According to experts, 26 percent of children under five in Yumbe District are stunted while three percent are overweight. PHOTO | MARKO TAIBOT
Samira Baiti's situation is a reflection of the struggles many refugees face. Living in Bidi Bidi Refugee Settlement, Baiti bears the heavy burden of caring for her malnourished child alone after she was abandoned by her husband. Her challenges are compounded by a severe lack of resources, as she struggles to provide sufficient food for her family.
“Our daily meal consists of posho and beans. At the beginning of every month, I receive four kilogrammes of maize and two kilogrammes of beans as food support. I also get some salt. All this is supposed to last the entire month,” she says.
In reality, the meagre food supply can hardly feed a family of five for a week. Baiti has had to make painful decisions, including putting an end to breastfeeding her baby due to inadequate nutrition. She feeds the baby on cow milk and vegetables, as advised by health workers.
“I have a piece of land but the yields are often poor due to prolonged dry spells and depleted soil fertility. Since I do not have the money to buy meat, fish, or other nutritious foods, I rely solely on beans to nourish my children,” Baiti says.
Over the years, Uganda has witnessed severe cuts in food assistance for more than 80 percent of refugees across all settlements. This means that, unlike the previous years, the refugees have been forced to produce food.
Zubeda Maida, a mother of five, was also abandoned by her husband, who claimed that their children were born with bald heads. The burden of providing for her family weighs heavily on her shoulders. Their diet mainly consists of beans and they are limited to one meal a day.
‘The inadequate supply of food has taken a toll on the health of my children. When my baby fell ill, the health workers informed me that she was anaemic due to malnutrition,” she says.
The two women find themselves in a condition highlighting the urgent need for support and sustainable solutions to combat malnutrition and food insecurity in refugee communities. The crisis of child malnutrition in Yumbe District has reached alarming levels, with more than 10,000 cases reported. Fifty-five percent of these households are classified as food insecure.
Zubair Ojjo, Yumbe district’s health officer, says food shortages are a major contributing factor to malnutrition. He adds that the issue stems from inadequate food procurement, compounded by the district’s role as a host to refugees, who also rely on local markets for food.
“The limited food supply is stretched thin as refugees and host community members compete for resources in the same markets. There are also low literacy levels among parents about proper nutrition. As a result, we are seeing an increase in cases of undernutrition and severe acute malnutrition, leading to kwashiorkor, mental health issues, and poor academic performance among children,” he notes.
He warns that if these cases are not managed properly, they could impose a significant health and economic burden on the district.
Worsening crisis
Mansur Candia, the district's nutrition focal person, says according to the food security and nutrition assessment conducted in 2022, the malnutrition rate stood at 25.8 percent, with 153 individuals suffering from severe malnutrition. In 2023, however, this figure rose to 27 percent.
“The situation is worsening. The year has just begun but we are already counting 50 malnourished children. By the end of the year, we may see this number double or even triple. This is a concerning trend, which requires an immediate and coordinated response," he states.
Yumbe Ariwa, Kululu, Kuru, and Romogi sub-counties report the highest malnutrition rates, with an average of 20 cases emerging from each sub-county every month.
Stephen Bakole, the district agriculture officer, identifies the provision of less nutritious food to refugees, poor farming practices among the host community and inadequate hygiene and sanitation practices as significant contributors to malnutrition.
Despite Yumbe District having fertile land for crop and animal farming across two seasons, food insecurity in the first season is often exacerbated by climate change, resulting in prolonged dry spells. The previous year was marked by a severe dry spell.
“In addition to the challenges posed by climate change, agricultural production in Yumbe has largely fallen to women, as young people and men show little interest in farming. This lack of participation makes it difficult for the limited workforce to produce enough food to meet the needs of the entire population,” Bakole says.
To combat these challenges, the district encourages farmers to invest in vegetable cultivation and poultry farming, utilising the Four-Acre Model supported by the Parish Development Model (PDM). This is aimed at promoting a balanced diet and addressing malnutrition.
The Four-Acre Model advocates for diversified farming. Farmers allocate one acre to coffee, another to fruits, the third to pasture, and the fourth to food crops.
The district has also implemented the Integrated Management of Acute Malnutrition (IMAM) programme in health facilities. Through this programme, therapeutic feeding is provided in outpatient departments (OPD) to support malnourished children and adults in regaining their strength.
Beyond treatment, efforts have also been made to create awareness within communities. The district has launched campaigns emphasising the importance of breastfeeding, food security, and balanced diets.
Twenty six per-cent of children under five in Yumbe District are stunted while three percent are overweight. PHOTO | MARKO TAIBOT
Costly fight against malnutrition
Peter Eceru, a programme manager with Action Against Hunger Uganda, says Uganda has witnessed a slight reduction in malnutrition cases over the years, although the numbers remain alarmingly high. He highlights that 26 percent of children under five are stunted while three percent are overweight.
“These figures present significant challenges to the country’s health and education systems and the broader development agenda. A severely malnourished child will visit a health facility more than nine times to seek care, compared to a child who is not malnourished. This is costly to the taxpayer. The same child, if stunted, will struggle to achieve their full academic potential,” he says.
Eceru further points out the link between malnutrition and school dropout rates saying in Uganda, 70 percent of learners attend school without meals, posing significant challenges to their learning.
“About 17 percent eventually drop out of school due to malnutrition-related causes. The situation is even more dire for refugees who face food shortages and lack access to land for farming,” he says.
To address these challenges, Action Against Hunger Uganda is implementing interventions to address food and nutrition challenges. One key initiative is the establishment of block farms in Adjumani and Yumbe districts to improve the nutrition outcomes in the country’s most affected areas.
Block farming is a collective approach in which small-scale farmers from refugee and host communities farm together on larger plots of land. This type of farming increases the capacity of resources available to improve food security and income for farmers.
“Under the Right to Grow, our findings demonstrated that about 90 percent of schools in these regions can only provide meals to learners in candidate classes. This ignores the lower primary levels crucial to a child's cognitive development. Our interventions are focused on advocating for policy changes in nutrition,” Eceru says.
He adds that even when civil society organisations step back, the systems built should empower communities and districts to implement nutrition-related projects, creating resilience and sustainability.
According to the World Food Programme (WFP), Uganda spends a staggering $718 million (Shs2.6 trillion) annually on combating malnutrition. This expenditure accounts for 5.6 percent of the country’s gross domestic product (GDP).
Edward Muganga, a senior public health specialist at the Ministry of Health, says the high costs underline the gravity of the situation. Malnutrition remains a persistent challenge despite Uganda’s agricultural potential and significant food exports.
“The cost of treating a single malnourished child can range from Shs5m to Shs10m. But even after treatment, the side effects of the condition may linger. This means enforcing prevention through awareness campaigns is a more sustainable solution,” he says.
Despite being a food-exporting nation, Uganda’s food insecurity levels remain classified as “serious,” according to the 2023 Global Hunger Index. Malnutrition is widespread, with 25 percent of children under five years old stunted and 31 percent undernourished, putting their physical and mental development at risk.
“There is a paradoxical behaviour contributing to malnutrition. Families will sell eggs, chicken, fruits, and vegetables yet their children go hungry. They prioritise earning money over improving their children’s access to nutritious food, only to spend the money they have earned on treating illnesses related to malnutrition,” he notes.
National and global commitments
The Government of Uganda, under the Second National Development Plan (NDP II), committed to ending all forms of malnutrition by 2030. The country’s global and regional commitments include meeting the internationally agreed targets for reducing stunting and wasting in children under five by 2025.
These targets also focus on addressing the nutritional needs of adolescent girls, pregnant and lactating women, and the elderly. According to the 2023 Joint Child Malnutrition Estimates by UNICEF, WHO, and the World Bank, acute malnutrition currently affects more than 268,000 children in Uganda.
Since 2001, the country has achieved notable milestones including reducing stunting to 24.4 percent from 45 percent, reducing the prevalence of underweight children from 10 percent to six percent, and reducing wasting in children from five percent to three percent.
The decline in stunting has been attributed to several nutrition-specific and sensitive interventions such as promoting Infant and Young Child Feeding (IYCF) and capacity building. These efforts highlight the importance of collaborative actions in improving child nutrition and reducing malnutrition-related challenges in Uganda.
However, the pace of progress is insufficient to meet Uganda’s global commitments by 2025. Without accelerated efforts, malnutrition continues to hinder the country’s development and burden its healthcare system.
“We urge leaders and communities to prioritise preventive measures and nutrition education. Awareness is key. Preventing malnutrition is far cheaper and more effective than treating its consequences,” Muganga says.
Uganda’s fight against malnutrition requires sustained commitment and collaborative action from government agencies, development partners and communities to ensure a healthier future for the nation’s children.
