Food insecurity, dietary diversity and the right to adequate food among households in landslide-prone communities in Eastern Uganda: A cohort study.

We assessed food insecurity, dietary diversity and the right to adequate food among households in communities in Eastern Uganda that were affected by major landslides in 2010 and 2018. A prospective cohort study was applied to select 422 households during May-August (the food-plenty season) of 2019. In January-March (the food-poor season) of 2020, 388 households were re-assessed. Socio-demographic, food security, dietary diversity and right to adequate food data were collected using structured questionnaires. Four focus groups discussions and key informant interviews with 10 purposively sampled duty-bearers explored issues of food insecurity, dietary and the right to adequate food. The affected households had significantly higher mean (SE) food insecurity scores than controls, both during the food plenty season: 15.3 (0.5) vs. 10.8 (0.5), and during food-poor season: 15.9 (0.4) vs. 12.5 (0.0). The affected households had significantly lower mean (SE) dietary diversity scores than controls during the food plenty season: 5.4 (0.2) vs. 7.5 (0.2) and during the food poor season: 5.2 (0.2) vs. 7.3 (0.1). Multivariate analyses showed that the disaster event, education and main source of livelihood, were significantly associated with household food security and dietary diversity during the food-plenty season whereas during the food-poor season, the disaster event and education were associated with household food security and dietary diversity. During both food seasons, the majority of affected and control households reported to have consumed unsafe food. Cash-handout was the most preferred for ensuring the right to adequate food. Comprehension and awareness of human rights principles and state obligations were low. The severity of food-insecurity and dietary diversity differed significantly between the affected and control households during both food seasons. Moreover, the right to adequate food of landslide victims faced challenges to its realization. There is need for policy and planning frameworks that cater for seasonal variations, disaster effects and right to adequate food in order to reduce landslide victims' vulnerability to food insecurity and poor dietary diversity. In the long-term, education and income diversification program interventions need to be integrated into disaster recovery programs since they are central in enhancing the resilience of rural livelihoods to shocks and stressors on the food system.

Seasonality- and disaster effects on food variety and food insecurity coping strategies among a landslide-prone cohort.

BACKGROUND & AIMS: Landslides may impact on nutritional health among vulnerable populations. However, there is limited data on the seasonal effects of landslides on diet and food security. Among the 2010 and 2018 households affected by the landslides in Eastern Uganda, we assessed seasonality and disaster effects on food varieties consumed and food insecurity coping strategies. This study is among the first to report on seasonal- and disaster effects on food varieties and food insecurity coping strategies among vulnerable populations in Uganda. METHODS: We used a three-stage simple random technique to select a total of 422 households during May-August (food-plenty season) in 2019, of whom 211 had been affected by the landslides and 211 had not (controls). Six months later, in January-March (food-poor season) of 2020, 388 households were re-assessed (191 affected and 197 controls). We analyzed data only from the households that participated in both food seasons to compare results between the two food seasons. Food variety scores (FVS) were obtained by summing the frequency of weekly intakes of 86 food items while a coping index was derived based on the severity weighting of household food insecurity coping strategies. RESULTS: After adjusting for covariates, significantly lower mean (SE) FVS were among the affected than controls during the food-plenty season: 9.3 (0.5) vs 11.4 (0.3), and during the food-poor season: 7.6 (0.5) vs 10.1 (0.1) (P < 0.001 for both). The affected households were more likely to use food insecurity coping strategies compared to controls (mean [SE]: 35.2 [2.1] vs. 27.1 [1.8], P < 0.001) during the food-plenty season and the severity further increased during the food-poor season: 42.1 (2.1) vs. 28.2 (2.1) (P < 0.001). Disaster exposure was associated with both household food varieties and food insecurity coping strategies during both food seasons (P < 0.001). The adjusted models, showed that, the affected compared to the controls had a significantly higher likelihood to rely on 5 of the 11 coping strategies during food-plenty season and 9 of the 11 coping strategies during the food-poor season. CONCLUSION: Low variety diets and coping strategies among disaster affected individuals cut across seasons and implies needs for strong social protection and targeted safety nets irrespective of season.

Malnutrition and Associated Risk Factors among Children 6-59 Months Old in the Landslide-Prone Bududa District, Eastern Uganda: A Cohort Study.

BACKGROUND: The United Nations Sustainable Development Goal 2.2 calls for an end to all forms of malnutrition. This might be derailed due to persistent landslide disasters in low-income countries like Uganda. OBJECTIVES: The prevalence of malnutrition and the impact of seasonal variations and associated factors were assessed among children aged 6-59 mo in the landslide-affected households in Bududa District, eastern Uganda. METHODS: A prospective cohort study using a 2-stage simple random technique was applied to select 422 households including 392 children during May-August (food-plenty season) 2019. After 6 mo, in January-March (food-poor season) 2020, 388 households and 366 children were assessed. Socioeconomic and demographic data were collected using structured questionnaires. Child malnutrition outcomes were defined according to WHO criteria. Factors associated with malnutrition outcomes were identified by bivariate and multivariate logistic regression. RESULTS: Stunting, underweight, wasting, and overweight prevalences were 37.7%, 13.3%, 3.6%, and 4.3%, respectively, in the food-plenty season and 42.6%, 14.2%, 2.1%, and 2.7%, respectively, in the food-poor season. Residing in the landslide-affected sub-county increased the odds for stunting [adjusted OR (aOR): 1.68; 95% CI: 1.08, 2.59; P = 0.025] and underweight (aOR = 4.25; 95% CI: 1.10, 15.36; P = 0.032) for children in the food-plenty season. Child age, sex, breastfeeding status, a nonimproved drinking water source, migration of any household member, and parents' education were significant risk factors in the food-plenty season. In the food-poor season, parents' education status, loss of any household member, child sex, and child age were significant risk factors. CONCLUSIONS: Stunting and underweight were more prevalent in the food-poor season while wasting and overweight were more prevalent in the food-plenty season. With the exception of child age, child sex, and parents' education, child malnutrition risk factors differed between food-plenty and food-poor seasons. There is a need to address seasonality factors in program interventions targeting children <5 y in landslide-prone areas.

Housing, water and sanitation implications on food insecurity and diet diversity in landslide affected communities: A cross-sectional survey of two districts in Uganda.

BACKGROUND: The major landslide of 2010 in Bududa district in Eastern Uganda is the most catastrophic natural disaster in Uganda's recorded history. An estimated 350 people died and some of the affected were resettled in Kiryandongo district. We assessed housing, water and sanitation practises of affected households and controls to establish possible implications on food insecurity and diet diversity. METHODS: This cross-sectional study assessed 1078 affected and control households in Bududa and Kiryandongo districts. The head of the households were either affected, selected from landslide disaster-affected communities, or controls from a random sub-county bordering the affected. Structured interviews were used and entries were tested statistically to report crude estimates based on the Pearson x2 and ANOVA, while adjusted analysis used multivariate analysis of co-variance (MANCOVA) and Wald's Odds Ratio (OR) of Binary Logistic Regression at the 95% CI. RESULTS: On adjusting for the disaster and covariates, households who had insufficient access to water scored higher mean (SE) on food insecurity than those who reported sufficient access: 13.1 (0.4) vs. 9.5 (0.3) (P < 0.01). Intriguingly, households who owned a toilet and those who reported always using soap to wash hands scored higher food insecurity than their counterparts: 11.1 (0.3) vs. 9.0 (0.6) (P < 0.01) and 11.3 (0.3) vs. 9.1 (0.5) (P < 0.01), respectively. However, not owning a toilet increased the likelihood of being food insecure (OR 3.43; 95% CI 1.31, 8.97; P = 0.02). In Kiryandongo, affected households scored higher food insecurity than controls: 9.5 (0.5) vs. 5.4 (0.5) (P < 0.01) and higher diet diversity scores (DDS): 6.7 (0.2) vs. 6.2 (0.2) (P = 0.04). Type of housing also predicted food insecurity (P < 0.01) and DDS (P = 0.03). Like Bududa, households with insufficient water access scored higher food insecurity while those owning toilet scored higher DDS. Uniquely, only number of rooms was linked to a high likelihood of being food insecure (OR 1.60; 95% CI 1.19, 2.15; P < 0.05). CONCLUSION: Disaster, food security and diet were sensitive to housing, water and sanitation and were integral to an adequate standard of living of victims of this landslide.