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.
Read more
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


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.

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
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.
Other UrbanBetter projects you might be interested in…
Global Diet and Activity Research (GDAR)
The Global Diet and Activity Research Group and Network (GDAR) is funded through the NIHR Global Health Research initiative. The goal is to help prevent non-communicable diseases (NCDs), such as type 2 diabetes, heart disease, and cancers, in low and middle income countries (LMICs).
Our work involves finding solutions that are affordable and created in partnership with local communities. GDAR builds on the expertise and knowledge of research in Cameroon, the Caribbean, Kenya, South Africa and the UK.
Integrating health into human settlements policy (LIRA study)
The LIRA study explores the knowledge, attitudes and practices of intersectoral collaboration between health and human settlements sectors among policymakers in Cape Town and Douala.
Using Cape Town, South Africa, and Douala, Cameroon, as case studies, this LIRA project (2018–2020), led by Tolullah Oni, seeks to develop a practical health and housing-integrated collaboration model that will improve urban policymaking and governance for the planning of African cities.
UrbanBetter project outputs

Participatory Air Quality Improvement for Healthy People and Climate Resilient Public Spaces in Lagos:
An UrbanBetter Workshop in Lagos
There is a growing focus on the importance of tackling air pollution as an entry point for both health and climate resilience in Lagos. Currently, there are multiple actors working towards a common goal ranging from government, civil society, academia and the private sector. In

Empowering Words for Cleaner Skies from the CLEAN-Air Africa Network
The fourth annual International Day of Clean Air for Blue Skies (07 September 2023) focusses on the theme, ‘Together for Clean Air’. The theme aims to highlight the urgent need for stronger partnerships, increased investment, and shared responsibility for overcoming air pollution. The CLEAN-Air Africa

Age-Friendly Public Spaces in African Cities: ISUH Africa Community of Practice Webinar Report
The Africa Community of Practice of the International Society for Urban Health hosted another webinar, on “Age-friendly Public Spaces in African Cities: Opportunities and Challenges”. This is part of the Urban Health in Africa Networking and Webinar Series held on 22nd June 2023. The speakers,

Safe public transport can support climate action and public health….Here’s how both governments and citizens can play a role
Olasumbo Olaniyi, UrbanBetter Disruptor and Cityzen, is an environmental advocate on a mission. She says: “My journey as an environmental advocate took a radical turn when I began to work with the team at UrbanBetter. It made me more sensitive to my environment and overall

Citizen science insights on air quality in 3 cities
The Cityzens for Clean Air campaign, part of the UrbanBetter Cityzens initiative, aims to amplify youth voices with advocacy on air pollution, climate and health using citizen scientist data generated by young people. The report is based on PM2.5 and NO2 air quality data collected

Urban Health Data in Africa and Latin America: Experiences, Challenges and Opportunities – ISUH Community of Practice Webinar Report
Hosted by the Africa Community of Practice of the International Society for Urban Health, the webinar “Urban Health Data in Africa and Latin America: Experiences, Challenges and Opportunities”, is part of the Urban Health in Africa Webinar Series and was held on 23rd February 2023.

Urban Health Data in Africa and Latin America: Experiences, Challenges and Opportunities -ISUH Africa Community of Practice webinar
Hosted by the Africa Community of Practice of the International Society for Urban Health, the webinar “Urban Health Data in Africa and Latin America: Experiences, Challenges and Opportunities”, is part of the Urban Health in Africa Webinar Series and will be held on 23rd February

Air Of Excitement 
In this blog #UrbanBetter Disruptor, Waziri Mainasara Abubakar writes about his recent visit to a park in Lagos and what he discovered about the air quality at the park. “We spoke and he’ll be more than delighted to host you guys. He said to me that he

An Activist Architect Advocating for Healthy Public Spaces
On the 25th of September 2022, Lagos held its first ever Car-Free day. To commemorate this event, Cityzens4CleanAir Run Leaders organised and led a run through the streets of Lagos, using the opportunity to advocate for clean air and healthy public spaces. We asked #UrbanBetter Disruptor, Olasumbo Olaniyi,

Appropriation of public space and urban infrastructure for leisure physical activity (ALPhA) -Second Lagos and Yaoundé stakeholder workshop reports
The research project “Informal Appropriation of Public Space for Leisure Physical Activity in Lagos and Yaoundé (ALPhA)”, led by the University of Cambridge, in collaboration with the Universities of Lagos and Yaoundé, aims to re-imagine urban space for healthy, safe leisure physical activity in Lagos,

Advancing participatory air quality management for urban health in Lagos:
Inaugural knowledge sharing and co-creation workshop
Air pollution – largely from industrial sources, motor vehicles, burning biomass and desert dust – kills more Africans than unsafe water, unsafe sanitation or childhood malnutrition, with significant implications for human development. Despite this, air quality monitoring remains inadequate across most of the continent. This highlights the

Urban Health Governance -ISUH Africa Community of Practice webinar report
The second webinar hosted by the Africa Community of Practice of the ISUH on the 28th of April 2022 centered around “Urban Health Governance”. This was a sequel to the inaugural webinar which is part of the Urban Health in Africa Webinar Series. The speakers

The other pandemic: social media engagement around non-communicable disease preventive behaviours during Nigeria’s COVID-19 lockdowns
Abstract Given the complexity of global health crises such as the COVID-19 pandemic, it is typical for crisis-focused interventions to have a multiplicity of impacts. Some of these impacts may yield positive or negative externalities for health priorities that do not have the same perceived

Urban Health Governance -ISUH Africa Community of Practice webinar
Hosted by the Africa Community of Practice of the International Society for Urban Health, the webinar, centred around “Urban Health Governance”, is part of the Urban Health in Africa Webinar Series and will be held on 28th April 2022. The speakers will include actors from

Pairing Academia and Policy for Transdisciplinary Research in Africa – Inaugural webinar of the ISUH Africa Community of Practice
The inaugural webinar of the Africa Community of Practice of the International Society for Urban Health (ISUH) – “Pairing academia and policy for transdisciplinary research in Africa” – was held on the 2nd December 2021. The event brought together over 30 scholars, government and non-government

A Systematic Review Protocol of Opportunities for Noncommunicable Disease Prevention via Public Space Initiatives in African Cities
Abstract Public spaces have the potential to produce equitable improvements in population health. This mixed-methods systematic review aims to understand the components of, determinants, risks, and outcomes associated with public space initiatives in African cities. This study will include quantitative and qualitative study designs that

Appropriation of public space and urban infrastructure for leisure physical activity (ALPhA)
-Lagos and Yaoundé stakeholder workshop reports
As part of the research project on Informal Appropriation of Public Space for Leisure Physical Activity in Lagos and Yaoundé, led by the University of Cambridge, in collaboration with the Universities of Lagos and Yaoundé, the ALPhA research team hosted a first stakeholder workshop on

Integrating health in human settlements
Health through human settlements: Investigating policymakers’ perceptions of human settlement action for population health improvement in urban South Africa.

The urban environment and leisure physical activity during the COVID-19 pandemic: a view from Lagos
In this commentary, we highlight five aspects of the ordinary – known interactions between urban environments and physical activity – that are amplified by the extraordinary – an unprecedented societal response to the ongoing COVID-19 pandemic. Using Lagos, Nigeria as a case study, we illustrate the possibility of re-thinking urban development and the potential for urban (re)form to address health inequalities in African megacities in the context of post-COVID-19 pandemic.

A participatory approach to building a coalition of health and planning sector urban actors in Africa-a Douala case-study
Developing a participatory approach to building a coalition of transdisciplinary actors for healthy urban planning in African cities – a case study of Douala, Cameroon

RICHE | Africa Workshop On Healthy Cities Report: Intersectoral Approaches To Non-Communicable Disease Prevention In Africa
Living in cities can create an urban advantage. They can give residents better access to opportunities such as employment and education, social connections, and services such as healthcare. But, rather than experiencing an urban advantage, residents of African cities are more familiar with an urban

RICHE | Africa Workshop On Healthy Cities: Intersectoral Approaches To Non-Communicable Disease Prevention In Africa
The “Healthy Cities: Intersectoral approaches to non-communicable disease prevention in Africa” workshop presented the opportunity to collaboratively identify opportunities to promote health and wellbeing and prevent non-communicable diseases in African cities through investments that support active living and healthy diets. Workshop participants were policy, civil

Integrating health into human settlements policy (LIRA study)
Using Cape Town, South Africa, and Douala, Cameroon, as case studies, this LIRA project (2018–2020), led by Tolullah Oni, seeks to develop a practical health and housing-integrated collaboration model that will improve urban policymaking and governance for the planning of African cities. The project brings together academic and non-academic stakeholders representing a range of expertise: public health, health geography, urban planning, and demography. The project contributes to SDG 3 and SDG 11.

A Systematised Review of the Health Impact of Urban Informal Settlements and Implications for Upgrading Interventions in South Africa, a Rapidly Urbanising Middle-Income Country
Informal settlements are becoming more entrenched within African cities as the urban population continues to grow. Characterised by poor housing conditions and inadequate services, informal settlements are associated with an increased risk of disease and ill-health. However, little is known about how informal settlement upgrading impacts health over time. A systematised literature review was conducted to explore existing evidence and knowledge gaps on the association between informal settlement characteristics and health and the impact of informal settlement upgrading on health, within South Africa, an upper-middle-income African country.
