Objectives The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods.
Design Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability.
Setting Three deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya).
Main outcome measure Types of foods and beverages sold and/or advertised.
Results Jamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets.
Conclusion Our study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.
- nutrition & dietetics
- public health
- statistics & research methods
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Contributors MAG, AL, RA, PG, EWK-M, KM, FZ and MH had the idea for the study. All authors were involved in designing the data collection approach and tools. NC, SK, MNW and AT collected the data under the supervision of AL, EWK-M, SM and FZ. MAG, RP, HO-K, NB and MH undertook the statistical analyses, with all authors scrutinising the results. MAG led the writing of the paper, with all authors contributing to revising and approving the paper. The corresponding author (MAG) had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Funding This work was supported by two funders. The ‘Dietary Transitions in Ghana’ project was funded by a grant from the Drivers of Food Choice (DFC) Competitive Grants Programme [grant number OPP1110043] which is funded by the Bill and Melinda Gates Foundation and the Department for International Development (DFID), and managed by the University of South Carolina Arnold School of Public Health, USA. DFC supports new research on understanding food choice among the poor in low/middle-income countries, strengthening country-level leadership in nutrition and fostering a global community of food-choice researchers. The TACLED project was funded by a Global Challenges Research Fund (GCRF) Foundation Award led by the MRC [grant number MR/P025153/1], and supported by AHRC, BBSRC, ESRC and NERC, with the aim of improving the health and prosperity of low/middle-income countries.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval Ethical approval for the study was acquired by each institution involved in the data collection process. In Ghana, ethics approval was obtained from the Ghana Health Service Ethics Review Committee (references: GHS-ERC 07/09/16 and GHS-ERC 02/05/17). In Kenya, ethics approval was obtained from the African Medical and Research Foundation (AMREF) (reference: ESRC P365/2017). The University of Sheffield recognised both of these approvals as meeting their ethical standards, as did Loughborough University for the Ghana Health Service. Additional ethical approval was obtained from the University of Liverpool (references: 1434 and 2288) and Loughborough University (reference: R17-P142).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data are openly available. Data for Jamestown and Ho Dome (Accra and Ho respectively, Ghana) can be accessed via https://doi.org/10.23708/QYHL8Chttps://doi.org/10.23708/QYHL8C. Data for Makadara (Nairobi, Kenya) can be accessed via https://doi.org/10.23708/G76QVS. All analytical code can be viewed at https://github.com/markagreen/Food_environment_ghana_kenya.