https://doi.org/10.18697/ajfand.107.21820 19658 

Afr. J. Food Agric. Nutr. Dev. 2022; 22(2): 19658-19701 https://doi.org/10.18697/ajfand.107.21820 
 

REVIEW OF GHANA’S FOOD ENVIRONMENT: DRIVERS OF 
AVAILABILITY, BARRIERS TO HEALTHY FOOD ACCESS, AND IMPACT 

OF INTERVENTIONS AND POLICIES 
 

Annan RA1, Agyapong NAF2, Apprey C1 and R Aryeetey3* 

 
 

 
Reginald A. Annan 

 
 
 

 
 
 
 
 
 
 
 
 
 
 
*Corresponding author email: raryeetey@ug.edu.gh 
 
1Department of Biochemistry and Biotechnology, College of Science, KNUST 
2Department of Clinical Nutrition and Dietetics, College of Health and Allied Sciences, 
University of Cape Coast 
3School of Public Health, University of Ghana 

  



 

 
 

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ABSTRACT 
 
Food environments exert a significant effect on population dietary choices and health 
outcomes. Policies that influence the food environment, can have a significant impact 
on individual and population dietary choices. This rapid review assessed the nature and 
interaction within the Ghanaian food environment, and the impact that existing school, 
workplace, and national food policies have on dietary intake and nutritional outcomes. 
Online databases and university repositories were searched for relevant articles and 
documents. A total of forty articles and documents were included in the review. 
Majority of the reviewed papers (85%) used a cross-sectional design. The findings 
show that traditional outlets (open markets) constitute the main food source among the 
Ghanaian populace, while convenience stores serve as an important source of processed 
foods. Prepared local foods are often consumed outside the home and are mainly 
sourced from street food vendors. Street foods are perceived as less expensive, 
convenient, and delicious. The food environment was found to influence dietary 
acquisition, intake, and nutritional outcomes. Although most nutrients provided by the 
School Feeding Programme (SFP) are below recommended intake standards, the SFP 
contributes positively to improved diets and nutrition status of school-age children. 
Children attending SFP-implementing schools experience higher intakes of protein, 
iron, zinc, calcium, vitamin A, folate, and have higher haemoglobin, and lower 
prevalence of stunting, underweight, and thinness than children in non-SFP 
implementing schools. Availability of a private room for breastfeeding mothers 
improved breastfeeding frequency. Ghana’s fatty meat restriction policy has reduced 
the availability and sale of fatty meat on the Ghanaian market. Reported drivers and 
barriers to healthy foods consumption include socio-economic factors, media 
information, food storage facilities, cultural perception, fruit seasonality, knowledge on 
the nutrient value of fruits and vegetables, safety profile of fruits and vegetables, and 
contribution of household production to dietary intake. In conclusion, the food 
environment review reveals the drivers of availability, barriers to healthy food access, 
and impact of interventions and policies on the Ghanaian food environment.  
 
Key words: Ghana, Food environment, policies, nutritional impact, health impact 
  



 

 
 

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BACKGROUND 
 
Population health, well-being, and development are linked intimately with the physical 
environments they live, work, play, eat, and interact [1]. The food environment 
constitutes the domain or conditions within which people acquire, prepare and consume 
food. Food environments are important because they significantly influence dietary 
choices beyond intra-personal characteristics such as age, sex, and religion [2]. 
Although its characteristics are complex, consensus exists that there are five 
interrelated components of the food environment: food affordability, availability, 
acceptability, accommodation, and spatial accessibility [3]. Of these, affordability and 
availability are known to have the strongest impact on food choice [4, 5].  
 
Globally, there is concern that the food environment has become predominantly 
unhealthy because of the increasing abundance, access, and consumption of cheap, 
ultra-processed, low nutrient-profile foods, which are widely distributed, aggressively 
advertised, and sold at unusually cheap prices [6, 7]. Simultaneously, there is 
diminishing availability and reduced market share of healthy foods [8], which are 
relatively expensive and inconvenient to access. Obtaining a healthy diet in an 
unhealthy environment is challenging. Ultra-processed foods are those made mostly 
from substances extracted from foods, such as fats, starches, added sugars, and 
hydrogenated fats. Such foods may also contain additives like artificial colors and 
flavors or stabilizers. Examples include frozen meals, soft drinks, hot dogs and cold 
cuts, fast food, packaged cookies, cakes, and salty snacks.  
 
Several interconnected factors have been associated with the changing food 
environment globally. Firstly, modernization, urbanization, economic development, 
and increased wealth are key predictors of shifts in the transition of diets to becoming 
more energy-dense [9]. Rapid unplanned and poorly controlled urbanization can 
increase unemployment, create/enlarge urban slums, and limited availability and 
accessibility to healthy foods [10]. Secondly, global trade liberalization has become an 
important driver of energy-dense foods distribution, increasing foreign direct 
investments in the production, advertisement, and sale of such foods [11, 12, 13]. 
Developing countries mainly bear the adverse effects of such trade practices since they 
currently account for the highest global increases in sales and expansion of such foods 
[14]. 
 
Attention to addressing the food environment as a significant risk factor for poor 
dietary intake and adverse health outcomes is recent [15, 16]. The shift from individual-
level factors, which seek to empower, usually through education, individuals to make 
the right dietary and physical activity decisions, have been necessitated by the 
realization that optimal food selection takes place within a complex and adaptable 
environment [17]. Furthermore, epidemiological studies have demonstrated a strong 
association between proximal environmental characteristics and population disease 
distribution. Again, the growing obesity and diet-related Non-Communicable Diseases 
(NCDs) trend among both adults and children [18, 19, 20], micronutrient deficiencies, 
growth retardation, and stunting are also associated with a poor diet. These have been 



 

 
 

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linked to unhealthy food environments, replete with obesity-causing foods [21, 22, 23]. 
These have called for interventions designed to promote healthy diets to incorporate 
strategies for maintaining a healthy food environment, replete with foods that meet 
both macronutrient and micronutrient needs at a reasonable cost, while limiting the 
availability and accessibility of processed or ultra-processed food [24, 25]  
 
Although food selection involves sub-conscious processes that drive consumers' 
decisions about what to purchase [26], the physical location of food affects dietary 
decision-making. In developed countries, supermarkets can provide a wide variety of 
healthy food options. Thus, their availability or proximity to neighborhoods can lead to 
healthy dietary patterns [27, 28, 29, 30]. Although supermarkets can increase access to 
healthy foods options like fruits and vegetables, they often at the same time stock a 
wide variety of ultra-processed foods that are potentially health-limiting [31]. Another 
important aspect of location is that people may need to travel long distances, out of 
their neighborhoods, to take advantage of lower price offers [32]. In such situations, 
road linkages and travel services such as the availability or non-availability of 
affordable public transport are also important in the food acquisition process [33].  
 
Measurements of food environments are not standardized [34, 35]. Most measures of 
the location used for food environment assessment incorporate geographic information 
systems, shelf space measures, and market basket surveys. Geographic positioning 
systems involve the collection of spatial locations of food outlets in the neighborhood 
using computerized applications. However, perceived food environment reports seem 
more reliable than GIS assessment [34, 36, 37]. Food availability and cost significantly 
influence dietary choice in regulated environments such as schools and workplaces, 
where movements are restricted. Thus, cafeterias, lunch programmes, and policies on 
these services can significantly affect dietary intake and nutritional status [38]. For 
instance, adults can spend about 50% of their waking time at work and, hence, 
consume most of their foods at work [39, 40]. Schools and workplaces are therefore 
important environments for healthy food interventions [41, 42], and nutrition 
interventions in these contexts have improved healthy food selection [43, 44], 
improved nutritional status and a reduction in chronic diseases among adults [45, 46]. 
 
The food systems and environment of developing country settings in Africa are 
predominantly informal. The role of supermarkets in Sub Saharan Africa began 
relatively recently, in the early 1990s, and was mainly limited to southern and northern 
Africa [47]. In Africa, the traditional informal food system of open markets and 
community-based small-scale food vendors continues to serve as a prominent source of 
fresh and staple foods for most population groups [48]. Formal food distribution chains 
may have well-regulated systems that can be targeted by a policy to improve diet 
quality. However, the informal food system is linked to the formal food system and is 
involved in sourcing from the formal system for retail. This explains why access to 
‘unhealthy’ food is common even in countries with strong informal food systems. 
Although Ghana's food environment remains understudied, the traditional informal 
food system supplying fresh and staple foods predominate. Supermarkets are 
expanding fast, and large multinational food corporations have been on the rise in the 



 

 
 

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last one or two decades, resulting in an influx of unhealthy foods [49]. Like in most 
sub-Saharan Africa, Ghana’s increasing prevalence of obesity and related NCDs has 
been partly attributed to the changing food environment. This review synthesizes 
evidence from research published in Ghana to leverage national, home, school, 
workplace, and neighborhood food environment policies and strengthen existing 
policies. 
 
Review questions 
The review sought to answer questions on sources of food purchased by rural and urban 
people, foods commonly consumed outside the home, relationship between 
neighborhoods food retail access, and diet quality, intake and weight status, national 
approaches and policies on food and nutrition, and their impact, and socio-cultural 
barriers and enablers to different population groups achieving healthy diets 
 
Search strategy 
This review included peer-reviewed articles, published documents, students' theses and 
policy papers that were conducted in Ghana or of relevance to Ghana as far back as 
possible and with no date restrictions. Google Scholar, PubMed, Cochrane, science 
direct, and JSTOR databases were searched for appropriate papers. Ghanaian 
University databases and repositories including the Kwame Nkrumah University of 
Ghana, University of Ghana, University of Cape Coast and University for Development 
Studies institutional repositories were also searched to find relevant theses. The Open 
Access Theses Dissertations (OATD) database was also searched to assess full articles 
of relevant students’ theses. The search for papers was done in English with the 
following keywords; Food shopping AND Ghana, Food acquisition AND Ghana, 
Buying food AND Ghana, Food environment and Disease AND Ghana, Food 
environment, diet quality, and disease AND Ghana, Food consumed outside the home 
AND Ghana, Street food consumption AND Ghana, School food environment, 
nutrition, weight ‘AND’ Ghana, School feeding programme, Nutrition ‘AND’ Ghana, 
food policies, nutrition weight, AND Ghana, Workplace food environment food 
consumption AND Ghana, Workplace food policies AND Ghana, Barriers to healthy 
food consumption AND Ghana. Google scholar was searched between 13/03/2020 and 
28/03/2020; Cochrane and PubMed databases were searched on 28/03/2020. JSTOR 
and Science Direct databases were searched on 29/03/2020. University databases were 
searched on 02/04/2020.  
 
Inclusion and exclusion criteria 
This rapid review presents data on Ghana, and includes studies conducted in or of 
relevance to Ghana. All published papers and thesis reports that collected data on the 
food environment in any neighborhood, workplace or school in Ghana, and/or nutrition 
policies in any neighborhood, work or school environment were included in this 
review. Papers that assessed the impact of the food environment on obesity and other 
chronic disease outcomes were also included. Students’ thesis was excluded if 
published peer reviewed journal articles based on the data from the theses were 
available; in such cases, the journal articles were included. 
 



 

 
 

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Evidence synthesis 
Figure 1 shows the regional distribution of studies while figure 2 shows the study 
selection process for this review. Six hundred and eighty-five thousand, seven hundred 
and six (685,706) papers were retrieved online. Out of these, 685, 570 were rejected 
based on their titles, or being duplicates. Of the 136 papers read, 96 papers were 
rejected during abstract screening or were not meeting a priori inclusion criteria. Forty 
documents met the inclusion criteria for this review. Synthesis of papers was done 
based on the frequencies of the study characteristics such as the region in which the 
study was conducted, outcome measures, and major findings. The majority of the 
studies (85.0%) used a cross-sectional design. One used a longitudinal design, and two 
were experimental studies. Most (8) of the studies were conducted in the Greater Accra 
region. Three (3) each were conducted in the Ashanti, and Eastern regions, four in the 
Northern region, four studies were nation-wide ten studies were conducted across two 
or more regions. Central and Volta regions were sites for two multi-region studies, 
while 1 study was conducted in the Brong Ahafo and Western regions. Another study 
also analysed a national policy document [50]. Two studies assessed the food 
environment by measuring food and nutrient provision and types of food outlets 
available in the food environment. A total of 57.9% of the documents assessed dietary 
outcomes using 24-hour recall, food frequency, weighed food record, and dietary 
diversity scores. The most frequently reported nutrition outcome was Body Mass Index 
(BMI) for adults (7.9%) and weight-for-age, height-for-age, weight-for-height, and 
MUAC-for-age for children and adolescents (31.6%). 
 
 
 



 

 
 

 https://doi.org/10.18697/ajfand.107.21820 19664 

 
 
Figure 1: Regional distribution of selected studies 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Two or mor regions=10 studies 
Nationwide=5 studies 
NB: Volta and Central were sites 
for multiregional studies 



 

 
 

 https://doi.org/10.18697/ajfand.107.21820 19665 

 

 
 
Figure 2: Study selection process for the review  
 
Data extraction 
Data extracted from the included studies were author, year of publication, region or 
district in which studies were conducted, sample size, mean, median or age range of 
study participants, methods and data on food environment. Table 1 presents summary 
of details for each paper reviewed.  
 
 
 

 

Records identified through 
database searching 

(n =685,706) 

Records without duplicates 
and with relevant titles  

n=134 

Records screened 
(n =136) 

Studies included in 
systematic review 

(n = 40) 

Records excluded 
(n =96) 

-conducted outside Ghana: 
(n=93) 

-students thesis that had 
papers already published 

from them  
(n=3) 

  

Records excluded due to 
duplicates: (n= 685,523) 
Irrelevant titles: (n=47) 

Id
en

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Sc

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El
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ib
ili

ty
  

Se
le

ct
ed

 



 

 
 

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Quality assessment 
The quality of studies was assessed based on a number of checklists as specified by 
Kmet, Cook and Lee [50]. The checklists consist of fourteen items for quantitative 
studies and items for ten qualitative studies (Tables 2 and 3). Each criterion on the 
checklist had a maximum point of 2 and a minimum of 0.Thus, for quantitative studies, 
the total maximum point was 28, while for qualitative studies, it was 20. For 
quantitative studies, longitudinal research, experimental and case-control studies were 
awarded the highest points, followed by cross-sectional and simple comparative 
studies. Studies with a higher sample size > 500 were awarded two points, while those 
with a smaller sample size were awarded one point. The synthesis and interpretation of 
the study's findings, based on results, were also marked with well explained and 
synthesized results being awarded the highest points. For instance, studies that assessed 
the impact of the school feeding program but did not collect baseline data nor matched 
cases with controls were awarded less points. Where there was randomization, higher 
points were awarded, compared to purposive sampling. Qualitative studies were 
assessed based on the description of the study objective, connection to a theoretical 
framework, and other criteria for quantitative studies. 
 
FINDINGS  
 
Sources of food purchased and consumed by rural and urban people in Ghana  
Of the eight studies that reported on sources of food purchased by Ghanaians [52-60, 
92], most were of average quality. Two studies on shopping outlet choices mentioned 
traditional or open-air markets, mini markets, convenience stores, cold stores, hawkers, 
and bakeries [52, 56]. Of these outlets, traditional markets, convenience stores, 
supermarkets, and hawkers were the most important sources among the lot [52, 56]. 
Traditional or open-air markets serve as the main source of uncooked foods for most 
households, preferred by the majority of households (87%). Almost all (99%) of 
respondents reported purchasing foods from traditional markets regularly in a suburb of 
Accra [52]. In Another survey in Accra, Tarkoradi and Tamale, about 70% of 
households reported purchasing foods from traditional markets at least once a week 
[56]. Traditional markets remain a key source for perishable produce such as fruits, 
vegetables, yam, cassava, plantain, local rice, fish and beef [52, 55, 56]. Processed 
foods, such as corned beef, baked beans, and oil are frequently sourced from traditional 
markets. Purchase frequency from supermarkets ranged between 8.7-62.7% but the 
number of times of purchasing food from a supermarket in a week was lower [52]. 
Supermarkets were a key source of processed foods such as canned vegetables, potato 
chips, sugary drinks, exotic and out-of-season fruits and vegetables [52, 55]. 
Convenience stores provided a wide variety of processed foods and had a higher 
patronage frequency than supermarkets among urban-dwelling households in Accra, 
Tamale and Takoradi [52, 56]. On the other hand, Hawkers were a key source of ready-
to-eat foods, fruits, and vegetables [53, 56]. 
 
Street foods play a significant role in Ghanaian food acquisition, especially among low-
income households [54, 57-60, 78]. Mensah et al. [57] reported that in Kumasi, street 
food consumption frequencies were 21%, 17%, and 10% among low, middle and high 



 

 
 

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income earners. Hiamey et al. [54] reported that among residents of Takoradi, the 
consumption of street foods was perceived as less costly. Other reasons given for the 
consumption of street foods included convenience, good taste, and limited time to 
prepare foods [54, 57]. Street foods play a significant role in the diet of both adults and 
children, for breakfast, lunch and supper, and include all types of meals and snacks. 
Millet porridge, boiled rice and tomato stew, wheat porridge, corn porridge, banku, 
fufu, tuo zaafi, soup, fried rice, fried yam, and soft drinks were frequently consumed 
street foods [54, 58]. About 50-80% of participants in cities consumed street foods, and 
the frequency of consumption ranged from once to twenty-one times a week [54, 58, 
60]. Breakfast and lunch are the most common foods obtained from street food vendors 
[58, 59]. In a study among 2-5year olds in two rural communities in the Central region, 
[58] reported that 75.7% of street foods purchased for the children were complete 
meals and contributed to about 20% of protein, vitamin B12, zinc and more than 50% of 
calcium intakes. Among poor urban adults in Accra, [60] it was reported that street 
food consumption was associated with a higher dietary diversity score. 
 
Foods commonly consumed outside home 
Seven studies, majority of which were of average quality, reported on the type of foods 
consumed outside the home [54, 57, 58, 61-64]. Among school-going adolescents in 
Cape Coast, aged between 13-19 years, foods consumed at school included waakye, 
kenkey with pepper and fried fish, fried rice and chicken. These were consumed by 
42% of them. The rates of consumption of other foods were: carbonated drinks 
(13.0%), canned fruit drinks (11.7%), pastries (16.5%) and ice cream (13.7%) [62].  
 
For children aged 2-5 years, in Central and Brong Ahafo regions, foods consumed 
outside the home included jollof rice, boiled plain rice, waakye, all with tomato sauce, 
grain-based porridges such as corn and millet porridge, kenkey, banku and akple with 
soup or stew, beans and gari, fried yam, doughnut, and fruits [58]. Grain-based 
porridges were the most frequently consumed outside the home. 
 

Among adults aged 30-60 years in Kumasi and Takoradi, about 90% of whom were 
workers, the foods consumed outside the home in order of frequency, reported by the 
two studies, were rice with tomato or beans stew (23.5%), banku with okro or tomato 
stew or grounded pepper (17.5%), fufu or kokonte with palm nut soup or light soup 
(14.4%). Other foods consumed were fried yam, fried plantain, fried rice, and sugar-
sweetened beverages [54, 57]. 
 
Relationship between neighbourhood food retail access, and diet quality, intake, 
and weight status  
Two studies conducted in poor urban areas in Accra reported the relationship between 
neighborhood or community food environment and dietary and nutritional outcomes 
[65, 66]. One was above average quality while the other was average. Findings from 
the two studies indicate that the food environment impacts the dietary acquisition, 
intake, and nutritional outcomes. Typical meals available in the home environment 
were banku /fufu with soup, boiled rice and tomato stew, waakye, fried rice, and jollof 



 

 
 

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rice. Convenience stores available in neighborhoods offered a wide range of processed 
foods [65]. This study did not indicate the level of processing of these foods. Lopéz-
Carra et al. [66] reported that the availability of a traditional market within the 
neighborhood was associated with lower consumption of ultra-processed foods. Among 
persons who dwell in neighborhoods without large food markets, 90% consume 
processed foods; in neighborhoods with large food markets, <30% of respondents 
reported consumption of processed foods [66]. Dake et al. [65] on the other hand, 
reported that each additional out of home-cooked food vendor in the neighborhood was 
associated with a reduction in 0.1kg/m2 BMI while an additional convenience store was 
associated with a 0.2kg/m2 increase in BMI. Fruits and vegetable availability in the 
home environment was, however, not associated with population body mass index.  
 
Availability of national policies and approaches on food and nutrition and their 
impact 
Seventeen studies reported on school-based approaches, school environment, and 
interventions that affect food intake in the school setting and the nutritional status of 
school-aged children [62, 67-82, 83]. Of the sixteen studies, seven reported on the 
effect of school meals (both privately and government-funded Ghana School Feeding 
Program (GSFP). Six studies either compared the GFSP with private feeding programs 
or compared schools that are beneficiaries of the GSFP with non-beneficiaries [67, 71, 
73, 75, 76, 80]. The quality scores for most of these studies were either high or average. 
Overall, results from the studies indicate that school-based dietary interventions, GSFP, 
and other school dietary programmes positively impact the nutritional status of school 
children. Children in schools implementing the GSFP or private school feeding 
programs have higher intakes of protein, iron, zinc, calcium, vitamin A, folate, higher 
haemoglobin and lower prevalence of stunting, underweight, and thinness compared to 
non-participants [67, 75]). Specifically, among rural children in the Northern region of 
Ghana, [67] reported that intake of protein (68g vs 54g), zinc (13.1mg vs 8.6mg), 
calcium (399mg vs 281mg), vitamin A (493µg vs 134.0µg), folate (245.8µg vs 134.0 
µg), and vitamin C (47.1mg vs 8.6 mg) were higher among children exposed to school 
feeding of any kind. Haemoglobin concentration was also higher for children exposed 
to school feeding (103±15g/l) compared to those not exposed to school feeding 
(97±18g/l) (p<0.001). In Abizari et al.’s[67] study, 90% of the daily vitamin A and 
vitamin C intakes were provided via the school lunch program.  
 
There were inconsistent findings regarding the association between school meals and 
nutritional status. Kwabla et al. [75] reported that, in the Eastern region, there was a 
higher prevalence of stunting among children not exposed to school feeding (17.2% vs 
16.2%) but the difference was not statistically significant. In a longitudinal study 
conducted across all the ten regions in Ghana, Gelli et al. [71] reported that the GSFP 
positively impacted the height-for-age z-scores of girls and participants in the lower 
age brackets (5-8 years). In contrast, among school children in the Volta region, Laar & 
Kubi [77] found that the prevalence of stunting and thinness were higher among 
children benefiting from the GSFP; non-beneficiaries of the GSFP had a 38.3 less 
likelihood of stunting compared to beneficiaries. Still in the Volta region, there were no 



 

 
 

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observed difference in stunting, underweight, thinness and overweight among children 
benefiting from the GSFP and non-beneficiaries [76].  
 
Seven studies provided details on types of food provided by school meals and three 
further reported the nutritional content of the foods [67-69, 73, 80, 82, 83]. The GSFP 
and private school feeding programs provided staple Ghanaian dishes such as banku 
and okro stew, rice and tomato sauce, waakye, tuo zaafi, and vegetable soup, gari and 
beans, banku and groundnut soup [67, 69, 73, 82, 80]. Three studies reported that 
nutrients provided by school meals in the Central, Upper West, Northern and Volta 
regions were less than one-third of the Recommended Nutrient Intakes (RNI) which is 
supposed to be met by the school feeding program [67, 68]. This was the case for both 
private school meals and meals provided by GSFP. However, private school meals had 
a higher nutrient profile [67, 68, 69, 80]. In a comparative cross-sectional study in the 
Volta region, Agbozo et al. [68] reported that all nutrients provided by the school meal 
were below recommendations, except for fat, vitamin A, and vitamin C. Calcium 
(62±18mg), magnesium (6.7±3.8mg) and potassium (31.25±15.8mg) provided via the 
school meals were extremely low. Fish was the most frequent animal protein, and the 
meals completely lacked dairy products [68, 73]. 
 
Two studies reported evidence of the impact of the school environment on the 
consumption pattern of pupils [62, 84]. Results from the two studies indicated that the 
school environment either supports unhealthy food consumption or makes it difficult to 
obtain healthy foods. Buxton [62] for instance, documented that among adolescent 
students in Cape Coast, a high proportion bought canned drinks (24.7%), pastries 
(16.7%) and ice cream (13.7%) in school during break time from food vendors. On the 
other hand, students in the Eastern region reported that options of foods available in the 
school are limited but they are not allowed to go out to purchase other foods [84].  
 
One study reported on national policy on fatty meat restriction [50]. The policy 
specifies acceptable fat content for different types of animal flesh, either produced 
domestically or exported into the country. For instance, deboned pork, mutton, and beef 
are required to contain up to 25% of fat while dressed poultry is required to contain up 
to 15% of fat. Thow and colleagues [49] reported that the implementation of the Ghana 
fatty meat policy which took effect in the early 1990s reduced the importation, 
availability, and sale of fatty meat on the Ghanaian market. This was most evident for 
turkey tails. However, nutritionists interviewed indicated that the policy has not 
impacted fatty meat consumption as turkey tails have been replaced by processed meat 
such as sausages and fried pork [78]. No study reported evidence of policies or the 
impact of the workplace food environment on consumption or nutritional outcomes. 
 
One study reported on the impact of the work environment on breastfeeding [74]. They 
found that, among lactating mothers who work in educational and health settings in 
Tamale, availability of private room for breastfeeding and refrigerator for storage of 
baby foods was associated with higher frequency of breastfeeding.  
 
 



 

 
 

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Socio-cultural barriers and enablers to different population groups achieving 
healthy diets 
Barriers to obtaining a healthy diet were reported by nine studies [53, 85-91]. The 
reported barriers and enablers included socio-economic factors, information from 
media, lack of storage facilities, cultural perception, fruit seasonality, lack of 
knowledge on the nutrient value of fruits and vegetables, concerns about possible 
contaminants in fruits and vegetables and limited own farm production. Among these 
factors, household socio-economic status determined by income levels, education level, 
marital status, number and characteristics of household members was the most reported 
barrier to the acquisition of healthy foods [53, 84-86, 89, 90]. For direct income 
measures, Florkowski et al. [53] and Amfo et al. [85], reported that low-income groups 
in the Greater Accra, Northern and Western regions spent a higher proportion of their 
income on vegetable purchases and had higher consumption levels compared to high-
income households. Contrarily, high-income households were associated with higher 
consumption of fruits [53]. Meng et al. [89] also found that in Accra and Tamale, fruit, 
vegetable and peanut purchase was associated with high income after controlling for 
location. Annan et al. [86] also reported that price was a major determinant of meat 
choice in the Ashanti region, regardless of health knowledge. Although individuals 
perceived domestic chicken as healthier, they purchased imported chicken because it 
was cheaper. 
 
Own farm production enabled households in the Northern region to meet about 50% of 
their grain needs, 60% of their groundnut needs, and 62% of their micronutrient needs 
[87, 88]. Crop diversity had a direct bearing on household dietary diversity; households 
with limited numbers of crops grown on their farms consumed less diverse diets [88]. 
 
In assessing barriers to adequate consumption of vitamin A and iron in the Ashanti and 
Brong Ahafo regions, Omari et al. [90] documented that lack of electricity and storage 
facilities were hindrances to the purchase and consumption of fish and meat. They 
further indicated that culturally, fruits were not perceived as part of main meals, and the 
population was not accustomed to consuming fruits regularly. Study participants (84%) 
further indicated that conflicting media reports on the health effect of consuming meat, 
served as a deterrent to their consumption. 
 
A conceptual framework used to summarise the review findings is presented in Figure 
3. 
 



 

 
 

 https://doi.org/10.18697/ajfand.107.21820 19671 

 
Figure 3: Conceptual framework of Ghana’s food environment review findings 
 
DISCUSSION  
 
This systematic review reveals Ghana’s food environment and provides evidence to 
leverage national, home, school, workplace, and neighborhood food environment 
policies and to serve as a basis for strengthening existing policies. Food-based dietary 
guidelines should consider issues around food availability and access as indicators of 
the ability of the population to follow the guidelines. This is why evidence on the 
nature of the food environment is a prerequisite for developing such guidelines. 
Characterizing the food environment is complex but comprises 3 main domains: 
physical, social, and person-oriented food environments, and these have several sub-
domains and measures. To fully understand the food environment requires all three 
dimensions. The physical food environment domain measures the numbers, location, 
density, and proximity of food venues in defined geographical areas, food availability 
and access in the home, and school, work places and institutions. The social food 
environment measures the nature, levels and extent of available support to enable 
people make healthy food choices, including instrumental or tangible support, 
encouragement or reinforcement, food choices and eating behaviours of family 
members that can serve as role models, price promotions, and school, work, and 
institution-based policies. The person-oriented domain assesses the perception of the 
physical and social environment, measuring perceptions of availability, access, 
affordability of price, acceptability of the product, and cultural appropriateness and 



 

 
 

 https://doi.org/10.18697/ajfand.107.21820 19672 

inclusiveness. It also measures perceived social norms, type and level of social support 
and perceptions of policies, practices or rules that impact behaviour. 
 
From the studies reviewed, Ghanaians buy both cooked and uncooked food from 
various sources, including traditional or open-air markets, mini markets, convenience 
stores, cold stores, hawkers or street food vendors, and bakeries. Traditional open-air 
markets are the key suppliers of fresh food, including fruits and vegetables, while 
convenient shops, rather than large supermarkets, drive the retail of most processed 
foods in both urban and rural areas, contrary to observations in more developed 
countries. They have a higher frequency of purchase completely outnumbering large 
supermarkets, which only started springing up in urban areas of the country in the past 
decade. Therefore, although large supermarkets or food giants are few in Ghana, 
unhealthy processed or ultra-processed obesogenic foods are commonly available and 
accessible through these numerous convenient stores. This means that to improve the 
healthfulness of food supply in Ghana, interventions should target the wide range of 
supply outlets recorded, but with special emphasis on convenient stores to curb the 
supply and promotion of processed food, while strengthening traditional open-air 
markets to continue supplying safe and fresh fruits and vegetables. 
 
The review reveals that buying and consuming, for all meal times, local Ghanaian 
dishes from hawkers and table top vendors (street foods) contribute significantly to 
cooked food purchased for consumption by Ghanaian adults and children alike, 
especially among low income households. Quick fried foods such as fried yam, 
plantain, sweet potatoes, and sugar-sweetened beverages are also frequently consumed 
street foods. Poor knowledge, attitude and hygiene practices have been reported among 
street food vendors across Africa [93]. Poor practices of street food vendors include 
discarding waste water and garbage nearby, which provide nutrients for insects and 
other pathogens and increase contamination and disease risk [93, 94]. Bacteriological 
contamination of street foods was reported among street vendors in Trinidad, and poor 
microbial quality and contamination of street foods have been reported across Africa 
[95, 96]. Street foods are also expected to have lower nutrient quality, but higher in 
salt, sugar, oil, and additional undesirable substances like food additives [97, 98]. In 
this review, to the contrary, a study reported that street foods contributed to about 20% 
of protein, vitamin B12, zinc and greater than 50% of calcium intakes among 2-5-year-
old children in the Central Region, and a higher dietary diversity among poor urban 
dwellers in Accra. Street food consumers in the reviewed studies reported ‘low cost’, 
and to a smaller extent, good taste and convenience as reasons for consumption. This 
lower cost may be due to sub-quality used, and the excess sugar, salt and oil added may 
make such foods tastier. According to this review, street foods are more likely to be 
patronised by the urban poor just as observed in other countries. This implies that the 
poor are more able to afford and so have access to the less healthy street food, and may 
also explain why diet-related NCDs are more common among poorer urban dwellers. 
With the reported contribution of street food to nutrient intake in children, and dietary 
diversity, and still the safety concerns and excessive unhealthy commodities like salt, 
sugar and oil concerns, Ghana’s street food environment should be given closer 
attention for it to serve the good purpose, while limiting any possible adversities. 



 

 
 

 https://doi.org/10.18697/ajfand.107.21820 19673 

 
That the food environment affects dietary decision making is commonly reported by 
studies in developed and LMICs. Poor food environment is associated with poorer food 
choices and intake and likewise, improvements in the food environment have led to 
improved dietary decision making, purchase, consumption and nutrition outcomes [98]. 
Two studies reported that the food environment impacted dietary acquisition, food 
choice, dietary intake, and nutritional outcomes in this review. Availability of a 
traditional market within a neighbourhood led to <30% consumption of ultra-processed 
food compared with 90% where there are many convenience stores and no traditional 
markets. They also showed that an additional street vendor reduced BMI by 0.1kg/m2 
compared with an increase in BMI by 0.2kg/m2 with an additional convenience store. 
Of the policies that targeted the food environment, implementation of national policy 
on fatty meat standards led to reduced importation, availability, and sale of fatty meat 
on the Ghanaian market. Breastfeeding policy at a work environment that made 
available a private room for breastfeeding and refrigerator for storing baby foods was 
associated with a higher frequency of breastfeeding. Moreover, school feeding 
programmes improved the nutritional status of pupils with lower nutritional 
requirements. Our findings, therefore, strengthen the available evidence, and further 
support calls for formulation of policies, and enforcement of available ones.  
 
In this review, the perceived socio-ecological barriers among Ghanaians to achieving 
healthy diets are information from media, lack of storage facilities, cultural perception, 
fruit seasonality, lack of knowledge on the nutrient value of fruits and vegetables, 
concerns about possible contaminants in fruits and vegetables and limited own farm 
production. The socio-economic barriers reported are income levels, education, marital 
status and household characteristics. This means that while the physical domain needs 
attention, the person-oriented domain should not be left out, whether these perceptions 
are real or apparent. These may require social behaviour change interventions. 
 
Study limitations 
This review has limitations. The reviewed papers do not address all the domains and 
subdomains and their interrelationship, but aspects of the physical and person-oriented 
environment, indicating the need for further studies to characterize Ghana’s food 
environment better. The review only included published works and students’ thesis, 
and may have missed data that exist on the other measures of the food environment. 
There is no nationally representative study on Ghana’s food environment, as most of 
the studies were limited to specific regions. Few studies assessed the impact of school 
meals on children’s nutritional status, and limited work exists on the impact of home 
and work food environment, neighborhood food environment, food marketing and 
advertising. The available data do not allow the calculation of the Food Environment 
Index, a scale of 0 (worst) to 10 (best), which weighs two indicators of the food 
environment: access to healthy foods and food insecurity.  
 
  



 

 
 

 https://doi.org/10.18697/ajfand.107.21820 19674 

CONCLUSION  
 
Ghana's existing physical food environment is driven by a wide range of food outlets, 
predominantly traditional open markets, convenience stores, and street food vendors. 
Ghanaians purchase food commodities from these sources, and low-income urban 
households regularly consume cooked food from street vendors. Convenience stores 
drive the availability and access to processed foods, and large supermarkets in urban 
areas are springing up. Outside the home, in schools and at work, traditional Ghanaian 
foods are commonly consumed and so are Sugar-Sweetened Beverages and other 
‘unhealthy foods’. Neighboring food access is associated with dietary intake and 
aspects of nutritional status, while policies on the food environment impact food 
availability and access, giving a strong argument for formulation and enforcement of 
policies that enhance the healthfulness of the food environment. Key socio-cultural and 
economic barriers for achieving healthy diets were identified. These should be 
considered in the development of the food-based dietary guidelines. 
 
 



  
 

 https://doi.org/10.18697/ajfand.107.21820 19675 

Table 1: Summary of Findings Table for Ghana’s food environment systematic review 

Study title Author Sam
ple 
size 

Study 
site 

Mean 
age if 
report
ed 

Study design Main 
study 
methods 

Major findings  Quality 
assessm
ent 

QA 

1. A School Meals 
Program 
Implemented at Scale 
in Ghana Increases 
Height-for-Age 
during Mid 
childhood in Girls 
and in Children from 
Poor Households: A 
Cluster Randomized 
Trial 

Gelli et 
al. [71]  

 
2626 

All ten 
regions 

5-
15yrs 

Longitudinal 
cluster 
randomized 
control trial 

Height 
for age, 
bmi for 
age, 
question
naire 

School feeding exertes no effect on HAZ and 
BMI for age. School feeding increases HAZ by 
0.12SD in children 5-8yrs but not in those 5-
15yrs. School feeding increased HAZ in girls by 
0.11 SDs, and BAZ only in boys aged 5-8y by 
0.19 SDs. In boys aged 9-15yrs, school feeding 
reduced HAZ by 0.2 SDs (p=0.047). 

22/28 9 

2. Nutritional quality of 
meals served under 
the Ghana school 
feeding programme 
at the Upper West 
and Central Region 
of Ghana 

Bigson 
et al. 
[69]  

Two 
town
s 
(720
) 
resp
onde
nts 

Upper 
West 
and 
Central 
Region 
(Wa 
and 
Cape 
Coast)  

Not 
report
ed 

Cross 
sectional, 
weights of 
food 
measured for 
5 days, 
questionnaire 

- Meals served under the school feeding 
programme included Rice and beans with tomato 
stew or groundnut soup Rice with tomato stew, 
Tuo Zaafi with green vegetable soup or dry okro 
soup Banku with okro soup or groundnut soup, 
Gari and beans Gari and beans, Banku and 
groundnut soup Gari with palava sauce or tomato 
stew, Jollof rice Rice and beans with tomato 
stew. Most nutrients in the foods did not meet the 
RDI. Fish was the commonly used source of 

16/22 7 



  
 

 https://doi.org/10.18697/ajfand.107.21820 19676 

animal protein and beans the commonly used 
plant protein.  

3. School feeding 
contributes to 
micronutrient 
adequacy of 
Ghanaian 
schoolchildren 

Abizari, 
et 
al.[67] 

4 
scho
ols 
(383 
stud
ents 
in 
all) 

Norther
n region 

5-
13yrs 

Cross 
sectional 
study 

Iron, 
status, 
weight, 
height, 
24hr 
recall, 
weight 
food 
records, 
Hb, 
HHS, 
question
naire 

The school foods were prepared with these food 
items: jollof rice (rice cooked in tomato sauce); 
waakye (rice and cowpeas cooked together and 
served with tomato sauce); gari and beans 
(roasted cassava grits and boiled cowpeas usually 
served with palm oil); tuo zaafi . Home intake 
was slightly higher among non-school fed pupils 
for protein (P¼0·041), Fe (P¼0·011), Zn 
(P¼0·005) and vitamin A (p=<0.005. For 
vitamins A and C, however, .90% of the daily 
intake was contributed by the school lunch. SFP 
participants had 6g/l higher Hb concentration 
than non-SFP participants (P,0·001). 

16/22 8 

4. Ghanaian Junior 
High School 
Adolescents Dietary 
Practices and Food 
Preferences: 
Implications for 
Public Health 
Concern 

 Buxton, 
C. 
N.[62] 

820 Central 
region 
(Cape 
Coast) 

13-19 
(mean 
not 
report
ed 

Cross 
sectional 

Questio
nnaire 

Of students who usually bought a snack or food 
at school, 41.7 bought cooked food such as 
waakye kenkey, fried fish, fried rice and fried 
chicken. 16.5% bought pastries; (13.7%), ice 
cream; 13.0%, soft drinks; and 11.7%, 
canned/packaged fruit juice. About a third 
(35.0%) of them preferred a soft drink for snack. 
Others 25.4% preferred an ice cream, 21.6%, 
pastries, and 14.5%, a type of fruit. Majority 
(52.9%) of the respondents indicated that they 
drank soft drinks most often at school.  

14/22 7 

5. Nutrition intakes and 
nutritional status of 

Owusu 
et 
al.[80] 

364 Greater 
Accra 

41±11
yrs for 
caregi

Cross 
sectional 

Anthrop
ometry, 
dietary 

Compared to children in the Ghana School 
Feeding Program (GSFP), children in the private 
school feeding program (NSFP) had significantly 

16/22 7 



  
 

 https://doi.org/10.18697/ajfand.107.21820 19677 

school age children 
in Ghana 

vers, 
10±2y
rs for 
childr
en 

intake 
assessm
ent, 
haemogl
obin 
levels, 
question
naire, 
weigh 
food 
record 

higher intakes of energy (2413 ± 626 kcal vs. 
1988 ± 627 kcal; P<0.001), protein (63 ± 17 g vs. 
53 ± 19 g; P<0.001) and zinc (10 ± 3 mg vs. 9 ± 
3 mg; P=0.004). Other micronutrients were 
similar in both groups. GSFP meals contributed 
12% to 18.1% of the total energy and nutrient 
intakes of the children; whereas, NSFP meals 
contributed from 17% up to 30% of the total 
energy and nutrient intakes of the children. 

6. A pilot study to 
determine the 
efficacy of 
consuming a highly 
Fortified groundnut 
nutritional 
supplement on the 
nutritional Status of 
school children 

Steiner 
Asiedu 
and 
Salia 
[81] 

Eigh
t 
publi
c 
scho
ols 
(901
) 
pupil
s 

Ashanti 
and 
Norther
n 
Region 
 

10.70
±1.97 
years 
for 
pupils 
and 
40.72
±10.4
1years 
for 
caregi
vers. 

Quasi 
experimental 
design with 
fortified 
groundnut-
based snack 

Hb 
status, 
height 
for age, 
bmi for 
age, 
dietary 
assessm
ent, 
question
naire 

The mean weight and height for the male 
participants in the intervention group improved 
significantly after the study weight 
(26.31±4.74kg to 28.53±5.51kg) and height 
(133.63±9.13cm to 137.70±9.74). A significant 
increase was observed in the mean haemoglobin 
concentration of all participants in the 
intervention group; males; 13.36±1.67g/dl to 
14.31±1.71g/dl, females; (13.87±1.88g/dl to 
14.34±1.63g/dl). 

16/22 8 

7. Nutritional Status of 
Pupils Attending 
Public Schools with 
and without School 
Feeding Programme 

Agbozo 
et al. 
[76, 68] 

417 
pupil
s, 14 
prim
ary 

Volta 
region,  
Hohoe 
district 

3-12 
years 

Cross 
sectional 
survey 

Weight, 
height, 
MUAC, 
Questio
nnaire, 
weight 

Differences in underweight, stunting, thinness 
and overweight observed were not significantly 
different among pupils attending schools with the 
Government School Feeding Program (GSFP) 
and those without GSFP. Pupils attending 
schools without the feeding programme were 

14/22 7 



  
 

 https://doi.org/10.18697/ajfand.107.21820 19678 

in Hohoe 
Municipality, Ghana 
Nutrient composition 
and dietary diversity 
of on-site lunch 
meals, and 
anthropometry of 
beneficiary children 
in private and public 
primary schools in 
Ghana 

scho
ols 

for age, 
height 
for age, 
BMI for 
age, 
MUAC- 
for age  

found to have significantly higher height-for-age 
mean z-scores (-0.28±1.2) compared to those 
attending schools with the feeding programme (-
0.64±1.0), p= 0.0057. Enrolment in schools 
implementing the Ghana school feeding 
programme did not significantly reduce 
underweight, stunting, thinness and overweight. 
Dairy products, eggs and meat were totally 
missing from the menus while very little fish was 
used. The meals were often eaten with tomato 
stew. The were no statistical differences in the 
nutrients provided by the lunch of private and 
public schools. 

8. Comparative study of 
the nutritional status 
of school aged 
children enrolled on 
the ghana school 
feeding programme: 
a case of kwabre east 
and the tolon districts 
of ghana 

Taricone 
[82] 

300 
pupil
s 

Ashanti 
and 
Norther
n 
Regions
, 
Kwabre 
East, 
Tolon 
districts 

6-
12yrs 
(Mean 
9.9 ± 
1.7) 

Comparative 
Cross 
sectional 

Height 
for age, 
weight 
for age, 
BMI for 
age, HB, 
24-hour 
recall, 
FFQ, 
weighed 
food 
intake, 
question
naire 

The prevalence of stunting among the children 
was higher in the Tolon district (15.3%) than in 
the Kwabre East district (6%). Prevalence of 
anaemia was significantly higher in Tolon than 
Kwabre 20.5% vs. 7.3%; p=0.001. The rate of 
thinness was significantly higher in Kwabre East 
than the Tolon district in the study children 
(21.3% vs. 10%; p=0.026). Having a low dietary 
diversity score was significantly associated with 
being undernourished in both districts.  

12/22 6 



  
 

 https://doi.org/10.18697/ajfand.107.21820 19679 

9. Assessment of the 
school feeding 
programme in 
Ghana: A study of 
primary schools in 
the Abura-Asebu-
Kwamankese district 
in the Central region 
of Ghana 

Nyarko, 
n.d [79] 

Five 
prim
ary 
scho
ols 

Central 
region, 
Abura 
Asebu 
Kwama
nkese  
 

Not 
report
ed 

Cross 
sectional 

Questio
nnaire,  

Teachers of pupils responded to a likert scale on 
the impact of school feeding program (SFP) on 
children. Most agreed that the SFP has had a 
positive impact on the childrens’ nutritional 
status.  

10/20 5 

10. Participation In 
Communal Day Care 
Centre Feeding 
Programs Is 
Associated With 
Higher Diet Quantity 
But Not Quality 
Among Rural 
Ghanaian Children  

 

Harding
[73] 

193 Brong 
Ahafo 
Region, 
Two 
commu
nities in 
Techim
an 

2-5 
years 

Cross 
sectional 

Intervie
ws 
Questio
nnaires, 
dietary 
assessm
ent, 
weighed 
food 
record, 
24-hour 
recall, 
DDS, 
HB 

Children in the communal school feeding 
programme group tended to be heavier than non-
participants (Table 2). The non-DCC group had 
almost 20% more children with anaemia, but 
there was no significant group difference in 
mean haemoglobin levels. Foods served were 
gari (ground dried cassava) and cowpea stew 
with red palm oil; jollof rice (rice cooked in a 
sauce made from tomato, chili pepper, onion and 
red palm oil); and boiled yam and kontomire 
(cocoyam leaves) stew prepared with red palm 
oil, ground groundnut, onion and chili pepper. 
The only Animal Source Food (ASF) included in 
the lunches was fish powder. 

14/22 6 

11. Evaluation of 
alternative school 
feeding models on 
nutrition, education, 
agriculture and other 
social outcomes in 

Gelli et 
al. [72] 

8407 All ten 
regions 

2-
15yrs 
 

Randomised 
design. 

Random
ized 
allocatio
n of 
children 
to 

For children aged 5–15 yrs, the mean z-scores 
for the anthropometrics measures of height for 
age and BMI for age were −0.925 (SD 1.35) and 
−0.592 (SD 0.924). Haemoglobin levels, for the 
sub-sample (n=714) was 11.3 g/dL (SD 1.34). 

16/22 8 



  
 

 https://doi.org/10.18697/ajfand.107.21820 19680 

Ghana: rationale, 
randomised design 
and baseline data 

groups, 
anthropo
metry, 
HB, 
question
naire 

12. Nutritional status of 
in-school children 
and its associated 
factors in 
Denkyembour 
District, eastern 
region, Ghana: 
comparing schools 
with feeding and 
non-school feeding 
policies 

Kwabla 
et al. 
[75] 

359 Eastern 
Region, 
2 public 
schools 
in 
Dekye
mbour 
District 

5-12 
years 

Cross 
sectional 

Questio
nnaire, 
anthros, 
height 
for age, 
BMI for 
age 

Prevalence of stunting was higher in schools 
without the school feeding programme 17.2% vrs 
16.2%. The prevalence of thinness was about 
twice higher (9.3%) in children with the school 
feeding programme. 1.9% of children in schools 
with the feeding programme were found to be 
overweight.  

12/22 6 

13. Nutritional status of 
school-age children 
in the Nkwanta South 
District - volta region 
of Ghana  

  
 

Laar et 
al. [77] 

650 Volta 
region, 
Nkwant
a South 

10-19 
years 

Cross 
sectional 

Questio
nnaire, 
anthropo
metry, 
HAZ, 
BAZ 

Prevalence of stunting and thinness was higher 
among children in schools on the feeding 
programme, while overweight was higher among 
children in schools not on the feeding 
programme. Feeding programme was 
significantly associated with stunting. If 
compared, the prevalence of overweight was 
higher among children in non-feeding schools 
(7.3%) than those in feeding schools (6.0%).  

12/22 6 

14. Consumer’s Food 
Shopping Choice in 
Ghana: Supermarket 

 
Meng et 
al. [56] 

1,01
0 

Norther
n, 
Western

39.2 
years 

Cross 
sectional 

Questio
nnaire, 
Househo

7.3% report shopping for food at supermarkets 
“more than once a week,” 9.8 % “once a week,” 
8.4 % “every other week,” 25.0 % “once a 

16/22 8 



  
 

 https://doi.org/10.18697/ajfand.107.21820 19681 

or Traditional 
Outlets? 

, and 
Greater 
Accra 
Tamale, 
Takorad
i, Accra  

ld 
survey 

month. 70 % of responding urban households 
report shopping at least once a week in open-air 
markets Convenience foods and some food 
snacks sold by hawkers are more likely to be 
purchased by households of a lower socio-
economic status. 17% of households purchased 
food in supermarkets at least weekly. 

15. Agricultural 
transformation and 
food and nutrition 
security in Ghana: 
Does farm 
production diversity 
(still) matter for 
household dietary 
diversity?  

Ecker, 
[88] 

11, 
217 

Nation
wide 

Not 
report
ed 

Cross 
sectional  

Nationw
ide 
survey 

Farm production diversification is positively 
associated with household dietary diversity. The 
regressions for the pooled sample show that 
cultivating one additional crop group increases 
the number of consumed food groups by 0.111. 

16/22  
 
 
8 

16. Street foods 
contribute to nutrient 
intakes among 
children from rural 
communities in 
Winneba and 
Techiman 
municipalities, 
Ghana  
 

Micah, 
[58] 

172 Central 
and 
Brong 
Ahafo, 
(Winne
ba and 
Techim
an) 

2-5 
years 
35±1.
2 for 
caregi
vers 
 

cross 
sectional 

Questio
nnaire, 
FFQ, 
weighed 
food 
record 

80% of caregivers in the two study areas had 
purchased street foods for their children at least 
once in the previous seven days. Porridges made 
from rice, millet, maize, or wheat were the most 
commonly purchased street foods. The majority 
of street foods (75.7%) were consumed by 
children as complete meals. Most of the 
caregivers purchased street foods for their 
children in the morning (75%); and evening 
(3.0%). Street foods contributed 35.7% to 
Animal Source Food (ASF) consumed by 
children in the Techiman communities and 4.2% 
in the Winneba area (P<0.01).  

12/22 6 



  
 

 https://doi.org/10.18697/ajfand.107.21820 19682 

17. Food retail 
assessment and 
family food purchase 
behavior in 
Ashongman Estates, 
Ghana 

Aryeete
y et 
al.[52] 

94, 
19 
food 
vend
ors 
and 
75 
Hou
seho
lds 

Accra, 
Ashong
man 

Not 
report
ed 

Cross-
sectional, 
Household 
survey,  

Questio
nnaire,  

Only five of the 13 supermarkets identified 
offered fresh produce. 98.7% of respondents buy 
from traditional outlets. More than two-thirds of 
respondents purchased weekly from traditional 
outlets (71%). 65% purchased food from 
supermarkets once or twice a month. The 
traditional market is the main source of staple 
foods. Households purchased from outlets that 
are close to them. 

14/22 7 

18. Are we indeed what 
we eat? Street food 
consumption in the 
Market Circle area of 
Takoradi, Ghana 

Hiamey 
et al. 
[54] 

220 Western 
region, 
Sekondi 
Takorad
i 
 

35-55 
years 

Cross 
sectional 
 

Income, 
Questio
nnaire 

Street foods eaten included rice with tomato stew 
or bean stew 23.5% Banku/stew with tomato 
stew, okro stew or pepper sauce 17.5% Fufu or 
kokonte with light soup or palm fruit soup 
14.4%. Carbohydrate staples were most 
purchased. Males consumed street foods 8 times 
a week while females consumed it 6 times a 
week. Street food consumption was higher for 
low income earners.  

14/22 7 

19. Urban Household 
Characteristics and  
Implications for Food 
Utilization in Accra 

David 
Okutu, 
[60] 

452 Accra 20-
50+ye
ars 

Cross 
sectional 

Questio
nnaire, 
seven- 
day 
recall 

Out of home foods contribute a greater 
proportion of dietary diversity. 53.4% of the 
households consumed foods prepared outside the 
home, and 46.6% consumed foods prepared at 
home. 13.4% of households depend on their 
harvests from fishing and farming. Foods eaten 
outside the home were associated with higher 
DDS. 

12/22 6
  



  
 

 https://doi.org/10.18697/ajfand.107.21820 19683 

20. Household dietary 
practices and family 
nutritional status in 
rural Ghana 

Nti, 
2008 
[59] 

400 
wom
en 

Eastern 
Region, 
Manya 
Krobo 
 

28.3ye
ars 

Cross 
sectional 

Questio
nnaire, 
anthropo
metry, 
dietary 
data,24- 
hour 
recall, 
FFQ, 
Weight, 
height, 
BMI 

Breakfast and lunch were the two main cooked 
meals usually purchased from food vendors, with 
supper being the least purchased outside the 
home. About 13% of the households always 
cooked their meals at home and never purchased 
food from food vendors. 

12/22 6 

21. Food and nutrient 
gaps in rural 
Northern Ghana: 
Does production of 
smallholder farming 
households support 
adoption of food-
based dietary 
guidelines? 

de Jager 
et al. 
[87] 

329 
Hou
seho
lds  

Norther
n 
Region, 
Karaga 

11.6(8
.2) 
month
s for 
child 
in the 
house
holds 

cross-
sectional 

Weight 
for age, 
length 
for age, 
BMI-
for-age, 
weight 
for 
height, 
question
naire, 
24- hour 
recall, 
dietary 
diversity 
score 

Households cultivated 5 hectares of land with 
four different crops. Most households produced 
grains (97%) and legumes, nuts and seeds (84%) 
but only 8% of households produced vegetables. 
Own food production allowed about 60% of 
households to cover their needs for maize and 
groundnut, less than 40% for rice and sorghum, 
and less than 5% for cowpea. 62% of the total 
quantity of micronutrients required by 
households was met by their production. 

12/22  



  
 

 https://doi.org/10.18697/ajfand.107.21820 19684 

22. Mapping Obesogenic 
Food Environments 
in South Africa and 
Ghana: Correlations 
and Contradictions 

Kroll et 
al. [55] 

309 
Hou
seho
lds 

Ashanti 
region, 
Kumasi 

Not 
report
ed 

Cross 
sectional 

FFQ, 
GPS of 
food 
outlets, 
question
naire 

One quarter of households consumed diets high 
in obesogenic foods, and only 23% consuming 
high amounts and varieties of protective food. 
Small shops play a greater role in providing 
access to the key foods. Stalls typically located 
in traditional markets served as sources for 
vegetables, fruits, legumes and fish while formal 
outlets were sources of sugary drinks. Informal 
stores were sources of bread, confectionery and 
sugar.  

14/22 7 

23. Analysis of Street 
Food Consumption 
Across Various 
Income Groups in the 
Kumasi Metropolis 
of Ghana  

Mensah 
et al. 
[57] 

210  Ashanti 
region, 
Kumasi 

31-60 
years 

Cross 
sectional 

Questio
nnaire,  

High income groups spent 9.56% of their total 
food expenditure on street food as compared to 
those in the middle (17.03%) and low (21.73%) 
income groups.  

12/22 6 

24. Examining the Role 
of Urban Food 
Spaces: A 
neighborhood Level 
Exploration of Food 
Geographies in 
Accra, Ghana  

 

Anna 
Carla 
Lopéz-
Carr et 
al. [66] 

31 
wom
en 

Greater 
Accra, 
Nima, 
Canton
ments, 
Jamesto
wn 

Not 
report
ed 

Qualitative 
cross-
sectional 
study 

Intervie
ws 

Households in Nima had easy access to the large 
food market. Households without access to a 
neighborhood market were more likely to 
consume highly processed foods. In Nima, the 
purchase of processed foods was low. In 
Cantonments and Jamestown, where there is no 
access to a neighborhood market, 90% of 
households purchase processed foods regularly. 
Lack of refrigeration facilities was a barrier to 
obtaining healthy foods. 

12/22 6 

25. The Local Food 
Environment and 
Body Mass Index 

Dake et 
al. [65] 

657 Greater 
Accra, 
James 

31 
years 

Cross 
sectional 

Weight, 
height, 
BMI, 

There was an abundance of out of home cooked 
foods, convenience foods but little access to 
fruits and vegetables. The most common types of 

18/22 9 



  
 

 https://doi.org/10.18697/ajfand.107.21820 19685 

among the Urban 
Poor in Accra, Ghana 

Town, 
Usser 
Town, 
Agbobl
oshie  

Physical 
activity 
level 
assessm
ent, 
DDS, 
spatial 
mapping 
of the 
food 
environ
ment  

out-of-home cooked foods available were plain 
boiled rice, rice boiled with refined vegetable oil, 
fried rice*, waakye., and jollof rice-Additional 
out-of-home cooked food place located in the 
neighbourhood decreases BMI by approximately 
0.1 kg/ m2 while each additional convenience 
store increases BMI by about 0.2 kg/m2. 

26. Factors Influencing 
Food Choices: 
Perception of Public 
and Private Junior 
High School 
Adolescent Students 
in Asiakwa in the 
Eastern Region of 
Ghana  

Janet 
Agyark
waa Oti 
[84] 

215 Eastern 
Region, 
Asiakw
a 

11-19 
years 

Cross 
sectional 

Quantita
tive and 
qualitati
ve data 

Students buy food frequently from the school 
canteen. Though most foods sold at the school 
canteen are not varied, students are not allowed 
to go out to buy food. Fruits were perceived as 
expensive by students and some could not afford 
it. 

12/22  

27. Expenditure on Fresh 
Vegetables, Fresh 
Fruits, and Peanut 
Products in Urban 
Ghana: Does 
Location Matter?  

 

Meng et 
al. [89] 

1010 Greater 
Accra, 
Norther
n 
Region 

Not 
report
ed 

Cross-
sectional 

Questio
nnaire 

Accra households have significantly higher fresh 
vegetable expenditure than the household in 
Tamale. High income households consume more 
vegetables and fruits. After controlling for socio-
demographic factors, the location factors did not 
have significant effects on the fresh fruit 
expenditure. Household numbers, marital status, 

18/22  



  
 

 https://doi.org/10.18697/ajfand.107.21820 19686 

older age, education, and income associated with 
fruit and vegetable consumption. 

28. Nutrition knowledge 
and food 
consumption 
practices and barriers 
in rural Ghana: the 
case of foods for 
preventing vitamin a 
and iron deficiencies 

Omari 
R, [90] 

300 Ashanti 
Region, 
Brong 
Ahafo, 
Region 

Not 
report
ed 

Cross 
sectional 

Qualitati
ve 
study, 
Focus 
group 

Barriers that affect availability and consumption 
of animal products were lack of storage facilities, 
irregular supply, lack of money and conflicting 
media reports on effects of meat consumption on 
health. The main reason for the low consumption 
of fruits was traditional Ghanaian food culture 
where fruits are not considered as food or part of 
the meal. Other barriers as shown in included 
lack of knowledge on the nutritional value of 
fruits (72%), laziness in washing and peeling 
(60%), and contamination with agrochemicals 
(80%). 

14/22  

29. Fruit and Vegetable 
Consumption 
Frequency by Urban 
Households in Ghana 
– Implications for 
Postharvest Handling 

Florkow
ski et al. 
[53] 

1076 Western
, 
Greater 
Accra, 
and 
Norther
n 
Region, 
(Takora
di, 
Accra, 
Tamale) 

Not 
report
ed 

Cross 
sectional 

Questio
nnaire, 
FFQ 

Income is influential in relation to fruit and 
vegetable consumption, especially for fruit. Also, 
the presence of children in the household is 
important for fruit consumption. Shopping at 
supermarkets was less frequent. Fruit and 
vegetable purchase was positively associated 
with high income levels. 
 

18/22  

30. The effects of 
income and food 
safety perception on 

Amfo, 
[84] 

300 Norther
n 

Not 
report
ed 

Cross 
sectional 

Questio
nnaire, 

The average monthly household food 
expenditure in Tamale is GH₵551.92. 
Vegetables and cereals account for more than 

14/22  



  
 

 https://doi.org/10.18697/ajfand.107.21820 19687 

vegetable 
expenditure in the 
Tamale Metropolis, 
Ghana 

Region, 
Tamale 

Qualitati
ve data 

half of total food expenditure. Fruits and 
vegetables take 34.1 percent of the food budget. 
Income proportion spent on vegetables is 
significantly lower for high-income households 
than middle- and low-income groups.  

31. Development, 
implementation and 
outcome of standards 
to restrict fatty meat 
in the food supply 
and prevent NCDs: 
learning from an 
innovative food 
policy in Ghana 

Thow et 
al. [49] 

Not 
Appl
icabl
e 

Not 
applica
ble 

Not 
applic
able 

Analysis of 
policy 
documents, 
policy 
analysis 
interviews, 
Health policy 
analysis 
triangle, 
trade data 
analysis 

28 semi 
structure
d 
intervie
w 
conduct
ed 
FAOST
AT 
import 
data 

Pork ‘Deboned carcasses are to contain no more 
than 25% total fat when determined in 
accordance with clause 3 of GS 70. Pork carcass 
shall have a backfat thickness not exceeding 2.5 
cm. Beef carcasses and cuts shall contain no 
more than 25% fat by mass when determined in 
accordance with clause 3 of GS 70. The policy 
reduced the availability of fatty meat especially 
turkey tail in the Ghanaian food environment. 

18/22  

32. Urban Livelihoods 
and Food and 
Nutrition Security in 
Greater Accra, 
Ghana 

Maxwell 
et al. 
[78] 

559 Greater 
Accra 

38±11
.8 

Cross 
sectional 
survey, 
Qualitative 
study 

Food 
acquisiti
on, SES,  

Street food consumption is higher among low 
income households. 

16/22  

33. Public awareness and 
perception of 
Ghana’s restrictive 
policy on fatty meat, 
as well as preference 
and consumption of 
meat products among 
Ghanaian adults 

Annan 
et al. 
[86] 

337 Ashanti 
Region, 
Kumasi 

18-
>50yr
s 

Cross 
sectional 

Questio
nnaire, 
FFQ, 
body 
composi
tion 
analysis, 
BMI 

Price affects consumption choice of meat 
regardless of knowledge. 

14/22  



  
 

 https://doi.org/10.18697/ajfand.107.21820 19688 

living in the Kumasi 
Metropolis 

34. The home school 
environment, 
physical activity 
levels, and adiposity 
of school-age 
children 

Gaa et 
al. [70] 

299 Norther
n 
Region, 
Tamale 

9.3(2.
14) 

Cross-
sectional 

Questio
nnaire, 
Intervie
w, 
physical 
activity 
question
naire, 
Anthrop
ometry 

Sweet foods were available and sold in the 
school environment. 

12/22  

35. Characterising the 
food and advertising 
environments of 
deprived 
neighbourhoods in 
African cities 

Green et 
al. N.D 
[64] 

621 
food 
outle
ts or 
adve
rtise
ment
s 

Greater 
Accra 
and 
Volta 
region  

N/A Cross 
sectional 

Neighbo
rhood 
audits, 
outlet 
type 
classific
ation, 
identific
ation 
and 
characte
rization 
of 
neighbo
urhoods 
food 
advertis

The food environment in Jamestown was highly 
informal (80.5%) with the majority of the outlets 
being fruit or vegetable stands and table tops. 
Food outlets in Ho were more formalized and 
43.9% of them were shops. Informal outlets had 
higher availability of healthy options compared 
to formal outlets. Foods sold in informal outlets 
included fruits and vegetables, staple foods, 
traditional dishes, poultry and eggs. Formal 
outlets sold predominantly processed foods such 
as sugar sweetened beverages and spreads, cakes 
and sweets.  

16/22  



  
 

 https://doi.org/10.18697/ajfand.107.21820 19689 

ement, 
GPS 
coordina
tes of 
outlets 

36. Dietary transitions in 
Ghanaian cities: 
leveraging evidence 
for policy and 
intervention to 
prevent diet-related 
non-communicable 
diseases  

Holdsw
orth et 
al. [91] 

 Greater 
Accra 
and 
Volta 
region 

 Cross-
sectional 

Qualitati
ve 24-
hour 
recall 

94% of study participants consumed energy-
dense meals, 66.8% consumed fried foods, 
55.8% consumed energy dense poor foods, 41% 
consumed nutrient poor foods, 38.5% consumed 
sweets, 36.2% consumed sweetened beverages. 
Financial constraint was a barrier to achieving a 
healthy diet. 

14/22  

37. Dietary behaviours in 
the context of 
nutrition transition: a 
systematic review 
and meta-analyses in 
two African countries 

Rousha
m et al. 
[63] 

26 
publi
shed 
studi
es 
invol
ving  
1260
5 
pers
ons 

Nation
wide 

Not 
report
ed 

Systematic 
review 

Meta 
Analysis 

13% of households in urban slums purchase 
cooked foods from street food vendors. 86% of 
university students purchase foods regularly 
from food vendors, of which 47% do so daily. 

18/22  

38. Dietary patterns and 
associated risk 
factors among school 
age children in urban 
Ghana 

Alangea 
et al. 
[61] 

487 Greater 
Accra 
region 

9-
15year
s 
12±1.
5years 

Cross-
sectional 

Food 
frequenc
y 
question
naire, 

Four main food consumption patterns were 
identified: energy dense; starchy roots and 
vegetables; grain-based and poultry; and 
fish/seafoods. Starchy roots and vegetables 
explained 13.7% of the pupils' diet. The energy 

14/22  



  
 

 https://doi.org/10.18697/ajfand.107.21820 19690 

height, 
weight,  

dense pattern identified in this study was 
characterized by the consumption of sugar 
sweetened beverages, candies, ice creams, fried 
foods, processed meats, spreads, toppings, and 
snacks like cakes, pies, doughnuts and other 
savory food. These foods are mostly sourced 
from the school environment.  

39. Street Food in Urban 
Ghana 
A desktop review 
and analysis of 
findings and 
recommendations 
from existing 
literature 
 

FAO, 
[92] 

Not 
appli
cabl
e 

Not 
applica
ble 

Not 
applic
able 

Desktop 
review of 
documents, 
project 
reports, 
workshops 
and 
conference 
proceedings  

Docume
nt 
review 

The consumption of street foods is high. 
Consumption frequency is similar across all 
socio-economic strata. 

18/22  

40. Workplace support 
for breastfeeding 
employees in 
educational and 
health settings in 
Ghana  

Iddrisu, 
Abdul-
Lateef, 
Hushie 
& 
Bashiru, 
[74] 

128 Tamale Not 
report
ed 

Cross- 
sectional 

Assessm
ent of 
breastfe
eding 
support 
systems 
at the 
workpla
ce 

Fridge for storing breast milk or other baby foods 
and availability of private rooms for 
breastfeeding were the least common forms of 
workplace support for breastfeeding. 

12/22  

 

 



 

 
 

 https://doi.org/10.18697/ajfand.107.21820 19691 

Table 2: Checklist for assessing quality of quantitative studies 

 Criteria  Yes 

(2) 

Partial 

(1) 

No (0) N/A 

1 Question / objective sufficiently described?     

2 Study design evident and appropriate?     

3 Method of subject/comparison group 

selection or source of information/input 

variables described and appropriate? 

    

4 Subject (and comparison group, if applicable) 

characteristics sufficiently described 

    

5 If interventional and random allocation was 

possible, was it described? 

    

6 If interventional and blinding of investigators 

was possible, was it reported 

    

7 If interventional and blinding of subjects was 

possible, was it reported? 

    

8 Outcome and (if applicable) exposure 

measure(s) well defined and robust to 

measurement / misclassification bias? 

    

9 Sample size appropriate?     

10 Analytic methods described/justified and 

appropriate? 

    

11 Some estimate of variance is reported for the 

main results? 

    

12 Controlled for confounding?     

13 Results reported in sufficient detail?     

14 Conclusions supported by the results?     

 

 



 

 
 

 https://doi.org/10.18697/ajfand.107.21820 19692 

Table 3: Checklist for assessing quality of qualitative studies 

 Criteria  Yes 

(2) 

Partial (1) No (0) N/A 

1 Question / objective sufficiently 

described? 

    

2 Study design evident and appropriate?     

3 Context of the study clear?     

4 Connection to a theoretical framework / 

wider body of knowledge? 

    

5 Sampling strategy described, relevant and 

justified? 

    

6 Data collection methods clearly described 

and systematic? 

    

7 Data analysis clearly described and 

systematic? 

    

8 Use of verification procedure(s) to 

establish credibility? 

    

9 Conclusions supported by the results?     

10 Reflexivity of the account?     

 

  



 

 
 

 https://doi.org/10.18697/ajfand.107.21820 19693 

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