Perceptions and attitudes towards food choice in adolescents in Gaborone, Botswana

The purpose of this qualitative study was to describe the factors that influence adolescent and adult perceptions and attitudes related to adolescent diet in Botswana. A series of 15 focus groups [12 adolescent focus groups (6 male and 6 female) & 3 parent focus groups] of approximately six to eleven members each were conducted in Gaborone, the capital city of Botswana in 2009–2010. Adolescents and parents of adolescents suggest that the main drivers of adolescent food choices have much to do with where the adolescent is in terms of time of day as well as with whom the adolescent is with. Outside of the home adolescents suggest that the real or perceived influence of companions place social standing on the ability to purchase and consume non-traditional foods, and that traditional foods leave adolescents open to ridicule. Additionally parents of adolescents suggest that while they prefer for their children to consume healthy foods, they frequently purchase unhealthy food items for their children based on the child\u27s taste preferences as well as social influence to prove you can buy “nice things” for one\u27s family. Adolescents and parents of adolescents suggest that increasing the availability and decreasing the costs of healthy food options are preferred possible interventions to increase healthful eating among adolescents. However, the adolescents also suggest that these healthy food options should not crowd out or completely replace unhealthy options, thus preserving the adolescents\u27 freedom to choose. This could pose a major challenge in any school-based adolescent obesity prevention program

The Association of General and Central Obesity with Dietary Patterns and Socioeconomic Status in Adult Women in Botswana

Dietary patterns and their association with general and central obesity among adult women were studied using a cross-sectional survey with multistage cluster sampling in urban and rural areas nationwide in Botswana. The participants in the study were adult women (N = 1019), 18–75 years old. The dietary patterns were identified using principal component analysis, and their associations with the body mass index and the weight-for-height ratio were examined. Factor analysis with varimax rotation was used to identify six dietary patterns (fast foods, refined carbohydrates, vegetables and fruits, fish and nuts, Botswana traditional foods, and organ and red meat dietary pattern). Overall, 24.5% of the women were overweight (BMI 25.0–29.99 kg/m2) and 24.5% were obese (BMI > 30 kg/m2). A waist-to-height ratio greater than 0.5 was observed for 42.2% of the women. With adjustment for age and education, individuals in the highest tertile of the Botswana traditional food pattern had a significantly higher risk of general obesity (RR = 1.40, 95% CI: 1.07–1.84) and central obesity (RR = 1.20, 95% CI: 0.97–1.48). With respect to the fish and nut pattern, a significant association was observed with central obesity only (RR = 1.43, 95% CI: 1.18–1.72). The Botswana traditional food pattern, characterised by a high carbohydrate intake, was found to be associated with a high risk of obesity in this study. However, more research is required to assess other factors contributing to obesity in women so that appropriate intervention programs can be put in place to help control this epidemic

Adolescent Obesity Prevention in Botswana: Beliefs and Recommendations of School Personnel

The study’s objectives were to gain school personnel’s (1) perceptions on diet, physical activity, body size, and obesity, (2) description of school food and physical activity practices, and (3) recommendations for programs to prevent adolescent obesity. The study took place in six junior secondary schools of varying socioeconomic status in Gaborone, Botswana. Using a qualitative descriptive design, semistructured interviews were conducted with key school personnel. Directed content analysis was used to summarize the findings. School personnel believed that obesity was an important problem. They felt that school food was unhealthy and that physical activity was provided insufficiently. Participants shared enthusiasm for a school-based health-promoting intervention that must be fun and include active engagement and education on healthy lifestyles for all students. Participants supported on-site food shop inventory changes and physical activity programs. Potential barriers listed were schools’ financial resources, interest of students, and time limitations of all involved

Socio-economic status and urbanization are linked to snacks and obesity in adolescents in Botswana

Objective To describe patterns of food consumption associated with overweight/ obesity (OW/OB) and their links to socio-economic status (SES) and urbanization. Design A nationwide cross-sectional survey. Setting Secondary schools in cities, towns and villages in Botswana, Africa. Subjects A total of 746 adolescent schoolchildren. Results OW/OB is associated with greater SES, city residence and a snack-food diet pattern. Students belonging to higher SES compared with those from a lower SES background reported significantly (P \u3c 0·01) more daily servings of snack foods (1·55 v. 0·76) and fewer servings of traditional diet foods (0·99 v. 1·68) and also reported that they ate meals outside the home more often (90 % v. 72 %). Students in cities ate significantly (P \u3c 0·01) more servings of snacks (1·69 v. 1·05 v. 0·51) and fewer servings of traditional foods (0·67 v. 1·52 v. 1·61) compared with those in urban and rural villages. The odds of OW/OB were increased 1·16-fold with a snack-food diet, a result that was diminished when controlled for SES. Conclusions These data suggest that nutritional transition occurs at different rates across urbanization and SES levels in Botswana. In cities, increasing the availability of fruit while reducing access to or portion sizes of snack items is important. Emphasis on continued intake of traditional foods may also be helpful as rural areas undergo economic and infrastructural development

HIV-associated gut microbial alterations are dependent on host and geographic context

Abstract HIV-associated changes in intestinal microbiota are believed to be important drivers of disease progression. However, the majority of studies have focused on populations in high-income countries rather than in developing regions where HIV burden is greatest. To better understand the impact of HIV on fecal microbiota globally, we compare the fecal microbial community of individuals in the U.S., Uganda, and Botswana. We identify significant bacterial taxa alterations with both treated and untreated HIV infection with a high degree of uniqueness in each cohort. HIV-associated taxa alterations are also significantly different between populations that report men who have sex with men (MSM) behavior and non-MSM populations. Additionally, while we find that HIV infection is consistently associated with higher soluble markers of immune activation, most specific bacterial taxa associated with these markers in each region are not shared and none are shared across all three geographic locations in our study. Our findings demonstrate that HIV-associated changes in fecal microbiota are overall distinct among geographical locations and sexual behavior groups, although a small number of taxa shared between pairs of geographic locations warrant further investigation, highlighting the importance of considering host context to fully assess the impact of the gut microbiome on human health and disease

Evaluation of the international standardized 24-h dietary recall methodology (GloboDiet) for potential application in research and surveillance within African settings

Abstract Background Collection of reliable and comparable individual food consumption data is of primary importance to better understand, control and monitor malnutrition and its related comorbidities in low- and middle-income countries (LMICs), including in Africa. The lack of standardised dietary tools and their related research support infrastructure remains a major obstacle to implement concerted and region-specific research and action plans worldwide. Citing the magnitude and importance of this challenge, the International Agency for Research on Cancer (IARC/WHO) launched the “Global Nutrition Surveillance initiative” to pilot test the use of a standardized 24-h dietary recall research tool (GloboDiet), validated in Europe, in other regions. In this regard, the development of the GloboDiet-Africa can be optimised by better understanding of the local specific methodological needs, barriers and opportunities. The study aimed to evaluate the standardized 24-h dietary recall research tool (GloboDiet) as a possible common methodology for research and surveillance across Africa. Methods A consultative panel of African and international experts in dietary assessment participated in six e-workshop sessions. They completed an in-depth e-questionnaire to evaluate the GloboDiet dietary methodology before and after participating in the e-workshop. Results The 29 experts expressed their satisfaction on the potential of the software to address local specific needs when evaluating the main structure of the software, the stepwise approach for data collection and standardisation concept. Nevertheless, additional information to better describe local foods and recipes, as well as particular culinary patterns (e.g. mortar pounding), were proposed. Furthermore, food quantification in shared-plates and -bowls eating situations and interviewing of populations with low literacy skills, especially in rural settings, were acknowledged as requiring further specific considerations and appropriate solutions. Conclusions An overall positive evaluation of the GloboDiet methodology by both African and international experts, supports the flexibility and potential applicability of this tool in diverse African settings and sets a positive platform for improved dietary monitoring and surveillance. Following this evaluation, prerequisite for future implementation and/or adaptation of GloboDiet in Africa, rigorous and robust capacity building as well as knowledge transfer will be required to roadmap a stepwise approach to implement this methodology across pilot African countries/regions

Additional file 2: of Evaluation of the international standardized 24-h dietary recall methodology (GloboDiet) for potential application in research and surveillance within African settings

Evaluation questionnaire in English. (PDF 505 kb