Low-calorie Sweeteners in the Era of Sugar Taxation in Africa: Public Health Opportunities and Policy Dilemmas

The introduction of sugar taxes in Africa, beginning with South Africa’s 2018 Health Promotion Levy and followed by similar fiscal measures in countries such as Ghana and Nigeria, has intensified policy debates on the role of low-calorie sweeteners (LCS). These fiscal interventions were designed to curb rapidly increasing rates of obesity, diabetes and other non-communicable diseases (NCDs), yet they have also triggered a swift shift toward LCS use as substitutes for sugar. This dual effect illustrates both progress in health-oriented policy and emerging challenges surrounding long-term health effects, regulatory coherence, and consumer equity. Artificial sweeteners such as aspartame and sucralose, together with natural alternatives including Stevia rebaudiana, Thaumatococcus daniellii and Pentadiplandra brazzeana, offer potential advantages in weight and glycemic control. However, evidence remains divided: while short-term randomized trials demonstrate benefits for energy balance and glucose regulation, long-term observational studies report inconsistent or adverse associations with metabolic and cardiovascular risk. Reflecting this uncertainty, the World Health Organization (WHO) in 2023 advised against the use of non-sugar sweeteners for weight management, creating tension between global recommendations and Africa’s urgent need for cost-effective dietary interventions. Beyond the health dimension, Africa’s sweetener policy landscape reveals underexplored agricultural, economic and governance opportunities. Indigenous sweeteners such as thaumatin and brazzein represent potential sources of regional innovation and trade diversification, yet investment, processing infrastructure, and regulatory alignment remain limited. This review synthesizes scientific, economic, and policy evidence on LCS in Africa to clarify how fiscal and regulatory instruments can support sustainable sugar reduction. It identifies key governance gaps uneven regulation, weak consumer awareness, and affordability barriers and proposes three strategic priorities: harmonized regional frameworks to ensure regulatory consistency, targeted investment in indigenous sweetener production, and equitable access to safe, affordable alternatives. By integrating global evidence with Africa’s contextual realities, this review offers a balanced framework for advancing public health while fostering inclusive economic development. Key words: Low-calorie sweeteners, Sugar tax, Stevia rebaudiana, Thaumatococcus daniellii, Pentadiplandra brazzeana, Africa, Nutrition transition