We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Economic access was perceived as a major barrier to accessing nutritionally safe and healthy foods. Home gardening supplemented household nutritional needs, particularly in Nairobi. Policies to enhance food safety in neighbourhood environments are required. Home gardening, food pricing policies and social protection schemes could reduce financial barriers to safe and healthy diets.

This paper compares nutrition intakes and nutritional status of school children from two public schools in neighbouring communities of Ghana with different school feeding programmes. One hundred and eighty-two caregiver and school-age child pairs were interviewed concerning socio-demographics, dietary practices, and food security in a cross-sectional design. The independent t-test was used to compare the contribution of the publicly funded Ghana School Feeding Programme and private School Feeding Programme meals to total daily nutrient intakes of the children. Predictors of nutritional status of the children were assessed using logistic regression models. The private school feeding programme contributed more energy, protein, and micronutrients as compared to the government school feeding programme. About two-thirds (67.0%) of the children were stunted, underweight, or anaemic. Child's age was a significant predictor of stunting. Undernutrition was prevalent among children from both programmes. Improved quality of diet from the feeding programmes may contribute to addressing malnutrition in these children.

Over the last two decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization and development. These changes have altered African food environments and subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition - obesity and other diet-related non-communicable diseases (DR-NCDs), along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and avail energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food environments. However, in Africa the necessary research and policy action have received insufficient attention. Contextual evidence to motivate, enable and create supportive food environments in Africa for better population health is urgently needed. In November 2020, the Measurement, Evaluation, Accountability and Leadership Support for Non-communicable diseases Prevention Project (MEALS4NCDs) convened the first Africa Food Environment Research Network Meeting (FERN2020). This three-day virtual meeting brought researchers from around the world to deliberate on future directions and research priorities related to improving food environments and nutrition across the African continent. The stakeholders shared experiences, best practices, challenges and opportunities for improving the healthiness of food environments and related policies in low- and middle-income countries. In this article, we summarize the proceedings and research priorities identified in the meeting to advance the food environment research agenda in Africa, and thus contribute to the promotion of healthier food environments to prevent DR-NCDs, and other forms of malnutrition.

Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support public sector actions that create healthy food marketing, retail, and provisioning environments for Ghanaian children using adapted methods from the International Network for Food and Obesity/NCDs Research Monitoring and Action Support (INFORMAS).Methods: The protocol for this observational study draws substantially from the INFORMAS' Food Promotion and Food Provision Modules. However, to appraise the readiness of local communities to implement interventions with strong potential to improve food environments of Ghanaian children, the MEALS4NCDs protocol has innovatively integrated a local community participatory approach based on the community readiness model (CRM) into the INFORMAS approaches. The setting is Ghana, and the participants include health and nutrition policy-makers, nutrition and food service providers, consumers, school authorities, and pupils of Ghanaian basic schools.Results: The study establishes a standardized approach to providing implementation science evidence for the prevention of non-communicable diseases (NCDs) in Ghana. It demonstrates feasibility and the innovative application of the INFORMAS expanded food promotion and food provision modules, together with the integration of the CRM in a lower-middle income setting.Conclusion: The research will facilitate the understanding of the processes through which the INFORMAS approach is contextualized to a lower-middle income African context. The protocol could be adapted for similar country settings to monitor relevant aspects of food environments of children.

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