Nourishing Spaces

Measuring adolescent dietary and physical activity behaviour in low- and middle-income countries.

The fastest growing cities in the world are in low- and middle-income countries (LMICs). This urbanisation is increasing access to unhealthy foods while reducing safe opportunities for physical activity like walking to school or exercise. As a result, LMICs are experiencing rising levels of non-communicable diseases like obesity, diabetes and hypertension.

There is an urgent need for interventions that improve urban environments to support healthy diet and physical activity behaviours. This is particularly important for adolescents because their behaviours at this life stage influence their future health in adulthood and the health of their future children. 

To understand how effective any such interventions are, we would need to be able to accurately measure the food and built environments that influence behaviour, and the diet and physical activity behaviours of adolescents. Given that LMIC urban contexts are often very different from cities in high-income countries, this study, which was part of the Nourishing Spaces project, aimed to synthesize what is known about methods to measure diet and physical activity behaviours and environments in LMICs.

Methods

We conducted literature reviews, a structured search for research studies, using three academic databases (Scopus, EbscoHost, and Web of Science), to understand existing evidence on:

-How to measure adolescent diet and physical activity behaviour, particularly in LMICs.
-Methods used to map food and built environments in LMIC cities.

Key findings

We found 227 research studies measuring adolescent diet and physical activity knowledge and behaviours in LMICs. 

These studies used a variety of tools such as questionnaires, interviews, behaviour records, and accelerometry. Concerningly less than 4 out of every 10 studies (37%) used tools that had been previously tested to assess whether the tools were suitable (accuracy or reliability) for use in LMICs. 

When we looked for studies that mapped urban food and physical activity environments, we found 60 studies that had been conducted in LMICs. These studies used various mapping tools like digital maps, geographical positioning systems (GPS), and geographic information systems (GIS). The limited number of research studies mapping environments is perhaps unsurprising given that mapping tools are quite expensive and need skilled research personnel to implement.7

Illustration I: Spatial distribution of out-of-home cooked foods, convenience stores and fruits and vegetables stands/sales by enumeration area in Accra, Ghana. Image by F. Dake.
Illustration II: GIS technology used to map the spatial distribution of supermarkets in Cape Town. The technique involves the layering of different geographical data sources, for example type and location of retail stores or land use plans, onto base maps in order to map and analyse features of interest. Images by Government Accountability Office (left) and Battersby and Peyton (right).

We were also interested in finding out if the researchers involved members of the community in any of the mapping studies. And we found one study in Kenya where researchers and community members collaborated to map the food environment in an informal settlement using a balloon aerial mapping technique. In this technique, an inexpensive digital camera (mounted inside an empty bottle) was first attached to an inflated helium balloon. The balloon was then released into the air, allowing the attached camera to capture images of the informal food environment at different heights. It was not clear whether any adolescents were involved in this mapping.

Illustration III: 1. Balloon mapping process in pictures: balloon mapping kit (a), assembling the kit for flight preparation (b), testing the inflated balloon (c), and balloon flight in one settlement in Nairobi, Kenya (d).
2. Visual representation of the village Bondeni/3A captured from the balloon on the air (a), Village 3A at street level (b), and use of balloon‐derived images for dumping ground identification (c).
Images by Sohel Ahmed and Grace Githiri.

Our project findings highlight the need for newer innovative and affordable mapping and assessment tools for measuring food and physical activity behaviours and environments that are tailored to adolescents. Such innovative research would benefit from participation of young community members in order to accurately capture the ‘lived’ environments and behaviours that influence the health of adolescents in the fastest growing cities globally. 

Funder 01
International Development Research Centre (IDRC)
Partners
Trish Muzenda (University of Cape Town)
Philip Dambisya (University of Cape Town)
Monika Kamkuemah (University of Cape Town)
Blessings Gausi (University of Cape Town)
Project outputs

Watch this space! 

In the meantime, read about the balloon aerial mapping research here.

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