Type, density, and healthiness of food-outlets in a university foodscape: a geographical mapping and characterisation of food resources in a Ghanaian university campus.

INTRODUCTION: Food environments are viewed as the interface where individuals interact with the wider food system to procure and/or consume food. Institutional food environment characteristics have been associated with health outcomes including obesity and nutrition-related non-communicable diseases (NR-NCDs) in studies from high-income countries. The objectives of this study were (1) to map and characterise the food-outlets within a Ghanaian university campus; and (2) to assess the healthiness of the food outlets. METHODS: Data collection was undertaken based on geospatial open-source technologies and the collaborative mapping platform OpenStreetMap using a systematic approach involving three phases: remote mapping, ground-truthing, and food-outlet survey. Spatial analyses were performed using Quantum Geographical Information System (QGIS) and comprised kernel density, buffer, and average nearest neighbour analyses to assess outlet distribution, density, and proximity. A classification system was developed to assess the healthiness of food-outlets within the University foodscape. RESULTS: Food-outlets were unevenly distributed over the University foodscape, with many outlets clustered closer to student residencies. Informal food-outlets were the most frequent food-outlet type. Compared to NCD-healthy food-outlets, NCD-unhealthy food-outlets dominated the foodscape (50.7% vs 39.9%) with 9.4% being NCD-intermediate, suggesting a less-healthy university foodscape. More NCD-unhealthy food outlets than NCD-healthy food outlets clustered around student residences. This difference was statistically significant for food outlets within a 100-m buffer (p < 0.001) of student residence and those within 100 and 500 m from departmental buildings/lecture halls (at 5% level of significance). CONCLUSION: Further action, including research to ascertain how the features of the University's food environment have or are influencing students' dietary behaviours are needed to inform interventions aimed at creating healthier foodscapes in the study University and other campuses and to lead the way towards the creation of healthy food environments at the home, work, and community levels.

Meat, fruit, and vegetable consumption in sub-Saharan Africa: a systematic review and meta-regression analysis.

CONTEXT: The dietary choices people make affect personal health and have consequences for the environment, both of which have serious implications for the 2030 Sustainable Development Agenda. In global reviews, the literature on meat, fruit, and vegetable consumption in sub-Saharan Africa (SSA) is limited. OBJECTIVE: This systematic review set out to quantify meat, fruit, and vegetable consumption in SSA populations and to answer the following question: How much meat, fruit, and/or vegetables are being consumed daily by which individuals in SSA over the years? DATA SOURCES: Following the PRISMA guidelines, the authors systematically searched the MEDLINE, EMBASE, ASSIA CINAHL, Web of Science, POPLINE, and Google Scholar databases to identify 47 (out of 5922 search results) studies reporting meat, fruit, and/or vegetable consumption in SSA populations. DATA EXTRACTION: Three independent investigators extracted data on year of data collection, study country, study population and geographical context, and population intake of meat, fruit, and/or vegetables. DATA ANALYSIS: Using STATA SE version 15 software, random-effects meta-regression analyses were used to test the effect of year of data collection and method of data collection on population meat, fruit, and vegetable consumption. The analyses also tested any association between age, sex, rural/urban residence, or a country's economic development and population intake of meat, fruits, and/or vegetables. The review was started in 2017 and completed in 2019. RESULTS: Richer SSA countries were likely to consume more meat (ß = 36.76, P = 0.04) and vegetables (ß =43.49, P = 0.00) than poorer countries. Vegetable intake has increased dramatically over the last 3 decades from ≈10 g to ≈110 g (ß = 4.43, P = 0.00). Vegetable (ß= -25.48, P = 0.00) consumption was higher in rural than in urban residents. Although the trend of meat consumption has risen (≈25 g to ≈75 g), the trend is nonsignificant (ß = 0.63, N.S.). Daily average per capita meat consumption was 98 g - above the 70 g recommendation - while fruit and vegetable intake (268 g) remain below the World Health Organization's recommendation (400 g). CONCLUSIONS: Given the low intake of plant-based foods, it is likely that SSA populations may be deficient in high-quality protein and micronutrients as suggested by the EAT-Lancet Commission. There is a need to promote both an adequate supply and demand of plant-based protein and micronutrients, including fruit, vegetables, nuts, seeds, and legumes, in SSA countries. While dietary changes in SSA may offer large absolute benefits, consideration of the magnitude of dietary change, particularly increasing or reducing meat consumption, will need to occur in a way that ensures that policy and interventions support the reduction of undernutrition and micronutrient deficiencies without worsening the prevalence and environmental impacts of noncommunicable diseases. There is also the need for preventive action that ensures that SSA populations do not increase their meat consumption as disposable incomes increase and countries' economic development rises, as is seen in most countries undergoing economic transformation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42018090497.