This report from the Karamoja Resilience Support Unit (KRSU) describes a participatory analysis of malnutrition in children and mothers in Karamoja, focusing on the seasonality of livelihoods and food availability, and on causes of malnutrition. A key aspect of the analysis was to assess whether the methods and approaches of participatory epidemiology (PE) could be adapted to provide useful information on malnutrition. The work was conducted with a total of 42 groups of women in agro-pastoralist and pastoralist areas of Karamoja and involved an initial ethnographic stage based on 22 focus group discussions (FGDs), followed by the use of monthly calendars and participatory causal analysis with 18 groups. Findings were triangulated against secondary data and literature. 

Key Findings:

• Child malnutrition in agro-pastoralist and pastoralist areas of Karamoja peaks in January and February, at the end of the dry season. In pastoralist areas, the peak falls rapidly to lower levels of malnutrition by May. In agro-pastoralist areas, the peak in malnutrition declines more slowly to low levels in July. This pattern of malnutrition is consistent with other dryland areas of East Africa. It is associated with livelihoods that are livestock-based and milk production that depends on access to pasture and water. In agro-pastoralist areas of Karamoja, the longer malnutrition period is related to a greater dependency on crop production, but in a context of high rainfall variability and uncertain crop yields.
• Current food security and nutrition assessment (FSNA) surveys are conducted in May/June and November/December. They measure the point prevalence of global acute malnutrition (GAM) at these times. The retiming of these surveys to January/February and October/November would capture the full variation in GAM each year. PE methods such as monthly calendars would be useful for complementing quantitative surveys since they show monthly variations in malnutrition and related indicators over a full 12-month period.
• The agro-pastoralist and pastoralist systems in Karamoja are driven by rainfall and depend on sufficient levels of livestock ownership to provide milk and animals to sell for grain. Human births show marked seasonality that coincides with rainfall and cow milk availability. Over decades, insufficient livestock numbers have led to low milk production and consumption, less preservation of milk and meat as dry season foods and fewer animals available to exchange or sell for grain.
• Women provide highly plausible accounts of the causes of malnutrition. They explain malnutrition mainly from the perspective of two root causes— the limited availability of livestock and milk, and social norms that make them overburdened with the work of childcare and finding food for the family. These two root causes are interlinked and cascade down into various other issues and problems. Notably, limited livestock ownership has a direct impact on food availability because milk supply is insufficient and also forces households towards more non-livestock sources of food and income, which traditionally are the domain of women. These non-livestock activities include crop production, on small plots and with high risk of rain failure, and a range of other activities that often involve considerable effort for limited reward—and which often hinder childcare. When women are working, unweaned children can remain at home under the care of siblings or other relatives, but with limited or no milk available to feed these children. Further problems stem from the livestock-gender root causes, such as loss of cattle affecting men’s self-identity and sense of purpose, men spending more time in villages than in the past and more consumption of local brew and hard liquor. In turn, this leads to even more violence towards wives and a continued non-spacing of pregnancies. For women, increasing workloads, the stress associated with finding food and income, and the risk of violence from husbands also leads to alcohol abuse.
• The root cause of malnutrition of low livestock ownership is consistent with a recent analysis of livestock poverty in Karamoja, which concluded that 56.5% of agro-pastoralist and pastoralist households were “livestock poor” and that such household faced poverty traps. When viewed against the causes of malnutrition described by women and their weighting of the causes, the concept of “malnutrition traps” arises, whereby households are constantly struggling to meet their food needs and manage seasonal variations in the availability and affordability of different food types; this burden falls largely on women.
• The results of the analysis show a need for a nutrition strategy for Karamoja that takes account of the seasonality of livelihoods and food systems, recognizes low livestock ownership and gender norms as root causes of malnutrition and views the interplay of these two root causes as contributing to a range of other production and household stresses and behaviors.
• Women propose logical solutions for addressing malnutrition and need to be more actively involved in analyzing malnutrition and contributing to program design. Their preferred programming to improve nutrition involved food relief during difficult times, restocking with livestock, income-generation activities that enabled childcare, better education and health, and activities to reduce alcohol consumption. Further participatory work is needed to assess how gender-based violence and more general negative behaviors against women can be addressed by more targeting of men.