Elyse Iruhiriye

Globally, 75% of adolescents do not meet recommendations for fruits and vegetables (F&V) consumption. This study investigated drivers of F&V choices among adolescents in Benin and identified barriers and facilitators to modifying F&V consumption. We conducted 16 focus group discussions (FGDs) with 126 adolescents and 5 semi-structured school observations in December 2024. FGDs were purposively chosen to explore variation by region (north/south), school location (urban/rural), adolescent age (12–15 years/16-18 years) and gender (boys/girls). Inductive and deductive thematic content analysis was performed using Atlas.ti . Findings showed that adolescents perceived a healthy diet as one composed of meals providing nutrients and strength, and including F&V. At home, adolescents mentioned eating staples and other vegetables more than other food groups. The foods adolescents reported typically eating at school varied by age, gender, and location. The primary categories of factors that influenced adolescent F&V choices were: intrapersonal (knowledge related to healthy eating and the nutrition and health benefits of F&V, taste preferences, and health prioritisation), socio-cultural (family and peer influences), and food environment (low availability, low affordability, convenience, and desirability). DFC factors were consistent across adolescent age, gender, and location. Multiple, dynamic, and multilevel factors influence adolescent F&V choices. Interventions that simultaneously address multiple barriers and involve family and peers are likely to be more successful in promoting F&V consumption and healthy diets than interventions only addressing individual barriers. Key messages: According to adolescents in Benin, a healthy diet was one composed of meals providing nutrients and strength and including fruits and vegetables (F&V). Intrapersonal, socio-cultural, and food environment factors influenced adolescent F&V choices regardless of adolescent gender, age, and location. Adolescent F&V choices are influenced by a dynamic interplay of multiple factors. Thus, interventions to improve adolescent diets should likely address several critical barriers in an integrated and holistic manner.

How does nutrition improve? We need to understand better what drives both positive and negative change in different contexts, and what more can be done to reduce malnutrition. Since 2015, the Stories of Change in Nutrition studies have analysed and documented experiences in many different African and Asian countries, to foster empirically-grounded experiential learning across contexts. This article provides an overview of findings from 14 studies undertaken in nine countries in South Asia, sub-Saharan Africa, and Europe between 2017 and 2021. The studies used a combination of methods, including regression-decomposition analyses of national datasets to assess determinants of nutritional change; policy process and food environment analyses; and community-level research assessing attitudes to change. This article takes a narrative synthesis approach to identify key themes across the studies, paying particular attention to multisectoral determinants, changes in the food environment, the role of structural factors (including longstanding social inequities), and changes in political commitment, cross-sectoral coherence and capacity. Given the inherent multisectoral nature of nutrition, many countries are experimenting with different models of ensuring coherence across sectors that are captured in this body of work. The relative immaturity of the policy sector in dealing with issues such as obesity and overweight, and associated influences in the wider food environment, adds a further challenge. To address these interrelated issues, policy must simultaneously tackle nutrition’s upstream (social/economic/equity) and downstream (health and dietary) determinants. Studies synthesised here provide empirically-driven inspiration for action.

Understanding how countries improve children’s nutrition can inform policies and contribute to further improvements. We examined the relationship between improvements in nutrition in Rwanda (1992–2017) and political commitment to- and policy coherence in- nutrition. We reviewed nutrition-relevant Rwandan policies and programs (2000–2018) and conducted 90 semi-structured interviews with national (n = 32), mid-level (n = 38), and community (n = 20) nutrition stakeholders and 40 community-level focus group discussions (FGDs). FGDs and sub-national interviews were conducted in ten purposefully selected districts, five each in which stunting decreased (reduced) and increased or stagnated (non-reduced) between the 2010 and 2014/15 Rwanda Demographic and Health Surveys. Analysis consisted of thematic analysis and the assessment of events, policy developments, and strategies that influenced nutrition in Rwanda, including operationalization of political commitment and policy coherence for nutrition. Political and institutional commitment to nutrition increased in Rwanda as evidenced by the adoption of a multisectoral nutrition policy that was reinforced with national and subnational horizontal coordination platforms. These platforms strengthened multisectoral strategies to address nutrition and supported operational and institutional commitment. The role of mid-level actors in nutrition governance increased as responsibilities for planning, implementing, and monitoring nutrition programs were increasingly delegated to sub-national administrative levels. Variations in policy implementation existed between reduced and non-reduced districts. Despite improvements, challenges remained in coordination, financial commitment, and capacity to address, monitor, and evaluate nutrition. Political commitment to- and policy coherence in- nutrition at the national level are important for improving nutrition, and when reinforced institutionally, can be translated to sub-national levels where implementation occurs.