Investigating and mapping out the formal urban food environment and diet quality of women of reproductive age within the city of Johannesburg, South Africa

Abstract

Background: The health of WRA is important since evidence shows that the diet quality and nutritional status of women, not only during pregnancy but also prior to pregnancy, affects the health of her offspring. One of the major influencing factors to these undesirable conditions is a poor diet quality. Food environments play a significant role in diet quality. Aim: This study sought to investigate the association between the formal urban food environment and diet quality of WRA within the city of Johannesburg, South Africa. Methods: In this cross-sectional study, WRA attending the Discoverers Community Health Centre (DCHC) in Roodepoort for family planning or antenatal care were recruited. Socio-demographic data were collected using interviewer-administered questionnaires. Body weight and height measurements were collected from non-pregnant women and mid-upper arm circumference (MUAC) from all women. Diet history was obtained using a multiple-pass 24-hour dietary recall method. Diet quality was measured in two ways: the Dietary Diversity Score (DDS) to categorise scores into the Minimum Dietary Diversity for Women (MDD-W) categories; and the Rapid Eating Assessment for Participants – Shortened Version (REAP-S) survey. The food environment was also measured in two ways: the modified Retail Food Environment Index (mRFEI) and measuring the median Euclidean distance from participant residential addresses to food retailers (grocery stores and fast-food outlets). Results: The study participants consisted of 427 WRA (142 non-pregnant and 285 pregnant) residing in the Roodepoort area. The mean age of participants was 29.8±6.5 years. Almost half were single (49 %), and although most of the participants had good education (78 % completed matric or a tertiary education), more than half were unemployed (53 %) and a third receiving social grants (33 %). The REAP-S survey results showed that the participants had a moderate diet quality based on dietary behaviours (REAP-S score = 27.1±3.3), with non-pregnant women having a lower REAP-S score than pregnant women (26.5±3.6 vs. 27.3±3.2). It was found that the study population had poor dietary diversity (DDS = 4.1±1.4) with 64 % of the study population not meeting the MDD-W (60 % pregnant and 72 % non-pregnant not meeting the MDD-W). The study found a correlation between the two diet quality scores (r = 0.159 p = 0.001) indicating the two measures had similar outcomes of diet quality. The environment was found to be an obesogenic food environment indicated by a low mRFEI score (31 %). The median distance from the study participants’ residential addresses to grocery stores was 337.6 (193.5–594.2) m and to fast-food outlets was 230.5 (141.4–416.6) m which indicates that a grocery store is as accessible as a fast-food outlet and that consumers may choose to visit either when visiting a food outlet. The study found no associations of either diet quality score with the mRFEI score; or either diet quality score v and the median distance to food retailers (grocery stores and fast-food outlets). Even so, many participants were overweight with the MUAC results indicating that 30 % may be obese and the BMI results of non-pregnant women indicating that the majority were overweight or obese (73 %). Conclusion: The study found that the participants live in an obesogenic food environment, majority did not reach the MDD-W and most non-pregnant participants were overweight or obese indicating that the food environment may have an impact on participant food choices, diet quality and thereby overall health, even though our results did not show an association. Several reasons are possible for our results showing no association between the diet quality and the food environment scores, including measuring a homogenous environment where there is little range of food exposure, as well as the study not considering the impact of the informal food environment (e.g. street vendors) on food choices. The health of WRA is important for the future generation’s health since evidence shows that nutritional status of women not only during pregnancy but also prior to pregnancy affects offspring health. It is therefore vital that the influence of the food environment on diet quality be fully understood and measures be taken to improve the health and well-being of WRA.

Agtergrond: Die gesondheid van vroue van vrugbare ouderdom (VVO) is belangrik omdat daar bewys is dat die dieetkwaliteit en voedingstatus van vroue, nie slegs tydens maar ook vóór swangerskap, die gesondheid van haar kinders beïnvloed. Een van die sleutelfaktore wat hierdie ongewenste toestande beïnvloed is swak dieetkwaliteit. Voedselomgewing speel ’n belangrike rol by dieetkwaliteit. Doel: Hierdie studie het gepoog om die assosiasie tussen die formele stedelike voedselomgewing en dieetkwaliteit van VVO in die stad Johannesburg, Suid-Afrika, te ondersoek. Metodes: VVO wat die Discoverers Gemeenskapsgesondheidsentrum in Roodepoort vir gesinsbeplanning of voorgeboortesorg besoek het, is vir hierdie deurnee-studie gewerf. Die sosio-demografiese data is met behulp van onderhoudvoerder-geadministreerde vraelyste ingesamel. Liggaamsgewig en lengtemetings van nie-swanger vroue, sowel as die omtrek van die middel-boarms (OMBA) van al die vroue, is geneem. Dieetgeskiedenis is met behulp van ’n meervoudige toegang, 24-uur dieet-herroepmetode verkry. Dieetkwaliteit is op twee maniere gemeet: die Telling vir Dieetdiversiteit (TDD) om tellings in die kategorieë van die Minimum Dieetdiversiteit vir Vroue (MDD-V) en die Vinnige-eet-assessering van Deelnemers – Verkorte Weergawe (VEAD-V) streekproef te kategoriseer. Die voedselomgewing is ook op twee maniere gemeet: die aangepaste Kleinhandelsvoedselomgewingsindeks (aKVOI) en meting van die euklidiese middelafstand vanaf die deelnemer se huisadres tot voedselkleinhandelaars (kruidenierswinkels en kitskos-afsetpunte). Resultate: Die deelnemers in die studie was 427 VVO (142 nie-swanger en 285 swanger) wat in die Roodepoort-area gewoon het. Die gemiddelde ouderdom van die deelnemers was 29.8±6.5 jaar. Byna die helfte was enkellopend (49%) en alhoewel die meeste van die deelnemers ’n goeie opvoeding gehad het (78% het matriek of tersiêre onderwys voltooi), was meer as die helfte (53%) werkloos en het ’n derde (33%) maatskaplike toelae gekry. Die resultate van die VEAD-V-streekproef het getoon dat die deelnemers matige/gemiddelde dieetkwaliteit gehad het weens dieetgedrag (VEAD-V-telling = 27.1±3.3), en nie-swanger vroue het ’n laer VEAD-V-telling gehad as swanger vroue (26.5±3.6 vs 27.3±3.2). Daar is bevind dat die studiebevolking swak dieetdiversiteit gehad het (TDD = 4.1±1.4) en 64% van die studiebevolking (60% swanger en 72% nie-swanger) het nie die MDD-V behaal nie. Die studie het ’n korrelasie tussen die twee dieetkwaliteitstellings getoon (r = 0.159, p = 0.001), wat aandui dat die twee metings soortgelyke uitkomste vir dieetkwaliteit gehad het. Daar is bevind dat die omgewing ’n obesogene voedselomgewing gehad het, wat deur ’n lae aKVOI-telling (31%) aangedui is. Die middelafstand vanaf die huisadresse van die deelnemers aan die studie tot by kruidenierswinkels was 337.6 meter (193.5–594.2) en tot by kitskos-afsetpunte was dit 230.5 meter (141.4–416.6), wat aandui vii dat ’n kruidenierswinkel net so toeganklik was as ’n kitskos-afsetpunt en dat verbruikers kon kies om enigeen van die voedsel-afsetpunte te besoek. Die studie het geen assosiasie tussen die dieetgehaltetelling en die aKVOI-telling, of tussen die dieetkwaliteitstelling en die middelafstand na voedselkleinhandelaars (kruidenierswinkels en kitskos-afsetpunte), gevind nie. Tog was baie deelnemers oorgewig: die MBAO-resultate het aangedui dat 30% vetsugtig kon gewees het en die BMI-resultate van nie-swanger vroue het aangedui dat die meeste van hulle vetsugtig was (73%). Gevolgtrekking: Die studie het getoon dat die deelnemers in ’n obesogene voedselomgewing gewoon het, dat die meerderheid nie die MDD-V bereik het nie en dat die meeste nie-swanger deelnemers oorgewig of vegsugtig was. Dit het aangedui dat die voedselomgewing ’n impak kon hê op deelnemers se voedelkeuses, dieetkwaliteit en derhalwe algehele gesondheid, alhoewel die resultate nie ’n assosiasie aangedui het nie. Die resultate het om verskillende redes nie ’n assosiasie tussen dieetkwaliteit en die voedselomgewingstellings getoon nie, insluitende die meting van ’n homogene omgewing waar daar beperkte blootstelling aan tipes voedsel was en dat die studie nie die impak van die informele voedselomgewing (byvoorbeeld straatverkopers) op voedselkeuses in ag geneem het nie. Die gesondheid van VVO is belangrik vir die toekomstige generasie se gesondheid, aangesien daar bewys is dat die dieetkwaliteit van vroue nie slegs tydens swangerskap nie, maar ook vóór swangerskap ’n uitwerking op hul kinders se gesondheid gehad het. Dit is derhalwe noodsaaklik dat die voedselomgewing se invloed op dieetkwaliteit volledig begryp word en metings geneem word om die gesondheid en welstand van VVO te verbeter.

Isendlalelo: Ibaluleke kakhulu impilo yabesifazane asebengathola abantwana ngokweminyaka yobudala (WRA) njengoba ubufakazi bukhombisa ukuthi iqophelo lokudla kanye nomsoco ekudleni abakudlayo kuyithinta kakhulu inzalo, futhi lokhu akwenzeki nje kuphela ngesikhathi sokukhulelwa kodwa nangaphambi kokukhulelwa. Iqophelo eliphansi lokudla lingezinye zezinto ezihamba phambili ekuphazamisekeni kwenzalo. Izimo zokuthola ukudla zidlala indima enkulu ngokweqophelo lokudla esikudlayo. Inhloso: Lolu cwaningo luhlose ukuphenya ngobudlelwano phakathi kwesimo sokudla ekutholakala emadolobheni kanye neqophelo lokudla kwabesifazane asebengathola abantwana (WRA) ngaphakathi edolobha eGoli, eNingizimu Afrika. Izindlela ezisetshenzisiwe: Lapha kusetshenziswe uhlelo lokuqoqa ulwazi eqoqweni labantu, i WRA kwabahambela i-Discoverers Community Health Centre ( DCHC ) e-Roodepoort ngaphansi kohlelo lokuhlela umndeni noma ukunakekelwa kwabakhulelwe. Ulwazi ngenhlalo yabantu luqoqwe kusetshenziswa uhlu lwemibuzo olulawulwa yilabo ababuza imibuzo. Lapha kuye kwaqoqwa izisindo zomzimba nezilinganiso zobude kwabesifazane abangakhulelwe kanye nesiyingi sengalo esimaphakathi nendawo (MUAC) kubo bonke abesifazane. Umlando wendlela yokudla utholakale ngokusebenzisa indlela yokukhumbula ukudla okudlile emahoreni angama-24 edlule. Iqophelo lokudla okudliwayo lihlolwe ngezindlela ezimbili: Imiphumela Yendlela Yokudla Okunhlobonhlobo (DDS) ukuze kuhlukaniswe izilinganiso ngezigaba ezithinta Ubumbalwa Bezinhlobonhlobo Zokudla Kwabesifazane (MDD-W); kanye nohlelo Lwenqubo Efinyeziwe – Ngokuhlola Indlela Yokudla Okusheshayo (REAP-S). Isimo sokuthola ukudla sihlolwe ngezindlela ezimbili: Ukulungiswa Kwezindawo Ezithengisa Ukudla (mRFEI) kanye nokuhlolwa kwebanga elimaphakathi le-Euclidean ukusuka lapho kuhlala khona abathengi kuya lapho kudayiswa khona (ezitolo zokudla nasezitolo zokudla okusheshayo). Imiphumela: Ababambiqhaza kulolu cwaningo kube abangama-427 WRA (abangama-142 babo abangakhulelwa kanye nabangama-285 abakhulelwe) abahlala endaweni yase-Roodepoort. Isilinganiso seminyaka yobudala yababambiqhaza abaneminyaka engama-29.8± 6.5. Cishe ingxenye yabo (49%) ayishadile, kanti nakuba iningi lababambe iqhaza lifundile (78% uphothule umatikuletsheni noma imfundo ephakeme), kodwa bangaphezu kwesigamu kubona abangasebenzi (53%) kanti ingxenye yesithathu yona ithola isibonelelo sikahulumeni (33%). Imiphumela yenhlolovo ye-REAP-S ibonise ukuthi ababambiqhaza badla ukudla okuseqophelweni elimaphakathi kuye ngokuthi ime kanjani indlela abadla ngayo (imiphumela ye-REAP-S = 27.1±3.3), nabesifazane abangakhulelwa abanesilinganiso esiphansi se-REAP-S uma kuqhathaniswa nabesifazane abakhulelwe (26.5±3.6 vs. 27.3±3.2). Ucwaningo luthole ukuthi inani labantu lidla ukudla okunhlobonhlobo okungenampilo (DDS = 4.1±1.4), kanti lapha kunabantu ix abangama-64% (abakhulelwe abangama-60% kanye nabangama-72% abangakhulelwa) abangasihlanganisi isilinganiso se-MDD-W. Ucwaningo luthole ukuthi kunokuhlobana phakathi kwemiphumela emibili mayelana neqophelo lokudla esikudlayo (r = 0.159, p = 0.001) nokusho ukuthi lezi zindlela ezisetshenzisiwe zozimbili zinemiphumela efanayo yeqophelo lokudla esikudlayo. Isimo siveza ukuthi ukudla okudliwayo yilokho okukhuluphalisa kakhulu uma kususelwa emiphumeleni ye-mRFEI ebonakala iphansi (31%). Ibanga elimaphakathi ukusuka endaweni ehlala abathengi okwenziwe ngabo ucwaningo ukuya ezitolo zokudla lingama-337.6 m (193.5–594.2) kanti ukuya ezitolo zokudla okusheshayo khona ngama-230.5 m (141.4–416.6), okubonisa ukuthi ibanga lokuya ezitolo zokudla lithi alilingane nokuya kwezokudla okusheshayo, kanti-ke abathengi bangakwazi ukuhambela nanoma yisiphi kulezi zitolo. Ngalolu cwaningo akukho ukuhlobana okutholakele phakathi kwemiphumela yeqophelo lokudla esikudlayo kanye neye-mRFEI, noma phakathi kweqophelo lokudla esikudlayo kanye nebanga elimaphakathi lokuhambela lapho kudayisa khona ukudla (izitolo zokudla nezitolo zokudla okusheshayo). Nanoma kunjalo, ababambiqhaza abaningi bakhuluphele ngokweqile, nemiphumela ye-MUAC ekhombisa ukuthi abangama-30% babo banokukhuluphala kanye nemiphumela ye-BMI yabesifazane abangakhulelwe ekhombisa ukuthi iningi labo lisinda ngokweqile noma likhuluphele (73%). Isiphetho: Ucwaningo luthole ukuthi ababambiqhaza bahlala endaweni enokudla okukhuluphalisayo, iningi labo alinaso isilinganiso esifanele se-MDD-W kanti iningi labangakhulelwe lisinda ngokweqile noma likhuluphele, lokhu-ke kusho ukuthi isimo sokuthola ukudla sinomthelela ekudleni okudliwayo, iqophelo lokudla kanye nempilo jikelele, nakuba imiphumela ingakukhombisi ukuhlobana kulezi zinto. Zikhona-ke izizathu ezimbalwa ezingadala le miphumela nengakhombisi ukuhlobana phakathi kweqophelo lokudla esikudlayo kanye nesimo sokuthola ukudla, okuhlanganisa ukulinganiswa kwendawo enokudla okumbalwa ongakuthola, kanjalo nokuthi ucwaningo aluwubhekanga umthelela wendawo engekho emthethweni okutholakala kuyo ukudla (isib. abathengisi basemgwaqweni). Ibaluleke kakhulu impilo yabesifazane asebengathola abantwana ngokweminyaka yobudala (WRA) uma sibheka ikusasa lempilo yethu njengoba, ubufakazi bukhombisa umsoco ekudleni okudliwayo okungenzeki nje kuphela ngesikhathi sokukhulelwa kodwa nangaphambi kokukhulelwa. Ngakho-ke kubalulekile ukuthi siwuqonde ngokugcwele umthelela wesimo sokutholakala kokudla ngokweqophelo lokudla esikudlayo futhi kuthathwe izinyathelo ezifanele zokwenza ngcono impilo nokuphila kahle ngokwe WRA