Food consumption patterns, seasonal dietary diversity, and factors affecting food intake in rural Eastern Uganda: A mixed-methods cross-sectional study

This mixed-methods cross-sectional study examines food consumption patterns, dietary diversity, and factors affecting food intake and malnutrition in the rural Mbale District in Eastern Uganda, during both wet and dry seasons. Participants (n = 100; 66% females) completed a food frequency questionnaire identifying foods and beverages consumed in the preceding 12 months. Individual interviews (n = 8) were conducted with key workers. Analysis of seventeen food items revealed seasonal variations in carbohydrate and protein sources. During the dry season, staples like matooke (mashed boiled plantains) and sweet and Irish potatoes were affected, while protein-rich foods such as beans and groundnuts saw increased consumption in the wet season. Fruit and vegetable intake also rose during the wet season. The main causes of malnutrition that emerged from the interviews were the lack of knowledge about food and nutrition, financial struggles, climate impact, and cultural beliefs. The last theme covered strategies to combat malnutrition. Although carbohydrate intake remains consistent throughout seasons due to reliance on posho (maize flour porridge) and cassava, variations in the number of meals and protein sources, particularly beans and groundnuts, were observed. Both of these, being the primary protein sources in rural households ’ diets, are highly susceptible to climate fluctuations. This may pose significant implications for food security, as heightened climate instability may impede their production. Solutions to combat malnutrition discussed by the interviewees include education, employment, family planning, and healthcare improvements. Professionals emphasise the need for comprehensive approaches to address these complex issues. In addition, data on food consumption during the dry and wet seasons should be collected as a difference in food consumption during the seasons may become more prominent with the need to implement tailored interventions.


Introduction
The Republic of Uganda has one of the fastest-growing economies in Africa and has been regarded as the 'breadbasket' of Eastern Africa.However, significant challenges persist in ensuring food security, with approximately 23% of the population facing severe food insecurity, particularly in the Eastern and Northern regions of the country (FAO IFAD UNICEF WFP WHO, 2022;Muggaga et al., 2022).The population, estimated at around 45.8 million, mainly resides in rural areas (74%), and only a small percentage lives in urban or semi-urban areas (The World Bank, 2023, Uganda Bureau of Statistics (UBOS), 2021a).Women and girls constitute the majority of the population (58%) (Uganda Bureau of Statistics (UBOS), 2021b); the total fertility rate declined and was, in 2021, 4.6 children per woman with one-third of the households headed by females and more than half of the population below the age of eighteen (The World Bank, 2023).
Although food production seems to be sufficient to satisfy the requirements of a rapidly growing population, since 2009, malnutrition has been the top risk factor contributing to the most deaths and disabilities combined (GBD 2019Risk Factors Collaborators, 2020).In addition, almost one in four children (24.4%) under 5 years (U5), was stunted, a reflection of chronic undernutrition, which leads to impaired growth and development (Uganda Bureau of Statistics (UBOS), 2022).According to the latest data available, the prevalence of underweight and stunting in U5 children in the rural Mbale District, located approximately 230 Km east of Kampala in Eastern Uganda where this study was conducted, were >25% and 10% respectively (Walakira et al., 2016).Women also face a heightened risk of undernutrition compared to men (Burgin, 2021).Among Ugandan women aged 15-49 years, the prevalence of underweight is 9%, with higher rates in rural areas and among younger women (Sserwanja et al., 2021, Sserwanja et al., 2020, Uganda Bureau of Statistics (UBOS) and ICF, 2018).This trend can be attributed to various factors, including the uneven distribution of food, seasonal and climatic factors, education level, access to clean water and proper sanitation, and above all gender, health, and wealth inequalities (Victora et al., 2021).
Notably, Ugandans exhibit significant gender-based disparities with documented losses in human development due to inequality (Nkoumou Ngoa and Lemven Wirba, 2021; United Nations Development Programme (UNDP), 2020).The evidence suggests that addressing nutrition improvement in Uganda necessitates a focus on income and gender equality pathways (Durairaj et al., 2019;Sekabira & Qaim, 2017).Men, primarily driven by financial interests, prioritise cash crops, while women, tasked with providing family sustenance, prioritise food crops (Nabuuma et al., 2021;Durairaj et al., 2019).At the same time, women are facing several challenges, including being overburdened by household responsibilities, decision-making and ownership issues, conflict over assets and resources, gender-based violence, cultural beliefs, traditional practices and reduced share of food, which have repeatedly put females at a disadvantage (Durairaj et al., 2019;Peterman et al., 2021;Sserwanja et al., 2020).
Data available in relation to Ugandan households' food consumption show that dietary diversity is poor, with fewer than four food groups consumed per day (SNV Netherlands Development Organisation, 2018).The diet in rural Uganda is mainly based on energy-dense starchy foods like plantain (matooke, mashed boiled savoury banana), roots (sweet potatoes, cassava), and cereals (white maize, millet, sorghum, etc.) (Sekabira et al., 2022).However, the shift from micronutrient-rich staples to less micronutrient-dense carbohydrates like white maize and cassava may potentially have a negative impact on micronutrient intake for vulnerable sub-groups, U5 children and women, especially if the intake of other foods like pulses, nuts, and green leafy vegetables is not adequate (World Food Programme (WFP), 2020; Mackay, 2019).In addition, seasonal dry and wet climate patterns with rainy seasons from March to May and from September to November, in the Eastern regions, affect food production (Durodola et al., 2020).Therefore, this mixed-methods cross-sectional study aims to examine food consumption patterns and dietary diversity during the wet and dry seasons in the rural Mbale District in Eastern Uganda.Additionally, the study aims to explore factors affecting food intake and malnutrition in this region of Uganda.

Methods
This mixed-methods cross-sectional study carried out in the Mbale District, employed both quantitative and qualitative designs.The Food Frequency Questionnaire (FFQ) was used to identify foods and beverages consumed in the preceding 12 months.Face-to-face interviews with key workers were performed to gain insights into the causes of malnutrition.In addition, observational field notes were used to provide a detailed description of food behaviour.

Food frequency questionnaire (FFQ)
A random sample of hundred (n = 100) participants living in several locations in the rural Mbale District (Table 1 and Fig. 1) participated in the study.A snowball sampling strategy was used to recruit participants, where one informant referred us to another informant (Shaghaghi et al., 2011).The Mbale Coalition Against Poverty (MCAP) health workers recruited the initial study participants in each community.Participants were eligible for enrolment in the study if they were 18 years of age or older, resided in the village and engaged in farming as their primary livelihood.The participants were asked to refer other participants who would be interested in taking part.Each participant was provided with a full explanation about the study, and informed consent was obtained prior to data collection.The FFQ was completed by 66 females and 34 males aged 18-70 years old [median age 41 y; (mean 43 y); >60% aged 30-40 y], with the majority (74%) having completed primary education, 16% secondary and tertiary education, and the rest (10%) not having attained any level of formal education.The average number of adults and children in the household was 3 and 5 respectively.The FFQ aimed to collect dietary intake data over the previous year.It listed several commonly consumed food items along with the frequency of consumption [always (every day/week), sometimes (once a month), very rarely (once/twice a year), and never] during the wet and dry seasons.Due to the lack of availability of validated FFQ tools to assess the habitual food intake of adults in rural Uganda, the tool used in this study is broadly based on the validated FFQ used to assess habitual food group intake among adults in urban and rural Botswana (Jackson et al., 2013).Although the questionnaire lacks formal validation, its content was informed by pertinent literature (Uganda Bureau of Statistics (UBOS), 2016, Rukundo, 2016, World Food Programme (WFP), 2013) including previous research by the authors (Filipponi et al., 2015) and consultation with the MCAP programme coordinators and community health workers.In addition, the questionnaire was piloted by staff and students  T. Filipponi et al. from the Uganda Christian University, Mbale Campus, and revised accordingly before being used to interview the participants.Each participant was asked about their food intake according to the questions listed in the FFQ.The interviews were conducted in Lugisu (local dialect); hence, local interpreters were engaged in the data collection process.

FFQ data analysis
The data were analysed using the Statistics Package for Social Scientists (IBM, SPSS Statistics Version 27.0).Shapiro-Wilk W tests (P > 0.05) indicated that data were not normally distributed.The disparity in meal consumption between the dry and wet seasons datasets (Fig. 1) was examined employing the Wilcoxon test method.Furthermore, differences in carbohydrate consumption (Table 2), animal protein (Table 3), plant protein and fruit and vegetable intake (Table 4) datasets were assessed using the Wilcoxon Signed-Ranks Test to determine variations in food consumption between wet and dry seasons.Statistical significance was established at P < 0.05.

Face-to-face interviews
Semi-structured interviews were performed with eight key informants.These comprised the head of a regional NGO, a rural hospital medical officer, a village health volunteer, a community health worker, a nursing sister working at the regional malnutrition treatment centre, a Red Cross volunteer, a local councillor and an education coordinator with an NGO.The participants worked and/or resided in the villages listed in Table 1.

Interviews data analysis
A 9-item interview schedule was devised by the authors based on previously published research.The interviews were conducted in the comfort of the respondent's workplace or home on a day and at a time convenient to the interviewees.They were conducted in English and each interview took approximately 30 min.A facilitator (TF) and moderator (PE) were present during the interviews.The facilitator's task was to administer the schedule of questions.The facilitator has experience in qualitative data collection in a similar setting (Filipponi & Oommen, 2021).The moderator's responsibility encompassed observing participants' nonverbal cues, noting significant pauses, prolonged discussions prompted by the questions posed, and discernible nonverbal expressions.The interviews were recorded and the -moderator (PE) transcribed the interviews within a few days from the data collection date while the content of the interviews was fresh in the researcher's mind.A complete, unabridged transcription that included all parts of words and hesitations was produced (Bloor et al., 2001).The thematic analysis method described by Braun and Clarke (2006) was used to analyse the data.The recordings were listened to several times to ensure the transcription accuracy and the interview transcripts were read and re-read to ensure familiarity with the data.The data analysis involved open coding in which broader generic themes were identified.This allowed the researchers to generate codes and organise the data into broader generic themes.Keywords and phrases that captured the participant's words' essence were coded into the themes (Braun & Clarke, 2006;Mihas, 2023).The coding was carried out by each researcher independently (TF, HO, PE), and the main themes were then agreed upon.Triangulation was established as the researchers independently read and coded the transcripts before meeting to reach a consensus on the main themes.The qualitative software NVivo 12 was used to code the data and provide a more rigorous approach to the content analysis.

Ethics
The study followed the Helsinki Protocol (Williams, 2008) and ethical approval was obtained from the University of South Wales (USW) Faculty Research Ethics Committee (reference number: 210606LR).The main ethical principles of informed consent, confidentiality, anonymity and data protection were maintained.Participants had been approached in advance of the day of the data collection and informed of the study, whilst consent was given on the day data collection took place.

Food frequency questionnaire
Statistically significant differences in meal consumption emerged when comparing wet and dry seasons revealing a higher daily meal frequency during the wet season compared to the dry season.The majority of respondents were able to have two meals daily; a meal was considered to be any substantial amount of food eaten at one time and could be any of the usual occasions such as breakfast, lunch and dinner.However, a notable variation in meal frequency was observed, with 46% of respondents reporting the consumption of three meals -breakfast, lunch, and supper -during the wet season.In contrast, less than a third (27%) reported a similar pattern during the dry season, and five participants indicated an inability to access food altogether during this period (Fig. 2).Posho, maize flour cooked with water to a porridge consistency, and cassava were the staples most consumed as shown in Table 2.Among animal proteins, chicken eggs were consumed with greater frequency, while the consumption of chicken, goat, beef and fish varied among respondents, with most indicating occasional intake (Table 3).However, no statistical significance between wet and dry seasons was noted (Table 3).Food items that showed a statistically significant increase in consumption in the wet season compared to the dry season out of the seventeen food items analysed are displayed in Tables 2 and 4.The main carbohydrate sources affected in the dry season were matooke (mashed boiled plantains) and sweet and Irish potatoes.Furthermore, the main sources of protein, beans and groundnuts, were both affected by the seasons with an increased consumption during the wet period.The consumption of fruit and vegetables was also greater in the wet seasons.On the contrary, the consumption of millet bread, a staple food made from a mixture of millet flour and cassava flour was higher in the dry season in comparison with the wet season.

Observational notes
The following notes were taken during the study.They reflect personal observations by the authors as well as the outcome of informal conversations with students, community workers and interpreters.
Observantions (if a title is needed here) Consumption of refreshments Many locals avoid taking food and/or water when away working in the field or when attending school.This is not always due to a lack of money to buy food.It was explained that locals are not willing to bring homemade food, 'packed lunches' or water when away from the house.(the background should be white as the other rows)

Raw food vs. cooked food
Locals do not like eating raw vegetables like carrots or tomatoes.Vegetables that are included in the meals are usually cooked.

Main meals
Main meals should contain a source of carbohydrates and preferably meat if possible.Vegetables are not considered an important part of the meal.

Staples
Matooke is the preferred source of carbohydrates by many locals.Posho which is made from maize flour and water is also commonly consumed and available.However, refined maize flour is preferred to unrefined flour.Cassava is also consumed; however, it seems to be the last source of carbohydrates consumed if nothing else is available.

Food taboo
It was explained that some foods are taboo and should not be provided to children or women depending on several beliefs.For example, pregnant women should refrain from eating eggs to avoid miscarriages, premature delivery, or stillbirth.

Eating practices
In some of the rural houses visited men and women ate in different areas.Male young adults and older men ate in the house whereas, women with the children ate in the kitchen/cooking area.

Interviews
The interviews were conducted with eight professionals who dealt with malnutrition in their professional roles.The professionals interviewed had several years of experience working in their roles or volunteering (Table 5).Several themes arose from these interviews.The  main causes of malnutrition were identified as the lack of knowledge about food and nutrition, financial resilience and the impact of climate change and cultural beliefs.The last theme portrayed the initiatives that, according to the participants, should be implemented to address malnutrition.
1 Food and Nutrition Knowledge All the participants commented on the parents' lack of education and knowledge to provide a satisfactory diet or the lack of variety in the diet given to their children.
"There is a lack of knowledge of the parents.We are blessed with fruit and vegetables, but they need guidance on a balanced diet.They eat posho (ground maize porridge) the whole day, without anything to support the balanced diet."(P2) "We give to children food which is not healthy for their development.We give them porridge or millet without enough milk which does not help the child grow well."(P7) "There is a need for education, to give these people information about balanced dieting.Some people do not know the components of a balanced diet -they eat matooke (boiled green bananas) all the year."(P4) "There is a knowledge gap in knowing how to mix different types of food to improve the nutrition of the children."(P5).

Financial resilience
Many participants mentioned the theme of financial resilience.
Despite living in an area with excellent agriculture the crops were not used to feed the family but were sold to obtain cash for other household needs: "Most of all because they sell everything to get a different commodity.Some will carry passion fruits to market to sell but they will not leave some home for their children.I am telling my people here if you have a cow with milk why can't you leave a cup for your family and take some to sell or trade."(P 7)

"They keep goats and sell the milk and do not keep any back for the children." (P2)
"They need money, they need money to buy soap, they need money for household goods.They eat maize made into a porridge.They eat vegetables, and that is for the whole year without changing the diet."(P5) There were financial pressures to help with the children's education or medical expenses: "They are trading foods to help their homes, pay school fees, or uniforms, or for medical fees for their children going to hospital if they are sick."(P1)

Climate
The participants also discussed the effect of climate change on local farmers as well as the importance of crops diversification.

"It is important to have an adequate supply of food and to promote diversification of animals and food crops which are drought resistant. This is the result of climate change and if we don't have crops which are drought resistant then we don't have food at all." (P2)
"From February to June there is not much food from here, it is just planting.Maybe some families they go with one meal all day and sometimes with nothing.And then the kiddie has not eaten in the day.And when it rains now, it rains too much."(P5)

Cultural beliefs
The interviewees recounted cultural practices causing the restriction of food to girls even when it was available.There were beliefs that some foods could be poisonous and were banned:  "In this area it is not only about having enough to eat but we have cultural prejudices, we actively discourage some foods for children.In this area girls are not supposed to eat chicken or liver, or they will die, but it is a myth, so there is a need for education."(P7) "They produce, for example they grow chicken which they sell.They don't even give the children the eggs they produce, which have very good nutritional value … It's forbidden."(P6) Although there was a positive status in having many children, it was recognised that large families imposed the burden of having to provide enough food for everyone, with the risk of malnutrition.
"Family planning is a major role here.In my village the rate at which we are reproducing is so high, families of ten children all wanting to be fed, and you are unable to feed them, then you have malnutrition.Some people believe children are wealth, it brings respect by the clan."(P7) "There is respect in having lots of children but may not be able to feed them all well."(P6) 5 Improvements for the future: A common theme that emerged was that future improvements in nutrition would depend upon improving education and the provision of employment: "Education, we need teams to go to the villages and educate on what to plant and how to feed." (P5) "We need to create an alternative source of income rather than relying on agricultural produce to earn money.If they can sell their labour in factories it would spare what they are growing at home.It will also take time from many adults who are otherwise idle and resort to drinking."(P2) "Health education on how to eat, how to do everything to improve the nutrition.Adopting family planning will help us getting an affordable number of children that we can provide all the necessities for."(P3) "Another thing is to encourage the mothers to breastfeed and to be treated for HIV.Before the children with malnutrition were dying because the mothers were not breastfeeding."(P8) "Number one is information given to the parents.We have many parents who are illiterate, don't read or write, so we have a school near here for them.We should promote these classes, we should ensure the children go to school, which the Government is trying to do something about."(P1)

Discussion
This mixed-methods cross-sectional study conducted in low-income settings in Eastern Uganda revealed several key findings regarding meal consumption patterns and food insecurity.Participants in rural communities consumed significantly more meals during the wet season compared to the dry season, with the majority having two meals daily.This aligns with national census data and other reports, where over half of the rural population reported two meals daily (Office of the Prime Minister, 2020; Uganda Bureau of Statistics (UBOS), 2016).In addition, 12% of the rural population could not afford more than one meal per day, with females recording the lowest daily intake (UBOS, 2016).Likewise, 24% of the participants reported consuming only one meal daily during the dry season, while 5% had no food.Despite the findings of the Nutrition Situation Report (2020) suggesting a reduction in the proportion of households reporting insufficient food to feed the family, this problem continues to be more prevalent among rural households and across Northern and Eastern regions.This persistence is concerning due to its potential effect on the most vulnerable groups, especially children and women of childbearing age (Office of the Prime Minister, 2020).This study addressed a critical gap by examining fluctuations in meal consumption and food supply patterns between wet and dry seasons, complementing existing reports (UBOS, 2021a(UBOS, , 2020(UBOS, , 2016) ) along with discussing the underlying causes and potential solutions.
Patterson et al. ( 2017) observed a correlation between the dry season and food insecurity in rural indigenous communities in Kanungu District, Uganda (Patterson et al., 2017).Similarly, Mbale District heavily relies on rainfed agriculture, leading to no agriculture production during the dry season, and exacerbating food insecurity (Durodola et al., 2020).Smallholder farmers in these areas face extreme poverty, food insecurity, and malnutrition, as agriculture is their main livelihood (Nabuuma et al., 2021;Walakira et al., 2016).Despite favourable rainfed conditions in Mbale, challenges like limited access to modern inputs, techniques, and agricultural knowledge persist (World Food Programme (WFP), 2020).Climate change further impacts food production, with increased rainfall in the 'long' rains causing floods and decreased rainfall in the 'short' rains affecting overall food availability (Farooq et al., 2022;van Bavel et al., 2020).Although the negative impact of climate change on local farmers and the need for specialised training were highlighted by the interviewees, they also highlighted farmers' tendency to sell crops for cash rather than consume them, potentially compromising household food security.Families may trade food items to afford school fees, uniforms, or medical expenses, indicating the trade-offs they make between immediate financial needs and ensuring food security for their households.However, this reliance on financial resilience poses risks, as it prioritises short-term economic stability over long-term food security.By selling agricultural produce instead of consuming it, families may leave themselves vulnerable to food shortages during lean periods.Furthermore, this reliance on cash income can perpetuate a cycle of poverty, especially if agricultural resources are not adequately managed for household consumption (Nabuuma et al., 2021).Indeed, rural households were reported to be twice more likely to be food-poor than urban households in the Eastern regions, where the Mbale District is located, presenting the highest number of food-poor households as the inability to afford the right food quantity and appropriate nutrient content was reported (UBOS, 2021a).This disparity notably impacts vulnerable demographics such as children and women of reproductive age, worsened by gender disparities and cultural norms (Acire et al., 2023;Nabuuma et al., 2021).Therefore, to enhance financial resilience, interventions should address not only economic vulnerabilities but also gender disparities such as equal access to resources and empowerment programmes for women in rural communities (Durairaj et al., 2019).
The latest report highlights the limited diversity in the Ugandan diet, with daily consumption typically derived from fewer than four food varieties (Uganda Bureau of Statistics (UBOS), 2021a).Our findings align with this and other reports, confirming that staples such as matooke (plantain, cooking bananas), posho made with maize flour, millet bread, sweet potatoes and cassava are primary dietary components (Mottaleb et al., 2021, Uganda Bureau of Statistics (UBOS), 2020).Furthermore, protein supply, averaging around 48 g/day per capita, primarily comes from plant products, nuts and pulses (beans, peas, lentils), with beans providing 95% of the dietary energy supply of the group (UBOS, 2020).Although, as stated in the observational notes, participants prefer matooke or refined maize flour in posho preparation over cassava, our data show that carbohydrate accessibility remains stable during the dry season.However, the availability of beans and groundnuts appears to decrease in the dry season.In addition, cassava shows little loss as it is more resistant to variability in climate (Shigaki, 2016), whereas beans which are also the main source of protein in the diet of rural households (UBOS, 2021a(UBOS, , 2020(UBOS, , 2016)), are most sensitive to climate variations and have important implications for food security (Hummel et al., 2018).
The themes that emerged from the interviews also highlighted the importance of crop diversification along with the impact of restrictions on the consumption of some food types due to cultural beliefs and practices as possible causes of malnutrition.As reported in the observational notes and by other authors, several cultural beliefs were described as barriers to consuming food rich in protein and micronutrients, an example is the restriction of egg consumption during pregnancy to avoid adverse pregnancy outcomes (Acire et al., 2023;Kiguli et al., 2019).However, consensus among all interviewees emphasised the necessity of educating communities on appropriate crop selection and dietary choices to enhance nutrition outcomes.Extensive evidence supports the positive correlation between nutrition, agricultural education and improved diet diversity as well as nutrition outcomes (Komakech et al., 2023;Murendo et al., 2023;Kajjura et al., 2019;Ickes et al., 2017).In addition, the respondents highlighted that improving nutrition in rural contexts necessitates multifaceted interventions encompassing not only education but also employment and healthcare provision.Indeed, creating alternative income sources beyond agriculture can alleviate financial strain and improve access to diverse foods (Anang & Apedo, 2023).Furthermore, healthcare initiatives, including nutritional education and family planning advocacy, are crucial for ensuring adequate provisioning for children within households (Canning & Schultz, 2012).Initiatives promoting breastfeeding and facilitating HIV treatment among mothers are particularly salient in averting malnutrition-related morbidity and mortality among children (Perez-Escamilla et al., 2018).Therefore, as reported by the participants, the causes of malnutrition are multiple and interrelated and would require a multisectoral approach with a clear focus on reducing inequalities to address the challenges of the sustainable development goals (SDGs) concerning access to safe and nutritious food for all at all times of the year (Duncan et al., 2022).
The strength of this study lies in the mixed-methodological approach taken which provides a broader picture of the situation and the problems faced.In addition, the focus on food consumption during the wet and dry seasons provides new insight which can further support the data reported by national food consumption surveys.However, one of the limitations of this study is that the questionnaire used to collect the food frequency data had not been validated in the population of interest which may have led to measurement and conclusion errors; nevertheless, no validated tools were available.In addition, the questionnaire was piloted by staff and students from the Mbale-based university and revised accordingly before being used to interview the participants.Dietary recall may also be subject to biases such as memory and subjects' ability to remember the type and quantity of food consumed in the previous months during the wet and dry seasons.In addition, some food items consumed less frequently could not have been captured in the responses.However, the food consumed in rural Uganda is largely based on starchy staples and legumes which may have less impact on memory bias and seasonal dietary changes (Holmager et al., 2021).The respondents were also asked to report any food items not listed in the questionnaire.Some foods (i.e., sorghum, chapati, pasta, etc.) were reported, although only by a limited number of respondents; hence, they were not included in the analysis.Although n = 100 participants from different communities consented to participate, the individuals who responded may not have been diverse and representative of the wider rural population.Yet, national surveys (UBOS, 2021a(UBOS, , 2020(UBOS, , 2016) ) have reported similar data to the one observed in this study.Finally, the study was conducted in 2018 and does not consider the implications of COVID-19 and more recent changes in climate on the rural population.However, more recently negative impacts on the diet of the rural population in terms of reduced variety and consumption of foods, especially animal-source food and increased food insecurity have been reported (Scarpa et al., 2023).
Overall, research on food consumption patterns, seasonal dietary diversity, and factors affecting food intake in rural Eastern Uganda highlights the complex interplay of socio-economic, cultural, and environmental factors shaping dietary habits and nutritional outcomes in the region.Addressing food security and nutrition challenges requires holistic and context-specific interventions that consider the diverse needs and circumstances of local communities.

Conclusion
This study has highlighted variations in food consumption during the wet and dry seasons in Mbale, Uganda which may impact household dietary intake and diversity.Although carbohydrate intake may not be affected, beans and groundnuts, which are the main sources of protein in the diet of rural households and are the most sensitive to climate variations may have implications for food security.This could negatively impact the diet of the most vulnerable: children and women of reproductive age, especially during times of crisis.Addressing malnutrition requires comprehensive approaches, including education, employment opportunities, healthcare, and promoting breastfeeding.Enhancing nutritional literacy, creating alternative income sources, and empowering women are crucial strategies for long-term improvement.Finally, data on food consumption during the dry and wet seasons should be collected as a difference in food consumption during the seasons may become more prominent with the need to implement tailored interventions.

Fig. 2 .
Fig. 2. Number of meals consumed in the wet season and dry season.

Table 1
Location of communities and numbers of household respondents.

Table 2
Carbohydrate intake during the wet and dry seasons.
a Difference in carbohydrate consumption between the wet and dry seasons.bbased on positive ranks.cbased on negative ranks.T.Filipponi et al.

Table 3
Animal protein intake during the wet and dry seasons.
a Difference in protein consumption between the wet and dry seasons.b based on negative ranks.

Table 4
Plant protein and fruit and vegetable intake during the wet and dry seasons.
a Difference in food consumption between the wet and dry seasons.b based on negative ranks.c Near significant.

Table 5
Gender and roles of the professionals interviewed.