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‘I should be disease free, healthy and be happy in whatever I do’: a cross-country analysis of drivers of adolescent diet and physical activity in different low- and middle-income contexts

Published online by Cambridge University Press:  09 October 2020

Susie Weller
Affiliation:
Clinical Ethics and Law (CELS), University of Southampton, SouthamptonSO17 1BJ,UK Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
Polly Hardy-Johnson*
Affiliation:
Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
Sofia Strommer
Affiliation:
Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
Caroline Fall
Affiliation:
Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
Ulka Banavali
Affiliation:
Regional Center for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Chiplun, India
Harsha Chopra
Affiliation:
Centre for the Study of Social Change, Mumbai, India
Ramatoulie E Janha
Affiliation:
MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba Field Station, Banjul, The Gambia
Shama Joseph
Affiliation:
Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
Kejal Joshi Reddy
Affiliation:
Diabetes Unit, KEM Hospital and Research Centre, Pune, India
Mubarek Abera Mengistie
Affiliation:
Jimma University, Jimma, Ethiopia
Stephanie V Wrottesley
Affiliation:
SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
Egnon Kouakou
Affiliation:
PAC-CI, Abidjan/Laboratory of Nutrition and Pharmacology, Faculty of Biosciences, UFHB de Cocody, Abidjan, Cote D’Ivoire
Mary Barker*
Affiliation:
Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK NIHR Southampton Biomedical Research Centre, University Hospitals Southampton Foundation Trust, Southampton, UK
*
*Corresponding author: Email pll@mrc.soton.ac.uk
*Corresponding author: Email pll@mrc.soton.ac.uk

Abstract

Objective:

To explore perceptions of how context shapes adolescent diet and physical activity in eight low- and middle-income (LMIC) sites at different stages of societal and economic transition.

Design:

Novel qualitative secondary analysis of eight data sets generated as part of the international Transforming Adolescent Lives through Nutrition (TALENT) collaboration.

Setting:

Diverse sites in India and Sub-Saharan Africa.

Participants:

Fifty-two focus group discussions with 491 participants (303 adolescents aged 10–17 years; 188 caregivers).

Results:

Analysis of pooled qualitative data identified three themes: (1) transitions in generational nutrition education and knowledge; (2) transition in caregiver–adolescent power balance and (3) the implications of societal and economic transition for diet and physical activity. Adolescents in urban and peri-urban areas could readily access ‘junk’ food. Diets in rural settings were determined by tradition, seasonality and affordability. Physical activity was inhibited by site-specific factors including lack of space and crime in urban settings, and the prioritisation of academic performance. Gender influenced physical activity across all sites, with girls afforded fewer opportunities.

Conclusions:

Interventions to improve adolescent diet and physical activity in LMIC need to be complex, context-specific and responsive to transitions at the individual, economic and societal levels. Moreover, solutions need to acknowledge gender inequalities in different contexts, as well as structural and cultural influences on diet and physical activity in resource-limited settings. Programmes need to be effective in engaging and reconciling adolescents’ and caregivers’ perspectives. Consequently, there is a need for action at both the community-household level and also through policy.

Type
Research paper
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Nutrition Society

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Footnotes

Susie Weller and Polly Hardy-Johnson are the co-first authors.

The TALENT collaboration comprises Laurence Adonis-Koffy, Yopougon University Hospital Faculty of Medical Sciences - UFHB de Cocody Abidjan Cote D’Ivoire; Edna N Bosire, SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Meera Gandhi, Centre for the Study of Social Change, Mumbai, India; Abraham Haileamlak, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia; Landing Jarjou, MRC Unit The Gambia; Julie Jesson, Inserm U1027, University of Toulouse, Paul Sabatier, France; Sarah H Kehoe, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, UK; Elizabeth Kimani-Murage, African Population and Health Research Center (APHRC), Nairobi, Kenya; GV Krishnaveni, Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India; Kalyanaraman Kumaran, MRC Lifecourse Epidemiology Unit, University of Southampton and Head, UK and Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India; Valeriane Leroy, Inserm U1027, University of Toulouse, Paul Sabatier, France; Sophie Moore, Kings College London, London, UK; Shane A Norris, SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Suvarna Patil, Regional Center for Adolescent Health and Nutrition, BKL Walawalkar Rural Medical College, Chiplun, India; Sirazul Ameen Sahariah, Centre for the Study of Social Change, Mumbai, India; Kate Ward, MRC Lifecourse Epidemiology Unit, University of Southampton, UK; Chittaranjan Yajnik, Diabetes Research Unit, KEM Hospital and Research Centre, Pune, India; Pallavi Yajnik, Diabetes Research Unit, KEM Hospital and Research Centre, Pune, India.

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