Mapping of Outdoor Food and Beverage Advertising Around Primary and Secondary Schools in Kampala City, Uganda

Abstract

Background: Overweight and obesity in children and adolescents are rising rapidly in low- and middle-income countries. Among the contributing factors for this increase is the marketing of unhealthy food products, which affects children’s dietary preferences, food choices, purchasing requests, and consumption patterns. Given that little is known about food marketing in Africa, including in Uganda, monitoring children’s exposure to food marketing is essential to generate evidence on the problem and develop meaningful policy responses. The aim of this study was to describe the food and beverage marketing environment surrounding schools in urban and peri-urban areas of Kampala city. Methods: Outdoor advertising around 25 randomly sampled primary- and secondary schools within a radius of 250 meters of each school was mapped. Information on size, setting, type, and position of the advertisements and the healthiness of the food and beverage promoted was collected using the INFORMAS Outdoor Advertising Protocol. The occurrence of advertising was described using frequencies, median, and density per 100m2. Results: A total of 1,034 branded advertisements was identified around the schools. Of these, 86% featured unhealthy products, 8% healthy, and 6 % miscellaneous. The most advertised products were sugar-sweetened beverages and alcoholic beverages (51% and 23%, respectively). Schools in the urban area were surrounded by more unhealthy ads than those in the peri-urban areas (median of 45 vs 24 ads). Conclusion: The considerable extent of unhealthy food and beverage advertisements around primary and secondary schools highlights the need for food marketing regulation in Uganda, in line with the World Health Organization’ recommendations, to ensure that young people are protected from unhealthy food marketing messages.

A scoping review of outdoor food marketing: exposure, power and impacts on eating behaviour and health

“…Content analysis was used to characterise the food types promoted and strategies used in the advertising. Two studies investigated price promotions [55,56], two identified promotional characters and premium offers [75,78], one specifically assessed child-directed marketing [57]. Others examined a mix of strategies including Posters, stickers, free-standing signs, banners, painting on walls or flags.…”

“…A study comparing four schools of varying deprivation found the school with lowest deprivation had no advertisements but there was no clear trend in extent of advertising by deprivation [105]. Two studies conducted in Mexico [81] and New Zealand [86] found outdoor food advertising to be more frequent around public schools than private schools, however a study in Uganda [75] found no significant difference in the number of core foods advertised around private and government funded schools, in all three studies private school was considered a proxy of high SES. In this New Zealand study, low decile areas had the greatest number of advertisements for non-core food, core food and non-core food and beverage, however when high decile schools were combined with areas around private schools, the greatest number of all food and beverage advertisements and non-core advertisements were found in high SES areas [86].…”

“…Coca Cola was frequently stated as the most prominent brand advertised [73,75,88,91,100]. Around 5% of all outdoor food advertisements in New Zealand [78] and Australia [100] were promoting a brand (rather than a specific product), however there were no brand only advertisements identified in a UK study [80].…”

“…Two studies found no significant difference in the number of core advertisements by SES [98,100], however a study of outdoor food advertising in Uganda found that there were more healthy food advertisements in high income areas [75]. Advertisements for fast food, takeaways, hot beverages and soft drinks were found to be more frequent in high-income areas [91,96,101].…”

“…Often, the foods promoted using persuasive creative strategies were soft drinks [73,76], non-core foods [77] and fast foods [57,76], however one study [75] observed outdoor food advertising in Uganda and found that 15% of healthy food advertisements used promotional characters.…”