**3.1 Economy, agriculture and social development**

Burundi is a land locked State in Central Africa and is one of the most densely populated countries on the continent, with 470 inhabitants per square kilometre. Its economy is heavily reliant on agriculture, which, despite the paucity of arable land, employs 80% of the population. Poverty is mainly rural and overwhelmingly affects

**79**

*Food and Nutrition Security in East Africa (Rwanda, Burundi and South Sudan): Status…*

small-holder farmers. Burundi is the second most densely populated country in Africa and the 5th poorest country in the world [16]. It has a population of about 11 million people with a birth rate of 6 children per woman of child-bearing age. The high population growth rate contributes significantly to its high poverty index and low scores on all food and nutrition indicators. The IMF has classified Burundi as having the highest level of poverty and worst health indicators in the EAC [17]. The country experienced unprecedented food and nutrition insecurity between 1993 and 2005 due to the breakout of the civil war [18], and again from 2015 to 2018 due to the political instability resulting from the extension of the term of the Presidency

Most of the Burundian population lives in abject poverty, especially in rural

Less than 5% of the country's population has access to electricity. While access to safe drinking water and sanitation remains very low, only about 52.1% of rural households and 2% of rural households have access to electricity [21]. Between 2010 and 2017, Burundi experienced a remarkable decline in fertility, which fell from 6.4

The economy is recovering slowly, with growth reaching about 1.6% in 2018 compared to 0.5% in 2017, after two consecutive years of recession in 2015 (−3.9%) and 2016 (−0.6%) [22]. The economy faces a fragile recovery that remains below the 4.2% recorded from 2004 to 2014 and many challenges including: a lack of budgetary resources to finance public investments, a persistent shortage of foreign exchange with falling international reserves, a vulnerable financial sector and

In order to prevent and control the spread of Ebola, Burundi has set up screening and treatment centres at various points along its border with the neighbouring Democratic Republic of Congo (DRC), with assistance from the World Bank. Despite recording fewer COVID-19 cases and deaths than other EAC Member States except South Sudan by the 27th April, 2020, it is likely to go into deep recession due to its fragile economy and the high dependence on other member States of the EAC

Malnutrition in childhood and pregnancy has many adverse consequences for child survival and long-term well-being. Malnutrition also has far-reaching consequences for human capital, economic productivity, and overall national development. According to the findings of the 2016–2017 Demographic and Health Survey, the country has a chronic malnutrition rate of 56%, one of the highest in the World. Malnutrition affects over 1 million children under 5 years of age [23]. The expected increase in the population to 15.3 million by 2030 and its doubling to 23.5 million by 2050, spells disaster for Burundi [22]. Furthermore, eighty-eight percent of the country's population resides in rural areas and 45% of the country's population is under 15 years of age [24]. While the level of poverty in Sub-Saharan Africa has reduced overall, the level of poverty in Burundi has stagnated. As of 2016, 78% of the population lived on less than US\$1.90 a day [24, 25]. Ninety percent of the population depends on agriculture and poverty disproportionately affects rural farmers [24]. Currently, Burundi ranks 132nd out of 157 countries in terms

areas. The level of food insecurity is almost twice as high as the average for sub-Saharan African countries, as was shown by 1.8 million people needing humanitarian assistance in 2018 according to the Humanitarian Response Plan [20]. Agriculture contributes 40% of the country's GDP and is the main source of employment for 80% of the country's population, despite not being able to generate

to 5.5 children per woman on average, thus slowing its population growth.

*DOI: http://dx.doi.org/10.5772/intechopen.95037*

beyond the legislated two terms of 5 years each [19].

adequate income.

increasing fiscal and current deficits.

trading bloc for its imports and exports.

**3.2 Food and nutrition security**

#### *Food and Nutrition Security in East Africa (Rwanda, Burundi and South Sudan): Status… DOI: http://dx.doi.org/10.5772/intechopen.95037*

small-holder farmers. Burundi is the second most densely populated country in Africa and the 5th poorest country in the world [16]. It has a population of about 11 million people with a birth rate of 6 children per woman of child-bearing age. The high population growth rate contributes significantly to its high poverty index and low scores on all food and nutrition indicators. The IMF has classified Burundi as having the highest level of poverty and worst health indicators in the EAC [17]. The country experienced unprecedented food and nutrition insecurity between 1993 and 2005 due to the breakout of the civil war [18], and again from 2015 to 2018 due to the political instability resulting from the extension of the term of the Presidency beyond the legislated two terms of 5 years each [19].

Most of the Burundian population lives in abject poverty, especially in rural areas. The level of food insecurity is almost twice as high as the average for sub-Saharan African countries, as was shown by 1.8 million people needing humanitarian assistance in 2018 according to the Humanitarian Response Plan [20]. Agriculture contributes 40% of the country's GDP and is the main source of employment for 80% of the country's population, despite not being able to generate adequate income.

Less than 5% of the country's population has access to electricity. While access to safe drinking water and sanitation remains very low, only about 52.1% of rural households and 2% of rural households have access to electricity [21]. Between 2010 and 2017, Burundi experienced a remarkable decline in fertility, which fell from 6.4 to 5.5 children per woman on average, thus slowing its population growth.

The economy is recovering slowly, with growth reaching about 1.6% in 2018 compared to 0.5% in 2017, after two consecutive years of recession in 2015 (−3.9%) and 2016 (−0.6%) [22]. The economy faces a fragile recovery that remains below the 4.2% recorded from 2004 to 2014 and many challenges including: a lack of budgetary resources to finance public investments, a persistent shortage of foreign exchange with falling international reserves, a vulnerable financial sector and increasing fiscal and current deficits.

In order to prevent and control the spread of Ebola, Burundi has set up screening and treatment centres at various points along its border with the neighbouring Democratic Republic of Congo (DRC), with assistance from the World Bank. Despite recording fewer COVID-19 cases and deaths than other EAC Member States except South Sudan by the 27th April, 2020, it is likely to go into deep recession due to its fragile economy and the high dependence on other member States of the EAC trading bloc for its imports and exports.

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

Malnutrition in childhood and pregnancy has many adverse consequences for child survival and long-term well-being. Malnutrition also has far-reaching consequences for human capital, economic productivity, and overall national development. According to the findings of the 2016–2017 Demographic and Health Survey, the country has a chronic malnutrition rate of 56%, one of the highest in the World. Malnutrition affects over 1 million children under 5 years of age [23]. The expected increase in the population to 15.3 million by 2030 and its doubling to 23.5 million by 2050, spells disaster for Burundi [22]. Furthermore, eighty-eight percent of the country's population resides in rural areas and 45% of the country's population is under 15 years of age [24]. While the level of poverty in Sub-Saharan Africa has reduced overall, the level of poverty in Burundi has stagnated. As of 2016, 78% of the population lived on less than US\$1.90 a day [24, 25]. Ninety percent of the population depends on agriculture and poverty disproportionately affects rural farmers [24]. Currently, Burundi ranks 132nd out of 157 countries in terms

*Food Security in Africa*

deficient countries like Burundi and Kenya.

**2.4 Recommendations**

The country should:

ment and growth

found there

**3. Burundi**

The increasing population requires land to build homes on, while road and rail infrastructure, industries, institutions and other social amenities also require land. The fixed amount of land available for these competing needs means that the arable land sizes will keep reducing and the chances of hunger, malnutrition and under-nourishment may increase due to reduced food production. Rwanda's "Feed the Future" Multi-Year Strategy identified market linkages, infrastructure, nutrition, innovation, and policy as focal points for support and intervention, making it multi-sectoral in order to make the strategy effective. Rwanda engaged development partners in order to revise the national food and nutrition policy and linked it with its 2013–2018 strategic plan, and the Comprehensive Africa Agriculture Development Programme [15]. This approach should bear fruit in a few years ahead. Climate variability has impacted on the country's agriculture, similar to the situation in the other member states of the EAC, with the potential for a rise in food and nutrition insecurity, both in the short and long-term. But the proportion of the food and nutrition insecure population in Rwanda will still be lower than in food-

• Identify multi-sectoral approaches and coordination efforts as key ingredients to accelerate progress in nutrition and food security programmes. The GoR having created a national early childhood development (ECD) program to have a family-focused approach to address child stunting in Rwanda, it is envisioned that the coordination secretariat and the ECD program will complement each

other and accelerate Rwanda's food security and nutrition agenda

among women and children and make it effective

**3.1 Economy, agriculture and social development**

improve the competitiveness of farmers and commodities

• Develop a new policy, focussed on integrated nutrition interventions that involve multi-sectoral management to prevent of all forms of malnutrition

• Develop a strategy that focuses on enabling improvements for private-sector-led growth in the agriculture sector and on building capacity within value chains to

• Discourage through social education, early child bearing as it contributes to malnutrition, with serious consequences for maternal health, baby develop-

• Concentrate its food security improvement interventions in Western Province as more than 42% of all severely food insecure households in Rwanda are

Burundi is a land locked State in Central Africa and is one of the most densely populated countries on the continent, with 470 inhabitants per square kilometre. Its economy is heavily reliant on agriculture, which, despite the paucity of arable land, employs 80% of the population. Poverty is mainly rural and overwhelmingly affects

**78**

of progress toward meeting the SDGs [25]. According to the most recent data, the maternal mortality ratio is 712 per 100,000 live births, 27% of female deaths are related to pregnancy or childbearing, and one in 13 children will die before reaching 5 years of age. Burundi's nutrition and food security situation has been adversely affected by the ongoing conflict and political instability, in addition to the recurrent natural disasters and epidemics. Burundi ranked last on the Global Hunger Index (GHI) in 2014 [26]. Approximately 2.6 million people were projected to be food insecure as of October 2017 and recent Famine Early Warning Systems Network (FEWS NET) 2018 estimates did not show any improvement [27]. The food security situation remained stressed through May 2018, with some poor households reaching crisis level of food insecurity [27]. Burundi's child stunting prevalence of 56% is among the highest in the world, with levels among the under-5 s having dropped by only 2 percentage points between 2010 and 2017. Also between 2010 and 2017, underweight and wasting prevalence remained virtually unchanged. Rural areas have a much higher prevalence of stunting than urban areas, at 59 and 28%, respectively. Following this pattern, Bujumbura Mairie, the most urban of the Provinces, has the lowest prevalence of stunting at 24%. In the rest of the country, which is highly rural, stunting prevalence varies from 49% in Bururi to 66% in Muyinga [23]. It has been established that stunting levels are linked to maternal education and wealth levels, as 40% of children whose mothers have secondary education or higher are stunted, while the prevalence rises to 61% of children whose mothers had no formal education. According to the wealth status of the mother, 31% of children in the highest wealth quartile are stunted, while in the lowest wealth quartile, 69% are stunted. In Burundi, the level of stunting increases with age, such that 36% of children 6–8 months old are stunted. The prevalence of stunting steadily increases in children and peaks at 66% among children aged 36–47 months. The high prevalence of stunting among children 36–47 months old may be a result of the early cessation of exclusive breastfeeding and inadequate complementary feeding of children 6–23 months of age [23]. The prevalence of exclusive breastfeeding drops dramatically among children 4–5 months old, such that 64% of these children are exclusively breastfed, while among those aged 1 day-3 months, the prevalence of exclusive breastfeeding is 93% [23]. The change to complimentary feeding puts children at risk of exposure to disease-causing agents that are transmitted through unsafe water and unhygienic food handling practices, which can lead to an increase in recurring infections and exacerbate malnutrition. In Burundi childbearing begins early, such that by the age of 19, twenty nine percent of adolescent girls had begun childbearing in 2016–2017, which is a slight decrease from 31 percent in 2010 [23, 28]. In Sub-Saharan Africa, the risk of stunting is 33% higher among first-born children of mothers under 18 years. Early child-bearing has been shown to be a key causative factor of malnutrition [28], because, relative to older mothers, adolescent girls are more likely to be malnourished and have a low birth-weight baby who is more likely to become malnourished, and be at increased risk of illness and death, than those born to older mothers [28]. The prevalence of anaemia among women of reproductive age and adolescent girls increased dramatically from 45 and 19%, in 2010 and 2016–2017, to 61% and 39%, in 2010 and 2016–2017, respectively. This further increases the risk of low birth weight that also contributes to child stunting. While 75% of the country's population has access to an improved water source, 95% do not treat their drinking water, thus posing a challenge to improvements in WASH. Only 34% of Burundians have access to an improved toilet, with 56% using non-slab or open latrines. These practices, coupled with flooding, increase the risk of disease. Burundi has suffered from recurrent cholera and malaria outbreaks, which can exacerbate ill-health and malnutrition. As of October 2017, there were more than 6.6 million cases of malaria in the country [26]. While recurrent

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*Food and Nutrition Security in East Africa (Rwanda, Burundi and South Sudan): Status…*

quality all contribute to acute malnutrition in the country [29].

infection contributes to high levels of chronic malnutrition, it also impacts on acute malnutrition. A half of Burundi's 18 Provinces have malnutrition levels of 5–9%, which is categorized as acute. In the Provinces, the wasting rates are 74, 74 and 81% in Kirundo, Kayanza, and Karusi, respectively. Malaria, diarrhea, and poor diet

Approximately 80% of the country's 11 million people live below the poverty line of US \$1.25/day [25]. The general drivers of food and nutrition insecurity for the country include an unplanned increasing population, improper use and sometimes, non-use of the available land for food production and when the two factors

Political stability is a prerequisite to long-term economic development of the country and therefore improvements in food production and long-term and sustained fall in food and nutrition insecurity. Infrastructure improvements, market access to the EAC markets, especially for its livestock, may assist in opening up the country to regional trade and contribute to cash inflows from the partner states of the EAC. However, its situation remains bleak in the face of political instability in the short term, low economic growth potential and unwillingness to fully integrate into the EAC. The stagnating rate of reduction in stunting and wasting will linger on for quite some time into the future, more so due to the significant population increase, despite any potential economic growth. Any improvements in food and nutrition security will still be low as the arable land will compete for land for housing, infra-

Depending on the extent of infection of the population by the COVID-19 pandemic and the level of control and management by government, the expected disruption to the already fragile Burundian economy is bound to have disastrous

• Reduce the malarial, diarrhea, and poor diet influence as they impact

• Improve access to safe water while improving food handling and hygiene

• Continue with the education of communities on the negative influence of early childbearing on child health, nutritional status and child growth and

• Discourage the early cessation of exclusive breastfeeding through appropriate maternal education, and by improving the adequacy of complementary feeding

• Work on reducing underweight and wasting prevalence in the rural areas

• Target rural farmers as poverty disproportionately affects them

consequences on food security, nutrition and health indices.

*DOI: http://dx.doi.org/10.5772/intechopen.95037*

are combined, falling food production results.

structure, industry and institutions.

The Government should endeavour to:

• Reduce unplanned population increases

**3.4 Recommendations**

malnutrition

development

of children 6–23 months of age

practices

**3.3 Prospects**

*Food and Nutrition Security in East Africa (Rwanda, Burundi and South Sudan): Status… DOI: http://dx.doi.org/10.5772/intechopen.95037*

infection contributes to high levels of chronic malnutrition, it also impacts on acute malnutrition. A half of Burundi's 18 Provinces have malnutrition levels of 5–9%, which is categorized as acute. In the Provinces, the wasting rates are 74, 74 and 81% in Kirundo, Kayanza, and Karusi, respectively. Malaria, diarrhea, and poor diet quality all contribute to acute malnutrition in the country [29].

#### **3.3 Prospects**

*Food Security in Africa*

of progress toward meeting the SDGs [25]. According to the most recent data, the maternal mortality ratio is 712 per 100,000 live births, 27% of female deaths are related to pregnancy or childbearing, and one in 13 children will die before reaching 5 years of age. Burundi's nutrition and food security situation has been adversely affected by the ongoing conflict and political instability, in addition to the recurrent natural disasters and epidemics. Burundi ranked last on the Global Hunger Index (GHI) in 2014 [26]. Approximately 2.6 million people were projected to be food insecure as of October 2017 and recent Famine Early Warning Systems Network (FEWS NET) 2018 estimates did not show any improvement [27]. The food security situation remained stressed through May 2018, with some poor households reaching crisis level of food insecurity [27]. Burundi's child stunting prevalence of 56% is among the highest in the world, with levels among the under-5 s having dropped by only 2 percentage points between 2010 and 2017. Also between 2010 and 2017, underweight and wasting prevalence remained virtually unchanged. Rural areas have a much higher prevalence of stunting than urban areas, at 59 and 28%, respectively. Following this pattern, Bujumbura Mairie, the most urban of the Provinces, has the lowest prevalence of stunting at 24%. In the rest of the country, which is highly rural, stunting prevalence varies from 49% in Bururi to 66% in Muyinga [23]. It has been established that stunting levels are linked to maternal education and wealth levels, as 40% of children whose mothers have secondary education or higher are stunted, while the prevalence rises to 61% of children whose mothers had no formal education. According to the wealth status of the mother, 31% of children in the highest wealth quartile are stunted, while in the lowest wealth quartile, 69% are stunted. In Burundi, the level of stunting increases with age, such that 36% of children 6–8 months old are stunted. The prevalence of stunting steadily increases in children and peaks at 66% among children aged 36–47 months. The high prevalence of stunting among children 36–47 months old may be a result of the early cessation of exclusive breastfeeding and inadequate complementary feeding of children 6–23 months of age [23]. The prevalence of exclusive breastfeeding drops dramatically among children 4–5 months old, such that 64% of these children are exclusively breastfed, while among those aged 1 day-3 months, the prevalence of exclusive breastfeeding is 93% [23]. The change to complimentary feeding puts children at risk of exposure to disease-causing agents that are transmitted through unsafe water and unhygienic food handling practices, which can lead to an increase in recurring infections and exacerbate malnutrition. In Burundi childbearing begins early, such that by the age of 19, twenty nine percent of adolescent girls had begun childbearing in 2016–2017, which is a slight decrease from 31 percent in 2010 [23, 28]. In Sub-Saharan Africa, the risk of stunting is 33% higher among first-born children of mothers under 18 years. Early child-bearing has been shown to be a key causative factor of malnutrition [28], because, relative to older mothers, adolescent girls are more likely to be malnourished and have a low birth-weight baby who is more likely to become malnourished, and be at increased risk of illness and death, than those born to older mothers [28]. The prevalence of anaemia among women of reproductive age and adolescent girls increased dramatically from 45 and 19%, in 2010 and 2016–2017, to 61% and 39%, in 2010 and 2016–2017, respectively. This further increases the risk of low birth weight that also contributes to child stunting. While 75% of the country's population has access to an improved water source, 95% do not treat their drinking water, thus posing a challenge to improvements in WASH. Only 34% of Burundians have access to an improved toilet, with 56% using non-slab or open latrines. These practices, coupled with flooding, increase the risk of disease. Burundi has suffered from recurrent cholera and malaria outbreaks, which can exacerbate ill-health and malnutrition. As of October 2017, there were more than 6.6 million cases of malaria in the country [26]. While recurrent

**80**

Approximately 80% of the country's 11 million people live below the poverty line of US \$1.25/day [25]. The general drivers of food and nutrition insecurity for the country include an unplanned increasing population, improper use and sometimes, non-use of the available land for food production and when the two factors are combined, falling food production results.

Political stability is a prerequisite to long-term economic development of the country and therefore improvements in food production and long-term and sustained fall in food and nutrition insecurity. Infrastructure improvements, market access to the EAC markets, especially for its livestock, may assist in opening up the country to regional trade and contribute to cash inflows from the partner states of the EAC. However, its situation remains bleak in the face of political instability in the short term, low economic growth potential and unwillingness to fully integrate into the EAC. The stagnating rate of reduction in stunting and wasting will linger on for quite some time into the future, more so due to the significant population increase, despite any potential economic growth. Any improvements in food and nutrition security will still be low as the arable land will compete for land for housing, infrastructure, industry and institutions.

Depending on the extent of infection of the population by the COVID-19 pandemic and the level of control and management by government, the expected disruption to the already fragile Burundian economy is bound to have disastrous consequences on food security, nutrition and health indices.

#### **3.4 Recommendations**

The Government should endeavour to:

