Objective: To explore determinants of dietary and physical activity behaviours among women of reproductive age. Design: Data were collected through focus group discussions (FGD). The FGD guide was based on a modified theoretical framework; theory of planned behaviour was incorporated with constructs of health belief model, precaution adoption process model, social cognitive and social support theory. Discussions were audio recorded, transcribed verbatim and analysed thematically. Setting: Kampala, Uganda. Participants: Women were categorised into young adults; 18–34 years and adults; 35–45 years Results: Separate FGD with independent participants were conducted for dietary and physical activity behaviours until data saturation was achieved. Six FGD were conducted per behaviour. Determinants of dietary behaviours at intra-individual level included gaps in food skills, knowledge and self-efficacy, food safety concerns, convenience, finances and physiological satisfaction. The social-cultural norms were relationship between vegetable consumption and low social status, consideration of fruits as a snack for children and not food and habitual orientation towards carbohydrate foods. At environment level, social networks and increased availability of energy-dense, nutrient poor, street and processed foods influence dietary behaviour. For physical activity, intra-individual determinants were knowledge gaps and self-efficacy, while socio-cultural norms included gender stereotypes. Home (limited space and sedentary entertainment like social media and TV) and physical environment (cheap motorised transportation) influence physical activity. Conclusion: The existing cultural beliefs promote dietary and physical activity behaviours which are divergent from healthy recommendations. Therefore, a comprehensive intervention is needed to address socio-cultural misconceptions, financial and time limitations in urban Uganda.

Abstract Urban sub-Saharan Africa is in a nutrition transition shifting towards consumption of energy-dense nutrient-poor diets and decreasing physical activity. Determinants of nutrition transition in sub-Saharan Africa are presently not well understood. The objective of this review was to synthesise available data on determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa according to the socio-ecological framework. We searched MEDLINE, Embase, Scopus, Web of Science and bibliographies of included articles for qualitative, observational and randomised controlled studies published in English from January 2000 to September 2018. Studies conducted within general populations of women aged 18–49 years were included. Searches were according to a predefined protocol published on PROSPERO (ID = CRD42018108532). Two reviewers independently screened identified studies. From a total of 9853 unique references, twenty-three studies were retained and were mainly from South and West Africa. No rigorous designed quantitative study was identified. Hence, data synthesis was narrative. Notable determinants of dietary behaviour included: convenience, finances, social network, food skills and knowledge gaps, food deserts and culture. Cultural beliefs include strong relationship between high social status and weight gain, energy-dense confectionery, salt or fat-rich foods. Physical activity is influenced by the fast-changing transport environment and cultural beliefs which instigate unfavourable gender stereotypes. Studies with rigorous qualitative and quantitative designs are required to validate and develop the proposed frameworks further, especially within East Africa. Nevertheless, available insights suggest a need for comprehensive skill-based interventions focusing on socio-cultural misconceptions and financial limitations.

More than half of the world's deaths in children below 5 years of age are caused by under nutrition. Early management of moderate acute malnutrition (MAM) is necessary to avoid deterioration to severe acute malnutrition. Corn soy blend plus (CSB+) mixed with vegetable oil and sugar is the traditional treatment for MAM but is too expensive for poor countries. The effectiveness of affordable and available local food materials are currently being studied as alternative food supplements to treat malnutrition. In this trial, the efficacy of sorghum peanut blend (SPB) mixed with ghee and honey for the treatment of MAM was compared to that of CSB+ among children 6-59 months old in Karamoja, Uganda. This was a single-blind randomized parallel trial in which two health centers were assigned on a 1:1 ratio to the two study groups. The participants (mothers and their moderately malnourished children) were recruited at the health centers and assigned to the groups depending on the health facility attended. Each child received a daily ration of either CSB+ or SPB for a maximum period of 3 months. Anthropometric measurements of the children were taken on a bi-weekly basis. The primary outcomes were the recovery rate and duration on the program before recovery. Of the recruited 440 participants, 392 completed the study and were included in the analysis (SPB group 194; CSB+ group 198). Analysis was by intention to treat. The recovery rates were not significantly different for the SPB group and the CSB+ group (82.3% and 76.8%, respectively; chi-square test P=0.093). Duration of recovery was significantly shorter for the SPB+ group, with a median of 43 days compared to 57 days for the SPB group (Kaplan-Meier survival test). The recovery rate and the duration of stay in the program were all within the acceptable Sphere Standards ($75% and #90 days, respectively). SPB has the potential to treat MAM.