Department of Population, Family and Reproductive Health
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Item The Africa Food Environment Research Network (FERN): from concept to practice(Global Health Promotion, 2022) Tandoh, A.; Aryeetey, R.; Agyemang, C.; 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 initiatives are: 1) building research capacity for innovative food environment research in Africa; 2) improving South-South, and South-North partnerships to stimulate a robust food environment research and monitoring in Africa and 3) sustaining dialogue and focusing priorities on 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.Item Optimism for the UN Proclamation of the Decade of Action on Nutrition: An African Perspective(Global Health: Science and Practice, 2016) Aryeetey, R.On Friday, April 1, 2016, the United Nations (UN) General Assembly proclaimed 2016 to 2025 as a decade of action on nutrition.1 Writing as an African living and working in sub-Saharan Africa, where up to 11% of gross domestic product (GDP) is lost to malnutrition2 and where malnutrition is declining rather too slowly for anyone’s liking, this proclamation captured my attention. Another reason this is significant for me and, I reckon, for many others is that this year also marks the beginning of the Sustainable Development Goals (SDGs),3 which articulate achieving zero hunger and the even more aspirational dream of ending all forms of malnutrition by the year 2030. Later this year in August in Rio de Janeiro, Brazil, the Nutrition for Growth Summit will also bring more attention to efforts to eliminate malnutrition around the world. Considering these and other events con aggregating around such a short duration, it would appear to an outside observer that the world is set for a momentous delivery of something really big for nutrition.Item Community perceptions on the factors in the social food environment that influence dietary behaviour in cities of Kenya and Ghana: A Photovoice study(Public Health Nutrition, 2022) Wanjohi, M.N.; Laar, A.; Aryeteey, R.; et al.Objective To explore communities’ perspectives on the factors in the social food environment that influence dietary behaviours in African cities. Design A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary behaviours. Follow-up in-depth interviews allowed participants to tell the ‘stories’ of their photographs. Thematic analysis was conducted, using data-driven and theory-driven (based on the socio-ecological model) approaches. Setting Three low-income areas of Nairobi (n=48) in Kenya, and Accra (n=62) and Ho (n=32) in Ghana. Participants Adolescents and adults, male and female aged ≥13 years. Results The ‘people’ who were the most commonly reported as influencers of dietary behaviours within the social food environment included family members, friends, health workers and food vendors. They mainly influenced food purchase, preparation and consumption, through 1) considerations for family members’ food preferences, 2) considerations for family members’ health and nutrition needs, 3) social support by family and friends, 4) provision of nutritional advice and modelling food behaviour by parents and health professionals, 5) food vendors’ services and social qualities. Conclusions The family presents an opportunity for promoting healthy dietary behaviours between family members. Peer groups could be harnessed to promote healthy dietary behaviours among adolescents and youth. Empowering food vendors to provide healthier and safer food options could enhance healthier food sourcing, purchasing and consumption in African low-income urban communities.Item Conference on ‘Nutrition dynamics in Africa opportunities and challenges for meeting the sustainable development goals’(Proceedings of the Nutrition Society, 2017) Aryeetey, R.; Colecraft, E.; Holdsworth, M.; et al.Although a substantial amount of nutrition research is conducted in Africa, the research agenda is mainly donor-driven. There is a clear need for a revised research agenda in Africa which is both driven by and responding to local priorities. The present paper summarises the proceedings of a symposium on how evidence can guide decision-makers towards context-appropriate priorities and decisions in nutrition. The paper focuses on lessons learned from case studies by the Evidence Informed Decision Making in Nutrition and Health Network implemented between 2015 and 2016 in Benin, Ghana, and South Africa. Activities within these countries were organised around problem-oriented evidence-informed decision-making (EIDM), capacity strengthening and leadership, and horizontal collaboration. Using a combination of desk-reviews, stakeholder influence-mapping, semi-structured interviews and convening platforms, these country-level studies demonstrated a strong interest in partnership between researchers and decision-makers, and the use of research evidence for prioritization and decision-making in nutrition. Identified capacity gaps were addressed through training workshops on EIDM, systematic reviews, cost-benefit evaluations, and evidence contextualization. Investing in knowledge partnerships and the development of capacity and leadership are key to driving the appropriate use of evidence in nutrition policy and programming in Africa.Item Editorial: The African food environments(Frontiers in Public Health, 2023) Laar, A.; Baye, K.; Zotor, F.; Asiki, G.; Lartey, A.Item INTEREST 2022: new perspectives in HIV treatment, pathogenesis and prevention in Africa(Therapeutic Advances in Infectious Disease, 2023) Baluku, J.B.; Torpey, K.Item Factors influencing dietary behaviours in urban food environments in Africa: a systematic mapping review(Public Health Nutrition, 2020-05-26) Laar, A.; Booth, A.; Mohindra, A.; Wanjohi, M.; Graham, F.; Pradeilles, R.; Cohen, E.; Holdsworth, M.Objective: To identify factors influencing dietary behaviours in urban food environments in Africa and identify areas for future research. Design: We systematically reviewed published/grey literature (protocol CRD4201706893). Findings were compiled into a map using a socio-ecological model on four environmental levels: individual, social, physical and macro. Setting: Urban food environments in Africa. Participants: Studies involving adolescents and adults (11–70 years, male/female). Results: Thirty-nine studies were included (six adolescent, fifteen adolescent/adult combined and eighteen adult). Quantitative methods were most common (twentyeight quantitative, nine qualitative and two mixed methods). Studies were from fifteen African countries. Seventy-seven factors influencing dietary behaviours were identified, with two-thirds at the individual level (45/77). Factors in the social (11/77), physical (12/77) and macro (9/77) environments were investigated less. Individual-level factors that specifically emerged for adolescents included selfesteem, body satisfaction, dieting, spoken language, school attendance, gender, body composition, pubertal development, BMI and fat mass. Studies involving adolescents investigated social environment-level factorsmore, for example, sharing food with friends. The physical food environment was more commonly explored in adults, for example, convenience/availability of food.Macro-level factors associated with dietary behaviours were food/drink advertising, religion and food prices. Factors associated with dietary behaviour were broadly similar for men and women. Conclusions: The dominance of studies exploring individual-level factors suggests a need for research to explore how social, physical and macro-level environments drive dietary behaviours of adolescents and adults in urban Africa. More studies are needed for adolescents and men, and studies widening the geographical scope to encompass all African countriesItem Identifying Models of HIV Care and Treatment Service Delivery in Tanzania, Uganda, and Zambia Using Cluster Analysis and Delphi Survey(BMC Health Services Research, 2017-12) Tsui, S.; Denison, J.A.; Kennedy, C.E.; Chang, L.W.; Koole, O.; Torpey, K.; Van Praag, E.; Farley, J.; Ford, N.; Stuart, L.; Wabwire-Mangen, F.Background: Organization of HIV care and treatment services, including clinic staffing and services, may shape clinical and financial outcomes, yet there has been little attempt to describe different models of HIV care in sub-Saharan Africa (SSA). Information about the relative benefits and drawbacks of different models could inform the scale-up of antiretroviral therapy (ART) and associated services in resource-limited settings (RLS), especially in light of expanded client populations with country adoption of WHO's test and treat recommendation. Methods: We characterized task-shifting/task-sharing practices in 19 diverse ART clinics in Tanzania, Uganda, and Zambia and used cluster analysis to identify unique models of service provision. We ran descriptive statistics to explore how the clusters varied by environmental factors and programmatic characteristics. Finally, we employed the Delphi Method to make systematic use of expert opinions to ensure that the cluster variables were meaningful in the context of actual task-shifting of ART services in SSA. Results: The cluster analysis identified three task-shifting/task-sharing models. The main differences across models were the availability of medical doctors, the scope of clinical responsibility assigned to nurses, and the use of lay health care workers. Patterns of healthcare staffing in HIV service delivery were associated with different environmental factors (e.g., health facility levels, urban vs. rural settings) and programme characteristics (e.g., community ART distribution or integrated tuberculosis treatment on-site). Conclusions: Understanding the relative advantages and disadvantages of different models of care can help national programmes adapt to increased client load, select optimal adherence strategies within decentralized models of care, and identify differentiated models of care for clients to meet the growing needs of long-term ART patients who require more complicated treatment management.Item Bioethics North and South: Creating a common ground(Ethics, Medicine and Public Health, 2018-01) Miles, S.H.; Laar, A.K.Bioethics as practiced in Europe, the United States, and Canada has a tenuous and tentative reach into the developing countries of Africa, South America, and Asia. This paper explores the problematic translation of bioethics between the Global North and South; and between resource rich and resource poor countries. As Alexander Capron put it in 2007, bioethics has a 10/90 problem, analogizing to the observation that medical research spends 90% of its resources on problems affecting 10% of the world's population. Today, UNESCO's bioethics website says bioethics focuses on “stem cell research, genetic testing, cloning, progress in the life sciences”. Any review of the most widely cited bioethics articles and journals finds that the writing is largely centered within an enclave of first world concerns. Stem cells and cloning are neither health care nor health science priorities of developing countries. The priorities of developing countries (i.e., those that would improve the health of populations or that refer to local diseases) are marginalized. Costly and/or impractical medical infrastructure is discussed or proposed. The first-world orientation of bioethics was perhaps somewhat practicable during a post-World War II stasis, but it is increasingly dysfunctional and even dangerous in the context of twenty-first century climate change, refugee movements, and disease vector migrations. A new global bioethics is urgently needed.Item Determinants of condom use by men in extramarital relationships in Nigeria(HIV/AIDS – Research and Palliative Care, 2013-05-23) Ankomah, A.; Adebayo, S.B.; Anyanti, J.; Ladipo, O.; Ekweremadu, B.Background: Extramarital sex is a high-risk behavior in terms of Human Immunodeficiency Virus (HIV) transmission, yet condom use in extramarital relationships is an understudied area in Africa, and Nigeria in particular, where such liaisons are not uncommon. This study highlights key determinants of condom use among men who engage in extramarital sex in Nigeria. Methods: Results are based on a subsample of 642 married men from a combined dataset from three waves of the National HIV/AIDS and Reproductive Health Survey (NARHS), a set of multiround nationally representative surveys. Logistic regression was employed to explore possible determinants of condom use in extramarital sex. The motivation, opportunity, and ability model was applied in selecting the determinants. Results: HIV risk-reduction knowledge was found not to be associated with condom use. At the full logistic regression model, being of the Yoruba tribe, having no misconception about HIV transmission, ability to discuss condom use, and ability to wear condoms were the key variables significantly associated with condom use in extramarital sex. Conclusion: Implementing HIV risk-reduction behavior change requires more than knowledge. Behavioral skills in condom use are critical. Intervention efforts should move away from knowledge about risk to concentrate on improving skills on how to discuss condom use and wear condoms correctly.