Consumption of Fruits and Vegetables in the Time of COVID - 19 Pandemic among Adult Refugees in Kyaka II Settlement in Uganda.

Abstract

Introduction: The COVID-19 pandemic has affected the world in many unprecedented ways, inter alia, threatening the food and nutrition security of vulnerable populations, particularly those living in low-to-middle-income countries (LMICs). Considering the ripple effects of the pandemic, it was expected to worsen the global consumption of fruit and vegetables (FV) which was generally low. FV are important because they provide micronutrients and diversify diets which is vital in the prevention of noncommunicable and communicable diseases, including COVID-19. Refugees are among the groups most vulnerable to food insecurity and poor dietary intake. The pandemic ravaged refugee livelihoods most likely exacerbating their FV consumption. However, little is known about the consumption behavior and prevailing factors influencing FV consumption among refugees in LMICs. This study aimed to explore changes in FV consumption among adult refugees in Kyaka II settlement in Uganda and to identify factors influencing their consumption behaviors during the pandemic.

Method: A qualitative descriptive study design with an embedded quantitative approach was conducted in the present study. The qualitative design included focus group discussions (FGDs) with refugees from the Kyaka II settlement and semi-structured interviews with key informants (KI) (representatives from governmental and non-governmental entities). Data collection was conducted over two time periods (October 2021 and January 2022). First, a sixty-item questionnaire was completed by the refugees, prior to taking part in the FGDs; and questions included sociodemographic data, food security status, and food consumption behaviors of refugees. Descriptive statistics from the short survey were presented as means and standard deviations for continuous variables and as frequencies and proportions for categorical variables. FGDs and key informant interviews (KIIs) were analyzed using content analysis and later triangulation of findings from FGDs and KII were conducted.

Results: A total of 12 FGDs were conducted (n = 68 refugee participants) and semi-structured interviews were completed with 11 KIs during the study period. Results from the short questionnaire showed that most of the refugees reported a low FV consumption and 88% were moderately to severely food insecure. A total of five categories with 31 emergent subcategories were noted based on the content analysis from the FGDs with refugees and interviews with KIs, respectively. The five main categories included 1) general patterns of FV purchasing and consumption behavior, 2) change in FV consumption during the pandemic, 3) facilitators of FV consumption, 4) barriers to FV consumption and 5) recommendations were noted with and. The major barriers to FV consumption expressed by refugees and KI were limited land access, low income as a result of cuts in food aid, COVID-19-related effects on the livelihoods of refugees and the local food supply. On the other hand, major facilitators to FV consumption were the perceived immune-boosting role of FV coupled with FV campaigns led at a national level. Recommendations offered by refugees and KIs to address some of the key challenges of FV consumption and improve food insecurity of refugees in Uganda included increased investment in agricultural training, knowledge empowerment, and access to land could

Conclusion: The consumption of FV among refugees in Uganda is inadequate and decreased during the pandemic due to socio-economic and COVID-19 related challenges. However, opportunities to avert this consumption crisis are present. Future research is needed to explore mechanisms of how to harmonize land access and use rights with self-reliance strategies to ensure food security and sustainable livelihoods.