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UNIVERSITY OF GHANA 
COLLEGE OF HEALTH SCIENCES 
SCHOOL OF PUBLIC HEALTH 
 
NUTRITION STANDARDS AND NATURE OF FOODS SOLD AT 
THE UNIVERSITY OF GHANA CANTEENS 
 
 
BY 
 
MAXWELL BISALA KONLAN 
(10382216) 
 
 
 
THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF 
GHANA, LEGON, IN PARTIAL FULFILMENT OF THE 
REQUIREMENT FOR THE AWARD OF MASTER OF PUBLIC 
HEALTH DEGREE. 
 
 
 
 
JULY, 2019
University of Ghana http://ugspace.ug.edu.gh
DECLARATION 
I, Maxwell Bisala Konlan hereby declare that except for references made to other people’s 
work which have been duly acknowledged, this research is my own work.  I affirm that this 
work has neither been submitted in whole nor part for the award of any degree. 
  
 
 
 
……………………………….. 
MAXWELL BISALA KONLAN 
(STUDENT) 
DATE:  
 
 
 
 
………………………….. 
DR. AMOS LAAR 
(SUPERVISOR) 
DATE:  
 
 
 
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DEDICATION 
This work is dedicated to the Almighty God for His grace and mercies, to my beloved 
mother of blessed memory and my entire family for their immense support and 
encouragement throughout this period of study. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
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ACKNOWLEDGEMENT 
My endless appreciation goes to the Almighty God, whose abundant grace has seen me to 
the successful completion of this work as a climax to the MPH program. 
My profound thanks to Dr Amos Laar, my supervisor for his support and encouragement 
that helped me to reach the completion of this work. 
To the staff of Physical Development and Municipal Service Directorate (PDMSD), 
University Legal Aid, Hall Masters and Food service managers of eateries operating within 
the University of Ghana main campus, I am grateful for your support. I deeply appreciate 
the immense contributions from all respondents. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
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ABSTRACT 
Background  
Substantial evidence have shown that food environment contributes to the increasing obesity 
and other nutrition-related non-communicable diseases (NCDs) among children and adults.  
The increasing obesity prevalence and nutrition-related NCDs suggest there is a need for a 
more comprehensive and robust approach including regulating environmental food 
exposures.  In certain jurisdictions, nutrition standards can regulate the nature and quality 
of foods sold in schools contributing to a healthy food environment.     
Aim:  The study aimed to determine the availability of nutrition standards and to assess the 
nature of foods sold in canteens at the University of Ghana. 
Methodology: A cross sectional study design using both qualitative and quantitative 
methods was used. In-depth interviews were conducted with stakeholders who have core 
mandate in regulation of food service businesses in the University of Ghana. A  
Questionnaire was used to determine nature of food and food hygiene practices of canteens 
at the University of Ghana. Descriptive statistics were used to summarize data from the 
different food categories sold at the canteens and presented in the form of means, 
percentages, graphs, tables and charts. Proportions were calculated for categorical variables. 
Associations were determined between food categories and some selected food outlets 
characteristics using the Pearson chi square. A p-value less than 0.05 was regarded as 
significant. 
Results:  There was sale of energy-dense foods in canteens of the University of Ghana.  
Majority of the eateries sold sugar sweetened beverages (84.7%), refined carbohydrates 
(80.6%), and fried foods (93.9 %). The sale of fruits or vegetables and whole grains were 
40.8% and 38.8% respectively. There was a significant association between the sale of sugar 
sweetened beverages and years of operation of food outlets. 
The study identified two nutrition standards that regulate food service business at the 
University of Ghana. These were food hygiene and safety standards (with University-wide 
application) and food-based standards (pertaining to the only female-residence of the 
University).  
The food hygiene and safety practices of the food outlets determined from several food 
hygiene and safety factors was fair.  
Conclusion: The University of Ghana canteens sell energy dense meals substantial 
consumption of which increases one’s risk to NCDs.  
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Majority of the food outlets were involved in the sale of sugar sweetened beverages, fried 
foods, refined carbohydrates compared to the sale of fruits and vegetables and whole grains. 
There was availability of food hygiene and food based standard with scanty information 
about its implementation and enforcement. The overall food hygiene score based on several 
factors to assess food hygiene and safety practices of the canteens was fair. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
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TABLE OF CONTENTS 
 
DECLARATION .................................................................................................................. i 
DEDICATION ..................................................................................................................... ii 
ACKNOWLEDGEMENT ................................................................................................ iii 
ABSTRACT ........................................................................................................................ iv 
TABLE OF CONTENTS ................................................................................................... vi 
LIST OF ABBREVIATIONS .......................................................................................... xii 
DEFINITION OF TERMS ............................................................................................. xiii 
CHAPTER ONE ................................................................................................................. 1 
1.1 Background ............................................................................................................ 1 
1.2 Problem Statement ...................................................................................................... 3 
1.3. Conceptual framework. .............................................................................................. 5 
1.4 Justification of Study .................................................................................................. 7 
1.5 Objectives of the Study ............................................................................................... 8 
1.5.1 General Objective ................................................................................................. 8 
1.5.2 Specific Objectives ............................................................................................... 8 
1.5.3 Research Questions ............................................................................................... 8 
CHAPTER TWO ................................................................................................................ 9 
LITERATURE REVIEW ................................................................................................... 9 
2.1 Nature and Profile of Foods in Public Schools ........................................................... 9 
2.2 Nutrition Standards in Schools ................................................................................. 10 
2.3 Food Environment and Obesity ................................................................................ 11 
2.4 Food Hygiene Practices in Public Setting Canteens. ................................................ 13 
2.5 Diet and Non-Communicable Disease ...................................................................... 14 
2.6 Nutrition Services in Schools .................................................................................... 15 
2.7 Nutrition standards and policies in Ghana. ............................................................... 16 
2.8 Food environment and food choice among school students ..................................... 17 
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2.9 Gaps in Literature ...................................................................................................... 19 
CHAPTER THREE .......................................................................................................... 20 
METHODOLOGY ............................................................................................................ 20 
3.1 Study Design ............................................................................................................. 20 
3.2 Study Site. ................................................................................................................. 20 
3.3 Study Population ....................................................................................................... 20 
3.4 Variables ................................................................................................................... 21 
3.4.1 Outcome (dependent) Variables ......................................................................... 21 
3.4.2 Explanatory (independent) Variables ................................................................. 21 
3.5 Inclusion Criteria ....................................................................................................... 21 
3.6 Exclusion Criteria...................................................................................................... 21 
3.7 Sampling Method ...................................................................................................... 22 
3.8 Data Collection Techniques and Tools ..................................................................... 22 
3.8.1 Determining the availability of nutrition standards ............................................ 22 
3.8.2 Describing the nature of foods and non-alcohol beverages. ............................... 22 
3.8.3 Assessing hygiene practices of canteens at the University of Ghana ................. 23 
3.9 Quality Assurance ..................................................................................................... 23 
3.10 Training of Field Workers ....................................................................................... 23 
3.10.1 Pre-Testing of Questionnaires .......................................................................... 24 
3.10.2 Editing Pre-Tested Questionnaires ................................................................... 24 
3.10.3 Data Entry and Processing ................................................................................ 24 
3.11 Data Analysis .......................................................................................................... 24 
3.11.1 Quantitative data analysis ................................................................................. 24 
3.11.2 Qualitative Data Analysis ................................................................................. 25 
3.12 Ethical Considerations ............................................................................................ 25 
3.13 Risks ........................................................................................................................ 26 
3.14 Compensation .......................................................................................................... 26 
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3.15 Participants’ Consent .............................................................................................. 26 
3.16 Confidentiality ........................................................................................................ 27 
3.17 Conflict of Interest .................................................................................................. 27 
CHAPTER FOUR ............................................................................................................. 28 
RESULTS .......................................................................................................................... 28 
4.1 Background characteristics of key informants from the University. ........................ 28 
4.1.1 Background characteristics of food outlets and canteen staff............................. 28 
4.2 Nature of foods sold at the university of Ghana canteens. ........................................ 30 
4.3 Associations between food categories and some selected food outlets characteristics.
 ......................................................................................................................................... 31 
4.4 Nutrition Standards ................................................................................................... 34 
4.4.1 Availability of nutrition standards ...................................................................... 34 
4.4.2 Implementation and enforcement of the existing nutrition standards................. 36 
4.4.3 Views of key informants on whether nutrition standards can help improve the 
nature and quality of foods on sale. ............................................................................. 37 
4.4.4 Views of key informants on the university Ghana’s priority in implementing and 
setting nutrition standards. ........................................................................................... 38 
4.4.5 Process food service businesses are required to satisfy before being granted a 
space to operate in the University of Ghana. ............................................................... 39 
4.5 Food hygiene and safety practices of food outlets. ................................................... 40 
4.6 Food hygiene and safety training among food outlets. ............................................. 42 
4.7 Food Outlets with presence of toilet and clean running water .................................. 42 
4.8 Percentage distribution of food inspection at the point of sale ................................. 43 
4.9 Food hygiene and safety levels of food outlets ......................................................... 44 
CHAPTER FIVE ............................................................................................................... 46 
DISCUSSION .................................................................................................................... 46 
5.1 Nature of foods sold in the University of Ghana canteens........................................ 46 
5.1.1 Sale of fruits and vegetables. .............................................................................. 47 
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5.1.2 Sale of sugar sweetened beverages. .................................................................... 48 
5.1.3 Sale of whole grains and refined carbohydrates ................................................. 50 
5.1.4 Sale of fried foods ............................................................................................... 51 
5.2 Availability of nutrition standards ............................................................................ 52 
5.3 Food hygiene and safety Practices of Food outlets ................................................... 54 
5.4 Study strengths .......................................................................................................... 55 
5.5 Limitations of the study ............................................................................................ 55 
CHAPTER SIX ................................................................................................................. 57 
CONCLUSIONS AND RECOMMENDATIONS .......................................................... 57 
6.1 Conclusions ............................................................................................................... 57 
6.2 Recommendations ..................................................................................................... 58 
REFERENCES .................................................................................................................. 59 
APPENDICES ................................................................................................................... 63 
Appendix 1. ..................................................................................................................... 63 
Appendix 2 ...................................................................................................................... 65 
Appendix 3 ...................................................................................................................... 68 
Appendix 4A ................................................................................................................... 70 
Appendix 4B ................................................................................................................... 74 
 
 
    
 
  
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LIST OF TABLES 
Table 4.1: Background characteristics of food outlets and Canteen staff  .......................... 29 
Table 4.2: Food based categorization of the different types of foods offered for sale. ...... 30 
Table 4.3: Associations between food categories and some selected food outlets 
characteristics. ................................................................................................. 32 
Table 4.4: Associations between food categories and some selected food outlets 
characteristics continued. ................................................................................. 34 
Table 4.5: Factors that determine food hygiene and safety practices of food outlets. ........ 41 
 
 
 
 
 
 
 
 
 
 
 
 
  
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LIST OF FIGURES 
Figure 1. 1: Conceptual framework for nutrition standards and nature of foods .................. 6 
Figure 4. 1: Percentage distribution of food outlets who have done food hygiene and safety 
training. .......................................................................................................... 42 
Figure 4. 2: Percentage distribution of food outlets with toilet and clean running water. .. 43 
Figure 4. 3: Percentage distribution of food inspection at the point sale among the food 
outlets. ............................................................................................................ 44 
Figure 4.4: Food hygiene and safety levels of the food outlets. ......................................... 45 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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LIST OF ABBREVIATIONS 
FAO                                        Food and Agriculture organization. 
HACCP    Hazard Analysis and Critical Control points 
NCDs     Non-communicable diseases 
PI     Principal investigator. 
PDMSD   Physical Development and Municipal Services Development 
SMEs     Small to Medium Size Enterprises. 
WHO                                     World Health Organization 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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DEFINITION OF TERMS 
Canteen:   A canteen is a well demarcated area with a shed where food or drinks are sold 
in an organization. 
Diet-related non communicable diseases: Type 2 diabetes, cardiovascular diseases and 
nutrition related cancers excluding micro nutrient deficiencies, under 
nutrition, osteoporosis, mental health and gastrointestinal diseases. 
Food hygiene: Food hygiene are the conditions and measures necessary to ensure the safety 
of food from production to consumption. 
Food environment: A food environment is the collective physical, economic, policy and 
social cultural surroundings, opportunities that influence people’s food and 
beverage choices and nutritional status. 
Healthy food: Foods recommended in national food based dietary guidelines or food based 
standards. 
Healthy food environment: A food environment that promotes the health and well -being 
of an individual is known as a healthy food environment. 
Nature of foods:  Refers to the food based categorization of a particular type of food which 
predicts its nutritional significance. 
Non Communicable Diseases: A non-communicable Diseases also known as chronic 
diseases are diseases which have a long duration as result of genetic, 
physiologic, environmental and behaviour factors. 
Nutrition standards: A Set of standard protocols that determine the wholesomeness and 
type of food sold in a particular jurisdiction, which could be in a form of 
nutrient based, food based standards or food hygiene and safety standard. 
 
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Obesity: Obesity is defined as a state of increased body weight due to adipose tissue 
accumulation which is of significant magnitude to cause an adverse health 
effect. 
Special diet: Special diet is any regular diet which has been modified by restriction of one 
or more nutrients for therapeutic purposes. 
Unhealthy foods: Processed foods and refined beverages high in saturated, trans and added 
sugars and/or salt. 
 
 
 
 
 
 
 
 
 
 
. 
.  
. 
. 
. 
 
 
 
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CHAPTER ONE 
INTRODUCTION 
1.1 Background 
Food and eating environment likely contribute to the increasing endemic of obesity and 
chronic diseases (Mary Story, Karen M. Kaphingst, Ramona Robinson-Obrien and Karen 
Glanz, 2008). Although food choices and eating habits can emanate from many sources, 
school food environment have a significant influence on students diet and play an important 
role in teaching and modelling appropriate health behaviours (Nicole Larson and Mary 
Story, 2010). 
 
There have been several individual-based interventions to tackle obesity in schools but most 
of these interventions have had limited success ( Karen Glanz, James F. Sallis, Brain E. 
Saelens and Lawrence D. Frank,  2005 ). Addressing obesity epidemic and diet related 
chronic diseases demand new focus on environmental food exposures that discourage 
excessive energy intake (Cummins & Macintyre, 2006). Food environment influences what 
is being consumed and hence addressing obesogenic promoting factors within the food 
environment can  effectively curtail the obesity menace (L'Abbé et al., 2013).  In certain 
jurisdictions there are evidences of reduction in high sugar, salt and fatty foods sold within 
the school environment. This has been attributed to the existence and implementation of 
nutrition standards policies regulating the nature and  types of food sold in such environment  
(Story et al., 2008) 
 
Nutrition standards for the purpose of this study is defined as set of standard protocols that 
determine the wholesomeness and  type of food sold in a particular jurisdiction,  which  
could be in a form of nutrient based standards, food based standards or food hygiene and 
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safety standard. (L'Abbé et al., 2013).   Stronger food policy and nutrition standards in 
schools are needed to provide healthy meals to students and limit their access to low nutrient 
and energy dense meals whiles increasing their frequency, duration and intensity of physical 
activity Story, Nanney, & Schwartz, 2009). 
 
Nature of foods refers to the food based categorization of a particular food which can be 
used to predict its nutritional significance (L'Abbé et al., 2013).   Nutritional profile and 
nature  of foods sold in the public settings contribute substantially to excessive energy intake 
leading to obesity epidemic ( Swinburn et al., 2011). Also food hygiene practices in schools 
can affect the nature of foods offered for sale and pre-dispose school children to food borne 
illnesses and hence it is of importance to assess the food hygiene practices of school 
canteens. Out-of-home eating has increased considerably over the past decades and 
contributes significantly to excessive energy consumption (Story et al., 2009). Eating out of 
home presents additional nutritional challenges compared to home foods ( Lachat et al., 
2009). 
 
When entering the University, many students leave their family environment and reside in 
the University. The University canteens are important contributor to out-of- home 
consumption of meals for students and staff. It has been shown in other contexts that school 
canteens can contribute to creation of an obesogenic environment (Bell & Swinburn, 2004), 
but can also represent an opportunity to improve students’ diet through effective strategies 
to regulate food environment through strengthening of existing food standards within the 
school environment. . Elsewhere school authorities show positive attitudes about providing 
a healthy food environment but have  limited commitment  in  enforcing  food standards in 
their schools (Neumark-Sztainer, French, Hannan, Story, & Fulkerson, 2005) 
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Over the years, the number of canteens in the University of Ghana has increased with 
increased student enrolment.  
 
Despite the increasing establishment of these canteens, there is limited information on the 
nutrition standards and protocols that regulate the operations of these canteens as well as 
the nature of foods sold in these canteens. This study therefore, sought to determine nutrition 
standards and nature of foods sold in within the Canteens of University of Ghana.  
 
1.2 Problem Statement 
There has been a global shift from consumption of home-made meals to frequent 
consumption of outside meals hence addressing obesity demands focus on environmental 
food exposures (Lachat et al., 2009). 
 
 Poor dietary and lifestyle related changes are risk factors for increase trend of obesity with 
a global prevalence of 39% and 13% for overweight and obesity respectively (WHO, 2004). 
This increasing trend of obesity poses a major risk of diet-related non-communicable 
diseases including diabetes, cardiovascular disease, hypertension, stroke and certain forms 
of cancer (Glanz et al., 2005). 
 
Africa is experiencing nutrition transition with increased consumption of meals outside from 
home. This transition has an adverse outcome of rapid economic development and 
globalization (Dalal et al., 2011). A notable trend that is observed as a result of this nutrition 
transition is a shift in our source of food. Frequent consumption of unhealthy meals outside 
home contributes to obesity. The increasing trend in obesity is influenced by unhealthy food 
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environments due to lack of nutrition standards to regulate the nature and quality of healthy 
foods sold at food service canteens (L'Abbé et al., 2013). 
 
The school food environment can contribute to obesity  due to the poor quality of meals sold 
at the canteens of the schools (L'Abbé et al., 2013).  . A  systematic review and meta-analysis 
of overweight and obesity epidemic in all the ten regions of Ghana by Ofori-Asenso et al., 
(2016) indicates that nearly 43% of Ghanaians are either overweight or obese with national 
prevalence of overweight and obesity estimated to be 25.4% and 17.1% respectively.  
Obesity prevalence in the University of Ghana has been on the rise with associated increase 
in non-communicable diseases. A research conducted by Mohammed and Vuvor (2012) to 
investigate the prevalence of obesity in University of Ghana basic school children reported 
high prevalence of obesity of 10.9%.   Another study conducted by Sutherland et al., (2018) 
to investigate the causes of death at the university of Ghana hospital from 1979-2015 found 
almost 60% of deaths were caused by NCDs. The study found that there was a shift from 
communicable to non-communicable diseases. Among the top ten causes of death were 
cardiovascular diseases and cancer. Diet plays a very important role in the development of 
NCDs and hence for this matter it is of relevance to investigate the food environment that 
expose students and staff to these increase risk of NCDs since they spend more hours in the 
University. 
 
This increasing obesity prevalence demands a more robust approach looking beyond 
individual based approach by assessing the environmental food exposures where individual 
based decisions are made (Cummins & Macintyre, 2006). There is increasing drive to 
achieve economic sustainability, making people to work out of  home and hence  relying on 
out-of-home meals (Lin, Guthrie, & Frazão, 1999).   
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Out-of-home meals contribute significantly to individual energy intake leading to the 
obesity epidemic (Lin et al., 1999). University canteen meals are considered out- of-home 
meals to students and staff. Due to convenience, majority of students eat 90% of their meals 
from university canteens according to a study by L’Abbe et al., (2013). Though the study 
was not done in Africa and for that matter Ghana, but there is likelihood of a similar trend 
among University of Ghana students.  
 
Despite the increased risk of excess energy consumption these canteen foods may present, 
there is paucity of data on the nutrition standards and nature of meals sold in most public 
university canteens in Ghana.   
 
Nutrition  standards in most schools are important for making healthy foods available by 
providing a way of standardizing the nutritional quality of foods offered across the 
jurisdiction  (L’Abbé et al., 2013). Obesity epidemic in most schools cannot be mitigated if 
out- of- home meals such as school canteens are not regulated by food standards to provide 
a healthy food environment (L’Abbé et al., 2013).  A healthy food environment makes it 
easy for achieving success in individual based interventions targeting obesity and diet-
related diseases (Cummins & Macintyre, 2006). In this regard, there is a need to determine 
nutrition standards and assess the nature of foods sold in the university of Ghana canteens. 
 
1.3. Conceptual framework. 
This study used an adapted modified logic framework for creating healthy food environment 
by Robles et al., (2012). The framework illustrates that nutrition standards such as food 
base, nutrient and food hygiene and safety standard can regulate the nature foods offered for 
sale in eateries as well as Food hygiene and safety of foods. Improved food hygiene and 
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safety can also improve the nature of foods by ensuring food is free from contamination. 
This can help maintain the nature and nutritional quality of foods.  The improved nature and 
nutritional profile of foods therefore lead to healthy food environment making healthy foods 
accessible in eateries. The availability of healthy meals consequently leads to improved 
dietary intake and this result in better health outcomes such as reduced obesity risk, reduced 
risk of cardiovascular diseases and diet- related NCDs. 
Figure 1. 1: Conceptual framework for nutrition standards and nature of foods 
 
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Source: Modified from the logic framework for creating healthy food environment by  
Robles et al., 2012. 
 
1.4 Justification of Study   
This study needs to be done to provide baseline data on the availability of nutrition standards 
and nature of foods sold at the canteens of University of Ghana hence this will contribute to 
provide a healthy food environment. 
 
The study will influence food policy and decision making in most public Universities in 
attempt to address the increasing global trend of obesity since out-of –home meals increase 
obesogenic environment (Bell & Swinburn, 2004). This data will be helpful for both public 
University management and the government for targeting interventions to improve the 
standards of food canteens within the public Universities in Ghana 
 
In Ghana, this research will provide a preliminary data to government and University 
management to strengthen existing nutrition standards and food policies in the public setting 
and University Canteens there by contributing to a healthy food environment.  The provision 
of a healthy food environment will lead to a population wide benefits by limiting the 
exposure of people to foods high in fat, sugar and salt and reduce their risk to obesity and 
dietary related non-communicable diseases. 
 
The study results will bring to light the nature of foods sold in the university canteens and 
its influence on obesogenic environment at the University campus. The results of the study 
will be used as preliminary data to trigger action campaign to curb the public health burden 
of obesity through strengthening of the existing food standards and limiting availability of 
certain foods that are high in sugar, salt and fat. 
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1.5 Objectives of the Study  
1.5.1 General Objective 
 The objective of the study was to determine the availability of nutrition standards and to 
assess the nature of foods sold at the University of Ghana canteens. 
 
1.5.2 Specific Objectives 
1. To determine the availability of nutrition standards for regulating food services at the 
University of Ghana. 
2. To assess the nature of foods sold at the canteens of University of Ghana. 
3. To assess the food hygiene and safety practices at the University of Ghana Canteens. 
 
1.5.3 Research Questions 
1. What nutrition standards regulate food service business at the University of Ghana?  
2. What is the nature of foods and non-alcoholic beverages sold at the university of Ghana 
canteens? 
3. What are the food hygiene practices of canteens at the University of Ghana? 
 
 
 
 
 
 
 
 
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CHAPTER TWO 
LITERATURE REVIEW 
This review of literature was conducted by searching for words and phrases relevant to the 
topic from search engines such as PubMed, ScienceDirect, Google scholar and Google. The 
Boolean operators “AND” and “OR” were used to broaden or restrict the search. References 
cited in retrieved articles were also followed up and used where they were found relevant. 
 
2.1 Nature and Profile of Foods in Public Schools 
The nature and profile of foods sold in universities can present a major setback to fighting 
the ever-increasing prevalence of obesity among students. Food access and availability 
determine what is being consumed by students (Deliens et al., 2014).  Therefore, a food 
environment which provides poor nature and quality of foods will predispose students to 
unhealthy food choices and hence increase their risk of obesity and diet-related NCDs.   
 
Poor nutritional profile and nature of foods sold in schools can contribute to  the increasing 
rate of adolescence obesity in most  schools (Craypo et al., 2002). A study done in California 
to investigate the frequency of fast foods sold in Californian high schools, found high 
prevalence of fast foods sold in schools (Craypo et al., 2002). The study reported that 65% 
of students liked fast foods in the 105 districts sampled (Craypo et al., 2002). This has 
implications for increasing the risk of obesity and diet-related NCDs in schools as fast foods 
may put students at risk of excessive energy consumption. 
 
Another study done to assess the nutritional profile of foods sold in a Belgian university 
reported that 17% of the meals consumed contained 2000mg of sodium. On the average 
37.5% of the meals  were supplied from fat ( Lachat et al., 2009). The meals consumed were 
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high in fat and protein compared to the Belgian university recommendations for a hot lunch 
( Lachat et al., 2009) . The study by Lachat et al., (2009) confirms that nutritional profile of 
foods sold in public Universities are of poor quality contributing to excessive energy 
consumption.  Therefore, there is a need for sustained efforts by introducing nutrition 
standards to regulate the food choices by limiting the sale of energy dense foods whiles 
promoting the sale of fruits and vegetables.  
 
2.2 Nutrition Standards in Schools 
Improving nutrition standards in schools is key strategy to improving healthy food 
environment thereby reducing risk of obesity and non-communicable diseases (L'Abbé et 
al., 2013). Students eat majority of their meals from school canteens and hence school 
canteens can provide an opportunity in reducing foods high in fat, sugar and salt whiles 
increasing the intake of whole grains, fruits and vegetables (L'Abbé et al., 2013). In a  review 
study by L’Abbe et al., (2013), several studies revealed that most public settings including 
schools have no nutrition standards in place with little information on nature of foods offered 
for sale in these schools.  
 
 It has been reported in other jurisdiction that strengthened nutrition policies in most schools 
can contribute to healthy food environment and limit the availability of foods high in fat, 
sugar and salt leading to reduction in obesity epidemic and diet-related NCDs (L'Abbé et 
al., 2013). Food environments contribute to the increasing obesity epidemic and chronic 
diseases. Healthy food environments and strengthened nutrition standards are effective 
strategies for creating population wide improvements in eating among school children 
(Story et al., 2008).  
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Over the years, most school authorities have shown limited commitment in setting nutrition 
or enforcing nutrition standards or policies in schools. A study by Simone et al., (2002)  to 
investigate school food policies and practices found that 65% of the School Principals 
believed it was important to have a nutrition standard or  policy in their schools but only 
32% of them had a policy or nutrition standard in their schools. The study found school 
authorities having a positive attitudes about providing a healthy food environment but 98% 
of the schools had soft drink vending machines with 77% having contracts with soft drink 
companies. This study results, reinforces the fact that most should authorities have adequate 
knowledge about the fact that nutrition standards are vital to improving students eating 
habits but there is lack of political commitment on the part of school authorities to either set 
nutrition standards or enforce the few existing ones to improve upon healthy food 
environment in schools. With schools being a very important avenues to shape and improve 
the eating habits of students, lack of sustained effort towards establishing nutrition standards 
will have implications for reduced risk of obesity and diet-related NCDs. 
 
2.3 Food Environment and Obesity 
Obesity is an imbalance of energy input and output leading to excessive accumulation of 
excess body fat which is of significant magnitude to cause an adverse health effect 
(Cummins & Macintyre, 2006).  A food environment is the collective physical, economic, 
policy and socio-cultural opportunities and conditions that influence people’s food and 
beverage choice and nutritional status (Laar et al., 2018). Researchers have described food 
environment using the ecological models.  There are four community food environments 
identified which include; community, organization, consumer and information food 
environments. 
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Several individual based dietary interventions have yielded less success with wide spread 
of obesity suggesting the need to focus on environmental food exposures where individuals 
based decisions are made in order to effectively fight the obesity menace (Cummins & 
Macintyre, 2006). Several observational studies have established unhealthy food 
environment and obesity rates to be higher in low income and deprived area. This 
contradicts the initial notion that, obesity is the disease of the affluence. 
 
A study conducted by Morland and Everson (2009) to investigate the disparities of access 
to healthy foods in the United states found that the prevalence of obesity was  lower in areas 
that had supermarkets with healthy meal options compared to areas with small grocery 
stores or fast food restaurants. This confirms the assertion that types of food stores and 
restaurants available in a particular locality determines food choice of consumers. The 
results of their suggested that the prevalence of obesity was lowered by 0.73 in areas that 
had at least one super market while each mile closer to a super market was associated with 
6% increase in obesity. A higher prevalence of obesity was associated with more than one 
franchised food restaurant (Morland & Evenson, 2009).    
 
In  reviewed studies by Holsten (2008) found five (5) out of the seven (7) reviewed studies 
showing significant association between obesity and unhealthy food environments. These 
findings suggest food environments may play a vital role to foods offered for sale and 
predispose people to increased consumption of energy dense foods leading to increased risk 
of obesity. 
 
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2.4 Food Hygiene Practices in Public Setting Canteens.  
Food safety and hygiene represent a key role to combating cholera outbreak and food 
poisoning in most public settings. However, there is limited available data regarding hygiene 
practices in most institutions in Ghana.  A literature review  to assess food safety and food 
hygiene studies in Ghana  reported that there were variations in  the safe levels of microbial 
levels in foods with most food canteens not adhering to international food safety 
management systems especially among the locally owned food businesses (Foriwaa & 
Lovatt, 2015). Based on the findings of the review study by  Foriwaa and Lovatt (2015), 
they recommended food hygiene and safety training and implementation of HACCP as key 
to addressing food hygiene problems in public sector eateries.  
 
In another study to assess the food hygiene knowledge, attitudes and practices of food 
vendors in   Accra the study revealed that, food hygiene knowledge and attitudes were 
satisfactory, however its use was challenging (Annor & Baiden, 2011).  Also gender, 
educational level of respondents, age of respondents did not influence their food hygiene 
practices. Microbial count of  food samples were generally high and the food hygiene 
knowledge and attitudes of the food handlers did not result in efficient food hygiene 
practices (Annor & Baiden, 2011).  
 
In a study by Marras et al., (2016) to investigate food hygiene practices of street food 
vendors in Accra, it was found that one half of the food vendors had valid food handler 
certificate. The overall based food hygiene score on quantitative analysis found that three 
quarters of the street food vendors scored between fair and extremely good. It turned out 
that the overall food hygiene and safety among the street food vendors was good. 
 
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The study also found that 3.5% of food outlets near schools having food handler certificate 
compared with whole sample, those with food hygiene training in the last year was 5% 
higher and medical training was 3% higher compared the overall sample. The overall food 
hygiene score was high in food eateries near schools compared to the sample of street food 
vendors. 
 
2.5 Diet and Non-Communicable Disease 
Diet-related NCDs is a leading cause of mortality with increase disease burden in low and 
middle income countries ( Lachat et al., 2013). World Health Organization (WHO) has 
recommended healthy diet as one of shared risk factors to reduce the risk of NCDs (Ministry 
of Health- Ghana, 2012). There is a link between consumption of saturated, trans and high 
sodium diet with increased risk of NCDs such as hypertension, ischemic heart diseases, 
diabetes, certain types of cancer among others(WHO, 2003). Increased consumption of 
fruits and vegetables have been shown to reduce the risk of NCDs yet fruits and vegetable 
consumption have been reported to be low among individuals (WHO, 2003).  There is the  
need to educate people to increase their consumption of fruits and vegetables and also ensure 
food environment that promotes the sale of fruits and vegetables. The World Health 
Organization in an effort to curb the proliferation of NCDs developed the global strategy on 
diet, physical activity and health. The document provides a tool for countries to adapt and 
implement the global strategy at national level. The frame work consist of population based 
approaches to increasing physical activity and global strategy on diet and marketing of food 
and non-alcoholic beverages to children. Despite these global efforts and strategies, there 
has been lack of commitment from government of member nations to effectively implement 
these strategies with continuous increase in NCDs ( Lachat et al., 2013).  In a systematic 
review on policies promoting the  role of diet and physical activity for prevention of NCDs 
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in low and middle income countries found 83% of policies but few countries proposed 
actions to promote healthier diet ( Lachat et al., 2013). Also in this same study only 12% 
had policies addressing all the four risk factors (alcohol intake, cigarette intake, unhealthy 
diet and physical inactivity).   
 
The disconnect between burden of NCDs and national responses to NCDs is a worrying 
trend as national nutrition policies or standards have a potential to  regulate food 
environments and result in population  wide benefits to curb the NCD epidemic. 
 
2.6 Nutrition Services in Schools  
Schools can be used as a medium to promote healthy dietary behaviors and help ensure 
appropriate nutrient intake (O’Toole et al., 2007). However, though most school authorities 
show positive attitudes towards improving nutrition services in their  schools yet only a few 
schools have policies to regulate food services (French et al., 2002). 
 
There have been increasing interest in foods sold in schools with some jurisdictions setting 
nutrition standards to regulate the sale of certain foods in schools. Despite the increasing 
concern, several schools do not have any policy or standard with the few who have not fully 
enforcing them.  Such low commitment on the part of school authorities can have 
implications on nutrition services offered in schools.  
 
In a study to investigate nutrition services and foods available in schools in the United States 
of America found that few states required schools to restrict the availability of deep- fried 
foods and prohibit the sale of foods that have low nutrient density.   
 
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Nutrition services in schools should be improved by ensuring opportunities to eat and drink 
at schools and to encourage daily consumption of whole grains, vegetables, fruits and low 
fat dairy products (O’Toole et al., 2007). Improved nutrition services in schools need 
improvement to reduce the risk of obesity among students with implementation of food 
preparation practices that reduce total fat, saturated fat, sodium and added sugar content of 
school meals (O’Toole et al., 2007). 
 
2.7 Nutrition standards and policies in Ghana. 
Nutrition standards serve as model for shaping eating habits of students in several settings. 
There is some evidence suggesting that nutrition standards if well enforced at the national 
or school levels can serve as an effective regulation of unhealthy food environments and 
hence reduce the risk of people to obesity and diet-related NCDs. There have been several 
nutrition policy interventions in many countries in attempt to combat  unhealthy food 
environment towards reducing obesity and diet-related NCDs (Laar et al., 2018). 
 
The government of Ghana signed the convention of WHO global strategy on diet, physical 
activity and health in attempt to foster healthy food environments through nutrition policy 
or standards. However, review of literature brings to light staggering nature of nutrition 
standards at the national, work or school levels. A literature review to assess Ghana’s 
policies for creating healthy food environments revealed that, there was no published 
evidence of nutrition standards for food composition however, the study found that, the 
2012-2016 strategy focusing on prevention and management of non-communicable diseases 
(NCDs) suggest that attempts may be made in future to address nutrition composition. . In 
this same study there was evidence of some progress of food composition standards in some 
countries, for example in Denmark the government has adopted a law on mandatory 
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maximum limits of sodium permitted in meat products, breads, soups seasonings and tinned 
foods. Also in South Africa, the government has adapted nutrition standards for target of 
salt reduction for some food categories (Laar et al., 2019)  
 
There was also no evidence of national nutrition standards in schools or work place. The 
Ghana government since 2005 has been implementing the School Feeding Program aimed 
at providing one warm nutritionally adequate locally produced meal. Despite several years 
of this program there have been limited information on available nutrition standards guiding 
the caterers and nutrition officers in charge of this program. A review study by Laar et al., 
(2019) to investigate Ghana’s policies towards creating healthy food environment found no 
published evidence of nutrition policy or standards by government in schools or other public 
settings for food service activities to ensure the provision and promotion of healthy food 
choices. With regards to schools, there was no evidence of good support and training 
systems to help schools and other public sector organizations and their caterers to meet the 
healthy food policies guidelines or standards. The review study revealed that there was some 
form of supervision for caterers contracted for the school feeding program but with no 
evidence of exist nutrition standards guiding the work of the caterers. 
 
2.8 Food environment and food choice among school students 
Food environment has long be associated with food choice among students. Food choice 
which has been mostly shaped by food availability and food environment has been reported 
as an important determinant of food choice among students. Though there been concern 
about the methodologies used to assess the relationship between food environment and food 
choice among school students, however several of such studies have shown a consistent 
relationship between food environments and food choice among school students (Deliens et 
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al., 2014) The complex interaction between food environment and food choice culminating 
to increase risk of obesity and diet-related NCDs needs to be fully understood to be able to 
put it efforts to promote healthy food environment that can improve upon healthy food 
choices of students. 
 
In a qualitative study to investigate the determinants of eating behavior in university 
students, food environment was reported as a strong determinant of food choice among 
students (Deliens et al., 2014). The study reported that meals offered in campus canteens 
influenced student food choices. Students were more likely to choose meals in campus 
canteens due to convenience. This was mostly reported as important predictor especially 
during exams when students don’t enough time and need to find convenience foods within 
the university environment. 
 
In another study, to assess the school food environment and dietary behaviors among 
adolescents there was a strong association between school food environment and food 
choices (Papas et al., 2007). The results indicated that fruits and vegetables intake was low 
whiles there was a positive consumption of total and saturated fatty foods. The school food 
environment was reported as contributor for decrease consumption of fruits and vegetables 
and positive association of consumption of total fat and saturated fatty foods. 
 
This consistent above findings brings to light the contributions of food environments to food 
choice among students. With the increasing rise of obesity among school children, there is 
a need to influence the establishment of healthy food environment by setting and 
enforcement of nutrition standards to be able to mitigate the impact unhealthy food 
environment. 
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2.9 Gaps in Literature  
A review of literature brings to light the staggering gaps that exist in available information 
on the nutrition standards and nature of foods and non-alcoholic beverages sold in most 
public universities in Ghana and its contributions to obesity and non-communicable 
diseases. 
 
 In Ghana there is paucity of data on the availability of nutrition standards and nature of 
foods and nonalcoholic beverages sold in schools and public settings. A review of several 
studies show there is no data on studies in Ghana on nutrition standards and nature of foods 
in schools. In a review by Laar et al., (2019) to investigate Ghana’s policies for creating 
healthy food environments reported there no published evidence of food provision or 
composition standards for Ghanaian schools and public sector settings. The study revealed 
that, the 2012-2016 strategy focusing on prevention and management of non-communicable 
diseases (NCDs) suggests that attempts may be made in future to address nutrition standards 
in the near future. With regards to the nature of foods sold in schools there is paucity of data. 
 
This study will provide a preliminary data for strengthening nutrition standards and regulate 
the profile of foods and non-alcoholic beverages in most public universities.  
 
  
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CHAPTER THREE 
METHODOLOGY 
3.1 Study Design 
 A cross-sectional study design using both qualitative and quantitative methods was used 
in this study. 
 
3.2 Study Site. 
The study was conducted at the University of Ghana main campus. The University currently 
has a student population of about 37,940. Legon Campus is located within an urban dwelling 
space with numerous economic activities. Legon campus serves as the main campus among 
the University’s various satellite campuses. It is located within the capital city of Ghana, 
Accra precisely the Ayawaso sub-metro Area. This campus have a very dynamic 
environment with teaching and residential facilities for students, lecturers and other workers 
of the university.. The University currently has 4 colleges and 18 schools. These schools has 
about 96 departments running various programs in the University. 
 
The University has an estimated number of 148 canteens with at least each hall having a 
minimum of two canteens providing various services of food retailing business to students. 
Within the campus and its surrounding are numerous economic activities including food 
retailing. 
 
3.3 Study Population 
Food service canteens within the University of Ghana main campus and key informants 
from food outlets and the University were the study population. 
 
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3.4 Variables 
3.4.1 Outcome (dependent) Variables 
The outcome variables of this study include: 
Nature of foods sold: eg. Sale of fruits and vegetables, the sale of sugar sweetened 
beverages, sale of whole grains, sale of refined carbohydrates and sale of fried foods. 
The availability of nutrition standards and Food hygiene and safety practices of canteens 
within the University of Ghana. 
 
3.4.2 Explanatory (independent) Variables 
The explanatory variables are: 
Type of food outlets: eg. Hall canteens, market canteens and table top foods. 
Type of food service business: individual and partnership 
 
Duration of operation of food service business: e.g < 5 years, 5-10 years and more than 10 
years of operation. 
 
3.5 Inclusion Criteria 
All canteens operating within the University of Ghana main campus and key informants 
from the university who are responsible for regulating food services were included. 
 
3.6 Exclusion Criteria  
 Canteens which sold only food provisions were excluded in the study. 
 
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3.7 Sampling Method  
A census was used in this study, where all canteens operating within the University of Ghana 
main campus were enumerated. 
 
3.8 Data Collection Techniques and Tools 
3.8.1 Determining the availability of nutrition standards 
A combination of qualitative and quantitative tools was used in data collection. The main 
instrument for qualitative data collection was an interview guide administered by the 
investigator to the University authorities who have the core mandate for regulating food 
service business on campus.  Key informant interviews was done by face-to-face interview 
with an interview guide and list of open ended questions relevant to assessing nutrition 
standards in the University of Ghana. Notes were taken during the interview as well as tape 
recording. The interview guide for determining availability of nutrition standards can be 
found in Appendix 1. 
 
3.8.2 Describing the nature of foods and non-alcohol beverages. 
A modified questionnaire adopted from a study by Marras et al., (2016) on street food 
vending in Accra, was used to help describe the nature of food and non-alcoholic beverages. 
All foods and non-alcoholic beverages was categorized into food group of nutritional 
significance.  This checklist contained a list of all possible foods and non-alcohol beverages 
which was grouped into fruits, vegetable salad, cooked dishes, industrial beverages, 
homemade snacks, natural or homemade beverages and prepackaged snacks. This was used 
to collect data to assess the nature of foods sold at the canteens of University of Ghana. This 
checklist can be found in Appendix 2. 
 
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3.8.3 Assessing hygiene practices of canteens at the University of Ghana 
Data on hygiene practices of the canteens was collected through the use of a modified 
questionnaire from a study by Marras et al., (2016) on street food vending in Accra, Ghana. 
The questionnaire contained a set of questions about several factors that determined food 
hygiene and safety levels. This included certified health food safety certificates, availability 
of water and cleanliness of water used in the canteen, use of detergents, practices and ways 
to preserving foods and ingredients, means for preparation of foods.  This check list can be 
found in Appendix 3. 
 
3.9 Quality Assurance 
Adequate mechanisms were put in place to safeguard and guarantee data accuracy and 
quality and to rid it of any bias. The measures included training of research assistants, pre-
testing of questionnaires, editing of completed questionnaires, and same day data entry. 
Research assistants were monitored on daily basis. All completed data was validated and 
entered on daily basis. Also, the dataset was cleaned before analysis. Completed 
questionnaires was kept under lock and key to prevent unauthorized people from gaining 
access to them. Also, the questionnaires and audio files will be discarded 6 months after 
publication of the findings of the study. 
 
3.10 Training of Field Workers 
Two (2) research assistants were recruited to help administer questionnaire, code and enter 
the information obtained into Microsoft Excel (version 2010).   These research assistants 
were fluent in English and were trained for two (2) days on the questionnaires and how to 
obtain consent, as well as handling the information collected. Their work was additionally 
supervised and reviewed daily.  
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3.10.1 Pre-Testing of Questionnaires 
The questionnaires were pre-tested prior to final administration to the candidate participants. 
Pre-testing was conducted among operators of canteens outside the University of Ghana 
Campus. However, this sample was not part of the sample for the main study. This stage 
also offered the interviewer a better understanding of the questionnaire and a chance to 
organize appropriate answers for likely questions that may be asked by some members of 
the study population. 
 
3.10.2 Editing Pre-Tested Questionnaires 
Exposed errors and inconsistencies from the conducted pre-testing were amended and 
reviewed before actual commencement of the study.  
 
3.10.3 Data Entry and Processing 
The information collected was screened thoroughly, validated, serialized and coded within 
24 hours before entry into Microsoft Excel 2010. After entry, the data set was crosschecked 
for errors with hard copies individually to ensure every variable defined is in the right place.  
 
3.11 Data Analysis 
3.11.1 Quantitative data analysis 
 Analysis of research data was done using Statistical Package for Social Science version 21. 
(SPSS).  Descriptive statistics were be used to summarize data from the different food 
categories sold at the canteens and presented in the form of means, percentages, graphs, 
tables and charts. Associations were determined between food categories and some selected 
food outlets characteristics using Pearson chi square. A p-value less than 0.05 was regarded 
as significant. The questionnaire used to collect information on the food hygiene and safety 
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practices of the canteens, had scores assigned to each questions ranging from -1 (extremely 
poor) to +1 (extremely good). The average scores of responses were used to evaluate the 
food hygiene and safety of food outlets on a 7-level scale:  Extremely good (> 0.7), very 
good (0.5 to 0.7), Good (0.2 to 0.4), fair (0.1 to -0.1), Poor (-0.2 to -0.4), very poor (-0.5 to 
-0.7), extremely poor (< -0.7).   
 
3.11.2 Qualitative Data Analysis 
The recorded IDIs were transcribed and compared with hand written field notes to ensure 
that every piece of the data were captured. The data was initially sorted into responses from 
the different categories of respondents namely availability of nutrition standards and 
implementation of existing nutrition standards. For each of the above categories of 
respondents, the responses (transcript and field notes) were manually analyzed using 
thematic content analysis technique. 
 
Themes were developed from the responses of participants to the various questions asked. 
Alphabets were used to code the various themes and the alphabets were used to label 
responses that were closely related to the respective themes. Responses were then grouped 
under the various themes and reported appropriately. Descriptive narratives supported by 
illustrative quotes were used to present the results to determine availability of nutrition 
standards. 
 
3.12 Ethical Considerations 
The study was done at the university of Ghana canteens. Ethical approval was obtained from 
the University of Ghana, College of Health Sciences Ethical and Protocol Review 
Committee as a requirement to conduct a research at the canteens of university of Ghana. 
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Approval was sought from the Director of Physical Development and Municipal Services 
Directorate (PDMSD) of University of Ghana. Subjects who were involved in the study 
were key informants from the university who regulate food service business, key informants 
from food service business, foods sold at the university canteens. 
 
3.13 Risks   
Participants in this study were not exposed to any risks. In view of this, the design of the 
questionnaire were well structured to facilitate the discourse. The respondents were told 
about the general nature of the study and assured of no potential harm. 
 
3.14 Compensation 
Compensation was not paid to participants for consenting to be part of the study. 
Participants’ contribution to this study was however, recognized and appreciated. 
 
Though the participants did not have any immediate or direct benefits from the study, their 
responses would be helpful in policy planning and formulation of nutrition standards in the 
university to promote a healthy food environment and contribute to WHO global action to 
prevention and control of NCDS. 
 
Participants were told of their freedom to decline participation or withdraw from the study, 
with no consequences should they decide to do so.  
 
3.15 Participants’ Consent 
A written informed consent was sought from study participants prior to data collection. 
Canteen managers and university authorities were required to sign a form to indicate 
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consent. All participants were allowed to ask any questions they might have in relation to 
the study.  
 
3.16 Confidentiality   
Participants were assured of confidentiality of the data to be collected. Regarding privacy 
and anonymity, the information provided were treated with strict confidentiality.  Filled 
questionnaires and tapes were kept under lock and key to prevent unauthorized people from 
gaining access to them. Questionnaires will be discarded 6 months after publication of the 
findings of the study. No participant’s name   was   mentioned in any of the report.  
 
3.17 Conflict of Interest  
 The Principal investigator declares no conflict of interest with respect to the conduct of this 
study. This study is being self-sponsored by the researcher in partial fulfillment for a 
Masters of Public Health Degree from the University of Ghana. 
 
 
 
  
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CHAPTER FOUR 
RESULTS 
The findings of nutrition standards and nature of foods sold in the University of Ghana 
Canteens are presented in this chapter. The results are presented under the following 
thematic areas; background characteristics of key informants and food outlets, nature of 
foods and food hygiene and safety status of food outlets. 
 
4.1 Background characteristics of key informants from the University. 
A total of nine eligible key informants from the university aged between 34 to 57 years were 
interviewed. The key informants who were directly responsible for regulating food service 
business in the University are staff of PDMSD (n=3), hall masters (n=5) and the University 
Legal Council (n=1).   
 
4.1.1 Background characteristics of food outlets and canteen staff. 
Table 4.1 presents the background characteristics of the food outlets and canteen staff.  Data 
was collected from 98 food outlets. Out of the 98 food outlets, 79.6% were canteens and 
20.4% were table top foods. Among the 79.6% canteens, majority were market canteens 
(71%) and the rest being canteens located in the halls (29%). 
 
The food outlets with the longest duration of operation was between 5-10 years (33.7%), 
followed by those who have been in operation for more than 10 years (24.5%) and those 
with less than 5 years of operation (10.2%). 
 
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With regards to type of food service business, 91.8% were individual businesses and 8.2% 
being partnership.   About 27.6% of food outlets reported having a menu and 10.5% reported 
having a special diet. 
 
Background information of Canteen staff who completed the questionnaire on behalf of the 
food outlets were made of owners (38.8%), followed by employees (33.7%) and managers 
(27.5%). Majority of those who completed the questionnaire were females (81.6%). Details 
can be found in Table 4.1 below. 
Table 4.1: Background characteristics of food outlets and Canteen staff (n=98 unless 
otherwise stated) 
Attribute         Frequency(n=98)                Percent (100%) 
 
Type of food outlet   
Canteen 76 79.6 
Table top foods 22 20.4 
Canteen type   
Market canteens 54 71 
Hall canteens 22 29 
Total 76 100 
Duration of food service   
in the University 
<5 years 10 10.2 
5 - 10 years 33 33.7 
more than 10 years 24 24.5 
Type of food service   
Individual 90 91.8 
Partnership 8 8.2 
Availability of Menu 27 27.6 
Presence of special diet  8 10.5 
Position of key   
informant 
Owner 38 38.8 
Manager 27 27.6 
Employee 33 33.7 
Sex of key informant   
Male 18 18.4 
Female 80 81.6 
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4.2 Nature of foods sold at the university of Ghana canteens. 
Out of the 98 food outlets,  93.9% sold  fried foods, 84.7% sold  sugar sweetened beverages, 
83.9%  sold s either fish or meat, 82.7% sold starchy roots and tubers, 80.6% sold  refined 
carbohydrates, 73.7% sold  carbonated drinks, 49%  sold energy drinks, 40.8% sold  fruits 
or vegetables, 45.6% sold sell industrial juice, 38.8% sold  whole grains and 22.4% sell 
industrial snacks.  Details are presented in table 4.2 below. 
 
Table 4.2: Food based categorization of the different types of foods offered for sale. 
 (n=98, unless otherwise stated). 
Attribute           Frequency (n=98)        Percent (100%) 
Food category   
Pre-packaged industrial 22 22.4 
snacks 
Ingredients include meat or 78 83.9 
Fish on sale 
Carbonated drinks 42 73.7 
Energy drinks on sale 28 49 
Industrial Juice 26 45.6 
 Fruits and vegetables   
Sale of fruits or vegetables 40 40.8 
 Whole grains   
Sale of  whole grains 38 38.8 
Fried foods  
Sale of Fried foods. 92 93.9 
 starchy roots and tubers   
Sale starchy roots and                        81                                        8  2  . 7                                                         
tubers 
Sugar sweetened 
beverage 
Sale of sugar sweetened 83 84.7 
beverages 
Refined Carbohydrates   
Sale of refined 79 80.6 
carbohydrates 
 
  
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4.3 Associations between food categories and some selected food outlets 
characteristics. 
A chi square analysis was used to explore the relationship between food categories and some 
selected food outlets characteristics. Results from the analysis (table 4.3) show that sale of 
whole grains (p<0.001) was significantly associated with type of food outlets. Sale of Sugar 
sweetened beverages (p<0.01) was significantly associated with years of operation of food 
outlets.  However, sale fruits or vegetables and sugar sweetened beverages were not 
significantly associated with type of food outlets. Also, sale of fruits or vegetables and whole 
grains were not significantly associated with years of operation of food outlets.  Food outlets 
characteristics (fruits or vegetables, whole grains and fried foods) were not significantly 
associated with type of business.   
 
Results from the analysis (Table 4.4) also show sale of refined carbohydrates and fried foods 
were not significantly associated with any of the food outlets characteristics (type of food 
outlets, operation of years of food outlets and type of business).  Details can be found in 
Table 4.3 and 4.4 below. 
 
 
 
 
 
 
 
 
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Table 4.3: Associations between food categories and some selected food outlets characteristics. 
 
Variable Fruits or vegetables P- Sugar sweetened        P-      Whole grains P-value 
 value beverages value 
 Yes   No  Yes No  Yes    No  
 Type of food          
outlet 
 Market 18 (34) 35 (66) 0.053 44 (83) 9 (17) 0.750 11 (20.8) 42 (79.2) < 0.001    
canteens 
 
Hall canteens 14 (63.6) 8 (36.4)  20 (90.9) 2 (9.1)  8 (36.4) 14 (63.6)  
Table top 8 (34.8) 15 (65.2)  19 (82.6) 4 (17.4)  19 (82.6) 4 (17.4)  
foods 
          
Years of 
operation of 
food outlet. 
<5 years 10 (27.8) 26 (72.2) 0.143 34 (94.4) 2 (5.6) <0.010 12(33.3) 24(66.7) 0.637 
5-10 years 15 (48.4) 16 (51.6)  28 (90.3) 3 (9.7)  12(38.7) 19(61.3)  
More than 10 15 (48.4) 16 (51.6)  21 (67.7) 10 (32.7)  17(54.8) 14 45.2)  
years 
          
Type of 
business 
Individual 36 (90) 54 (60) 0.712 77 (85.6) 13 (14.4) 0.604 35 (38.9) 55 (61.1) 0.626 
Partnership 4 (10) 4 (50)  6 (75) 2 (25)  3 (37.5) 5 (62.5)  
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Table 4.4: Associations between food categories and some selected food outlets 
characteristics continued. 
Variable Refined carbohydrates P-value Fried foods P-value 
    Yes       No      Yes  No  
Type of food outlet       
Market canteens 39 (73.6) 14 (26.4) 0.180 34 (94.4) 2 (5.6) 1.000 
Hall canteens 20 (90.9) 2 (9.1)  29 (93.5) 2 (6.5)  
Table top foods 20 (87) 3 (13)  29 (93.5) 2 (6.5)  
Years of operation       
of food outlets 
<5 years 28(22.2) 8 (77.8) 0.565 34 (94.4) 2 (5.6) 1.000 
5-10 years 27(87.1) 4 (12.9)  29 (93.5) 2 (6.5)  
More than 10 years 24(22.6) 7 (77.4)  29 (93.5) 2 (6.5)  
Type of business       
Individual 73 (18.9) 17 (18.9) 0.650 85 (94.4) 5 (5.6) 0.409 
Partnership 6 (25) 2 (25)  7 (87.5) 1 (12.6)  
 
4.4 Nutrition Standards 
4.4.1 Availability of nutrition standards 
There   were some nutrition standards available in the University of Ghana with very scanty 
information about its implementation and enforcement. Out of the nine key informants 
interviewed, four confirmed availability of some nutrition standards. The nutrition standards 
that were reported to be available were food hygiene and safety and food based standards. 
There was no availability of nutrient based standard in the university. These were responses 
of some key informant’s in relation to nutrition standards: 
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“We do not have any standard specifically on nutrient standards, we only have a 
standard on food hygiene. In relation to food hygiene and safety, we are normally 
interested in medical screening, sanitation and hygiene. We ensure food vendors do 
not sell closely to refuse dumps, we expect that hygienically  finger nails of food 
vendors should be cut, the food sellers should cover their hair, the cooking area 
should be neat and ensuring food sellers wear apron when selling food”(male , 43 
years). 
“There is nothing specifically on food based and nutrient standards in the tenancy 
agreement except a few clauses on food hygiene that states the kitchen and other 
cooking materials are subject to inspection by PDMSD. So PDMSD are supposed 
to be in charge of that food hygiene standard” (Female, 35 years). 
 
The only food based standard in the university was at Volta hall where the hall management 
have taken initiative to sell vegetables salads and smoothies and were not applicable to the 
entire University Community. 
 “So for Volta hall, we have a standard where one of our private canteen can only 
serve salads and smoothies. They prepare different types of salads and smoothies 
for sale.  One of key things was that we didn’t want competition with our kitchen 
where they will sell the same meals with them because it’s an income generator for 
us. Also we needed healthy foods like the salads and smoothies hence they need for 
such initiative” (female, 48 years). 
 
With the exception of the standard on food hygiene, there was no evidence of written 
documents on the food based standard.  
“There are few things I may say we do in relation to nutrition standards and that 
has to do with the sale of vegetable salad and smoothies but they are not written 
guidelines. 
There is some regulation for food service canteens in the tenancy agreement 
document, which talks about  food hygiene, waste disposal, no trash in cooking area 
hazardous material, smoking and no noise around the premises”   (female, 35 years) 
 
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4.4.2 Implementation and enforcement of the existing nutrition standards. 
Despite the availability of some nutrition standards, some of the key informants expressed 
concerns about the implementation and enforcement of the standards. These are the 
responses of some key informants in relation to implementation and enforcement of 
nutrition standards: 
“No, am not sure standard on hygiene are being implemented as it should be. Until 
recently, there was a little challenge with the implementation, the head of the 
Environmental Department of PDMSD felt they should have been in charge of the 
market instead of the Estate Department leading to confusion of roles. The university 
auditors came around and discovered that in the process of their audit only two 
people in the market had gone for their medical exam so a query was raised” (Male, 
34 years). 
 
“Night market as I discussed, is not in good shape. They are supposed to dispose 
their refuse around the  Ecobank Credit union area, which is very far and hence they 
sometimes dump the refuse with sacks around the market. They (market women) 
should have containers and dustbins to help them dispose refuse well. So I think the 
standards on hygiene and sanitation are not being implemented as it should be 
(Male, 34 years)” 
 
Again, another officer had this to say regarding the implementation and enforcement of 
existing nutrition standards. 
“I was given the task to write a report on the state of bush canteen and night market 
canteens. It’s true that food canteens at night market don’t have a place of 
convenience and also they have sewage problems, no proper drainage, they do not 
have a place for waste disposal, no dust bins and there is improper waste disposal. 
Most of them store waste in fertilizer sacks” (Male, 44 years) 
 
Some of the hall masters expressed dissatisfaction in the implementation and enforcement 
of food hygiene and safety practices of some of the canteens in their halls and the university 
in general. 
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“I do not think PDMSD does a regular checkup of these canteens as they should. I 
know for sure that PDMSD are responsible for food hygiene of these canteens but I 
doubt if they do it as their supposed monitor” (Female, 48 years). 
  
4.4.3 Views of key informants on whether nutrition standards can help improve the 
nature and quality of foods on sale. 
The key informants expressed positive views on the role of nutrition standards in regulating 
the nature and quality of foods sold at the canteens of University of Ghana. All of them 
unanimously indicated nutrition standards are key in the regulation of unhealthy meals but 
this can only be done only if it is well implemented and enforced. These were some 
responses of key informants in relation to whether nutrition standards can improve the 
quality and nature of foods offered for sale: 
“Yes definitely nutrition standards can help improve the nature and quality of foods. 
I know of a few instances not in the halls but generally in the university where one 
or more people have had poisoning. One of our student died from night market after 
having food poisoning from night market could recover from it. So definitely if the 
university will come up with some form of legislation to curb these things we would 
all go for it” ( Female 48 years). 
“It will go a long way to improve health by regulating the sale of unhealthy meals. 
As you are coming with this research, I will also plead that environmental health 
officers should have Dietitians in their monitoring team to ensure that food canteens 
staff and food vendors are educated on how to improve the quality of the 
foods”(Male, 44 years). 
“Certainly yes, nutrition standards can help improve the nature and quality of foods 
sold on campus. We are managers and if we have to do anything that will ensure the 
students, the staff and lecturers are eating well, why not. If the university hospital 
can give us Dietitians in that regard we will be willing to partner with them for 
technical assistance” (Male, 34 years). 
 
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4.4.4 Views of key informants on the university Ghana’s priority in implementing 
and setting nutrition standards. 
Key informants expressed their views about lack of priority on the part of the University of 
Ghana in setting and enforcing of nutrition standards to make the University a nutrition 
friendly school. All key informants reported nutrition standards are not of priority to the 
University. They expressed lack of commitment on the part of university to setting, 
implementing and enforcement of nutrition standards. These are the responses of key 
informants in relation to their views on whether nutrition standards are of priority to the 
university. 
 “As a University, I wouldn’t say it was been a priority to the university may be a 
particular university department like the nutrition and food science department 
because it’s in their field they would have done a lot of research in that field but not 
much has been done as a university in general in relation to nutrition standards” 
(Female, 48 years). 
“The university has not put much priority in regulating food standards. I think it’s 
so because may be they do not have policies and I don’t know how they are going to 
regulate it” (Female 35 years). 
“The focus of the University has not been on nutrition standards. May be the 
nutrition departments can send a proposal so it can factored it. Even the food for 
senior members is always pastries and drinks. This is because that has not been the 
core mandate of the university” (Female, 35 years) 
“I would say much attention has not be given to set nutrition standards in the 
university. More priority can be put in to attach Dietitians to PDMSD to help in the 
nutrition standards to enable us to set nutrition standards” (Male, 43 years). 
 
Only one of the key informant said nutrition standards have been a priority to the university. 
This was the response of the key informant: 
“From where I sit I think the university have given priority to nutrition standards, 
thus why we have PDMSD to regulate medical exams of people selling food. The 
university have the programs as to whether they do well in terms of monitoring is 
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another issue but I will say the university has some priority as far as health and 
nutrition standard is concern” (Male, 46 years)  
4.4.5 Process food service businesses are required to satisfy before being granted a 
space to operate in the University of Ghana. 
All the key informants described a process they consider before issuing permission for food 
service business to operate in the University. The processes were similar across food service 
businesses in the halls, market, and other rented food service business within the University. 
Some of those processes were an application letter, medical screening, payment of rent, and 
tenancy agreement as some of the processes or requirement a person will have to satisfy 
before being qualified and granted a space to set up a food service business. These were the 
responses of key informants on the some of the process they consider in granting license to 
food service managers: 
 “Food service canteen managers are first of all required to bring an application 
and inform us what they need the space for.  After the form has been filled we 
generate an allocation letter, in which they are certain things they are required to 
satisfy which include, paying their rent, report to the environment health department 
of PDMSD for medical screening to be done since they are going to sell food” (Male, 
35 years) 
“The university has guidelines and criteria for allowing people to sell food not just 
in the halls but on campus in general. They are normally required to apply to 
PDMSD and you will need to take some medical  tests am not sure of the test but 
some tests like TB among others, once you pass you are then allowed to apply to the 
hall” (Female, 48 years) 
“I think it went through a bidding process and we have a developmental community 
and who interacted with them and the winner was given the contract which happened 
to be tasty treats. In the bidding process they were asked to bring a proposal 
specifying what business they would want to run. Whether it is for food alone or 
pastries alone. These were things the committee looked at in awarding the contract” 
(, Male, 46 years). 
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4.5 Food hygiene and safety practices of food outlets.  
The food hygiene and safety practices of canteens were determined by measuring several 
factors that can determine the food hygiene and safety status of food outlets.  The food 
hygiene and safety factors of the food outlets turned out that 79.6% had valid food handler 
certificate with those who have done medical screening for their staff less than 12 months 
being 45.9% and the least of them having done medical screening for their staff more than 
24 months ago (11.2%). Availability of clean water for hand washing at selling point 
revealed 62.2% of the food outlets had buckets with clean running water for hand washing 
and buckets with dirty water at food outlets least (7.1%). Those with hand sanitizer or soap 
at selling point was 82.7%. Majority of the food outlets prepares food on the spot, followed 
by those who prepare from home (28.6%) and 5.1% reported having professional kitchen or 
laboratory. About 28.6% reported buying meat/fish/eggs/chicken on the same day whiles 
28.6% reported the sale of left overs. About 66.3% reported having a fridge for food storage 
with 79.6% reported selling food whiles it’s hot. Majority about 69.4% reported using 
disinfectant for treating vegetables. With regards to the use of fuel type, 72.4% reported the 
use of electricity and 44.9% reported using charcoal or wood.  
 
 
 
 
 
 
  
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Table 4.5: Factors that determine food hygiene and safety practices of food outlets.  
Attribute            Frequency (n=98)           Percent (100%) 
   
Valid food handler certificate 78 79.6 
  
Medical screening 
Less than 12 months ago 45 45.9 
Between 12 to 24 months ago 23 23.5 
More than 24 months ago 11 11.2 
Never 19 19.4 
Water for washing at food 
outlet  
Running water from plastic tanks 9 9.2 
In buckets (clean water) 61 62.2 
In buckets (dirty water) or No 7 7.1 
water 
Presence of hand sanitizer or 81 82.7 
soap at selling point. 
Place of food Preparation   
Professional kitchen /laboratory 5 5.1 
On the spot 55 56.1 
At home 28 28.6 
Not Applicable 10 10.2 
When meat/fish/eggs/chicken   
are    
Purchased 28 28.6 
On the same day 
Sale of left overs 28 28.6 
Presence of a fridge for food 65 66.3 
storage 
Food is served hot. 78 79.6 
Use  of disinfectant for treating 68 69.4 
vegetables 
Use of electricity or gas 71 72.4 
Use of wood/charcoal 44 44.9 
 (n=98, unless otherwise stated). 
  
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4.6 Food hygiene and safety training among food outlets. 
The graph below shows the distribution of food outlets who have done food hygiene and 
safety training for their staff. A total of 68.4% of the food outlets reported conducting a food 
hygiene safety training for their staff whiles 31.6% of reported no food hygiene and safety 
training. Figure below presents details. 
 
Figure 4. 1: Percentage distribution of food outlets who have done food hygiene and 
safety training 
Food Hygiene and safety training 
31.6
Yes
No
68.4
 
 
4.7 Food Outlets with presence of toilet and clean running water 
The graph below shows the distribution of food outlets with a toilet facility and clean 
running water. It turned out that 70.4% of the food outlets has a toilet with clean running 
water whiles 29.6% has a no toilet facility with clean running water and safety training. 
Details can be found below. 
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Figure 4. 2: Percentage distribution of food outlets with toilet and clean running 
water 
Presence of toilet with clean running water.
29.6
Yes
No
70.4
 
 
4.8 Percentage distribution of food inspection at the point of sale 
The figure below shows the percentage distribution of food inspection at the point of sale 
among food outlets. Majority of the food inspection at the point of sale was done quarterly 
(30.6%), followed by monthly (25.5%) with 14.3% of food outlets reported no food 
inspection has ever taken place at the point of sale. About 13.3% reported food inspection 
at the point of sale half yearly and 11.2% yearly and a few reported food inspection at the 
point of sale weekly (5.1%). Details are shown in the figure below.  
  
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Figure 4. 3: Percentage distribution of food inspection at the point sale among the 
food outlets 
Food inspection at the point of sale
35
30.6
30
25.5
25
20
14.3
15 13.3
11.2
10
5.1
5
0
weekly Monthly Quarterly Half yearly Yearly Never
Duration
 
 
4.9 Food hygiene and safety levels of food outlets 
The figure 4.3 shows the food hygiene and safety levels of food outlets. The results of the 
food hygiene and safety levels revealed that 5% of the food outlets scored very poor, 20% 
scored poor,   5% scored  fair, 26% scored good, 24% scored  very good and 18% scored 
extremely good. Details can be found in the figure below. 
 
  
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Percentage
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Figure 4.4: Food hygiene and safety levels of the food outlets 
Food hygiene and safety levels of food outlets
30
26
25 24
20
20
18
15
10
5 5
5
0
Very poor Poor Fair Good Very good Extremely good
Food hygiene and safety levels
 
 
 
 
  
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Percentage
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CHAPTER FIVE 
DISCUSSION 
This chapter discusses the findings of the study under the following areas; nature of foods 
sold in the University of Ghana canteens, nutrition standards in University of Ghana and 
food hygiene and safety practices of canteens or eateries in University of Ghana. 
 
5.1 Nature of foods sold in the University of Ghana canteens 
One of the objectives was to assess the nature of foods sold in the University of Ghana 
Canteens. The study revealed the sale of energy dense foods at the canteens of University 
of Ghana.  Majority of the food outlets sold sugar sweetened beverages, refined 
carbohydrates, and fried foods. Though a number of the food outlets sold fruits or 
vegetables, there is still a need to foster an environment that will allow the sale of more 
fruits or vegetables.  
 
This current study findings is consistent with a study done in Columbia which investigated 
nutrition services, foods and beverages sold in schools which found high sale of  sugar 
sweetened beverages, deep fried foods and low sale of fruits and vegetables (O’Toole et al., 
2007). Also, another study done in Belgian to assess the nutritional profile of foods offered 
in a Belgian University canteen also showed availability of poor quality of foods offered for 
sale (Lachat et al., 2009).  
 
This has implications for food choices and excess energy consumption since meal choices 
and consumption is mostly determined by what is available (Deliens et al., 2014).  Given 
the rise of obesity and diet-related NCDs, effective regulation of sale of unhealthy food 
choices in schools is needed to improve the dietary intake of students. Also students cannot 
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make healthy food choices if what is being offered for sale are unhealthy. This hampers the 
efforts by schools and health professionals to build healthy eating habits among students 
through nutrition education.  Students are receiving inconsistent messages about health and 
safety of foods given the unhealthy food environment they are surrounded with (O’Toole et 
al., 2007).  The high prevalence of energy dense meals found in these eateries will expose 
students to consumption of  energy dense meals hence increasing their risk of diet-related 
NCDs (Kubik et al., 2003). Policy makers in schools also need to effectively regulate the 
sale of non-nutritive foods through implementation of healthy nutrition policies. The 
outcome of the study also further suggests more research need to be done on school food 
environment and its contributions to obesity and health of students given the rise of obesity 
among students in schools ( Story et al., 2009). 
 
5.1.1 Sale of fruits and vegetables. 
The study reported 40.8% of the food outlets sold either fruits or vegetables. This is 
consistent with the findings by Marras et al.,  that reported the sale of fruits and vegetables 
among food vendors in Accra  to be   between 30-46% (Marras et al., 2016) .  The sale of 
fruits or vegetables in this study did not vary much from that reported in the Accra street 
food survey. This may be because that study was also conducted in Ghana hence a similar 
trend of the sale of unhealthy foods over the sale of fruits and vegetables.  The low sale of 
fruits or vegetables compared to energy dense meals reflect a common practice where food 
service businesses prioritize the sale of non-nutritive foods over nutritive foods (Lachat et 
al., 2009). This suggests there is a need for nutrition policy to promote the sale of fruits and 
vegetables. Also food service managers should be educated on the need to provide healthy 
food choices.  
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Fruits and vegetables intake has been generally regarded as healthy due to its numerous 
health benefits ( Slavin & Lloyd, 2012).  The World Health Organization recommends 5-6 
servings of fruits and vegetables per day for maximum health benefits (WHO, 2018). Given 
the unique role fruits and vegetables play to improve health it has always been recommended 
that schools foster an environment that will promote the sale of fruits and vegetables. The 
University of Ghana  has no formal written policy  that promotes the sale of fruits and 
vegetables and hence for that matter it was not surprising the sale of fruits or vegetables 
were low in the food outlets compared to the sale of sugar sweetened beverages, fried foods, 
pastries and refined carbohydrates. This has implications for increased risk of obesity and 
diet-related NCDs since fruits and vegetables consumption has been strongly associated 
with low disease risk ( Slavin & Lloyd, 2012).  
 
Also the high availability of energy dense meals offered within the University environment 
will present challenges for nutrition and dietetics practice because students and staff who 
need to have diet and lifestyle changes will find it difficult to comply with dietary regimen 
which may be attributed to lack of access to healthy foods. The data also show there is a 
need for further research to investigate why there is generally low sale of fruits and 
vegetables among eateries in schools for interventions toward improving the availability of 
fruits and vegetables offered for sale. The evidence of this findings reinforces the need for 
nutrition policies to promote the sale of fruits and vegetables among eateries in schools. 
 
5.1.2 Sale of sugar sweetened beverages. 
Data pertaining to the study reported high sale of sugar sweetened beverages among the 
food outlets. The study found 84.7% sale of sugar sweetened beverages among the food 
outlets. 
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The sale of sugar sweetened beverages was the second largest food category of nutritional 
importance among the food outlets in the University of Ghana. Most of the sugar sweetened 
beverages were industrial pre-packaged beverages. The outcome of the study is in line with 
a study done in the United States to investigate foods and beverages available for sale in 
schools which found high availability of sugar sweetened beverages. The sale of sugar 
sweetened beverages offered for sale in vending machines, canteens, snack bars  was 
between 78.9% to 99.5%  in all the schools sampled  (Kann et al.,  2005).  The similarities 
in the sale of the sugar sweetened beverages could have been attributed to high purchase of 
sugar sweetened beverages among students since it’s been shown as common meal option 
for students due convenience (L’Abbé et al., 2013). 
 
Excessive consumption of sugar sweetened has been linked to risk of obesity, diabetes and 
other metabolic diseases (Malik et al., 2010). Due to this WHO recommends limiting intake 
of sugar to less than 10% of the total energy intake(WHO, 2018). The results of the study 
therefore has implications for obesity and risk of metabolic diseases prevention since 
availability of meal choice can influence its consumption and purchase. There is also a need 
for further research on the nutritional contributions of these sugar sweetened beverages and 
risk of obesity. High availability of sugar sweetened beverages will have implication on the 
practice of dietetics and nutrition professionals effort toward educating people to limit the 
intake of energy dense meals and reduce their risk of diabetes, obesity, cardiovascular 
diseases and other diet-related NCDs. Policy makers must influence food environment 
towards restriction of refined sugary beverages and improve the nutritional quality of foods 
offered for sale in schools particularly given that a significant association between the sales 
of sugar sweetened beverages and years of operation of food outlets was found in this study. 
Majority of the food outlets with regards to the data from this study shows most of the food 
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outlets have been in operation for more than ten (10) years and hence a significant 
association between the sale of sugar sweetened beverages and years of operation of food 
outlets could therefore imply a common practice of selling sugar sweetened beverages 
among the food outlets.  This observation is of public health significance because students 
and staff may have been long exposed to sugar sweetened beverages given the several years 
of operation of the food outlets. The exposure of sugar sweetened beverages will increase 
risk of consumption of energy dense meals leading to obesity and diet-related NCDs. This 
findings therefore suggest that food outlets within the University are potential places to 
consider when implementing food environment policies aimed at ensuring a healthy food 
environment at the University 
 
5.1.3 Sale of whole grains and refined carbohydrates 
The study found sale of whole grains and refined carbohydrates to be 38.8% and 80.6% 
respectively.  This is in agreement with the study to investigate nutrition services in schools 
that found high sale of refined carbohydrates (O’Toole et al., 2007).  Adequate consumption 
of whole grains has been shown to be protective of cancer, obesity, type 2 Diabetes, 
cardiovascular diseases whiles excess consumption of refined carbohydrates increase risk 
of obesity and type 2 diabetes ( Slavin, 2004).  Despite the recommendations of choosing 
whole grains over refined carbohydrates there is still a gap with what is being provided in 
most food outlets.  
 
The high sale of refined carbohydrates over whole grains is a worrying trend due to 
increased risk of obesity and diet-related NCDS. This will also have implications on 
managing diabetic patients since it has been shown that adequate intake of whole grains 
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improves glycemic control whiles intake of refined carbohydrates will result in poor 
glycemic control (Slavin, 2004).  
 
To effectively prevent diabetes and improve the glycemic control of patients with diabetes 
a diet focusing on whole grains is key and hence the high available of refined carbohydrates 
will make it difficult for access to healthy foods and make diet interventions difficult to 
comply with within the University of Ghana campus. 
 
There is a need for setting nutrition standards and policies to regulate and promote the sale 
of whole grains over refined carbohydrates to effectively reduce the risk of obesity and its 
associated health risk. 
 
The study reinforces the fact that what is being offered for sale in food outlets in the 
University of Ghana are of poor nutritional quality and hence there a need to regulate 
unhealthy food environment in the University and this can be achieved if nutrition policies 
are put in place to regulate the sale of whole grains over the sale of refined carbohydrates. 
 
5.1.4 Sale of fried foods 
Majority (93.9%) of the food outlets were involved in the sale of fried foods. Fried foods 
was the highest food category available for sale among the food outlets. The outcome of the 
study is similar with a study done in Belgian to investigate the nutritional profile of foods 
sold in a Belgian University which reported high sale of deep fried foods. This trend was 
not different in the University of Ghana because generally most school food environments 
are unhealthy due to lack of policies to regulate meal options available for sale. 
 
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The high sale of fried foods presents a risk to obesity and diet related NCDs. There are 
several risks associated with intake of fried foods to obesity, cardiovascular disease, 
diabetes, hypertension among others (Gadiraju et al.,  2015).  The high sale of fried foods 
in canteens of University of Ghana will predispose the students and staff of the University 
to excessive energy intake leading to obesity and risk of NCDs. The results of this study has 
implications on nutrition and dietetics practice. The rise of NCDs has led to various 
recommendations of less energy dense diet and hence if food environments offer highly 
energy dense meals it will be challenging for individuals to effectively limit their energy 
consumption given the sale of the high energy dense meals.  
 
The evidence from this research suggest there is a need to engage food service managers to 
limit the sale of fried foods and adapt to  other cooking methods which will reduce the 
energy content of foods prepared for sale. Further research to ascertain the type and amount 
of total fat contained in these fried foods will help in policy interventions towards creating 
a healthy food environment. 
 
5.2 Availability of nutrition standards 
One of the study objectives was to determine the availability of nutrition standards in the 
University of Ghana that regulate food service businesses. There was availability of 
nutrition standards for food hygiene and safety and food based standard.  The food hygiene 
and safety standard was the only nutrition standard that was universally applicable to all 
food service businesses legally registered with the University and was part of the rules and 
regulations policy document expected to be observed by food service businesses operating 
within the University of Ghana.  
 
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The food based standard was only applicable to a private canteen in Volta hall an initiative 
taken by hall management to promote the sale of fruits and vegetables.  
 
This  was consistent with study done in Minnesota to investigate school policies and 
practices regulating sale of school lunches and snacks which found  few of the schools 
having nutrition policies and standards regulating the sale of  foods, however 
implementation of policies were a challenge  to ensuring  a healthy food environment 
(Neumark-Sztainer et al., 2005).  
 
Another study done in Ghana done by Laar et al., (2019) to investigate Ghana’s policies for 
creating healthy food environments found no evidence of nutrition standards for nutrition 
composition. However the study found that, the 2012-2016 strategy focusing on prevention 
and management of non-communicable diseases (NCDs) suggests that attempts may be 
made in future to address establishment of nutrition composition standards. The results of 
the study were different from the review study by Laar et al., (2019) because their study 
reviewed literature on evidence of published nutrition policies or standards whiles this study 
focused on availability of existing nutrition policies at the University of Ghana.  
 
There are several public health implications associated with this outcomes. Though some 
few standards exist in the University of Ghana the evidence of the data from this study 
suggest there is a need for setting more nutrition standards to fight the ever increasing risk 
of diet-related NCDs. 
 
The evidence will trigger policy actions in schools to improve school food environment 
through establishment of nutrition standards. Also such policy action can contribute to 
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limiting students and staff to consumption of energy dense foods and reduce the burden of 
obesity and diet-related NCDs. 
 
5.3 Food hygiene and safety Practices of Food outlets 
Food hygiene and safety plays an important role in ensuring food is wholesome for 
consumption (Annor & Baiden, 2011).  The food hygiene and safety practices was therefore 
an important objective of this study.  The study revealed that, 5% of the food outlets scored 
very poor, 5% scored fair, 20% scored poor, 26% scored good, 24% scored very good and 
18% scored extremely good. The overall food hygiene and safety practices score was fair.  
 
The study findings  differ from a study in Ghana  that investigated the food hygiene and 
safety levels of food vendors in Accra,  which found an overall food hygiene score of food 
vendors to be good (Marras et al., 2016).  It would have been expected that the food hygiene 
and safety practices among the University of Ghana food outlets should have be better 
compared to the food hygiene practices of street food vendors since University of Ghana is 
an academic institution but this was not the case.  This difference could have been attributed 
to the differences in individual food outlet factors used to compute the food hygiene and 
safety practice practices. 
 
The overall food hygiene and safety practices being fair has implications for prevention of 
food borne diseases among students and staff.  The findings of the study revealed there was 
no toilet facility for food outlets in the night market and this is a worrying trend as it poses 
a major threat to food hygiene and safety.  Given the unique location of night market where 
it is closer to various halls and its proximity to University of Ghana basic schools, it’s a 
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disturbing situation to know that despite the availability of  several food outlets operating 
within the night market there is no  toilet facility for food vendors. 
 
The evidence of this research will therefore be used to trigger action campaign towards 
establishing of a toilet with clean running water to facilitate the food hygiene and safety 
practices of food vendors at the night market. Also there is a need to PDMSD to improve 
upon food inspection at the point of sale and ensure there is improvement in the food hygiene 
standards of various food outlets within the University of Ghana. Policy makers in the 
University can also build on the evidence of this study to strengthen food hygiene and safety 
policies in the University. Clinicians can also use this evidence to target public health 
interventions to improve the food hygiene and safety among food vendors in the University 
community to reduce the risk of food borne diseases among staff and students. 
 
 5.4 Study strengths  
The major strength of this study is that, a census was used to collect data on all food outlets 
operating within the University of Ghana. The results from this research is a true state of 
nutrition standards, nature and food hygiene practices of all food outlets operating within 
the University of Ghana main campus. 
 
5.5 Limitations of the study 
An important limitation of this study is that the study only looked at what is being offered 
for sale in the food outlets. There was no proximate analysis done to determine the energy 
and nutrient contribution of meals consumed by students and staff.  However, data on foods 
collected were grouped under food groups of nutritional significance hence the outcome of 
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this survey still provides useful information for policy intervention against creating healthy 
food environment in an attempt to prevent the increase risk of diet-related NCDs.  
 
Also, the study did not explore the percentage of students who eat their meals from these 
food outlets to enable us have actual picture of the implications of what is being offered for 
sale. This therefore suggest an indication for further research studies in these 
aforementioned areas to fully understand the complex interaction between food 
environments, obesity and health. 
 
 Finally this study was a cross-sectional study and therefore limited by its design since data 
collection was conducted at just one point in time. However data collection was conducted 
at a period when school was in full session so that a true representation of the different food 
options offered for sale in the eateries of University of Ghana were captured. 
 
 
 
 
 
 
 
 
 
 
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CHAPTER SIX 
CONCLUSIONS AND RECOMMENDATIONS 
This chapter summarizes and concludes on the study findings. In addition, it gives 
recommendations on how to improve school food environment. 
 
6.1 Conclusions 
The study revealed high prevalence of energy dense meals sold at the University of Ghana. 
Majority of the food outlets were involved in sale of sugar sweetened beverages, refined 
carbohydrates, pastries and fried foods.  
 
The indepth interview revealed the only available nutrition standards that regulated food 
service business were food hygiene and safety s and food based standards. The food hygiene 
and safety standards was the only standard that was universally applicable to all food outlets 
legally registered in the University. The food based standard was only applicable to one 
food outlet in Volta hall where one of their canteen has been set aside for the sale of fruits 
and vegetables. 
 
The food hygiene and safety Practices of the food outlets were found to be fair based on 
food hygiene and safety categorization by Marras et al., 2016 Though some of the individual 
food hygiene and safety factors such as availability of clean water at selling point and the 
availability of soap or hand sanitizer at selling point were generally acceptable there is still 
a need to improve upon the hygiene and safety practices of food outlets.  
 
 
 
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6.2 Recommendations 
Given the rise of obesity and diet related NCDs, there is a need for a more united front and 
commitment by University  authorities to set nutrition standards to regulate the nature and 
improve on the nutritional profile of foods sold at the canteens of the university.  
 
The evidence of the study revealed that canteens at the night market do not have a toilet 
facility. This a major challenge to food hygiene and safety given the strategic location of 
night market.  
 
The study therefore recommends University authorities take steps to address the toilet 
facility problem at the night market of University of Ghana. 
 
There is a need for further studies to do proximate analysis of the nutrient contributions of 
foods sold in these canteens. 
 
The study recommends policy makers in the university to strengthen the food hygiene and 
safety standards of food outlets to improve upon the food hygiene and safety practices of 
the food outlets.  
 
The Physical, Developmentand Municipal Services Directorate (PDMSD) should ensure 
medical screening among staff of various food service businesses are enforced. 
 
The study also recommends the university employs more Dietitians to ensure that food 
service businesses in the University adhere to nutrition guidelines to improve the nutritional 
profile of foods offered for sale.. 
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Bell, A. C., & Swinburn, B. A. (2004). What are the key food groups to target for 
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Craypo, L., Purcell, A., Samuels, S. E., Agron, P., Bell, E., & Takada, E. (2002). High 
High Survey, 72(2), 78–82. 
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nation? International Journal of Epidemiology, 35(1), 100–104. 
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Asia, S. (2011). Non-communicable diseases in sub-Saharan Africa : what we know 
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Deliens, T., Clarys, P., Bourdeaudhuij, I. De, & Deforche, B. (2014). Determinants of 
eating behaviour in university students : a qualitative study using focus group 
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Ghana. Food Control, 47, 92–97. https://doi.org/10.1016/j.foodcont.2014.06.041 
French, S. a., Story, M., & Fulkerson, J. a. (2002). School food policies and practices: a 
state-wide survey of secondary school principals. Jounal of American Diet 
Association. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12487541 
Gadiraju, T. V, Patel, Y., Gaziano, J. M., & Djoussé, L. (2015). Fried Food Consumption 
and Cardiovascular Health : A Review of Current Evidence, (September), 8424–
8430. https://doi.org/10.3390/nu7105404 
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Environments: Concepts and Measures., 19(5), 330–333. 
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Holsten, J. E. (2008). Obesity and the community food environment : a systematic review, 
12(3), 397–405. https://doi.org/10.1017/S1368980008002267 
Kubik, M. Y., Lytle, L. A., Hannan, P. J., Perry, C. L., & Story, M. (2003). The 
Association of the School Food Environment With Dietary Behaviors of Young 
Adolescents, 93(7), 1168–1173.Kann, J. Grunbraum, M, L Mckenna, H.Wechsler, G. 
. G. (2005). Competitive foods and beverages available for purchase in secondary 
schools - Selected sites, United States, 2004. Journal of School Health, 75(10), 370–
374. https://doi.org/10.1111/j.1746-1561.2005.tb06639.x 
L’Abbé, M., Schermel, A., Minaker, L., Kelly, B., Lee, A., Vandevijvere, S., … Walker, 
C. (2013). Monitoring foods and beverages provided and sold in public sector 
settings. Obesity Reviews, 14(S1), 96–107. https://doi.org/10.1111/obr.12079 
Laar, A, Barnes, A. Tandoh, A. Bash, K. Aryeetey, R. Mensah, K. Zotor, F. Vandevijvere, 
S. Holdsworth M. (2018). Bench marking Ghana’s Food Environment policies 
against international examples and progress within the development cycle: The 
Ghana healthyFoo, G. S. 2018. (2016). Benchmarking Ghana’s Food Environment 
Policies against Internatonal examples and progress within development cycle. 
Lachat, C. K., Huybregts, L. F., Roberfroid, D. A., Van Camp, J., Remaut-De Winter, A. 
M. E., Debruyne, P., & Kolsteren, P. W. (2009). Nutritional profile of foods offered 
and consumed in a Belgian university canteen. Public Health Nutrition, 12(1), 122–
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Lachat, C., Otchere, S., Roberfroid, D., Abdulai, A., Seret, F. M. A., Milesevic, J., … 
Kolsteren, P. (2013). Diet and Physical Activity for the Prevention of 
Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic 
Policy Review. PLoS Medicine, 10(6). https://doi.org/10.1371/journal.pmed.1001465 
Lin, B., Guthrie, J., & Frazão, E. (1999). Nutrient Contribution of Food Away From 
Home. Americans’ Eating Habits: Changes and Consequences, (January), 213–242. 
Malik, V. S., Popkin, B. M., Bray, G. A., Després, J. P., Willett, W. C., & Hu, F. B. 
(2010). Sugar-sweetened beverages and risk of metabolic syndrome and type 2 
diabetes: A meta-analysis. Diabetes Care, 33(11), 2477–2483. 
https://doi.org/10.2337/dc10-1079. 
Marras, S., Ag-Bendech, M., Laar, A. (2016). Street Food Vending in Accra, Ghana. 
Technical Report 2016. Food and Agriculture Organization of the United Nations, 
Accra. 
 
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Ministry of Health- Ghana. (2012). National Policy for the Prevention and Control of 
Chronic Non-Communicable Diseases in Ghana, (August), 1–27. 
Mohammed, H., & Vuvor, F. (2012). Prevalence of childhood overweight/obesity in basic 
school in Accra. Ghana medical journal, 46(3), 124. 
Morland, K. B., & Evenson, K. R. (2009). Health & Place Obesity prevalence and the 
local food environment, 15, 491–495. 
https://doi.org/10.1016/j.healthplace.2008.09.004 
Neumark-Sztainer, D., French, S. A., Hannan, P. J., Story, M., & Fulkerson, J. A. (2005). 
School lunch and snacking patterns among high school students: Associations with 
school food environment and policies. International Journal of Behavioral Nutrition 
and Physical Activity, 2, 1–7. https://doi.org/10.1186/1479-5868-2-14. 
Ofori-Asenso, R., Agyeman, A. A., Laar, A., & Boateng, D. (2016). Overweight and 
obesity epidemic in Ghana—a systematic review and meta-analysis. BMC Public 
Health, 16(1), 1239. 
O’Toole, T. P., Anderson, S., Miller, C., & Guthrie, J. (2007). Nutrition services and foods 
and beverages available at school: Results from the school health policies and 
programs study 2006. Journal of School Health, 77(8), 500–521. 
https://doi.org/10.1111/j.1746-1561.2007.00232.x 
Papas, M. A., Alberg, A. J., Ewing, R., Helzlsouer, K. J., Gary, T. L., & Klassen, A. C. 
(2007). The Built Environment and Obesity, 29(27), 129–143. 
https://doi.org/10.1093/epirev/mxm009. 
Robles, Brenda, et al. "Comparison of nutrition standards and other recommended 
procurement practices for improving institutional food offerings in Los Angeles 
County, 2010–2012." Advances in Nutrition 4.2 (2013): 191-202. 
Slavin, J. (2004). Whole grains and human health. Nutrition Research Reviews, 17(1), 99–
110. https://doi.org/10.1079/nrr200374 
Slavin, J. L., & Lloyd, B. (2012). Health Bene fi ts of Fruits and Vegetables 1, 506–516. 
https://doi.org/10.3945/an.112.002154.506 
Story, M, Nanney, M. S., & Schwartz, M. B. (2009). Schools and obesity prevention: 
creating school environments and policies to promote healthy eating and physical 
activity. The Milbank Quarterly, 87(1), 71–100. https://doi.org/10.1111/j.1468-
0009.2009.00548.x 
StoryMary, Kaphingst, K. M., Robinson-O’Brien, R., & Glanz, K. (2008). Creating 
Healthy Food and Eating Environments: Policy and Environmental Approaches. 
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Annual Review of Public Health, 29(1), 253–272. 
https://doi.org/10.1146/annurev.publhealth.29.020907.090926 
Swinburn, B. A., Sacks, G., Hall, K. D., McPherson, K., Finegood, D. T., Moodie, M. L., 
& Gortmaker, S. L. (2011). The global obesity pandemic: Shaped by global drivers 
and local environments. The Lancet, 378(9793), 804–814. 
https://doi.org/10.1016/S0140-6736(11)60813-1 
WHO. (2004). WHO’s global strategy on diet, physical activity and health: Response to a 
worldwide epidemic of non-communicable diseases. Scandinavian Journal of 
Nutrition/Naringsforskning, 48(2), 58–60. 
https://doi.org/10.1080/11026480410033539 
WHO. (2003). Diet, nutrition and the prevention of chronic diseases. World Health 
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WHO. (2018). Healthy diet, (August), 1–6. 
 
 
  
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APPENDICES 
Appendix 1.  
Key informant interview guide. 
Interview guide for assessing nutrition standards. 
 
Informant Name:                               
 
Informant Title/Position:     
 
Length of time in current position:                             
  
 
Length of time with organisation:                               
 
Interview date:                               
 
Interviewer Name:                               
  
Thank you for granting me audience to interview you. I am an interviewer on the ongoing 
survey to assess profile of foods and non-alcoholic beverages and nutrition standards for 
regulating food service business on campus. We are interviewing stakeholders and therefore 
interested in your point of view. We will be grateful if we could take a few moments of your 
time. 
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Nothing you tell me will be personally attributed to you in any reports that result from this 
evaluation. All of the reports will be written in a manner that no individual comment can be 
attributed to a particular person.  
Your participation in this interview is voluntary.  Are you willing to be interviewed?  
Do you have any questions before we begin? 
 
1. What guides your department decisions to issuing of licenses to food service 
managers to operate food service business in the University of Ghana? 
2. Are there available nutrition standards that guides the regulation of food business in 
this university? If no why? 
3. If there are nutrition standards, are they being implemented as required? If not why? 
4. Do you think nutrition standards can improve health by regulating food options 
available for staff and students? If yes how? If no why? 
5. Do you think strengthening and setting nutrition standards has been a priority to 
university management? 
6. Do you think the food options available for sale in the university canteens are healthy 
and safe for consumption? If yes why? And If no why? 
7. What has been the contribution of your department to enhance the provision of 
healthy meals at these canteens? Kindly mention some of the initiatives. 
8. In your opinion do you think it is important to set nutrition standards to regulate food 
services and ensure the profile of foods sold are healthier in these canteens? 
9.  What measures do you put in place to ensure hygiene and food safety practices at 
the canteens of the university? 
                                              Thank you for your time 
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Appendix 2 
Questionnaire for assessing the nature of foods. 
N QUESTION ANSWER SCORE OPTION 
1 Your position  Owner  Single choice 
 Manager 
 Employee 
2 Key informant  Male  Single choice 
Gender  Female 
3.  Duration of  food  Number   
service in the 
university 
4. Type of business  Individual  Single choice 
 Partnership 
 Chain/Franchising 
5. Apart from the  Number   
owner, how many 
people work in 
this business? 
6. Food on sale  Fruit  Multiple choice 
 Vegetable salad 
 Cooked dishes 
 Snacks (Natural/homemade 
snacks) 
 Snacks (Pre-packaged industrial) 
 Beverages (Natural and home- 
made) 
 Beverages (Industrial) 
7.  Ingredients Yes/No  Single choice 
include meat or 
fish or eggs 
8. Fruit  Apples  Multiple choice 
 Banana 
 Coconut 
 Pineapple 
 Pawpaw 
 Mango 
 Grapes 
 Watermelon 
 Pear 
 Orange 
 others 
9. Cooked dishes  Banku  Multiple choice 
 Beans stew 
 Beef (Fried/grilled/stewed 
 Chicken(fried/grilled/stewed) 
 Chofi 
 Fish (grilled/fried/stewed) 
 Fufu 
 Eggs 
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 Garden eggs stew 
 Gari (Dry/wet) 
 Groundnut soup 
 Hausa koko 
 Khebab (Meat) 
 Khebab (soya) 
 Kenkey 
 Koko 
 Kokonte 
 Kontomire stew 
 Koose 
 Lightsoup 
 Meat pie 
 Noodles 
 Okro soup 
 Omo tuo 
 Palm soup 
 Red pepper. 
 Red  red 
 Rice (Plain/fried/boiled) 
 Rice porridge 
 Shito 
 Tombrown 
 Tomato stew 
 Tou-zaafi 
 Talia (Macaroni) 
 Waakye 
 Plantain (Fried or roasted) 
 Yam (Fried or roasted) 
 Sweet potatoes 
(Fried or roasted) 
 others 
 
10. Pastries and  Cupcakes  Multiple choice 
homemade snacks  Bofrot 
 Nuts 
 Porn corn 
 Nkate cake 
 Bread 
 Bread with cream 
 others 
 
11. Home-made  and   Bottled water  Multiple choice 
Natural beverages  Sachet water 
 Coconut water 
 Fresh fruit juice 
 Animal milk 
 Vegetable milk 
 Herb tea 
 Coffee 
 Wines and spirits 
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 Brukina 
 Sobolo 
 Asana 
 Lamuji 
 Fula 
 Others 
12 Industrial  Carbonated drinks  Multiple choice 
Beverages  Energy drink  
 Industrial Juice  
 others 
 
 
 
 
 
 
 
  
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Appendix 3 
Questionnaire for assessing food hygiene and safety of Canteens. 
 
 QUESTION ANSWER SCORE OPTION 
1 Your position  Owner  Single choice 
 Manager 
 Employee 
 
2 key informant Gender  Male  Single choice 
 Female 
3  Duration  of food  Number   
service in the 
university of Ghana 
4. Does food canteen Yes/No  Single choice 
possess a valid Food 
Handler Certificate? 
5.  Food canteen has done  Less than 12 1 Single choice 
training courses on months ago  
food and hygiene  Between 12 to 24 0 
safety for staff. months ago  
 More than 24 -1 
hours ago  
 Never -1 
6. Food Canteen has  Less than 12 1 Multiple 
done medical months ago  choice 
screening medical  Between 12 to 24  
screening for staff. months ago 0 
 More than 24  
hours ago -1 
 Never 
7.  How often do food  Never  Single choice 
inspectors visit you to  Yearly 
assess food and  Half yearly 
hygiene changes  Quarterly 
 Monthly 
 Weekly 
 Daily 
8. Water for washing is  Running water 1 Single choice 
available at selling from public  
point supply  
 Running water 0 
from plastic  
tanks  
 In buckets (dirty -1 
water) or No 
water 
9. Soap or hand sanitizer  Yes 1 Single choice 
is available on the spot  No -1 
 
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10. Food canteen has  Yes 1 Single choice 
toilet with clean  No -1 
running water 
11. Where do you prepare  Professional 1 Multiple 
/cook food? kitchen  choice 
/laboratory  
 On the spot 0 
 At home 0 
12 When do you buy  The same day 1 Single choice 
meat/fish/eggs  The day before 0 
 A few days -1 
before. 
13 Do you sell left overs?  Yes -1 Single choice 
 No 1 
 
14 Does food canteen  Yes 1 Single choice 
have a fridge?  No  
-1 
15. Cooked food is served  Yes 1 Single choice 
hot?  Warm 0 
 No -1 
16. Vegetables prepared  Yes 1 Single choice 
on the spot are washed  No -1 
with disinfectant 
17. Type of fuel used for  Electric/Gas 1 Multiple 
cooking on the spot  Wood/Charcoal 0 choice 
 Hazardous -1 
material 
 
 
  
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Appendix 4A 
 Consent Form for key informant Interview. 
Study Title: “Nutrition Standards and nature of foods sold at the University of Ghana 
Canteens” 
General information about the research  
Good morning/evening Sir/madam. My name is Maxwell Bisala Konlan a post-graduate 
student from the School of Public Health, University of Ghana.    We would like to invite 
you to take part in a research project entitled: Nutrition standards and nature of foods 
sold at the university of Ghana Canteens” You will be interviewed by one of the members 
of the research team. The interviewer may be accompanied by another member of the 
research team, who will be observing, recording and taking detailed notes during the 
interview. It will involve individual interviews.  We will however, want to get your consent 
for participating in the study, so what you are about to hear is part of the process of informed 
consent.     
 
This is a research/study. This process will give you a basic idea of what the research is about 
and what your participation will involve.  We will also describe your right to withdraw from 
the study at any time.   
 
What is the purpose of this research? 
The study aims to assess the nutrition standards and nature of foods sold at the university of 
Ghana canteens. 
 
 
 
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Risks/discomforts 
Although there are no known discomforts and risks associated with this research, it is always 
possible that you may experience discomfort when addressing sensitive issues that may arise 
during the interviews. However, the research team has taken reasonable safeguards to 
minimize potential but unknown risks. If you experience psychological distress or other 
discomforts as a result of your participation in this study, please contact the principal 
investigator listed below. Please note that while nothing you tell us will be shared with 
anyone other than the researchers you are free to not respond to any of the questions posed 
by the researchers. You may also choose to pause or stop the interview at any time, and your 
data will be discarded and not used in the study.  
 
Benefits 
There are no direct benefits to you by participating in this research. The knowledge and 
information gathered would help in policy planning towards strengthening existing food 
policies to promote a healthy food environment in the university. 
 
Protecting data confidentiality 
We will protect information about you to the best of our ability. The information that you 
provide during the interview will be kept private. The only people who will have access to 
the information you provide are members of the research team. Your name will not be used 
in documents, reports, or publications related to this research. The data from the interview 
will be labeled by code numbers. All study documents will be kept in locked file cabinets 
PI’s office.  You will not be named in any reports. Some measures will be taken to preserve 
anonymity and confidentiality of the data collected from you. These include using 
identification numbers instead of your real names, not disclosing your response to questions 
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to members outside of the research team, reporting results of the study in a way not to 
disclose your identities. In fact, we highly value your participation in the study and will 
avoid behaviors that will compromise your anonymity.  
How long will my data be kept by the researchers?  
We do not intend to retain the interviews for an indefinite period of time. In accordance with 
Local Research Data Management Policy, the research data will be retained for 5 years in 
case the original data set needs to be referred to in the future. 
Compensation 
No compensation is provided for participation in this survey interview. However, we 
appreciate your time to help assess nutrition standards and policies regulating food canteens 
in the university. 
Voluntary Participation and Right to Leave the Research 
Your participation in this research is completely voluntary. Also, you can choose to end 
your participation at any time during the interview. 
Contacts for Additional Information 
Principal Investigators at:  Maxwell Bisala Konlan, University of Ghana hospital, Box LG 
79, legon.  Telephone: +233542205538 Email: konlanmaxwell@yahoo.com 
 
  
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VOLUNTEER AGREEMENT 
The above document describing the benefits, risks and procedures for the research title 
“NUTRITION STANDARDS AND NATURE OF FOODS SOLD AT THE UNIVERSITY 
OF GHANA CANTEENS” has been read and explained to me. I have been given an 
opportunity to have any questions about the research answered to my satisfaction. I agree to 
participate as a volunteer. 
 
 
____________________                                 ___________________________________  
Date                                                        Name and signature or mark of volunteer 
 
 
 
 
I certify that the nature and purpose, the potential benefits, and possible risks associated 
with participating in this research have been explained to the above individual. 
 
 
_______________________                        ______________________________ 
Date                                                       Name Signature of Person Who Obtained consent. 
 
 
 
  
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Appendix 4B 
Consent Form for Canteen staff. 
 
Study Title: “Nutrition Standards and nature of Foods Sold at the University of Ghana 
Canteens” 
General information about the research  
Good morning/evening Sir/madam. My name is Maxwell Bisala Konlan a post-graduate 
student from the School of Public Health, University of Ghana.    We would like to invite 
you to take part in a research project entitled: Nutrition standards and nature of foods 
sold at the university of Ghana Canteens” I would be very glad if you could participate 
in it. Your participation would allow you to give us the mandate to assess your menus, the 
food options available for sale and the food hygiene practices of your canteen. We will 
however, want to get your consent for participating in the study, so what you are about to 
hear is part of the process of informed consent.     
 
This is a research/study. This process will give you a basic idea of what the research is about 
and what your participation will involve.  We will also describe your right to withdraw from 
the study at any time.   
 
What is the purpose of this research? 
The study aims to assess the nutrition standards and mature of foods sold at the university 
of Ghana canteens. 
Risks/discomforts 
Although there are no known discomforts and risks associated with this research, it is always 
possible that you may experience discomfort and inconvenient by perhaps giving us some 
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portions of your food for assessment. However, the research team has taken reasonable 
safeguards to minimize potential but unknown risks. If you experience any discomforts as 
a result of your participation in this study, please contact the principal investigator listed 
below. Please note that while nothing observed in your company will be shared with anyone 
other than the researchers. You may also choose to pause or stop the interview at any time, 
and your data will be discarded and not used in the study.  
 
Benefits 
There are no direct benefits to you by participating in this research. The knowledge and 
information gathered would help in policy planning towards strengthening existing food 
policies to promote a healthy food environment in the university. 
 
Protecting data confidentiality 
We will protect information about your company to the best of our ability. The information 
that will be gathered in your company will be kept private. The only people who will have 
access to the information gathered are members of the research team. Your company’s name 
will not be used in documents, reports, or publications related to this research. The data from 
the interview will be labeled by code numbers. All study documents will be kept in locked 
file cabinets PI’s office.  Your company will not be named in any reports. Some measures 
will be taken to preserve anonymity and confidentiality of the data collected from the 
company. These include using identification numbers instead of your real company names, 
not disclosing the data gathered to members outside of the research team, reporting results 
of the study in a way not to disclose your identities. In fact, we highly value your 
participation in the study and will avoid behaviors that will compromise your anonymity.  
 
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How long will my data be kept by the researchers?  
We do not intend to retain the interviews for an indefinite period of time. In accordance with 
Local Research Data Management Policy, the research data will be retained for 5 years in 
case the original data set needs to be referred to in the future. 
Compensation 
No compensation is provided for participation in this survey interview. However, we 
appreciate your time to help assess nutrition standards and policies regulating food canteens 
in the university. 
Voluntary Participation and Right to Leave the Research 
Your participation in this research is completely voluntary. Also, you can choose to end 
your participation at any time during the interview. 
 
Contacts for Additional Information 
Principal Investigators at:  Maxwell Bisala Konlan, University of Ghana hospital, Box LG 
79, legon.  Telephone: +233542205538 Email: konlanmaxwell@yahoo.com 
 
  
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VOLUNTEER AGREEMENT 
The above document describing the benefits, risks and procedures for the research title 
“NUTRITION STANDARDS AND NATURE OF FOODS SOLD AT THE UNIVERSITY 
OF GHANA CANTEENS” has been read and explained to me. I have been given an 
opportunity to have any questions about the research answered to my satisfaction. I agree to 
participate as a volunteer. 
 
 
____________________                                 ___________________________________  
Date                                                            Name and signature or mark of canteen manager 
 
 
 
 
I certify that the nature and purpose, the potential benefits, and possible risks associated 
with participating in this research have been explained to the above individual. 
 
 
_______________________                        ______________________________ 
Date                                                        Name Signature of Person Who Obtained consent. 
 
 
 
 
 
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