*3.1.1 Political context and development challenges*

After the end of the armed conflict in 1986, the Government formed by the National Resistance Movement introduced a host of structural reforms and investments, most of which led to the long and sustained period of high growth and poverty reduction between 1987 and 2010. Policy and legal frameworks continue to improve, notably through the operationalization of the Public Financial Management Act, 2015 [37], though gaps in implementation in procurement and anti-corruption remain major concerns, with consequences for development indicators and directly for public sector-led enablers of food availability and access.

Uganda surpassed the *Millennium Development Goals* target of halving poverty by 2015, and made significant progress in reducing the proportion of the population that suffers from hunger, and in promoting gender equity and economically empowering women. According to the Uganda Poverty Assessment of 2013, more

**107**

*Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges…*

than 67% of the population lived above the extreme poverty line of US \$1.90/day. However, the vulnerability for every 2–3 Ugandans falling back into poverty exists. Estimates from the Uganda National Household Survey of 2016/2017 suggest that the proportion of the population living below the national poverty line rose slightly from 20% in financial year (FY) 2012/2013 to about 21% in FY 2016/2017 [38]. All Uganda's regions registered an increase in the number of poor persons with the notable exception of Northern Region (**Figure 4**), which is the poorest, and where poverty, decreased from 44 to 33%. With one-third of children under five being stunted, Uganda is among the 20 countries worldwide with the highest prevalence of under-nutrition. Stunting in rural compared to urban areas stands at 36% and 19%, respectively. At over 3%, Uganda's annual population growth rate is among the highest in the world, despite observed reduction in fertility rate. Uganda's population of 42 million is expected to reach 100 million by 2050, while the annual urban growth rate of 5.2% is among the highest in the world and is expected to grow from 6.4 million (2014) to 22 million by 2040 [39]. Uganda's refugee population has almost tripled since July 2016 and was around 1.8 million by the end of 2019, making it the largest refugee host in Africa, and the third largest in the world. While its open-door refugee policy is one of the most progressive in the world, as refugees enjoy access to social services, land and can move and work freely, the continued influx is straining host community-refugee relations, service delivery and is likely

Despite producing a variety of food crops and animal food products, malnutrition remains a problem and therefore pockets of under-nourishment and hunger co-exist. Micronutrient deficiencies are common and are exhibited as goiter, vitamin A deficiency and iron-deficiency anemia in the general population, though more common in the poor, children and women of child-bearing age. High malnutrition and under-nutrition rates are generally due to predisposing diseases, HIV/ AIDS, inadequate food intake, ignorance, cultural taboos, poverty, etc. The Uganda Food and Nutrition Policy of 2003 emphasized the promotion of good nutritional status of Ugandans through multi-sectoral and coordinated interventions that focused on food security, improved nutrition and increased incomes [40]. The country conducts periodic national income and expenditure surveys, with the latest being the 2009/2010 Uganda National Household Survey. The survey estimated that the incidence of income poverty in Uganda fell by 6.6% points in the 2005/2006 financial year from 31.1 to 24.5% in 2010 [41]. The incidence of income poverty in

rural and urban areas was estimated at 27.2 and 9.1, respectively [41].

about 15% are underweight and 6% suffer from acute malnutrition [42].

Malnutrition in all its forms remains largely a "hidden problem" since a majority of children affected are moderately malnourished and identifying malnutrition in

Although Uganda currently produces sufficient food to meet the needs of its growing population, the absolute number of Ugandans unable to access recommended calories still remains significant in all regions due to the uneven distribution of food, access constraints related to seasonality factors, poverty, inequality in regional wealth distribution and the burden of diseases. The proportion of the population unable to access adequate calories decreased nationally from 23% in 1997 to 15% in 2006 [40]. However, the persistent high rates of malnutrition in children under 5 are symptomatic of the underlying problems of inadequate access to food, suboptimal infant feeding practices, poor health care and sanitation and hygiene practices within the different regions of the Country. It is estimated that more than 30–38% of children suffer from chronic malnutrition (stunting), while

*DOI: http://dx.doi.org/10.5772/intechopen.95036*

to negatively influence environmental sustainability.

**3.2 Food and nutrition security**

*Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges… DOI: http://dx.doi.org/10.5772/intechopen.95036*

than 67% of the population lived above the extreme poverty line of US \$1.90/day. However, the vulnerability for every 2–3 Ugandans falling back into poverty exists. Estimates from the Uganda National Household Survey of 2016/2017 suggest that the proportion of the population living below the national poverty line rose slightly from 20% in financial year (FY) 2012/2013 to about 21% in FY 2016/2017 [38]. All Uganda's regions registered an increase in the number of poor persons with the notable exception of Northern Region (**Figure 4**), which is the poorest, and where poverty, decreased from 44 to 33%. With one-third of children under five being stunted, Uganda is among the 20 countries worldwide with the highest prevalence of under-nutrition. Stunting in rural compared to urban areas stands at 36% and 19%, respectively. At over 3%, Uganda's annual population growth rate is among the highest in the world, despite observed reduction in fertility rate. Uganda's population of 42 million is expected to reach 100 million by 2050, while the annual urban growth rate of 5.2% is among the highest in the world and is expected to grow from 6.4 million (2014) to 22 million by 2040 [39]. Uganda's refugee population has almost tripled since July 2016 and was around 1.8 million by the end of 2019, making it the largest refugee host in Africa, and the third largest in the world. While its open-door refugee policy is one of the most progressive in the world, as refugees enjoy access to social services, land and can move and work freely, the continued influx is straining host community-refugee relations, service delivery and is likely to negatively influence environmental sustainability.

#### **3.2 Food and nutrition security**

*Food Security in Africa*

member states faces similar food insecurity threats such as livestock and crop diseases. The common crop diseases include: banana bacterial wilt, cassava brown streak disease, stalk borer disease and recently, maize necrosis which was first spotted in Kenya. Regional cooperation would be required to find solutions to most of these economic and food security threats. In the livestock sector, Food and Mouth Disease often breaks out, as well as a number of other common livestock diseases that affect the livestock trade across the EAC trading bloc. They are a constant hindrance to planned improvements to food security in the livestock sub-sector.

After the end of the armed conflict in 1986, the Government formed by the National Resistance Movement introduced a host of structural reforms and investments, most of which led to the long and sustained period of high growth and poverty reduction between 1987 and 2010. Policy and legal frameworks continue to improve, notably through the operationalization of the Public Financial Management Act, 2015 [37], though gaps in implementation in procurement and anti-corruption remain major concerns, with consequences for development indicators and directly for public sector-led enablers of food availability and access.

Uganda surpassed the *Millennium Development Goals* target of halving poverty by 2015, and made significant progress in reducing the proportion of the population that suffers from hunger, and in promoting gender equity and economically empowering women. According to the Uganda Poverty Assessment of 2013, more

*Regions of Uganda (note that Teso, Acholi and Karamoja are in eastern and northern regions, respectively).*

*3.1.1 Political context and development challenges*

**106**

**Figure 4.**

Despite producing a variety of food crops and animal food products, malnutrition remains a problem and therefore pockets of under-nourishment and hunger co-exist. Micronutrient deficiencies are common and are exhibited as goiter, vitamin A deficiency and iron-deficiency anemia in the general population, though more common in the poor, children and women of child-bearing age. High malnutrition and under-nutrition rates are generally due to predisposing diseases, HIV/ AIDS, inadequate food intake, ignorance, cultural taboos, poverty, etc. The Uganda Food and Nutrition Policy of 2003 emphasized the promotion of good nutritional status of Ugandans through multi-sectoral and coordinated interventions that focused on food security, improved nutrition and increased incomes [40]. The country conducts periodic national income and expenditure surveys, with the latest being the 2009/2010 Uganda National Household Survey. The survey estimated that the incidence of income poverty in Uganda fell by 6.6% points in the 2005/2006 financial year from 31.1 to 24.5% in 2010 [41]. The incidence of income poverty in rural and urban areas was estimated at 27.2 and 9.1, respectively [41].

Although Uganda currently produces sufficient food to meet the needs of its growing population, the absolute number of Ugandans unable to access recommended calories still remains significant in all regions due to the uneven distribution of food, access constraints related to seasonality factors, poverty, inequality in regional wealth distribution and the burden of diseases. The proportion of the population unable to access adequate calories decreased nationally from 23% in 1997 to 15% in 2006 [40]. However, the persistent high rates of malnutrition in children under 5 are symptomatic of the underlying problems of inadequate access to food, suboptimal infant feeding practices, poor health care and sanitation and hygiene practices within the different regions of the Country. It is estimated that more than 30–38% of children suffer from chronic malnutrition (stunting), while about 15% are underweight and 6% suffer from acute malnutrition [42]. Malnutrition in all its forms remains largely a "hidden problem" since a majority of children affected are moderately malnourished and identifying malnutrition in

these children without regular assessments is difficult [42]. Increasingly, Uganda similar to other developing countries is experiencing the double burden of malnutrition where high levels of under-nutrition co-exist with a growing prevalence of overweight and obesity. Malnutrition plays a major role in child morbidity and mortality as wasting and underweight have been shown to significantly increase the risk of both morbidity and mortality in children [42]. Vitamin A and iron deficiencies also carry an increased risk of morbidity and mortality in children [43]. Vitamin A deficiency seems to be linked with an increased risk of mortality from measles and severe diarrhoeal diseases [43], while iron deficiency carries significant adverse consequences for child development [44]. Malnutrition starts early in infancy for children in Uganda. The substantial proportion of children born with low birth weight suggests that high fertility rates, short birth intervals, young maternal age and maternal malnutrition are likely factors that contribute significantly and adversely to child malnutrition from birth. High childhood disease infection rates may be attributable to poor feeding practices, where liquids other than breast milk might be introduced early, such that these foods, if not sanitary enough and safe to eat, serve as avenues for disease spread. As the prevalence of stunting increases with age in children, it is a reflection of continuous nutritional deprivation of children from an early age and as they grow. The prevalence of stunting is highest in northern and southwest Uganda, although the rate of decline since 2001 is fastest in the western region and slowest in the northern and eastern regions. The prevalence of underweight is highest in the East, Central, Northern and Southwest regions, and the rate of decline is slower than the rate of change for stunting. Wasting is rising in all regions, with the smallest increase in Central Region [42]. In women, chronic energy deficiency was 12% in the 2006 Uganda Demographic and Health Survey and has been rising across all regions [42]. Overweight and obesity in women is also rising, but most rapidly in urban areas, Western and Central Regions [42]. Deficiencies in Vitamin A and Iodine, and Iron-deficiency anemia (IDA) remain significantly prevalent as discussed earlier. Vitamin A deficiency affects 20% of women and children, and IDA affects 73% of preschool children and 49% of women of child-bearing age [42]. The immediate causes of malnutrition for children in Uganda continue to be the high disease burden resulting from malaria, diarrhoeal diseases and acute respiratory infections, as well as inadequate dietary intake resulting from suboptimal infant feeding practices, as is commonly found in other developing economies. While breastfeeding is nearly universal, exclusive breastfeeding tapers off rapidly and by six months, only 11% of infants are exclusively breastfed. In addition, late initiation of breastfeeding (86%) and the use of pre-lacteal feeds (54%) are common [42]. Early introduction of foods and liquids and inappropriate complementary feeding are also widespread. Adequate feeding practices are used for only 28% of children under two, when considering continued breastfeeding, appropriate frequency of feeding and diet diversity, three key indicators of adequate complementary feeding. Infant and young child feeding (IYCF) practices are suboptimal, and while social and behavior change communication (SBCC) is one response to address this, SBCC alone will not adequately improve feeding practices. Poverty and food insecurity at the household level play a significant role, but women's lack of control over their time, their competing household and reproductive roles may undermine their IYCF capabilities. To succeed, SBCC efforts must engage men as partners in change. The underlying causes of malnutrition in Uganda remain inadequate water and sanitation, lack of dietary diversity, inadequate health infrastructure and access to health care and food insecurity [42]. Although access to health services has improved in the past decade, the quality of the services has remained generally poor [42]. From casual observations by this author on a recent trip to Uganda (December, 2019),

**109**

country.

**3.3 Prospects**

*Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges…*

sanitation and hygiene has not improved, if not worsened in marginalized areas like Karamoja and northern Uganda, and is exacerbated by increasing urbanization and

Due to the increasing population and deforestation of the country, more arable land is being brought under cultivation for more food production. However, the continuing influx of refugees from South Sudan due to the civil war in that country, political instability further north in the Republic of Sudan and a host of internal factors, are likely to impact negatively on the country's food production capacity. Although indicators of food poverty, malnutrition and under-nutrition are yet to rise significantly, the increasing population and depressed economic growth are likely to negatively affect the food security and nutrition status in the country in the long-term. Rainfall in 2019 remained erratic in most of Uganda as influenced by Cyclone Idai that affected much of southern Africa, and whose effects spilled into parts of Central and Eastern Africa. The effects of this and other natural factors are largely unpredictable, but the outlook does not seem beyond redemption as Uganda can largely feed its people. Recent trade deals with Kenya and the opening of the Kenya-Uganda border with the aim of minimizing interruptions in trade and travel, is already increasing food trade between Uganda's border Counties and Kenya's

population rise. Food insecurity varies regionally, with the Northern Region suffering from the highest levels of food insecurity, followed by parts of East and East Central Regions and parts of Southwest Uganda. Common causes of food insecurity across Uganda are the lack of diversification in livelihoods, high dependence on agriculture and wage labour, declining wages and rising food prices. While poverty declined across Uganda from 56% in 1992 to 31% in 2006 [42], improvements in the prevalence of poverty are largely attributable to economic growth rather than income distribution and welfare improvement. In fact, income inequality between the wealthy and the poor has steadily widened. Gender inequality seems to be significantly intertwined with poverty and food insecurity in Uganda and has been identified as a primary reason for the persistent poverty. Poverty may be gendered as income inequality seems to be rising as a high percentage of women lack access to resources such as capital. Gender inequality may therefore exacerbate food insecurity for women and children. While 80% of women contribute labour for food production, they own less than 8% of the land on which to farm [42]. Men may earn significantly more than women but spend more of their income on non-food items, while women are left to close the household food security gap. Women are the primary caregivers in families, but may have the least decisionmaking power; as a result, they have less control over their family care role and time, than they should. In Uganda, women's low involvement and high fertility rates are two critical factors that undermine health and nutrition outcomes in their children. Taking the multiplicity of factors into account, gender inequality substantially undermines women's capabilities to achieve and ensure food security for their families. This situation calls for approaches that improve the design and delivery of nutrition services to prevent, reduce and control malnutrition at the policy, leadership and programme levels, as well as to promote coordination and resource mobilization. Despite the above gloomy picture, Uganda's nutrition situation is better than many other countries in eastern and southern Africa, as Uganda currently produces sufficient food to meet the needs of most of its growing population. Nationally, the proportion of the population unable to access adequate calories decreased from 15% in 2006 to 11% in 2015 [45], and the country is likely to meet the SDG 2 with robust policies in place. **Figure 4** presents a Map of Uganda showing the regions of the

*DOI: http://dx.doi.org/10.5772/intechopen.95036*

*Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges… DOI: http://dx.doi.org/10.5772/intechopen.95036*

sanitation and hygiene has not improved, if not worsened in marginalized areas like Karamoja and northern Uganda, and is exacerbated by increasing urbanization and population rise. Food insecurity varies regionally, with the Northern Region suffering from the highest levels of food insecurity, followed by parts of East and East Central Regions and parts of Southwest Uganda. Common causes of food insecurity across Uganda are the lack of diversification in livelihoods, high dependence on agriculture and wage labour, declining wages and rising food prices. While poverty declined across Uganda from 56% in 1992 to 31% in 2006 [42], improvements in the prevalence of poverty are largely attributable to economic growth rather than income distribution and welfare improvement. In fact, income inequality between the wealthy and the poor has steadily widened. Gender inequality seems to be significantly intertwined with poverty and food insecurity in Uganda and has been identified as a primary reason for the persistent poverty. Poverty may be gendered as income inequality seems to be rising as a high percentage of women lack access to resources such as capital. Gender inequality may therefore exacerbate food insecurity for women and children. While 80% of women contribute labour for food production, they own less than 8% of the land on which to farm [42]. Men may earn significantly more than women but spend more of their income on non-food items, while women are left to close the household food security gap. Women are the primary caregivers in families, but may have the least decisionmaking power; as a result, they have less control over their family care role and time, than they should. In Uganda, women's low involvement and high fertility rates are two critical factors that undermine health and nutrition outcomes in their children. Taking the multiplicity of factors into account, gender inequality substantially undermines women's capabilities to achieve and ensure food security for their families. This situation calls for approaches that improve the design and delivery of nutrition services to prevent, reduce and control malnutrition at the policy, leadership and programme levels, as well as to promote coordination and resource mobilization. Despite the above gloomy picture, Uganda's nutrition situation is better than many other countries in eastern and southern Africa, as Uganda currently produces sufficient food to meet the needs of most of its growing population. Nationally, the proportion of the population unable to access adequate calories decreased from 15% in 2006 to 11% in 2015 [45], and the country is likely to meet the SDG 2 with robust policies in place. **Figure 4** presents a Map of Uganda showing the regions of the country.

#### **3.3 Prospects**

*Food Security in Africa*

these children without regular assessments is difficult [42]. Increasingly, Uganda similar to other developing countries is experiencing the double burden of malnutrition where high levels of under-nutrition co-exist with a growing prevalence of overweight and obesity. Malnutrition plays a major role in child morbidity and mortality as wasting and underweight have been shown to significantly increase the risk of both morbidity and mortality in children [42]. Vitamin A and iron deficiencies also carry an increased risk of morbidity and mortality in children [43]. Vitamin A deficiency seems to be linked with an increased risk of mortality from measles and severe diarrhoeal diseases [43], while iron deficiency carries significant adverse consequences for child development [44]. Malnutrition starts early in infancy for children in Uganda. The substantial proportion of children born with low birth weight suggests that high fertility rates, short birth intervals, young maternal age and maternal malnutrition are likely factors that contribute significantly and adversely to child malnutrition from birth. High childhood disease infection rates may be attributable to poor feeding practices, where liquids other than breast milk might be introduced early, such that these foods, if not sanitary enough and safe to eat, serve as avenues for disease spread. As the prevalence of stunting increases with age in children, it is a reflection of continuous nutritional deprivation of children from an early age and as they grow. The prevalence of stunting is highest in northern and southwest Uganda, although the rate of decline since 2001 is fastest in the western region and slowest in the northern and eastern regions. The prevalence of underweight is highest in the East, Central, Northern and Southwest regions, and the rate of decline is slower than the rate of change for stunting. Wasting is rising in all regions, with the smallest increase in Central Region [42]. In women, chronic energy deficiency was 12% in the 2006 Uganda Demographic and Health Survey and has been rising across all regions [42]. Overweight and obesity in women is also rising, but most rapidly in urban areas, Western and Central Regions [42]. Deficiencies in Vitamin A and Iodine, and Iron-deficiency anemia (IDA) remain significantly prevalent as discussed earlier. Vitamin A deficiency affects 20% of women and children, and IDA affects 73% of preschool children and 49% of women of child-bearing age [42]. The immediate causes of malnutrition for children in Uganda continue to be the high disease burden resulting from malaria, diarrhoeal diseases and acute respiratory infections, as well as inadequate dietary intake resulting from suboptimal infant feeding practices, as is commonly found in other developing economies. While breastfeeding is nearly universal, exclusive breastfeeding tapers off rapidly and by six months, only 11% of infants are exclusively breastfed. In addition, late initiation of breastfeeding (86%) and the use of pre-lacteal feeds (54%) are common [42]. Early introduction of foods and liquids and inappropriate complementary feeding are also widespread. Adequate feeding practices are used for only 28% of children under two, when considering continued breastfeeding, appropriate frequency of feeding and diet diversity, three key indicators of adequate complementary feeding. Infant and young child feeding (IYCF) practices are suboptimal, and while social and behavior change communication (SBCC) is one response to address this, SBCC alone will not adequately improve feeding practices. Poverty and food insecurity at the household level play a significant role, but women's lack of control over their time, their competing household and reproductive roles may undermine their IYCF capabilities. To succeed, SBCC efforts must engage men as partners in change. The underlying causes of malnutrition in Uganda remain inadequate water and sanitation, lack of dietary diversity, inadequate health infrastructure and access to health care and food insecurity [42]. Although access to health services has improved in the past decade, the quality of the services has remained generally poor [42]. From casual observations by this author on a recent trip to Uganda (December, 2019),

**108**

Due to the increasing population and deforestation of the country, more arable land is being brought under cultivation for more food production. However, the continuing influx of refugees from South Sudan due to the civil war in that country, political instability further north in the Republic of Sudan and a host of internal factors, are likely to impact negatively on the country's food production capacity. Although indicators of food poverty, malnutrition and under-nutrition are yet to rise significantly, the increasing population and depressed economic growth are likely to negatively affect the food security and nutrition status in the country in the long-term. Rainfall in 2019 remained erratic in most of Uganda as influenced by Cyclone Idai that affected much of southern Africa, and whose effects spilled into parts of Central and Eastern Africa. The effects of this and other natural factors are largely unpredictable, but the outlook does not seem beyond redemption as Uganda can largely feed its people. Recent trade deals with Kenya and the opening of the Kenya-Uganda border with the aim of minimizing interruptions in trade and travel, is already increasing food trade between Uganda's border Counties and Kenya's

Counties of Trans Nzoia, Bungoma, Busia, Kakamega and Turkana. Uganda is the net gainer from these commercial transactions, and its economy is bound to benefit from the increased trade and the likely increased local agricultural output to meet the increasing demand for more food in Kenya. The analysis of the food and nutrition outlook in Uganda indicates that:


In conclusion, 89% of Uganda's population is food secure. This population still has normal access to food from their own production and in the market. Food prices in the markets are affordable, and consumers can experience an acceptable food consumption score as most can afford at least three meals per day of a diversified diet. They also have adequate energy intake. Eleven percent of the total population in the country is chronically food insecure. These are scattered in the Karamoja, Teso and Acholi districts and in the slums in the major cities of Kampala and Entebbe. The food security prospects for Karamoja are expected to remain volatile and unpredictable. Food availability is not a limiting factor in most regions of Uganda except in Karamoja, East, Central and West Nile, where production and productivity, frequent dry spells and lack of extension services constrain food production. Although food is largely available, food access and utilization are major limiting factors in the three regions but minor limiting factors in other regions. This has been attributed to the low level of incomes, poor storage practices, lack of awareness of what constitutes good nutrition, cultural food preferences, poor sanitary and food preparation practices and wastage of food during harvest periods due to festivities.
