Spotlight on Africa: Moving the nutrition agenda

Dr Francis B. Zotor Opinion May - 27 - 2014 , 09:23

Africa is rich in economic resources, and yet in most parts, the continent is unable to feed itself sufficiently. Within the same continent ,there are also increasing levels of non-communicable diseases (NCDs) bringing about a double-burden disease situation.

Many African countries are demonstrating evidence of a state of nutritional transition characterised by a move to a more energy dense diet, high in fat and low in essential nutrients which in part is due to the availability of lower cost energy-based foods.

As a consequence, obesity has emerged and is rising with some of the more economically advanced countries demonstrating patterns of prevalence as we have seen in the USA and Europe which have reached epidemic levels.

Obesity as a health risk

Obesity is a major and modifiable risk factor for the occurrence of other chronic lifestyle and nutrition diseases, including diabetes mellitus, cardiovascular diseases, diseases of bone and some cancers. In West Africa, rising levels of obesity and NCDs, including cardiovascular diseases and diabetes, are being reported and Ghana is no exception.

Overweight and obese adults (i.e. a Body Mass Index (BMI) of over 25 for those aged 20 or above) are increasing rapidly. In 2008, rates of 50 to 69 per cent were reported in South Africa and 25 to 49 per cent in countries including Nigeria, Namibia, Kenya, Botswana and Ghana. These figures are more accurately reflected in the recent report *(2013 Global Food Policy Report) further fuelling this debate.

Unhealthy diets, energy dense and a lack of physical activity, especially for those on low and middle incomes and in poverty, are fuelling the obesity epidemic, which in turn is contributing to serious chronic diseases. Health services are struggling to cope and in many parts of Africa may be ill equipped to cope with the strain on services.

It is well recognised that the role of nutrition and physical activity are important in the formulation of preventive and management strategies for these nutrition and lifestyle-related chronic NCDs. There is work that we need to address at a number of levels.

The first area is capacity. At the Federation of African Nutrition Societies (FANUS) conference in 2011 in Nigeria, identified the fitness of the curriculum for nutritionists as one aspect which requires development to shift the balance of training from malnutrition to undernourishment and chronic diseases.

The meeting attracted leading nutritionists and participants from the UK from across African universities. Modification of curricula to reflect this growing need is crucial but is the capability and capacity evident?

This requires investment for development and training and a route towards accreditation of courses with minimum standards of training for nutritionists in these countries.

If the courses for training nutritionists and other health professionals are not fit for the purposes of changing the profile of health-related diseases, then the workforce capacity does not exist to help address this problem.

A second challenge is around measurement or dietary assessment. The tools available for assessing and monitoring dietary change over time are not robust or complete. Investment to improve these tools for data gathering is required.

These tools will help capture local diet and lifestyle-related data which provides an important baseline for appropriate interventions which are culturally sound.

The third challenge and as yet poorly researched is the design of appropriate interventions for awareness raising, prevention and management of obesity and consequential chronic disease.

Communicating health issues, beyond language barriers to African populations (or any particular group) is important and well recognised but awareness of cultural sensitive models which are consistent with the ways people live their lives will be more successful.

Very little money is spent in Africa on obesity prevention and development of such programmes. This needs to change.

The fourth challenge is the development of health systems to monitor and deal with diseases and their management – again bothering on capacity. This leads me to the fifth point, which is probably the most important challenge.

In Africa, we have to recognise we have a problem with obesity and chronic diseases and as nutritionists, we are working to advocate sustainable action to address this with policy makers and funders.

Challenges of malnutrition

The challenges of undernutrition and undernourishment have been a necessary primary focus of funding, but to the expense of paucity in chronic disease research. Much less development and less is available for chronic diseases in Africa, particularly sub-Saharan Africa (SSA) and yet there is the emerging need to address the above challenges.

Using the UK Department of Health as an example, the focus on obesity was raised around 10 years ago to tackle obesity in the UK. The Department for International Development (DFID), UK, on the other hand has more recently included nutrition as part of its strategic work – but what is the reality of this for funding the work that is required for chronic nutrition-related diseases.

Through the momentum generated by the UN’s Scaling Up Nutrition (SUN) Movement, significant improvements have been reported by a number of African countries, notably, Zambia, Tanzania and Malawi where nutrition has been placed at the heart of government.

Academic forum

Through the SUN Movement, nutrition professionals desirous of seeing the local SUN Movement succeed have formed what is dubbed an “Academic Platform” spearheaded by nutritionists to not only strengthen civil society organisations but also to address our over nutrition challenges.

A professional body and learned society for nutritionists across the African continent, the African Nutrition Society (ANS) is stepping up efforts to address these challenges. It is currently focusing on promoting professional training in nutrition and nutrition education to support the health workforce in tackling nutrition-related health challenges.

The society is making efforts towards meeting the Millennium Development Goals and in particular, the post 2015 agenda to support less achieving countries in Africa. One of our overriding interests is in how to promote education in the effective utilisation of traditional food sources to maximise nutritional benefits in poor communities with limited food resources.

The society is working with academic institutions and nutrition professional bodies to help harmonise training to ensure a high calibre of scientists and practitioners.

The society’s capacity building include training workshops, supporting the training of health professionals in the use of existing tools to reduce the burden of malnutrition; partnering with other learned societies such as the Nutrition Society of UK and the American Society for Nutrition to create an e-learning hub to provide materials and training at low cost to support partner countries in Africa and South Asia.

The ANS through its biennial Africa Nutritional Epidemiology Conferences (ANEC) has over the last 12 years also provided a solid platform for nutrition dialogue and scientific discussions and dissemination of research, programmatic good practice and training workshops in Africa, tapping into expertise from across the globe and attracting the best scientists to participate in scientific dialogue on African soil.

The society has created a common platform for a vast number of young nutrition scientists and students from fields such as health, agriculture, nutrition to learn and work together.

This year, the society will jointly organise a postgraduate scientific symposium organised with the Africa Nutrition Graduates network (AGSNet), which is expected to attract and promote research excellence among young scientists.

The ANS is also in partnership with various multilateral and bilateral organisations to promote nutrition efforts at combating nutritional problems on the continent with scientists supporting the SUN efforts at country level across the continent.

The society’s strength lies in building capacity for the workforce through external partnerships, especially with other learned societies and the hope of attracting funding from developmental partners to support our efforts in this direction.

This is in line with the society’s belief that without a well-trained and competent nutrition workforce, nutrition policies and interventions cannot be properly implemented, or rolled out and sustained. Human resource capacity, the society notes, is central to long term success. ANS, therefore, seeks to champion this cause and at the same time encourage participation in specific projects, including interventions.

Major conference

In July this year, the society will hold a major conference, ANEC VI. It is a major biennial conference that will be held in Accra, Ghana from July 20 – 25 on the theme: “Addressing Africa’s food and nutrition security: new challenges and opportunities for sustainability”.

The theme reflects contemporary global debate on the way forward in addressing the unmet needs for nutrition in Africa and how to mitigate and sustain gains in the medium to long term. It is expected that the outcome of this event will provide the opportunity to addressing among others, Africa’s capacity building and chronic disease challenges.

The writer is the President of the African Nutrition Society and also a senior academic at the School of Public Health, University of Health and Allied Sciences, Hohoe.

* Africa’s New Nutrition Initiatives. 2013 Global Food Policy Report. ISBN 978-0-89629-562-9.

www.ifpri.org/gfpr2013