Is there a need for region-specific policies for malnutrition in Africa?

Malnutrition and undernourishment affect about 1 in 5 people in Africa and remains one of the most important public health problems in African countries. It is a major cause of stillbirths, wasting and stunting in children and low productivity in adults. Meanwhile, incomes across the continent are rising and this is expected to impact the dynamics of malnutrition and undernourishment.

For example, with rising incomes, there is ‘nutrition transition’ where people trade consumption of staple calorie (energy) rich foods for aspirational foods that are rich in other nutrients e.g. proteins. This produces greater diversity in diets, and some consumption patterns are starting to converge to the patterns observed in more developed countries. Understanding these dynamics in the relationship between rising incomes and demand for nutrition (i.e. foods, calories and nutrients) is important for any policy-makers who seek to promote nutritional improvement.

There have been a large number of studies looking at the relationship between rising incomes and demand for nutrition for countries across Africa.  For example, a study by Camara (2013) discusses how incomes shape demand for nutrients across the seasons in Mali.  However, the implications for policy-making can be hard to identify, as several factors might influence the results of any individual study. If we could better recognise and understand these factors, this could inform better policies for nutritional improvement. 

With this in mind, my colleagues and I recently used a meta-analysis of 66 studies to examine how one factor - regional placement of African countries (i.e. North, Southern, East, West and Central Africa) - might explain variations in the relationship between rising income and demand for nutrition.

We decided to focus on regions because different areas of Africa are characterised by differences in agricultural resources (e.g. soils and climate).  Furthermore, there are also regional differences in food cultures, such as preferences for staple crops. We already knew that these biophysical and cultural differences can lead to marked differences in food production and consumption patterns.   For example, per capita production of tubers in Central Africa is about five times the per capita production of tubers in North Africa whilst per capita production of cereals in Central Africa is only about a third of the per capita production of cereals in North Africa (FAO, 2011). What we did not know is how these differences might interact with the effects of rising incomes to affect demand for nutrition.

By aggregating and statistically analysing the 66 studies we found that differences between African regions do play a significant role in determining how rising incomes alter the demand for different types of foods and nutrients. For some food groups, for example for cereals, the variation can be related to food consumption and production patterns across Africa because regions with low production and consumption of cereals had the highest responses for cereal demand due to rising incomes, and vice versa. However, there was no clear or straightforward explanation for the effects on other food groups. We also found that the relationship between income and demand for calories was significantly different between the regions. These differences may influence how growth in incomes will affect the demand for food, and nutritional status.  This also may result in regional differences in the effectiveness of policies for nutritional improvement.

Our results confirm that if similar policy interventions were to be made in different countries, these would have varying impacts on nutritional improvement, depending on the regional location of countries. Examples of income based macro-level policies for nutritional improvement might include direct cash transfers to poorer groups and/or indirect income transfers such as taxing wealthier groups to subsidise food access and prices for the poor. More targeted micro-level policies might involve programmes to supplement feeding vulnerable sections of society such as children, through nutritious school meals; and/or pregnant women through nutritious hospital meals. Our results show the need to allow for region-specific considerations when designing such policies for nutritional improvement across Africa.

Disclaimer: The views expressed in this blog post are the views of the author(s), and not an official position of the institute or funder.