Impact of ultra-processed foods on type 2 diabetes and associated economic burden in african countries

This thesis examines the role of food environments in shaping dietary behaviours, type 2 diabetes (T2D) outcomes, and the associated economic burden in Kenya and selected African countries. Using a multi-method and multi-country research design, the study investigates the availability and marketing of ultra-processed foods (UPFs) and their implications for population health and health system costs in low- and middle-income country settings. Part I assesses food environments in Kenya across modern retail outlets, school neighbourhoods, and broadcast media. Using standardized INFORMAS methodologies, the findings demonstrate widespread availability and pervasive marketing of UPFs, with greater exposure in urban and lower socioeconomic settings. Marketing strategies frequently targeted children and adolescents and were associated with increased brand recognition, food preferences, and consumption behaviours, contributing to obesogenic food environments. Part II examines the relationship between UPF consumption and diabetes outcomes using ecological time-series analyses across nine African countries between 2010 and 2024. The analyses reveal a consistent positive association between rising per capita sugar-sweetened beverage sales and increasing national T2D prevalence, providing region-specific evidence that food system driven dietary transitions are contributing to the growing diabetes burden in Africa. Part III quantifies the economic burden of T2D on patients and public healthcare systems in Kenya and Tanzania. The findings show substantial out-of-pocket expenditures for households and significant costs to health systems, largely driven by outpatient care and the management of diabetes-related complications, with additional vulnerabilities observed during the COVID-19 pandemic. Overall, this thesis emphasizes upstream prevention addressing structural and commercial food environment determinants regionally.