Vegetables for Healthy Diets in Low- and Middle-Income Countries: A Scoping Review of the Food Systems Literature

Background: Vegetables are an essential element in healthy diets, but intakes are low around the world and there is a lack of systematic knowledge on how to improve diets through food system approaches. Methods: This scoping review assessed how studies of food systems for healthy diets have addressed the role of vegetables in low- and middle-income countries. We apply the PRISMA guidelines for scoping reviews to narratively map the literature to an accepted food systems framework and identify research gaps. Results: We found 1383 relevant articles, with increasing numbers over 20 years. Only 6% of articles looked at low-income countries, and 93% looked at single-country contexts. Over half of articles assessed vegetables as a food group, without looking at diversity within the food group. 15% looked at traditional vegetables. Issues of physical access to food were among the least studied food system topics in our review (7% of articles). Only 15% of articles used a comprehensive food system lens across multiple dimensions. There is also a research gap on the impacts of different policy and practice interventions (13% of articles) to enable greater vegetable consumption. Conclusions: Food system studies necessarily drew on multiple disciplines, methods and metrics to describe, analyze, and diagnose parts of the system. More work is needed across disciplines, across contexts, and across the food system, including understanding interventions and trade-offs, and impacts and change for diets particularly of marginalized population groups. Filling these gaps in knowledge is necessary in order to work toward healthy vegetable-rich diets for everyone everywhere.

Download Full-text

Reverse thinking: taking a healthy diet perspective towards food systems transformations

Food Security ◽

10.1007/s12571-021-01204-5 ◽

2021 ◽

Author(s):

I. D. Brouwer ◽

M. J. van Liere ◽

A. de Brauw ◽

P. Dominguez-Salas ◽

A. Herforth ◽

...

Keyword(s):

Food Environment ◽

Food Systems ◽

Food System ◽

Unintended Consequences ◽

Healthy Diet ◽

Middle Income ◽

Middle Income Countries ◽

Conflicting Objectives ◽

Healthy Diets ◽

Low And Middle Income

AbstractFood systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.

Download Full-text

Multimorbidity of chronic non-communicable diseases and its models of care in low- and middle-income countries: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2019-033320 ◽

2019 ◽

Vol 9 (10) ◽

pp. e033320 ◽

Cited By ~ 2

Author(s):

Fantu Abebe Eyowas ◽

Marguerite Schneider ◽

Biksegn Asrat Yirdaw ◽

Fentie Ambaw Getahun

Keyword(s):

Scoping Review ◽

Grey Literature ◽

Communicable Diseases ◽

Multiple Chronic Conditions ◽

Middle Income ◽

Non Communicable Diseases ◽

Middle Income Countries ◽

Co Morbidity ◽

Scoping Reviews ◽

Low And Middle Income

IntroductionMultimorbidity is the coexistence of two or more chronic non-communicable diseases (NCDs) in a given individual. Multimorbidity is increasing in low- and middle-income countries (LMICs) and challenging health systems. Individuals with multimorbidity are facing the risk of premature mortality, lower quality of life and greater use of healthcare services. However, despite the huge challenge multimorbidity brings in LMICs, gaps remain in mapping and synthesising the available knowledge on the issue. The focus of this scoping review will be to synthesise the extent, range and nature of studies on the epidemiology and models of multimorbidity care in LMICs.MethodsPubMed (MEDLINE) will be the main database to be searched. For articles that are not indexed in the PubMed, Scopus, PsycINFO and Cochrane databases will be searched. Grey literature databases will also be explored. There will be no restrictions on study setting or year of publication. Articles will be searched using key terms, including comorbidity, co-morbidity, multimorbidity, multiple chronic conditions and model of care. Relevant articles will be screened by two independent reviewers and data will be charted accordingly. The result of this scoping review will be presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guideline.Ethics and disseminationThis scoping review does not require ethical approval. Findings will be published in peer-reviewed journal and presented at scientific conferences.

Download Full-text

The Importance of a Food Systems Approach to Low and Middle Income Countries and Emerging Economies: A Review of Theories and Its Relevance for Disease Control and Malnutrition

Frontiers in Sustainable Food Systems ◽

10.3389/fsufs.2021.642635 ◽

2021 ◽

Vol 5 ◽

Author(s):

Pablo Alarcon ◽

Paula Dominguez-Salas ◽

Eric M. Fèvre ◽

Jonathan Rushton

Keyword(s):

Public Health ◽

Food Safety ◽

Emerging Economies ◽

Food Systems ◽

Food System ◽

Systems Science ◽

Multidisciplinary Teams ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Our review explores the changing food production, distribution and consumption environment in low and middle-income countries and emerging economies as a basis for framing how to study food systems in order to address public health issues of food safety and nutrition. It presents the state of knowledge on existing food systems science and its use in terms of sustainable actions for food safety and public health. The review identifies a knowledge gap in food system mapping and governance, with value chain mapping of key commodities often missing. Despite a number of initiatives, the application of food systems methods is highly variable in scope and quality. Most analyses concentrate on specific commodities, rarely taking into account the need for a whole diet approach when looking at nutrition or the assessment of a range of infectious agents and their interactions when looking at food safety. Of the studies included in the review there is a growing observation of “informal” food systems, a term used inconsistently and one that requires revision. “Informal” food systems link to the formal sector to provide food security, yet with trade-offs between economic efficiencies and food safety. Efforts to improve food safety are hampered by inadequate food safety capacities and a lack of policy coherence leading to: inadequate investment; fragmented food quality control systems; weak or non-existent traceability mechanisms; weak foodborne disease surveillance; obsolete food regulation; and weak regulatory enforcement. In-depth food systems assessments can complement risk analysis to identify risky behaviors and understand institutional settings in order to improve codes of practice and enforcement. Methods for looking at food safety from a food systems perspective are emerging, yet existing nutrition and food systems science are not advancing sufficiently in response to nutritional public health problems. There is an urgency for improved understanding of the structure and drivers of the food systems, for better planning of changes that leads to nutrients access and healthy levels of eating. It is proposed that countries and international institutions provide an atlas of food system maps for the key commodities based on an agreed common methodology and developed by multidisciplinary teams.

Download Full-text

Examining the double burden of malnutrition for preschool children and women of reproductive age in low-income and middle-income countries: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2021-054673 ◽

2021 ◽

Vol 11 (12) ◽

pp. e054673

Author(s):

Jason Mulimba Were ◽

Saverio Stranges ◽

Ishor Sharma ◽

Juan Camilo Vargas-Gonzalez ◽

M. Karen Campbell

Keyword(s):

Preschool Children ◽

Scoping Review ◽

Low Income ◽

Reproductive Age ◽

Women Of Reproductive Age ◽

Double Burden ◽

Middle Income ◽

Middle Income Countries ◽

Scoping Reviews ◽

Double Burden Of Malnutrition

IntroductionThe majority of the populations in low-income and middle-income countries (LMICs) are encountering the double burden of malnutrition (DBM): the coexistence of both undernutrition and overnutrition sequalae. With DBM being a new phenomenon in research, little is known about its aetiology, operational definitions and risk factors influencing its manifestation. The proposed scoping review is aimed at mapping literature with regard to the DBM phenomenon among preschool children and women of reproductive age in LMICs who are among the most high-risk groups to encounter DBM.MethodsA comprehensive literature search will be conducted in the following electronic databases: MEDLINE, EMBASE, Scopus, CINAHL, LILACS and ProQuest Dissertations and Thesis Global. Additionally, searches in other government and institutional sources (WHO website and university repositories) and forward and backward citation tracking of seminal articles will also be done. Two reviewers will independently conduct title and abstract screening and full-text screening. Similarly, data extraction and coding will independently be done by two reviewers. Information extracted from included literature will be analysed qualitatively using thematic analysis approach and reported as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.Ethics and disseminationEthical approval is not required for this study because the review is based on literature from publicly available sources. The dissemination of our findings will be done through presentations in relevant conferences and publication in a peer-reviewed journal.

Download Full-text

Metrics to analyze and improve diets through food Systems in low and Middle Income Countries

Food Security ◽

10.1007/s12571-020-01091-2 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1085-1105

Author(s):

Mequanint B. Melesse ◽

Marrit van den Berg ◽

Christophe Béné ◽

Alan de Brauw ◽

Inge D. Brouwer

Keyword(s):

Food Systems ◽

Food System ◽

Systems Approach ◽

Analytical Framework ◽

Data Availability ◽

Middle Income ◽

The Sustainable Development ◽

Middle Income Countries ◽

Public Data ◽

Low And Middle Income

Abstract Taking a food systems approach is a promising strategy for improving diets. Implementing such an approach would require the use of a comprehensive set of metrics to characterize food systems, set meaningful goals, track food system performance, and evaluate the impacts of food system interventions. Food system metrics are also useful to structure debates and communicate to policy makers and the general public. This paper provides an updated analytical framework of food systems and uses this to identify systematically relevant metrics and indicators based on data availability in low and middle income countries. We conclude that public data are relatively well available for food system drivers and outcomes, but not for all of the food system activities. With only minor additional investments, existing surveys could be extended to cover a large part of the required additional data. For some indicators, however, targeted data collection efforts are needed. As the list of indicators partly overlaps with the indicators for the Sustainable Development Goals (SGDs), part of the collected data could serve not only to describe and monitor food systems, but also to track progress towards attaining the SDGs.

Download Full-text

Implementation of colorectal cancer screening interventions in low-income and middle-income countries: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2020-037520 ◽

2020 ◽

Vol 10 (6) ◽

pp. e037520

Author(s):

Désirée Schliemann ◽

Nicholas Matovu ◽

Kogila Ramanathan ◽

Paloma Muñoz-Aguirre ◽

Ciaran O'Neill ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Scoping Review ◽

Low Income ◽

Middle Income ◽

Crc Screening ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Scoping Reviews

IntroductionColorectal cancer (CRC) imposes a significant global burden of disease. CRC survival rates are much lower in low-income and middle-income countries (LMICs). Screening tends to lead to an improvement in cancer detection and the uptake of available treatments and, in turn, to better chances of cancer survival. Most evidence on CRC screening interventions comes from high-income countries. The objective of this scoping review is to map the available literature on the implementation of CRC screening interventions in LMICs.Methods and analysisWe will conduct a scoping review according to the framework proposed by Arksey and O’Malley (2005). We will search MEDLINE, EMBASE, Web of Science and Google Scholar using a combination of terms such as “colorectal cancer”, “screening” and “low-middle-income countries”. Studies of CRC screening interventions/programmes conducted in the general adult population in LMICs as well as policy reviews (of interventions in LMICs) and commentaries on challenges and opportunities of delivering CRC screening in LMICs, published in the English language before February 2020 will be included in this review. The title and abstract screen will be conducted by one reviewer and two reviewers will screen full-texts and extract data from included papers, independently, into a data charting template that will include criteria from an adapted template for intervention description and replication checklist and implementation considerations. The presentation of the scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidance.Ethics and disseminationThere are no ethical concerns. The results will be used to inform colorectal screening interventions in LMICs. We will publish the findings in a peer-reviewed journal and present them at relevant conferences.

Download Full-text

Climate change, climate-related disasters and mental disorder in low- and middle-income countries: a scoping review

BMJ Open ◽

10.1136/bmjopen-2021-051908 ◽

2021 ◽

Vol 11 (10) ◽

pp. e051908

Author(s):

Isobel Sharpe ◽

Colleen M Davison

Keyword(s):

Climate Change ◽

Mental Health ◽

Mental Disorder ◽

Scoping Review ◽

Grey Literature ◽

Post Traumatic Stress ◽

Middle Income ◽

Middle Income Countries ◽

Scoping Reviews ◽

Low And Middle Income

IntroductionClimate change and climate-related disasters adversely affect mental health. Low- and middle-income countries (LMICs) are particularly vulnerable to the impacts of climate change and climate-related disasters and often lack adequate mental healthcare infrastructure. We used the scoping review methodology to determine how exposure to climate change and climate-related disasters influences the presence of mental disorders among those living in LMICs. We also aimed to recognise existing gaps in this area of literature.MethodsThis review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. To identify relevant studies, we searched five electronic databases (MEDLINE, EMBASE, Global Health, APA PsycInfo and Sociological Abstracts) from 1 January 2007 to 31 December 2019. We also searched the grey literature. Included studies had an adult-focused LMIC population, a climate change or climate-related disaster exposure and a mental disorder outcome. Relevant study information was extracted and synthesised.ResultsFifty-eight studies were identified, most of which (n=48) employed a cross-sectional design. The most commonly studied exposure–outcome combinations were flood-related post-traumatic stress disorder (PTSD) (n=28), flood-related depression (n=15) and storm-related PTSD (n=13). The majority of studies identified a positive exposure–outcome association. However, few studies included a baseline or comparator (ie, unexposed) group, thereby limiting our understanding of the magnitude or nature of this association. There was also great heterogeneity in this literature, making studies difficult to pool or compare. Several research gaps were identified including the lack of longitudinal studies and non-uniformity of geographic coverage.ConclusionTo our knowledge, this was the first scoping review to investigate the relationship between climate change and climate-related disaster exposures and mental disorder outcomes in LMICs. Our findings support the need for further research, but also highlight that mental health should be a priority within LMIC climate change policy considerations.

Download Full-text

Patient-reported outcomes for diabetes and hypertension care in low- and middle-income countries: A scoping review

PLoS ONE ◽

10.1371/journal.pone.0245269 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245269

Author(s):

Sarah Masyuko ◽

Carrie J. Ngongo ◽

Carole Smith ◽

Rachel Nugent

Keyword(s):

Scoping Review ◽

Low Income ◽

English Language ◽

Patient Reported Outcome Measures ◽

Low Income Countries ◽

Future Research ◽

Middle Income ◽

Middle Income Countries ◽

Patient Reported ◽

Low And Middle Income

Introduction Patient-reported outcome measures (PROMs) assess patients’ perspectives on their health status, providing opportunities to improve the quality of care. While PROMs are increasingly used in high-income settings, limited data are available on PROMs use for diabetes and hypertension in low-and middle-income countries (LMICs). This scoping review aimed to determine how PROMs are employed for diabetes and hypertension care in LMICs. Methods We searched PubMed, EMBASE, and ClinicalTrials.gov for English-language studies published between August 2009 and August 2019 that measured at least one PROM related to diabetes or hypertension in LMICs. Full texts of included studies were examined to assess study characteristics, target population, outcome focus, PROMs used, and methods for data collection and reporting. Results Sixty-eight studies met the inclusion criteria and reported on PROMs for people diagnosed with hypertension and/or diabetes and receiving care in health facilities. Thirty-nine (57%) reported on upper-middle-income countries, 19 (28%) reported on lower-middle-income countries, 4 (6%) reported on low-income countries, and 6 (9%) were multi-country. Most focused on diabetes (60/68, 88%), while 4 studies focused on hypertension and 4 focused on diabetes/hypertension comorbidity. Outcomes of interest varied; most common were glycemic or blood pressure control (38), health literacy and treatment adherence (27), and acute complications (22). Collectively the studies deployed 55 unique tools to measure patient outcomes. Most common were the Morisky Medication Adherence Scale (7) and EuroQoL-5D-3L (7). Conclusion PROMs are deployed in LMICs around the world, with greatest reported use in LMICs with an upper-middle-income classification. Diabetes PROMs were more widely deployed in LMICs than hypertension PROMs, suggesting an opportunity to adapt PROMs for hypertension. Future research focusing on standardization and simplification could improve future comparability and adaptability across LMIC contexts. Incorporation into national health information systems would best establish PROMs as a means to reveal the effectiveness of person-centered diabetes and hypertension care.

Download Full-text

Contraceptive Dynamics Among Women with Disabilities in Low-and Middle-Income Countries: A Scoping Review Protocol

10.21203/rs.3.rs-1123750/v1 ◽

2021 ◽

Author(s):

Getalem Aychew Beyene ◽

Solomon Mekonnen Abebe ◽

Gedefaw Abeje Fekadu ◽

Achenef Asmamaw Muche ◽

Bisrat Misganaw Geremew

Keyword(s):

Scoping Review ◽

Unmet Need ◽

Cochrane Library ◽

Knowledge Gaps ◽

Women With Disabilities ◽

Middle Income ◽

Middle Income Countries ◽

Contraceptive Usage ◽

Scoping Reviews ◽

Low And Middle Income

Abstract Introduction Contraceptive dynamics is the use of contraception, unmet need, discontinuation and/or switching of contraception. Women with disabilities (WWDs) in low- and middle-income countries (LMICs) face a common problem: a low prevalence of contraceptive usage and a high unmet need. Despite the fact that certain studies have been conducted in high-income countries, there is a scarcity of research on the degree of contraceptive method mix, unmet need, contraception discontinuation, and switching among WWDs in LMICs. As a result, the scoping review's goal is to investigate, map available evidence, and identify knowledge gaps on contraceptive dynamics within LMICs WWDs. Methods The scoping review is guided by the six-stage Arksey and O'Malley methodology framework. Published articles will be retrieved from databases such as PubMed (Medline), the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Global Health. Grey literature databases will be searched using electronic search engines such as Google scholar, Google, OpenGrey, and Worldcat. In addition, a manual search of reference lists from recognized studies will be conducted, as well as a hand search of the literature. There will be no restrictions on study design or publication year. Two independent reviewers will screen relevant publications, and data will be charted accordingly. The Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guideline will be used to convey the findings of this scoping review. Discussion When compared to non-disabled women, WWDs had a lower prevalence of contraceptive usage and a higher unmet need in LMICs. This indicates a pervasive issue that could compromise the United Nations (UN) General Assembly Convention article 25, which guarantees PWDs access to SRH services, and make the situation difficult to address. Despite these facts, they are the most marginalized people. on the planet. It is critical to map available evidence and identify knowledge gaps in order to do this. As a result, the findings of this scoping review will be significant in terms of the contraceptive dynamic among WWDs in LMICs. Registration: Open Science Framework (OSF), with registration number; DOI/10.17605/OSF.IO/XCKPT.

Download Full-text

Global access to COVID-19 vaccines: a scoping review of factors that may influence equitable access for low and middle-income countries

BMJ Open ◽

10.1136/bmjopen-2021-049505 ◽

2021 ◽

Vol 11 (9) ◽

pp. e049505

Author(s):

Elizabeth F Peacocke ◽

Lieke Fleur Heupink ◽

Katrine Frønsdal ◽

Elin Hoffmann Dahl ◽

Lumbwe Chola

Keyword(s):

Scoping Review ◽

Scale Up ◽

Equitable Access ◽

Publication Type ◽

Middle Income ◽

Middle Income Countries ◽

Scoping Reviews ◽

Systematic Selection ◽

Meta Analyses ◽

Low And Middle Income

ObjectiveTo identify the factors contributing to equitable access to COVID-19 vaccines for low and middle-income countries (LMIC).MethodsWe conducted a scoping review following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and a five-stage framework for scoping studies. We performed systematic searches for published peer-reviewed literature in five databases: Medline, Embase, Web of Science, Global Index Medicus and COVID-19 Evidence Epistemonikos (August 2020, updated May 2021).ResultsSystematic selection according to predefined criteria resulted in the final inclusion of 45 peer-reviewed articles, with no limitations on study design or publication type. We derived four key factors that potentially influence equitable access to COVID-19 vaccines in LMICs: (1) collectively agreed global mechanisms or frameworks; (2) bilateral purchasing, contracting, and vaccine prices; (3) vaccine manufacturing that is supported by sharing know-how; and (4) countries’ strength in implementing vaccination programmes.ConclusionsThis scoping review highlights the ongoing challenges for the international community in ensuring equitable access to COVID-19 vaccines for LMICs. The literature suggests that vaccine manufacturing can influence the supply of vaccines, as can the role of patent holders who can influence global governance through their role in the distribution of COVID-19 vaccines. Our findings indicate that including the principles of equitable access throughout vaccine research and development, procurement, scale-up and distribution processes can support equitable access for LMICs. Advances made with mRNA vaccines may have additional benefits in relation to expanding the manufacturing of other vaccine. Finally, the exploration and scale-up of such capacities of LMICs are likely to prove to be a valuable investment, even after the pandemic.

Download Full-text