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Food insecurity: implications for health in Uganda

Martina talks about the NOURISH project. This project explores why food security, climate change, and healthcare are interlinked.
We have discussed the importance of food as the foundation for good health. Ensuring good nutrition requires a mindset of thinking about health systemically. Let’s look at nutrition from a systems perspective. Good nutrition relies on the environment, because that’s how we grow our food. It requires food security. That means knowing with certainty where the next meal is coming from. And when we think about food security, we need to consider the availability of food, our access to that supply, our utilisation of food, and the sustainability of our food supply. Will what we have now, after the harvest, be enough to see us through the planting, or the lean season?
This approach requires us to think about the whole food supply chain and its impact on our health and on our lives. Researchers in Medicine, Natural Sciences, Economics, and Public Health from Trinity College Dublin in Ireland, along with our partners in Uganda, have been collaborating since 2012 on the NOURISH project, which is funded by Irish Aid. This project takes a cross-disciplinary approach to examining food security nutrition and HIV treatment outcomes in Uganda. We have done several studies that will help us to understand how these factors interact to impact on the lives of Ugandans living in both rural and urban communities, and how do these factors challenge SDG3 Health? Like many African countries, Uganda is changing rapidly.
Although a third of the population live on less than $1.90 cents per day, still for many, income has improved. Life expectancy at birth has increased. And the Human Development Index, which is a global measure of progress, has increased substantially over the last decade. Nonetheless, some areas of Uganda, particularly the northern part, which over the last number of years has suffered from climate variability and increasing temperatures, remains very vulnerable to poverty and food insecurity. In that area, there are many ethnic groups and different lifestyles, including farming and pastoralism, or herding of cattle and goats.
To understand more about the links between food security, nutrition, and health in this part of Uganda, NOURISH researchers from Gulu University, Trinity College Dublin, and the National University of Singapore carried out a household survey of almost a thousand households in the Karimoja region. They asked questions about the food intake and health of women and children living in the household. The researchers visited the households at two time points to understand the impact of climate variability on that household’s food intake and nutritional status and to see how communities cope with change. In Karimoja, 20% of households were food insecure and a further 38% moderately food insecure in 2012.
This means that over half a million people did not have reliable access to a sufficient quantity of affordable nutritious food. Our researchers wanted to understand their experience in greater detail to help the government and NGOs to plan programmes that would tackle hunger. We looked at the experience of women in four different districts in Karimoja and found that the percentage of women getting their recommended daily allowance of calories was very low during the first visit in October to December 2014. For example, only 17% of women in one district, Kaabong, were getting their recommended daily allowance of calories.
When the researchers returned to the households during April to June 2015, they found that there were significant differences in calorie intake between these two seasons in three out of four districts, Kaabong, Moroto, and Amudat. This meant that the different communities, even while living in close proximity to each other, had different abilities to increase calorie intake, depending on the season. In Kaabong, for example, women were more able to increase calorie intake across the seasons. Women were really relying on the change in season to help them access more food. During the times researchers visited Karimoja, the harvest season, which would normally occur in the autumn, was delayed by a few months due to variable rainfall and as a result of climate change.
So the first research visit occurred during a time of scarcity. This was unexpected. This explains why calorie intake was so low among some districts at that time. Although the harvest was expected, it was delayed, and that led to a shortage of food. This pattern of drought and scarcity has been seen over several years now in Karimoja. And it’s leading researchers to believe that climate change is severely affecting the area. Since households depend on the harvest season to secure sufficient food, we can see the changes in climate cause real problems for food and calorie intake for nutritional status, and therefore for the overall health of communities.
Organisations such as the Famine Early Warning Systems network, map food insecurity globally, including in countries like Uganda. And this is very useful for governments and NGOs to have access to detailed data when they are planning to help people suffering from food insecurity and hunger. As well as changes to climate, other socioeconomic factors impact the experience in health of women living in Karimoja. The region has a very low level of education. In some districts, fewer than 10% of women have attended primary school. And this must be taken into account when governments and NGOs are considering how to tackle malnutrition. For example, written materials conveying the importance of a balanced diet will not be helpful to groups that cannot read.
Local cultural beliefs and practises also influence health. In Karimoja, NOURISH researchers found evidence that some cultural beliefs may disadvantage women. For example, the belief that eating certain animal products is associated with miscarriage or illness in the child. This means that women will not eat these foods. And this can contribute to low protein intake and associated health problems, such as anaemia. Other local practises are protective of health. For example, some local communities are good at adapting to times of scarcity by making the best use of wild foods, such as berries and other plants that grow locally to prevent hunger and sustain themselves. Some of these beneficial practises should be protected. Some practises are influenced by the external environment.
For example, sorghum, which is used in the alcohol brewing industry, can be grown in this area in preference to more nutritious crops. While this brings some economic growth, at times of scarcity, communities may resort to eating the brewed sorghum residue, which is not nutritious, to supplement a meagre diet. Looking to the future, the economic development of an area must be planned to take into account the importance of nutrition and health as well as economic growth. The NOURISH research project has given us some insights into the kinds of disruption that are associated with changes in the climate. When rains are delayed, the harvest is delayed, leading to food scarcity and malnutrition for groups that may not be able to cope.
Some groups, such as women and children, can suffer more disadvantage than others in these circumstances. What is interesting about this study is how it shows the many interconnecting challenges to achieving SDG3. Three In this case, climate change is having a major impact on the health and well-being of people living in the Karimoja region of Uganda. So health will not be achieved in this context without also tackling hunger, which is addressed by SDG2, and climate change, which is addressed by SDG13. In the next step, we will explore another aspect of the work carried out by NOURISH researchers. We have considered food security and how that affects nutrition and health.
Next we will look at the case of people living with HIV disease and their food intake and nutritional status and how that will impact on their ability to fight what is a devastating disease.

In this video, Martina explains the challenge of food insecurity that rural communities in Uganda face.

For example, in Karimoja 20% of households were food insecure and a further 38% moderately food insecure in 2012. This means that over half a million people did not have reliable access to a sufficient quantity of affordable, nutritious food.

The NOURISH study gives us some insight into the disruption associated with changes in the climate. When rains are delayed, the harvest is delayed, leading to food scarcity and malnutrition for groups that may not be able to cope. Some groups, such as women and children, can suffer more than others in these circumstances.

When we think about the SDGs, we can see that this challenge related to SDG 3 is also related to SDG 13: Climate Action.

  • Can you think of any other SDGs that food insecurity in Uganda relates to?
  • Click here to review the SDGs.
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