By Peter Yiga, Pui Yee Tan, Yun Yun Gong (University of Leeds), Caitlin Shannon (Care International), and Mathews Mhuru (National Food and Nutrition Commission, Zambia)
July 25, 2023

Zambia is experiencing a double burden of malnutrition- which may signal an ongoing nutrition transition- shaped by food supply and demand pressure, alongside international food and agriculture policies. However, nutrition transitions are insufficiently documented in the Zambian context. Furthermore, there is little knowledge of the short and long-term impact of a nutrition transition on interrelated human, animal and environmental health.

Under the FoSTA-Health project, a socio-ecological food environment framework has been used to map changes and trends in agricultural practices, food market structures and consumer preferences. We have reviewed the impacts of these changes on dietary behaviours and One Health outcomes. The methodology employed involves a search of MEDLINE, Embase, Scopus, Web of Science, bibliographies and Zambian government websites for studies on the topic from January 2000 to April 2023. The review identified 12 studies.

At the macro level, agricultural policies in Zambia incentivise maize and soybean production through input subsidies. Consequently, 80% of rural households are engaged in monoculture production systems, which translates into low food-supply diversity. Since 2008, soybean production has increased by 450%, taking up large amount of land used for agriculture. However, only 1.5% is processed directly for human food needs; the majority goes into feed production (80% of which is exported) and edible oil processing. Likewise, trade policies are creating imbalances, incentivizing the production and processing of cereals and edible oil over other food groups. Food safety policies are largely inadequate, and robust regulations are few and not fully implemented.

At the physical environment level, low food market diversity has been characterized by a 2-fold increase in the availability of maize and edible oil and a decrease in other food groups such as fruits and vegetables over the last two decades. Additionally, there is an increased availability of cheaper energy–dense, nutrient-poor foods, driven by the emergence of supermarkets and fast-food outlets. The gaps in food safety regulations and lapse in enforcement have translated into a higher availability of unsafe food and feed in the market. In relation to this, there are growing concerns about the use of unregulated pesticides/inorganic fertilisers/GMO seeds and pollution of water and agricultural land from the mining sector.

At the social and intra-individual level, there is limited evidence. Nonetheless, available insights show that existing perceptions may be reinforcing unhealthy dietary patterns. Evidence shows a higher preference for maize, edible oil and animal products-based diets and a negative perception towards soy food products. There is also evidence that, among the public, there are limited skills and knowledge regarding processing, storage and preparation of food, and lack of awareness/low-risk perception of food safety hazards.

The population as a whole has low dietary diversity-- 70% of urban children do not eat a diversified diet, 90% of adults do not meet the WHO fruit and vegetable recommendations and 60% of urban households eat <5 food groups. On health outcomes, data over the last two decades shows a slowing decrease in stunting and micronutrients deficiency and an escalating increase in overweight and obesity with the attendant noncommunicable disease - burden.

Ongoing transformations may be pushing the food system in Zambia further away from meeting the WHO recommendations for health and sustainable diets. However, there is limited data on current dietary patterns. Additionally, there are limited insights on consumer perceptions on food safety. Food safety concerns and impact on One Health need to be mapped out urgently. Evidence on how to manage these contaminants will inform policy to build stronger food safety measures.  Action on healthy diet policy, food literacy and campaigns will need to be promoted, monitored and evaluated for optimal One Health outcomes.

Over the coming months, the FoSTA-Health team will carry out research that will add to the evidence base around these key issues. The research questions will be reviewed by relevant stakeholders in Zambia. Please follow us on this website, on Twitter, and on LinkedIn for updates.

(Photo by R. du Plessis on Unsplash)