Implications for Health and Environmental Sustainability of Urbanisation and the Nutrition Transition: Perspectives from Rural and Urban Uganda

Carolyn Imelda Auma began her studies at the University of Sheffield in September 2015 as a PhD student. Just before she commenced her studies at the University of Sheffield, she worked as part of a team of consultants that was involved in a multi-stakeholder review of the Uganda Development Strategy Investment Plan 2010/11-2014/15. Prior to this, she worked at the Food and Agricultural Organisation (FAO) Somalia in Nairobi, Kenya as an International Nutrition Analyst Intern for 6 months. Carolyn also previously worked as a Graduate Research Assistant at the School of Food Technology, Nutrition and Bio-engineering at Makerere University for about two years, upon the completion of her undergraduate degree. Aside from this, she has volunteered as a researcher at the School of Food Technology, Nutrition and Bio-engineering at Makerere University, National Crops Resources Research Institute (NaCRRI) and National Agricultural Research Institute (NARI), Biosciences Department, all in Uganda. She holds a BSc. in Food Science and Technology (First Class Hons.) from Makerere University, Uganda and MSc. International Public Health Nutrition (Distinction) from the University of Westminster.


As urbanisation increases in sub-Saharan Africa, dietary changes consonant with the nutrition transition are likely to occur. These may have implications for both health and environmental sustainability. Some authors have suggested that younger women, particularly low-income women in sub-Saharan Africa, are more vulnerable to dietary changes compared with men of a similar age. 

To explore the dietary practices among rural and urban women of reproductive age in Uganda; the social, cultural and physical influences behind them and the implications thereof for environmental sustainability in order to propose an acceptable, affordable, healthy and environmentally sustainable diet adaptable to the Ugandan context.


To explore dietary practices and the healthiness and environmental sustainability of these dietary practices, principal component analysis of secondary data from the 2008 Uganda Food Consumption Survey will be used. This will be coupled with primary data collected via qualitative 24-hour recall interviews and Photovoice interviews among rural and urban Uganda women (n=54) of reproductive age. To explore the influences behind the dietary practices of Ugandan women of reproductive age, Photovoice will be used. Lastly, to propose an acceptable, affordable healthy and an environmentally sustainable Ugandan diet, OptiFood a software programme that uses mathematical modelling, will be used.

Expected outcomes
It is anticipated that this research will shed light on dietary practices of Ugandan women and the influences behind them, and so encourage discourse among public health practitioners and policy makers towards more healthy and environmentally sustainable dietary patterns.

A copy of Carolyn's poster for the Grantham Symposium can be seen here:

Qualitative Investigation of the Wellness Recovery Action Plan in a UK NHS Crisis Care Setting

The following article was published in the Journal Issues In Mental Health Nursing and can be reached via the following link.

Publisher weblink:

Since studying at ScHaRR Michael has been promoted within the NHS, is working part time in research for The University of Birmingham, and is also working as a visiting lecturer at Sheffield Hallam University.

Crisis theory suggests that in addition to presenting a threat to mental well-being, crises are also opportunities where successful interventions can lead to successful outcomes. UK mental health crisis teams aim to reduce hospital admission by treating people at home and by building resilience and supporting learning from crisis, yet data on repeat crisis episodes suggest this could be improved. This qualitative study sought to explore the Wellness Recovery Action Plan (WRAP) as a means of supporting resilience-building and maximising the opportunity potential of crisis. The following themes emerged: The meaning of crisis; Engaging with the WRAP process; WRAP and self-management; and Changes and transformations. This research suggests that WRAP has potential in supporting recovery from crisis, revealing insights into the nature of crisis which can inform the further development of crisis services.

Author details
Michael Ashman, Lived Experience Development Worker, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust; former Master of Public Health student, The School of Health and Related Research, the University of Sheffield.
Vanessa Halliday, Senior Lecturer, The School of Health and Related Research, The University of Sheffield, Sheffield.
Joseph Cunnane, Consultant Psychiatrist, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust.

Ashman, M., Halliday, V., & Cunnane, J.G., (2017). Qualitative Investigation of the Wellness Recovery Action Plan in a UK NHS Crisis Care Setting. Issues In Mental Health Nursing. 2017, VOL. 38, NO. 7, 570–577.
doi: 10.1080/01612840.2017.1300840. Published online: 18 Jul 2017

A systematic review of barriers to and facilitators of physical activity for people with autism spectrum disorder

Liam graduated from the Master of Public Health (MPH) programme at ScHARR in 2016 with Distinction. He decided to study for an MPH because he wanted to develop the skills he had learnt in his undergraduate psychology degree in public health research, a field of study that combined his interests in biology, sociology and medicine at a population level. Throughout the programme, Liam was able to advance his knowledge of statistics and health psychology, while learning completely new skills in epidemiology, disease control and systematic reviewing. He also worked outside the taught modules as Vice-President of the Public Health Society, where he was primarily responsible for planning activities and events for students on the programme. Liam is currently working as a Research Assistant at the University College London Research Department of Primary Care and Population Health. He is working on a project exploring factors influencing STI testing behaviour of young people in the UK, using a theory-based online questionnaire.



Autism spectrum disorder is a lifelong neurodevelopmental disorder that affects people of all ages and across cultures. It is believed that autism spectrum disorder can contribute to lower levels of physical activity in people with the condition. Interest in the factors mediating this relationship has increased in recent years.


To identify the barriers to and facilitators of physical activity for people with autism spectrum disorder.


Systematic review.

Data Sources

ASSIA, ERIC, MEDLINE, PsycINFO, Social Care Online, Web of Science, IBSS, LISA PEI, Social Services Abstracts, Sociological Abstracts and NAS Library Catalogue. Hand searching of reference lists of identified articles was also conducted.

Eligibility Criteria

Journal articles published in the English language from 1943 to March 2016. Journal articles were required to contain qualitative data relating to physical activity in people with autism spectrum disorder.


Seventeen studies were included in the data synthesis. Most of the barriers and facilitators were labelled as either personal, social, environmental or policy and programme related. Using physical activity to reduce social stress was also a facilitator of physical activity.


Results from this synthesis can inform interventions and policies to encourage people with autism spectrum disorder to engage in physical activity. Further qualitative research would be beneficial to developing a more accurate picture of barriers and facilitators relevant to adults with autism spectrum disorder.

The role of information and communication technologies in health system resilience after the 2015 Nepal earthquake

Olivia Crane graduated from the Master of Public Health (MPH) programme at ScHARR in 2016. She applied for the programme after deciding on a career change away from Communications in the private sector, towards Public Health. The Masters programme built on her background in anthropology and gave huge new insight into the links between health systems and the ways people live and organise themselves socially.
Since graduating from the MPH programme, Olivia has started working with the Public Health Guidelines department at the National Institute of Health and Care Excellence (NICE) as an Assistant Technical Analyst. The skills she learnt during the programme were invaluable in opening up this opportunity!

The title of Olivia's dissertation project was 'The Role of Information and Communication Technologies in Health System Resilience after the 2015 Nepal Earthquake' 
The project was offered through a research attachment to staff from ScHARR and the Department of Politics,  Dr. Julie Balen and Dr. Simon Ruston respectively. The time Olivia spent living in Nepal as a child for 6 years gave her both a passionate interest in the country, and some useful background understanding of language and culture.


Background: Information and Communication Technologies (ICTs) are increasingly recognised for their important role, and even greater potential in mitigating, preparing for, responding to, and recovering from natural disasters. However, to date, the vast majority of research into their use in disasters has been conducted in high-income country settings. This research should be expanded into low- and middle-income countries, particularly as vulnerability to natural disasters increases with poverty. Here the role of ICTs during a series of earthquakes that occurred in Nepal in April 2015 is explored.
Methods: In depth semi-structured interviews (n=24) and focus groups (n=4) were conducted in March and April 2016, almost one year post-earthquake. Data collection took place in three settings, namely (i) at village level in Barpak, the epicentre of the earthquake; (ii) at district level in Gorkha, the capital of the district in which Barpak is situated; and (iii) at central level in Kathmandu, the capital city of Nepal. Participants were individuals affected by the earthquake, and those in formal health system roles as well as informal grassroots responders. Data was recorded, professionally translated and transcribed, and underwent thematic analysis using NVIVO 11.
Results: Perceptions of the role of ICTs and their value varied greatly between groups. While access and capability were found to be key barriers to use rurally, ICTs formed a greater part of the response in urban settings. This was particularly true for the informal response, which relied on ICTs for networking and coordination. The response of the formal health system lagged behind in terms of ICTs, generally relying more upon traditional methods of disaster management. Preparation was severely lacking in all areas, including communication planning.
Conclusions: The findings of this study indicate that the complex problems of access and capability remain key barriers to ICT use in Nepal, as seen in other low-income country literature. It demonstrates the potential of ICTs for giving people voice, and in developing community intelligence for the benefit of affected groups as well as for the information of decision makers within the formal system. It also reveals the scope for increased connectedness between the formal health system and the informal health system response, which currently operate separately but with many of the same aims.

Universal health coverage in developing countries and its impact on improving access to antenatal care and maternal health outcomes: A systematic review

Simbiat Olayinka Lawal recently completed the Master of Public Health (MPH) programme at ScHARR. Simbiat chose to study the MPH to gain more knowledge on the role of healthcare policy and management and also to develop her research skills, especially in health services research. In particular, the course developed Simbiat's knowledge of healthcare financing systems and enabled her to develop and refine her research skills. Taking part in the MPH program at ScHARR also equipped Simbiat with several other skills such as team work, time management and an ability to strive. Simbiat believes that the new skills she has obtained from studying the MPH  will enable her to work in a role that will help Africa, and particularly her home country, Nigeria, to achieve universal health coverage and health equality as well as working towards sustainable development goals. In the future, Simbiat plans to pursue a doctorate degree in public health policy and management, alongside conducting research into the Nigerian healthcare system.

The title of Simbiat's dissertation project was: Universal health coverage in developing countries and its impact on improving access to antenatal care and maternal health outcomes: A systematic review.


Background: Universal health coverage (UHC) refers to equal access to healthcare services across all socio-economic quintiles and reduction in financial risk incurred from the utilisation of health services. It is an important goal which would help reduce maternal mortality rates. However, the effectiveness of different healthcare financing (UHC) schemes on improving access and utilisation of maternal health services and on selected pregnancy outcomes amongst women of different socio-economic, educational and residential (rural or urban) backgrounds in developing countries, is not well understood.

Aim: This study aimed to examine the utility of UHC in improving access, utilization and pregnancy outcomes in women in developing countries.

Method: A systematic literature review was performed to answer the research question. Electronic databases; Medline, ASSIA, Cochrane library, TRIP, PubMed REMINER, CINAHL and Google scholar were used to retrieve all relevant studies on universal health coverage. Also, references of included studies and online resources of organisations such as WHO, UN and WORLD BANK were also searched to avoid omission of important literature. The inclusion and exclusion criteria were developed using the PICO (population, intervention, comparator and outcome) framework.

Result: A total of 13 studies were included in the review; of which 2 studies were from Bangladesh, 6 from Ghana, 1 from Uganda, 1 from Congo and 3 studies from two or more of the following countries: - (Ghana, Rwanda, Philippines, Senegal and Mali). There was a positive association between UHC and improved access, utility of antenatal health services and better increased access to emergency obstetric care (e.g. C-sections) despite women socioeconomic status, educational and residential (rural and urban) backgrounds: Antenatal health care (three to four or more ANC visits); NHIS (OR=1.182, p=0.05, OR=1.09, p=<0.01), other insurance (OR=2.37, p=<0.05 and OR=2.41, p=<0.05), voucher (OR=2.787, p=<0.001, OR=1.913, p= ≤0.001, (OR=0.2855, p=<0.001). Delivery at a healthcare facility; free delivery policy increased facility delivery by 2.3%, p=0.015, CI 0.50-4.05, NHIS policy increased facility delivery by 7.5%, p= ≤0.001, CI 4.97-9.92, other insurance coverage (e.g. CBHI) (OR=4.74, p= <0.10), and vouchers (OR=2.539, p= ≤0.001). Births attended by a skilled birth attendant; free delivery policy (OR=1.67, p= <0.01), NHIS policy (OR=1.65, p =<0.01 and OR=1.375, p=0.05), other insurance policy (free ANC policy) (OR=1.17, p= <0.01) and voucher scheme (OR=3.582, p= ≤0.001) and (OR=0.2119, p= <0.001). Emergency obstetric care (e.g. C-section); Fee exemption (OR=0.329, p= <0.0001), other insurance OR=1.13 vs. OR=1.26, p=<0.001, vouchers (OR=1.536, p= <0.01).

Conclusion: Universal health coverage through various strategies, if implemented adequately, sufficiently increases the utilization of maternal health care services. More women on UHC received emergency obstetric care such as C-section than those without. Future studies should endeavour to examine whether these benefits spill over to reducing maternal mortality. There should also be efforts to find out the barriers to universal adoption of UHC policies by developing countries, such as sources of funding, suitability of different policies in different developing economies.

Food insecurity and social support among Ghanaians living in Greater Manchester, UK: A qualitative study

Hibbah Araba Saeed joined the University of Sheffield in October 2013, as a PhD student at the School of Health and Related Research, Section of Public Health.  Prior to starting her PhD, Hibbah worked as a Research Assistant at the Noguchi Memorial Institute for Medical Research, Ghana.
Hibbah's PhD research is on Determinants of Dietary Behaviour among Ghanaians living in the United Kingdom.  The research adopts a mixed method research approach to explore the determinants of dietary behaviour, dietary change following migration and household food insecurity among Ghanaians living in the United Kingdom. This article presents the findings from the qualitative aspect of the study.

Food insecurity and social support among Ghanaians living in Greater Manchester, UK: A qualitative study


Background: In the UK, minority ethnic groups tend to have higher levels of poverty than the white British population and therefore may be at high risk of food insecurity. Ghanaians are thought to have a high level of social support in their communities, but the role of this resource in relation to food security is unknown. We explored perceptions of three main components of food insecurity (availability, accessibility, utilization) among Ghanaians. The role of social support in enhancing food security was explored to identify potential coping mechanisms for food insecure households.

Methods: We conducted 29 in-depth interviews using purposive sampling among Ghanaians aged ≥25yrs living in Manchester. Participants varied in socioeconomic status, gender and migration status. Utilizing a framework analysis approach, we analysed themes using the three main components of food security and also generated new themes from the data.

Findings: Overall, participants did not describe their personal experiences of food insecurity but some identified that food insecurity existed among Ghanaians in the community. Participants reported that food insecure household may be reluctant to make use of food banks because of pride/perceived social stigma. Also the type of foods served were considered culturally unappealing. This reluctance does not extend to close and trusted networks including the church. Within the church, people have trusted allies that they engage with for specific needs including financial support when needed.

Conclusion: Our analysis suggests that the church context forms a trusted base in which people operate. We recommend that to be able to reach the most deprived among the Ghanaian community, churches could be used as a channel for interventions.

Click here to view a poster about Hibbah's qualitative research study