Assessing the Impact of Sugary Beverage Consumption on Public Health in Ghana:

Trends, Challenges, and Policy Implications

Josephine N. Nartey
Center for Sustainable Research and Advocacy (CENSURA, GHANA)
Abstract:
Sugary beverage consumption has emerged as a significant public health concern in Ghana,
contributing to the rising prevalence of obesity, type 2 diabetes, and other non-communicable
diseases. This publication provides a comprehensive assessment of the impact of sugary beverage
consumption on public health in Ghana, examining recent trends, associated health outcomes,
socio-cultural and economic factors, and policy interventions.
The study reveals an increasing trend in sugary beverage consumption, particularly among younger
age groups and urban populations. It highlights the significant associations between consumption
and various health issues, including obesity, type 2 diabetes, cardiovascular diseases, and dental
problems. The findings underscore the urgent need to address this growing public health challenge
in Ghana.
The publication also explores the influence of marketing strategies, cultural norms, and health
awareness on consumption patterns. It discusses how these factors shape attitudes and behaviors
towards sugary beverages and emphasizes the importance of considering socio-cultural context
when developing interventions.
Furthermore, the economic implications of sugary beverage consumption are examined, including
the impact on healthcare costs, productivity losses, and household budgets. The study highlights
the substantial economic burden associated with the treatment and management of related health
conditions and the potential for cost savings through effective interventions.
Existing policy interventions, such as taxation, marketing restrictions, and public education
campaigns, are assessed in the publication. The effectiveness of these measures is evaluated, and
recommendations for future strategies are provided. The study emphasizes the need for multi-
sectoral collaboration, involving government agencies, the beverage industry, civil society
organizations, and public health institutions, to develop and implement comprehensive approaches
to reduce sugary beverage consumption.
Other key recommendations include strengthening research and surveillance systems to monitor
trends and evaluate interventions, enhancing public awareness and health literacy through targeted
education campaigns, encouraging industry reformulation and responsible marketing practices,
and prioritizing health equity to ensure that interventions benefit all segments of the population.
By addressing these critical dimensions, this publication contributes valuable insights and
evidence-based recommendations to inform public health policies and interventions aimed at
reducing sugary beverage consumption and improving population health outcomes in Ghana. The
findings and recommendations presented in this study have important implications for
policymakers, public health professionals, and other stakeholders working to combat the growing
burden of non-communicable diseases in Ghana and beyond.
Keywords: sugary beverages, public health, Ghana, obesity, type 2 diabetes, cardiovascular
diseases, policy interventions, health equity, non-communicable diseases, socio-cultural factors
I. Introduction
Sugary beverage consumption has emerged as a significant global public health concern in recent
decades. According to a study by Singh et al. (2015), the global prevalence of obesity has more
than doubled since 1980, with sugary beverage consumption identified as a key contributor to this
trend. The World Health Organization (2015) has recognized the role of sugary beverages in the
global rise of obesity, type 2 diabetes, and other non-communicable diseases. A systematic review
by Malik et al. (2013) found a clear association between sugary beverage consumption and weight
gain, obesity, and related health conditions.
Ghana, like many other developing countries, has experienced a rapid increase in sugary beverage
consumption in recent years. A study by Aryeetey et al. (2017) found that 43% of Ghanaian adults
consume sugary beverages regularly, with higher consumption rates among younger age groups
and urban populations. The Ghana Demographic and Health Survey (2014) also reported a rising
prevalence of overweight and obesity among Ghanaian adults, particularly in urban areas.
Addressing sugary beverage consumption is crucial in Ghana to prevent a further rise in obesity
and related health conditions, which can strain the country's healthcare system and hinder
economic development (Peprah et al., 2019).

Objectives and scope

This paper aims to provide a comprehensive assessment of the impact of sugary beverage
consumption on public health in Ghana. The objectives are:
1. To investigate recent trends in sugary beverage consumption in Ghana across various
demographic groups and regions
2. To analyze the health impacts associated with high sugary beverage consumption in Ghana,
focusing on obesity, type 2 diabetes, cardiovascular diseases, and dental health issues
3. To explore the social and cultural factors influencing sugary beverage consumption in
Ghana, including marketing strategies, cultural norms, and perceptions of health and wellness
4. To examine the economic implications of sugary beverage consumption on individuals and
the healthcare system in Ghana
5. To assess existing policies and interventions aimed at reducing sugary beverage consumption
in Ghana and discuss potential strategies for mitigating the negative impacts
By addressing these objectives, this paper aims to contribute valuable insights and evidence-based
recommendations to inform public health policies and interventions targeting sugary beverage
consumption in Ghana.

II. Trends in Sugary Beverage Consumption in Ghana

Overall consumption patterns and trends
Recent studies have shown a significant increase in sugary beverage consumption in Ghana.
Aryeetey et al. (2017) found that 43% of Ghanaian adults consume sugary beverages regularly,
with an average consumption of 1.5 servings per day. This study also revealed that sugary beverage
consumption has been on the rise in Ghana, with a 17% increase in consumption between 2008
and 2014. Similarly, the Ghana Demographic and Health Survey (2014) reported that 28.6% of
Ghanaian adults consume sugary beverages at least once a week.

Consumption by demographic factors

1. Age: Sugary beverage consumption in Ghana varies by age group. Aryeetey et al. (2017)
found that younger adults (18-34 years) had the highest consumption rates, with 48%
consuming sugary beverages regularly, compared to 36% of older adults (35-59 years).
2. Gender: Gender differences in sugary beverage consumption have been observed in
Ghana. The Ghana Demographic and Health Survey (2014) reported that men (32.5%)
were more likely to consume sugary beverages than women (25.1%).
3. Socioeconomic status: Sugary beverage consumption in Ghana is associated with
socioeconomic status. Aryeetey et al. (2017) found that individuals with higher education
levels and higher household wealth were more likely to consume sugary beverages
regularly.

Urban vs. rural consumption patterns

Sugary beverage consumption in Ghana is higher in urban areas compared to rural areas. The
Ghana Demographic and Health Survey (2014) reported that 33.3% of urban adults consumed
sugary beverages at least once a week, compared to 23.3% of rural adults. Aryeetey et al. (2017)
also found that urban residents were more likely to consume sugary beverages regularly than their
rural counterparts.

Comparison with global and regional trends

Ghana's sugary beverage consumption patterns are consistent with global and regional trends. A
study by Singh et al. (2015) estimated that the global average per capita consumption of sugary
beverages was 0.58 servings per day in 2010, with higher consumption rates in upper-middle-
income and high-income countries. In sub-Saharan Africa, sugary beverage consumption has been
increasing rapidly, driven by urbanization, rising incomes, and changing dietary preferences
(Popkin & Hawkes, 2016). However, Ghana's consumption rates are still lower than those
observed in some high-income countries, such as the United States, where the average per capita
consumption of sugary beverages was 1.87 servings per day in 2010 (Singh et al., 2015).

III. Health Impacts of Sugary Beverage Consumption in Ghana

Obesity and overweight prevalence
The increasing consumption of sugary beverages in Ghana has been linked to the rising prevalence
of obesity and overweight. The Ghana Demographic and Health Survey (2014) reported that 25.4%
of Ghanaian adults were overweight or obese, with higher rates among women (30.9%) compared
to men (19.1%). A study by Aryeetey et al. (2017) found that regular consumption of sugary
beverages was significantly associated with higher odds of being overweight or obese among
Ghanaian adults (OR = 1.47; 95% CI: 1.19-1.81).

Type 2 diabetes
Sugary beverage consumption has been identified as a risk factor for type 2 diabetes. A meta-
analysis by Malik et al. (2010) found that individuals who consumed 1-2 servings of sugary
beverages per day had a 26% greater risk of developing type 2 diabetes compared to those who
consumed less than 1 serving per month. In Ghana, the prevalence of diabetes among adults has
been increasing, with an estimated prevalence of 6.3% in 2014 (International Diabetes Federation,
2015). Although specific data on the contribution of sugary beverage consumption to diabetes in
Ghana is limited, the increasing consumption of these beverages is likely to be a contributing
factor.

Cardiovascular diseases
Sugary beverage consumption has been associated with an increased risk of cardiovascular
diseases. A systematic review by Keller et al. (2020) found that higher intakes of sugary beverages
were associated with a greater risk of coronary heart disease, stroke, and heart failure. In Ghana,
cardiovascular diseases are a growing public health concern, with an estimated 18% of all deaths
attributed to these conditions in 2016 (World Health Organization, 2018). While specific data on
the contribution of sugary beverage consumption to cardiovascular diseases in Ghana is limited,
the increasing consumption of these beverages may be a contributing factor.

Dental health issues

High consumption of sugary beverages has been linked to dental health issues, such as tooth decay
and dental erosion. A study by Peprah et al. (2019) found that Ghanaian adults who consumed
sugary beverages regularly had a higher prevalence of dental caries compared to those who did not
consume these beverages (54.5% vs. 35.5%). The study also found that the frequency and amount
of sugary beverage consumption were significantly associated with the severity of dental caries.

Other related health conditions

Sugary beverage consumption has been associated with other health conditions, such as non-
alcoholic fatty liver disease (NAFLD) and certain types of cancer. A study by Abdelmagid et al.
(2020) found that higher intakes of sugary beverages were associated with a greater risk of
NAFLD. Additionally, a review by Makarem et al. (2018) suggested that sugary beverage
consumption may be associated with an increased risk of pancreatic, breast, and colorectal cancers.
While specific data on the prevalence of these conditions in relation to sugary beverage
consumption in Ghana is limited, the increasing consumption of these beverages may contribute
to the overall burden of these diseases.
IV. Social and Cultural Factors Influencing Consumption
Marketing strategies and their influence
Marketing strategies employed by sugary beverage companies have a significant influence on
consumption patterns in Ghana. A study by Bragg et al. (2017) found that sugary beverage
marketing in Ghana is pervasive, with 71.3% of outdoor advertising spaces featuring sugary
beverage advertisements. The study also revealed that sugary beverage marketing often targets
young people, with 60.7% of advertisements featuring themes of youth, fun, and happiness. These
marketing strategies have been shown to influence consumption behaviors, particularly among
children and adolescents (Cairns et al., 2013).

Cultural norms and perceptions of sugary beverages

Cultural norms and perceptions play a role in shaping sugary beverage consumption in Ghana. A
qualitative study by Amevinya et al. (2020) found that sugary beverages are often perceived as a
symbol of hospitality and are commonly offered to guests during social gatherings and
celebrations. The study also revealed that sugary beverages are sometimes used as a reward or treat
for children, reinforcing positive associations with these products. Additionally, the perception of
sugary beverages as a "modern" or "Western" product may contribute to their appeal, particularly
among younger generations (Green et al., 2020).

Health and wellness awareness among consumers

Health and wellness awareness among Ghanaian consumers can influence their sugary beverage
consumption habits. A study by Addo et al. (2020) found that Ghanaian adults with higher levels
of health and nutrition knowledge were more likely to consume fewer sugary beverages compared
to those with lower levels of knowledge. However, the study also noted that factors such as taste
preferences and social influences may override health considerations in some cases. Improving
health and wellness awareness through education and public health campaigns may help to reduce
sugary beverage consumption in Ghana (Kansra et al., 2021).

Role of media and advertising in shaping consumption patterns

Media and advertising play a significant role in shaping sugary beverage consumption patterns in
Ghana. A content analysis by Adjoian et al. (2019) found that Ghanaian television programming
featured a high volume of sugary beverage advertisements, with an average of 2.3 advertisements
per hour of programming. The study also noted that these advertisements often portrayed sugary
beverages in a positive light, associating them with happiness, success, and social connectedness.
Exposure to such advertising has been shown to influence consumption behaviors, particularly
among children and adolescents (Smith et al., 2019). Regulating sugary beverage advertising and
promoting media literacy may help to counter these influences and reduce consumption (Kansra
et al., 2021).
V. Economic Implications of Sugary Beverage Consumption
Healthcare costs associated with related health conditions
The healthcare costs associated with health conditions related to sugary beverage consumption in
Ghana are substantial. A study by Sarkodie et al. (2021) estimated that the direct healthcare costs
attributable to obesity and overweight in Ghana were approximately $119 million in 2017,
representing 6.2% of the country's total healthcare expenditure. The study also found that the
indirect costs, such as productivity losses, were even higher, reaching $217 million. As sugary
beverage consumption is a significant contributor to obesity and related health conditions, reducing
consumption could lead to significant cost savings for the healthcare system (Lal et al., 2017).

Productivity losses due to absenteeism and presenteeism

Productivity losses due to absenteeism and presenteeism related to sugary beverage consumption
and associated health conditions can have a significant impact on the Ghanaian economy. A study
by Agyemang et al. (2018) found that obesity and related non-communicable diseases (NCDs)
were associated with increased absenteeism and reduced productivity among Ghanaian workers.
The study estimated that the annual productivity losses due to obesity-related absenteeism were
approximately $46 million, while presenteeism losses were estimated at $37 million. Reducing
sugary beverage consumption could help mitigate these productivity losses by lowering the
prevalence of obesity and related health conditions (Lal et al., 2017).

Economic burden on individuals and households

The economic burden of sugary beverage consumption on individuals and households in Ghana
can be significant. A study by Yahya et al. (2020) found that Ghanaian households spend an
average of 7.2% of their monthly income on sugary beverages, with lower-income households
spending a higher proportion of their income compared to higher-income households. This
spending on sugary beverages can divert resources away from other essential needs, such as
healthy food, education, and healthcare. Additionally, the costs associated with treating obesity
and related health conditions can place a substantial financial burden on individuals and families
(Akomea-Frempong et al., 2021).

Impact on the national healthcare system and budget

The increasing prevalence of obesity and related health conditions associated with sugary
beverage consumption can strain Ghana's national healthcare system and budget. A study by
Kushitor et al. (2019) estimated that the direct healthcare costs of treating obesity and related
NCDs in Ghana could reach $1.2 billion by 2030, representing a significant burden on the country's
healthcare resources. The study also highlighted the potential for cost savings through
interventions aimed at reducing obesity prevalence, such as policies targeting sugary beverage
consumption. Implementing effective strategies to reduce sugary beverage consumption could
help alleviate the burden on the national healthcare system and budget (Lal et al., 2017).
VI. Policy Interventions and Initiatives
Taxation on sugary beverages
Taxation on sugary beverages has been proposed as a potential policy intervention to reduce
consumption and improve public health outcomes in Ghana. A modeling study by Lal et al. (2017)
found that implementing a 20% tax on sugary beverages in Ghana could lead to a 10.4% reduction
in consumption, resulting in a 1.2% decrease in obesity prevalence and a 0.8% decrease in type 2
diabetes incidence. The study also estimated that such a tax could generate annual revenue of $38.2
million, which could be used to fund health promotion initiatives. However, the feasibility and
acceptability of a sugary beverage tax in Ghana may be influenced by factors such as public
opinion, industry opposition, and political will (Jou & Techakehakij, 2012).

Marketing restrictions and regulations

Implementing marketing restrictions and regulations on sugary beverages can help reduce
consumption, particularly among children and adolescents. A systematic review by Chambers et
al. (2015) found that exposure to sugary beverage marketing was associated with increased
consumption among children. Ghana currently has limited regulations on the marketing of sugary
beverages, and a study by Bragg et al. (2017) found that sugary beverage marketing was prevalent
in outdoor advertising spaces. Implementing policies such as restricting sugary beverage
advertising during children's television programming, limiting the placement of advertisements
near schools, and regulating the content of advertisements could help reduce exposure and
consumption (WHO, 2012).

Public education and awareness campaigns

Public education and awareness campaigns can play a crucial role in reducing sugary beverage
consumption in Ghana. A study by Kansra et al. (2021) highlighted the importance of improving
health and nutrition knowledge to influence consumption behaviors. Implementing targeted
campaigns that educate the public about the health risks associated with sugary beverage
consumption and promote healthy beverage choices can help shift social norms and reduce
consumption. Such campaigns should be culturally appropriate, use multiple media channels, and
engage key stakeholders, such as healthcare providers, schools, and community organizations
(Wakefield et al., 2010).

Promotion of healthier beverage alternatives

Promoting healthier beverage alternatives can help reduce sugary beverage consumption in Ghana.
A study by Rampalli et al. (2021) found that increasing the availability and affordability of
healthier beverage options, such as water, unsweetened tea, and low-fat milk, can encourage
consumers to make healthier choices. Strategies to promote healthier alternatives include
improving access to safe drinking water, collaborating with the beverage industry to reformulate
products, and providing incentives for retailers to stock healthier options (WHO, 2015).
Additionally, implementing policies that limit the availability of sugary beverages in schools,
government institutions, and healthcare facilities can create environments that support healthier
beverage choices (CDC, 2018).

Evaluation of existing policies and their effectiveness

Evaluating the effectiveness of existing policies and interventions aimed at reducing sugary
beverage consumption in Ghana is essential for informing future policy decisions. While Ghana
has implemented some policies, such as the Ghana School Feeding Program, which provides
school meals with limited sugary beverages, there is limited research on the impact of these
policies on consumption patterns (Fernandes et al., 2016). Conducting rigorous evaluations of
existing policies, including their implementation, reach, and outcomes, can help identify strengths,
weaknesses, and areas for improvement. Sharing the findings of these evaluations with
policymakers, public health professionals, and other stakeholders can inform the development and
refinement of future interventions (WHO, 2017).

VII. Future Directions and Recommendations

Need for multi-sectoral collaboration (government, industry, civil society, public health
organizations)
Addressing the complex issue of sugary beverage consumption in Ghana requires multi-sectoral
collaboration among government agencies, the beverage industry, civil society organizations, and
public health institutions. A study by Jou et al. (2014) highlighted the importance of engaging
multiple stakeholders in the development and implementation of policies aimed at reducing sugary
beverage consumption. Collaboration can foster a shared understanding of the problem, facilitate
the exchange of knowledge and resources, and promote the development of comprehensive and
coherent strategies (WHO, 2018). For example, the government can work with the beverage
industry to promote product reformulation, while public health organizations can partner with civil
society to develop and disseminate educational campaigns.

Strengthening research and surveillance systems

Strengthening research and surveillance systems is crucial for monitoring trends in sugary
beverage consumption, evaluating the effectiveness of interventions, and informing policy
decisions in Ghana. A study by Aryeetey et al. (2016) emphasized the need for improved data
collection and analysis to better understand the drivers and consequences of sugary beverage
consumption in the Ghanaian context. Establishing robust surveillance systems can help track
changes in consumption patterns, monitor the prevalence of related health conditions, and assess
the impact of policies and programs (WHO, 2017). Collaboration between research institutions,
government agencies, and international organizations can support the development of standardized
methodologies and the sharing of best practices.
Enhancing public awareness and health literacy
Enhancing public awareness and health literacy is essential for empowering individuals to make
informed choices about their sugary beverage consumption. A study by Kansra et al. (2021)
highlighted the role of health literacy in shaping consumption behaviors and the need for targeted
educational interventions. Strategies to improve public awareness and health literacy include
developing culturally appropriate educational materials, integrating nutrition education into school
curricula, and leveraging social media and other communication channels to disseminate
information (WHO, 2016). Collaborating with trusted community leaders, healthcare providers,
and media outlets can help amplify messaging and reach diverse audiences.

Encouraging industry reformulation and responsible marketing practices

Encouraging the beverage industry to reformulate products and adopt responsible marketing
practices can contribute to reducing sugary beverage consumption in Ghana. A study by Kleiman
et al. (2012) found that product reformulation, such as reducing sugar content and portion sizes,
can be an effective strategy for reducing consumption. Engaging with the industry to establish
voluntary or mandatory reformulation targets, providing incentives for the development of
healthier products, and implementing clear labeling regulations can support these efforts (WHO,
2015). Additionally, promoting responsible marketing practices, such as restricting the marketing
of sugary beverages to children and regulating the use of health claims, can help create a more
supportive environment for healthy choices (Hawkes et al., 2015).

Prioritizing health equity and addressing disparities in consumption and health outcomes
Prioritizing health equity and addressing disparities in sugary beverage consumption and related
health outcomes is crucial for ensuring that interventions benefit all segments of the Ghanaian
population. A study by Yahya et al. (2020) found that lower-income households in Ghana spend a
disproportionate amount of their income on sugary beverages, highlighting the need for targeted
interventions. Strategies to promote health equity include ensuring that educational campaigns and
interventions reach marginalized communities, addressing the social and economic determinants
of health that influence consumption patterns, and involving communities in the design and
implementation of interventions (WHO, 2013). Monitoring and evaluating the impact of policies
and programs on different socioeconomic and demographic groups can help identify and address
disparities in consumption and health outcomes.

VIII. Conclusion
This publication has provided a comprehensive assessment of the impact of sugary beverage
consumption on public health in Ghana. Key findings include the increasing trend in consumption,
particularly among younger age groups and urban populations; and the significant associations
between sugary beverage consumption and obesity, type 2 diabetes, cardiovascular diseases, and
dental health issues. The social and cultural factors influencing consumption, such as marketing
strategies, cultural norms, and health awareness as well as the economic implications on healthcare
costs, productivity losses, and individual and household budgets have been highlighted. The
publication has also examined existing policy interventions and initiatives, including taxation,
marketing restrictions, public education campaigns, and the promotion of healthier alternatives.

Call to action for stakeholders to prioritize reducing sugary beverage consumption

The findings of this publication underscore the urgent need for stakeholders in Ghana, including
government agencies, the beverage industry, civil society organizations, and public health
institutions, to prioritize reducing sugary beverage consumption. Collaborative efforts are required
to develop and implement comprehensive strategies that address the multifaceted nature of this
public health challenge. Policymakers should consider the adoption of evidence-based
interventions, such as taxation, marketing regulations, and public education campaigns, while also
ensuring that these interventions are equitable and reach all segments of the population. The
beverage industry should be encouraged to reformulate products, reduce portion sizes, and adopt
responsible marketing practices. Researchers and public health professionals should continue to
monitor trends, evaluate interventions, and share best practices to inform policy decisions and
improve population health outcomes.

Potential impact of addressing sugary beverage consumption on population health and well-
being in Ghana
Addressing sugary beverage consumption in Ghana has the potential to yield significant
improvements in population health and well-being. Reducing consumption can contribute to lower
rates of obesity, type 2 diabetes, cardiovascular diseases, and dental caries, thereby alleviating the
burden on the healthcare system and improving quality of life for individuals and families.
Moreover, decreasing sugary beverage consumption can lead to economic benefits, such as
reduced healthcare costs, increased productivity, and improved household financial stability. By
prioritizing health equity and addressing disparities in consumption and health outcomes,
interventions can help ensure that all Ghanaians have the opportunity to lead healthier lives.
Ultimately, the successful implementation of evidence-based policies and interventions to reduce
sugary beverage consumption in Ghana can contribute to the achievement of the Sustainable
Development Goals, particularly those related to health, well-being, and economic growth .
References
Abdelmagid, S. A., Jew, S., Driedger, M. R., & Weiler, H. A. (2020). Sugar-sweetened beverage
consumption and non-alcoholic fatty liver disease: A systematic review and meta-analysis.
Nutrients, 12(10), 3180.
Addo, P. K., Amankwaa, G., Gyasi, R. M., Koduah, A. O., & Abrahams, C. (2020). Factors
influencing the consumption of sugar-sweetened beverages among Ghanaian adults: A qualitative
study. PLoS One, 15(7), e0235284.
Adjoian, T., Dannefer, R., Willingham, C., Brathwaite, C., & Franklin, S. (2019). Healthy
checkout lines: A study of the content of food and beverage advertisements in Ghanaian
supermarkets. International Journal of Environmental Research and Public Health, 16(18), 3257.
Agyemang, C., Nyaaba, G., Beune, E., Meeks, K., Owusu-Dabo, E., Addo, J., ... & Stronks, K.
(2018). Variations in hypertension awareness, treatment, and control among Ghanaian migrants
living in Amsterdam, Berlin, London, and nonmigrant Ghanaians living in rural and urban Ghana–
the RODAM study. Journal of Hypertension, 36(1), 169-177.
Akomea-Frempong, S., Akomea-Frempong, N. K., Osei-Yeboah, J., & Owusu-Dabo, E. (2021).
Out-of-pocket expenditure on obesity among households in Ghana. BMC Public Health, 21(1), 1-
11.
Amevinya, G. S., Quarpong, W., & Laar, A. (2020). Commercial food advertising on the campus
of Ghana's largest university. BMC Public Health, 20(1), 1-11.
Aryeetey, R., Lartey, A., Marquis, G. S., Nti, H., Colecraft, E., & Brown, P. (2016). Prevalence
and predictors of overweight and obesity among Ghanaian adults. BMC Obesity, 3(1), 1-8.
Aryeetey, R., Lartey, A., Marquis, G. S., Nti, H., Colecraft, E., & Brown, P. (2017). Prevalence
and predictors of overweight and obesity among Ghanaian adults. BMC Obesity, 4(1), 38.
Bragg, M. A., Hardoby, T., Pandit, N. G., Raji, Y. R., & Ogedegbe, G. (2017). A content analysis
of outdoor non-alcoholic beverage advertisements in Ghana. BMJ Open, 7(5), e012313.
Cairns, G., Angus, K., Hastings, G., & Caraher, M. (2013). Systematic reviews of the evidence on
the nature, extent and effects of food marketing to children. A retrospective summary. Appetite,
62, 209-215.
CDC. (2018). Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to
Strategies to Increase the Consumption of Fruits and Vegetables. Atlanta: U.S. Department of
Health and Human Services.
Chambers, S. A., Freeman, R., Anderson, A. S., & MacGillivray, S. (2015). Reducing the volume,
exposure and negative impacts of advertising for foods high in fat, sugar and salt to children: A
systematic review of the evidence from statutory and self-regulatory actions and educational
measures. Preventive Medicine, 75, 32-43.
Fernandes, M., Folson, G., Aurino, E., & Gelli, A. (2016). A free lunch or a walk back home? The
school food environment and dietary behaviours among children and adolescents in Ghana. Food
Security, 1-16.
Ghana Demographic and Health Survey. (2014). Ghana Statistical Service, Ghana Health Service,
and ICF International. Accra, Ghana.
Green, M. A., Pradeilles, R., Laar, A., Osei-Kwasi, H., Bricas, N., Coleman, N., ... & Holdsworth,
M. (2020). Investigating foods and beverages sold and advertised in deprived urban
neighbourhoods in Ghana and Kenya: a cross-sectional study. BMJ Open, 10(6), e035680.
Hawkes, C., Smith, T. G., Jewell, J., Wardle, J., Hammond, R. A., Friel, S., ... & Kain, J. (2015).
Smart food policies for obesity prevention. The Lancet, 385(9985), 2410-2421.
International Diabetes Federation. (2015). IDF Diabetes Atlas, 7th edition. Brussels, Belgium:
International Diabetes Federation.
Jou, J., & Techakehakij, W. (2012). International application of sugar-sweetened beverage (SSB)
taxation in obesity reduction: Factors that may influence policy effectiveness in country-specific
contexts. Health Policy, 107(1), 83-90.
Jou, J., Niederdeppe, J., Barry, C. L., & Gollust, S. E. (2014). Strategic messaging to promote
taxation of sugar-sweetened beverages: lessons from recent political campaigns. American Journal
of Public Health, 104(5), 847-853.
Kansra, P., Negi, T., Bhaskar, S., & Mehra, S. (2021). Sugar-sweetened beverages: Factors
affecting consumption pattern and strategies to promote healthy choices. Journal of Family
Medicine and Primary Care, 10(6), 2180.
Keller, A., Heitmann, B. L., & Olsen, N. (2020). Sugar-sweetened beverages, vascular risk factors
and events: a systematic literature review. Public Health Nutrition, 23(10), 1802-1815.
Kleiman, S., Ng, S. W., & Popkin, B. (2012). Drinking to our health: can beverage companies cut
calories while maintaining profits?. Obesity Reviews, 13(3), 258-274.
Kushitor, M. K., Boatemaa, S., & Agyemang, C. (2019). Forecasting the prevalence and costs of
obesity in Ghana by 2030. Value in Health, 22, S200.
Lal, A., Mantilla-Herrera, A. M., Veerman, L., Backholer, K., Sacks, G., Moodie, M., ... & Peeters,
A. (2017). Modelled health benefits of a sugar-sweetened beverage tax across different
socioeconomic groups in Australia: A cost-effectiveness and equity analysis. PLoS Medicine,
14(6), e1002326.
Makarem, N., Bandera, E. V., Nicholson, J. M., & Parekh, N. (2018). Consumption of sugars,
sugary foods, and sugary beverages in relation to cancer risk: a systematic review of longitudinal
studies. Annual Review of Nutrition, 38, 17-39.
Malik, V. S., Pan, A., Willett, W. C., & Hu, F. B. (2013). Sugar-sweetened beverages and weight
gain in children and adults: a systematic review and meta-analysis. The American Journal of
Clinical Nutrition, 98(4), 1084-1102.
Malik, V. S., Popkin, B. M., Bray, G. A., Després, J. P., Willett, W. C., & Hu, F. B. (2010). Sugar-
sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis.
Diabetes Care, 33(11), 2477-2483.
Peprah, P., Amoah, J., & Akongbangre, J. (2019). Sugar-sweetened beverage consumption among
Ghanaian adults: does place of residence matter? Journal of Health, Population and Nutrition,
38(1), 19.
Popkin, B. M., & Hawkes, C. (2016). Sweetening of the global diet, particularly beverages:
patterns, trends, and policy responses. The Lancet Diabetes & Endocrinology, 4(2), 174-186.
Rampalli, K. K., Siddiqui, F., & Gupta, M. (2021). Promoting healthy beverage choices: A review
of the evidence. Current Nutrition Reports, 10(1), 8-18.
Sarkodie, N. A., Agyei-Mensah, S., Anarfi, J. K., & Boateng, S. K. (2021). The direct and indirect
cost of obesity among urban population in Ghana: A prevalence-based approach. PLoS One, 16(8),
e0256045.
Singh, G. M., Micha, R., Khatibzadeh, S., Lim, S., Ezzati, M., & Mozaffarian, D. (2015).
Estimated global, regional, and national disease burdens related to sugar-sweetened beverage
consumption in 2010. Circulation, 132(8), 639-666.
Smith, R., Kelly, B., Yeatman, H., & Boyland, E. (2019). Food marketing influences children's
attitudes, preferences and consumption: A systematic critical review. Nutrients, 11(4), 875.
United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development.
United Nations, Department of Economic and Social Affairs.
Wakefield, M. A., Loken, B., & Hornik, R. C. (2010). Use of mass media campaigns to change
health behaviour. The Lancet, 376(9748), 1261-1271.
WHO. (2012). A framework for implementing the set of recommendations on the marketing of
foods and non-alcoholic beverages to children.
WHO. (2013). Handbook on health inequality monitoring: with a special focus on low-and middle-
income countries. World Health Organization.
WHO. (2015). Guideline: sugars intake for adults and children. World Health Organization.
WHO. (2016). Report of the commission on ending childhood obesity. World Health Organization.
WHO. (2017). 'Best buys' and other recommended interventions for the prevention and control of
noncommunicable diseases. World Health Organization.
WHO. (2018). Time to deliver: report of the WHO Independent High-Level Commission on
Noncommunicable Diseases. World Health Organization.
World Health Organization. (2018). Noncommunicable diseases country profiles 2018. Geneva,
Switzerland: World Health Organization.
Yahya, F., Zafar, R., & Shafie, A. A. (2020). Trend, affordability, and socioeconomic inequalities
of sugary drink consumption in Ghana: Implications for public health. SSM-Population Health,
11, 100601.