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Journal ArticleDOI

Contribution of street food to dietary intake of habitual urban consumers: A cross-sectional study in Kampala city, Uganda.

24 Apr 2020-Nutrition and Health (SAGE PublicationsSage UK: London, England)-Vol. 26, Iss: 3, pp 187-195

TL;DR: This study indicates a significant contribution of street food for urban consumers but men derive more benefit than women in terms of nutrient intake and inclusion in meals from street food in meals.

AbstractBackground:Street food has continued to be a popular food source in the urban settings of developing countries and is proving to be a vital urban dietary source. However, its dietary contribution a...

Summary (4 min read)

1 Introduction

  • 2 Street food vending has been a feature of urban contexts.
  • Given the current rate of urbanisation that is being experienced world 8 over (UNDESA, 2014), street food may continue being an embraced part of the food system.
  • There is still dearth of data in 11 Uganda and Africa regarding the micronutrient contribution of street food especially among 12 habitual consumers, which leaves unknown potential risk for nutrient deficiencies or excesses 13 that may be associated with existing trends of street food choices.
  • The authors also sought to understand 21 gender-related differences in street food consumption and contribution to dietary intake.

23 Study setting:

  • 24 The study was conducted in Kampala, the biggest city and capital of Uganda, with a 25 population of more than 1.5 million people (Uganda Bureau of Statistics, 2014).
  • Major economic activities in Kampala 3 are employment income and small- and large-scale trading, all of which account for more 4 than 80% of the working population (Uganda Bureau of Statistics, 2002).

5 Study design and population:

  • 6 This was a descriptive cross-sectional study that employed quantitative methods of data 7 collection and analysis.
  • The study population were street food consumers aged 18 years and 8 above, residing and or working in the five administrative divisions of Kampala capital city in 9 May and June 2017.

12 Eligibility

  • 13 Habitual street food consumers aged 18 years and over who had been residing and /or 14 working within the five city divisions for at least two months prior to the study were 15 included.
  • All individuals who met the inclusion criteria but declined signing the informed 16 consent, were operating at more than one station during daytime, were street food vendors, 17 were having physical, auditory or speech disability were excluded.

18 Sample size and sampling procedure:

  • 19 The sample size was calculated using Kish’s formula for cross sectional studies (Kish, 1965).
  • Individuals residing or working within half-mile radius of each 3 selected trading centre meeting the inclusion criteria formed the sampling frame, from which 4 the final sample was randomly selected.
  • Only individuals who self-reported 7 eating street food at least two days in a typical week on first contact were listed on the 8 sampling frame.
  • The interviews were conducted from space of homes and work places 9 deemed comfortable by participants.
  • All divisions in Kampala contributed an almost equal 10 number of respondents (approximately 32 respondents from each division).

11 Data collection:

  • 12 Interviewer-led pretested semi-structur d questionnaires were used to collect information 13 from respondents.
  • Two nutritionists, previously trained on the study and data collection tools, 14 led the interviews in supervision of the first author.
  • The questionnaires had been translated 15 into the commonly used language ‘Luganda’ prior to data collection to ensure that similar 16 questions were asked without alteration in meaning, which consequently reduced on 17 interviewer bias.
  • The questionnaires collected information on sociodemographic 18 characteristics, dietary intake, food consumption frequency, and anthropometric data.

19 Study Variables and their measurements:

  • 20 Sociodemographic characteristics of participants that were captured by the interviewer-led 21 questionnaire included; age, marital status, religion, education, socioeconomic status, 22 monthly income.
  • The weight was 4 recorded to the nearest 0.1kg while the height was recorded to the nearest 0.1cm.
  • BMI was 5 then computed for each participant in kg/m2.
  • 6 Dietary intake was assessed using a single 24-hour diet intake recall questionnaire, which 7 captured data on foods and beverages consumed by the participants in the previous day 8 (between midnight and midnight).
  • This study specifically focused on assessing dietary intake of the 12 following nutrients: protein, carbohydrates, total fat, saturated fat, fibre, calcium, sodium, 13 vitamin A, folate, vitamin C, and iron.

20 Statistical analysis

  • 21 Dietary intake data from the 24-hour recall questionnaire of each participant was entered into 22 the Nutritics® software version 4.3 (Dublin, Ireland) to obtain individual energy and nutrient 23 values.
  • Analyses for the different nutrients were 4 expressed as percentage energy (%E) and grams (g) for the macronutrients as appropriate, 5 and as milligrams (mg) and micrograms (µg) for the micronutrients.
  • Nutrient values for all 6 participants were later transferred to STATA version 13.0 (Collage Station, TX, USA) and 7 merged with the existing variables from the sociodemographic and anthropometric 8 characteristics.
  • To obtain proportions of individuals that included street foods at different meal occasions, the authors 10 employed a scoring approach using MS® Excel (version 2016).
  • All outputs from the 23 analyses were further stratified by gender.

1 Results

  • 2 Data from 160 habitual street food consumers (40% men and 60% women) were analysed, 3 leaving the three (03) who had incomplete data on key variables.
  • The mean age of the 5 participants was 29.6 years (SD: 11.5 years) with no significant difference between men and 6 women.
  • Gender was also associated with marital status (p=0.028), employment (p<0.001), 8 individual income (p=0.004), and street food consumption frequency (p=0.044), whereas 9 majority of men were single, manual labourers, earned more and had a higher street food 10 consumption compared to women.

11 Street food contribution towards the daily nutrient intake of habitual consumers

  • 12 The nutrient contribution of street foods towards total daily intakes is presented in Table 2. 13 Overall, for macronutrients, highest contribution was to fat intakes (49.1%) and lowest to 14 carbohydrate intakes (25.6%).
  • Only 30% of overall daily energy intake came from street 15 food.
  • For daily micronutrient intakes, the highest contribution was to sodium (38.4%) and 16 calcium (36.5%), contributing more than a third of daily intake.
  • In men, the contribution of street food towards the diet was highest for fat (52.1%), 22 sodium (50.8%) and calcium (50.6%), whereby slightly over a half of the total dietary intake 23 of these nutrients was derived from street food.

1 Proportion of participants including street foods at various meal occasions

  • 2 Regarding how street food featured in the different meal occasions as shown in Figure 1, 3 majority of participants opted to include street food at breakfast (50%), whereas lunch and 4 snacks featured the least overall street food inclusions from participants (all 20%).
  • Men had a 5 higher proportion of street food inclusion than women for all meal occasions.

7 Contribution to daily energy and micronutrient intake from street food

  • 8 This study set out to assess the contribution of street food to the diets of habitual street food 9 consumers.
  • Noteworthy in this 14 population segment is the significant variation between men and women regarding street food 15 energy contribution, with men recording about twice as much as women (41.6% vs 19.9% 16 respectively).
  • The fact that in the present study only habitual consumers and all participants from various 5 circles of employment were considered unlike the studies in Kenya, Burkina Faso and 6 Nigeria, could explain the observed figurative variations.
  • High energy intake is a risk for overweight and obesity (World Health 9 Organization, 2014).

15 Contribution to daily micronutrient intake from street food

  • Street food proved a considerable source of dietary sodium and calcium but low 18 vitamin A. However, 23 studies that have assessed calcium, vitamin A, vitamin C and iron have reported varying 24 figures.
  • Moreover, higher intake of these micronutrients in 2 the latter were recorded in women than men (Oguntona et al., 1998).
  • This could be due to differing cultural and geographical 9 influence on kind of street foods available and population choices that may be associated with 10 the two regions.
  • Women in this street food consuming population also have very low intake 11 of vitamin and mineral sources from street food.

17 Street food inclusion in daily meals

  • 18 Street foods among this habitual consuming population are popularly included at breakfast 19 compared to other meals.
  • Foods observed to be commonly included in breakfast were chapatti, mandazi, 3 Ugandan pancakes, deep fried cassava, rolex (chapatti roll), katogo (mixed combination of 4 matooke and sauce).
  • The big proportion of unmarried men in their study may explain the 5 observed high inclusion of street foods in most meals among men than women.
  • Food 6 preparation is a role that is attached to women in the cultural confines of Uganda, and 7 therefore men who are not married will opt for out of home sources of food/meals.
  • Moreover, the likelihood of underreporting of fat intake 13 among participants that is commonly reported (Macdiarmid and Blundell, 1998) may mean 14 the value indicated in their study is likely lower than the actual value.

17 Strengths and limitations

  • 18 One of the key strengths of this study is that it incorporates gender-based analysis of street 19 food contributions to the daily diets of habitual consumers in regard to both macro and micro 20 nutrients, which has not been well studied in the region.
  • Studies that incorporated gender21 based comparisons have mainly focused on macronutrient differences.
  • Additionally, the authors 22 present results from a habitual street food consuming population given that their urban settings 23 are increasingly adopting street food as a major and accessible food source, which they believe 24 could impact nutritional status.
  • Their study is limited by the fact that it was based on 25 individual intake recall that may not reflect actual intake.
  • The fact that there may be variation of street food types across the 4 different parts of the country and across different countries could limit generalisation of their 5 findings to a broader population.

10 Conclusion

  • 11 Street food offers considerable nutrition benefits towards the diet of habitual consumers, 12 although these benefits are much more enjoyed among men than women.
  • There is however 13 concern regarding low dietary supply of micronutrients from street food choices of this 14 habitual consuming urban population.
  • It is therefore 17 important that this population, particularly the physiologically at-risk women to constantly 18 include adequate amounts of food rich in iron, folate, calcium and vitamin A in their daily 19 homemade meals or any other sources to boost their intake.
  • Men on the other hand need 22 caution on fat and salt intake, since a substantial portion comes from their street food choices.

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WestminsterResearch
http://www.westminster.ac.uk/westminsterresearch
Contribution of street food to dietary intake of habitual urban
consumers: a cross-sectional study in Kampala city, Uganda
Sseguya, W., Matovu, N., Swann, J. and Draper, A.
This is a copy of the accepted author manuscript of the following article: Sseguya, W.,
Matovu, N., Swann, J. and Draper, A. (2020) Contribution of street food to dietary intake
of habitual urban consumers: a cross-sectional study in Kampala city, Uganda. Nutrition
and Health. Advanced online publication. doi:10.1177/0260106020919629 . The final
definitive version is available from the publisher Sage at:
https://dx.doi.org/10.1177/0260106020919629
© The Author(s) 2020
The WestminsterResearch online digital archive at the University of Westminster aims to make the
research output of the University available to a wider audience. Copyright and Moral Rights remain
with the authors and/or copyright owners.
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For Peer Review
Contribution of street food to dietary intake of habitual
urban consumers: A cross-sectional study in Kampala city,
Uganda
Journal:
Nutrition and Health
Manuscript ID
NAH-19-0163.R1
Manuscript Type:
Original Article
Date Submitted by the
Author:
04-Mar-2020
Complete List of Authors:
Sseguya, Wenceslaus; St. Francis Hospital Nsambya,
Matovu, Nicholas; Republic of Uganda Ministry of Health
Swann, Jessica; University of Westminster
Draper, Alizon; University of Westminster
Keywords:
Street food, Diet, Meal, Nutrient, Urban, Uganda
Abstract:
Background: Street food has continued to be a more popular food source
in urban settings of developing countries and proving a vital urban
dietary source. However, its dietary contribution among patronising
urban populations is yet to be comprehensively understood.
Aim: To assess how street food contributes to dietary intake of habitual
street food consumers.
Methods: We conducted a community-based cross-sectional study
among habitual street food consumers in Kampala city. We defined
habitual intake as consumption of a serving of any street food for
≥2days/week regardless of the food group and number of times
consumed in a particular day. Questionnaires were used to capture
quantitative data on sociodemographic characteristics, anthropometry,
24-hour diet intake and 2-month street food consumption frequency. The
Nutritics® diet analysis software version 4.3 and STATA version 13.0
were used for nutrient and statistical analyses respectively.
Results: Street food contributed considerably to daily intake of fat
(49.1%), sodium (38.4%) and calcium (36.5%) and least towards daily
intake of vitamin A (11.3%). Majority of consumers opted for street food
at breakfast (50%) whereas lunch and snacks featured the least for
overall street food inclusions (all 20%). Overall, men demonstrated more
dietary intake and inclusion at meals from street food than women.
Conclusion: This study indicates significant contribution of street foods
for urban consumers but with men derive more benefit than women in
terms of nutrient intake and inclusion in meals from street food.
https://mc.manuscriptcentral.com/nah
Nutrition and Health

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For Peer Review
Contribution of street food to dietary intake of habitual urban consumers:
A cross-sectional study in Kampala city, Uganda.
Wenceslaus Sseguya
1,2
, Nicholas Matovu
3
, Jessica Swann
2
, Alizon Draper
2
1
St Francis Hospital Nsambya, Kampala, Uganda
2
University of Westminster, London, United Kingdom
3
Ministry of Health, Kampala, Uganda
Corresponding Author:
Wenceslaus Sseguya
P.O. Box 7146, Kampala
Email: seguyawenceslaus@yahoo.com
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For Peer Review
1
1 Contribution of street food to dietary intake of habitual urban consumers:
2 A cross-sectional study in Kampala city, Uganda.
3 Abstract
4 Background: Street food has continued to be a more popular food source in urban settings of
5 developing countries and proving a vital urban dietary source. However, its dietary
6 contribution among patronising urban populations is yet to be comprehensively understood.
7 Aim: To assess how street food contributes to dietary intake of habitual street food
8 consumers.
9 Methods: We conducted a community-based cross-sectional study among habitual street
10 food consumers in Kampala city. We defined habitual intake as consumption of a serving of
11 any street food for ≥2days/week regardless of the food group and number of times consumed
12 in a particular day. Questionnaires were used to capture quantitative data on
13 sociodemographic characteristics, anthropometry, 24-hour diet intake and 2-month street
14 food consumption frequency. The Nutritics
®
diet analysis software version 4.3 and STATA
15 version 13.0 were used for nutrient and statistical analyses respectively.
16 Results: Street food contributed considerably to daily intake of fat (49.1%), sodium (38.4%)
17 and calcium (36.5%) and least towards daily intake of vitamin A (11.3%). Majority of
18 consumers opted for street food at breakfast (50%) whereas lunch and snacks featured the
19 least for overall street food inclusions (all 20%). Overall, men demonstrated more dietary
20 intake and inclusion at meals from street food than women.
21 Conclusion: This study indicates significant contribution of street foods for urban consumers
22 but men derive more benefit than women in terms of nutrient intake and inclusion in meals of
23 street foods.
24 Keywords: street food, diet, meal, urban, Uganda
25
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TL;DR: Under-reporting of food intake is one of the fundamental obstacles preventing the collection of accurate habitual dietary intake data and requires a multidisciplinary approach (including psychology, sociology and physiology) to advance the understanding of under-reporting in dietary intake studies.
Abstract: Under-reporting of food intake is one of the fundamental obstacles preventing the collection of accurate habitual dietary intake data. The prevalence of under-reporting in large nutritional surveys ranges from 18 to 54% of the whole sample, but can be as high as 70% in particular subgroups. This wide variation between studies is partly due to different criteria used to identify under-reporters and also to non-uniformity of under-reporting across populations. The most consistent differences found are between men and women and between groups differing in body mass index. Women are more likely to under-report than men, and under-reporting is more common among overweight and obese individuals. Other associated characteristics, for which there is less consistent evidence, include age, smoking habits, level of education, social class, physical activity and dietary restraint. Determining whether under-reporting is specific to macronutrients or food is problematic, as most methods identify only low energy intakes. Studies that have attempted to measure under-reporting specific to macronutrients express nutrients as percentage of energy and have tended to find carbohydrate under-reported and protein over-reported. However, care must be taken when interpreting these results, especially when data are expressed as percentages. A logical conclusion is that food items with a negative health image (e.g. cakes, sweets, confectionery) are more likely to be under-reported, whereas those with a positive health image are more likely to be over-reported (e.g. fruits and vegetables). This also suggests that dietary fat is likely to be under-reported. However, it is necessary to distinguish between under-reporting and genuine under-eating for the duration of data collection. The key to understanding this problem, but one that has been widely neglected, concerns the processes that cause people to under-report their food intakes. The little work that has been done has simply confirmed the complexity of this issue. The importance of obtaining accurate estimates of habitual dietary intakes so as to assess health correlates of food consumption can be contrasted with the poor quality of data collected. This phenomenon should be considered a priority research area. Moreover, misreporting is not simply a nutritionist's problem, but requires a multidisciplinary approach (including psychology, sociology and physiology) to advance the understanding of under-reporting in dietary intake studies.

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TL;DR: By focusing on undernutrition and overweight, the GNR puts malnutrition in a new light and identifies bottlenecks in the scale-up of nutrition-specific and nutrition-sensitive approaches and highlights actions to accelerate coverage and reach.
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Abstract: In 2012, food insecurity is still a major global concern as 1 billion people are suffering from starvation, under-, and malnutrition, and the Food and Agriculture Organization of the United Nations (FAO) has concluded that we are still far from reaching millennium development goal (MDG) number 1: to halve extreme poverty and hunger by 2015. In sub-Saharan Africa, the number of people suffering from hunger is estimated at 239 million, and this figure could increase in the near future. There are many examples of food insecurity in sub-Saharan Africa, some of them having reached catastrophic dimensions, for example, in the Horn of Africa or southern Madagascar. Food insecurity is not just about insufficient food production, availability, and intake, it is also about the poor quality or nutritional value of the food. The detrimental situation of women and children is particularly serious, as well as the situation among female teenagers, who receive less food than their male counterparts in the same households. Soaring food prices and food riots are among the many symptoms of the prevailing food crisis and insecurity. Climate change and weather vagaries, present and forecast, are generally compounding food insecurity and drastically changing farming activities, as diagnosed by the Consultative Group on International Agricultural Research (CGIAR) in June 2011. The key cause of food insecurity is inadequate food production. Since the global food crisis of 2007–2008, there has been an increasing awareness throughout the world that we must produce more and better food; and we should not be derailed from this goal, despite some relief brought by the good cereal harvests in 2011–2012. This is particularly true in sub-Saharan Africa, which needs and wants to make its own green revolution. The African challenge indeed is key to mitigating food insecurity in the world. Commitments were made by the heads of states and governments of the African Union to double the part of their domestic budgets devoted to agriculture in 2010–2011, so as to reach 10%. Technical solutions exist and there are indeed, throughout Africa, good examples of higher-yielding and sustainable agriculture. But good practices have to spread throughout the continent, while at the same time social and economic measures, as well as political will, are indispensable ingredients of Africa’s green revolution. It is also necessary that international donors fulfil their commitment to help African farmers and rural communities and protect them against unfair trade, competition, and dumping of cheap agrifood products from overseas.

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TL;DR: Although the amounts differed from place to place, even at the lowest values of the percentage of energy intake range, energy from street foods made a significant contribution to the diet.
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Frequently Asked Questions (1)
Q1. What have the authors contributed in "Contribution of street food to dietary intake of habitual urban consumers: a cross-sectional study in kampala city, uganda" ?

The authors conducted a community-based cross-sectional study among habitual street food consumers in Kampala city. This study indicates significant contribution of street foods for urban consumers but with men derive more benefit than women in terms of nutrient intake and inclusion in meals from street food.