Africa: Inadequate Diets Are Making Populations Vulnerable to COVID-19

The 2020 Global Nutrition Report looks beyond global and national patterns, revealing significant inequalities in nutrition outcomes within countries and populations.
18 May 2020

Johannesburg — AllAfrica's Nontobeko Mlambo spoke with Dr Jane Battersby, an Associate Professor at the University of Cape Town's African Centre for Cities, on the need to address malnutrition in all its forms by tackling injustices in food and health systems. They were speaking after the release of the Global Nutrition Report.

Please give us an overview of what you consider the most worrying and most promising aspects of this report

The Global Nutrition Report is the world leading, independent assessment of the state of global nutrition and has been going since 2013. This year the focus of the report is inequity with specific focus on the food system and universal health coverage. In terms of global figures we are looking at the situation where we have 1 in 9 people in the world are either hungry or undernourished, and 1 in 3 people are over weight or obese. In the African context we are battling with all three types of malnutrition. Around the world there are is 37 countries that are battling with childhood stunting, anemia in women of reproductive age and overweight and 27 of those 37 countries are in Africa. But we are seeing some progress. One of the areas where there have been progress has been the reduction of childhood stunting, the number of children under the age of 5 who are too short for their age has been reduced. In 2012 there were just under a 166 million children globally who were stunted and by 2018 that was reduced to 149 million, so we are making progress on childhood stunting which is great news.

In some countries there has been quite dramatic progress - Ethiopia is a good example of an African country that is making progress, in 2000 Ethiopia 's 57.6% of children under the age of 5 were stunted and by 2016 they have managed to get that down by 38.4%. So we are seeing progress in some areas but it's too slow, there is still more that needs to be done.

For many people food is more about culture,  and nutritional value may not be uppermost in their minds. At times staple foods are not enough to provide all the nutrients the body needs. To what extent does this contribute to malnutrition across the African continent?

For much of the continent the staple is maze meal of some form, there are a few questions around that. The first question is, has that always been the cultural practice? To what extent is that dependent on those staples as a result of long-term agricultural funding? So there is concern that there has been too much money put towards staple food rather than producing a broader range of more diverse and healthier foods. One of the findings of the report is in Burkina Faso the cost from egg calories is 15 times that that of a staple maize.

There is also a question of is a cultural diet. A cultural diet because of the long standing culture or is it a part of this agricultural support. The other concern we have is that, increasingly we are seeing people dependent, particularly in urban areas, on more highly processed versions of those foods. In a South African context you think about the dominance of a couple of big maize meal sellers dominating the market. If you go to many areas there are things like instant pap which are more inefficient than the kind of maize meal you would get in the rural areas. There is a question of the quality of those diets, whether or not the qualify of that food is the same as it always was and I think people are still focused on getting those staples. But we have to make sure that this is made affordable.

Less than 20% of Zimbabwe's children have access to dietary diversity, according to the World Food Programme. The COVID-19 pandemic along with U.S. economic sanctions will impact on this as well. How can authorities counter such trade barriers, tariffs, and restrictions on financial transactions and still win the fight against malnutrition?

The Zimbabwe case is complex and multi-layered, and will require a full analysis. However, what I can say is that the challenge of food insecurity and malnutrition in Zimbabwe is stark. While U.S. economic sanctions play a role, there are other local policy decisions that shaped access to food by Zimbabweans (such as the repealed Statutory Instrument 64 of 2016). The food outcomes are not just the outworking of problems in the food system, but also wider multi-dimensional poverty that shapes food access and food utilisation. The Global Nutrition Report this year focuses on inequity as a cause of malnutrition. These inequities manifest in food systems, health systems and wider social and economic systems. The solutions to child malnutrition are to be found in food and trade policy, but also in concerted, targeted poverty alleviation measures and targeted nutrition interventions.

Considering the widespread damage caused by locusts in East Africa in the past three months, and now floods in a number of areas in the region. What are strategies you can suggest for facing this threat to nutrition?

The first is that there is a need to monitoring of locust migration trajectories to get ahead in terms of spraying. There is a need to provide seed and other inputs to support the farmers who have lost their initial crops. The research that we have conducted in secondary cities in Kenya has found that people access food from a range of sources that come from local and global sources. A diversity of sources of food provides some resilience to shocks and crises like these. In terms of wider nutrition issues in Kenya - we have found in most of the African counties that we work in there is agricultural policy and funding has focused too much on the production of core staple crops. This is making diverse diets more costly for citizens.

The Global Nutrition Report argues that in terms of both health and systemic resilience, there is a need for food systems to "go beyond a narrow focus on energy intake; reduce the dominance of cereal production (maize, rice and wheat); and increase the availability of healthy foods such as fruits and vegetables, nuts and whole grains".

Diversifying of agricultural support could improve both nutrition and food security but also increase systemic resilience.

Malnutrition during the COVID-19 Crisis

What is showing up from the work that was in the report is how vulnerable food systems have already been. We are seeing the impact of that playing out in the food crisis. We are also seeing those existing health disparities really being magnified. Often times the health professionals have failed to consider nutrition adequately, and yet we are seeing with comorbidity and mortality from COVID-19 that nutrition is often essential. For an example in the Western Cape (South Africa), the figures that have been released by the premier on mortality has shown that all but 6% of deaths had some form of comorbidity and most important of those were hypertension, diabetes and obesity. So the consequences of inadequate diets are making our populations very vulnerable to COVID-19.

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