A decade of nutrition research in Africa: Assessment of the evidence base and academic collaboration

Objective: Malnutrition in Africa has not improved compared with other regions in the world. Investment in the build-up of a strong African research workforce is essential to provide contextual solutions to the nutritional problems of Africa. To orientate this process, we reviewed nutrition research carried out in Africa and published during the last decade. Design: We assessed nutrition research from Africa published between 2000 and 2010 from MEDLINE and EMBASE and analysed the study design and type of intervention for studies indexed with major MeSH terms for vitamin A deficiency, protein–energy malnutrition, obesity, breast-feeding, nutritional status and food security. Affiliations of first authors were visualised as a network and power of affiliations was assessed using centrality metrics. Setting: Africa. Subjects: Africans, all age groups. Results: Most research on the topics was conducted in Southern (36 %) and Western Africa (34 %). The intervention studies (9 %; n 95) mainly tested technological and curative approaches to the nutritional problems. Only for papers on protein–energy malnutrition and obesity did lead authorship from Africa exceed that from non-African affiliations. The 10 % most powerfully connected affiliations were situated mainly outside Africa for publications on vitamin A deficiency, breast-feeding, nutritional status and food security. Conclusions: The development of the evidence base for nutrition research in Africa is focused on treatment and the potential for cross-African networks to publish nutrition research from Africa remains grossly underutilised. Efforts to build capacity for effective nutrition action in Africa will require forging a true academic partnership between African and non-African research institutions

Evidence-informed decision making for nutrition: African experiences and way forward

Although substantial amount of nutrition research is conducted in Africa, the research agenda is mainly donor-driven. There is a clear need for a revised research agenda in Africa which is both driven by and responding to local priorities. The present paper summarises proceedings of a symposium on how evidence can guide decision makers towards context-appropriate priorities and decisions in nutrition. The paper focuses on lessons learnt from case studies by the Evidence Informed Decision Making in Nutrition and Health Network implemented between 2015 and 2016 in Benin, Ghana and South Africa. Activities within these countries were organised around problem-oriented evidence-informed decision-making (EIDM), capacity strengthening and leadership and horizontal collaboration. Using a combination of desk-reviews, stakeholder influence-mapping, semi-structured interviews and convening platforms, these country-level studies demonstrated strong interest for partnership between researchers and decision makers, and use of research evidence for prioritisation and decision making in nutrition. Identified capacity gaps were addressed through training workshops on EIDM, systematic reviews, cost-benefit evaluations and evidence contextualisation. Investing in knowledge partnerships and development of capacity and leadership are key to drive appropriate use of evidence in nutrition policy and programming in Africa

The Global Nutrition Report 2014: Actions and Accountability to Accelerate the World’s Progress on Nutrition

In 2013, the Nutrition for Growth Summit called for a Global Nutrition Report (GNR) to strengthen accountability in nutrition so that progress in reducing malnutrition could be accelerated. This article summarizes the results of the first GNR. By focusing on undernutrition and overweight, the GNR puts malnutrition in a new light. Nearly every country in the world is affected by malnutrition, and multiple malnutrition burdens are the ‘‘new normal.’’ Unfortunately, the world is off track to meet the 2025 World Health Assembly (WHA) targets for nutrition. Many countries are, however, making good progress on WHA indicators, providing inspiration and guidance for others. Beyond the WHA goals, nutrition needs to be more strongly represented in the Sustainable Development Goal (SDG) framework. At present, it is only explicitly mentioned in 1 of 169 SDG targets despite the many contributions improved nutritional status will make to their attainment. To achieve improvements in nutrition status, it is vital to scale up nutrition programs. We identify bottlenecks in the scale-up of nutrition-specific and nutrition-sensitive approaches and highlight actions to accelerate coverage and reach. Holding stakeholders to account for delivery on nutrition actions requires a well-functioning accountability infrastructure, which is lacking in nutrition. New accountability mechanisms need piloting and evaluation, financial resource flows to nutrition need to be made explicit, nutrition spending targets should be established, and some key data gaps need to be filled. For example, many UN member states cannot report on their WHA progress and those that can often rely on data >5 y old. The world can accelerate malnutrition reduction substantially, but this will require stronger accountability mechanisms to hold all stakeholders to account. J Nutr doi: 10.3945/jn.114.206078

How Can the Operating Environment for Nutrition Research Be Improved in Sub-Saharan Africa? The Views of African Researchers

Optimal nutrition is critical for human development and economic growth. Sub-Saharan Africa is facing high levels of food insecurity and only few sub-Saharan African countries are on track to eradicate extreme poverty and hunger by 2015. Effective research capacity is crucial for addressing emerging challenges and designing appropriate mitigation strategies in sub-Saharan Africa. A clear understanding of the operating environment for nutrition research in sub-Saharan Africa is a much needed prerequisite. We collected data on the barriers and requirements for conducting nutrition research in sub-Saharan Africa through semi-structured interviews with 144 participants involved in nutrition research in 35 countries in sub-Saharan Africa. A total of 133 interviews were retained for coding. The main barriers identified for effective nutrition research were the lack of funding due to poor recognition by policymakers of the importance of nutrition research and under-utilisation of research findings for developing policy, as well as an absence of research priority setting from within Africa. Current research topics were perceived to be mainly determined by funding bodies from outside Africa. Nutrition researchers argued for more commitment from policymakers at national level. The low capacity for nutrition research was mainly seen as a consequence of insufficient numbers of nutrition researchers, limited skills and a poor research infrastructure. In conclusion, African nutrition researchers argued how research priorities need to be identified by African stakeholders, accompanied by consensus building to enable creating a problem-driven national research agenda. In addition, it was considered necessary to promote interactions among researchers, and between researchers and policymakers. Multidisciplinary research and international and cross-African collaboration were seen as crucial to build capacity in sub-Saharan nutrition research

Developing a Sustainable Nutrition Research Agenda in Sub-Saharan Africa-Findings from the SUNRAY Project

<p>Developing a Sustainable Nutrition Research Agenda in Sub-Saharan Africa—Findings from the SUNRAY Project</p

Development of a school-based intervention to improve the daily diet of adolescents in urban Benin

Low- and middle-income countries (LMIC) are facing increasing rates of overweight and obesity, like high-income-countries (HIC). This trend is associated with a rapid urbanization and subsequent changes in diet and lifestyles and is observed in various population groups. Particularly, adolescents are subjected to these contemporary nutrition and health problems. Adolescents’ well-being has long been neglected in LMIC although they are vulnerable and represent a large share of the population. The present PhD research targeted adolescents in Benin, a west-African low-income country where they constitute 23% of the total population. Its purpose was to provide evidence for the development of a school-based intervention to improve adolescents’ diet in urban Benin. Specific objectives were to: - review the association of out-of-home eating with the risk of overweight and obesity and anthropometric changes, - evaluate the importance of out-of-home eating in the daily diet of school adolescents in urban Benin, - assess socioeconomic and demographic differences in the diet of school adolescents in urban Benin, - identify the determinants of fruit and vegetable consumption in school adolescents in urban Benin and - test a school-based intervention aiming at increasing the daily fruit intake of adolescents in urban Benin. The 1st chapter of this document explains the background and justification of the research. Chapter 2 reviews systematically the evidence on the link between out-of-home eating and anthropometric changes and reports a positive association of frequent out-of-home eating, in the broad sense, with the risk of overweight, obesity and weight change. Chapter 3 measured the daily food, energy, macronutrient intakes and the contribution of out-of-home prepared foods in school-going adolescents on school days in Cotonou, the largest city in Benin. Two face-to-face 24-hour dietary recalls were used for this purpose. Out-of-home prepared foods represented 40% and more in the adolescents’ daily intakes. Low and high out-of-home consumers, respectively defined as the 1st and 3rd tertiles of the sample’s mean percent energy from out-of-home prepared foods, had a comparable nutrition status. They were also similar with regard to the overall daily diet, except for the consumption of sweet foods, fruits and vegetables. High out-of-home consumers had higher intakes of sweet foods, fruits and vegetables than low consumers. However, both categories had a fruit and vegetable intake which was far below the minimum 400g recommended daily, a high intake of sweet foods and a high fat intake. Chapter 3 concludes that a fruit and vegetable school-based program is urgently needed in adolescents in urban Benin. It was expected that such a program would affect the overall diet and, particularly, would lower the consumption of sweet foods of school-going adolescents. In chapter 4, socioeconomic and demographic correlates of food groups consumed by school adolescents in Cotonou were identified using a questionnaire. The findings show that household wealth, sex and age mediate the adolescents’ food consumption. Adolescents from wealthier households consume more fruits and vegetables, sweet foods and meat but less cereals than those from poor households. Females had a higher intake of meat and meat products and a lower intake of cereal and cereal products than males. Younger adolescents consume more sweet foods and less cereals and cereals products than the older. Hence, the diet of younger females from wealthier households was more indicative of current dietary changes in LMIC, which are conducive to overweight and obesity. Chapter 5 used focus group discussions to appraise views and perceptions of urban Beninese adolescents about factors influencing their fruit and vegetable consumption. Participants were selected from 2 private and 2 public schools in Cotonou. Sixteen sessions were conducted with 153 students. The more frequently discussed school-related determinants were availability and accessibility of fruits and vegetables, which have already been reported by studies from HIC. Cost of fruits and vegetables was also important for the adolescents. The food safety of fruits and vegetable meals outside home and particularly at school was a key context-specific barrier to their consumption by the adolescents. The participants had a higher preference for fruits than vegetables and made proposals for school-based fruit interventions. Findings from the focus groups were used to design a school-based fruit program which was pilot-tested. This is presented in Chapter 6. The intervention consisted in operating a fruit stall, under strict hygiene conditions, in a school selected by convenience in Cotonou. It was conducted during a period when fruits were expensive and less available and lasted 2 months. The intervention increased mean daily fruit intake of students who consumed fruits from the stall by 166g. At the same time, mean fiber intake increased and mean percent energy from fat declined from 33 to 28%, a level in the recommended range (15-30%). Although, these subjects represented only 22% of the study sample, it was concluded that the results were promising since the intervention was novel and was implemented in a short time frame and during a period where fruits were expensive. In Chapter 7, the implications for public health practice are elaborated. The present research suggests that formal school canteens providing healthy foods, like fruits, be installed progressively in secondary schools in Cotonou and over Beninese cities as a means to improve adolescents’ diet. This strategy would be a formal expansion of the fruit stall and hygiene conditions could more easily be controlled in canteens operated by registered school staff. Suggestions for future research are also made in this chapter

Association of out-of-home eating with anthropometric changes : a systematic review of prospective studies

In the present review, the association of out-of-home eating with anthropometric changes was examined. Peer-reviewed studies in eight databases were searched, and 15 prospective studies were included in the review. The quality of the data was assessed by considering risks of bias in sample selection, data collection methods, and the appropriateness of statistical tests. From this, seven studies, which used relatively large samples or had a follow-up period longer than 10years, were retained for further analysis. It was concluded that eating out-of-home frequently, in the broad sense, is positively associated with the risk of becoming overweight or obese and weight change. With regard to specific out-of-home sources, the review shows that eating at fast-food outlets is associated with a greater increase in body weight and waist circumference over time than eating at restaurants and takeaway foods positively predict BMI change in women. More research is needed on out-of-home foods other than fast-foods and restaurant foods, such as street, canteen, and school foods