Zimbabwe’s food insecurity paradox: hunger amid potential

A research paper on the paradox of poverty in a situation of great potential agricultural yields in Zimbabwe's quest for food security.Food security is one of the primary goals for human and sustainable development the world over. At the global level, one of the millennium development goals is halving the number of undernourished people in the world by 2015. In Zimbabwe, food security has been at the centre of development goals and strategies since independence in 1980. Zimbabwe has also ratified all the conventions regarding sustainable development, including the United Nations Millennium Development Goals. In the 1980s, Zimbabwe received international acclaim for its agricultural policies and grain surpluses212 but many households in the rural areas faced chronic food insecurity. Although Zimbabwe has the potential to achieve food security, it has experienced food shortages since the 1990s at both the national and household levels. Food self sufficiency in Zimbabwe could be achieved primarily through production and then distribution to the population through appropriate marketing policies and channels. In 1985, grain self-sufficiency was 212 per cent and Zimbabwe was regarded as the grain basket of the Southern African Development Community." However, production of the main staple food crops has been declining over the years. Whilst low production can be attributed to poor and erratic rainfall, low soil fertility and other institutional and policy factors have been responsible for lagging production from the 1999/2000 season onwards

Perinatal HIV infection is associated with deficits in muscle function in children and adolescents:a cross-sectional study in Zimbabwe

Objectives: To determine how muscle strength, power, mass, and density (i.e. quality) differ between children living with HIV (CWH) and those uninfected, and whether antiretroviral therapy (ART) regime is associated with muscle quality.Design: A cross-sectional study in Harare, Zimbabwe.Methods: The study recruited CWH aged 8–16years, taking ART for ≥2years, from HIV clinics, and HIV-uninfected children from local schools. Muscle outcomes comprised grip strength measured by hand-held Jamar dynamometer, lower-limb power measured by standing long-jump distance, lean mass measured by dual-energy X-ray absorptiometry, and muscle density (reflecting intramuscular fat) by peripheral quantitative computed tomography. Linear regression calculated adjusted mean differences (aMD) by HIV status.Results: Overall, 303 CWH and 306 without HIV, had mean(SD) age 12.5(2.5) years, BMI 17.5(2.8), with 50% female. Height and fat mass were lower in CWH, mean differences(SE) 7.4(1.1)cm and 2.7(0.4)kgs, respectively. Male CWH had lower grip strength (aMD 2.5[1.1,3.9]kg, P &lt; 0.001), long-jump distance (7.1[1.8,12.5]cm, P = 0.006), muscle density (0.58[0.12,1.05]mg/cm3, P = 0.018, but not lean mass 0.06[-1.08,1.21]kg, P = 0.891) versus boys without HIV; differences were consistent but smaller in females. Mediation analysis suggested the negative effect of HIV on jumping power in males was partially mediated by muscle density (P = 0.032). CWH taking tenofovir disoproxil fumarate (TDF) had lower muscle density (0.56[0.00,1.13]mg/cm3, P = 0.049) independent of fat mass, than CWH on other ART.Conclusions: Perinatally-acquired HIV is associated, particularly in males, with reduced upper and lower-limb muscle function, not mass. Intra-muscular fat (poorer muscle quality) partially explained reductions in lower-limb function. TDF is a novel risk factor for impaired muscle quality.</div

The IMpact of Vertical HIV infection on child and Adolescent Skeletal development in Harare, Zimbabwe (IMVASK Study):a protocol for a prospective cohort study

INTRODUCTION: The scale-up of antiretroviral therapy (ART) across sub-Saharan Africa (SSA) has reduced mortality so that increasing numbers of children with HIV (CWH) are surviving to adolescence. However, they experience a range of morbidities due to chronic HIV infection and its treatment. Impaired linear growth (stunting) is a common manifestation, affecting up to 50% of children. However, the effect of HIV on bone and muscle development during adolescent growth is not well characterised. Given the close link between pubertal timing and musculoskeletal development, any impairments in adolescence are likely to impact on future adult musculoskeletal health. We hypothesise that bone and muscle mass accrual in CWH is reduced, putting them at risk of reduced bone mineral density (BMD) and muscle function and increasing fracture risk. This study aims to determine the impact of HIV on BMD and muscle function in peripubertal children on ART in Zimbabwe. METHODS AND ANALYSIS: Children with (n=300) and without HIV (n=300), aged 8-16 years, established on ART, will be recruited into a frequency-matched prospective cohort study and compared. Musculoskeletal assessments including dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, grip strength and standing long jump will be conducted at baseline and after 1 year. Linear regression will be used to estimate mean size-adjusted bone density and Z-scores by HIV status (ie, total-body less-head bone mineral content for lean mass adjusted for height and lumbar spine bone mineral apparent density. The prevalence of low size-adjusted BMD (ie, Z-scores <-2) will also be determined. ETHICS AND DISSEMINATION: Ethical approval for this study has been granted by the Medical Research Council of Zimbabwe and the London School of Hygiene and Tropical Medicine Ethics Committee. Baseline and longitudinal analyses will be published in peer-reviewed journals and disseminated to research communities

A farming system framework for investment planning and priority setting in Ethiopia

This study highlights the diversity of farming systems in Ethiopia and their significance as a basis for planning agriculture-led development interventions in diverse landscapes. This report has been developed as an output of the ACIAR Small Research Activity (SRA) ‘Farming systems approach to supporting national CAADP [Comprehensive Africa Agriculture Development Programme] investment planning for sustainable intensification and climate-smart agriculture in Africa’

Labour after Land Reform: The Precarious Livelihoods of Former Farmworkers in Zimbabwe

What happens to labour when major redistributive land reform restructures a system of settler colonial agriculture? This article examines the livelihoods of former farmworkers on large‐scale commercial farms who still live in farm compounds after Zimbabwe's land reform. Through a mix of surveys and in‐depth biographical interviews, four different types of livelihood are identified, centred on differences in land access. These show how diverse, but often precarious, livelihoods are being carved out, representing the ‘fragmented classes of labour’ in a restructured agrarian economy. The analysis highlights the tensions between gaining new freedoms, notably through access to land, and being subject to new livelihood vulnerabilities. The findings are discussed in relation to wider questions about the informalization of the economy and the role of labour and employment in a post‐settler agrarian economy, where the old ‘farmworker’ label no longer applies

Zimbabwe’s land reform: challenging the myths

Most commentary on Zimbabwe’s land reform insists that agricultural production has almost totally collapsed, that food insecurity is rife, that rural economies are in precipitous decline, that political ‘cronies’ have taken over the land and that farm labour has all been displaced. This paper however argues that the story is not simply one of collapse and catastrophe; it is much more nuanced and complex, with successes as well as failures. The paper provides a summary of some of the key findings from a ten-year study in Masvingo province and the book Zimbabwe’s Land Reform: Myths and Realities. The paper documents the nature of the radical transformation of agrarian structure that has occurred both nationally and within the province, and the implications for agricultural production and livelihoods. A discussion of who got the land shows the diversity of new settlers, many of whom have invested substantially in their new farms. An emergent group ‘middle farmers’ is identified who are producing, investing and accumulating. This has important implications – both economically and politically – for the future, as the final section on policy challenges discusses.ESR

Growth Profiles of Children and Adolescents Living with and without Perinatal HIV Infection in Southern Africa: A Secondary Analysis of Cohort Data

Impaired linear growth and slower pubertal growth can be associated with perinatal HIV infection. We characterised growth relative to population norms, among the full adolescent period in southern Africa to better understand processes leading to morbidity in adulthood. We conducted a secondary analysis of 945 adolescents aged 8-20 years from urban Malawi and Zimbabwe; we included children with HIV (CWH), an uninfected comparison group from a cohort study, and CWH with co-morbid chronic lung disease (CLD) from a randomised controlled trial. We used latent class analysis of anthropometric Z-scores generated from British 1990 reference equations at two annual time-points, to identify growth trajectory profiles and used multinomial logistic regression to identify factors associated with growth profiles. Growth faltering (one or more of weight-for-age, height-for-age, or BMI-for-age Z-scores < -2) occurred in 38% (116/303) of CWH from the cohort study, 62% (209/336) of CWH with CLD, and 14% (44/306) of HIV-uninfected participants. We identified seven different growth profiles, defined, relatively, as (1) average growth, (2) tall not thin, (3) short not thin, (4) stunted not thin, (5) thin not stunted, (6) thin and stunted and (7) very thin and stunted. Females in profile 3 exhibited the highest body fat percentage, which increased over 1 year. Males at older age and CWH especially those with CLD were more likely to fall into growth profiles 4-7. Improvements in height-for-age Z-scores were observed in profiles 6-7 over 1 year. Interventions to target those with the worst growth faltering and longer-term follow-up to assess the impact on adult health are warranted

Effect of HIV infection on growth and bone density in peripubertal children in the era of antiretroviral therapy: a cross-sectional study in Zimbabwe.

BACKGROUND: Faltered linear growth and pubertal delay, which are both common in children with HIV in sub-Saharan Africa, might affect adolescent bone accrual and future fragility fracture risk. We investigated the association of HIV with bone density adjusted for skeletal size in peripubertal children in Zimbabwe. METHODS: We did a cross-sectional study of baseline data from the IMVASK cohort, which enrolled children aged 8-16 years with HIV who had been taking antiretroviral therapy (ART) for at least 2 years, and children of the same age without HIV. Children with HIV were recruited from public sector HIV clinics at Parirenyatwa General Hospital and Harare Central Hospital (Harare, Zimbabwe), and children without HIV were recruited from six schools in the same suburbs that the hospitals serve. Sociodemographic, clinical, and anthropometric data were collected. Dual-energy X-ray absorptiometry (DXA) was used to measure the bone outcomes of total-body less-head bone mineral content for lean mass adjusted for height (TBLH-BMCLBM), and lumbar spine bone mineral apparent density (LS-BMAD), and we assessed the prevalence of low TBLH-BMCLBM and low LS-BMAD (defined by Z-scores of less than -2·0). Size adjustment techniques were used to overcome the size dependence of DXA measurement. We used linear regression models, with multiple imputation for missing data, to assess relationships between risk factors and TBLH-BMCLBM and LS-BMAD Z-scores in children with and without HIV. FINDINGS: We recruited 303 children with HIV (mean age 12·4 years [SD 2·5]; 151 [50%] girls) and 306 children without HIV (mean age 12·5 years [SD 2·5]; 155 [51%] girls). In children with HIV, median age of HIV diagnosis was 3·0 years (IQR 1·2-5·8), and median ART duration was 8·1 years (6·2-9·5); for 102 (34%) children, ART included tenofovir disoproxil fumarate (TDF). Children with HIV had a higher prevalence of low TBLH-BMCLBM Z-score than children without HIV (29 [10%] of 279 children with available data vs 18 [6%] of 292 with available data; p=0·066) and a higher prevalence of low LS-BMAD Z-score (40 [14%] of 279 vs 17 [6%] of 293 with available data; p=0·0007). HIV and male sex were associated with earlier pubertal (Tanner) stage. The negative associations between HIV and Z-scores for TBLH-BMCLBM and LS-BMAD were more pronounced with pubertal maturation, particularly in girls. Among children with HIV, TDF exposure and orphanhood were associated with lower TBLH-BMCLBM Z-score in confounder-adjusted analysis. Current TDF use (vs non-TDF-based ART) was associated with a reduction in TBLH-BMCLBM Z-score of 0·41 (95% CI 0·08-0·74; p=0·015) and in LS-BMAD Z-score of 0·31 (0·08-0·69; p=0·12). INTERPRETATION: Despite ART, HIV is associated with substantial skeletal deficits towards the end of puberty. The extent of bone deficits associated with TDF and its widespread use in children in sub-Saharan Africa are a concern for future adult fracture risk. FUNDING: Wellcome Trust

Food systems under stress in Southern Africa : agenda for research and action

In IDL-1019