Differential returns from globalization to women smallholder coffee and food producers in rural Uganda - African Health Sciences, Vol. 13, No. 3

The African Growth and Opportunity Act was signed into law under the former American President, Bill Clinton in 2000 and while the promises of economic stability and better working conditions sounded great, unfortunately this was not the case. The Guardian's recent publication: "Uganda has little to show for African trade agreement with the US", emphasizes this very issue, that although the African growth and Opportunity Act was a great step to diminishing the poverty-stricken communities within African countries, not much has changed since. Further, special interest is taken by the author in regards to gender inequality. This inequality of women is important when discussing working conditions in developing countries.

While the signing was an important step in gaining traction of this issue, it is by no means the first step that has been taken against inequality and poverty of workers in the developing countries of Africa. In the late 1980's, it is suggested by Kanyamurwa et al. in their journal: "Differential returns from globalization to women smallholder coffee and food producers in rural Uganda", that globalization-related measures were applied in Uganda to create a more liberal trade, as well as hopes to stimulate export in coffee and other agriculture sectors. The intention being, that doing this would not only revitalize agricultural production, but also increase the incomes of farmers and improve rural food security throughout the country. To this end, the authors' objective of the study was to explore the different effects the measures had on the health and dietary outcomes of female owners and operators of small coffee and food farms in Uganda.

The methods used in this study were of a cross- sectional comparative interview survey of 190 female coffee producers, as well as a 191 female food producers in Ntungamo district, Uganda, employing mainly quantitative methods of data collection, specifically targeting the sampled households. Three months after the original quantitative data was collected, the authors also utilized qualitative data from the same households. Extra qualitative information was collected from key informants at national, district, and community levels using qualitative interviews based on an unstructured interview guide in order to concretize the study. Using indicators of production, income, access to food and dietary patterns, women's health and health care and from the two study-groups selected from the same area, female coffee producers represented a higher level of integration into liberalized export markets.

While Uganda's economy grew exponentially throughout this period, the household economic and social gains after the liberalization of the markets  may have been less than expected. In the survey carried out, both food and coffee producers were similarly poor, involved in similar scales of production, and of the same age and education level. Yet, coffee producers had greater land and livestock ownership, greater access to inputs, higher levels of income and used a greater variety of markets than food producers. Consequently, however, they spent longer hours to obtain these economic gains, and spent more money on healthcare and food from commercial sources. Their health were similar to the food producers, but with poorer dietary outcomes and far greater food stress.

In summary, it is suggested by Kanyamurwa et al., that the small-scale women farmers who are producing food cannot rely on the economic infrastructure to give them support for sustaining meaningful levels of agricultural production. Yet, despite having higher incomes than their food producing neighbours, female farmers who are dependent on producing coffee as an export commodity cannot rely on the income made by their crops to sustain their health and nutritional wellbeing. Consequently, both groups have limited levels of autonomy to address these very crucial issues.



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Esha Homenauth -- A Student Perspective: Role of Nutrition in Anti-Retroviral Therapy

In Africa, approximately 25 million people are victim to HIV/AIDS (UNAIDS, 2006). In Malawi 46% of young adults between the ages of 15-24 are affected, with 60% of the infections occurring mostly among girls. Gender, demographic and geographical discrepancies in HIV/AIDS prevalence exists within the country, reinforcing the need for government interventions. Through improved education on modes of HIV transmission, risk reduction, blood screening and efficient barrier methods, antibody testing, disclosure and notification of partners, prevention of mother-to-child transmission (PMTCT) services, medical treatment and management of infected individuals including the use of anti-retroviral therapy (ART), the risk of transmission of HIV/AIDS will be greatly reduced.

Wasting and weight loss are the main problems among HIV-infected individuals. Adequate nutrition is important for successful ART. Research shows that malnutrition prior to ART is significantly associated with increased mortality (Ni et al, 2006). As such, nutritional intervention plays an integral role in the HIV treatment program, reinforcing the need for an improved diet to enhance ART acceptability, adherence and effectiveness.

A study by Bisika and Mandere published in vol. 20 no 3 of the Malawi Medical Journal focuses on identifying an intervention that would complement the the use of ART in Malawi. Qualitative data was collected through consultative workshops and in-depth interviews with health professionals and representatives from community-based organizations. 85% of the ART beneficiaries reported inability to afford a balanced diet due to illness, while 17% reported missed treatment due to lack of food. Bisika and Madere argue that the institutional capacity to implement nutritional support is limited due to already strained human resources, food storage facilities and size of health facilities. They also highlight the cost associated with nutritional support for ART beneficiaries as well as differential food assistance for individuals at different stages of infection.

Most patients on ART battling HIV indicate the need for nutritional support when ill.Health officials suggested the need for therapeutic and supplementary feeding and food rationing for individuals experiencing weight loss due to malnutrition. Therapeutic and supplementary feeding was provided based on information about adult BMI, pregnant or lactating mothers and children weight for height ratio. Due to unfamiliarity of therapeutic nutrition, the need for nutritional education is imperative. Food rationing was provided to individuals who lacked food security. Researchers suggest that advances in nutrition for HIV infected individuals on ART will require increasing the number of facilities that provide nutritional support as well as addressing limitations such as irregular food supplies and human resources.

In summary, this paper highlights the importance of adequate nutrition for individuals affected with HIV/AIDS. An appropriate diet is important for all individuals utilizing anti-retroviral therapy, not just those affected in developing countries. However, the role of nutrition is fundamental in developing countries due to unpredictable availability and unequal distribution of food supply. Information regarding the measures in place in developing countries like Malawi is important as it highlights the short comings in dealing with the HIV/AID epidemic. In Malawi, as the number of individuals affected by HIV/AIDS increases, the pressure on these already strained resources also increases. Providing open access to this article as well as others in this issue allow relevant information regarding the importance of improved nutrition on the health status of HIV/AIDS-affected individuals. It allows provides a forum for discourse among public health officials in these developing countries to seek out interventions in order to improve the livelihood of these infected individuals.

Bisika, T., & Mandere, G.(2008)Integration of nutrition in the antiretroviral therapy scale up plan for Malawi. Malawi Medical Journal; 20(3):93 - 98