Although Botswana has never conducted any comprehensive study to find out why nutritional inequality persists in the country, lower income households have a less healthy consumption basket than higher income ones which could help explain the drivers of nutrition inequality. The need to identify dietary nutrient gaps and interpreting their public health significance can’t be over emphasised, because it is essential for improving poor diets and reducing malnutrition.
There is evidence which indicates that the burden of nutrient deficiencies and inadequate nutrient intake or availability exists in Botswana, but this data is often underused in decision-making. The nutrition gap is defined as the mismatch between the nutrients needed for a healthy diet and the nutrients consumed. In Botswana this occurs across all age groups, and can undesirably affect health. While there are many reasons that could help explain such gaps in Botswana, the most likely are affordability, lack of availability and access of food choices.
The Food and Agricultural Organisation (FAO) of the United Nations (UN) which is a specialised agency that leads international efforts to defeat hunger and improve nutrition and food security notes that there are over 800 million people in the world who do not have enough food to eat and this has a direct bearing on malnutrition. Botswana is no exception because malnutrition has grown to become a public health nutrition concern. The high prevalence of malnutrition in Botswana makes it the largest contributor to disease.
The 2020 Global Nutrition Report Action on equity to end malnutrition which examines the critical role of addressing inequity to end malnutrition in all its forms states that the prevalence of inequalities in adult nutrition in Botswana is very high.
“Large sex gaps in obesity are found in countries in the same regions, most notably South Africa (women 39.6%, men 15.4%, difference 24.2%), Lesotho (women 26.7%, men 4.6%, difference 22.0%), Botswana (women 29.3%, men 8.1%, difference 21.2%), Eswatini (women 26.2%, men 5.4%, difference 20.8%) and Zimbabwe (women 25.3%, men 4.7%, difference 20.5%),” states part of the report. The report assessed 194 countries from across the globe to determine their progress towards meeting eight 2025 global nutrition targets. Of the 54 African countries, Botswana is among 14 countries that will not meet even one nutritional target.
The report further highlights that Botswana is one of the 5 countries in the Southern African Development Community (SADC) countries which are on track to meet zero (0) global nutrition targets. The other countries being Namibia, Mozambique, Mauritius and Madagascar.
The 2025 global nutritional targets are: 1. achieve a 50% reduction of anaemia in women of reproductive age, 2. achieve a 40% reduction in the number of children under-5 who are stunted, 3. achieve a 30% reduction in low birth weight; 4. ensure that there is no increase in childhood overweight; 5. increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%; 6. reduce and maintain childhood wasting to less than 5%, 7. Reduce childhood overweight, adult obesity and 8. Reduce adult diabetes.
Grain and cereal researcher, Lakayana Sepapi says in order for Botswana to close the nutrition gap, there is need for Botswana to completely reshape her food ecosystem. “The chances of malnutrition surging in Botswana are very high mainly because the Covid-19 pandemic has not only resulted in the decline in household income, but has also triggered changes in the availability and affordability of nutritious foods,” she says.
A study conducted by the International Food Policy Research Institute (IFPRI) which provides research-based policy solutions to sustainably reduce poverty and end hunger and malnutrition in developing countries, notes that high food prices could help explain why countries such as Botswana continue to struggle with a double burden of malnutrition extremes. Among other things, the study highlighted that most of the non-cereal foods and nutritious foods are pricey and beyond the reach of scores of people in low income countries.
Sepapi also said with most companies having been forced to scale back their salaries drastically necessitated by Covid-19 pandemic, “most households would be left with no option but to transition to buying the cheapest calories to eat—the aim being to maintain quantity and not quality.
“As a result, anaemia, stunting, wasting and other nutritional deficiencies are highly likely to surge,” says Sepapi.
In another report prepared by the World Health Organisation (WHO) entitled 2020 State of Food Security and nutrition report, the report notes that over sixty four percent of Batswana cannot afford a healthy diet. Furthermore the report highlights that thirty two percent of household income is channelled towards food expenditure.
“A healthy diet helps to protect against malnutrition in all its forms, as well as non-communicable diseases (NCDs),” notes WHO. It also provides the body with essential nutrition such as fluids, macronutrients, micronutrients, and adequate calories and helps to improve overall health.
Another nutritionist who spoke to this publication on condition of anonymity indicated that while high food prices of healthy food might be the reason for nutrition inequality, he says another issue might lack of knowledge.
“If people are to buy healthy and nutritious food, then they must be educated and sensitised about the advantages of doing so. It must be clearly explained to citizens that healthy food lowers healthcare costs. I haven’t seen any aggressive campaigns in Botswana which aim to inform people about nutritional knowledge,” he says.
Although the pandemic is far from over, it is becoming evident that the pandemic is expected to pose nutritional risks to Botswana in the short and long term. Prior to the pandemic, Botswana was already struggling with a double burden of malnutrition extremes. Various global fora such as FAO and SADC Secretariat’s Regional Vulnerability Assessment and Analysis (RVAA) Programme noted that undernourishment (PoU) in Botswana is pegged at 22.5%.
Since the beginning of the pandemic, nutritional scientists have cautioned of the need to target poor diets through effective and cost-effective approaches.
Inequities in food and health systems exacerbate inequalities in nutrition outcomes that in turn can lead to more inequity, perpetuating a vicious cycle. If nutritional inequality is left unchecked, it might lead to diet-related chronic diseases. Nutritional deficiencies can also be exacerbated by lifestyle behaviours or the presence of a chronic disease or condition.
