food security and nutrition assessment

Food Security and Nutrition AssessmentRefugee Settlements and Kampala

December 2020

UNHCR Representation in Uganda

Key stakeholders

• GOU: OPM, MoH, UBOS, DLGs.

• UN: UNHCR, WFP, UNICEF.

• NGOs: MTI, IRC, ACF, FHU, SCI,

AHA, LWF, AFI, AVSI, ALIGHT, AIRD,

HFU, OPWIG, PACHEDO, PAG.

• Refugees, VHTs, RWCs.

Thematic areas

• Demography

• Nutrition

• Health

• Food Security

• LITN

• WASH

• GBV

• Energy

Methodology

• Cross-sectional study, SMART methodology, cluster sampling

• 42,530 individuals, 7141 households reached in settlements and Kampala

• 51.8% female and 48.2% male

Nutrition

0

3

6

9

12

2014 2015 2016 2017 2020

% C

hild

ren

6-5

9 m

on

ths

Global Acute Malnutrition

ALL South West West Nile

0

2

4

6

8

2015 2016 2017 2020

% C

hild

ren

6-5

9 m

on

ths

Severe and Moderate Acute Malnutrition

MAM SAM

Acute Malnutrition

Acute Malnutrition

0

1

2

3

4

5

6

7

8

West Nile South West Kampala

% C

hild

ren

6-5

9 m

on

ths

GAM by Weight for Height Z-Scores

GAM MAM SAM

0

1

2

3

4

South West West Nile Kampala

% C

hild

ren

6-5

9 m

on

ths

GAM by MUAC

GAM MAM SAM

0

10

20

30

40

50

2015 2016 2017 2020

% C

hild

ren

6-5

9 m

on

ths

REGIONAL STUNTING TREND ANALYSIS

West Nile South West

Stunting

Stunting and Underweight

0

10

20

30

40

50


% C

hild

ren

6-5

9 m

on

ths

Stunting Underweight

Anemia Trends

0

20

40

60

80

2014 2015 2016 2017 Jan2020

Dec2020

% C

hild

ren

6-5

9 m

on

ths

Anemia children (6-59) trends

All West Nile South West

0

15

30

45

60

2014 2015 2016 2017 Jan 20 Dec 20

% W

RA

15

-49

ye

ars

Anemia WRA (15-49) trends

South West West Nile

IYCF

0

20

40

60

80

100

2014 2015 2016 2017 Jan 2020 Dec 2020

% c

hild

an

em

ia v

co

nsu

me

Iro

n-r

ich

Child Anemia and Iron-rich foods

Iron-rich foods Child Anemia

Anemia

0

10

20

30

40

50

60

70

80%

Ch

ildre

n 6

-50 m

onth

s, W

RA

15

-49 y

ears

Children (5-59 months) Non Pregnant WRA (15-49 years)

Contributing Factors

• Low dietary diversity – coping

mechanism to ration cuts, less

Vit C (plant-based diets)

• Disease incidence – malaria,

intestinal worms

0

20

40

60

80

100

120

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Incid

en

t R

ate

Malaria Incidence Rates 2020

U5 Crude

IYCF – Optimal Breastfeeding

0 10 20 30 40 50 60 70 80 90 100

Use of infant Formula

Bottlefeeding

Breastfeeding at 2 years

Breastfeeding at 1 year

Exclusive BF

Early Initiation of BF

Optimal Feeding practices

All South West West Nile

IYCF – Complementary Feeding and Dietary Diversity

0 10 20 30 40 50 60 70 80 90

Timely intro of CF (6-8 months)

Consumption of Iron-rich foods

Consuming 1-3 food groups

Consuming 4-7 food groups


Palorinya (7.8%), Kyangwali (10.6%) Nakivale (16.3%) had lowest MDD-C

25.2% SW, 21.9% WN consumed iron-rich foods

Maternal Nutrition

0 2 4 6 8

Total Malnutrition

Severe Malnutrition

Moderate Malnutrition

Malnutrition among PLWs

Kampala South West West Nile

0 20 40 60 80

Underweight

Normal

Overweight

Obesity

Malnutrition in non-pregnant WRA


Maternal Nutrition

0 10 20 30 40 50 60 70 80

West Nile

South West

Kampala

Women Dietary Diversity (MDD-W)

5-7 food groups 1-4 food groups

98.7% grains & tubers

79.7% legumes & pulses

51.6% nuts & seeds

50.1% dark green leafys

Health

Child Health

0 5 10 15 20 25

Adjumani

Bidibidi

Imvepi

Lobule

Kampala

Kiryandongo

Kyaka II

Kyangwali

Nakivale

Oruchinga

Palabek

Palorinya

Rhino Camp

Rwamwanja

Diarrhea

0

20

40

60

80


Treatment of Diarrhea

ORS ZINC

Child Health

0

20

40

60

80

100


% C

hild

ren

ta

rge

t a

ge

Child Health

Measles Vaccination Vit. A Suppl. Deworming

65

70

75

80

85

90

2015 2016 2017 Jan 20 Dec 20

% C

hild

ren

12

-59

mo

nth

s

TREND ANALYSIS - DEWORMING

SRH - ANC

93.7% were

enrolled for ANC

in last pregnancy

– 95.3% SW,

94.2% WN,

74.9% K’LA

0

20

40

60

80


% P

reg

na

nt o

n A

NC

NUMBER OF ANC VISITS

1-3 times 4-7 times ≥8 times

SRH – Family Planning

14.7% ever used FP -

SW 19.8%,

WN 11.1%,

K’LA 4.9%

0

20

40

60

80

COCs Condoms Depo

Provera

Implant IUD POPs Other

% W

RA

wh

o e

ver

use

d F

P

MOST PREFERRED FP METHOD


SRH - Family Planning

0 5 10 15 20 25 30 35 40

Easy to use

Readily available

Less side effects

Not easy to identify in use

Other

Takes longer in body

Reasons for choice of FP method


SRH - Family Planning

0 5 10 15 20 25 30 35 40

Easy to use

Readily available

Less side effects

Not easy to identify in use

Other

Takes longer in body

Reasons for preference of FP method


Barriers to Family Planning

0 10 20 30 40 50 60

Don’t know about FP

Don’t know where to access it

My culture not permit

Not available at facility

Other

Partner is against it

Side effect of FP

Still want to have children


WASH

0 20 40 60 80 100

Cloth

Filter Composite

Other

Chlorine

Settle bottom

Boil

None

Drinking Water Safety Method


0 10 20 30 40 50 60 70

Protecetd hand dug well

Protected spring

Surface water

Unprotected dug well

Piped connection

Boreholes

Public tap

Drinking Water Sources


WASH

0

10

20

30

40

50

60

<10L 10-14.9L 15-19.9L ≥20L

WATER CONSUMPTION L/P/D


WASH

0 20 40 60 80 100

Bucket toilet

Others

Open defecation

Communal latrine

Flush toilet

Household latrine

Fecal Disposal Method


Energy and Environment

Energy

0

20

40

60

80

100

Wood Charcoal Other

COOKING FUEL SOURCES


Livelihoods

Unmet Basic Needs

0

10

20

30

40

50

60

70

Water Energy Assets Debt Savings Educ Other None Utilities Hygiene Healthcare Food


Food Security

GFA Cash Expenditure

0 10 20 30 40 50 60 70 80 90 100

Water

Livelihoods

Debt

Savings

Education

Utilities

Energy

Hygiene

Healthcare

Food


Household Food Consumption

Insufficient food consumption from47% in Jan 2020 to 33% in Dec 2020

Food consumption in 11/13settlements. Substantial gains inOruchinga, Nakivale and Kyaka II.

11/13 settlements had just receiveddouble GFA during data collection.

Above-average 2020 second seasonharvests and low staple food pricessince May 2020.

45

%

34

%

26

%

48

%

59

%

54

%

38

%

62

%

52

% 57

%

74

%

46

%

32

%

47

%

25

%

43

%

11

%

47

%

21

%

38

%

19

%

20

%

15

%

31

%

50

%

47

%

14

%

33

%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Ad

jum

ani

Bid

ibid

i

Imvep

i

Kir

yan

do

ng

o

Ky

aka

II

Ky

angw

ali

Lo

bu

le

Nak

ival

e

Oru

chin

ga

Pal

abek

Pal

ori

nya

Rhin

o

Rw

amw

anja

Set

tlem

ent

aver

age

Pro

po

rtio

n o

f H

Hs

Proportion of HHs with insufficient food consumption

FSNA, Jan-2020 FSNA, Dec-2020

Settlement Markets Food Prices

Maize grain1,214 1,227 1,142 1,009 924 880 844 876 889 840 801

Beans

3,467 3,603

3,186 3,151 3,228 3,135 2,992

2,741 2,633 2,699 2,671

Vegetable oil5,786

5,969 5,790 5,757 5,788 5,693 5,657 5,718

6,040 6,229

6,418

Salt

3,086

2,314 2,079 2,003 1,945 2,071 1,977 2,000 1,980 1,983 2,018

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

UG

X/k

g

Market price trends Jan 2020-February 2021• Food prices low since Apr-

May June 2020, above

average harvests in 2020.

• Retail prices for maize,

beans and salt reduced by

28%, 23% & 30% between

Mar 20 and Feb 2021.

• The cost Food MEB

reduced by 18% overall (-

23% in SW & -14% in WN)

• FS more likely moderated

by higher consumption in

Dec

Economic Vulnerability High HH spending on food is proxy of

economic stress. Limited capacity to

meet essential needs and manage

fluctuations in prices.

Proportion of economically stressed

HHs increased by 45% from Jan to

Dec 2020.

More spending on food likely due to

the ration reductions, and decreased

spending on non-food items due to the

lock-down.

52%

15%

24%

16%

35%

19%

40%36%

22%

11%

21% 23% 20%27%

82%79% 77%

60% 63%

85%

74%

54%57%

86% 85%

72%

49%

72%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ad

jum

ani

Bid

ibid

i

Imvep

i

Kir

yan

do

ng

o

Ky

aka

II

Ky

angw

ali

Lo

bu

le

Nak

ival

e

Oru

chin

ga

Pal

abek

Pal

ori

nya

Rhin

o

Rw

amw

anja

Set

tlem

ent

aver

age

Pro

po

rtio

n o

f ho

use

ho

lds

Proportion of households with high food expenditure share

FSNA, Jan 2020 FSNA, Dec 2020

Overall Food InsecurityOverall, the prevalence of food insecurity

unchanged between the two surveys.

Impact of ration cuts likely cushioned by

reduced food prices, good harvests.

Regional difference remain, food

insecurity at 26% in SW and 36% in WN

Food security deteriorated in Bidibidi and

Rhino camp and improved in Kyaka II,

Nakivale and Oruchinga.

42%

25%22%

39%

56%

36%32%

46%

36%

30%

59%

35%

23%

37%

28%

41%

17%

41%

30%

43%

23% 24%18%

33%

58%

49%

14%

36%

0%

10%

20%

30%

40%

50%

60%

70%

Ad

jum

ani

Bid

ibid

i

Imvep

i

Kir

yan

do

ng

o

Ky

aka

II

Ky

angw

ali

Lo

bu

le

Nak

ival

e

Oru

chin

ga

Pal

abek

Pal

ori

nya

Rhin

o c

amp

Rw

amw

anja

Set

tlem

ent

aver

age

Pro

po

rtio

n o

f H

Hs

Proportion of Food Insecure households

FSNA, Jan-2020 FSNA, Dec-2020

Household Food Consumption (updated)

42%

25%

43%

11%

47%

21%

38%

19% 20%

15%

31%

50%47%

14%

33%

45%

34%

26%

48%

59%

54%

38%

62%

52%

57%

74%

46%

32%

47%

MVAM March 2021 FSNA, Dec-2020 FSNA, Jan-2020

Proportion HHs with Insufficient Consumption

Considerations and Risk Factors to Monitor• Food Prices (return to normal from low)

• Resumption of education. Substitution of expenditures towards food to become more unlikely.

• Double distributions (monitor food consumption and food security outcomes in the 2nd month

after distribution).

Settlement Distribution Mode

November December January February

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

Rwamwanja Double *

Kyangwali Double * *

Kyaka II Double * *

Nakivale Single * * *

Oruchinga Single *

Rhino Camp Double *

Palorinya Double * *

Imvepi Double * *

Bidibidi Double * *

Lobule Double * *

Actions on AnemiaImmediate Implementation status

Anemia typing (causal analysis) Pilot done, planned for scaleup

Deworming Routine, planned for scaleup

Bi-annual anemia screening + treatment Part of 2021 activities

Iron-Folic Acid supplementation Routine, limited to pregnant women

Mid-term to long term

Nutrition-sensitive food systems

Fortification of school meals Not done

Kitchen gardens (variety) Done, small scale

Biofortification (iron-rich beans, orange-fleshed potatoes) Pilot, small scale

Food Security and Livelihoods Ongoing, gaps

Kyangwali Pilot** Ongoing

Others

MIYCAN and Anemia sensitization Ongoing, scaleup

Malaria control Ongoing

What has worked elsewhere

Fortifying rice in school meals

contributed to a 20% reduction

in Anemia in 99,231 in Odisha,

India at a cost of $0.06 – $0.09

per child over 3 years -

Nutrition Exchange

Weekly Iron-Folic Acid for all WRA

and regular deworming reduced

Anemia (WRA) from 37.5% to

19.3%, Iron deficiency from 22.8%

to 9.3%, and intestinal worms from

76.2% 23.0% over 12 months in

Vietnam - WHO

Take Away

• Continuity of treatment services for acute malnutrition, anemia

• Aligning short term and long-term actions on anemia reduction

• Potential areas of investment – nutrition-sensitive food systems,

school feeding, kitchen gardens, behavior change

• Midterm to long term actions on food security and livelihoods

The end

food security and nutrition assessment

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