Scope of implementation of food environment policy in Côte d'Ivoire and prioritization of actions using the Healthy Food Environment Policy Index (Food-EPI)

Dohe Franck Tieissiehi; Marie-Christine  Etty; Amoin Georgette  Konan; Koffi Pierre Valery  Niaba; Francis  Kouassi; Julien Soliba  Manga; Jean Claude  Moubarac; Stefanie  Vandevijvere; Adama  Diouf; Rebecca Rachel  Assa

doi:10.23751/pn.v27i4.17461

Authors

Dohe Franck Tieissiehi Université Félix Houphouët-Boigny https://orcid.org/0009-0002-7437-4673
Marie-Christine Etty Département de Médecine Sociale et Préventive (DMSP) et Centre de recherche en Santé Publique (CReSP) https://orcid.org/0000-0002-0222-576X
Dr Konan A.G. UFR Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire https://orcid.org/0000-0002-3556-6579
Dr Niaba K. Département de Biochimie et Microbiologie, Université Jean Lorougnon Guédé, Daloa, Côte d'Ivoire https://orcid.org/0009-0002-7437-4673
Dr Kouassi SE-CONNAPE, Abidjan, Côte d’Ivoire https://orcid.org/0009-0002-7437-4673
Dr Julien Département de Nutrition Université de Montréal, TRANSNUT, Montréal, Canada https://orcid.org/0009-0002-7437-4673
Pr Jean-Claude Moubarac Département de Nutrition Université de Montréal, TRANSNUT, Montréal, Canada https://orcid.org/0000-0001-8409-7855
Dr Stefanie Sciensano, Service of Lifestyle and Chronic Diseases, Brussels, Belgium https://orcid.org/0000-0003-3225-7524
Pr Adama D. Département de Biologie Animale, Laboratoire de Recherche en Nutrition et Alimentation Humaine (LARNAH), Université Cheikh Anta Diop, Dakar, Sénégal https://orcid.org/0009-0002-7437-4673
Pr Assa UFR Biosciences, UPR Biochimie et Sciences des Aliments, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire https://orcid.org/0009-0002-7437-4673

Keywords:

Food-EPI, Côte d'Ivoire, Public policy, Level of implementation, healthy eating environments

Abstract

Background and aim: The nutrition transition, marked by evolving dietary habits, has negatively impacted food systems in Côte d’Ivoire. This study evaluated existing public health nutrition policies and identified strategic interventions to foster healthier food environments

Methods: This study was conducted using the Food-EPI tool, developed by the INFORMAS network and adapted to the Ivorian context. The tool comprises two core components (policy and infrastructure support), 13 domains, and 59 good practice indicators - including 12 novel indicators specifically addressing the double burden of malnutrition

Results: Among the 59 indicators, the implementation level of nutrition policies in Côte d'Ivoire was rated as 'very low' for none, 'low' for 34, 'medium' for 24, and 'high' for only one. From the 115 identified actions, 20 were prioritized and recommended to the government for improving food environments. These actions specifically address school food environments, breastfeeding promotion, and nutrition financing

Conclusions: This study revealed low overall implementation of nutrition policies. Consequently, priority actions were identified to enhance food environments and effectively address the double burden of malnutrition in Côte d’Ivoire.

References

1. Food and Agriculture Organization of the United Nations. Sustainable food systems for healthy diets and improved nutrition in Africa. Regional Symposium for Africa, Abidjan, Ivory Coast. Rome, FAO 2017; available at https://www.fao.org/africa/events/detail-events/fr/.

2. World Bank Group. Global database on child growth and malnutrition. WHO World Health Organization. 2022;Accessed12/08/2024 https://donnees.banquemondiale.org/indicateur/SH.STA.WAST.ZS?locations=CI&_gl=1*9twcl3*_gcl_au*MTI3MzA2MzIzMi4xNzIzNDY4MzUw.

3. Fismen AS, Mathisen JR, Vlad I et al. Pilot test of the NOURISHING policy index - Assessing governmental nutrition policies in five European countries. Obesity Reviews 2023;24(S1): e13532.

4. Tieissiehi DF, Konan AG, Niaba KPV et al. Inventory and Structuring of Policy Documents Relating to Food Environments in Côte d’Ivoire. Am. J. Food Nutr. 2023;11(4):112-120.

5. Hawkes C, Thow AM, Downs S et al. Identifying effective food systems solutions for nutrition and non-communicable diseases: examples from the fats supply chain. SCN News 2013;40.

6. Hawkes C, Smith TG, Jewell J et al. Smart food policies for obesity prevention. Lancet 2015;385: 2410-2421.

7. Hill M & Varone F. The Public Policy Process. Eighth edition, Abingdon, Oxon; New York, NY: Routledge 2021.

8. Glanz K, Sallis JF, Saelens BE et al. Healthy nutrition environments: concepts and measures. Am J Health Promot. 2005;19:330-333.

10. Lang T & Rayner G. Overcoming policy cacophony on obesity: an ecological public health framework for policymakers. Obes. Rev 8. Suppl. 2007;1:165-181.

11. Swinburn B, Vandevijvere S, Kraak V et al. Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed Government Healthy Food Environment Policy Index. Obes. Rev. 14, Suppl. 2013;1:24-37.

9. World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. Geneva: WHO 2013.

12. Mahesh R, Vandevijvere S, Dominick C. and Swinburn B. Relative contributions of recommended food environment policies to improve population nutrition: results from a Delphi study with international food policy experts. Public Health Nutr. 2018;21(11):2142-2148.

13. Vandevijvere S, Barquera S, Caceres G et al. An 11‐country study to benchmark the implementation of recommended nutrition policies by national governments using the Healthy Food Environment Policy Index, 2015‐2018. Obes Rev. 2019;20:57-66.

14. Laar A, Barnesb A, Aryeeteya R et al. Implementation of healthy food environment policies to prevent nutritionrelated non-communicable diseases in Ghana: National experts’ assessment of government action. Food Policy. 2020:93(10):190.

15. Manga JS, Diouf A, Vandevijvere S et al. Evaluation and prioritisation of actions on food environments to address the double burden of malnutrition in Senegal: perspectives from a national expert panel. Public Health Nutr. (2022):1-13.

16. National Multisectoral Nutrition Information Platform Mise en place d’une National Multisectoral Nutrition Information Platform (PNMIN), Côte d’Ivoire. 2017; https://pnmin.gouv.ci/ (accessed December 2024).

17. SE-CONNAPE. Plan de communication de la plateforme nationale multisectorielle d’information pour la nutrition 2020-2023. Secrétariat Exécutif du Conseil National pour la Nutrition, l'Alimentation et le développement de la Petite Enfance. (Côte d’Ivoire). 2020.

18. Vandevijvere, S, Mackay, S, D’Souza E and Swinburn B. How healthy are New Zealand food environments? A comprehensive assessment 2014-2017. The University of Auckland, Auckland, New Zealand 2018.

19. Asiki G, Wanjohi MN, Barnes A et al. Benchmarking food environment policies for the prevention of diet-related non-communicable diseases in Kenya: National expert panel’s assessment and priority recommendations. PLoS One 2020;15(8): e0236699. https://doi.org/10.1371/journal.pone.0236699.

20. Wongpakaran N, Wongpakaran T, Wedding D et al. A comparison of Cohen’s Kappa and Gwet’s AC1 when calculating inter-rater reliability coefficients: a study conducted with personality disorder samples. BMC Med. Res. Methodol. 2013;13:1-7.

21. Vanderlee L, Goorang S, Karbasy K et al. Creating healthier food environments in Canada: Current policies and priority actions - Ontario report. Toronto; University of Toronto. 2017;Available at: www.labbelab.utoronto.ca/Food-EPI-Canada-2017.

22. Phulkerd S, Vandevijvere S, Lawrence M et al. Level of implementation of best practice policies for creating healthy food environments: assessment by state and non-state actors in Thailand. Public Health Nutr. 2017;20(3):381-390.

23. Saint Ville, Arlette S., Gordon M. Hickey, and Leroy E. Phillip. How do stakeholder interactions influence national food security policy in the Caribbean? The case of Saint Lucia. Food Policy 68 2017;53-64.

24. National Development Plan (NDP) Strategic orientations of the National Development Plan for Côte d'Ivoire from 2021 to 2025. Ministry of Planning and Development. (Côte d’Ivoire). 2021;2:191p.

25. SE-CONNAPE, (2016) National Multi-sectoral Nutrition Plan 2016-2020. Secrétariat Exécutif du Conseil National pour la Nutrition, l'Alimentation et le développement de la Petite Enfance (Côte d’Ivoire). 2016;38 pages.

26. Glanz K, Basil M, Maibach E et al. Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control as influences on food consumption. J Am Diet Assoc. 1998;98:1118–1126.

27. French SA, Jeffery RW, Story M et al. Pricing and promotion effects on low-fat vending snack purchases: the CHIPS study. Am J Public Health. 2001;91:112–117.

28. Laar A. The role of food environment policies in making unhealthy foods unattractive and healthy foods available in Africa. EclinicalMedicine. 2021;36 ; https://doi.org/10.1016/j.eclinm.2021.100908

29. National Multisectoral Nutrition Information Platform La nutrition dans les documents cadres de Côte d'Ivoire : analyse des politiques, stratégies et plans, nationaux et sectoriels. Plateforme Nationale Multisectorielle d'Information pour la Nutrition (Côte d'Ivoire). 2020; page 37.

30. Laar AAP, Aryeetey R, Agyemang C et al. Perspective: Food Environment Research Priorities for Africa: Lessons from the Africa Food Environment Research Network. Adv Nutr. 2022;13:739–747.

31. Namugumya BS, Candel JJL, Talsma E.F & Termeer CJAM. Towards concerted government efforts? Assessing nutrition policy integration in Uganda. Food Secur. 2020;12:355–368.

32. Droog NMS, Dijkstra CS, Selm NV, Poelman MP, Mackenbach JD. Unveiling viewpoints on national food environment policies in the Dutch newspaper discourse: an interpretative media content analysis. Int. J. Behav. Nutr. Phys. Act. 2024;21:1-15.

33. Baker P, Friel S, Gleeson D, Thow A-M, Labonte R. Trade and nutrition policy coherence: a framing analysis and Australian case study. Public Health Nutr. 2019;22(12):2329–2337.

34. Duque MAN., Núñez EO., Tamayo EMP., Mialon M. Eric Crosbie and Christian Paul Torres de la Rosa “Favoring those who contributed to their political campaigns”: an analysis of the incentives received by the food industry in Colombia in the period of 2018—2020. 2025.

35. Scaling Up Nutrition (SUN), la Stratégie du Mouvement pour le renforcement de la nutrition SUN 3.0 (2021-2025). https://scalingupnutrition.org/sites/default/files/2022-08/SUN-Strategy-2021-2025_FRE_web1.pdf consulté le 07 juillet 2025.