1. Introduction: The Problem and Objectives of This Narrative Review
2. The Nutrition Transition in Africa
|Nutrient (unit) Recommended intake (INL98) *||Rural women; Living in deep rural areas||Rural women; From farms||Women living in informal settlements||Urban middle class women||Urban upper class women|
|N = 290||N = 148||N = 172||N = 292||N = 105|
|Calcium (mg)||384 (14)||418 (20)||387 (18)||408 (14)||512 (23)|
|INL98 = 800|
|Zinc (mg)||7.8 (0.2)||7.1 (0.3)||7.6 (0.3)||8.2 (0.2)||10.6 (0.3)|
|INL98 = 12|
|Iron (mg)||8.4 (0.2)||7.5 (0.3)||8.3 (0.2)||10.4 (0.4)||10.4 (0.4)|
|INL98 = 18|
|Vit ** A (RE)||573 (40)||533 (56)||773 (82)||892 (40)||1248 (86)|
|INL98 = 800|
|Vit C (mg)||30 (2)||25 (3)||32 (3)||43 (2)||83 (4)|
|INL98 = 60|
3. The Consequences of the Nutrition Transition in Africa
4. The Determinants of the Nutrition Transition in Africa
5. “New” Directions for Policy and Interventions
- Plan for holistic, integrated nutrition interventions which will be aligned to all other health promotion campaigns in a country, such as improvement of mother-and child health, anti-smoking, responsible alcohol use, living with a specific condition such as HIV/AIDS or diabetes, school nutrition programs, increased activity initiatives, and others.
- All interventions should be evidence-based, addressing proven public health problems in the country, with methods known to be potentially successful. A starting point would be to use quality baseline data, scientific theory for planning, and implementation methods to change societal behavior.
- Under- and over-nutrition should be addressed simultaneously. Interventions should aim for optimal, balanced, adequate, but prudent diets for all. This means that food security for all should be a high priority, and that both the under-nourished and “over-nourished” (overfed) people in a population should be reached with positive messages of how to choose a healthy diet.
- Involve communities in the planning of the nutrition intervention, using a “bottom-up” rather than a “top-down” approach. Many programs have shown that community ‘buy-in” is necessary for compliance to advice and recommendations.
- Get all stakeholders on board from the planning stage to ensure that they will help in the implementation of the policy and/or intervention(s). These stakeholders should include local governance bodies, the agricultural and food industries (all involved in production, distribution and marketing of food and beverages), non-governmental organizations, united nations organizations, medical schemes, advertising industry, all institutions providing meals to consumers such as the army, homes for the elderly, schools, etc. All these stakeholders are collectively responsible for creating the food environment from which consumers make their choices. They should all work together to ensure an environment in which safe, healthy, cultural and traditional choices are available and affordable. Countries could consider legislation to help to create this environment, such as a ban on advertisements of undesirable foods and beverages on children’s television programs, or a-ban on selling energy-rich, nutrient-poor foods in school canteens. The food industry realizes that there is a market for “healthier foods” but their agenda and motives in developing and marketing these foods are still questionable.
- Focus on diversification of diets (a food-based approach) rather than a reliance on fortified foods and supplements, where possible. There may be circumstances where fortification and supplementation will be necessary to address specific micronutrient deficiencies, provided that there is good evidence that these deficiencies pose a public health problem. Also, there must be convincing evidence that fortification and supplementation would be safe and effective.
- It is a human right to be food and nutrition secure. Therefore, in addition of “creating” a suitable food environment, individuals should be enabled to make the right choices. This means appropriate consumer education and social marketing to target groups with strategies that will help to change behavior. Consumer-friendly and understandable food-based dietary guidelines  are useful to promote healthy eating and educate consumers on healthy dietary choices.
- Nutrition “capacity” within the health and other sectors in all African countries should be developed and increased. Even rich, developed, industrialized countries, have insufficient nutritionists and dietitians to “serve” the population. Therefore, nutrition capacity to promote healthier diets can be increased by training other professionals (physicians, nurses, pharmacists, agriculturists, and others) in nutrition.
- Only implement interventions at scale after thorough field-testing in appropriate target groups. All interventions should be evaluated regularly after implementation to adapt and change if they are not working. These evaluations should include input, process, output, outcome and impact assessments.
- Use all available resources to implement interventions aimed at healthier eating. Innovative, creative and original use of available infrastructure and existing programs, based on knowledge of local beliefs, attitudes and practices, could ensure positive results.
6. Research Challenges for Africa
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