Doctoral Degrees (Human Nutrition)

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Browsing Doctoral Degrees (Human Nutrition) by browse.metadata.advisor "Ekesa, Beatrice"

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    Development of contextualised food-based strategy to improve the dietary diversity and nutritional status of children aged 12 to 36 months in rural farming households in central Uganda
    (Stellenbosch : Stellenbosch University, 2020-12) Nabuuma, Deborah; Mbhenyane, Xikombiso; Ekesa, Beatrice; Faber, Mieke; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY: Food insecurity, low dietary diversity, and malnutrition remain prevalent in sub-Saharan Africa. Food-based strategies have a high potential of improving diet quality in agriculture-dependent communities and their development and effectiveness can be enhanced by systematic approaches. This study aimed to develop a food-based strategy to improve the dietary diversity of children aged 12 to 36 months from rural smallholder farming households in Central Uganda. An embedded-sequential, mixed-methods research design was used: i) quantitative situation analysis using household and market surveys, ii) qualitative assessment of community perspectives using focus group discussions, iii) design of the food-based strategy using intervention mapping, and iv) qualitative validation using key informant interviews and focus group discussions. The results showed household food production and food consumption were mainly based on cereals and grains, roots, tubers, cooking bananas and legumes. There was low dietary diversity; 78% of six- to 23-month-old children did not meet the minimum dietary diversity and 71% of children ≥ 24 months were consuming less than three food groups. The most accessed markets had limited diversity of food groups (six out of 11 (55%)) compared to other markets in the community. Food production and consumption focused on priority crops that alleviated hunger and contributed to income – mainly maize, cooking bananas, sweet potatoes, cassava and beans. Food production was influenced by access to land, production costs, income potential, climate and farmer knowledge. The cost of food and market availability influenced the type and quantity of food bought and consumed. Poor perception towards meetings/training and inadequate nutrition information and skills were noted. These findings, relevant theory and literature were applied using intervention mapping to systematically identify determinants, outcomes, objectives, and pathways to improve dietary diversity. The resulting contextualised food-based strategy (CFBS) aims to improve dietary diversity of children in smallholder farming households through improved household production, income utilisation, and food consumption practices by: i) increasing diversity of foods produced, particularly fruits and vegetables, ii) increasing access to diverse foods through appropriate income and market, including an increase in diversity of foods in consumer markets and financial literacy, and iii) improving the quality of diets consumed, especially diversity, frequency, nutrient quality and safety through nutrition education. Actors included policy makers, development organisations, extension workers, community-level groups, community champions and smallholder farmers. Validation results rated the factors and actors in the CFBS as important for improving productivity, food availability, dietary diversity, livelihoods of smallholder farmers, thereby verifying the strategy and design process used. To improve dietary diversity among rural smallholder farmers, their food security and production challenges need to be addressed. This increases the relevance and motivation to participate and implement recommended practices. Markets have the potential to significantly contribute to dietary diversity. However, this requires adequate supply and demand of diverse foods in rural consumer food markets, as well as income and financial literacy to facilitate financial decisions that promote dietary diversity. The CFBS empowers smallholder farmers to decide on a course of action that achieves dietary diversity, having been equipped with information and skills on agriculture, nutrition and finances.