; Harrison, E.; Ahorlu, C.K.; Steiner-Asiedu, M.
Background: Nutritional anemia is a public health problem among Ghanaian schoolchildren. There is need to employ dietary modification strategies to solve this problem through school and household feeding programs. Objective: To evaluate the effectiveness of cowpea-based food containing fish meal served with vitamin C-rich drink to improve iron stores and hemoglobin concentrations in Ghanaian schoolchildren. Methods: The study involved cross-sectional baseline and nutrition intervention phases. There were 150 participants of age 6 to 12 years. They were randomly assigned to 3 groups, fish meal -vitamin C (n = 50), vitamin C (n = 50), and control (n = 50), and given different cowpea-based diets for a 6-month period. Height and weight measurements were done according to the standard procedures, dietary data were obtained by 24-hour recall and food frequency questionnaire, hemoglobin concentrations were determined by Hemocue Hemoglobinometer, and serum ferritin and complement-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. Participants' blood samples were examined for malaria parasitemia and stools for helminthes using Giemsa stain and Kato-Katz techniques, respectively. Results: Mean ferritin concentration was not significantly different among groups. End line mean or change in hemoglobin concentrations between fish meal-vitamin C group (128.4 ± 7.2/8.3 ± 10.6 g/L) and control (123.1 ± 6.6/4.2 ± 10.4 g/L) were different, P < .05. Change in prevalence of anemia in fish meal-vitamin C group (19.5%) was different compared to those of vitamin C group (9.3%) and the control (12.2%). Levels of malaria parasitemia and high CRP among study participants at baseline and end line were 58% and 80% then 55% and 79%, respectively. Level of hookworm infestation was 13%. Conclusion: Cowpea-based food containing 3% fish meal and served with vitamin C-rich drink improved hemoglobin concentration and minimized the prevalence of anemia among the study participant (PDF) Impact of Cowpea-Based Food Containing Fish Meal Served With Vitamin C-Rich Drink on Iron Stores and Hemoglobin Concentrations in Ghanaian Schoolchildren in a Malaria Endemic Area. Available from: https://www.researchgate.net/publication/282045286_Impact_of_Cowpea-Based_Food_Containing_Fish_Meal_Served_With_Vitamin_C-Rich_Drink_on_Iron_Stores_and_Hemoglobin_Concentrations_in_Ghanaian_Schoolchildren_in_a_Malaria_Endemic_Area [accessed Sep 12 2018].
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 sensitivity of the 2014 budget statement of Republic of Ghana
(Proceedings of the Nutrition Society, 2015-11) Laar, A.; Aryeetey, R.N.O.; Akparibo, R.; Zotor, F.; The Ghana SUN Academic Platform
Ghana's Constitution and several international treaties she has ratified demonstrate support for fundamental human rights to nutrition and freedom from hunger. However, it is unknown how this support is being translated into investment in nutrition. National budgets are important vehicles through which governments communicate intent to address pertinent national challenges. The present paper assesses the nutrition sensitivity of Ghana's budget statement for the year ending 31 December 2014. We perused the budget in its entirety, examining allocations to various sectors with the goal of identifying support for direct nutrition interventions. We examined allocations to various sectors as per cent of gross domestic product (GDP). The review shows that the total revenue and grants for the 2014 fiscal year is Ghana Cedis (GH¢) 26 001·9 million (25 % of GDP). The total expenditure for the same period is estimated at GH¢34 956·8 million (33·1 % of GDP). The health sector is allocated GH¢3 353 707 814 (3·8 % of GDP). As of 28 October 2014, the Bank of Ghana's Official Exchange Rate was US$1 = GH¢3·20. It is one of the key sectors whose interventions directly or indirectly impact on nutrition. However, the proportion of the national budget that goes to direct nutrition interventions is not evident in the budget. Nutrition is embedded in other budget lines. Allocations to relevant nutrition-sensitive sectors are very low (<0·5 % of GDP). We conclude that Ghana's 2014 budget statement pays scant attention to nutrition. By embedding nutrition in other budget lines, Ghana runs the risk of perpetually rolling out national spending actions insensitive to nutrition