Food insecurity, dietary diversity and the right to adequate food among households in landslide-prone communities in Eastern Uganda: A cohort study

We assessed food insecurity, dietary diversity and the right to adequate food among households in communities in Eastern Uganda that were affected by major landslides in 2010 and 2018. A prospective cohort study was applied to select 422 households during May-August (the food-plenty season) of 2019. In January-March (the food-poor season) of 2020, 388 households were re-assessed. Socio-demographic, food security, dietary diversity and right to adequate food data were collected using structured questionnaires. Four focus groups discussions and key informant interviews with 10 purposively sampled duty-bearers explored issues of food insecurity, dietary and the right to adequate food. The affected households had significantly higher mean (SE) food insecurity scores than controls, both during the food plenty season: 15.3 (0.5) vs. 10.8 (0.5), and during food-poor season: 15.9 (0.4) vs. 12.5 (0.0). The affected households had significantly lower mean (SE) dietary diversity scores than controls during the food plenty season: 5.4 (0.2) vs. 7.5 (0.2) and during the food poor season: 5.2 (0.2) vs. 7.3 (0.1). Multivariate analyses showed that the disaster event, education and main source of livelihood, were significantly associated with household food security and dietary diversity during the food-plenty season whereas during the food-poor season, the disaster event and education were associated with household food security and dietary diversity. During both food seasons, the majority of affected and control households reported to have consumed unsafe food. Cash-handout was the most preferred for ensuring the right to adequate food. Comprehension and awareness of human rights principles and state obligations were low. The severity of food-insecurity and dietary diversity differed significantly between the affected and control households during both food seasons. Moreover, the right to adequate food of landslide victims faced challenges to its realization. There is need for policy and planning frameworks that cater for seasonal variations, disaster effects and right to adequate food in order to reduce landslide victims' vulnerability to food insecurity and poor dietary diversity. In the long-term, education and income diversification program interventions need to be integrated into disaster recovery programs since they are central in enhancing the resilience of rural livelihoods to shocks and stressors on the food system.

Seasonality- and disaster effects on food variety and food insecurity coping strategies among a landslide-prone cohort

BACKGROUND & AIMS

Landslides may impact on nutritional health among vulnerable populations. However, there is limited data on the seasonal effects of landslides on diet and food security. Among the 2010 and 2018 households affected by the landslides in Eastern Uganda, we assessed seasonality and disaster effects on food varieties consumed and food insecurity coping strategies. This study is among the first to report on seasonal- and disaster effects on food varieties and food insecurity coping strategies among vulnerable populations in Uganda.

METHODS

We used a three-stage simple random technique to select a total of 422 households during May-August (food-plenty season) in 2019, of whom 211 had been affected by the landslides and 211 had not (controls). Six months later, in January-March (food-poor season) of 2020, 388 households were re-assessed (191 affected and 197 controls). We analyzed data only from the households that participated in both food seasons to compare results between the two food seasons. Food variety scores (FVS) were obtained by summing the frequency of weekly intakes of 86 food items while a coping index was derived based on the severity weighting of household food insecurity coping strategies.

RESULTS

After adjusting for covariates, significantly lower mean (SE) FVS were among the affected than controls during the food-plenty season: 9.3 (0.5) vs 11.4 (0.3), and during the food-poor season: 7.6 (0.5) vs 10.1 (0.1) (P < 0.001 for both). The affected households were more likely to use food insecurity coping strategies compared to controls (mean [SE]: 35.2 [2.1] vs. 27.1 [1.8], P < 0.001) during the food-plenty season and the severity further increased during the food-poor season: 42.1 (2.1) vs. 28.2 (2.1) (P < 0.001). Disaster exposure was associated with both household food varieties and food insecurity coping strategies during both food seasons (P < 0.001). The adjusted models, showed that, the affected compared to the controls had a significantly higher likelihood to rely on 5 of the 11 coping strategies during food-plenty season and 9 of the 11 coping strategies during the food-poor season.

CONCLUSION

Low variety diets and coping strategies among disaster affected individuals cut across seasons and implies needs for strong social protection and targeted safety nets irrespective of season.

Malnutrition and Associated Risk Factors among Children 6-59 Months Old in the Landslide-Prone Bududa District, Eastern Uganda: A Cohort Study

BACKGROUND

The United Nations Sustainable Development Goal 2.2 calls for an end to all forms of malnutrition. This might be derailed due to persistent landslide disasters in low-income countries like Uganda.

OBJECTIVES

The prevalence of malnutrition and the impact of seasonal variations and associated factors were assessed among children aged 6-59 mo in the landslide-affected households in Bududa District, eastern Uganda.

METHODS

A prospective cohort study using a 2-stage simple random technique was applied to select 422 households including 392 children during May-August (food-plenty season) 2019. After 6 mo, in January-March (food-poor season) 2020, 388 households and 366 children were assessed. Socioeconomic and demographic data were collected using structured questionnaires. Child malnutrition outcomes were defined according to WHO criteria. Factors associated with malnutrition outcomes were identified by bivariate and multivariate logistic regression.

RESULTS

Stunting, underweight, wasting, and overweight prevalences were 37.7%, 13.3%, 3.6%, and 4.3%, respectively, in the food-plenty season and 42.6%, 14.2%, 2.1%, and 2.7%, respectively, in the food-poor season. Residing in the landslide-affected sub-county increased the odds for stunting [adjusted OR (aOR): 1.68; 95% CI: 1.08, 2.59; P = 0.025] and underweight (aOR = 4.25; 95% CI: 1.10, 15.36; P = 0.032) for children in the food-plenty season. Child age, sex, breastfeeding status, a nonimproved drinking water source, migration of any household member, and parents' education were significant risk factors in the food-plenty season. In the food-poor season, parents' education status, loss of any household member, child sex, and child age were significant risk factors.

CONCLUSIONS

Stunting and underweight were more prevalent in the food-poor season while wasting and overweight were more prevalent in the food-plenty season. With the exception of child age, child sex, and parents' education, child malnutrition risk factors differed between food-plenty and food-poor seasons. There is a need to address seasonality factors in program interventions targeting children <5 y in landslide-prone areas.

Mapping of outdoor food and beverage advertising around primary and secondary schools in Kampala city, Uganda

BACKGROUND

Marketing of unhealthy foods and beverages is recognized as a contributing factor to the global increase in overweight and obesity, particularly among children. Such marketing negatively affects children's dietary preferences, food choices, purchasing requests, and consumption patterns. Given that little is known about food marketing in Africa, including in Uganda, monitoring children's exposure to food marketing is essential to generate evidence on the problem and develop meaningful policy responses. The aim of this study was to describe the food and beverage marketing environment surrounding schools in urban and peri-urban areas of Kampala city.

METHODS

Outdoor advertising around 25 randomly sampled primary and secondary schools within a radius of 250 m of each school was mapped. Information on size, setting, type, and position of the advertisements and the healthiness of the foods and beverages promoted was collected using the INFORMAS Outdoor Advertising Protocol. The occurrence of advertising was described using frequencies, median, and density per 100m2.

RESULTS

A total of 1034 branded advertisements were identified around the schools. Of these, 86% featured unhealthy products, 7% healthy products, and 7% miscellaneous products. The most advertised products were sugar-sweetened beverages and alcoholic beverages (51 and 23%, respectively). Schools in the urban area were surrounded by more unhealthy ads than those in the peri-urban areas (median of 45 vs 24 advertisements).

CONCLUSION

The widespread extent of unhealthy food and beverage advertisements around primary and secondary schools highlights the need for food marketing regulation in Uganda, in line with the World Health Organization's recommendations, to ensure that young people are protected from unhealthy food marketing.

Realization of the right to adequate food and the nutritional status of land evictees: a case for mothers/caregivers and their children in rural Central Uganda

Background

In developing countries like Uganda, the human right to adequate food (RtAF) is inextricably linked to access to land for households to feed themselves directly through production or means for its procurement. Whether RtAF is enjoyed among Ugandan land evictees, is unknown. We therefore explored this among land evictees (rights-holders) in Wakiso and Mpigi districts in rural Central Uganda. We assessed food accessibility and related coping strategies, diet quality and nutritional status of children 6–59 months old, and their caregivers. Effectiveness of the complaint and redress mechanisms in addressing RtAF violations was also explored.

Methods

In this cross-sectional study, quantitative data was collected using a structured questionnaire, with food security and nutritional assessment methods from a total of 215 land evictees including 187 children aged 6–59 months. Qualitative data was collected by reviewing selected national and international documents on the RtAF and key informant interviews with 15 purposively sampled duty-bearers. These included individuals or representatives of the Uganda Human Rights Commission, Resident District Commissioner, Sub-county Chiefs, and local Council leaders.

Results

We found that 78% of land evictees had insufficient access to food while 69.4% had consumed a less diversified diet. A majority of evictees (85.2%) relied on borrowing food or help from others to cope with food shortages. Of the 187 children assessed, 9.6% were wasted, 18.2% were underweight and 34.2% were stunted. Small, but significant associations, were found between food accessibility, diet quality, food insecurity coping strategies; and the nutritional status of evictees. We observed that administrative, quasi-judicial and judicial mechanisms to provide adequate legal remedies regarding violations of the RtAF among evictees in Uganda are in place, but not effective in doing so.

Conclusion

Land eviction without adequate legal remedies is a contributor to food insecurity and undernutrition in rural Central Uganda. It is essential that the Government strengthens and enforces the policy and legal environment to ensure adequate and timely compensation of evictees in order to reduce their vulnerability to food insecurity.

Electronic supplementary material

The online version of this article (10.1186/s12914-018-0162-6) contains supplementary material, which is available to authorized users.