Section 1 Introduction

1.1 Country Context: The Gambia

Population and demographics

The Gambia is a small West African nation with an estimated population of 2.7 million. Its economy is predominantly agrarian, driven by crop production, livestock rearing, and fishing (Government of The Gambia, 2021a). Over 60% of the population is under the age of 25. While predominantly rural, rapid urbanisation has taken place since 1960, when only 12.13% of the total population lived in urban areas, compared to 64.47% in 2023 (The Global Economy, 2024).

The country experiences a high dependency ratio of 202 dependents per 100 working individuals, which strains food access and household nutrition (Government of The Gambia, 2021b). A diverse ethnic makeup exists in the country, including groups such as the Mandinka, Fula, Wolof, and Jola, with distinct cultural practices that influence food consumption and nutritional habits (GBoS and ICF, 2021).

Key health and malnutrition statistics

• Infant and young child feeding: Only 16.5% of children aged 6 to 23 months meet minimum dietary standards, and the diets of children often lack diversity across all geographical regions (WFP and Government of The Gambia, 2023).

• Child undernutrition: 18% of children under five are stunted; 5% wasted; and 12% underweight (Gambia—Demographic and Health Survey 2019-2020).

• Micronutrient deficiencies: 72% of under-fives and 50% of women of reproductive age suffer from anaemia; 18.3% of children are vitamin A deficient, leading to impaired immune function and increased risk of childhood blindness (GBoS and ICF, 2021).

• Obesity and NCDs: 32.6% of urban women over the age of 35 are obese (van der Sande et al., 2001), and the prevalence of hypertension and diabetes is increasing due to the impact of dietary changes and sedentary lifestyle.

• Hypertension: According to a national WHO STEPS survey, one in three Gambian adults aged 25–64 years is hypertensive, with 86% of hypertensive men and 71% of hypertensive women unaware of their condition (Cham et al., 2018). Hypertension was more prevalent in rural and semi-urban areas, with rural men having 3.2 times and women 2.5 times the odds of hypertension compared to urban counterparts.

Food systems and climate vulnerability

Environmental factors, including climate change, desertification, and erratic rainfall, negatively impact agricultural production. The Gambia's agriculture is largely rain fed, making it highly vulnerable to climate variability and extreme weather events (Carr et al., 2024). This vulnerability significantly affects rural households who depend on agriculture for subsistence and income, leading to cyclical food insecurity and undernutrition (IIASA, 2023; WFP and Government of The Gambia, 2023). Climate-driven disruptions in local food production reduce access to diverse, nutrient-rich foods, particularly in rural areas (Carr et al., 2024), forcing many households to rely on calorie-dense but nutrient-poor imported staples and processed foods (Ali et al, 2023). Over 80% of rice (the country’s staple food), is imported, increasing the risk of supply shocks and food price volatility (Carr et al., 2024). Rural food insecurity affects more than half of households, while 29% of all Gambian households lack regular access to sufficient and nutritious food (WFP and Government of The Gambia, 2023).

Current nutritional landscape and dietary habits

Despite a sufficient national energy supply, the quality and diversity of the Gambian diet remains poor. The typical diet is low in fruits and vegetables and high in refined carbohydrates, sugars, and oils (Ali et al., 2023). Traditional staples such as rice, millet, sorghum, cassava, and groundnuts remain central to the Gambian diet, with common dishes including benachin (Jollof rice), domoda (peanut stew), ebbeh (chunky tuber and seafood soup), and millet or sorghum porridges. However, rapid urbanisation and decreased domestic production has led to increased consumption of processed and imported foods, such as refined grains, sugary snacks, and cooking oils, contributing to a shift away from traditional dietary patterns (Ali et al., 2023). This contributes to a double burden of malnutrition, with persisting undernutrition among vulnerable groups coexisting with rising rates of overweight and obesity, as well as micronutrient deficiencies, especially in urban areas (Cham et al., 2020; Kiosia et al., 2024). These changes have contributed to a growing burden of nutrition-related non communicable diseases as noted by Bosu (2014). According to Jobe et al. (2023), implementing policies to reduce sodium and ultra-processed food consumption is urgently needed to improve NCD outcomes in The Gambia. Their recent nationwide survey found that awareness, treatment, and control of hypertension remain critically low among middle-aged and older Gambians, highlighting significant gaps in screening and care across the health system (Jobe et al., 2023).

Socioeconomic and cultural factors affecting nutrition

Nutrition in The Gambia is deeply influenced by complex socioeconomic and cultural factors. Poverty remains widespread, particularly in rural areas, limiting access to adequate, diverse and nutrient-rich foods. Cultural taboos and beliefs influence dietary choices; for instance, certain foods may be reserved for specific groups (eggs and milk for children and women, and organ meats like liver restricted for men since considered to have spiritual association) or avoided by others due to traditional beliefs (fish is believed to cause worms or speech delays in children and eating eggs in pregnancy is thought to make the baby mute or stuttering) (Perez and Garcia, 2013). In addition, gender dynamics influence food distribution within households, often leaving women and children with less food (Chesson et al., 2023; Janha et al., 2020).

Thus, the interplay between climate vulnerability, socioeconomic and cultural factors, and the national food system contributes not only to food insecurity but also to inadequate diet quality, with significant public health implications.

Sustainability and food sovereignty

Promoting sustainable agricultural practices and encouraging the consumption of locally grown, nutrient-dense foods can improve food security, support livelihoods, and reduce dependency on imports. Addressing post-harvest food losses aggravated by limited local processing infrastructure is also critical. Perishable crops such as mango, tomato, and cashew apple often go to waste during peak seasons due to inadequate storage, transportation, and value addition facilities (Carr et al., 2024). Investing in processing and preservation can reduce these losses and enhance income opportunities for smallholder farmers.

Strengthening local food systems through climate-smart agriculture, increased access to fertilizers, and the use of drought-resistant crop varieties is essential for building resilience to climate change (FACE Africa, 2023). The EAT-Lancet Commission recommends a "planetary health diet" that requires increased consumption of fruits, vegetables, whole grains, legumes, and nuts, while reducing the intake of red meat, sugar, and refined grains (EAT-Lancet Commission, 2019). Promoting such sustainable diets not only supports environmental sustainability but also enhances public health outcomes (Alliance Bioversity CIAT, 2022; IIASA, 2023). It is timely that the Food and Agriculture Organization (FAO) is developing Food-Based Dietary Guidelines (FBDG) for The Gambia in collaboration with various national organisations such as the National Nutrition Agency and The MRC Unit The Gambia at LSHTM, to promote healthier dietary patterns and tackle the nutritional challenges arising from the country's ongoing dietary shifts (FAO, 2024). This knowledge exchange project complements the efforts of the above global and local organisations by identifying priority areas to address in order to reduce the double burden of malnutrition and promote food sustainability in the Gambia.

This KE project also aligns with multiple Sustainable Development Goals (SDGs - a collection of 17 interlinked global goals designed to be a "blueprint for peace and prosperity for people and the planet" (United Nations, 2025), including SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), SDG 12 (Responsible Consumption and Production), SDG 13 (Climate Action), and SDG 17 (Partnership for the goals) by encouraging climate-resilient agriculture, minimising food waste, and promoting equitable access to nutritious, culturally appropriate foods (FAO, 2024). Emphasising sustainable dietary practices can further mitigate environmental challenges like land degradation, water scarcity, and climate-related disruptions, all of which undermine food security and nutrition.

1.2 Key themes and priorities identified in stakeholder meetings

The stakeholder consultations identified several key themes and priority areas critical to the development of a Sustainable Nutrition Strategy for The Gambia.

• Food and nutrition policy development: Participants stressed the need to establish national dietary guidelines to address the double burden of undernutrition and rising obesity. The development of national FBDG and food composition tables aligned with local food systems was seen as a critical step.

• Indigenous food systems and sustainability: Local crops such as millet, sorghum and baobab were recognised for their nutritional and ecological value. The commercialisation of baobab is currently being explored through partnerships with academic institutions in Rotterdam and other local cooperatives (e.g. Oolu Ltd). The stakeholders emphasised the need to encourage local food product development using the above-mentioned underutilised and traditional crops.

• Nutrition education and capacity building: Proposals emphasised the need to integrate nutrition education into school curriculum, as part of university degrees and public health campaigns. The University of The Gambia (UTG) also aims to develop their newly established Centre for Nutrition and Food Technology to support long-term research and professional training in the field. The need to analyse the nutritional composition of foods and provide evidence-based information on their health effects to the public were among the priority areas identified.

• School feeding and early childhood nutrition: Recommendations included strengthening the World Food Programme’s Home -Grown School Feeding (HGSF) initiative by sourcing more food from local farmers and improving the nutritional quality of meals. There is also an urgent need for targeted interventions focused on adolescent nutrition and improved weaning practices.

• Public engagement and behaviour change: Effective strategies were proposed, such as community-based nutrition education and the application of behavioural science to promote healthier eating habits. Empowering the public to recognise appropriate life stage-specific portion sizes and effectively incorporate diverse food groups in their daily diet is key to promoting public health in The Gambia.

• Food system resilience and policy innovation: Stakeholders recommended intersectoral policies linking agriculture, education, and health to build a more resilient and sustainable food system.

1.3 The foundation of a healthy and sustainable diet

The foundation of a healthy and sustainable diet is created by balancing considerations for human health and planetary health. In most countries, this is set by developing national FBDG that provide guidance to the public regarding consumption of different food groups in terms of quantity and quality (FAO, 2025a). Since the FAO definition of ‘food sustainability’ came into existence, several countries have incorporated planetary health also into FBDG (FAO, 2025b). Considering the ongoing development of the Gambia’s FBDG, it is pertinent to focus this report on the main food groups that form the basis of a healthy sustainable diet while simultaneously integrating the key themes and recommendations identified in this project.

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