Participants at the SAPLING Uganda Nutrition stakeholders' workshop- May 2023

FoodSENSE offers new ways of assessing and tackling malnutrition in Uganda

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CGIAR’s Sustainable Animal Productivity and Livelihoods, Nutrition and Gender inclusion Initiative (SAPLING) has developed a tool for assessing, identifying and responding to food and nutrition security problems in developing countries. 

The Food Security, Environments and Nutrition: Structured Evidence (FoodSENSE), is a decision support process developed by SAPLING researchers to aid decision makers in identifying barriers to improved food security and nutrition, and then to structure dialogue for prioritisation of appropriate solutions for target demographic groups. The tool provides site-specific information on foods consumed, where they are sourced and the nutritional outcomes. It is also used to evaluate food systems and environments, including markets, value chains and socio-cultural norms and their effects on household nutrition.

Working under SAPLING, researchers from the International Livestock Research Institute (ILRI) piloted the tool at the beginning of 2023 to identify food and nutrition challenges in the Central Uganda districts of Mukono, Masaka and Mpigi, which are some of the SAPLING project sites in Uganda. As part of the tool’s validation, representatives from national and local governments, academia, the United Nations, research institutions, the civil society and industry met for a two-day workshop in April 2023 in Kampala. They assessed the nutritional status of residents in the three districts, reviewed the survey results and kick-started dialogue on potential solutions to the key challenges identified.

This research is part of SAPLING’s work package 2 that focuses on promoting consumption of livestock-derived foods as part of diverse diets. A social behaviour change communication (SBCC) intervention aimed at influencing behaviour around diets and food safety practices will be developed as part of this work. 

Malnutrition is rampant in Uganda. Data are scarce and not up to date, but available data shows that among children younger than five years, 53% suffer from anaemia, 29% from stunting and 11% are underweight. Among women of reproductive age, 32% have anaemia and 9% are underweight while 24% are overweight or obese. Malnutrition is especially widespread in areas where commercial farming of crops like sugarcane and tea is practiced because family land is allocated to these crops and little, if any, is left for growing food crops. Additionally, increased household preference for market production reduces production for own consumption even when households have the capacity. Seemingly, the income derived from the commercial crops is not used to purchase nutritious foods, likely due to limited knowledge on nutrition. This situation is worsened by soil exhaustion and climate change, which make agriculture increasingly unpredictable and expensive.

Despite these challenges, the nutrition sector in Uganda is plagued by underfunding, evidenced by the limited number of personnel at all levels, as well as low capacities and inadequate equipment at health facilities to screen and manage malnutrition. There is limited dialogue and cross-sectoral engagement between key government ministries, departments and agencies such as the the Ministry of Health, Ministry of Agriculture, Animal Industries and Fisheries; the Ministry of Finance, Planning and Economic Development and local governments. In most cases, nutrition is seen as a mandate of the Ministry of Health and its sister agencies. How to facilitate the much-needed multisectoral approach remains a challenge. 

‘We can now identify challenges to food and nutrition security across the food system and, working with stakeholders, tailor solutions to specific locations depending on severity of the challenges, available structures and resources,’ said Jim Hammond, a senior scientist at ILRI. 

Hammond, who was part of the team that developed the tool said it will soon be made available to stakeholders to use in nutrition evaluations.

Key bottlenecks to food and nutrition security in Mukono, Mpigi and Masaka districts Proposed interventions 
  • Limited awareness and knowledge on nutrition
  • Limited consumption of livestock derived foods because they are more costly than plant-based foods
  • Poor water, sanitation and hygiene practices including use of unsafe water 
  • Low handwashing and uncommon use of soap 
  • Prohibitive cost of farm inputs, which results in low input use and subsequent poor farm productivity; 
  • Climate and weather-related risks. 
  • Weak governance and enforcement around food safety, 
  • Limited diversification of produce
  • Inequalities in food distribution between men and women, which is in some cases buttressed by social cultural norms surrounding consumption of certain foods 
  • Inability to afford basic caloric needs. 
  • Poor storage facilities resulting in food waste 
  • Shortages of staple foods during dry seasons 
  • SBCC- targeted messaging to create awareness and mindset change using appropriate channels
  • Establishment of community seed banks and demonstration sites for both crop and livestock farming
  • Small holder farm insurance schemes; establishment of cooperatives and improving farmer access to microfinance and credit schemes. 
  • Promotion of processing and value addition to farm produce
  • Infrastructural development targeting roads and food processing facilities like milk dispensing automated teller machines and slaughterhouses
  • Establishment and improvement of storage facilities to reduce postharvest losses, improving access to agrovet services 
  • Support production of fortified foods by small and medium enterprises 

Ongoing interventions to tackle malnutrition in the three districts and other parts of the country include provision of a SBCC package by the Ministry of Health that focuses on pregnant and lactating women and mothers of children under the age of five by providing them with information through care groups, school feeding programs, school kitchen gardens and linking pregnant mothers to health facilities to access iron supplements. However, most of these interventions are implemented with support from civil society organizations and development partners, which may limit their continuity and sustainability once the projects end. To address this, stakeholders called for proper data collection and integration of nutrition interventions in ongoing government programs.

Margaret Nanozi, the district health officer Mpigi District, said,

‘food security and nutrition should be integrated in community-level programs such as the Parish Development Model, a development approach implemented by the Uganda government, to tackle the problem in the district.’ 

She noted the need for data on those most vulnerable and where they live so that solutions are tailormade.

Participants emphasized the importance of mainstreaming gender empowerment and transformative approaches into intervention activities and training implementing staff accordingly. Participants also noted that emergency response still constitutes a large part of nutrition work in Uganda and that there is need to plan for long-term nutrition and human development. 

Nazarius Tumwesigye, professor in the Department of Epidemiology and Biostatistics at Makerere University and one of the workshop participants, said,

'there is need for awareness creation and mindset change among farmers and households on nutrition to prevent emergencies. The government should develop systems to support long-term nutrition, just like it has done for emergency response to epidemics. We also need to improve the visibility of research outputs and promote the use of evidence from researchers to inform policy.’

Way forward

Analysis of the site-specific challenges and proposed interventions is ongoing and will be compiled into a report that will be shared with stakeholders for their review and adoption. As part of the implementation, stakeholders will participate in the co-creation of the SBCC intervention, including the tools and messages to be used in the respective sites.

The FoodSENSE tool will also be reviewed by researchers and stakeholders and presented to officials of the three districts and the Ministry of Health technical working group at the national level for validation and adoption before being made available to national partners and stakeholders.