Mapping the consumer foodshed of the Kampala city region shows the importance of urban agriculture.

Due to rapid urbanisation, food systems in sub-Saharan African cities are increasingly under pressure. Through the lens of a foodshed, this paper quantitatively analyses the spatial extent of the food provisioning area for consumers of different socio-economic status in Kampala (Uganda). Based on a primary dataset of surveys with households and food vendors, we map the foodshed by registering where consumers obtain their food, and the origin of where it is grown. We show that 50% of the food consumed in the city originates from within a 120 km proximity to Kampala, including 10% from within the city itself. At present, urban agricultural activities are twice as important as international imports for the urban food provision. Established, high-income urban dwellers have a more local foodshed due to their broad participation in urban agriculture, while low-income newcomers rely heavily on retailers who source food from rural Uganda.

Assessment of environmental exposure factors on child diarrhea and systemic inflammation in the Eastern Cape.

Poor environmental technologies and gastrointestinal illnesses have been hypothesized to be a primary cause to the lack of impact of child health programs on child stunting rates (low height-for-age) in South Africa. This study assessed correlations between environmental exposures (water source, water treatment, sanitation, refuse), diarrheal occurrences, and systemic inflammation proxies among female and male children under five years of age in the Eastern Cape. A conceptual model was hypothesized using structural equation (SE) modeling and two sex-specific (female and male) datasets were subsequently generated from the data and applied to the hypothesized SE model. Results suggested that environmental exposure variables associated with diarrhea and systemic inflammation proxies were different between females and males. For diarrheal occurrences among females, an increase in local authority management of refuse (compared to household management) (0.161, p-value (p) = 0.007), sharing sanitation facilities (0.060, p = 0.023), and a decrease in the frequency of the treatment of drinking water (-0.043, p = 0.025) were correlated with an increase in diarrhea. For males, an increase in household use of flush toilets (as compared to ventilated pit latrines) was correlated with an increase in diarrhea (0.113, p = 0.027). For systemic inflammation among both sexes, an increase in household use of water pumped into the premises (as compared to a public water tap) and an increase in diarrheal occurrences were correlated with an increase in systemic inflammation. The data support an increased focus on sex and gender specific factors among field practitioners and policy makers working in the environmental health field in South Africa.

A comparative analysis of socioeconomic inequities in stunting: a case of three middle-income African countries.

BACKGROUND: Despite increased economic growth and development, and existence of various policies and interventions aimed at improving food security and nutrition, majority of countries in sub-Saharan Africa have very high levels of child malnutrition. The prevalence of stunting, an indicator of chronic malnutrition, is especially high. METHODS: In this paper, we use Demographic and Health Survey datasets from three countries in the region that obtained middle-income status over the last decade (Ghana, Kenya and Zambia), to provide a comparative quantitative assessment of stunting levels, and examine patterns in stunting inequalities between 2007 and 2014. RESULTS: Our analyses reveal that stunting rates decreased in all three countries over the study period, but are still high. In Zambia, 40% of under 5-year olds are stunted, compared to 26% in Kenya and 19% in Ghana. In all three countries, male children and those living in the poorest households have significantly higher levels of stunting. We also observe stark inequalities across socio-economic status, and show that these inequalities have increased over time. CONCLUSIONS: Our results reveal that even with economic gains at the national level, there is need for continued focus on improving the socio-economic levels of the poorest households, if child nutritional outcomes are to improve.

Keystones affecting sub-Saharan Africa's prospects for achieving food security through balanced diets.

Socio-economic dynamics determine the transition from diets characterized by the risk of famine, to those characterized by the risk of diet-related non-communicable disease (DR-NCD). This transition is of particular concern in Sub-Saharan Africa (SSA) in which key socio-economic interactions that influence diet include economic growth and rapid urbanization; inequality and a growing middle class; and obesogenic food environments and an increasing prevalence of DR-NCD. In each case, countries in SSA are among those experiencing the most rapid change in the world. These interactions, styled as 'keystones', affect the functioning of other components of the food system and the diets that result. Data from the wealthiest quartile of countries in SSA suggest that these keystones may be increasing the risk of DR-NCD, widening inequalities in health outcomes due to unbalanced diets. To address this, new consumer and government capabilities that address these keystones are required. Food sensitive urban planning, supporting food literacy and fiscal management of consumption are examples.

The economic impacts of premature adult mortality: panel data evidence from KwaZulu-Natal, South Africa.

Measuring the household level economic impacts of AIDS-related deaths is of particular salience in South Africa, a country struggling with a legacy of poverty and economic inequality in the midst of an HIV epidemic. Household panel data that span more than a decade permit us to resolve many of the statistical problems that make it difficult to determine these impacts. After allowing for the impact of demographic adjustments and other coping strategies, we found evidence that these impacts are quite different across different types of households, and that the largest and most persistent effects were in the middle ranges of the South African income distribution, that is, households just above the poverty line. Households below that level seem less severely affected, whereas those above it seem to recover more quickly. All these results need to be treated with caution because their statistical precision is weak.

The impact of life skills education on adolescent sexual risk behaviors in KwaZulu-Natal, South Africa.

PURPOSE: To assess the impact of exposure to life skills education by youth in KwaZulu-Natal Province (KZN, South Africa) on knowledge and behaviors associated with the spread of HIV/AIDS. METHODS: Data come from a panel study of 2222 youth from several population subgroups in KZN. The youth were aged 14-24 years when interviewed in 1999 and 2001. The intervention was a full coverage life skills education program for all students in middle and secondary schools. Impact was measured as net dose-response relationships between life skills exposure and outcomes. Econometric methods were used to control for nonrandom exposure to life skills education. Outcomes included sexual behavior and condom use indicators. RESULTS: Significant effects, albeit modest in magnitude, were observed on selected areas of sexual-reproductive health knowledge and perceived condom self-efficacy, along with larger effects on condom use at first and last sex. No consistent effects on age at sexual initiation, secondary abstinence, or partnering behaviors were observed among these youth. CONCLUSIONS: School-based life skills education appears capable of communicating key information and helping youth develop skills relevant to reducing HIV risk. However, the South African national program has yet to be fully implemented, and whether this initiative will result in sustained behavior modification among youth on a sufficient scale to affect the HIV/AIDS epidemic is uncertain.

Communities, opportunities, and adolescents' sexual behavior in KwaZulu-Natal, South Africa.

In 2002, the prevalence of HIV among South African clinic attendees under the age of 20 was 15 percent, suggesting a correspondingly high level of unprotected sex and risky sexual behavior. Past research focused on the dynamics of individuals' and partners' sexual decisionmaking without accounting for the larger context in which such decisions are made. Do adolescents' opportunities for schooling, work, and other community activities make a difference? This study uses data collected from a representative sample of young people living in KwaZulu-Natal, South Africa, to explore these questions. Logit analyses show that for girls, higher levels of education reduced the probability of having had sex in the 12 months prior to the survey, and average wages were positively associated with condom use. Greater participation in community sports increased risk-taking behaviors among boys but decreased them among girls. Within the household, education of adults had a positive effect on condom use for both boys and girls.