Exploring influences on adolescent diet and physical activity in rural Gambia, West Africa; food insecurity, culture and the natural environment

Objective: to explore, from the perspectives of adolescents and caregivers, and using qualitative methods, influences on adolescent diet and physical activity in rural Gambia.Design: six focus group discussions (FGDs) with adolescents and caregivers were conducted. Thematic analysis was employed across the dataset.Setting: Rural region of The Gambia, West Africa. Participants: participants were selected using purposive sampling. Four FGDs, conducted with 40 adolescents, comprised: girls aged 10-12 years; boys aged 10-12 years; girls aged 15-17 years, boys aged 15-17 years. Twenty caregivers also participated in two FGDs (mothers, fathers). Results: all participants expressed an understanding of the association between salt and hypertension, sugary foods and diabetes, and dental health. Adolescents and caregivers suggested that adolescent nutrition and health were shaped by economic, social and cultural factors and the local environment. Adolescent diet was thought to be influenced by: affordability, seasonality and the receipt of remittances; gender norms, including differences in opportunities afforded to girls, and mother-led decision-making; cultural ceremonies and school holidays. Adolescent physical activity included walking or cycling to school, playing football and farming. Participants felt adolescent engagement in physical activity was influenced by gender, seasonality, cultural ceremonies and, to some extent, the availability of digital media. Conclusions: these novel insights into local understanding should be considered when formulating future interventions. Interventions need to address these interrelated factors, including misconceptions regarding diet and physical activity that may be harmful to health. <br/

Anthropometric nutritional status, and social and dietary characteristics of African and Indian adolescents taking part in the TALENT (Transforming Adolescent Lives through Nutrition) qualitative study.

Objective: to describe the anthropometry, socio-economic circumstances, diet and screen time usage of adolescents in India and Africa, as context to a qualitative study of barriers to healthy eating and activity. Design: cross-sectional survey, including measured height and weight and derived rates of stunting, low body mass index (BMI), overweight and obesity. Parental schooling and employment status, household assets and amenities, and adolescents’ dietary diversity, intake of snack foods, mobile/smart phone ownership and TV/computer time were obtained by questionnaire. Settings: four settings each in Africa (rural villages, West Kiang, The Gambia; low-income urban communities, Abidjan, Cote D’Ivoire; low/middle-class urban communities, Jimma, Ethiopia; low-income township, Johannesburg, South Africa) and India (rural villages, Dervan; semi-rural villages, Pune; city slums, Mumbai; low-middle/middle-class urban communities, Mysore).Participants: convenience samples (N=41-112 per site) of boys and girls aged 10-12y and 15-17y recruited for a qualitative study.Results: both undernutrition (stunting and/or low BMI) and overweight/obesity were present in all settings. Rural settings had the most undernutrition, least overweight/obesity and greatest diet diversity. Urban Johannesburg (27%) and Abidjan (16%), and semi-rural Pune (16%), had the most overweight/obesity. In all settings, adolescents reported low intakes of micronutrient-rich fruits and vegetables, and substantial intakes of salted snacks, cakes/biscuits, sweets and fizzy drinks. Smart phone ownership ranged from 5% (West Kiang) to 69% (Johannesburg), higher among older adolescents. Conclusions: the ‘double burden of malnutrition’ is present in all TALENT settings. Greater urban transition is associated with less undernutrition, more overweight/obesity, less diet diversity and higher intakes of unhealthy/snack foods. <br/