This post originally appeared on the Transform Nutrition West Africa website.
Read more A4NH research and perspectives on coronavirus and the ongoing global pandemic.
The COVID-19 pandemic continues to generate unprecedented global impacts. Much has already been written about potential interactions with food and nutrition security. To date, this has largely comprised questions and hypotheses, as well as experiences and lessons learnt from past epidemics. Many organizations have a dedicated web page, including IFPRI and A4NH.
On 1 April, Lancet Global Health published this commentary on the COVID-19 pandemic in west Africa. The authors concluded that early comparisons with the timing and trajectory of European epidemics did not support the hypothesis that the virus will spread more slowly in countries with warmer climates. They suggest there is an urgent need to improve responses capabilities in the region.
From 3-10 April, Transform Nutrition West Africa (TNWA) conducted a rapid survey of partners in West Africa to better understand national responses to the COVID-19 pandemic, and their own views on potential impacts on food and nutrition security in the region. We received 12 detailed responses from 6 countries, which we collated and synthesized. They are summarized below.
We are grateful to the following nutrition professionals, all of whom responded quickly and comprehensively: Olaide Aderibigbe, Eva Edwards and Rakiya Idris (Nigeria), Bernice Worlali Kunutsor, Kingsley Kwadwo Asare Pereko, and Ronald Miah (Ghana), Robert Kindo (Burkina Faso), Henry Allieu and Sibida George Bun-Wai (Sierra Leone), Aboubakar Dokan Kone and Youssouf Keita (Mali), Tougan Polycarpe Ulbad (Benin). We will continue to work with our partners, sharing information and experiences, as the situation evolves.
Stuart Gillespie, TNWA Director
Countries vary, though most are now following similar multi-pronged strategies to control the spread of the virus. Initial preparations were hampered, in some cases, by the belief that Africans were immune to the disease and/or that the virus would not spread in warmer climates. Many countries have since announced a “state of (public health) emergency”.
Most countries have since instigated the following types of response:
There have been other responses, beyond the health system – for example, suspension of bank loan interest, distribution of cash and food to poor households and communities, tax and cash incentives for frontline workers. The private sector has made donations e.g. financial contributions, donations of ambulances, medical supplies, facemasks, sanitizers, and some food and beverage distribution.
There has been a widespread politicization of the pandemic and conspiracy theories are rife, some amplified by social media, that have hampered the response in some countries.
Responses vary between and within countries, though initial fear and some panic was common across the region. Responses also depend on socioeconomic group. Those in higher socioeconomic groups were reported to have a better understanding of COVID-19 and are more likely to comply with public health recommendations. Those in lower socioeconomic groups are hardest hit as they earn their living from daily activities, many of which are now prohibited. Many believe the pandemic is about ‘rich people’, the elite, the political class who have access to overseas travel – not them. Compliance is consequently low amongst this group, who say hunger is a far greater risk for them than the virus. There are differences too with regard to urban/rural areas, with the latter more likely to live life as before – and with regard to religion, in which some view COVID-19 as an attack on their faith.
Other stated responses by the public include mass migration on the initial announcement of lockdown (putting more at risk of infection), subsequent patchy and partial adherence to lockdown measures, panic-buying and hoarding of food, widespread misinformation on social media, stigma (which has prevented some from being tested). On some occasions, non-compliance has led to arrests, seizure of cars, with violence reported in some cities. NGOs also report increase in domestic violence following stay-at-home orders.
Ebola epidemics in West Africa led to the establishment of infrastructure and systems (testing labs, isolation centres, trained personnel, inter-state communications and surveillance) that have been re-activated for the COVID-19 response. Countries hit hard by Ebola seem to have had better compliance with lockdown measures (e.g. Sierra Leone). The public are more aware of the importance of hygiene though water access is still a major problem. There is nonetheless a universal view that capacity is not sufficient to cope with the epidemic.
Hunger and malnutrition will increase as the livelihoods of the poor have been impacted (“Hunger will kill before coronavirus kills” is a slogan in Nigeria). Where food becomes unavailable, inaccessible and unaffordable, nutrition will be hit hard, especially among already-vulnerable populations. Families will likely adopt “coping strategies” such as reducing the frequency, quantity and quality of food eaten in order to survive the lockdown – with potential long-term effects. Pregnant and lactating women could suffer nutritional deficiencies if they cannot afford a healthy, diverse diet.
Food prices are going up, especially nutritious food. Access to fresh foods is also limited posing a challenge for food safety. Many small businesses have shut down and there are few effective measures to provide basic needs for people – especially where jobs, income and purchasing power of the poor are being hit.
This is the start of raining season and many cannot farm, which lead to longer term food insecurity. Social distancing, and lockdowns will likely have a grave impact on food production, disrupting supply, transport marketing and distribution chains. If producers cannot sell their produce and buyers cannot buy, there will be significant food spoilage and wastage. Some countries rely significantly on imported foods so closed borders and reduced economic activities will impact on availability and price of certain foods. Exporting countries are also experiencing the pandemic so trading has declined significantly.
It’s also likely there will be an increase in the prevalence of overweight and obesity, as ultra-processed fast foods are available, and people have less physical activity. People cannot visit gyms and are forced to stay at home (a group of residents was arrested in Lagos for taking to the streets for work-out).
On the health side, hospitals are restricting admissions to emergency cases making health care inaccessible which may increase or exacerbate malnutrition, if co-morbidities are not addressed.
In Burkina Faso, there’s an additional challenge of reduced agricultural production and civil insecurity which has internally displaced many people, who are in need of humanitarian assistance. Acute malnutrition among children under-five and pregnant and lactating women had increased even prior to COVID-19. The situation could become grave if the epidemic hits these five regions hard.
Advocacy should focus on educating governments and public on the central importance of nutrition to people’s survival. The nutrition community should provide leadership regarding healthy eating/healthy diets as a way to boost immunity. Working within the multisectoral nature of the nutrition space, nutrition professionals should provide and disseminate nutrition guidance and strategies for purchasing and using food ingredients, for adopting safe food handling practices, limiting intake of sugar, salt and fat, scoping the diets of West Africa to generate a list of foods which are readily available, affordable and have high nutritional value. Training in home gardening and use of other materials for planting (plastics, used tyres, bags etc.) in the absence of land could be undertaken. Easy recipes using locally available food ingredients which deliver high nutritional value could be disseminated in public information campaigns. There is also a need for clear information on the diet of people with COVID-19, especially children of mothers, and how to manage fake news about the link between feeding, breastfeeding and COVID-19.
The nutrition community also has a role in advising government on approaches to target the most vulnerable for safety nets and food aid in the context of reduced food access (physical and economic). Nutritionists need to keep attention and required resources for systematic management of cases of acute malnutrition in children under five and pregnant and lactating women, continued exclusive breastfeeding for babies under six months old, and vitamin A supplementation for children aged 6 to 59 months.
Some countries have integrated nutrition into their institutional response. For example, in Sierra Leone, a food assistance and nutrition (FAN) pillar has been established as part of the Emergency Operations Center response. A multisectoral platform comprising government ministries, NGOS, and the SUN nutrition secretariat, the FAN pillar coordinates the provision of food assistance and safety nets to vulnerable groups and households to help contain and mitigate COVID-19.
Overall, there’s a crucial need for cross-country collaboration to share lessons and experiences. Transform Nutrition West Africa will continue to play its part in support such regional cooperation.
Photo: Joshua Oluwagbemiga
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