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Dietary perception, behavior, and nutritional status can all be influenced by exposure to information. Behavior change communication that is appropriately designed and implemented is critical for motivating optimal dietary behavior. On the other hand, inadvertent or deliberate misinformation can drive unhealthy dietary behaviors. As part of the process to develop food-based dietary guidelines (FBDGs) for Ghana, this rapid evidence review examined the nature, extent, sources, and medium of food and nutrition information dissemination and promotion in Ghana. PubMed, Cochrane, Google Scholar, and Open Access Theses Dissertations (OATD) databases were searched systematically using keywords to identify relevant peer-reviewed and grey literature. The review included 31 documents, after excluding 1,302 documents for ineligibility (based on irrelevant title, abstract, and duplicates). Limited reporting of undernutrition was found in print and electronic media. Unhealthy foods, including sugar-sweetened beverages, snacks, yogurt, instant noodles, candy/chocolate, and ice cream were frequently advertised through various communication media. Children are highly exposed to food advertisements, which target them. Promotional characters, animation, billboards, and front-of-store displays; product-branded books, and toys are common strategies for food marketing and advertisement in Ghana. The most frequently reported sources of health and nutrition information were television, radio, social media, health professionals, families, and friends. Children and adults experienced changes in food preferences and choices as a result of exposure to food advertised on television. The commonly used traditional media were radio and television; printed newspaper use has declined tremendously in the past decade. Social media use (particularly WhatsApp, Facebook, and YouTube) is highest in urban areas, and is growing rapidly; young adults are the most active users of social media platforms. Experts recommend regulation as a mitigation for nutrition miscommunication and inaccurate promotion. The current review highlights the need for regulation of food marketing, and advertisement to safeguard a healthy food environment in Ghana. Key words: advertisement, promotion, diet, regulation, social media, food, Ghana, INTRODUCTION Due to modern technological innovations, information can be communicated these days via multiple media including radio, television, magazines, and the world wide web. Depending on the target group and [...]

As part of the process by the government of Ghana to develop food-based dietary guidelines, a review of policies and programs was commissioned. The review aimed to identify and describe the policy environment, with a focus on identifying the type of existing policies, priorities, and programs related to nutrition and health between 2010 and 2020. The review also tracked the evolution of changes in policies and programs over the same period. Using a systematic rapid scoping review approach, policy and program documents were identified and classified according to relevant nutrition-specific and nutrition-sensensitive sectors, including health, agriculture and food, human development, social protection, and trade. Data from included documents were extracted using an excel extraction tool. The extracted data including policies, programs, objectives, coverage of the policies/programs, intended outcomes, target groups, and agencies responsible for implementing these policies and programs. More than 70 government documents, plus other reports and literature sources describing government policy and programs with relevance for nutrition were identified. Most of these policies and programs were not designed to directly address malnutrition. This is because, the policies and programs neither referenced nutrition objectives, nor nutrition outcomes. However, the existing policies and programs had aspects that can be leveraged (either through redesign or implementation) to contribute to improved nutrition outcomes. A key challenge in the nutrition programming landscape is the non-existence of a comprehensive and costed national nutrition strategic plan to accompany the national nutrition policy. The key nutrition priorities of the Government of Ghana and its partners, as expressed in the documents reviewed included infant and young child feeding, stunting reduction, anemia, and food security. There were key nutrition-related issues which have not been prioritized, although current local and global evidence as well as stakeholder opinion suggests these have already become, or are rapidly becoming important priorities. These include overweight and obesity, diet-related chronic diseases, nutrition of school-age children, and nutrition of the elderly. These nutrition issues, if not appropriately addressed, will continue to exact significant human health, economic, and social costs for Ghana. There is need for a comprehensive nutrition strategy that leverages opportunities across multiple sectors to improve nutrition for today and for the future. Key words: Policy, Nutrition, Ghana, Diet, Programs, Government, Priorities, obesity, anemia, stunting, INTRODUCTION Adequately funded policies and programs are necessary to drive initiatives to address malnutrition[1]. If designed appropriately, nutrition policies are important to frame the nutrition problem, characterize the context, identify [...]

Food-Based Dietary Guidelines (FBDG) provide culturally-appropriate and actionable recommendations based on which populations can make healthy food choices. Food systems sustainability, from production to consumption, and disposal of food and food-related items, should be a critical consideration for developing such guidelines. This rapid review assesses Ghana's food systems to determine the level of sustainability to inform the FBDG recommendations. Peer-reviewed articles, documents and reports of relevance to Ghana were included in this rapid review. A hundred and eight papers, answering different questions on food system sustainability were reviewed. Bread, cereals, fish and indigenous vegetables are the most frequently consumed food groups. Sugar-Sweetened Beverages are the most consumed imported foods. In rural areas, 53% of dietary protein comes from plant sources. Fish is the main the source of animal protein for most Ghanaian households. There is intensive exploitation of marine and fresh water resources. Most livestock are raised by smallholder farmers using free-range system. Poultry is frequently kept on deep litter system and only a few are large-scale. Crop production for household consumption and small-scale animal rearing are predominant, especially in Northern Ghana. By weight, fruits and vegetables are the least cultivated and consumed crops at the household level. Wood is the commonest source of fuel for cooking, especially in rural areas. Single use plastic is the most used and preferred material for food packaging. Indiscriminate and poor management of waste and pesticide misuse is commonly reported. The findings suggest the need for promoting production diversification, use of clean fuel and reusable food packaging as part of FBDGs to enhance sustainability of Ghana's food systems. Key words: sustainability, food system, Ghana, Food-based Dietary Guidelines, production, diversification, INTRODUCTION As the world's population continues to rise steadily [1], there is increased global awareness and efforts to produce adequate quantities and variety of nutritious, affordable foods, while preserving the [...]

As part of a process to develop food-based dietary guidelines (FBDGs), the national Multi-sectoral Technical Task Team coordinating FBDGs development in Ghana has commissioned a desk review of the nutrition and health situation, and trends for all persons living in Ghana, across the entire life cycle. Using a rapid scoping review method, multiple electronic databases were systematically searched using keywords related to nutrition and health outcomes, as well as potential drivers of nutrition and health in Ghana. The review included evidence from peer-reviewed articles, unpublished manuscripts, dissertations, reports of nationally representative surveys, and other grey literature (reports of nutrition situation evaluations commissioned by international and local agencies), spanning the decade starting from 2010. A total of 48 documents were included in this review: 15 for infants and young children, 14 for adolescents, 19 for adults and women of reproductive age, and five for the elderly. Among children under five, anemia and stunting were the most prevalent nutrition-related outcomes, 62% and 19%, respectively. Underweight prevalence of 11% was observed among young children; wasting rates have remained below 10%, but registered about 20% prevalence in northern Ghana. Different levels of micronutrient deficiencies, particularly iron deficiency were reported across all age groups. Nutrient deficiency rates were higher among adolescent girls and women of reproductive age. Vitamin A deficiency was also high (21%) among under-fives. Overweight and obesity rates were high among women of reproductive age (40%) and adolescents (11% to 18% between 2013 and 2017), and still increasing. Underweight and overweight coexists among the elderly (50 years and above), at a rate of 10% and 20%, respectively. An increasing prevalence of central adiposity has also been reported among women of reproductive age (high waist circumference of 80.6%) and persons older than 60 years (67% in 2015). Rates of hypertension and cancers have also increased within the study period. Hypertension rates have been increasing with age, particularly among urban dwellers. Majority of persons with hypertension are not receiving treatment . Incidence of breast, cervical, and liver cancers were 20%, 14%, and 12% in 2018. Ghana is experiencing a double burden of malnutrition characterized by co-existing high levels of undernutrition and overnutrition. The national FBDGs for Ghana should prioritize recommendations and actions that address the dual burden of undernutrition and overnutrition. Key words: Nutritional status, Micronutrient Deficiency, Ghana, undernutrition, Overweight, Anemia, Stunting, non-communicable disease, INTRODUCTION Malnutrition in all its forms is linked with reduced productivity, increased susceptibility to infections, and impaired recovery from illness. Addressing malnutrition is, thus, recognized as a global human development [...]

Ghana continues to address persistent malnutrition through political action and programme development. Government-led efforts have included the formulation of multi-sectoral policies and programmes to improve the diet and nutritional status of various at-risk population groups. Globally, an important tool for promoting healthy diets are Food-Based Dietary Guidelines (FDBGs). To achieve and sustain the desired goal of promoting healthy eating habits and lifestyles, FBDGs require, among many factors, supportive national policies and programmes. When coherently incorporated in relevant nutrition-related policies and programmes, FBDGs enhance their impact on shaping and sustaining healthier dietary habits. In this context, it is essential to understand the national policy and programme environment and its potential contribution during the formulation of FBDGs. The present review aimed to identify existing nutrition-related education and social protection policies and programmes in Ghana and their relevance to the development and implementation of FBDGs. Previously conducted scoping reviews, gap analyses, and a benchmarking report of Ghana's public health nutrition policies were used as information sources to identify relevant policies and programmes. Additionally, websites of relevant government ministries, departments and agencies were searched to retrieve applicable policies or actions that were not included in previous reviews. Nutrition-related education policies that were identified primarily support school health services, whereas social protection policies broadly target social assistance, social welfare, social equity and insurance-based policies and programmes. Specific ways these policies and programmes could support the development and implementation of Ghana's dietary guidelines include embedding FBDGs in the school nutrition curriculum to motivate healthier food choices by schoolchildren and using FBDGs to plan meals provided as part of the country's school feeding programme. Regarding social protection, existing instruments such as food transfers, social pensions and conditional cash transfers could be aligned with FBDGs to ensure vulnerable households can access foods and follow recommended guidelines. Although some nutrition actions are incorporated in existing policies and programmes, there are opportunities to improve their nutrition sensitivity. Key words: Ghana, food-based dietary guidelines, nutrition education, social protection, INTRODUCTION Ghana has demonstrated political commitment to addressing the problem of malnutrition--particularly food insecurity and undernutrition with clinical and community-based programmes for many decades. The country is a signatory to [...]

Food-based dietary guidelines (FBDGs) are important tools for promoting healthy eating and nutrition education at the population level. Currently, more than 100 countries worldwide have developed FBDGs with majority of existing FBDGs in high-income countries. However, there are a few countries in Africa which have developed FBDGs. This review describes and compares the characteristics of existing FBDGs in Africa. Data were extracted from all existing FBDGs from African countries which have been archived in the Food and Agriculture Organization's (FAO) online repository of FBDGs. In addition, supporting documentation from other sources linked to the identified FBDGs were also reviewed. Extracted data were coded and synthesized to describe the purpose of the FBDGs, the process for developing the FBDGs, and how healthy diets were expressed in the FBDGs. In addition, the FBDGs were examined for content on considerations for planetary health, and non-dietary recommendations. A checklist was used to extract the evidence in the identified documents. Of the 47 African countries in the WHO Africa region, only eight FBDGs were identified from seven countries. South Africa had two FBDGs (including a FBDG for young children). Multi-disciplinary technical working groups were convened in developing majority of the FBDGs. The working groups utilised scientific evidence on diet-related diseases and nutrient requirements as a basis for recommendations. All the FBDGs were intended as a tool for promoting healthy diets among the lay population. The FBDGs that were reviewed included between six and sixteen dietary messages. Diet diversification was promoted as the most common recommendation across African country FBDGs. The recommendations often promoted consumption of four to six food groups communicated using text as well as images (food guide). Local availability and cultural acceptability were important values promoted as part of an optimal diet in some of the countries. However, none of the recommendations addressed environmental sustainability. Apart from South Africa, none of the FBDGs had been evaluated or revised. Across Africa, there is a need for increased focus on developing new FBDGs or revising existing ones as a tool for meeting the dietary information needs of populations at risk of malnutrition in all its forms. Key words: Food-based, Dietary, Guidelines, diversity, Africa, Health, Non-communicable, Sustainability, INTRODUCTION Unhealthy diets are a major avoidable risk factor for mortality and morbidity across the lifespan [1,2]. One in five deaths, globally, has been linked to unhealthy diets [1]. On [...]

The prevalence of obesity and diet related non-communicable diseases (NCDs) are rapidly increasing in Africa. Consumption of pre-packaged foods is one of the main drivers of these NCDs. Pre-packaged foods tend to contain high levels of energy, fat, sugar, and salt, which are known risk factors for NCDs. Food labels can guide consumers to make informed healthy food choices. Therefore, it is important to analyze how health-related information is communicated on food labels. In Ghana, there is paucity of evidence on what health-related information is available to consumers of pre-packaged foods. This study describes health-related information on labelled pre-packaged foods sold in local retail shops in Accra. A cross-sectional survey and quantitative content analysis of food label information were employed in this study. Pre-packaged food labels photograph data were sourced from shops and content analyzed to describe their health-related information. Nutrition and health-related information were classified using the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support (INFORMAS) system. Three hundred and fifty-one (N=351) pre-packaged foods and non-alcoholic beverages were sampled, out of which 2.3% products were unlabelled. Out of 343 labelled products, 92% disclosed ingredient list information and 68.8% had nutrition declaration. Between the two nutrition labelling formats: Back-of-Pack (BOP) and Front of Pack (FOP), BOP was the dominant (87.3%) format. Various types of FOPs were identified however, Guidelines Daily Allowance (GDA) was the most common format. The study found that 18% of labelled pre-packaged foods carried nutrition claim and about 7% had a health claim. Most of the claims were written and the others were a combination of words, numbers, and pictures/symbols. This study has shown a high disclosure of health-related label information on pre-packaged food but information presentations on labels were not consistent. The insight gained from this study shows that the presentation of health-related label information does not meet the current recommendations of Codex and the benchmarks set out by INFORMAS in promoting a healthy food environment. Key words: Pre-packaged Foods, Food/Nutrition labels, health-related information, retail shops, Accra, INTRODUCTION Obesity and diet-related non communicable diseases (NCDS) are the leading cause of death and disability worldwide [1]. In Ghana, obesity and diet--related NCDs are increasing and have become a [...]

Food-related beliefs and attitudes influence dietary behaviors and are important drivers of nutrition outcomes. Understanding beliefs and attitudes that drive dietary behaviors, as part of the process for developing Food-based Dietary Guidelines is critical for targeting messages to motivate healthy dietary diets. This rapid review was undertaken to summarize readily available local evidence on food-related beliefs, attitudes, and associated practices in Ghana. A rapid review of 39 peer-reviewed publications and graduate-level theses on the dietary behaviors of Ghanaians was conducted between November and December 2020. The study only included articles published between 1990 and 2020 involving apparently healthy populations living in Ghana. Documents were identified through a systematic literature search of Google Scholar and PubMed. Data on food-related knowledge, beliefs, attitudes, and practices were extracted into an excel template and analyzed using thematic content analysis. The sampled research included primarily cross-sectional studies of urban, rural, peri-urban and mixed localities throughout Ghana: one was a prospective research. A range of food-related taboos were identified and classified as taboos for the general population, pregnancy-related, or child-related. Although awareness of food-related taboos was common, they were not extensively practiced. Energy-giving and nutrient-dense foods are commonly promoted during pregnancy. Culturally prescribed pre-lacteal feeds and other infant and young child feeding (IYCF) behaviors reported in the studies were not aligned with IYCF recommendations. A 3-meals-a-day pattern was observed, commonly, across all age groups; most adult meals, particularly supper, was prepared at home. However, ready-to-eat meals were regularly purchased by adults and adolescents. Adolescents frequently reported snacking and skipping meals; breakfast was the most frequently skipped meal. Fruits and vegetables were the least consumed food groups across all age groups. Muslim faith was associated with consuming more diverse diets and greater fruit and vegetable consumption. The findings of this review provide an overview of food-related beliefs and practices of Ghanaians and can inform decisions on areas to emphasize in food-based dietary guidelines and associated nutrition education messages to promote healthy diets in the Ghanaian population. Effective nutrition education is needed to dispel harmful food beliefs and practices and promote healthy food choices across the life cycle. Dietary patterns in Ghana are linked with cultural and religious practices that are often unique to particular subgroups, although there are common strands of beliefs across ethnic groups. These beliefs can result in either adverse or beneficial outcomes, depending on what eating patterns it determines. Key words: food prohibitions, dietary practices, dietary pattern, Nutrition, Ghana, INTRODUCTION Dietary behaviors encompass the various processes associated with food choice, eating behaviors, and actual dietary intake, all of which are regulated by environmental, socioeconomic, and sociocultural influences [1,2]. It [...]

Developing Ghana's first Food-based dietary guidelines: An evidence-informed process Globally, sub-optimal diets across the entire lifecycle have been identified as an important driver of malnutrition in all its forms (global [...]

In recent years, there has been considerable attention surrounding the topic of front-of-package (FOP) nutrition information disclosures. FOP nutrition disclosures are typically used to provide nutrient information that may help [...]