Food-SAMSA

Food Environments in Africa: Addressing Malnutrition with a Syndemics Approach (Food-SAMSA)

Different forms of malnutrition – including undernutrition, micronutrient deficiencies, and obesity – can coexist and interact at the level of societies, communities, households, and individuals through the life course and across generations. For example, undernutrition in childhood can predispose individuals for obesity and associated diseases later in life, mediated through a number of physiological pathways. At the level of societies, efforts to reduce undernutrition by subsidising staples as a cheap source of calories can drive increases in obesity. The term double burden of malnutrition has been coined for this coexistence and interaction between different forms of malnutrition, which is widespread across the Global South, including sub-Saharan Africa, South Asia, and parts of South-East Asia.

Food-SAMSA addresses this double burden of malnutrition by examining its determinants and by exploring interventions at the macro (policy), the meso (community) and the micro (interpersonal) level. As part of the project, we work with partners from South Africa to: i) adapt existing approaches for assessing and improving food environments to contexts with a double burden of malnutrition; ii) implement and evaluate them in South Africa, and, iii) strengthen capacities and expand existing regional networks to support food environment research and action across Sub-Saharan Africa.

Funder: Federal Ministry of Agriculture, Food and Regional Identity (BMLEH)

Project partners: University of Cape Town (UCT), South African Medical Research Council (SAMRC), University of Western Cape (UWC), LMU Munich

Project period: 2021-2025

Project website: https://foodsamsa.samrc.ac.za/

Selected publications

• Klinger C, Okanmelu E, Delobelle P, Theurich M, Rincon Camargo D, Gedrich K, Holliday N, Rehfuess EA, Alaba O, Mchiza Z, Lambert EV, Vandevjvere S, Vanderlee L, Sacks G, von Philipsborn P: Tool for Assessing Food Industry Commitments and Practices to Address the Double Burden of Malnutrition: A Delphi Study. Globalization and Health 2026, 22 (4). https://doi.org/10.1186/s12992-025-01175-8
  
  
• Holliday N, Muhali MK, Lembani M, Nonkeneza H, Feni M, McHiza ZJ-R, Hill J, Klinger C, Rehfuess EA, von Philipsborn P & Delobelle P (shared last authors): Drivers and levers of the double burden of malnutrition in Cape Town, South Africa: insights from in-depth interviews with multi-sectoral stakeholders. BMC Public Health 2025, 25(1):2966, https://doi.org/10.1186/s12889-025-24210-0
  
  
• Wentzel A, Nguyen K, von Philipsborn P, Levitt N, Mchiza Z: Prevalence of Metabolic Syndrome Among Adolescents in Cape Town, South Africa: A Cross-Sectional Analysis Comparing Five Diagnostic Criteria to Explore Suitability. Diabetes Research and Clinical Practice 2025. https://doi.org/10.1016/j.diabres.2025.113053
  
  
• Holliday N, Delobelle P, Klinger C, Mchiza ZJ-R, Alaba O, Vandevijvere S, von Philipsborn P, Geffert K: Policy implementation and recommendations to address the double burden of malnutrition in South Africa: expert assessment using the expanded Healthy Food Environment Policy Index (Food-EPI). BMC Medicine 2025, 23(1):360. https://doi.org/10.1186/s12916-025-04191-y
  
  
• Wentzel A, Eichinger M, Govender L, Esterhuizen B, Sekgala MD, Nguyen K, von Philipsborn P, Mchiza ZJ: The extent of outdoor food and beverage advertising surrounding primary and secondary schools in poorly resourced townships in Cape Town, South Africa. Health & Place 2024, 90:103371. https://doi.org/10.1016/j.healthplace.2024.103371