Background Even before the COVID-19 pandemic, one in two people in Africa were food insecure. The burden of malnutrition remains high (e.g. childhood stunting, anaemia in women of reproductive age) or are increasing (e.g. overweight and obesity). A range of coordinated actions are required to improve this situation, including increasing local food production and consumption. The aim of this review was to provide a systematic and comprehensive overview of recently published research into the health, social, economic, and environmental impacts of community food production initiatives (CFPIs) in Kenya, Cameroon and South Africa. Methods We searched eight electronic databases covering health, social, environmental, economic and agricultural sciences. Primary research studies published from 1 January 2014 to 31 December 2018 were considered. Data on geographic location, study design, type of CFPI and the impacts assessed were abstracted from eligible articles. Findings We identified 4828 articles, 260 of which required full-text review and 118 met our eligibility criteria. Most research was conducted in Kenya (53.4%) and South Africa (38.1%). The categories of CFPIs studied were (in order of decreasing frequency): crop farming, livestock farming, unspecified farming, fisheries, home / school gardens, urban agriculture, and agroforestry. The largest number of studies were on the economic and environmental impacts of CFPIs, followed by their health and social impacts. The health impacts investigated included food security, nutrition status and dietary intake. One study investigated the potential impact of CFPIs on non-communicable diseases. Over 60% of studies investigated a single category of impact. Not one of the studies explicitly used a theoretical framework to guide its design or interpretation. Conclusions Our findings on research studies of CFPIs suggest the need for a greater focus on interdisciplinary research in order to improve understanding of the relationships between their health, environmental, economic, and social impacts. Greater use of explicit theoretical frameworks could assist in research design and interpretation, helping to ensure its relevance to informing coordinated intersectoral interventions and policy initiatives. Diet, nutrition and food insecurity in Sub-Saharan Africa remain major public health concerns, with its people being some of the most nutritionally insecure in the world. 1 Factors compounding the risk of malnutrition and poor health are conflict, climate variability, poor infrastructure, and a dietary transition towards processed and ultra-processed foods that are energy dense as well as high in refined sugars, saturated fats, and salt. 2 This shift in dietary patterns, to
Background Tobacco smoking is a major cause of chronic disease and premature mortality. Its effects are socially patterned. Observational studies show that low socioeconomic status [SES] is associated with higher smoking prevalence and lower cessation rates. Interventions in primary care may improve or exacerbate health inequalities depending on socioeconomic patterning of access and uptake. Data on the impact of trials of smoking cessation interventions delivered in primary care on health inequalities by SES have not been synthesised. Aims To examine the impact of smoking cessation interventions delivered in primary care on inequalities in health by socioeconomic status. Methods We searched the Cochrane database of systematic reviews from inception until June 2019. We included reviews of trials of smoking cessation interventions delivered in primary care and published in English. Findings We identified eight Cochrane reviews (413 studies). Eighty five studies included an intervention delivered in primary care. Interventions were: behavioural, (very) brief advice, and pharmacological (including nicotine replacement therapy). Full texts were accessed for 70 studies; 17 reported an SES measure. Two studies targeted low-SES groups. There was heterogeneity in SES measures used across the studies, which included household income, occupational level and social class. Three studies analysed SES as a predictor of effectiveness of the smoking cessation intervention; none found effectiveness differed by SES. Implications This summary and critique of Cochrane reviews demonstrates that trials of smoking cessation interventions delivered in primary care are not designed to allow analysis of effects by measures of SES. Studies rarely reported SES of participants at baseline and hardly ever as a predictor of smoking cessation. Our work highlights the need for routine reporting of SES amongst trials and greater consensus in included measures. Consistent reporting of a core set of SES indicators will enable testing of similarities between trial groups and differential effects by SES.
free legislation, the persisting relative inequalities in SHS exposure by SES highlight the need for continued investment in tobacco control policies.
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