Availability of healthy and unhealthy foods in modern retail outlets located in selected districts of Greater Accra region, Ghana

Background and objective: Availability of unhealthy (nutritionally poor) foods can influence preference, purchasing and consumption of such foods. This study determined the healthiness of foods sold at modern retail outlets- supermarkets and mini-marts in the Greater Accra Region of Ghana. Methods: All modern retail outlets located in six districts of Greater Accra were eligible. Permanent structured outlets with floor area 225kcal/100 g were classified as unhealthy. The ratio of the area occupied by unhealthy to healthy foods was used to determine the healthiness of modern retail outlets. Results: Of 67 retail outlets assessed, 86.6% were mini-marts. 85.0% of the total shelf area was occupied by foods categorized as unhealthy. Refined grains/grain products were the most available, occupying 30.0% of the total food shelf space, followed by sugar-sweetened beverages (20.1% of total shelf space). The least available food group–unprocessed staples, and occupied 0.1% of the total food shelf space. About two-thirds of food products available (n =3952) were ultra-processed. Across retail outlets, the ratio of ultra-processed-to-unprocessed foods ranged from 3 to 7 with an average (SD) of 5(2). Thus, for every healthy food, there were five ultra-processed ones in the studied retail outlets. Conclusion: This study reveals widespread availability of ultra-processed foods in modern retail outlets within the selected districts. Towards a healthier food retail environment, public health and food regulators, in partnership with other stakeholders need to institute measures that improve availability of healthy foods within supermarkets and mini-marts.