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Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: Evidence for policy action from Ghana and Kenya

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posted on 30.10.2020, 09:37 by Michelle Holdsworth, Rebecca PradeillesRebecca Pradeilles, Akua Tandoh, Mark Green, Milkah Wanjohi, Francis Zotor, Gershim Asiki, Senam Klomegah, Zakia Abdul-Haq, Hibbah Osei-Kwasi, Robert Akparibo, Nicolas Bricas, Carol Auma, Paula Griffiths, Amos Laar
Growing urbanisation in Africa is accompanied by rapid changes in food environments, with potential shifts towards unhealthy food/beverage consumption, including in socio-economically disadvantaged populations. This study investigated how unhealthy food and beverages are embedded in everyday life in deprived areas of two African countries, to identify levers for context relevant policy. Deprived neighbourhoods (Ghana: 2 cities, Kenya: 1 city) were investigated (total = 459 female/male, adolescents/adults aged ≥13 y). A qualitative 24hr dietary recall was used to assess the healthiness of food/beverages in relation to eating practices: time of day and frequency of eating episodes (periodicity), length of eating episodes (tempo), and who people eat with and where
(synchronisation). Five measures of the healthiness of food/beverages in relation to promoting a nutrient-rich diet were developed: i. nutrients (energy-dense and nutrient-poor -EDNP/energy-dense and nutrient-rich -EDNR); and ii. unhealthy food types (fried foods, sweet foods, sugar sweetened beverages (SSBs). A structured meal pattern of three main meals a day with limited snacking was evident. There was widespread consumption of unhealthy food/beverages. SSBs were consumed at three-quarters of eating episodes in Kenya (78.5%) and over a third in
Ghana (36.2%), with those in Kenya coming primarily from sweet tea/coffee. Consumption of sweet foods peaked at breakfast in both countries. When snacking occurred (more common in Kenya), it was in the afternoon and tended to be accompanied by a SSB. In both countries, fried food was an integral part of all mealtimes,
particularly common with the evening meal in Kenya. This includes consumption of nutrient-rich traditional foods/dishes (associated with cultural heritage) that were also energy-dense: (>84% consumed EDNR foods in both countries). The lowest socio-economic groups were more likely to consume unhealthy foods/beverages. Most eating episodes were <30 min (87.1% Ghana; 72.4% Kenya). Families and the home environment were
important: >77% of eating episodes were consumed at home and >46% with family, which tended to be energy dense. Eating alone was also common as >42% of eating episodes were taken alone. In these deprived settings, policy action to encourage nutrient-rich diets has the potential to prevent multiple forms of malnutrition, but
action is required across several sectors: enhancing financial and physical access to healthier foods that are convenient (can be eaten quickly/alone) through, for example, subsidies and incentives/training for local food vendors. Actions to limit access to unhealthy foods through, for example, fiscal and advertising policies to disincentivise unhealthy food consumption and SSBs, especially in Ghana. Introducing or adapting food-based dietary guidelines to incorporate advice on reducing sugar and fat at mealtimes could be accompanied by cooking


The ‘Dietary transitions in Ghana’ project was funded by a grant from the Drivers of Food Choice Competitive Grants Programme [grant number OPP1110043], which is funded by the Bill & Melinda Gates Foundation and The Foreign, Commonwealth and Development Office and managed by the University of South Carolina Arnold School of Public Health, USA

The TACLED project was funded by a Global Challenges Research Fund Foundation Award led by the MRC [grant number MR/P025153/1], and supported by AHRC, BBSRC, ESRC and NERC.



  • Sport, Exercise and Health Sciences

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Global Food Security




Elsevier BV


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This paper was accepted for publication in the journal Global Food Security and the definitive published version is available at

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Dr Rebecca Pradeilles. Deposit date: 29 October 2020

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