Nana Ama Frimpomaa Agyapong

Objectives: This paper explores the characteristics of Ghanaian households’ consumption of obesogenic versus protective foods, including their retail, distribution, and origin. Design: A household food consumption survey was conducted using an adapted Prospective Urban and Rural Epidemiology study Food Frequency Questionnaire. Product pathways for selected obesogenic (processed meat, Sugar-Sweetened Beverages, and biscuits) and protective (cooked vegetables, legumes, and fish) foods were traced from retailers through distributors/wholesalers to producers. Setting: Rural and urban communities in the Ashanti Region and selected retail/wholesale/producers nationwide. Participants: 612 households, 209 retailers and 185 wholesalers/distributors. Results: About 20% of households consume Sugar-Sweetened Beverages (SSB) and confectionery weekly, and just 2% consumed processed meat. Of the protective foods, fish had the highest proportion of households consuming weekly (74.5%), followed by cooked vegetables (53.1%) and legumes (22.8%). Frequent SSB consumption is higher in younger (p<0.001), male (p=0.010), urban (p<0.001), and more educated (p<0.001) food purchaser households. Below 10% of households followed the healthiest dietary pattern (high-protective-and-low-obesogenic) but higher in older and more educated food purchaser households. In contrast, most households (about 80%) consumption patterns did not discriminate between obesogenic and protective foods. Generally, characteristics of purchasers from retail/wholesale outlets agree with those of households, where obesogenic foods were retailed to younger, less educated buyers than older, more educated ones. While the protective foods had a strong local producer presence, the obesogenic foods were predominantly imported. Conclusion: Household consumption and retail/distribution of obesogenic foods are associated with socio-demographic characteristics, but obesogenic foods are almost entirely produced outside Ghana. Policies that regulate importation on health grounds can promote a healthier food environment.

Objective: This study aimed to determine differences in food consumption by the NOVA food categories in South Africa and Ghana and how they relate to poverty and food supply systems. Design: This study used a cross-sectional design to assess household food acquisition and lived poverty index. Setting: The study was conducted in Khayelitsha and Mount Frere, urban and rural communities in South Africa, respectively, and Ahodwo and Ejuratia, urban and rural communities in Ghana, respectively. Participant: An adult in charge of or knowledgeable about household food acquisition and consumption was selected to participate in the study. Results: A total of 1299 households participated in the study. Supermarkets were a prominent source of ultra-processed foods for households in South Africa, while informal outlets were an important source of ultra-processed foods in Ghana. Consumption of unprocessed foods was higher among South African households (58·2 %) than Ghanaian households (41·8 %). In South Africa, deprivation was associated with increased odds of infrequent consumption of both unprocessed foods (OR 3·431 P < 0·001) and ultra-processed foods (OR 2·656 P < 0·001) compared with non-deprivation. In Ghana, no significant differences were observed between deprived households and non-deprived households in relation to the consumption of the NOVA food classes. Conclusion: Different food supply systems and poverty are associated with household acquisition of the different NOVA food classes. Policies should be geared towards formal shops in South Africa and informal shops in Ghana to reduce the consumption of key obesogenic foods.

Objective: The objective of this commentary is to provide an overview of the rationale and objectives of the Researching the Obesogenic Food Environment (ROFE) project that was conducted in Ghana and South Africa. Design: Narration has been used to describe the main objectives, phases as well as the methods used for the conduct of this project. Setting: The project described in this commentary was conducted in Khayelitsha and Mount Frere in South Africa and Ahodwo and Ejuratia for Ghana. Participant: Participants of the study described here include households in South Africa and Ghana, stakeholders and policymakers, and various actors within the food chain in both countries. Results: The ROFE findings provide a good understanding of the extent of the impact of the food environment on consumption, characteristics of value chains of healthy and unhealthy foods, as well as the potential for improved governance and policy that is relevant to the region. The supplement provides the opportunity to share the extensive findings of the ROFE project. Nine papers that describe the process and findings of the three phases of the ROFE project have been presented. Some of the papers focus on phases of the ROFE, while others cut across different phases and explore the linkages between the phases. Briefly descriptions of key findings of some of the papers in the supplement are provided. Conclusion: Together, the findings of the ROFE study presented in this supplement have increased understanding of how communities in SA and Ghana interact with their food supplies and have led to identification of specific opportunities to improve food supply policies, in ways that create incentives for the production and consumption of healthy, relative to unhealthy foods.

Background: Involving patients and the public as stakeholders (hereafter described as contributors) in the design and management of research studies is increasingly recognised as central to conducting ethical, meaningful and translatable research. Consulting and co‐producing are two methods for involving public contributors in the research cycle. This abstract describes the methodology used to establish a co‐production model for the PREVENT Next Generation (NextGen) research program, alongside initial impact the contributors have had on the program. The NextGen research programs aims to explore brain health in young adults (aged 18‐39), and all contributors represent this age group.Method: Adverts appealing for public contributors were sent to voluntary and community sector enterprises, universities, promoted on social media and spread via word of mouth. The first round of recruitment focused on contributors living in North America and Europe, with recruitment underway in Ghana. Contributors watched an introductory video, completed a form to indicate interest and were sent an invite to a virtual meeting. The aim of the initial work was to consider and feedback on the NextGen proposal, beginning the co‐production by identifying topics of interest for inclusion in planned work.Result: Public contributors joined the initial meetings and were supportive of the need to understand more about brain health in young adults. Public contributors were interested in exploring topics such as the role of sex differences, social relationships and air pollution on brain health. Considering the focus groups (Phase 1 of NextGen), contributors advised having a choice of times that would support adults in work or education to join, as well as expressing a preference for virtual engagement for such studies.Conclusion: Employing a public involvement and co‐production model from the initial design stage of the NextGen study has proven invaluable to identifying topics of importance to include in future studies involving this age group. Future work will continue to develop the NextGen research program work with public contributors. Expansion of the public contributors to represent different global regions is underway, and will be critical to designing an inclusive study that is meaningful to the populations from which participants are enrolled.

The NOVA food classification system is a simple tool that can be used to assess the consumption levels of different categories of foods based on their level of processing. The degree to which food is processed has a significant impact on health outcomes. In Ghana, no study exists on the consumption of the different NOVA food groups among tertiary students and how it relates to their metabolic outcomes. This study assessed the frequency of food intake according to the NOVA classification and how they relate to body mass index, waist circumference, and blood pressure. The barriers to the consumption of healthy foods among students were also assessed. This was a cross‐sectional study conducted among 352 students of the Takoradi Technical University. Questionnaire was used to obtain sociodemographic information as well as data on perceived barriers to healthy food consumption. Food frequency questionnaire was used to obtain data on dietary intake. The weight, height, waist circumference, waist‐to‐hip ratio, and blood pressure of all participants were measured. Chi‐square was used to compare categorical variables between males and females and to determine the association between the frequency of food intake according to the NOVA classification and metabolic indicators. The prevalence of overweight and obesity was 23.8%. More than half (51.1%) of the students had elevated blood pressure. The majority of study participants (54.2%) had a high frequency of consumption of both unprocessed and ultra‐processed foods. Male students who frequently consumed ultra‐processed foods (1–6 times/day) had significantly high blood pressure. High consumption of both ultra‐processed and unprocessed foods was also associated with elevated blood pressure among male students. Limited time to prepare healthy meals and the high cost of unprocessed foods were among barriers to which most students strongly agreed to. Establishment of canteens that provide affordable healthy foods, teaching students time management, and nutrition education can mitigate barriers to healthy food consumption.

Background: Anaemia persistently remains a grave public health challenge in most sub-Saharan African countries. Understanding the perspectives of young adults concerning the multi-factorial nature of anaemia may be an important step towards meeting the 2025 global nutrition target of halving anaemia since these individuals might be in the process of reproductive decisions. Aim: To explore the relationship between students’ knowledge about individuals at risk of developing anaemia, and anaemia consequences, and anaemia prevention strategies in a tertiary student cohort. Methods: This sequential exploratory study adopted a mixed-methods approach to triangulate the data collection. A semi-structured questionnaire was used to gather baseline data regarding students’ perspective on anaemia. Themes that emerged from the initial questionnaire data analyses guided a focus group discussion (FGD) to further explore students’ perspectives on anaemia. FGD data was thematically analysed to unearth reasons behind questionnaire item selection. Structural equation modeling (SEM) was used to explore the relationship between constructs in the anaemia knowledge questionnaire. Results: Overall, 543 students participated in the initial questionnaire data acquisition compared to 16 in the FGD. Our latent variable structural model showed that knowing the causes of anaemia did not significantly (p > 0.05) associate with either knowledge about anaemia consequences (b = 0.113) or knowledge about anaemia prevention strategies (b = 0.042). However, knowledge about individuals at-risk of anaemia was significantly positively associated with both anaemia prevention strategies (b = 0.306, p < 0.05) and knowledge about consequences of anaemia (b = 0.543, 95%). Moreover, knowing the consequences of anaemia seemed to significantly positively mediate the association between knowledge about at-risk groups and preventive measures that could be adopted (b = 0.410, p < 0.05). Conclusions: Systems thinking public health educational campaigns that highlight the consequences of anaemia and at-risk groups are more likely to inspire the adoption of preventive strategies among young adults.

Background The covid-19 pandemic undoubtedly affected child welfare clinic services. However, there is limited data on how attendance to child welfare clinics during the pandemic associates with the nutritional status of children. This cross-sectional study, therefore, sought to assess child welfare clinic attendance within the covid-19 restriction era and how it associates with the nutritional status of children. Methods The study was conducted in four health facilities– one hospital, one health centre and two outreach centres. A total of 300 mother-child pairs participated in the study. Socio-demographic, dietary (multiple 24hr recalls), anthropometric (weight, height and mid-upper arm circumference) and biochemical (haemoglobin) characteristics were assessed for all children. Also, information on child welfare clinic attendance, vaccinations and supplementations were obtained from the maternal and child health record book. Results The median age of the children was 15(14) months. The mean weight-for-age and height-for-age z scores were -0.630(1.66) and -0.770(1.99). Among study participants, the mean number of attendances to child welfare clinics from the index case through the restriction period and after the easing of restrictions were 6.0(3.0) vrs 7.0(4.0), pConclusions Findings from this study revealed that the covid-19 restriction period was associated with a decline in child welfare clinic attendance, vitamin A supplementation and vaccination. The study showed that children who missed CWC during the covid-19 restriction era were more likely to have nutrient consumption below recommended levels. High prevalence of stunting and anaemia exist among children. Frequent nutrition education, nutrition surveillances and provision of micronutrient powders can help mitigate malnutrition among children.

The elderly population is increasing worldwide. Dietary habits play a crucial role in prolonging life and preventing diseases. This cross-sectional study sought to investigate the dietary habits of the elderly in the Kwahu South District of the Eastern Region of Ghana and further ascertain the factors that constitute nutritional challenges among this group. A mixed method approach was used for the study. A questionnaire and focus group discussion guide were used to solicit data from study participants. A total of 97 participants made up of 59 males and 38 females participated in the study. Data on food habits reveal that staple food consumption especially those grown within the study area is common. Rice (34.1), game meat (47.1), banana (63.9), and garden eggs (27.8) were the commonly consumed foods by frequency. Mood (41.2) and stress (24.8) were identified as the most predominant determinants of food habits. Poly medication, toothache and loss, immobility, and financial and technological challenges were amongst the nutritional challenges mentioned by the elderly in this study. Results from the focus group discussion revealed high nutrition knowledge among the elderly through factors such as financial constraints that were mentioned as a barrier to the translation of this knowledge into practice. Strengthening of existing interventional programmes such as the Livelihood Empowerment Against Poverty and social interventions is needed to improve the dietary habits and nutritional intakes of the elderly.

Background Overweight and obesity have become threats to public health in all regions across the globe including sub-Saharan Africa where prevalence used to be low. Policies to regulate the food environment and promote healthy food consumption look promising to reducing the prevalence of obesity but in Ghana there is not enough data to elicit a policy response. This study assessed the association between dietary consumption, anthropometric measures, body composition and physical activity among rural and urban Ghanaian adults. Methods This was a cross-sectional study involving 565 Ghanaian adults. Structured interviewer administered questionnaires were used to collect information on socio-demographics. Dietary consumption was assessed using household food frequency questionnaire and 24-h recall. Height, weight, BMI, waist circumference and body composition of all participants were determined. The World Health Organization's Global Physical Activity Questionnaire (GPAQ) was used to assess physical activity levels. Mann-Whitney U test was used to analyze differences in anthropometric measures, body composition and consumption among rural and urban participants. Principal component analysis was used to analyze household food frequency data and nutrient analysis template was used to analyze 24-h recall. Chi-square was used to measure differences in obesity prevalence by community and gender. Multinomial logistic regression was used to model the risk factors associated with obesity. Results The prevalence of overweight and obesity using BMI were 29.9 and 22.9% respectively. Use of waist circumference measurement resulted in the highest overall obesity prevalence of 41.5%. Prevalence of obesity was higher among females compared to males across all measures with the exception of visceral fat that showed no significant difference. Four different patterns were derived from principal component analysis. Among urban participants, the staple pattern showed a significant negative correlation with visceral fat (r - 0.186, p-value 0.013) and BMI (r - 0.163, p-value 0.029). Multinomial logistic regression revealed that males (AOR 19.715, CI 9.723-39.978, p-value < 0.001) had higher odds of being of normal weight compared to females. Conclusion Prevalence of overweight and obesity continue to rise in Ghana, especially among females. Public education and screening as well as interventions that regulate the food environment and make affordable and available healthy food options are needed to control the rise in obesity prevalence.