Assessing the implementation of public policies aimed at addressing the double burden of nutrition in Burundi: perspectives and recommendations.
Non-communicable diseases (NCDs) are the leading cause of premature mortality in Africa, with Burundi facing a growing double burden of malnutrition effects: undernutrition and rising obesity rates. Despite recent policy efforts, including national strategies and increased health spending, the country's health system remains under-resourced and vulnerable to nutrition-related health challenges.
This study aimed to assess the extent of implementation of public policies aimed at creating healthy food environments in Burundi using the Food Environment Policy Index (Food-EPI), and to identify policy gaps and priorities for addressing the double burden of malnutrition.
From December 2022 to February 2024, the Healthy Food Environment Policy Index (Food-EPI) tool was used to benchmark 56 policy and infrastructure indicators against Good Practice Statements. Documentation was reviewed, and evidence was validated by a panel of 24 experts from government, academia, and civil society through two workshops. Experts scored the level of policy implementation using a five-point Likert scale and prioritized future actions based on importance, achievability, and effectiveness.
Of the 56 indicators assessed, 27% were rated as "very little or no implementation" and 37% as "low implementation." Only 13% were rated as "high." Infrastructure support indicators generally scored higher than policy components. Thirteen indicators were not addressed in any existing policy documents. Experts identified 13 priority actions, seven of which aligned with WHO "double-duty actions." Inter-rater reliability was moderate (Gwet AC2 = 0.46).
Significant policy gaps remain in Burundi's approach to improving food environments. There is an urgent need for comprehensive, multisectoral strategies to strengthen public health nutrition and reduce the impact of diet-related NCDs.
This study aimed to assess the extent of implementation of public policies aimed at creating healthy food environments in Burundi using the Food Environment Policy Index (Food-EPI), and to identify policy gaps and priorities for addressing the double burden of malnutrition.
From December 2022 to February 2024, the Healthy Food Environment Policy Index (Food-EPI) tool was used to benchmark 56 policy and infrastructure indicators against Good Practice Statements. Documentation was reviewed, and evidence was validated by a panel of 24 experts from government, academia, and civil society through two workshops. Experts scored the level of policy implementation using a five-point Likert scale and prioritized future actions based on importance, achievability, and effectiveness.
Of the 56 indicators assessed, 27% were rated as "very little or no implementation" and 37% as "low implementation." Only 13% were rated as "high." Infrastructure support indicators generally scored higher than policy components. Thirteen indicators were not addressed in any existing policy documents. Experts identified 13 priority actions, seven of which aligned with WHO "double-duty actions." Inter-rater reliability was moderate (Gwet AC2 = 0.46).
Significant policy gaps remain in Burundi's approach to improving food environments. There is an urgent need for comprehensive, multisectoral strategies to strengthen public health nutrition and reduce the impact of diet-related NCDs.