• Applying the Food Multimix concept for sustainable and nutritious diets

      Zotor, Francis B.; Ellahi, Basma; Amuna, Paul; University of Health and Allied Sciences; University of Chester (Cambridge University Press, 2015-08-11)
      Background: Despite a rich and diverse ecosystem and biodiversity, worldwide, more than 2 billion people suffer from micronutrient malnutrition or hidden hunger. Of major concern are a degradation of our ecosystems and agricultural systems which are thought to be unsustainable thereby posing a challenge for the future food and nutrition security. Despite these challenges, nutrition security and ensuring well balanced diets depend on sound knowledge and appropriate food choices in a complex world of plenty and want. We have previously reported on how the food multimix (FMM) concept, a food-based and dietary diversification approach can be applied to meeting energy and micronutrient needs of vulnerable groups through an empirical process. Our objective in this article is to examine how the concept can be applied to improve nutrition in a sustainable way in otherwise poor and hard-to-reach communities. We have reviewed over 100 FMM food recipes formulated from combinations of commonly consumed traditional candidate food ingredients; on average five per recipe, and packaged as per 100 g powders from different countries including Ghana, Kenya, Botswana, Zimbabawe and Southern Africa, India, Mexico, Malaysia and United Kingdom; and for different age groups and conditions such as older infants and young children, pregnant women, HIV patients, diabetes and for nutrition rehabilitation. Candidate foods were examined for their nutrient strengths and nutrient content and nutrient density of recipes per 100 g were compared to reference nutrient intakes (RNIs) for the different population groups. We report on the nutrient profiles from our analysis of the pooled and age-matched data as well as sensory analysis and conclude that locally produced FMM foods can complement local diets and contribute significantly to meeting nutrient needs among vulnerable groups in food-insecure environments. Key words: food multimix, candidate foods, sustainable, food security, resource-poor, nutrition interventions.
    • Building systemic capacity for Nutrition: Training towards a professionalised workforce for Africa.

      Ellahi, Basma; Annan, Reginald; Sarkar, Swrajit; Amuna, Paul; Jackson, Alan A.; University of Chester; University of Kumasi; University of Central Lancashire; University of Greenwich; University of Southampton (Cambridge University Press, 2015-06-15)
      The fundamental role played by good nutrition in enabling personal, social and economic development is now widely recognised as presenting a fundamental global challenge that has to be addressed if major national and international problems are to be resolved in the coming decades. The recent focus provided by the Millennium Development Goals and the Scaling-Up-Nutrition (SUN) Movement has been towards reducing the extent of nutrition-related malnutrition in high burden countries. This has served to emphasise that there is a problem of inadequate professional capacity in nutrition that is sufficiently widespread to severely limit all attempts at the effective delivery and sustainability of nutrition-related and nutrition-enabling interventions that have impact at scale. Many high burden countries are in sub-Saharan Africa where there is a high dependency on external technical support to address nutrition-related problems. We have sought to explore the nature and magnitude of the capacity needs with a particular focus on achieving levels of competency within standardised professional pre-service training which is fit for purpose to meet the objectives within the Scaling-Up-Nutrition movement in Africa. We review our experience of engaging with stakeholders through workshops and a gap analysis of the extent of the problem to be addressed, and a review of current efforts in Africa. We conclude that there are high aspirations but severely limited human resource and capacity for training that is fit-for-purpose at all skill levels in nutrition-related subjects in Africa. There are no structured or collaborative plans within professional groups to address the wide gap between what is currently available, the ongoing needs and the future expectations for meeting local technical and professional capability. Programmatic initiatives encouraged by agencies and other external players, will need to be matched by improved local capabilities to address the serious efforts required to meet the needs for sustained improvements related to Scaling-Up-Nutrition in high burden countries. Importantly, there are pockets of effort which need to be encouraged within a context in which experience can be shared and mutual support provided.
    • Exploring the health status of older persons in Sub Saharan Africa

      Audain, Keiron A.; Carr, Michelle; Dikmen, Derya; Zotor, Francis B.; Ellahi, Basma; University of Zambia; University of Chester; Hacettepe University; University of Health and Allied Science; University of Chester (Cambridge University Press, 2017-05-10)
      Sub-Saharan Africa has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation; Sub-Saharan Africa is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases. The aim of this review is to highlight available research on the health status of older persons in Sub-Saharan Africa, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in Sub-Saharan Africa on older persons (aged 50 years and older) related to health indicators including nutritional status, non-communicable diseases and HIV burden. Whilst it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions.
    • Layers of listening: qualitative analysis of the impact of early intervention services for first-episode psychosis on carers’ experiences

      Anna, Lavis,; Lester, Helen; Everard, Linda; Freemantle, Nick; Amos, Tim; Fowler, David; Hodgekins, Jo; Jones, Peter B.; Marshall, Max; Sharma, Vimal; et al. (Cambridge University Press, 2015-08)
      Background: Early Intervention Services (EIS) comprise low-stigma youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice. Aims: By analysing carers’ accounts of their daily lives and affective challenges during a relative’s first-episode psychosis against the background of wider research into Early Intervention Services, this paper explores relationships between carers’ experiences and EIS. Methods: Semi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS. Results: Our data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these service user-focused engagements also emerge; they risk leaving carers’ emotions unacknowledged and compounding an existing lack of helpseeking. Conclusions: By focusing on EIS’s engagements with carers, this paper draws attention to an urgent broader question; as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?
    • Older adults and violence: An analysis of domestic homicide reviews in England involving adults over 60 years of age

      Benbow, Susan M.; Bhattacharyya, Sarmishtha; Kingston, Paul; University of Chester; Older Mind Matters; Betsi Cadwaladr University Health Board (Cambridge University Press, 2018-01-11)
      Domestic Homicide Reviews (DHRs) are conducted when an individual aged 16 or over appears to have died from violence, abuse or neglect by a person to whom they are related or with whom they are in an intimate relationship or who is a member of the same household. DHRs aim to identify lessons to be learned, to improve service responses to domestic abuse, and to contribute to prevention of domestic abuse/ homicide. We submitted freedom of information requests to English Local Authorities to identify DHRs where victim, perpetrator, or both were aged over 60. Collected Reports and/ or Executive Summaries were thematically analysed. Analysis identified four key themes in the context of the key relationship and caring: major mental illness of the perpetrator; drug and/or alcohol abuse; financial issues; and a history of domestic abuse in key or family relationships. We analysed 14 adult family homicides, 16 intimate partner homicides, and five homicide-suicides. Age per se did not emerge as a significant factor in our analysis. Terminology needs to be standardised, and training/ education regarding risk assessment improved in relation to age, myths around ageing/ dementia, and stresses of caring. Management of mental illness is a key factor. A central repository of DHR Reports accessible for research and subject to regular review would contribute to maximising learning and improving practice.
    • Some limits and political implications of participation within health and social care for older adults

      Carey, Malcolm; University of Chester (Cambridge University Press, 2018-03-14)
      This paper critically examines service user participation and involvement for older adults. It concentrates upon research and community-led engagement for older people, and maintains that despite extensive support and expansion, participation offers a complex form of governance and ideological control, as well as a means by which local governments and some welfare professions seek to legitimise or extend their activities. Some of the paradoxes of participation are discussed, including tensions that persist between rhetorical claims of empowerment, active citizenship and democratic engagement on one hand, despite tendencies towards risk-aversion, welfare retrenchment and participant ambivalence on the other. The paper also highlights practical problems in relation to participative research and community involvement, and questions arguments that participation may challenge the authority of welfare professionals. Critical theory is drawn upon to contextualise the role of participative narratives within wider welfare, including its role in moving debate away from ownership or redistribution while masking and validating policy related goals which can counter many older people’s needs. Tension is also noted between participation projects represented as resource to support ageing identities as opposed to those representing technologies for social regulation and conformity.
    • Sugar sweetened beverage consumption in the early years and implications for type 2 diabetes: A sub-Saharan Africa context

      Audain, Keiron A.; Levy, Louis; Ellahi, Basma; University of Zambia; Public Health England; University of Chester (Cambridge University Press, 2019-02-28)
      This review aims to explore trends of early consumption of sugar-sweetened beverages (SSBs) in Sub-Saharan Africa (SSA), within the context of growing child and adolescent obesity and escalating type-2 diabetes prevalence. We explore efforts to mitigate these, drawing on examples from Africa and elsewhere. SSBs including carbonated drinks and fruit juices, play a contributory role in the development of obesity and associated non-communicable diseases. SSA is an attractive market for beverage companies owing to its rapid economic growth, growing middle class and youthful populations. SSBs already contribute significantly to total sugar and energy consumption in SSA where a plethora of marketing techniques targeted at younger people are utilised to ensure brand recognition and influence purchasing and brand loyalty. Coupled with a general lack of nutrition knowledge or engagement with preventative health, this can lead to frequent consumption of sugary drinks at a young age. Many high and some middle income countries public health efforts address increasing prevalence of obesity and type-2 diabetes by focussing on strategies to encourage reduction in sugar consumption via health policy and public education campaigns. However, similar efforts are not as developed or forthcoming in low-income countries. Health care systems across SSA are ill-prepared to cope with epidemic proportions of non-communicable diseases, particularly when contextualized with the ongoing battle with infectious diseases. We conclude that greater efforts by governments and the nutrition community to educate the public on the health effects of increased and excessive consumption of SSBs are necessary to help address this issue.