Healthy and environmentally sustainable dietary behaviours among rural and urban Ugandan women of reproductive age in the context of the nutrition transition: a mixed methods study

Background: The aim of this mixed methods PhD was to explore the healthiness and environmental impact of the dietary behaviours of rural and urban Ugandan women of reproductive age (WRA) and identify factors influencing these behaviours. Methods: In study one, principal component analysis was used to explore evidence for dietary transitions and describe Ugandan women’s dietary patterns using secondary data. In study two, dietary data collected using a qualitative 24hr recall, were used to assess the healthiness and environmental impact of the dietary intake of WRA using nutrient profiling and greenhouse gas emission data. In study three, multiple correspondence analysis and cluster analysis were performed on data from study two to compare current dietary patterns with those from study one and categorise participants into dietary typologies. Study four established factors influencing women’s dietary practices using Photovoice. Findings: In study one, urban residency was associated with the ‘transitioning, processed, low environmental impact’ (β=1.19 [1.06, 1.32]) and ‘animal-based high environmental impact’ (β=0.45 [0.28, 0.61]) dietary patterns, but not with the ‘plantbased low environmental impact’ pattern (β=-0.49 [-0.62, -0.37]). Some consistency was observed in dietary patterns identified from studies one and three. Study three identified four dietary typologies: ‘urban, low-impact, early-stage transitioners’, ‘urban, medium-impact, mid-stage transitioners’, ‘rural, low-impact, early-stage transitioners’ and ‘rural, low-impact, traditionalists’. Study two suggested that urban and better educated WRA were more likely to consume healthy, lower impact foods. Study four identified convenience, meal balancing, perceptions, family, friends, food vendor reputation, availability and economic and physical access as key factors influencing dietary practices. Conclusion: Ugandan WRA are experiencing early-mid stages in the nutrition transition. Family provides an avenue through which interventions aimed at impressing positive perceptions towards healthy and lower impact dietary practices can be targeted. Home gardens, urban farming and improved transportation can address challenges in availability and access to healthy, lower impact foods