Evaluation of public actions on food environments to combat the double burden of malnutrition in Benin using the Food-EPI tool

Main Article Content

Reynald Santos
Charles Sossa Jerome
Colette Azandjeme
Clémence Metonnou
Julien Soliba Manga
Stefanie Vandevijvere
Jean-claude Moubarac
Adama Diouf

Keywords

Public policy, Evaluation, Food environments, Benin

Abstract

Background and aim: Despite national policies and food-related interventions, Benin still faces a number of nutritional problems. The food environment, which is crucial to health, receives little attention in food policies. Monitoring food environments is essential to combat the double burden of malnutrition (DBM). The objective was to assess the level of implementation of public policies and government actions aimed at creating healthy food environments in BENIN. Methods: The evaluation was carried out using the INFORMAS Food-EPI module. Initially, the module contained 47 indicators relating to the prevention of obesity and diet-related non-communicable diseases. This tool was initially adapted to the Benin context. Following its implementation in sub-Saharan Africa (Ghana, Kenya and Senegal), 12 new indicators were added to make the Food-EPI tool more sensitive to the DBM. A group of independent experts (n=22) and government experts (n=21) assessed the level of the implementation of public policies using a Likert scale and identified the priority actions. Results: Of the 59 indicators compiled from 61 policy documents, the implementation level of public policies was assessed as "very low" for 27 indicators, "low" for 24 indicators and "medium" for 8 indicators. The inter-rater reliability index was estimated at 0.94 (CI: 0.92-0.97) and considered good. The experts identified 116 actions, 10 of which were prioritized in terms of importance, achievability and effect on the DBM, and recommended to the Beninese government. In the "Policy" component, priority actions focused mainly on food promotion, supply, pricing and retailing. In the "Infrastructure Support" component, priority actions focused on governance, leadership, monitoring and evaluation. Conclusions: This study proposes a list of priority actions to the government to transform the food environments towards reducing the DBM in Benin.

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References

1 Food and Agriculture Organization of the United Nations, World Health Organization. Africa Regional Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition in Africa; 16 November 2017; Abidjan, Cote d'Ivoire.
2 Ajong AB, Kenfack B, Ali IM, et al. Hypocalcaemia and calcium intake in pregnancy: A research protocol for critical analysis of risk factors, maternofoetal outcomes and evaluation of diagnostic methods in a third-category health facility, Cameroon. PloS One 2020; 15: e0241812.
3 Ajong AB, Kenfack B, Ali IM, et al. Ionised and total hypocalcaemia in pregnancy: An analysis of prevalence and risk factors in a resource-limited setting, Cameroon. PloS One 2022; 17: e0268643.
4 Ajong AB, Kenfack B, Ali IM, et al. Adverse maternofoetal outcomes associated with ionised calcaemia, total calcaemia, albuminaemia, and calcium supplementation in pregnancy: Analysis from a resource-limited setting. PloS One 2022; 17: e0271525.
5 Ajong AB, Kenfack B, Ali IM, et al. Calcium supplementation in pregnancy: An analysis of potential determinants in an under-resourced setting. PloS One 2023; 18: e0292303.
6 Ajong AB, Yakum MN, Aljerf L, et al. Association of hypertension in pregnancy with serum electrolyte disorders in late pregnancy among Cameroonian women. Sci Rep 2023; 13: 20940.
7 Food And Agriculture Organization Of The United Nations. Influencing food environments for healthy diets. 2016
8 Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. The Lancet 2013; 381: 670-679.
9 Cecchini M, Sassi F. Tackling obesity requires efficient government policies. Isr J Health Policy Res 2012; 1: 18
10 Thow AM. Trade liberalisation and the nutrition transition: mapping the pathways for public health nutritionists. Public Health Nutr 2009; 12: 2150-2158.
11 Aljerf L, Aljerf N. Food products quality and nutrition in relation to public. Balancing health and disease: Food safety & hygiene promotion. Prog Nutr 2023; 25: e2023024–e2023024.
12 Melese AT, Ayele DT, Aljerf L, et al. Investigating the phytoavailability of metals in roots of Croton macrostachyus and Phytolacca dodecandra: induced rhizosphere processes. Biometals Int J Role Met Ions Biol Biochem Med 2023; 36: 1347–1359.
13 Bello FMY, Koukou E, Bodjrenou SF, et al. Towards adequate food environment in Benin public primary schools, the challenge of food supply and hygiene practices: a case study of three municipalities. Prog Nutr 2023; 25: e2023043.
14 Programme Alimentaire Mondial, Service de l’Analyse de la Sécurité Alimentaire (VAM). Analyse globale de la vulnérabilité, de la sécurité alimentaire (AGVSA 2017). 2017.
15 Irache A, Gill P, Caleyachetty R. Intra-household double burden of overweight/obesity and anaemia: Evidence from 49 low-and middle-income countries. Matern Child Nutr 2022; 18: e13298.
16 Institut National de la Statistique et de l'Analyse Économique (INSAE). Enquête démographique et de santé (EDSB-III) 2006. Bénin, 2006.
17 Institut National de la Statistique et de l'Analyse Économique (INSAE). Enquête démographique et de Santé (EDSB-V) 2017-2018. Bénin, 2018.
18 Programme Alimentaire Mondial. Examen stratégique national « faim zéro » au Benin à l’horizon 2030. 2018.
19 Shelf L. Development of a method for classification of hospitals based on results of the diagnosis-related groups and the principle of case-mix index. East Mediterr Health J Rev Sante Mediterr Orient Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit 2016; 22: 327–334.
20 Aljerf L, Alhaffar I. Salivary Distinctiveness and Modifications in Males with Diabetes and Behçet’s Disease. Biochem Res Int 2017; 2017: 9596202.
21 Programme National de Lutte contre les Maladies Non Transmissibles. Rapport final de l'enquête pour la surveillance des facteurs de risque des maladies non transmissibles par l'approche STEPSwise'' de l'OMS. Benin, 2015.
22 Programme National de Lutte contre les Maladies Non Transmissibles. Enquête globale sur la santé des élèves au Bénin en 2016 Fact Sheet. Bénin, 2016.
23 Conseil de l’alimentation et de la nutrition. Plan Stratégique de Développement de l’Alimentation et de la Nutrition. 2009.
24 Swinburn B, Vandevijvere S, Kraak V, et al. Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed G overnment Healthy Food Environment Policy Index. Obes Rev 2013; 14: 24-37.
25 Swinburn B, Sacks G, Vandevijvere S, et al. INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles. Obes Rev Off J Int Assoc Study Obes 2013; 14 Suppl 1: 1-12.
26 Vandevijvere S, Swinburn B, International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS). Pilot test of the Healthy Food Environment Policy Index (Food-EPI) to increase government actions for creating healthy food environments. BMJ Open 2015; 5: e006194.
27 Laar A, Barnes A, Aryeetey R, et al. Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: National experts' assessment of government action. Food Policy 2020; 93: 101907.
28 Manga JS, Diouf A, Vandevijvere S, et al. Evaluation and prioritisation of actions on food environments to address the double burden of malnutrition in Senegal: perspectives from a national expert panel. Public Health Nutr; 25: 2043-2055.
29 Asiki G, Wanjohi MN, Barnes A, et al. Benchmarking food environment policies for the prevention of diet-related non-communicable diseases in Kenya: National expert panel's assessment and priority recommendations. PLoS ONE 2020; 15: e0236699.
30 World Health Organization. Double-duty actions for nutrition [Online]. Available at: https://apps.who.int/iris/bitstream/handle/10665/255414/WHO-NMH-NHD-17.2-eng.pdf?ua=1. Accessed March 20, 2023.
31 Vandevijvere S, Barquera S, Caceres G, et al. An 11-country study to benchmark the implementation of recommended nutrition policies by national governments using the Healthy Food Environment Policy Index, 2015-2018. Obes Rev 2019; 20: 57–66.
32 Laar A, Barnes A, Aryeetey R, et al. Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: National experts' assessment of government action. Food Policy 2020; 93: 101907.
33 Pineda E, Poelman MP, Aaspõllu A, et al. Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries. Lancet Reg Health - Eur; 23. Epub ahead of print 1 December 2022. DOI: 10.1016/j.lanepe.2022.100522.
34 Sánchez-Nóchez CM, Ramirez-Zea M, Vandevijvere S, et al. Benchmarking public policies to create healthy food environments compared to best practice: the Healthy Food Environment Policy Index in Guatemala. Arch Public Health 2022; 80: 174.
35 Government of the Republic of Benin. School feeding - Meeting of WFP representatives in West and Central Africa: Benin shares its experience with country directors. [Online]. Available at: https://www.gouv.bj/article/2211/alimentation-scolaire-reunion-representants-afrique-ouest-centre-benin-partage-experience-avec-directeurs-pays/. Accessed August 14, 2023.
36 Allemandi L, Tiscornia MV, Ponce M, et al. Sodium content in processed foods in Argentina: compliance with the national law. Cardiovasc Diagn Ther 2015; 5: 197-206.
37 Hofman KJ, Tollman SM. Population health in South Africa: a view from the salt mines. Lancet Glob Health 2013; 1: e66-e67.
38 Gov.UK. Food standards: labelling and composition, [Online]. Available at: https://www.gov.uk/guidance/food-standards-labelling-durability-and-composition. Accessed April 11, 2022.
39 Ministry of Health New Zealand. A Focus on Pacific Nutrition, [Online]. Available at: https://www.health.govt.nz/publication/focus-pacific-nutrition. Accessed April 11, 2022.
40 Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework. Obes Rev Off J Int Assoc Study Obes 2013; 14 Suppl 2: 159-168.
41 Gov.uk.Tackling obesity: government strategy, [Online]. Available at: https://www.gov.uk/government/publications/tackling-obesity-government-strategy. Accessed April 20, 2022.