Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: Evidence for policy action from Ghana and Kenya
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Date
2020
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Global Food Security
Abstract
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.
Description
Research Article
Keywords
Eating practices, Unhealthy foods, Food environment