PARTNERSHIPS FOR HEALTHY DIETS AND NUTRITION IN URBAN AFRICAN FOOD SYSTEMS – EVIDENCE AND STRATEGIES

Technical Report on Qualitative Data Collection (Focus Group Discussions)

Pictures of the participants discussing: Picture by Fongar A/Alliance of Bioversity International and CIAT

December 2020

by

Andrea Fongar1, Beatrice Ekesa1, Youri Dijkxhoorn2, and Vincent Linderhof2

1The Alliance of Bioversity International and CIAT 2Wageningen Economic Research

Kampala, 09 December 2020 Technical Report on qualitative data collection – December 2020, Kampala Uganda

Executive Summary

Poverty and malnutrition hotspots are moving from rural to urban communities, as Africa is urbanizing. The population in cities and countries are faced with the coexistence of overweight, obesity, micronutrient deficiency and undernourishment, the so-called ‘triple’ burden of malnutrition. The question is Who is and Why are they affected remains unclear. The project ‘NOURICITY’ seeks to answer these questions by engaging in a chain of multi- stakeholder participatory events and fieldwork meant to deliver a blueprint for partnerships seeking to improve urban nutrition in Africa. The urban population in Uganda increased from 7.4 million in 2014 to 9.4 million in 2017 attributed to the establishment of new urban areas, rural-urban migration and population growth. Still, countrywide 26% of the population are food insecure and malnutrition in all its form is persistent. The project aims at improving urban nutrition in Uganda by bridging knowledge gaps about the systemic and individual drivers of the urban food systems and by developing partnerships to improve nutrition in urban areas. Therefore, a qualitative data collection exercise to gather information about dietary knowledge, food environment, food sources, food choices and key information sources was carried out in Kanyanya parish, Kawempe division. Kanyanya parish has around 26,800 inhabitants and is sub-divided into five zones as its demographic characteristics are similar to those of Kawempe division and Kampala city. The data collection through focus group discussion (FGD) guides the survey and associated questionnaires for measuring the effectiveness of interventions for healthier diets. With the support of a facilitator and a note- taker, FGDs took place at three purposively selected meeting venues in three zones in February 2020. Working closely with the zone leader, for each discussion, the total participants were 30 community members (10 women, 10 men and 10 youth). In total, 85 participants (34 women, 24, men and 27 youth) from the five zones of the parish participated at the 3-day activity. Considering the sub-groups of women, men and youths’ data was collected from 9 FGDs (3 women, 3 men and 3 youth). Agreeing on operational definitions such as healthy food and food safety by the participants was a challenge as the opinions were quite diverse. As healthy food participants mentioned the following statements: balanced diets, bodybuilding food, and foods with nutrients like vitamins. Key food safety concerns were storage and preparation of food, but also the preservation of food was mentioned. Concerning the food environment, the majority of the community has access to tap water (70%), which is used as drinking water. Over 80% use pit latrines as sanitation facility, although the conditions vary substantially. Improper disposal of human refuse and garbage was reported in all zones. Nearly all groups mentioned the absence of a designated garbage collection space, but collection services from private companies and governmental (KCCA) are available at a cost. Findings showed that decisions about food choice are positively influenced by price, availability, taste and preferences. In return, price, lack of cash and the availability of healthy food items are limiting factors. As the four most important factors which determine food availability price, availability of roads and traders and demand was indicated. Most of the

Page 2 of 38 Technical Report on qualitative data collection – December 2020, Kampala Uganda parish members use food stalls as the main food outlet and the traditional markets are used by almost everyone. The biggest, but also most distant market (timewise) is Kalerwe to each of the zone, on average 48 minutes by foot. About nine other markets were mentioned by the participants. As the main source of information and news, 100% of the groups/participants named the community radio or radio, as well as television. Community meetings and leaders as a source of information were named by 44%, 33% indicated a smartphone and 22% social medial, newspapers or rumours. The main identified challenges within the food system in the parish Kanyanya include elements of the food supply chain, such as post-harvest losses and poor infrastructure and transport of food towards the community/parish. Challenges within the food environment of the community include issues around food safety, the availability and affordability of the preferred and healthy food items. Additionally, the missing knowledge and awareness of healthy food and waste management influence the component consumer behaviour and the external drivers of the food system. The area suffers from flooding and poor waste and sanitation practices. The named challenges will be further investigated and used to establish and design possible interventions for the next project steps.

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Table of Content

Executive Summary ...... 2 Table of Content ...... 4 Table of Tables ...... 5 Table of Appendix ...... 5 List of Abbreviations ...... 6 Acknowledgement ...... 6 1. Introduction ...... 7 1.1. Objectives ...... 8 2. Methods ...... 8 2.1. Selection and description of the study area ...... 8 2.2. Participants and data collection ...... 10 2.3. Recruitment of enumerators and training ...... 11 2.4. Data cleaning, reporting and coding ...... 11 3. Results ...... 11 3.1. General issues ...... 12 3.2. Dietary knowledge and home food environment ...... 13 3.3. Food choice ...... 17 3.4. Food source ...... 19 3.5. Information source, perception ...... 20 4. Conclusion...... 20 5. References ...... 22 Appendix ...... 23

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Table of Tables Table 1 Characteristics of Kanyanya parish, Kawempe division and Kampala city ...... 9 Table 2 Timetable, zone and venue of the FGD ...... 10 Table 3 Disaggregated numbers of participants of the nine FGD ...... 12 Table 4 Healthy food definitions by the different groups and zones ...... 13 Table 5 Food safety definitions by the different groups and zones ...... 15 Table 6 Main source of drinking water per zone and sub-group ...... 16 Table 7 Perception of sanitation facilities in the community ...... 16 Table 8 Common food items named according to food group classification ...... 19 Table 9 Main food outlets of the communities and estimated proportion of usage ...... 19 Table 10 Source of information regarding food safety, health and nutrition ...... 20

Table of Appendix Appendix Table 1 Perception of population growth in the last year ...... 23 Appendix Table 2 Perception of food prices, climatic issues and environmental incidents in the last year ...... 24 Appendix Table 3 Perception of diseases and traffic accidents in the last year ...... 25 Appendix Table 4 Perception of excessive crime and any other issues in the last year ...... 26 Appendix Table 5 Perceived difference between population size within five different zones 27 Appendix Table 6 Perceived difference in over-and-under the presence of population groups between the five different zones ...... 28 Appendix Table 7 Perceived difference in the presence of roads, food outlets, churches, schools and medical posts between the five different zones ...... 29 Appendix Table 8 Examples and comment on healthy food items ...... 30 Appendix Table 9 Examples and comment on unhealthy food items ...... 31 Appendix Table 10 Named actions points for food safety ...... 32 Appendix Table 11 Named risk factors for food safety ...... 33 Appendix Table 12 Most preferred meals (type) in this community ...... 34 Appendix Table 13 Common food items named by the different groups ...... 35 Appendix Table 14 Food outlets where the community usually buys food products ...... 35 Appendix Table 15 Frequency of consumption per food group ...... 36 Appendix Table 16 Opinion of the different groups on practices around food...... 36 Appendix Table 17 Market accessibility, travel time and most purchased food items ...... 37 Appendix Table 18 Main sources of information and news in the community ...... 38

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List of Abbreviations

AE Adult equivalent CV Curriculum vitae FG Food group FGD Focus group discussions HH Household KCCA Kampala Capital City Authority NPS-LSMS Ugandan National Household Panel Surveys SD Standard deviation UFS Urban food systems UGX Ugandan Shilling VHT Village Health Teams WAZ Weight-for-age Z-score WHO World Health Organization WHZ Weight-for-height Z-score

Acknowledgement The NOURICITY project is part of LEAP-Agri, a joint Europe Africa Research and Innovation initiative related to Food and Nutrition Security. The work is funded by the EU and donors from Germany and the Netherlands. The project is jointly implemented by Wageningen Economic Research, the Alliance of Bioversity International and CIAT, and BoP innovation centres.

A special thanks go to our field assistant Martha Nalweyiso in managing and creating the contacts on the ground and her high commitment throughout the activity. In addition, the authors thank the enumerators, Edwin Mwebembezi, Mary Francis Nakibuule, Maureen Naakyi, Agnes Namirimu, Sylivia Nyabasha, and William Bamusubire, who contributed and collected the data presented in the current report. Additionally, we would like to thank the village/zone leaders and the participants for their cooperation and time.

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1. Introduction

Africa is urbanizing fast and its poverty and malnutrition hotspots are moving from rural to urban communities [1]. Rising dietary aspirations of African urban populations often lead to increased consumption of unhealthy processed foods but hunger remains an issue [2,3]. In African cities, therefore, overweight, obesity, micronutrient deficiency and undernourishment coexist, displaying a ‘triple’ burden to the population and economy [4,5]. The question is Who is affected and why are they affected? How to reverse the course of malnutrition? Who needs to be involved? We seek to answer these questions by engaging in a chain of multi-stakeholder participatory events and fieldwork meant to deliver a blueprint for partnerships seeking to improve urban nutrition in Africa.

The population of Uganda grew by 13.5 million from 2002 to 2017, representing an average annual growth rate of 3.0%[6]. In the same time, the urban population increases from 7.4 million in 2014 to 9.4 million in 2017 [6], which is attributed to the establishment of new urban areas, rural-urban migration and an increase in population. Countrywide still 26% of the population is food insecure [7]. Despite the wide variety of foods available in Uganda, the diet is poorly diversified with staples like maize, bananas, sweet potatoes, cassava, and potatoes contributing over 51% of the dietary energy consumption in Kampala [8]. Within the Kampala region around 18% of the children under the age of five years are stunted, while 4% are wasted (WHZ < -2SD), around 7% underweight (WAZ <-2SD) and 4% overweight (WHZ>+2SD) [9]. Among children aged 6-23 months, only 14% consume a minimum acceptable diet, while 34% to 62% reached minimum dietary diversity (breastfed and non-breastfed children) [10]. Among adults, 5% and 25% of men and women in Kampala are anaemic while, 20% and 44% of men and women respectively are overweight or obese [10]. Mean dietary energy consumption, which indicates the food available for human consumption, was reported at 2,226 kcal/person/day national wide (Kampala district 2,347 kcal/person/day) within the UNHS 2016/2017 report [8]. Recently, a survey looking into slum-dwellers in four parishes in Kampala, located in Kawempe and Nakawa division reported energy consumption of 2,444 kcal/day/AE [11].

The project ‘NOURICITY – partnerships for Healthy Diets and Nutrition in Urban African Food Systems – evidence and strategies’ aims at improving urban nutrition in Uganda by bridging knowledge gaps about systemic and individual drivers of urban food systems (UFS) and by developing partnerships for improved nutrition in urban areas. The research involves several components: (i) exploratory analysis of panel data on food consumption based on the latest Ugandan National Household Panel Surveys (NPS-LSMS), (ii) participatory mapping of UFS and of nutrition-related policies in a study site in the Kampala region, (iii) designing and testing policy and other interventions to influence a behavioural change of the study populations, and (iv) the co-creation of successful partnerships with local stakeholders for improved urban nutrition in Kampala district. The named activities will improve our understanding of the drivers of urban nutrition in Uganda and provide a solid foundation for comprehensive, effective interventions and policies.

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The report will describe the focus group discussion (FGD) activity of the project, which is included within the third component of the project and was carried out in February 2020. The information of the discussions will provide in-depth information needed to develop, implement and scale-up the policy interventions, which intend to bring about a change in eating/feeding practices of the households studied. Moreover, the FGDs results will be used for the structure of the questionnaire and the adequate formulation of questions in the questionnaire.

1.1. Objectives

This project aims to improve the nutrition of the urban poor in Uganda. The research will investigate: a) urban food sources, characteristics and rural-urban linkages as “systemic” drivers of food choices and nutrition, b) people’s access to nutrition-related knowledge (formal and informal, indigenous and Western), income, food tastes, habits and culture, as “individual” drivers of food choices, c) how systemic and individual drivers combine to determine people’s food consumption and nutritional status. Therefore, the objectives of the current qualitative survey were to understand the current development of the population, their dietary knowledge and the food environment, common food sources and food choices, as well as key information sources for the community in the selective parish.

2. Methods In the method section, the selection process and the study area are described, the recruitment and training of the enumerator, the selection of the community members, as well as the organisation of the FGD are explained. 2.1. Selection and description of the study area Uganda is stratified into several administrative units namely districts, counties, constituencies, sub-counties, parishes and villages. The central region includes Kampala district, which is, after Wakiso district the second most populated area in Uganda [9]. The 2002 national census estimated the population of Kampala town at 1,189,142. On 27th August 2014, the national population census estimated the population at 1,507,080 [12]. Kampala is subdivided into five administrative sub-counties, 76 parishes, and 3,213 villages. The sub-counties are Kampala Central, Rubaga, Makindye, Kawempe, and Nakawa Division, respectively. Kawempe division was purposefully chosen for the project activities. The division is located in the Northern part of Kampala and is administratively divided into 19 parishes, 13 being informal settlements and 744 villages [13,14]. The entire division occupies 7,644 acres of land, 25% of the area is occupied by the slum area [14]. The population of the area was about 338,215 inhabitants and 94,202 households in 2014 [12].

Within Kawempe division, the selection criteria were based on the percentage of people that consume less than two meals per day (16-20%). In total, six parishes fell under this category. After discussions with the local team members, three parishes were identified to be suitable for the survey. After an explorative walk and key interviews with selected inhabitants of the

Page 8 of 38 Technical Report on qualitative data collection – December 2020, Kampala Uganda respective parishes, Kanyanya parish was selected. Demographic characteristics are similar to those of Kawempe division and Kampala city (see Table 1) [12].

Table 1 Characteristics of Kanyanya parish, Kawempe division and Kampala city (2016) VARIABLE KANYANYA KAWEMPE KAMPALA PARISH DIVISION CITY Demographics Population 26,844 338,665 1,507,080 Number of households 7,086 94,202 414,406 Average household size 3.79 3.60 3.64 Share female-headed household (%) 29.7 30.8 30.3 Share of age classes (%) 0-4 17.0 15.2 14.5 0-17 45.2 42.4 41.3 18-30 33.9 36.3 36.5 21-59 19.0 19.5 20.3 60+ 1.9 1.8 1.8 Share of labour market participation per age class (%) 10-17 11.6 11.9 12.2 18 and above 69.4 67.4 67.8 Illiteracy rate per age class (%) 10-17 5.5 6.3 6.8 > 18 5.9 5.8 5.6 > 60 20.9 24.4 21.7 Source: Linderhof et al. (2020) [15]

In addition, 16.1% of households in Kanyanya consume less than 2 meals per day, which is above the average of Kampala city [12]. The parish has approximately 26,800 inhabitants and is predominantly a lower and middle-class residential area. Kanyanya is sub-divided into five zones, namely Lutuunda, Wampampa, Kikuubo, Kiyanja and Kitambuza.

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Figure 1 Map of Kanyanya parish in Kawempe District, Kampala, Uganda. Displaying the five different villages.

2.2. Participants and data collection In total, three FGD were carried out in a 3-day activity within three zones of Kanyanya parish, which targeted 90 participants from the five zones, disaggregated into women, men and youth. In cooperation with the village leader and the research assistant of the Alliance office, community members were identified for the activity. Four of the five zones were grouped according to their location. The meeting took place in common meeting places of the respective zone and the participants were invited via an invitation letter stating time and place of the activity. Table 2 displays the structure of the activity, time and meeting place. Thirty participants per day were invited, including ten representatives from women, men (both above the age of 30 years) and youth. Table 2 Timetable, zone and venue of the FGD DATE START TIME PARTICIPANTS ZONES VENUE 10th Feb 8:30 am 30 participants* Wampamba & Lutuunda Mpewo Valley 11th Feb 8:30 am 30 participants* Kikuubo & Kiyanja New Life International Church 12th Feb 8:30 am 30 participants Kitambuza Uganda Martyrs Primary School *15 participants per zone.

Following the FGD protocol, at each day, the project team was introduced to the community member by the respective village leader, followed by a brief explanation of the main intention of the discussion in the local language by the research assistant. Furthermore, ground rules were set and explained for a fruitful discussion in the main group. After the general introduction, the group were subdivided into three gender-disaggregated smaller groups (women, men and youth) and paired with two enumerators (facilitator and note-taker). In the

Page 10 of 38 Technical Report on qualitative data collection – December 2020, Kampala Uganda small groups, the consent form was explained and signed, the voice recording explained, and a timekeeper identified. During the discussion, the participants were provided with snacks and drinks, which were locally purchased from the women of the community.

2.3. Recruitment of enumerators and training The focus group discussion was conducted in the local language Luganda, to ensure that the community members feel comfortable and to engage in a lively discussion. Thus, we recruited six enumerators to conduct the session in the local language. The recruitment of the enumerators started late January with the collection of curriculum vitae (CVs) from recommended enumerators from the Alliance of Bioversity International and CIAT colleagues. In total, ten CVs were received, and all were invited for interviews on the 3rd of February 2020. The interview was facilitated by Dr Andrea Fongar and Dr Beatrice Ekesa at the Alliance of Bioversity International and CIAT office in Kampala, Uganda. After the interviews, six enumerators were shortlisted and invited to the enumerator training on the 7th of February. During the one day of training, they received a brief on the project, its objective and its expected importance to the target community and the research community. The main part of the training involved ensuring the enumerators and conversant with the tools to be used during the FGD (facilitators guide and note-takers guide).

2.4. Data cleaning, reporting and coding

The enumerators were grouped in teams of two for each FGD. Each group provided a report according to the FGD guide to the field assistant, which was crossed checked and validated with the voice recordings. Nine reports were established according to the facilitator guide for each sub-group and submitted to the field assistant, who compiled and verified the answers with the voice recordings of each session. Afterwards, the reports were submitted to the Alliance office, and entered in excel and partially in STATA. After the verification and cross- checks with the field assistant and enumerator, the excel file was shared with the research team. 3. Results The results section is divided into five sub-sections, which will present results on general issues, dietary knowledge and food environment, food choices and sources, as well as main sources of information within the community. From the 90 targeted participants, 85 participants took part in the 3-day activity, leading to an attendance rate of 94%. Slightly more women participated compared to men and youth. The highest turnout was in Kitambuza zone, followed by Kikuubo and Kiynaja zones. The disaggregated attendance numbers are displayed in Table 3.

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Table 3 Disaggregated numbers of participants of the nine FGD

ZONE WOMEN MEN YOUTH TOTAL 1 Wampamba & Lutuunda 9 8 8 25 2 Kikuubo & Kiyanja 12 6 11 29 3 Kitambuza 13 10 8 31 Total 34 24 27 85

3.1. General issues The first part of the discussion evolved around major events in the year preceding the study (last 12 months). All groups agreed that the parish grew in population size, mainly through rural-urban migration. Additionally, one group member indicated the existence of “a high birth rate in the community” which contributed to the population growth. Excessive food prices were mentioned by 78% (7 of the 9 groups), which was generally linked to the festive season around Christmas. Most groups mentioned climatic issues due to prolonged rains and weather inconsistencies. Nearly all groups indicated that the area suffered from environmental incidents during the last year. Heavy pollution of water streams and improper garbage disposal was the most raised issues. In terms of disease and epidemics, the three women groups recognised an increase in diarrhoea and an outbreak of measles compared to other years. Traffic accidents rarely happen within the area, as the number of vehicles is few due to the limited number of roads. Excessive crime issues were mentioned by six of the nine groups with most reported crimes being domestic violence and theft (see for more differentiated answers Appendix Table 1 to

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Appendix Table 5).

The second set of questions was about the structure of the different zones, the perceived difference and similarities of the population, the presence of roads, food outlets, churches, schools or medical posts. Lutuunda was recognized as the zone with the highest population by three groups, as well as Kikuubo. The responses to the question of over-and under- presence of particular groups of people were mixed. Female-headed households are reported to be few in Wampamba, but highest in Lutuunda. More female-headed households are present in Kikuubo compared to Kiyanja, while Kitumabuza is supposed to have the highest number compared to the other zones. Presence of youth was reported highest in Lutuunda, and Kikuubo and Kitumabuza zones host the highest population of elderlies (above 60 years of age) (Appendix Table 6).

The road network within the parish was perceived as very poor by the community members. Participants from Wampamna and Lutuunda indicated that 80% of the road are poor and mostly are marram roads, only 20% of the roads within the zone are tarmac roads. While Kikuubo and Kiyanja zone only has one tarmac road. In terms of the presence of food outlets availability was stated for each zone, however, Kikuubo is the zone with the most food outlets. Presence of churches was mentioned in all zones. Schools are more present according to the participants in Kitambuza zone, more in Kikuubo compared to Kiyanja and more schools in Lutuunda compared to Wampamba. Medical centres are also present within all zones, Kitambuza holds mostly private clinics (Appendix Table 7).

3.2. Dietary knowledge and home food environment

In this section we asked about the perception of healthy food and food safety of the community, and if the environment can contribute to food safety. Additionally, the source of drinking water, use of sanitation facilities and common practices of garbage disposals of the community were of interest.

First, the participants were asked to agree on a definition of healthy foods. As in many groups, the members could not agree on one definition, the definition with the highest agreements is listed in Table 4. The definitions given were very diverse, some examples included defining healthy foods as a balanced diet, bodybuilding food, foods with nutrients like vitamins, as well as the duration of cooking plays a crucial role to maintain the value of the food item.

Table 4 Healthy food definitions by the different groups and zones ZONE GROUP N DEFINITION OF HEALTHY FOOD AGREE Wampamba Men 8 Foods with bodybuilding food, energy-giving food and with 5 & Lutuunda vitamins Women 9 Healthy foods mean foods which have nutrients like vitamins 7 and calcium which keep our bones strong. Youth 8 Healthy food is food that is important to the body and causes 8 no harm to the body when consumed.

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Kikuubo & Men 5 Healthy foods are foods that contain all the nutrients needed 5 Kiyanja in the body for growth and maintenance. Women 12 It means bodybuilding foods 11 Youth 11 Balanced diet 4 Kitambuza Men 10 Foods that give us life and prevent diseases 6 Women 13 It means not cooking food so much to lose the food values. 11 Not cooking food in polythene bags. Eating food that is not fried. Eating food that does not have chemicals. It means washing food before cooking it Youth 8 Food that is important to our life and builds the body. 8

Different food items were characterized as healthy by different groups. Eight of the nine groups named posho as a healthy food item, six groups mentioned beans and cowpeas, five groups mentioned leafy vegetables or greens such as green and red amaranths (dodo and buga), African nightshade (nakati), eggplant (ntula) or cabbage. Matooke and sweet bananas were indicated by four groups and millet by two. Below three interesting quotes are displayed, which were capture during the discussion of healthy food items at the different men’s groups:

Participant 2: ‘Vegetables like nakati, amaranths. These prevent constipation and should be eaten in small quantities.’

Participant 6: ‘Narrated that, all foods are good and healthy but the way it is prepared and handled is what makes it bad”. Thus, there is no food that is bad.’

Participant 3: ‘Vegetables are good for pregnant women in that they provide them with iron. Iron also prevents swelling of the legs in pregnant women.’

More quotes and comments are listed in Appendix Table 8. Fried rice, fried eggs and fried meat, chips, Irish potatoes, oily foods, cooking banana, soda and alcohol were food items identified as unhealthy. The group of men on day two additionally named foods which were sprayed, expired (supermarket), and processed, such as maize flour or groundnuts, grafted fruits, yam as unhealthy. Tinned foods, matooke, cold food, chips and overcooked foods were examples mentioned by one of the women’s groups (see also Appendix Table 9).

Participant 4: ‘Irish potatoes wouldn’t be bad because they are usually recommended by doctor to be taken by young children (babies) as their start food.’ (Youth)

Participant 3: ‘Bananas (cooking type) are unhealthy because they have no nutrients.’ (Women’s group)

Participant 7: ‘Foods can turn to be unhealthy especially when a person eats only one type of food for a longer period (month after month-lunch and super) of time without change. This food later becomes poisonous. The body starts to lack other foods like proteins and vitamins. When the person lacks starch in the food, then he/she becomes stunted and unhealthy.’ (Men’s group)

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Similar to the identification of healthy food no uniform agreement was found while defining the meaning of food safety within each group. Table 5 displays the definitions with the highest agreement among the participants. Key food safety concerns were storage and preparation of food, but also the preservation of food.

Table 5 Food safety definitions by the different groups and zones ZONE GROUP N DEFINITION OF FOOD SAFETY AGREE Wampamba Men 8 Storing food for future purposes to prevent it from getting spoilt. 7 & Lutuunda Women 9 Foods without chemicals, clean (it should be washed before 7 cooking and stored well after preparations. Youth 8 Ensuring that the food we eat doesn’t bring any harm to our body 7 Kikuubo & Men 5 Food that is safe and not harmful to the body. 3 Kiyanja Women 12 Preparing food in a clean environment and washing all foods 11 before preparation and it also includes storing food in a safe environment Youth 11 Ensuring that the food prepared is fresh, prepared from a clean 7 environment and it gets ready properly and then served using clean containers Kitambuza Men 10 The way food is stored/kept well and safe 8 Women 13 It means not cooking food so much to lose the food values. Not 11 cooking food in polythene bags. Eating food that is not fried. Eating food that does not have chemicals, also food that is stocked for a long time like beans and groundnuts are not safe because during the storing process they are sprayed with chemicals to prevent them from going bad. It means washing food before cooking it Youth 8 Ways through which we can preserve food 5

Furthermore, the participants named action points and risk factors concerning food safety. As action points the different men groups identified, smoking and sun drying fish and seeds, as well as salting meat and fish and communal work such as cleaning the surrounding areas by removing garbage. Perishable foods (meat and fish) should be roasted and covered well to prolong shelf-life. The women’s groups highlighted actions point such as sensitization ad importance of community on how to be clean, to stop disposing of faeces and garbage in water streams, as well as sensitization about nutrition and consumption of dietary foods. Proper cooking and storage practices and the consumption of warm food were key points in the eyes of the youth. Risk factors such as weather changes, lack of awareness and knowledge were mentioned by the men and women. Key risk factor to the youth was time.

Participant 4: ‘Said that 50% of the people in the community have the incapacity to own a refrigerator while 15% have the inability to buy charcoal or fuel (especially the youth).’

Participant No.10: ‘Time, we always have a lot of different things to do and we fail to find ample time to prepare our food in a safe way.’

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If the environment can contribute to food safety was a challenging question to the community members. Most groups answered that the environment cannot contribute to food safety, the reason being the dust which contaminates food, natural hazards, pollution, incorrect disposal of garbage and congestions.

Majority of the community has access to tape water (70%) as main drinking water, followed by water from protected spring wells (31%), harvested rainwater (11%) and springe water/wells. Table 6 displays the answers per zone and sub-group. Generally, it was mentioned that the water is boiled before drinking, rainwater is very seasonal, and the source of drinking water depends on the area you are living in. Majority of people within Kitumbuza zone collect rainwater, as the tape water is not as reliable.

‘Participant from men group in Kitambuza: “Said that due to geographical location of the area, there are no spring well. Protected spring well is located in the neighbouring community (Kikuubo). Kitambuza people who live close to this community have access to protected spring well. Also, there is a service provider within the community called Bahai who collects water (using a bicycle) from the protected spring well and sells it to the community people who live uphill”. The cost of each Jerrican is 500 UGX.’

Table 6 Main source of drinking water per zone and sub-group ZONE GROUP PROTECTED TAPE HARVESTED/ SPRING WATER/ SPRING WELL WATER RAINWATER WELLS

Wampamba Men 18% 80% 2% & Lutuunda Women 95% 2% 3% Youth 75% 5% 20% Kikuubo & Men 75% 22% 3% Kiyanja Women 80% 5% 15% Youth 25% 60% 10% 5% Kitambuza Men 5% 80% 15% Women 50% 50% Youth 90% 10%

The majority of households has access to pit latrines, however, conditions vary and most are in very poor conditions (see Table 7). The usage of the garbage pit and collection centre to dispose of human refuse and sanitation products, as well as the improper disposal into water streams, was mentioned in some groups.

Table 7 Perception of sanitation facilities in the community ZONE GROUP PIT LATRINE FLUSHING LINED ECO- WATER TOILETS TOILETS TOILET STREAM

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Wampamba Men 80% 20% & Lutuunda Women 100% Youth 60% 35% Kikuubo & Men 60% 20% 10% 1% Kiyanja Women 85% 10% Youth 70% 5% Kitambuza Men 87% 10% 3% Women 100% Youth 90% 10%

One participant of the men’s group in Wampamba and Lutuunda zone mentioned that

‘…some community people (5%) who don’t have toilets but use polythene bags. At night, these used polythene bags are thrown by the roadside or anywhere’.

This was indicated by nearly all groups. The youth group in Kitambuza zone explained that it is mandatory in their zone that each household pays 3,000 UGX per month for the garbage collection service for weekly cleaning. Households which are not cooperating are punished by the local leaders.

Nearly all groups said that they do not have a designated collection space for the garbage, but a collection service private (e.g. home care), as well as governmental (KCCA) is available. However, the service is too expansive for most community members. Prices ranged between 3,000-10,000 UGX for a household. Moreover, it was indicated that the collection service is very unreliable. Food waste is collected in small percentages and used as animals’ feeds, such as banana peels, leaves etc. Participants mentioned that people with animals also collect food waste from other households (estimate 80%) to rear their animals, but also used as manure from those who have a garden.

3.3. Food choice

In this section the discussion evolved around food choices of the community, what are the most preferred meals, how frequent are those preferred meals consumed, what are common food items and where are they bought, as well as what determines people’s food of choices.

The most preferred meal according to almost every group was “Matooke’ steamed cooking banana mashed and eaten with either meat (beef) or fish and rice. The taste was indicated as the reasons for the preference and meal choice. Additionally, availability at the market and good preparation time was indicated for the preferred meals. Appendix Table 12 displays the three preferred meals, and reasons, disaggregated per zone and type of group. When asked if the listed meals are also the most consumed in the community, this was confirmed by almost every group. The men and youth group in Kikuubo and Kiynaja reported that fish and meat are very expensive and therefore, not commonly consumed. The seasonality of matooke was also mentioned as an issue for consumption.

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Additionally, the key representatives were asked to name common food items within their respective food group, frequency of consumption, and where the items are usually bought. In total 46 different food items were named. Around 30% of the food items are only purchased at the market, 16% in shops and 10% at food stalls (see Appendix Table 13 and Appendix Table 14).

The most named and consumed food groups were other vegetables (15%), followed milk and milk products (14%), leafy vegetables (12%) and legumes, nuts and seeds (12%). Table 8 displays the named food groups by the community. Daily consumption was mentioned for the FG legumes, nuts and seeds (n=12) and other vegetables (n=11). Dark green leafy vegetables are often consumed weekly (n=8), flesh meat more monthly and rarely (see also Appendix Table 15).

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Table 8 Common food items named according to food group classification FOOD GROUP N % CEREAL 16 8 WHITE ROOTS AND TUBERS 10 5 VITAMIN A-RICH VEGETABLES & 6 3 TUBERS DARK GREEN LEAFY VEGETABLES 23 12 OTHER VEGETABLES 29 15 VITAMIN A-RICH FRUITS 5 3 OTHER FRUITS 17 9 FLESH MEAT 19 10 EGGS 8 4 FISH AND SEAFOOD 9 5 LEGUMES, NUTS & SEEDS 24 12 MILK AND MILK PRODUCTS 27 14

Positive influences which determine the food choice of the community were price, availability, taste and preferences. On the other hand, price, lack of cash and availability were mentioned as the most important limitations. Cultural and traditional constraints are very limited within the community; besides the common religious constraints, it was mentioned that women are not supposed to eat chicken and people from west fish. Similar to the named positive influences and constraints the three most important factors which determine food availability were price, availability of roads and traders and demand. Mixed feelings were reported when asked about the food handling and practices within the community (see Appendix Table 16).

3.4. Food source

In this section the food source was of interest, we wanted to identify the nearest market possibilities and which food outlets are frequently used by the community. The main food outlets and the proportion of estimated usage are displayed in Table 9. Food stalls are used by every member of the community in the five zones. The market is used by almost everyone. It was mentioned that mostly the food stall owners and the food carts frequently go to the market to buy fresh products for display at their outlet.

Table 9 Main food outlets of the communities and estimated proportion of usage ZONE MARKET STALLS SHOPS FOOD CARTS* VENDORS SUPERMARKET (%) (%) (%) (%) (%) (%)

WAMPAMBA 73 100 87 50 30 & LUTUUNDA KIKUUBO & 77 100 73 75 20 KIYANJA KITAMBUZA 100 100 100 45 *FOOD CHARTS ARE SEASONAL

The most distant market is Kalerwe to each of the zone. The community members need on average 48 minutes by foot to reach this market. Wampampa and Lutuunda only mentioned

Page 19 of 38 Technical Report on qualitative data collection – December 2020, Kampala Uganda two accessible markets for their zone, namely Kalerwe and Mperererew. The group from Kikuubo and Kiyanja named eight different markets (mostly 10 minutes by foot) and Kitambuza five (5-45 minutes by foot) (see Appendix Table 17).

3.5. Information source, perception

In the last section of questions, we wanted to know from the community members their sources of information. As the main source of information and news, 100% of the groups/participants named the community radio or radio, as well as television. Community meetings and leaders as a source of information were named by 44%, 33% indicated a smartphone and 22% social medial, newspapers or rumours (Appendix Table 18). The top three sources regarding food safety, health and nutrition information are listed in Table 10.

Table 10 Source of information regarding food safety, health and nutrition ZONE SOURCES OF INFORMATION WAMPAMBA & TV/radios Village Health Teams (VHTs)/ Smartphones/ LUTUUNDA Health Centres Newspaper KIKUUBO & Community radio/Radio/ Communication from community Mobile phone/ Social KIYANJA TV leaders Media/ Newspaper KITAMBUZA Radio/Community Radio/ Local herb sellers/vendors/ Smartphones/ TV (Bukedde TV) Community meetings WhatsApp INFORMATION IS GROUPED AS PER LOCATION

In Wampamba and Lutuunda participants mentioned that the village health teams usually go around the community and do door to door sensitization on those topics. Six groups mentioned the use of mobile phones to receive information.

4. Conclusion The results of the FGDs will be used for the structure of the questionnaire and the adequate formulation of questions in the questionnaire for the surveys in Kanyanya parish. The results display a snapshot of the current food system, and the food and nutrition security situation within the parish Kanyanya in Kampala, Uganda. We conclude with the most visible challenges identified along the components of the food system. Within the elements of the food environment, food supply chain and consumer behaviour challenges were identified related to post-harvest losses, poor infrastructure and transportation of food to the city and area. Perishable food products from outside of town are often already overripe and of poor quality leading to food safety issues. Urban food production e.g. urban agriculture and backyard gardening, such as kitchen gardens or sack gardening were hardly mentioned. It would be interesting to capture those types of urban food production and the availability of land, as well as the interest of the households in community gardening during the baseline survey. Urban agriculture possibilities could potentially increase the availability of fresh and healthy food item. Hence, the upcoming survey should try to capture information on the current food item intake (in terms of quality and quantity), as well as the availability/affordability of preferred and healthy food items.

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During the discussion, the lack of knowledge and awareness towards healthy food and waste management was a main limiting factor, which in return influences the component consumer behaviour and the external drivers of the food system. Kanyanya suffered from flooding and poor waste and sanitation practices, which both were related to nutrition and health outcomes. At the same time, the parish was growing mostly due to rural-urban migration. Additionally, the indication of the preferred meals indicated a shift towards more fried and processed foods. Thus, as mentioned to capture actual dietary intake and the diversity of food will be important to establish the interventions and partnerships in the right direction.

While the discussion already highlighted the preferred information source, the community radio, it would be good to explore the main information source further. Nevertheless, the preference of radio or television as an information source, also in regard to the COVID-19 pandemic, opens the floor to technological information related interventions. Nutrition and health-related aspects could be discussed at the local radio station, or short video clips could be shared.

From an observational perspective at the time of the focus group discussion, the area and community were very eager to share thoughts and to reflect on healthy eating, especially youth groups, which could be potential voices to distribute information. In general, more information about common groups and organisation within the parish would be interesting, as well as to get the contacts for potential partnerships.

Under the COVID19 pandemic and standard operational processes, a face-to-face households survey could not be administered in 2020. We propose to hire a local, aerated, open-space venue to conduct the survey, where it is much easier to control and adhere to the regulations. The venue will be equipped with handwashing facilities, and each respondent and enumerator will be provided with masks. A list of households from the parish can obtain from the village leaders from which a random sample can be drawn, which will be invited to an appointment at the venue. Transportation cost will be reimbursed.

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5. References 1. Sahn DE, Stifel DC. Urban-Rural Inequality in Living Standards in Africa. J Afr Econ. 2003;12: 564–597. doi:10.1093/jae/12.4.564 2. Tschirley D, Reardon T, Dolislager M, Snyder J. The Rise of a Middle Class in East and Southern Africa: Implications for Food System Transformation. J Int Dev. 2015;27: 628– 646. doi:10.1002/jid.3107 3. Ziraba AK, Fotso JC, Ochako R. Overweight and obesity in urban Africa: A problem of the rich or the poor? BMC Public Health. 2009;9: 465. doi:10.1186/1471-2458-9-465 4. Popkin BM. The Nutrition Transition in the Developing World. Dev Policy Rev. 2003;21: 581–597. doi:10.1111/j.1467-8659.2003.00225.x 5. WHO. Obesity and overweight. 2018 [cited 2 Dec 2019]. Available: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight 6. Uganda Bureau of Statistics. Population & Censuses. 2019 [cited 14 May 2019]. Available: https://www.ubos.org/explore-statistics/20/ 7. IFPRI. 2015 Nutrition Country Profile: Uganda. Global Nutrition Report; 2015. Available: http://ebrary.ifpri.org/utils/getfile/collection/p15738coll2/id/129844/filename/130055 .pdf 8. Uganda Bureau of Statistics (UBOS). Uganda National Household Survey (UNHS) 2016/2017 Report. Kampala, Uganda: UBOS; 2018. Report No.: UNHS 2016/2017. 9. Uganda Bureau of Statistics (UBOS), ICF. Uganda Demographic and Health Survey 2016. Key Indicator Report. Kampala, Uganda: UBOS, and Rockville, Maryland, USA: UBOS and ICF; 2017. 10. Uganda Bureau of Statistics (UBOS), ICF. Uganda Demographic and Health Survey 2016. Kampala, Uganda and Rockville, Maryland, USA: UBOS and ICF; 2018. 11. Wanyama RN. Food Security and Dietary Patterns among the Urban Poor in Africa. 2019 [cited 20 Aug 2019]. Available: https://ediss.uni-goettingen.de/handle/11858/00- 1735-0000-002E-E637-8 12. Uganda Bureau of Statistics. The National Population and Housing Census 2014 – Main Report. Kampala, Uganda: UBOS; 2016. Available: https://www.ubos.org/onlinefiles/uploads/ubos/2014CensusProfiles/KAMPALA- KCCA.pdf 13. Human Rights Focus. Land Conflict Mapping Tool (LCMT). 2019 [cited 14 May 2019]. Available: http://www.lcmt.org/uganda/kampala/nakawadivision/mbuyai 14. Slum Settlements in Kampala - a Access to Information request to Ministry of Lands, Housing and Urban Development. In: Ask Your Government Uganda [Internet]. 15 Aug 2014 [cited 17 May 2019]. Available: http://askyourgov.ug/request/slum_settlements_in_kampala 15. Linderhof V, Dijkxhoorn Y, Fongar A, Onyango J, Ekesa B. The Kanyanya food challenge: the first results of mapping the food system. 2020 [cited 20 Nov 2020]. Available: https://research.wur.nl/en/publications/the-kanyanya-food-challenge-the-first-results- of-mapping-the-food

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Appendix General issues

Appendix Table 1 Perception of population growth in the last year ZONE GROUP GROWTH OF POPULATION HOW MANY (%) FROM WHERE COMMENTS Wampamba Men 1 7 Other parts of the country & Lutuunda Women 1 99 99 Many people migrated to this area but we do not where they come from. Youth 1 99 Other neighbouring towns Kikuubo & Men 1 0 Most people migrate from upcountry Kiyanja in search of jobs. The majority being the youth Women 1 99 Nansana and other areas "Especially in Kikuubo and lutuunda zones" Youth 1 99 Villages Kitambuza Men 1 People come from different areas like Participant 8: Also there a high birth rate in the Busoga. community leading to the growth of population. Women 1 99 99 Youth 1 99 Nearby areas Due to the presence of cheap houses for rent and the good security condition of the area. 1=Yes, 0=No, 99=Do not know

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Appendix Table 2 Perception of food prices, climatic issues and environmental incidents in the last year ZONE GROUP EXCESSIVE COMMENT ON EXCESSIVE FOOD CLIMATE COMMENT CLIMATE ENVIRONMENTAL COMMENT ENVIRONMENTAL FOOD PRICES PRICES ISSUES INCIDENTS Wampamba Men 1 Participant 7: Mainly due to food 1 Participant 3: Due to 1 “Due to sewage disposal” & Lutuunda scarcity prolonged rains. Women 1 There was an increase in food 1 excessive rainfall 1 There was heavy pollution of water prices in the last year. no droughts in the last year streams last year due to excessive rains. People who have poor toilet facilities (filled up) use this chance to dispose of human refuse in water streams Youth 1 During festival Season 1 Participant 4: Yes, during 1 Participant 2: Pollution of water streams September mostly floods and tranches plus improper food waste disposal Kikuubo & Men 0 Participant 5: Food prices are 1 There were inconsistent 1 due to poor drainage channels Kiyanja seasonal. If food is in plenty and weather changes perishable, the prices are high and vice versa. Women 1 Especially in Kiyanja zone 1 Rainfall - floods 1 Youth 1 During festival Season 0 1 Participant 2: there is pollution of water streams; some people throw garbage in the water streams. Kitambuza Men 0 Participant 3: Food prices have 0 Participant 1: The climate 1 No heavy pollution of the water stream been fluctuating depending on has been favourable. There but food waste in public issues the season. There are no stable has been enough rainfall prices for food. and sunshine Women 1 During festival Season 1 1 Youth 1 But only during the festive days 1 Heavy rains starting from not much such as Easter holiday, Idd days early October until early and Christmas holiday. January. 1=Yes, 0=No, 99=Do not know

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Appendix Table 3 Perception of diseases and traffic accidents in the last year ZONE GROUP DISEASES COMMENT DISEASES TRAFFIC COMMENT TRAFFIC (EPIDEMY) ACCIDENTS Wampamba Men 0 1 Participant 7: Most affected are passengers (Elderly and youth) during the evening hours. & Lutuunda Women 1 increase in Diarrhoea 0 There were just a few cases. Youth 0 0 Participant 1: They rarely happen. Kikuubo & Men 0 1 Victims- Both the elderly and youth; traffic accidents were high and caused cars and Kiyanja motorcycles. Women 1 Outbreak of diarrhoea 1 and measles Youth 0 0 Participant 9: There are not many vehicles in this zone because we don’t have many roads, we only have one main road and the rest are feeder roads. Kitambuza Men 0 0 don't have the main road Women 1 Outbreak of measles 0 No traffic accidents because they do not have many roads Youth 0 0 Not many accidents have occurred within the area due to the smaller number of cars that use the roads within the area. 1=Yes, 0=No, 99=Do not know

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Appendix Table 4 Perception of excessive crime and any other issues in the last year ZONE GROUP EXCESSIVE CRIME ISSUES COMMENT CRIME ANY OTHER Wampamba Men 1 Participant 6: Theft while walking at night. 0 & Lutuunda Women 1 There were excessive crime issues because thugs would even 0 attack you during the day. Youth 0 Participant 5: Killing dogs and throwing them on the roads. Kikuubo & Men 1 Participant 6: Most crimes reported are related to domestic 0 Kiyanja violence and youth theft Women 1 mostly in Kikuubo zone 0 Youth 1 Participant 10: Due to the high unemployment rate in this area Participant 10: Political instabilities. (especially in the youth), they resort to stealing. Participant 1: Increased unemployment rate. Kitambuza Men 0 Not excessive but to a small extent. For instance, like food theft 0 Women 1 0 Youth 0 A small number of cases of bag and phone grabbers but mostly 0 during morning hours and festive seasons. However, most of the criminals, come from nearby zones. 1=Yes, 0=No, 99=Do not know

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Appendix Table 5 Perceived difference between population size within five different zones ZONE GROUP SIZE OF THE POPULATION GROWTH IF SO, WHAT ABOUT COMMENT POPULATION GROWTH COMMENT MIGRATION? POPULATION GROWTH Wampamba Men Lutuunda 1300 Both these accounts for 65%. Population growth & Lutuunda Wampamba 8000 more in Wampamba Women Lutuunda highest There are has been an increase in the Wampamba has got the population size of the population in some zones like smallest population of Lutuunda because people come looking all zones and roads as for business opportunities. well. Youth Lutuunda highest Participant 1: Lutuunda has many population people compared to other zones Kikuubo & Men More growth in Kikuubo with 45%. Kiyanja is 55% Kiyanja Kiyanja than Kikuubo. Women Kikuubo most populated And there have also been some migrations amongst all zones Youth Kikuubo most populated Kitambuza Men 25,000 Women Lutuunda highest population Youth Kikuubo most populated 1=Yes, 0=No, 99=Do not know

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Appendix Table 6 Perceived difference in over-and-under the presence of population groups between the five different zones ZONE GROUP OVER OR UNDER-PRESENCE OF PARTICULAR GROUPS Wampamba Men FHH are very few and these More youth (68%) than Mixed ethnical groups & Lutuunda constitute 2% in both zones. the elderly in both religious groups in both zones zones. Women Wampamba has a few female- Lutuunda has got so many Many elderly people in many westerners (Banyankole) in Lutuunda headed households. Lutuunda has youths compared to other Wampamba zone. zone. These are permanent residents. They the biggest number of female- zones Wampamba has got the bought land and constructed permanent headed households. smallest number of youths. structures. Youth Balance in all Zones Kikuubo & Men Female-Headed Households are Kikuubo has more youth (20%) Kikuubo has more There were mixed ethnical, and religious Kiyanja more in Kikuubo than in Kiyanja (4%) elderly (10%) groups in both zones Women most female-headed households are Most elderly are in Kitambuza Ethnic group of Banyankole in kikuubo and in Kikuubo zone, most youths are in zone that has the most religious backgrounds Kikuubo, is Kitambuza. Youth Do not know Kitambuza Men FHH are 0.5% while MHH are 99.5%, More youth than the elderly, Religious backgrounds; Christians (Catholics, Protestants and Born Again) are 88% while the Muslims are 12%/ People with particular ethnical are from the central region with a proportion of 70% Women Most female households are in Most youths are in kikuubo Most elderly people Particular ethnic group in Kitambuza, Kitambuza zone are in Kitambuza zone, Youth The youth are mostly within Kitambuza is populated Kitambuza zone is mostly occupied by the Kikuubo zone. by mostly the middle- Baganda aged between 30-60 years

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Appendix Table 7 Perceived difference in the presence of roads, food outlets, churches, schools and medical posts between the five different zones ZONE GROUP PRESENCE OF ROADS PRESENCE OF FOOD PRESENCE OF CHURCHES PRESENCE OF SCHOOLS PRESENCE OF MEDICAL OUTLETS POSTS Wampamba Men 80% of roads are poor Food outlets are available in Churches facilities Schools constitute 60% in Medical facilities are available & Lutuunda 20% tarmac in both both zones. available in both zones. both zones in both zones. zones Women Lutuunda many roads Lutuunda has many food There are more churches There are more schools in Wampamba has got fewer (mostly marram roads; outlets in Lutuunda zone Lutuunda zone compared medical posts. few tarmac roads) Wampamba has got the compared to other zones. to other zones. Wampamba has fewer smallest food outlets Wampamba has got fewer Wampamba has got roads. churches fewer schools Youth All roads are the same Participant 4: Kikuubo zone Balance in all areas Balance in all areas Balance in all areas Kikuubo & Men Roads are generally Food outlets are available in Churches all zones, more in Kiyanja has few schools Medical posts more in Kiyanja poor (one tarmac road both zones. Kikuubo and Kikuubo more. Kikuubo in both zones) Women Kiyanja has the most Most food outlets in Kiyanja has more churches, Kikuubo has more schools Kiyanja has more medical roads (feeder roads. Kikuubo posts Youth All zones have roads, Most food outlets in At least every zone has At least every zone has At least every zone has these only that they are in a Kikuubo these institutions in place. these institutions in institutions in place. marram state. place. Kitambuza Men The roads are too poor They are more in the area Churches do exist in the Schools do exist in the medical posts do exist in the but have no market area area area Women Wampamba zone has Most food outlets in Most churches are in Kitambuza zone has the Kiyanja zone has the most the most roads Kikuubo Kitambuza most schools, medical posts Youth All roads are the same Most food outlets in All zones have churches All zones have schools, All zones have medical posts Kikuubo within but Kitambuza has Kitambuza has food outlets mostly private clinics but in small numbers.

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Dietary knowledge and home food environment

Appendix Table 8 Examples and comment on healthy food items

ZONE GROUP EXAMPLES OF HEALTHY FOODS COMMENTS Wampamba Men Posho and beans, meat, bananas Participant 4: Pumpkins plus pumpkin seeds contain potassium. Milk contains all food nutrients & Lutuunda Participant 3: Groundnuts contains proteins. Fruits contain vitamins Participant 3: Greens are helpful for vision purposes. Millet porridge contains carbohydrates Women Posho, Matooke, Fruits (Pawpaw, pineapple, passion fruits and oranges), Sweet potato, Greens (Nakati, Carrots and Bugga), Irish potato(boiled), Beef, Yams Youth Posho, Milk, Cassava, vegetables, Beans Participant 3: Eggs; they contain proteins. Posho; because it is energy giving food, Milk (it contains all the nutrients), Cassava (it contains starch), vegetables (they contain vitamins and proteins), Beans; contain proteins Kikuubo & Men Fruits such as oranges, avocado, pawpaw’s, guavas. Participant 3: Fruits such as oranges, avocado, pawpaw’s, guavas. These are tasty, Kiyanja Vegetables like Nakati, amaranths, cassava, yams, Participant 2: Vegetables like Nakati, amaranths. These prevent constipation and posho and bananas should be eaten in small quantities; Cassava, yams, posho and bananas are energy giving foods Women Posho, cassava, beans, Irish potatoes, fish, eggs, meat, soya beans, leafy vegetables (like nakati, buga, dodo), cowpeas, millet, fruits, matooke, rice, sweet potatoes, pumpkin, silverfish, chicken, groundnuts, milk. Youth Boiled eggs, Rice, Beans, Posho Participant 9: Boiled eggs, because they have many nutrients. Participant 2: Rice, because it contains starch. Participant 4: Beans because they contain proteins. Participant 1: Posh, because they contain carbohydrates. Kitambuza Men Yams, black tea, Fruits such as mangoes, passion Participant 4: Explained that, some people eat food when they don’t know whether Participant 3: Yams are good because they provide energy, more useful in men fruits and pineapples, yellow bananas (sweet they are harmful to their lives. because they cleanse the urethra, sweet as they can be eaten during breakfast with bananas and bogoya (bananas-roasting type)), Jack Participant 1: Healthy foods are foods that are healthy for our lives because there black tea, and also prevents diseases. fruits, Cassava, Millet and sorghum, Pumpkin, also exist foods that are bad. So, during cooking, are the important ingredients are Participant 6: Emphasized that yams are good in that they last longer in the Vegetables like cabbages, Ntula, Milk, Irish potatoes destroyed which makes food to be bad. stomach and when cooked, its shelf-life is extended and thus does not get spoilt Participant 6: Narrated that, all foods are good and healthy but the way it is quickly; prepared and handled is what makes it bad. Thus, there is no food that is bad. Participant 7: Fruits such as mangoes, passion fruits and pineapples. Natural sugars Participant 7: Said that, foods should be prepared well without using excess are obtained from those fruits. cooking oil and should be accompanied with fruits (for instance fresh pawpaw’s) for Participant 8: Jack fruits are also important in such a way that you get satisfied and them to give us life. don’t get hungry very fast; Participant 3: Said that generally, examples of healthy foods are comprised of Participant 4: Said, yellow bananas, for instance, sweet bananas and bogoya energy giving foods, bodybuilding foods, those that maintain the body and prevents (bananas-roasting type) provide vitamins like vitamin C. Cassava-Obtain starch that disease, and those that provide iron. is used in the body. Participant 4: Said that when preparing sauce, it should be boiled/steamed but not Participant 1: Millet and sorghum- these give us iron, starch and carbohydrates; fried. Pumpkin- obtain iron for the body. Participant 3: Said he chose definition one because healthy foods should have Participant 3: Vegetables are good for pregnant women in that they provide them nutrients, should be prepared/cooked well and the utensils used for cooking should with iron. Iron also prevents swelling of the legs in pregnant women; Milk- these be clean which makes the food to be safe. are bodybuilding foods and good for the children. Women Pumpkin, carrot, leafy vegetables, fruits, cassava, beans, groundnuts, silverfish, millet, cowpeas Youth Vegetables, Fruits; Posho, Liver; Meat

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Appendix Table 9 Examples and comment on unhealthy food items ZONE GROUP EXAMPLES OF UNHEALTHY FOOD COMMENTS Wampamba Men Too many oils, chicken skin Participant 7: Cassava that is premature tends to be bitter. So most people put peeled cassava in water to neutralize the bitterness; Too much meat especially the red & Lutuunda meat affects the gut; foods can turn to be unhealthy especially when a person eats only one type of food for a longer period (month after month-lunch and super) of time without change. This food later becomes poisonous. The body starts to lack other foods like proteins and vitamins. When the person lacks starch in the food, then he/she becomes stunted and unhealthy. Participant 3: Also, chicken skin is not good as it can cause disease because it contains fats. Value-added products like bread, cakes, sodas and chapati found in supermarkets. Participant 6: Eating a lot of pork causes more fats in the body which leads to pressure. Participant 1: Processed sorghum. Due to wear and tear of the machines, some metal particles get mixed up with sorghum flour. Women Fried Rice, chips, fried meat, Fried eggs All fried foods are unhealthy. All food types are good, but we just have to avoid eating fried foods. We are supposed to eat boiled foods. Youth Irish Potatoes, oily foods Participant 5: Irish potatoes; overconsumption brings gas in the stomach. Participant 7: There is no unhealthy food if well prepared, preserved and consumed in its right proportion. Participant 1: Oily foods, like chips and meat, they cause pimples and they can lead to some parts of the body fail to function. Participant 4: Irish potatoes wouldn’t be bad because they are usually recommended by doctor to be taken by young children (babies) as their start food. Kikuubo & Men Food, which was sprayed, expired foods Participant 5: Said that, unhealthy foods are those foods sprayed using chemicals and are poisonous to the body. Expired foods like bread and foods that have moulds. Kiyanja (supermarket), processed foods such as maize flour Participant 3: Narrated that foreign metals are mixed with food during processing due to wear and tear of machines. Processed food like maize flour and groundnuts. or groundnuts, grafted fruits, yams Participant 1: Expired foods are mainly found in supermarkets. However, it’s hard to identify it early because they erase old dates and indicate new dates. Foods like yams planted in urban wetlands are unhealthy because they are contaminated with toxins from industries/factories. Women Tinned foods, matooke, cold food, fried foods, chips, overcooked food (for example cooking matooke from morning to evening) Youth Chapati with beans, pork, posho and porridge, Participant 2: Kikomando (chapatti with beans) because it is made of almost wheat only hence increased starch content. processed foods Participant 11: Pork; because it has a lot of fats. Participant 1: Posho and Porridge, taking them at the same time is not healthy because they contain the same nutrients. Participant 3: Processed foods; because they have preservatives which are sometimes not good for our health. Kitambuza Men Banana (cooking type), soda and alcohol (spirits), Participant 3: Bananas (cooking type) are unhealthy because they have no nutrients; Pork-it has a lot of fats and toxins. When eaten in excess, it leads to diabetes or pork hypertension. Participant 8: Sprits are not good for the body in that they destroy the lungs. Women None Youth Wheat, too much red meat, processed Participant 4: Too much consumption of red meat. Participant 8: Processed foods, they contain preservatives which are not good for the body

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Appendix Table 10 Named actions points for food safety ZONE GROUP ACTION POINTS: COMMENTS Wampamba Men Smoking and sun drying (fish and Processing maize grain into flour Store cassava in water for some days Use of refrigerators Participant 4: Said that, storing depends on the type of & Lutuunda pumpkin seeds)/ Salting of meat/fish if it’s not consumed at that time food and purpose. Toplines are good for drying on maize Drying beans and maize on tarpaulins and beans, and at the same time prevent stones from under the sun prevent pest attack mixing in food. Participant 1: Mentioned that, cassava and sweet potatoes can be sliced into chips and dried. Participant 7: Perishable foods like meats/fish and fresh fruits (for instance pawpaw, watermelon, oranges) can be stored in a refrigerator. Participant 2: Said that where one has no refrigerator, in most cases they tend to buy what is just enough to be consumed by the family at that particular moment. Women We need to sensitize the people in the We should burn all the garbage The utensils should be cleaned very They should provide toilet facilities because community how to be clean and the around us to avoid the flies from well before serving food. some people have no toilets, they dispose of importance of cleanliness. They should contaminating our food. the faeces in the water streams. stop disposing of faeces and garbage in We should ensure we drink boiled water. water streams. There should be rules and regulations, those people who dispose of faeces in the water streams should be arrested. Youth Consuming food at the right time Consuming well-cooked food Proper hygiene Good preservation methods Kikuubo & Men To cover food well after cooking To prepare food which is enough for To warm food that was cold before To practice urban farming especially for Kiyanja the family to prevent eating leftovers eating vegetables like Nakati, tomatoes and cabbages Doing communal work, for instance, cleaning the surrounding area by removing garbage Women Not preparing food in polythene bags Sensitizing people about nutrition and Preparing food from a safe Putting up special enforcements on hygiene at Keeping utensils in a clean place after eating dietary foods environment the community level cleaning them Youth Using clean cooking materials and serve Ensuring that food is well/properly preparing fresh food items at times, it is a bit tricky for us who eat food in food in clean containers” kept (in a condition that doesn’t the restaurants because we aren’t always sure attract moulds) of how it has been prepared, it is after eating it and get stomach upset then you realize that the food you ate hasn’t been safe Kitambuza Men Food that is in raw form should be placed Some foods are put in fridges and Food should be put in clean Perishable foods for instance meat and fish Participant 5: Keeping food safe and well includes the on a raised ground (rack) before it’s those without fridges should cover containers should be roasted to prolong on its self-life. way food is stored, cooked and eaten/handled (for cooked to avoid dust and germs. Such the food. This helps to prevent fries Then covered well and stored in a cupboard. instance washing hands before eating). foods include tomatoes nakati, cabbages from contaminating the food and meat To dry certain types of food under the sun. For instance, beans and groundnuts Women For those who have gardens, it is Sensitizing people about keeping food Landlords should ensure that their Strict health laws should be put up in a important to grow their food as this safe and hygiene tenants pay garbage collection community helps avoid food sprayed with chemicals services as this would improve hygiene in the community Youth Ensure food is clean Ensure food is well kept or preserved Proper cooking practices/ensuring Ensure drinking water after eating food is warmed if cold before eating

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Appendix Table 11 Named risk factors for food safety

ZONE GROUP RISK FACTORS: COMMENTS Wampamba Men Electricity fluctuations which are Change in weather- when It’s costly to buy charcoal or firewood Lack of awareness especially Participant 4: Said that, 50% of the people in the community have & Lutuunda abrupt/ Failure to run the refrigerator there’s no sunshine, fish (fuel) to smoke fish/meat when the housekeepers are left the incapacity to own a refrigerator while 15% have the inability to for longer hours due to high (silverfish) cannot dry. at home buy charcoal or fuel (especially the youth). maintenance costs Lack of enough space for storing food Women We prepare our food in the open The pit latrines are filled up space whereby it is dusty which and the flies that come from makes our food contaminated. there contaminate our food. Youth Time; I could have prepared my tea Preparation; for example, half- Environment; when food is prepared Ignorance; which sometimes properly and I get an emergency cooked food from the unclean environment results in eating too much food before consuming it, by the time I (neighbouring tranches) compared to what our stomach come back to take it, I find it can easily digest somehow contaminated. Kikuubo & Men Lack of awareness Low levels of income and Kiyanja political interference Women cooking food in polythene bags Cooking food close to polluted Garbage is littered everywhere Toilets in the area are not in water streams good condition (they are full) and when it rains sewage goes through different homes. Youth Participant 10: Time, we always have Participant 3: Poor sanitation, Participant 4: Lack of enough resources, Participant 9: Lack of Generally, there was a clear understanding of food safety and a lot of different things to do and we limited gazetted areas for especially to preserve our food after knowledge, not knowing the healthy food with extensive discussion on both topics. fail to find ample time to prepare our garbage disposal increases cooking before serving it for example kind of food that is good and food in a safe way. improper garbage disposal warmers and spirit to help keep food safe for our bodies. which contaminates the food warm for some good time before we eat in the long run plus the consumption especially at the functions. water we drink. Kitambuza Men Lack of enough space. Most people Lack of better storage facilities Due to power/electricity fluctuations Lack of awareness and Participant 3: Some homes have racks used for drying utensils after live in single rooms and have no and lack of capacity knowledge. Some people within cleaning/washing them. The area is overpopulated and there is lack kitchen. the community do not know of enough space. Some people cook close to the pit latrines and how to store food and which bathrooms. foods should be stored and Participant 8: The surrounding environment is not conducive. Some where to store it homes keep pets (cats) that steal other people’s food. Also, rubbish is all over the area since they have no designated places for disposal. Women Garbage is littered everywhere, Many dirty water streams, People refuse to attend community Generally, people are dirty. the most important food safety definition that the majority have sensitization meetings about hygiene, emphasized is avoiding eating food that has chemicals by washing all and foods before preparation Youth Food shortage; this forces people to Unclean environment Using unclean containers during the eat anything that they come across. preparation of food and eating.

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Food choice

Appendix Table 12 Most preferred meals (type) in this community ZONE GROUP 1ST PREFERRED REASONS 2ND PREFERRED REASONS 3RD PREFERRED MEAL REASONS MEAL MEAL Wampamba Men Matooke + meat Matooke is the staple Rice + meat Liked more by children Posho + beans Cheap and affordable & Lutuunda food; tasty because of the taste Women Matooke+ Rice+ It is tasty and it contains Matooke+ Rice+ It is tasty Matooke+ Rice+ It is tasty Fish proteins. Meat Chicken Youth Matooke, beans, Easy to prepare; Cheap; Rice+ matooke + Easy to prepare, Cheap, Chapatti with beans Readily available, Very g.nuts, meat Available; Recommended posho with meat Available, Recommended (Kikomando) cheap vegetables by healthy practitioners by healthy practitioners Kikuubo & Men Matooke + Fish Tasty Matooke + Meat Tasty Rice + meat Tasty Kiyanja Women Matooke + rice+ Tasty, very nutritious, it Matooke + rice Since meat can be cut into Matooke + rice + fish Very nutritious and tasty chicken lasts 7 days in the stomach +meat different pieces it can easily serve a big family; it is also fast to prepare; it is also cheaper than chicken Youth Matooke with Delicious, Easy and quick Chips + chicken Accessible, Loved and Chapatti with beans Delicious, Readily meat to prepare; available mostly consumed by the (Kikomando) available, Accessible at youth. all times Kitambuza Men Bananas Taste good; Matooke is the Rice + chicken Good for children; Rice can Posho + fish Posho is an energy (Matooke) + meat staple food for the be easily prepared/ Rice is giving food; Posho is community; Matooke can also readily available. easily prepared; Posho also be consumed with any Chicken is nutritious and is cheaper and available; type of sauce lasts in the body for 7 days One cannot feel hungry Women Matooke+ rice+ It is tasty, takes a long time Matooke+ It contains proteins, tasty, Matooke+ rice+ meat tasty fish in the stomach, has chicken+ rice spends 7 days in the proteins stomach Youth Rice + meat It’s delicious; It’s easy and Kikomando/ Rolex Cheap and Affordable, Matooke and Common in the market; quick to prepare. available and accessible groundnuts Most liked by the always people

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Appendix Table 13 Common food items Appendix Table 14 Food outlets where the named by the different groups community usually buys food products FOOD ITEM N % Avocado 6 3.08 PRODUCTION SITE N % Banana 5 2.56 Butcher 7 3.59 Bbuga (amaranth) 4 2.05 Butchery, Supermarket 2 1.03 Beans 8 4.1 Dairy/ Vendors 1 0.51 Beans (fresh) 1 0.51 Dairy/ milk men 1 0.51 Beef 4 2.05 Diary shops 3 1.54 Bitter eggplants 2 1.03 Diary, Vendors, Supermarket 1 0.51 Bitter tomatoes 1 0.51 Diary/ Vendors 1 0.51 Bugga (these are red) 4 2.05 Diary/ Vendors 1 0.51 Cabbage 8 4.1 Fish factory, Market 1 0.51 Cassava 3 1.54 Household/market 1 0.51 Chicken 9 4.62 Market 56 28.72 Cowpeas 3 1.54 Market, Vendor 1 0.51 Dodo 3 1.54 Market, Butcher 1 0.51 Eggplants 7 3.59 Market, Shop 6 3.08 Eggs 8 4.1 Market, Shop, Supermarket 1 0.51 Fish 2 1.03 Market, Supermarket 1 0.51 G/nuts 3 1.54 Market, Vendor 18 9.23 Ghee 9 4.62 Market, Vendors, household 3 1.54 Green pepper 2 1.03 gardens Groundnuts 6 3.08 Market/ Shops 1 0.51 Jackfruit 7 3.59 Market/food outlets 1 0.51 Jjobyo 1 0.51 Markets and own gardens 1 0.51 Mangoes 2 1.03 Markets and stalls 2 1.03 Matooke 5 2.56 Milkmen 1 0.51 Meat(Beef) 4 2.05 Outlets/stalls 4 2.05 Milk 9 4.62 Own garden and markets 1 0.51 Nakati (solanum aethiopicum) 9 4.62 Own trees 1 0.51 Onions 6 3.08 Retail shops 8 4.1 Oranges 1 0.51 Shop 31 15.9 Pawpaw 1 0.51 Shops, Markets 1 0.51 Peas 3 1.54 Shops, Markets 7 3.59 Pineapples 5 2.56 Shops, stall 1 0.51 Pork 1 0.51 Shops, supermarket 2 1.03 Posho 9 4.62 Stall 20 10.26 Red meat (Beef) 1 0.51 Stall, market 1 0.51 Rice 6 3.08 Supermarket, Shop, Market 1 0.51 SilverFish (Mukene) 4 2.05 Supermarkets 4 2.05 Smoked fish/SilverFish 1 0.51 Sukuma wiki 1 0.51 Sweet potatoes 1 0.51 Tomatoes 6 3.08 Watermelon 2 1.03 Wheat (chapati) 1 0.51 Yoghurt 9 4.62

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Appendix Table 15 Frequency of consumption per food group FOOD GROUP DAILY EVERY OTHER WEEKLY MONTHLY RARELY ONCE PER DAY WEEK Cereal 8 8 0 0 0 0 White roots and tuber 6 3 1 0 0 0 Vitamin A rich vegetables & 6 0 0 0 0 0 tubers Dark green leafy vegetables 5 7 8 2 0 1 Other vegetables 11 8 6 2 1 1 Vitamin A rich fruits 0 2 2 1 0 0 Other fruits 3 4 5 3 1 1 Flesh Meat 0 1 5 6 6 1 Eggs 2 2 1 1 2 0 Fish and Seafood 3 4 1 1 0 0 Legumes, nuts and see 12 5 3 2 2 0 Milk and Milk product 8 4 5 4 6 0

Appendix Table 16 Opinion of the different groups on practices around food ZONE GROUP GOOD BAD DISCUSSION GOOD Wampamba Men 2 6 Participant 3: Those operating restaurants should be supervised. & Lutuunda Women 1 8 Participant 5: There is a difference between the food prepared at home and the food prepared in the restaurants. The difference is that we use banana leaves to steam our food at home while in the restaurants they use polythene bags or sacks which is a threat to our health since the polythene bags consist of chemicals. Youth 6 2 Participant 7: These days, people are taught how to cook food in schools. Participant 6: Food is always well prepared, only that some restaurants don’t have sanitary facilities for human disposal. Kikuubo & Men 6 Participant 3: Because its lunchtime, some restaurant serves food when Kiyanja it’s to yet ready. Participant 1: In restaurants, they just dump plate in water and also use a dirty cloth for wiping. Women 0 11 Youth 6 4 Participant 7: Implementation of rules and regulations concerning food safety. Kitambuza Men 0 10 Women 13 0 Enforcement laws should be put on garbage collection whereby it should be compulsory for everyone to pay for garbage collection services. Youth 1 7

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Appendix Table 17 Market accessibility, travel time and most purchased food items ZONE MARKETS TRAVEL FOOD ITEMS MOSTLY PURCHASED TIME 1 Wampamba Kalerwe 38 All food types are purchased & Lutuunda Mperererwe 18 All food types are purchased Kikuubo & Kasule 10 Matooke, cassava, vegetables, tomatoes, onions, and others Kiyanja Kilokole 10 Matooke, cassava, vegetables, tomatoes, onions and others Shaniter 10 Matooke, cassava, vegetables, tomatoes, onions and others Kalerwe 60 Leafy vegetables, sweet potatoes, cassava, matooke, banana, potatoes, cassava, beans, peas Mperererwe 10 Matooke, sweet potatoes Tula-Kilokole 10 Posho, rice, beans, groundnuts (many wholesale shops) Kikuubo 10 Banana, Potatoes, Cassava, beans, vegetables, peas Mukirokore 15 Banana, Potatoes, Cassava, beans, vegetables, peas Kitambuza Kitala 5 Cassava, matooke and sweet potatoes Kalerwe 45 Cassava, bananas, vegetables, fruits, matooke, sweet potatoes, yams, pumpkin, starchy foods, legumes Kikuubo 15 Starchy foods, legumes, vegetables and fruits Kizanyilo 5 Starchy foods, vegetables, legumes Mperererwe 15 Matooke, cassava and sweet potatoes 1by foot one way in minutes

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Information source, perception

Appendix Table 18 Main sources of information and news in the community ZONE GROUP MAIN SOURCES OF COMMENT INFORMATION AND NEWS Wampamba Men Television, radio, smartphones, Participant 4: Said that the public address system is often & Lutuunda newspapers used in the community. Women Community leaders, Television, Participant 5: We use Television (Most of the people in Radio (local) this community watch agataliiko nfufu on Bukedde television) Participant 8: We also use Radio like CBS (Central Broadcasting Services). This is a local radio station for the Baganda Kingdom. Youth Radio, Television, Newspaper, Participant 4: Public address (voice of Kanyanya) Social Media Kikuubo & Men Television, Radio Kiyanja Women Community radio, Mobile Phones, Radio, Television, Community leaders (door to door) Youth Local radio (voice of Kikuubo)/ Radio, Village meetings, Social media, Television, Rumours Kitambuza Men Radio, Television Participant 4: Narrated that, they normally listen to Simba radio and watch Bukedde T/V channel. Women Television, Radio, Community Radio Youth Public address systems (outdoor speakers), Community meetings, radio, television, phones, rumours

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