Advertisement
Browse Subject Areas
?

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here.

  • Loading metrics

A systematic review of sub-national food insecurity research in South Africa: Missed opportunities for policy insights

  • Alison Misselhorn ,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Writing – original draft, Writing – review & editing

    ‡ AM is lead analyst and co-author on this work. SLH is co-researcher and co-author on this work.

    Affiliation Institute for Food, Nutrition and Well-being, University of Pretoria, Pretoria, Gauteng, South Africa

  • Sheryl L. Hendriks

    Roles Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Visualization, Writing – original draft, Writing – review & editing

    Sheryl.Hendriks@up.ac.za

    ‡ AM is lead analyst and co-author on this work. SLH is co-researcher and co-author on this work.

    Affiliation Institute for Food, Nutrition and Well-being and the Department of Agricultural Economics, Extension and Rural Development, University of Pretoria, Pretoria, Gauteng, South Africa

A systematic review of sub-national food insecurity research in South Africa: Missed opportunities for policy insights

  • Alison Misselhorn, 
  • Sheryl L. Hendriks
PLOS
x

Abstract

Food insecurity is an intractable problem in South Africa. The country has a tradition of evidence-based decision making, grounded in the findings of national surveys. However, the rich insights from sub-national surveys remain a largely untapped resource for understandings of the contextual experience of food insecurity. A web-based search identified 169 sub-national food insecurity studies conducted in the post-apartheid period between 1994 and 2014. The systematic review found that the studies used 27 different measures of food insecurity, confounding the comparative analysis of food insecurity at this level. While social grants have brought a measure of poverty relief at household level, unaffordable diets were the root cause of food insecurity. The increasing consumption of cheaper, more available and preferred ‘globalised’ foods with high energy content and low nutritional value lead to overweight and obesity alongside child stunting. Unless a comparable set of indicators is used in such surveys, they are not able to provide comparable information on the scope and scale of the problem. Policy makers should be engaging with researchers to learn from these studies, while researchers need to share this wealth of sub-national study findings with government to strengthen food security planning, monitoring, and evaluation at all levels.

Introduction

It is well documented that food insecurity is caused by structural inequalities [1]. Since 1994, food security has been acknowledged as a national priority [2]. This prioritisation is evident in the key guiding national policies such as the Reconstruction and Development Programme (1994) [3], the Integrated Food Security Strategy (2012) [4] and later the National Policy on Food and Nutrition Security [5]. Over the last two decades following South Africa’s transition to a democratic state, food security has received significant policy attention and a range of interventions have been implemented by the Government, NGOs, civil society groups and the public sector [6].

However, South Africa has no official measure of food insecurity although the 2014 National Policy on Food and Nutrition Security’s [5] implementation plan includes a list of possible indicators, the measures, these have not been formally adopted as official measures for regular reporting across monitoring and evaluation systems in various national departments and bodies. Regular national surveys report on various elements of food access, the experience of hunger and nutrition statistics [7]. It is reported that around 26% of South African households or 13–15 million people have either inadequate or severely inadequate access to food [7]. Recently, Africa Check [8] have queried the validity of such claims. Africa Check explains that: “Determining how many hungry people there are in South Africa is not as straightforward as calculating 26% of the population”. Hendriks et al. (2016) have noted that the rich body of sub-national research studies is largely ignored and could provide important information regarding experiences of individuals, households, and communities to assist in determining the scope and scale of hunger, malnutrition and food insecurity in the country [9].

This paper presents the findings of a systematic review that set out on an ambitious task to explore and document the reality of food insecurity in South Africa over 20 years from the 1994 dawn of democracy to 2014 by drawing on the large body of hitherto un-synthesised peer-reviewed, published and unpublished research. The review sought to answer two research questions. Firstly, how is food insecurity experienced in South Africa, including the challenges to food access, availability, utilisation (nutrition) and stability and the short and long-term consequences (including coping, adapting, trade-offs) of food insecurity? Secondly, the study explored the implications of the above for decision makers and policy makers at all scales in South Africa.

Methods

This study adopted a structured systematic review process. A brief review was undertaken of the theory and practice of systematic reviews relevant to social science research [1019]. More specific review methods were then considered, including meta-synthesis [20], thematic synthesis [21], narrative reviews [2224], realistic reviews [2527], and framework analysis [2832], as well as existing systematic reviews related to food security [3343]. This exercise informed the research design and theoretical framework.

A preliminary search of the food security literature was undertaken using through the University of X’s online databases, including Sabinet, Academic Search Complete via Ebsco Host, and SCOPUS using the following search terms:

  • “Food security” AND “coping” AND “south Africa
  • “Food” AND “coping” AND “South Africa”
  • “Food security” AND “study” AND “South Africa”.

A coding (theoretical) framework was developed, based on applied policy research broadly falling into four categories: contextual, diagnostic, evaluative and strategic [18]. Fig 1 indicates the flow diagram for record identification, while Fig 2 presents a diagrammatic representation of the four categories. Contextual findings referred to the primary category in that the other three were dependent on these findings. Contextual findings related to the question of the ‘state’ of food insecurity in South Africa and how food insecurity was experienced, as evidenced in the studies reviewed. Sub-categories encompassed measurable outcomes of food insecurity, such as malnutrition, as well as attitudes, perceptions, and needs. The remaining three categories were ‘secondary' in that they drew on the findings from the ‘primary' category. The first of these, diagnostic findings, speak to the causes or reasons for the state of food security and relate to failures in the principle determinants of food security. These included: food stability (variability over time of supply and access), food access (mediating factors of affordability, allocation, power relations), food utilisation (nutritional value in terms of dietary quality, diversity and quantity, social value, food preparation and safety); and food availability (production, distribution and exchange) [44, 45]. The nutritional dimension is integral to the concept of food security.

thumbnail
Fig 2. The four categories in the theoretical framework for the study.

https://doi.org/10.1371/journal.pone.0182399.g002

Evaluative findings related to the impacts and outcomes of food insecurity. Prior to data analysis, these were defined very broadly to fall under the five key resources people can draw on in their lives and livelihoods to survive, secure food and pursue their wellbeing namely: human, social, financial, physical and natural capitals. Finally, the strategic findings related to new theories, policies, responses, plans and actions among all stakeholders, and required drawing on literature and documentation additional to the studies included in the review.

The criteria for inclusion and exclusion of a study and the final set of keywords and search terms were finalised following a peer review by two independent reviewers who evaluated the methods and the coding framework proposed. The final set of inclusion and exclusion criteria were that each study needed to:

  • Have been written or published between the start of 1995 and the end of 2014 (20 years)
  • Focus on one or more aspects of the state or ‘lived’ experience of food insecurity (access, utilisation, availability of food) or one or more aspects of nutrition (macro and micro-nutrition malnutrition, obesity)
  • Be primary empirical work undertaken at sub-national scale
  • Have aims and objectives clearly stated
  • Have a clear description of methods used, including data collection, sampling and analysis, and
  • Show attempts to determine the reliability or validity of the data analysis.

The terms used in the search are presented in Table 1. These terms were employed in searching the University of X’s online electronic databases, specialist websites (including local and global NGOs such as IFPRI, WHO, and others), and eliciting additional studies through personal contact with authors and experts in the field. The initial body of literature included 220 studies. The research study details were recorded in MS Excel in the apriori descriptive mapping categories of geographic focus, aims of the study, peer review status, type of report, key findings, methods and sample size. Inclusion and exclusion criteria were applied to the title, abstracts and keywords. An Atlas.ti project was developed to simultaneously filter and code the studies. Finally, a body of 169 studies was included in the Atlas.ti database. The full list of studies is provided in S1 Appendix, which also shows the primary groups each document was assigned to.

Results and discussion

The aims and disciplinary foci, socio-economic and environmental contexts, as well as methods, varied considerably across the studies. Each of the 169 studies in this review focused on different geographic environments and unique socio-economic contexts (Fig 3). A large proportion of studies (107) focused on rural communities, but even within these areas, an enormous diversity was evident. Similarly, the aims and objectives of the studies were diverse, which means their findings focussed on an array of different issues related to food security. The categorised range of the aims and objectives of the studies is shown in Fig 4. There are also many different ways in which the researchers of the included studies attempted to measure food insecurity, with the choice of measurement tool likely being at least partially influenced by the study context and aims.

The multiple tools and methods used to gauge food security status across the 169 studies in this review are shown in Fig 5. If an author used more than one measure, both were counted. Thirty-four of the studies did not directly measure food security or did not reveal what measure(s) they used.

Some measures, such as anthropometry (to assess under-nutrition), or the coping strategies index, essentially gauge the impacts or symptoms of food insecurity. Others are very narrow in their interpretation of determinants of food security–such as those only assessing the amount maize a household grows. The measures of food security depicted in Fig 5 can be broadly grouped into three approaches to assessing food insecurity, namely those that focus on:

  • Food security rather than nutrition—they attempt to establish a ‘level’ of food insecurity, often related to food quantity and/or diversity;
  • Nutritional aspects of food security—macro- and micro-nutrient quantity and/or quality of intake; and
  • Anthropometric outcomes of poor nutrition using anthropometric measures.

Although these ‘categories’ are not mutually exclusive, their different focus is evident in the language of the 192 coded quotations across the studies that described the ‘state’ of food security among their participants. If an author used more than one measure, both were counted. These quotations were explored in Atlas.ti, and grouped under the three categories above. See S1 Appendix for more detailed network diagram for these.

The range of food security ‘levels’ described varies enormously across the studies. This is likely to reflect the varying definitions and tools, as well as the situation-specific experiences. Irrespective of how it is measured, the studies confirm that the ability to secure food remains an uncertainty for the majority of South Africans. Even if only studies with sample sizes over 200 are included from the general population (excluding those covering ‘special populations' such as HIV-positive individuals), the picture is bleak (Table 2). An average of 68% of participants in these studies experiences difficulty in securing a dependable supply of food. The figures are not at odds with those evident in National level surveys, with the percentage of households in the country that ‘run out of money to buy food' estimated at 70% in the National Food Consumption Survey of 2005, and 46% in the South African Social Attitudes Survey of 2008 [46].

thumbnail
Table 2. Food Security estimates in studies examining levels of food security in the general population with sample sizes over 200.

https://doi.org/10.1371/journal.pone.0182399.t002

Impacts on growth and physical development are among the many impacts of food insecurity experienced by South Africans. Stunting–having a height for age below minus two standard deviations below the population norms—ranged from 16% to 48% in the various studies, but the studies are all unique in their sample type (including age groups) and focus (Table 3).

thumbnail
Table 3. Estimates of retarded physical development in those studies which measured weight for height or height and weight for age.

https://doi.org/10.1371/journal.pone.0182399.t003

The National Food Consumption Surveys of 1999 and 2005 suggest that stunting in South African children has hardly decreased from 21,6% in 1999 to 18% in 2005 [46]. However, these figures still mask the significant inter-community and inter-household variations in nutrition security in which some are mired in chronic, debilitating insecurity marked by retarded development, and others are far less affected.

Some studies included in this review make the argument that the evidence that food insecurity–or even inadequate dietary intake–causes stunting is weak. In a study in Gauteng and Limpopo Provinces, a quantitative food-frequency questionnaire was used to assess the diets of 30 stunted children in a rural area and 40 in an urban area through interviews with their mothers/caregivers (study 149) [62]. Diets of inadequate quality were found in both groups with no significant differences. The authors of this study conclude that inadequate dietary quality was not the primary cause of stunting. An earlier study, in the North West Province, measuring weight and height for age among 396 children 10–12 years found that differences in diet did not influence whether a child was below or above the 5th centile ([61] pg 95). The authors conclude that: “there must be caution in over blaming under nutrition, and overrating the health disadvantages from mild to moderate malnutrition” (Study 139) ([61] pg 9). A study in the rural Free State province found no correlation between dietary diversity and BMI; though the reasons are not explored (Study 73) [63].

While these studies do not explore possible impacts of nutritional deficits other than stunting, they do raise important questions about how food security is measured.

Challenges to food access, food utilisation, food availability, and food nutrition

The causes and consequences of food insecurity in South Africa are not uniform from place to place and from household to household. There were over 90 discrete codes assigned in Atlas.ti to causes of food insecurity cited in the 169 studies. Fig 6 shows only those causes cited in five or more studies, indicating to some extent the range of social, economic and biophysical dynamics of food insecurity in the country. The following sections discuss key thematic areas that emerged in the Atlas.ti analysis that also are reflective of how the causes of food insecurity are understood in the studies.

thumbnail
Fig 6. The causes of food insecurity cited in the 169 studies in the review.

https://doi.org/10.1371/journal.pone.0182399.g006

Poverty

Despite variation and complexity, poverty remains the principal underlying cause of South Africa’s food insecurity. It is by far the most-cited driver, with 51% (86) of the studies in the review citing poverty and/or lack of income as a cause of being food insecure. Of these, 70% (60) studies empirically assessed household or individual income against food security, in 12 participants themselves cited poverty as a cause of their food insecurity, in nine studies participants revealed they often ran out of money to buy food. Four of the studies citing poverty as a driver of food insecurity drew on the author(s)' view from the evidence, and one assessed household assets against food security status.

There are many factors that can help alleviate food insecurity and malnutrition, but being able to afford to purchase food remains a key determinant. Living in poverty also has secondary livelihood impacts that further entrap people in a state of food security. The central role of poverty and unemployment has important implications for interventions and decision-making.

Even rural South Africans are highly reliant on food purchase as a means to access food [64, 65], and rural households in South Africa spend a higher proportion of their total expenditure on food than their urban counterparts, even though their per capita gross expenditure on food is lower [66]. However, it must be kept in mind that higher transaction costs are common for rural households in accessing purchased food, such as the cost of transport to markets.

Food affordability is governed by both food prices and purchasing power (income), which means economic downturns bring a double threat to the food security of low-income households. The food price crisis between 2007 and 2009 highlighted the precarious levels of affordability of food for many South Africans. The impact of past and future food price increases can increase hunger and also decrease dietary quality, with a higher reliance on affordable staple starches and lower consumption of fruit and vegetables [66, 67]. This has multiple consequences for children’s physical, psychological, educational, and social development.

Referring to the 2008 General Household Survey (GHS), Jacobs highlights a rise in the experience of household hunger by two to three percentage points following food price inflation during 2007/8, together with the general economic downturn [68]. Female-headed households were more severely affected, and in terms of location, those most affected were in rural areas of the Eastern Cape and KwaZulu-Natal. Engel’s law [69]–that the share of a household’s expenditure on food increases as poverty increases–is borne out in the 2008 General Household Survey [68]. Households experiencing the worst food insecurity which adults ‘often or always go hungry’ reported a 67% share of expenditure on food [68].

The ability to access and purchase food in markets is a key consideration for both urban and rural food security, which highlights the influential role of food retail in the food system. The food sector in South Africa is increasingly dominated by major retail groups, which has arguable advantages in keeping food prices down due to purchasing power and economies of scale [70]. However, the impact is not quite that straightforward. The dominance of major food retail groups means that it is increasingly difficult for small-scale producers to break into a market that is centralized under corporate, buyer-driven control, and favours large-scale producers [70]. Smaller food outlets (formal and informal) are also increasingly squeezed out due to price competition, yet these traders are often preferred by consumers for their better geographic accessibility, and also represent critical livelihoods for many [70]. In the African Food Security Urban Network (AFSUN) survey of eleven African cities, 2008–2009, about 70% of households sourced food from informal outlets across all the surveyed cities. In Johannesburg this figure was 85% [70].

The role of government social grants

Given the pivotal role of poverty in food security, it is to be expected that social protection plays a prominent role in food security in South Africa. This is one of the Government’s primary tools in mitigating the impacts of poverty and unemployment, and many of the studies included in the review make reference to the high level of dependence their participants have on social grants for food security (Studies 46, 55, 60, 66, 80, 82, 96, 101, 108, 142, 158) [50, 7180]. These studies have disparate study aims, ranging from intervention impact assessments to exploring the relationship between culture and food security.

Almost all of the studies emphasize that grants such as the child support grants prevent absolute food insecurity. One study called for an increase of social protectionist policies in the context of HIV and AIDS and food security (Study 60) [73], and another for attention to the removal of barriers to grant access as an important policy consideration (Study 96) [75]. Grants were also argued in studies to contribute to transforming gender relations (Studies 116, 143) [81, 82] (See the section below on gender dynamics).

Those affected by HIV and AIDS are often particularly dependent on grants. In one study undertaken among 82 HIV/AIDS-affected households the Capricorn District in Limpopo Province, about 42% were found to rely on more than one social grant for their survival (Study 66) [80]. The potential double-edged impact of social grants is well illustrated in the nexus between HIV and AIDS and the disability grant. Trade-offs may come into play, suggesting the on-going challenge that Governments face in mitigating short-term deprivation without undermining long-term development. In a study based on 14 months of urban ethnographic field work in the Western Cape with 35 HIV-positive men and women, the links between HIV/AIDS and food security were investigated (Study 91) [83]. Patients were found to be modifying their adherence to ART in order to maintain low CD4 counts so that they would remain eligible for the disability grant; a clear example of a conflict of interests between long-term health and immediate economic survival. Similarly, two studies in the review found that the grant system acted as a disincentive to homestead food farming–or subsistence farming (Studies 55, 158) [72, 79]. In Study 55, a combination of annual survey work, interviews, participant observation, and ethnographic field research work was drawn on to conclude that grants buffered against absolute food insecurity, but also as provided for enough food purchase to discourage homestead food gardening. In Study 158, the claim that social grants, along with factors such as access to cheap sources of alcohol, had reduced the motivation of the men in the community to engage in farming came directly from a study participant.

Taking a food systems perspective, a study investigating the role of the retail sector in food security in the face of declining subsistence agriculture argued that for a food system to be truly adaptive, it cannot be dependent on external social assistance (Study 43) [84]. This work is based on survey data from Mpumalanga Province with 117 households in three villages.

This high dependence on social grants is by no means a new finding, but what is notable is the schism among the studies, in which grants were viewed variously as aides and obstacles to long-term food security.

Social capital

Social capital is largely a relational human resource; both accrued and built through interaction between people and within and between groups. It is a somewhat contested concept, partly because it does not introduce previously unexplored resources into social science, rather providing a means to group, examine and articulate them. Social capital in relatively recent literature is taken to include relations of trust, reciprocity, and exchange, common rules and norms, which serve to create connectedness–bonding, bridging or linking–between people and groups (See for e.g. [85, 86, 87]). Social capital is relatively intangible and as a result difficult to measure. Moreover, it does not herald universally benign impacts on people’s lives. Sometimes it brings negative consequences, such as exclusion and imbalances of power (See for e.g. [88]).

Nevertheless, social capital has been linked for some time with a range of development benefits (e.g. [89]), such as the ability to manage livelihood shocks [90]. Elements such as trust and social harmony have been found to be positively associated with child nutritional status across four developing countries (Peru, Ethiopia, Vietnam and a state of India) [91]. Drawing on data from the KwaZulu-Natal Income Dynamics Study, households in communities with higher levels of social capital were found to be more likely to cope with economic shocks [92].

Not many studies included in the review incorporated an explicit focus on the role of social capital. What is clear from those that do is the context-specific nature of the social dynamics of food security. Food security policies and programming cannot escape these dynamics if interventions are to have a real impact on the experience of food insecurity in South Africa. A multi-disciplinary five-year study on rainwater harvesting in the Eastern Cape found that social meaning, as well as social networks and relationships, were critical to the success of future rainwater harvesting interventions (Study 55) [72].

A study explicitly focusing on the relationship between social capital and food security was undertaken among 50 households in a peri-urban village in KwaZulu-Natal (Study 90) [93]. This work found that three forms of social capital play a pivotal role in household food security–church membership, social networks and savings club. Their roles, however, played out in very different ways in different households, in which the same community level institution can bring positive impacts for some households but exclusionary impacts for others (Study 90) [93].

Similarly, an investigation into the relationship between food security and attributes of social capital in two villages in Mpumalanga found no relationship between social capital and food security in one village, but significant relationships between food security and collective action and cooperation, social cohesion, and self-esteem in the other (Study 31) [94].

Together, these studies emphasize the mutable and context-specific nature of social resources, which are inescapably critical to lives and livelihoods, but very challenging to consider in policies and programming.

Role of food gardens

Of the 169 studies, 23 included a focus on community or homestead gardens, and 13 of these studies were undertaken in urban or peri-urban settings. Six overarching themes emerged in relation to the role of community or homestead gardens in food security, two of which reflect positive impacts resulting from food garden initiatives, and four of which conversely qualify this positive interpretation to varying degrees. A network diagram showing the above themes, together with the paraphrased quotations associated with these themes and their connections, is presented in Fig 7.

thumbnail
Fig 7. Network diagram showing six themes in the review related to the role of food gardens in food security together with key points noted in the relevant studies.

https://doi.org/10.1371/journal.pone.0182399.g007

Theme One: was that gardens played a positive role in alleviating food security (Studies 3, 5, 13, 21, 23, 28, 29, 47, 52, 53, 65, 77, 106, 163, 166) [56, 95108].

Theme Two: highlighted the impact that community gardening had on building various forms of social capital (Studies 3,11, 32, 77, 166) [95, 102, 105, 109, 110].

Theme Three: related to the first—was that household and community gardens can contribute to food security, but cannot assure it (Studies 11, 21, 23, 29, 33, 47, 56, 101, 106, 163) [56, 76, 98, 103, 104, 106, 107, 109, 111, 112]

Theme Four: Food gardens are frequently only able to provide seasonal fresh produce, which means their role in diet can be erratic (Studies 3, 4, 77, 109) [95, 96, 102, 113].

Theme Five: In conflict with more positive findings, however, some studies found that food gardens failed to play any significant role in food security (Studies 43, 46, 101, 109) [71, 76, 84, 113].

Theme Six: A final theme was that for gardens to play a decisive role in food security, long term sustained support and/or inputs are required (Studies 21, 43, 47, 109) [84, 98, 106, 113].

The overall picture from the review was that food gardens have the potential to make some contribution to household and community food security, but they require extensive and sustained inputs and/or support to do so. This finding reflects a divergence previously observed in the literature for and against food gardens as a solution to food insecurity (Study 109) [113]. While the role of food gardens in assuring sufficient food may be constrained, the evidence from the review suggests that food gardens can nevertheless play an important part in improving diet quality to include fresh fruit and vegetables–even if only seasonally. They can also contribute to building knowledge about healthy dietary choices, and to building social capital and community development through enhanced networks and cooperation. In the light of the importance of social dynamics noted in the section above on social capital, this is not an insignificant benefit. What remains pivotal is the level of the many resources needed to sustain them.

What factors moderate the impact of food gardens?

Several studies in the review reveal the impediments to food gardens. In a study examining the impact of the Integrated Food and Nutrition Programme, the limits to food garden contributions to food security were seen to relate to fragmented and inconsistent service provision–such as distribution of agricultural tools without associated training (Study 46) [71]. The difficulty experienced by some gardeners in accessing inputs such as water and suitable land was also noted. The study emphasized the importance of understanding the context and engaging with potential beneficiaries to gather relevant information prior to developing interventions. It was clear that long term sustained support and mentoring increases the likelihood of food garden success in relation to food security; a factor particularly highlighted in a study investigating the impact of school gardens in Johannesburg (Study 47) [98].

The cost related limitations of gardening were frequently noted in the studies, affecting the ability to purchase seed, protect gardens from livestock, and to provide sufficient water. A study examining the role of the retail sector in food security in Mpumalanga noted, “While a number of rural households still maintain homestead gardens to supplement their diets, such gardens are increasingly confined to households at the upper ends of the socioeconomic spectrum with the natural, human and financial capital to be able to devote to such non-remunerative productivity.” (Study 43) [84].

Urban food systems

Thirty-two of the 169 studies specifically focussed on urban food security, including but not limited to urban food gardens. An overriding message from these studies was that the current urban food system fails to provide food security to the poor in urban areas. This was no surprise in the light of what is known about the high levels of urban food insecurity levels in South Africa [114]. It is estimated (from 2007 data) that more than 50% of the seriously hungry reside in the densely populated urban centres of Cape Town, Ekurhuleni and Johannesburg [65].

The role of urban agriculture, including homestead and community food gardens received mixed treatment–as noted above. A number of prevailing challenges associated with urban agriculture as a solution to food insecurity were reported. As a survivalist strategy amongst the poor, it suffers from the previously highlighted need for both economic and social power to be sustainable—power that the poor seldom have. Review work related to the low-income township of Khayalitsha in Cape Town argues that urban agriculture nevertheless holds potential livelihood benefits, but the need for long-term inputs, particularly under marginal environmental conditions, remains unavoidable [115]. The fragile role of urban agriculture was brought home in a study in Msunduzi in KwaZulu-Natal that drew on data gathered in the 2008–2009 African Food Security Urban Network baseline survey (Study 88) [48]. The survey was administered to a sample of 556 households in a range of lower-income neighborhoods, including new and old townships, informal settlements, peri-urban areas and areas with ‘traditional’ housing. Urban agriculture was found to make only a small contribution to food security, with only 11% of households citing agriculture as a regular food source.

A number of study recommendations look to government to afford this environment, by delivering agricultural assets and land space as well as skills development, educational support, and the removal of institutional barriers (Studies 11, 13, 18, 21, 163) [97, 104, 106, 109, 116]. At the same time, the ability of government to fill this gap apparently remains weak, and without this environment, current urban agriculture is far from being a panacea for the plight of the hungry. The study of Ruysenaar on the role of urban agriculture in food security provides a nuanced critique of the levels of food system understanding and integration, and institutional dynamics required to give urban agriculture a chance of having an effect (Study 109) [113]. He examines the impact of the urban agriculture-orientated programme implemented by the Gauteng Department of Agriculture, Conservation, and Environment. While finding modest benefits, he argues that the safety net functionality of the urban agriculture programme is blurred with income opportunities and that this together with severe operational and institutional shortcomings within the Department confounds any possibility of sustained food security benefits.

Deagrarianization

Bryceson defined deagrarianization as a process of reorientation of economic activities or livelihoods, changes in occupational activity, and realignment of human settlement away from agrarian patterns. “Measurable manifestations of this process are: a diminishing degree of rural household food and basic needs self-sufficiency, a decline in agricultural labor relative to non-agricultural labor in rural households.” ([117] pg 99]).

One of the arguments put forward for the abandonment of farming following the political transition in the early 1990 is the decrease in government support to former homelands [118]. The cases in the review presented a number of other reasons for the decrease in agricultural production in these areas. One study makes a case for the local availability of high-energy processed foods acting as a disincentive to agricultural production (Study 43) [84]. These authors note: “an overall trend that grounds many of this study’s findings is the process of deagrarianization together with climate variability and, in particular, erratic rainfall patterns” (Study 43) ([84] pg 352]). Other studies find social grants are a disincentive to home farming (Studies 55, 158) [72, 79]. Declining agricultural production is also found in urban and peri-urban agriculture in the Eastern Cape over the ten years prior to the authors’ investigation–i.e. since the mid-1990s (Study 23) [107].

In a study investigating the association between a water irrigation scheme and food security in KwaZulu-Natal, a key point made that the farmer population in the area was aging, with the younger generation looking to move to off-farm ventures which they expect will be more lucrative (Study 45) [119]. This is echoed in studies in the Free State Province (Study 56) [112], KwaZulu-Natal (Studies 90, 168) [93, 120], Limpopo (Study 81) [121], and Eastern Cape (Study 108) [77]. “..the majority of the rural poor are no longer interested in farming due to poor returns, and youths view farming as an unpleasant business enterprise” (Study 108) ([77] pg, 65). Agricultural activities may even be viewed as stigmatised. For example, a study investigating rainwater harvesting and conservation practices in the Eastern Cape found that food farming is viewed as a signal of poverty, HIV/AIDS, and family abandonment among the community under study (Study 55) [72]: “…the stigmas of poverty association with food farming also resonate in the wider communities of interests associated with village livelihoods, standing and belonging. That the majority of food farmers in the two villages are single women and/or aged women, enables a further association of food farming with abandonment and isolation” (Study 55) ([72] pg 11).

Role of wild food and indigenous crops

A number of studies confirm that wild food sources play a role in the food security of rural households. In the Bushbuckridge District of Limpopo Province, over 91% of households have been found to harvest edible wild plants, 27% of whom consume these daily (Study 113) [122]. Similarly, in northern KwaZulu-Natal, a study across four districts with 99 participants indicated that over 90% consume wild plants, both as a food source and for medicinal purposes (Study 49) [123].

Other studies make a convincing case for wild protein sources being important to nutrition. For example, a study in Eastern Cape Province looking at patterns of food acquisition and consumption among 850 rural children found that 62% of children were supplementing their diets with wild foods, and 30% relied on wild food for more than half their food consumption. Moreover, wild food offered a wider livelihood benefit–particularly for more vulnerable children, with 47% of children selling some of the wild food they collected (Study 135) [124]. Wild food such as insects, birds, and reptiles, was seen as an important protein source for these children, a finding which is in agreement with findings in other studies in the review (Studies 43, 150) [84, 125]. A study in Limpopo Province in two villages found 47 different wild plan species used among 27 families, 95% of which were indigenous. These were used in various roles including firewood, food, and medicine (Study 146) [126].

Wild fruits and leafy vegetables are widely reported on as a long-standing rural food source. A study among 100 rural households in KwaDlangezwa Village in northeast KwaZulu-Natal, an area highly affected by HIV and AIDS, found that the collection of wild spinach was most the commonly used coping strategy in times of hardship and food insecurity (Study 60) [73]. A number of studies in the review confirm that households draw on wild food resources in times of shock, including agricultural related shocks and economic shocks (Studies 3,10, 18, 78, 85) [116, 127131]. Their availability, however, is markedly seasonal (Studies 73, 153) [63, 132]. In addition to being gathered in the wild, indigenous vegetable crops are also widely consumed by (especially rural) communities in South Africa. These commonly include crops such as sorghum, cowpea, African sweet potatoes, Amaranth leaves, wild pear and buffalo thorn (Study 44) [133].

The level and success of the domestication and consumption of indigenous (sometimes referred to as traditional) plants are often associated with indigenous knowledge (Study 124) [134]. Yet, a number of studies noted that the availability of both wild and cultivated African vegetables have been declining in recent years due not only to declining indigenous knowledge, but to wider cultural changes, and habitat losses (Studies 14, 51, 59, 142, 153, 154) [78, 132, 135138].

Gender dynamics

Social resources were frequently linked with leveraging individual power and agency. The position of South African women in the formal and informal institutions in the country has historically left them more vulnerable to food insecurity than men [139]. Food insecurity is embedded in the unequal power women in South Africa have over resources, despite their frequently playing the most active role in providing for household food security. The role of women in agriculture and food security, and their particular powerlessness and vulnerability has been widely researched and reported (e.g. [140]).

The review studies endorse the central role of women in South Africa in the pursuit of household food and security and nutrition (Study 86, 158, 168) [120, 141, 142]. Moreover, household food availability from agricultural production is often driven by women (Studies 55, 75, 86 167) [72, 142144]. However, the studies find them severely hampered by poor decision-making power, exclusionary socio-economic institutions, and a lack of access to—and control over—both farm and non-farm assets (Studies 19, 140, 143, 145, 152, 157, 158, 160, 168) [82, 120, 141, 145150]. The review studies do not reveal novel perspectives on the gendered aspects of food insecurity, rather they reinforce and give voice to what is already known. Fig 8 shows the key codes related to gender (in colour), and associated quotations (paraphrased where necessary for brevity) from the studies.

thumbnail
Fig 8. Gender dynamics and food security codes and associated quotations.

https://doi.org/10.1371/journal.pone.0182399.g008

The review studies call for greater government support for women in agriculture and recognition of the fundamental role they play in both household and national food security (Studies 75, 123, 140, 145, 152) [144, 146, 148, 149, 151], as well as attention to the structural hindrances to gender equity (Study 143) [82] such as the important role of social protection, and how this can better work in concert with other government policies (Study 116) [81]. Hart proposes that interventions should also consider existing roles, responsibilities and perspectives to allow for a gendered understanding of food security dynamics prior to being developed (Study 123) [151].

Short and long term consequences of food insecurity, including coping, adapting and trade-offs

The above sections have explored the body of evidence in the review studies relating to the experience of food insecurity–the most common threads in the tapestry of food insecurity in South Africa. In the following sections, attention is given to two areas that are treated here as key ramifications of these food insecurity threads.

Coping and not coping

The state of being food insecure is both a cause and consequence of cycles of vulnerability [152]. It is also linked to broader aspects of risk and vulnerability in human-environment interactions (e.g. [153]). Being food insecure is always a result of a resource shortage of one kind or another, which means by definition there are no means for an individual or household to draw on to buffer a food security shock or stressor. Trade-offs result in which people have to either offset short versus long term needs or trade one comfort for another.

The most common response to food shortages found in the review studies was for individuals or households to reduce the frequency, quality or size of their meals. (Studies 1, 2, 3, 10, 13, 15, 16, 18, 19, 41, 43, 59, 66, 76, 82, 96, 101, 108, 160, 169) [4951, 55, 7577, 80, 84, 97, 116, 130, 131, 136, 145, 147, 154157]. This makes intuitive sense in the face of food shortages. However, there are obvious nutritional impacts over time, depending on the extent of deprivation. Other health impacts include the well-documented impact of defaulting on medication if it must be taken with food, as is the case with anti-retroviral which has broad implications in the face of HIV and AIDS pandemic, and/or if there is a cost attached to obtaining it (Studies 20, 160) [145, 158]. Reduced physical function in the face of food shortages (Study 79) [159], increased risk of post-natal depression (Study 117) [160], and fatigue and concentration deficits (Study 35) [161] are also reported across the studies.

There are also other coping strategies frequently employed that have significant implications for deepening vulnerability and reducing resilience in the face of further livelihood stressors. Strategies to procure food such as selling assets (Study 2, 18, 78) [116, 128, 154], for example, or engaging in transaction sex (Study 18, 20, 87) [128, 158, 162], expose individuals to health and livelihood risks and contribute to a downward spiral of vulnerability.

A nutrition transition

An emerging feature of food insecurity in South Africa are micronutrient deficiencies and overweight malnutrition occurring alongside stunting. While dietary preferences play some role, a significant driver of this transition was considered to be the availability of relatively cheap, processed and ‘globalised’ food that is high in energy but generally of poor nutritional value (Studies 15, 30, 38, 62, 79, 98, 141) [53, 55, 58, 60, 159, 163, 164]. Seen in this light, the transition to a globalised diet is not only one of the faces of the experience of food insecurity, but also a consequence of limited resources to support healthy eating.

Overweight, ascribed to the availability of relatively cheap high energy ‘globalised’ food occurred extensively alongside features of food insecurity such as stunting in the studies in this review (studies 15, 30, 38, 62, 79, 98, 141) [53, 55, 58, 60, 159, 163, 164]. The review studies confirm that South African diets are highly dependent on cereals, particularly maize, and frequently lack dietary variety (Studies 2, 3, 8, 43, 62, 68, 84, 99, 109, 144, 149) [47, 62, 84, 113, 131, 154, 163, 165168].

In one Study among HIV-positive adults included in our review, the prevalence of food insecurity was measured at 70% among the participants—using the Household Food Insecurity Access Scale—yet the prevalence of overweight and obesity were higher than any other form of malnutrition (sample size 300 in a KwaZulu-Natal mixed peri-urban and rural settlement) (Study 62) [163]. Similarly, in a prospective cohort study amongst 162 children in rural Limpopo Province, a high prevalence of stunting (48%) was found (low height for age), together with a high prevalence of overweight (22%) and obesity (24%). Moreover, 19% of the sample were both stunted and overweight (Study 98) [53].

A cross-sectional study in 2007, examined a sample of 4000 children in rural Mpumalanga and found 18% stunting among children between the ages of one and four years, with 32% of children at 12 months year being undernourished (Study 30) [60]. Stunting and underweight were also found to be high among adolescent boys, being highest among boys aged 14 years (19%). At the same time, a high prevalence of combined overweight and obesity was found among adolescent girls, reaching a peak at aged 18 years (25%).

A study among children attending primary schools in the Western Cape found that 2% of children were underweight, 19% were stunted, and 20% were overweight or obese. Learners with a lower standard of living scores were those that were more likely to purchase unhealthy food items from a food vendor for lunch rather than carry a lunchbox to school. These learners were also more likely to be overweight or obese (Study 141) [58].

A number of studies included in the review reported the observation that ‘high energy foods’ were eaten in preference to high-nutrient content foods (studies 15, 38, 43, 47) [55, 84, 98, 164]. In addition to the issue of overweight, the issue of micronutrient malnutrition is also raised in the review studies. One study that included a sample of 285 institutionalised and community-dwelling black South African men and women over the age of 60 found no association between BMI and added sugar intake, but reported that: "Our data have demonstrated that in elderly South African women, but not men, who have little financial means, the nutrient-diluting effect of a high sugar consumption places them at high risk for inadequate micronutrient, protein and fibre intakes" (Study 79) ([159] pg 104).

Echoing this, in a cross-sectional study of 136 adults, in rural KwaZulu-Natal, the authors concluded that there was excess caloric intake together with inadequate micronutrient inadequacies in rural South African communities (Study 93) [169]. This study made use of a 24-hour recall tool, together with food quantities, and also collected 16 composite dishes from the community for nutritional analysis.

Food availability in local markets does not necessarily translate into food security for those accessing it. Available alternative ‘globalised’ foods offer cheaper or more appealing options to consumers. A thesis study included in the review lends support to this notion. The study looked at the impact of the government’s Nutritional Supplementation Programme on children’s food security using a mixed methodology, reporting “… no association between food access (FA) and nutritional security (NS), meaning that food security does not automatically translate to nutritional security” (Study 15) ([55] pg. i). This is a bold statement, but one that may need to be taken quite seriously in the consideration of food security in South Africa. The definition of food security does, in fact, include nutrition, but the authors nevertheless emphasize the transition in food insecurity focus being from accessing ‘enough food’ to accessing ‘enough of the right kind of food' for many of the poor in South Africa.

A cross-sectional, comparative, population-based study was undertaken in North West Province among 1854 participants from 37 different locations [170]. The survey looked at a range of socio-economic indicators as well as nutrition. The risk of non-communicable disease was assessed through measurement of 50 discrete biological variables indicative of—for example–diseases such as diabetes mellitus. The findings suggest that a ‘nutrition transition' does not necessarily lead to a reduced intake of micronutrients. Rather, the authors find that urbanization improved micronutrient intake, but also increased the risk of overweight and obesity, and–perhaps even more importantly–the risk of non-communicable disease [170].

Implications for policy and practice

The recommendations from the studies included in this review were surprisingly scattered and generally weak. About 47% of the studies do not make any specific recommendations for policy or programming based on their work. The remainder largely makes broad comments that have limited currency in terms of translation into specific recommendations.

An area of particular emphasis was in recommendations related to agriculture and food gardens. No less than 40 papers of the 169 (about 24%) in the systematic review provide recommendations linked to improving various forms of support for agriculture or food gardening as a means to address food insecurity. Of these papers, 38 were specifically investigating agriculture or food gardening. It is clear that agriculture remains a high-level focus in regard to food security in South Africa, and that it is an area with many challenges.

There was a strong focus on better governmental department or institutional coordination (Studies 46, 72, 92, 109, 118, 122, 123, 140) [71, 113, 121, 146, 151, 171173], which is a recommendation already given much treatment in food security literature in South Africa. Six of eight studies specifically explored government programming or policies.

Among the studies that expressly explored gender issues, there was a concomitant call for acknowledgment of, and support for, the role of women in agriculture, including their land rights (Studies 75, 123, 140, 145, 152) [146, 148, 149, 151, 174].

In urban areas, the provision of urban agricultural land space and agricultural assets was strongly emphasized (studies 11, 13, 21) [97, 106, 109]. Notwithstanding the mixed evidence for their efficacy, in both rural and urban areas state support for community or household food gardens was a focus in a number of studies (studies 1, 4, 5, 13, 15, 18, 47, 76) [49, 51, 55, 9598, 116]. Improved agricultural extension services were seen as critical for agricultural endeavors generally (studies 45, 123, 129, 162) [119, 151, 175, 176].

A number of studies stressed the importance of support for low-technology approaches to agriculture which are appropriate to the context and environmental conditions. These included low-input agriculture (Studies 125, 142, 159) [78, 177, 178] as well as farming indigenous crop varieties for their local-level environmental adaptability. The nutritional value was also highlighted (Studies 44, 51, 86, 97, 124) [133135, 179, 180]. However, the above recommendations need to be seen in the light of declining engagement in small-scale agriculture as outlined in the section on deagrarianisation above.

Conclusions

The experience of food insecurity found in this review was characterised by issues affecting the ability of individuals and households to access sufficient food. This resonated with–and expands on—the shift in food security ‘paradigms’ narrated on in the 1990s by Maxwell, who observed that since the 1970s the focus in analysis and programming has moved from being on national production deficits to being orientated towards the consumer, at the level of household and individual livelihoods and capabilities (see [181]). These shifts have also seen the commensurate change in the way food security is measured, and how best to do so has been the subject of scholarly debate for some time [37, 182].

The use of 27 different measurement tools across the 169 studies is indicative not only of the different disciplinary backgrounds of the authors but also of the difficulty in establishing an absolute ‘state' of food insecurity that is comparable across space and time. Some approaches focussed on measuring food security through a composite food access index, others on quantifying micro- and macro-nutrient intake, and still others on malnutrition outcomes such as stunting. This makes a direct comparison of relative food insecurity across the studies very difficult.

A wide range of food insecurity drivers was cited across the studies, with each study reflecting local level, context-specific dynamics. Nevertheless, the very high reliance on purchased food means that being able to afford food is the predominant challenge in South Africa, with 51% of studies specifically citing poverty as a food insecurity driver. Food prices are a cause for concern and discussion. In the light of poverty, there is a high dependence on government grants, which is seen as preventing households from falling into absolute hunger, but may be a disincentive to engaging in more sustainable food security efforts, such as food gardens. This is resonant with the kinds of trade-offs involved among the food insecure, in which coping strategies frequently have short as well as long-term negative impacts on livelihood resilience.

Food production is beset with access-related issues including affordability of agricultural inputs, poor access to farm and non-farm resources, and failing or exclusionary formal and informal institutions. Given these challenges, it is perhaps not surprising that deagrarianisation emerged as a theme in the studies. Deagrarianisation also takes place in the context of a rapidly urbanising world. Urban food systems were discussed by some studies.

The exclusionary practices of formal and informal institutions were repeatedly raised in relation to agriculture and other aspects of food access. Access to social resources was particularly mentioned in relation to gender dynamics, which disadvantage women in myriad ways in the food security landscape.

The so-called nutrition transition creates a (relatively new) dimension to food insecurity, and one that is linked to markets and food availability, food choices and nutrition, as well as food access. This transition sees a move towards the increasing consumption of cheaper, more available, and/or preferable ‘globalised’ foods, which have a high-energy content but generally low nutritional value, and which are heralding overweight and obesity alongside features of malnutrition such as stunting. However, all of the food security issues raised in the studies, are components of a food system that has multiple ailments but also multiple opportunities.

A high level of local specificity in the causes, experience and consequences of food insecurity in South Africa is evident from the reviewed research. Decision-makers need to consider the local level context in developing and implementing interventions. From an operational perspective, the ‘how’ of interventions- their process- matters at least as much as their ‘what’. Misselhorn’s framework for intervention processes incorporates social capital, participation, coordination, and learning interactions as essential elements in food security interventions [183].

The study highlights the need for paying more attention to what we are measuring and being precise in how food insecurity is measured. While there are no agreed on measures internationally, it is important for the food security research community and national departments entrusted with monitoring and evaluation of food security (primarily the Departments for Planning, Monitoring and Evaluation; Agriculture, Forestry and Fisheries; Health; Rural Development and Land Reform and Statistics South Africa) to confer and agree on a minimum set of indicators, methodologies and the interpretation of these indicators for reporting in more consistent ways. The wealth of sub-national surveys could provide additional rich understandings of local and household level experiences of food security and informed evidence for more appropriate policy making and designing of intervention programmes. Policymakers at all spheres of government (national, provincial and municipal) should be engaging with this wealth of researchers and sub-national study findings to enrich their food security planning, monitoring, and evaluation.

References

  1. 1. Allen P. Realizing Justice in Local Food Systems. Cambridge Journal of Regions, Economy and Society. 2010;3(2):295–308.
  2. 2. Hendriks SL. Food security in South Africa: Status quo and policy imperatives. Agrekon. 2014;53(2):1–24.
  3. 3. Republic of South Africa. White Paper on Reconstruction and Development. 1994.
  4. 4. South African National Department of Agriculture. Integrated Food Security Strategy. Pretoria2002.
  5. 5. South African Department of Agriculture Forestry and Fisheries (DAFF). Food and Nutrition Security Policy. 2015.
  6. 6. Hendriks SL, Olivier NJJ. Review of the South African Agricultural Legislative Framework: Food Security Implications. Development Southern Africa. 2015;32(5):555–76.
  7. 7. Statistics South Africa (Stats SA). General Household Survey 2014. Pretoria2015.
  8. 8. Wilkinson K. Are there 13, 14 or 15 million hungry people in South Africa? Africa Check, 2016.
  9. 9. Hendriks SL, Van Der Merwe C, Ngidi MS, Manyamba C, Mbele M, McIntyre M, et al. What are we measuring? A comparison of household food security indicators from a sample of households in the Eastern Cape Province, South Africa. Ecology of Food and Nutrition. 2016;55(2):141–62. pmid:26789552
  10. 10. Bambra C. Real world reviews: a beginner’s guide to undertaking systematic reviews of public health policy interventions. Journal of Epidemiology and Community Health. 2011;65:14–9. pmid:19710043
  11. 11. Pettigrew M, Roberts H. Systematic Reviews in the Social Sciences: a practical guide. Oxford: Blackwell Publishing; 2006.
  12. 12. EPPI Centre. EPPI Centre Methods for Conducting Systematic Reviews. Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI Centre), Social Science Research Unit, Institute of Education, University of London, 2010.
  13. 13. Daly J, Willis K, Small R, Green J, Welch N, Kealy M, et al. A hierarchy of evidence for assessing qualitative health research. Journal of Clinical Epidemiology. 2007;60(1):43–9. pmid:17161753.
  14. 14. Harden A. Mixed-Methods Systematic Reviews: Integrating Quantitative and Qualitative Findings. National Center for the Dissemination of Disability Research (NCDDR), 2010.
  15. 15. Jones ML. Application of systematic review methods to qualitative research: practical issues. Journal of Advanced Nursing. 2004;48(3):271–8. pmid:15488041.
  16. 16. Harden A, Garcia J, Oliver S, Rees R, Shepherd J, Brunton G, et al. Applying systematic review methods to studies of people’s views: an example from public health research. Journal of Epidemiol Community Health. 2004;(58):794–800.
  17. 17. Popay J, Rogers A, Williams G. Rationale and standards for the systematic review of qualitative literature in health services research. Qualitative Health Research. 1998;8(3):341–51. pmid:10558335
  18. 18. Ritchie J, Spencer L. Analysing Qualitative Data. In: Bryman A, Burgess R, editors. The Qualitative Researcher's Companion Taylor and Francis Books Ltd; 1994.
  19. 19. White H, Waddington H. Why do we care about evidence synthesis? An introduction to the special issue on systematic reviews. Journal of Development Effectiveness. 2012;4(3):351–8.
  20. 20. Walsh D, Downe S. Meta-synthesis method for qualitative research: a literature review. J Adv Nurs. 2005;50(2):204–11. Epub 2005/03/25. pmid:15788085.
  21. 21. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. ESRC National Centre for Research Methods, Methods for Research Synthesis Node, Evidence for Policy and Practice Information and Co-ordinating (EPPI-)Centre, Social Science Research Unit, London, 2007.
  22. 22. Bae J-M. Narrative reviews. Epidemiology and Health. 2014;36:e2014018. pmid:25223334
  23. 23. Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. Journal of Chiropractic Medicine. 2006;5(3):101–17. pmid:19674681
  24. 24. Snilstveit B, Oliver S, Vojtkova M. Narrative approaches to systematic review and synthesis of evidence for international development policy and practice. Journal of development effectiveness. 2012;4(3):409–29.
  25. 25. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review–a new method of systematic review designed for complex policy interventions. Journal of Health Services Research & Policy. 2005;10:21–34. PMID: 22203800.
  26. 26. Pawson R, Tilley N. Realistic Evaluation. London: Sage Publications; 1997.
  27. 27. Reading R. [Commentary on] Realist review to understand the efficacy of school feeding programmes. Child: Care, Health & Development. 2008;34(2):281–2. pmid:2009778664. Language: English. Entry Date: 20080328. Publication Type: journal article.
  28. 28. Carroll C, Booth A, Cooper K. A worked example of "best fit" framework synthesis: A systematic review of views concerning the taking of some potential chemopreventive agents. BMC Medical Research Methodology. 2011;11(1):29. pmid:21410933
  29. 29. Carroll C, Booth A, Leaviss J, Rick J. "Best fit" framework synthesis: refining the method. BMC Medical Research Methodology. 2013;13(1):37. pmid:23497061
  30. 30. Dixon-Woods M. Using framework-based synthesis for conducting reviews of qualitative studies. BMC Medicine. 2011;9(1):39. pmid:21492447
  31. 31. Gale N, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology. 2013;13(1):117. pmid:24047204
  32. 32. Smith J, Firth J. Qualitative data analysis: the framework approach. Nurse Researcher 2011;18(2):52–62. pmid:21319484
  33. 33. Akbari F, Azadbakht L. A Systematic Review on Diet Quality among Iranian Youth: Focusing on Reports from Tehran and Isfahan. Archives of Iranian Medicine (AIM). 2014;17(8):574–84. pmid:97269974.
  34. 34. Bortoletto Martins AP, Canella DS, Baraldi LG, Monteiro CA. Cash transfer in Brazil and nutritional outcomes: a systematic review. Revista de Saude Publica. 2013;47(6):1–12. pmid:95302055.
  35. 35. Carter MA, Dubois L, Tremblay MS. Place and food insecurity: a critical review and synthesis of the literature. Public Health Nutrition. 2014;17(1):94–112. pmid:23561752.
  36. 36. Korth M, Stewart R, Langer L, Madinga N, Rebelo Da Silva N, Zaranyika H, et al. What are the impacts of urban agriculture programs on food security in low and middle-income countries: a systematic review. Environmental Evidence. 2014;3(1):1–10. pmid:34687987.
  37. 37. Marques ES, Reichenheim ME, de Moraes CL, Antunes MM, Salles-Costa R. Household food insecurity: a systematic review of the measuring instruments used in epidemiological studies. Public Health Nutrition. 2014:1–16. PMID: 24650538.
  38. 38. Morais DdC, Dutra LV, Franceschini SdCC, Priore SE. [Food insecurity and anthropometric, dietary and social indicators in Brazilian studies: a systematic review]. Ciência & Saúde Coletiva. 2014;19(5):1475–88. pmid:24897212.
  39. 39. Sherman M, Ford JD. Market engagement and food insecurity after a climatic hazard. Global Food Security. 2013;2(3):144–55. pmid:31126834.
  40. 40. Steyn NP, Mchiza Z, Hill J, Davids YD, Venter I, Hinrichsen E, et al. Nutritional contribution of street foods to the diet of people in developing countries: a systematic review. Public Health Nutrition. 2014;17(06):1363–74. pmid:23680029
  41. 41. Thompson HE, Berrang-Ford L, Ford JD. Climate Change and Food Security in Sub-Saharan Africa: A Systematic Literature Review. Sustainability (2071–1050). 2010;2(8):2719–33.
  42. 42. Tirivayi N, Groot W. Health and welfare effects of integrating AIDS treatment with food assistance in resource constrained settings: A systematic review of theory and evidence. Social Science & Medicine. 2011;73(5):685–92. pmid:2011253552. Language: English. Entry Date: 20111014. Revision Date: 20141003. Publication Type: journal article.
  43. 43. van Rooyen C, Stewart R, de Wet T. The Impact of Microfinance in Sub-Saharan Africa: A Systematic Review of the Evidence. World Development. 2012;40(11):2249–62. PMID: 28357702.
  44. 44. Committee on World Food Security. Global Strategic Framework for Food Security & Nutrition (GSF), Second Edition. Available online as of 5/12/2014 at: http://www.fao.org/cfs/cfs-home/global-strategic-framework/en/: Committee on World Food Security, 2013.
  45. 45. World Food Summit. Declaration of the World Summit on Food Security. Rome, 16–18 November 2009: 2009.
  46. 46. Labadarios D, McHiza ZJ-R, Steyn NP, Gericke G, Maunder EMW, Davids YD, et al. Food security in South Africa: a review of national surveys. Seguridad alimentaria en Sudáfrica: revisión de las encuestas nacionales. 2011;89(12):891–9. pmid:70233412.
  47. 47. De Cock N, D'Haese M, Vink N, Rooyen C, Staelens L, Schönfeldt H, et al. Food security in rural areas of Limpopo province, South Africa. Food Security. 2013;5(2):269–82.
  48. 48. Crush J, Caesar M. City Without Choice: Urban Food Insecurity in Msunduzi, South Africa. Urban Forum. 2014;25(2):165–75.
  49. 49. Walsh CM, van Rooyen FC. Household Food Security and Hunger in Rural and Urban Communities in the Free State Province, South Africa. Ecology of Food and Nutrition. 2014;54(2):118–37. pmid:25551521
  50. 50. Masekoameng M, Maliwichi LL. Determinants of Food Accessibility of the Rural Households in Sekhukhune District Limpopo Province, South Africa. Journal of Human Ecology. 2014;47(3):275–83.
  51. 51. Ballantine NM. Purchasing Determinants of Food Insecurity Conditions Amongst Shoppers at Klipplaat: Nelson Mandela Metropolitan University; 2007.
  52. 52. Ndobo F, Sekhampu TJ. Determinants of vulnerability to food insecurity in a South African township: A gender analysis. Mediterranean Journal of Social Sciences. 2013;4(14):311–7.
  53. 53. Mamabolo RL, Alberts M, Steyn NP, Delemarre-van de Waal HA, Levitt NS. Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa. Public Health Nutrition. 2005;8(5):501–8. pmid:16153331.
  54. 54. Ogunlade AO, Kruger HS, Jerling JC, Smuts CM, Covic N, Hanekom SM, et al. Point-of-use micronutrient fortification: lessons learned in implementing a preschool-based pilot trial in South Africa. International Journal of Food Sciences & Nutrition. 2011;62(1):1–16. pmid:57244505.
  55. 55. Tshabalala ZP. An assessment of the impact of food access on children on the nutrition supplementation programme to combat protein-energy malnutrition: University of KwaZulu-Natal; 2014.
  56. 56. Selepe BM. The impact of home gardens on dietary diversity, nutrient intake and nutritional status of pre-school children in a home garden project in Eatonside, the Vaal triangle, Johannesburg, South Africa: University of KwaZulu-Natal; 2010.
  57. 57. Faber M, Schwabe C, Drimie S. Dietary diversity in relation to other household food security indicators. International Journal of Food Safety, Nutrition and Public Health. 2009;2(1):1–15. PMID: 19124008.
  58. 58. Abrahams Z, de Villiers A, Steyn NP, Fourie J, Dalais L, Hill J, et al. What's in the lunchbox? Dietary behaviour of learners from disadvantaged schools in the Western Cape, South Africa. Public Health Nutrition. 2010;14(10):1752–8. pmid:2011260112. Language: English. Entry Date: 20120323. Revision Date: 20120323. Publication Type: journal article.
  59. 59. Kruger A, Lemke S, Phometsi M, Van't Riet H, Pienaar A, Kotze G. Poverty and household food security of black South African farm workers: the legacy of social inequalities. Public Health Nutrition. 2006;9(7):830–6. pmid:17010247.
  60. 60. Kimani EW. Exploring the paradox: double burden of malnutrition in rural South Africa: University of the Witwatersrand; 2010.
  61. 61. Walker AR, Walker BF. Moderate to mild malnutrition in African children of 10–12 years: roles of dietary and non-dietary factors. International Journal Of Food Sciences And Nutrition. 1997;48(2):95–101. pmid:9135771.
  62. 62. Theron M, Amissah A, Kleynhans IC, Albertse E, MacIntyre UE. Inadequate dietary intake is not the cause of stunting amongst young children living in an informal settlement in Gauteng and rural Limpopo Province in South Africa: the NutriGro study. Public Health Nutrition. 2006;10(4):379–89. PMID: 11282778.
  63. 63. Matla MTH. The contribution of food access strategies to dietary diversity of farm worker households on Oranje farm in the Fouriesburg district (RSA): University of Pretoria; 2008.
  64. 64. Baiphethi M, Jacobs P. The contribution of subsistence farming to food security in South Africa. Agrekon. 2009;48(4):459–82.
  65. 65. Altman M, Hart TGB, Jacobs PT. Household food security status in South Africa. Agrekon [English Ed]. 2009;48(4):345–61.
  66. 66. Aliber M. Exploring Statistics South Africa's national household surveys as sources of information about household level food security. Agrekon: Agricultural Economics Research, Policy and Practice in Southern Africa. 2009;48(4):384–409.
  67. 67. Schönfeldt HC, Gibson N, Vermeulen H. The possible impact of inflation on nutritionally vulnerable households in a developing country using South Africa as a case study. Nutrition Bulletin. 2010;35(3):254–67. pmid:52994885.
  68. 68. Jacobs P. Household food insecurity, rapid food price inflation and the economic downturn in South Africa. Agenda. 2010;24(86):38–51. PMID: 28042687.
  69. 69. Zimmerman CC. Ernst Engel's Law of Expenditures for Food. The Quarterly Journal of Economics. 1932;47(1):78–101.
  70. 70. Crush J, Frayne B, Crush J. Supermarket expansion and the informal food economy in southern African cities: implications for urban food security. Journal of Southern African Studies. 2011;37(4):781–807.
  71. 71. Prinsloo R, Pillay V. Impact of the integrated food and nutrition programme in Kungwini, South Africa. Social Work and Social Sciences Review. 2014;17(2):6–21.
  72. 72. Minkley G. Rainwater harvesting, homestead food farming, social change and communities of interests in the eastern cape, south Africa. Irrigation and Drainage. 2012;61(SUPPL.2):106–18.
  73. 73. Kaschula S. Using People to Cope with the Hunger: Social Networks and Food Transfers Amongst HIV/AIDS Afflicted Households in KwaZulu-Natal, South Africa. AIDS & Behavior. 2011;15(7):1490–502. pmid:65832762.
  74. 74. Dodd NM, Nyabvudzi TG. Unemployment, Living Wages and Food Security in Alice, Eastern Cape, South Africa. Journal of Human Ecology. 2014;47(2):117–23.
  75. 75. Saloojee H, De Maayer T, Garenne ML, Kahn K. What's new? Investigating risk factors for severe childhood malnutrition in a high HIV prevalence South African setting. Scandinavian Journal of Public Health. 2007;35:96–106. pmid:2009662398. Language: English. Entry Date: 20080822. Revision Date: 20091218. Publication Type: journal article.
  76. 76. Shisanya SO, Hendriks SL. The contribution of community gardens to food security in the Maphephetheni uplands. Development Southern Africa. 2011;28(4):509–26. pmid:65456221.
  77. 77. Musemwa L, Muchenje V, Mushunje A, Aghdasi F, Zhou L. Household food insecurity in the poorest province of South Africa: level, causes and coping strategies. Food Security. 2015;7:647–55. pmid:35959190.
  78. 78. Hart TGB. The Significance of African Vegetables in Ensuring Food Security for South Africa's Rural Poor. Agriculture and Human Values. 2011;28(3):321–33. http://link.springer.com/journal/volumesAndIssues/10460. PMID: 1253116.
  79. 79. Trefry A, Parkins JR, Cundill G. Culture and food security: A case study of homestead food production in South Africa. Food Security. 2014;6(4):555–65.
  80. 80. Akinboade OA. Gender, HIV-AIDS, Land Restitution and Survival Strategies in the Capricorn District of South Africa. International Journal of Social Economics. 2008;35(11):857–77. http://www.emeraldinsight.com/journals.htm?issn=0306-8293. PMID: 1011895.
  81. 81. Patel L, Hochfeld T. It buys food but does it change gender relations? Child Support Grants in Soweto, South Africa. Gender & Development. 2011;19(2):229–40. pmid:62823270.
  82. 82. Aphane M, Dzivakwi R, Jacobs P. Livelihood strategies of rural women in Eastern Cape and Limpopo. Agenda: Empowering Women for Gender Equity. 2010;24(84):66–74.
  83. 83. Jones C. 'If I take my pills I go hungry": The Choice Between Economic Security and HIV/AIDS Treatment in Grahamstown, South Africa. Annals of Anthropological Practice. 2011;35(1):67–80. pmid:66590170.
  84. 84. Pereira LM, Cuneo CN, Twine WC. Food and cash: Understanding the role of the retail sector in rural food security in South Africa. Food Security. 2014;6(3):339–57.
  85. 85. Adger WN. Social Capital, Collective Action and Adaptation to Climate Change. Economic Geography. 2003;79(4):387–404.
  86. 86. Tzanakis M. Social capital in Bourdieu’s, Coleman’s and Putnam’s theory: empirical evidence and emergent measurement issues. Educate. 2013;13(2):2–23.
  87. 87. Putnam R. Bowling Alone: America's Declining Social Capital. Journal of Democracy. 1995;6(1):65–78.
  88. 88. Portes A. SOCIAL CAPITAL: Its Origins and Applications in Modern Sociology. Annual Review of Sociology. 1998;24:1. PMID: 1056932.
  89. 89. Evans P. Governmetn Action, Social Capital and Development: Reviewing the Evidence on Synergy. World Development. 1996;24(6):1110–32.
  90. 90. Scoones I. Sustainable Rural Livelihoods: A Framework for Analysis. Brighten: Institute for Development Studies United Kingdom, 1998.
  91. 91. De Silva MM, Harpham T. Maternal social capital and child nutritional status in four developing countries. Health and Place. 2007;13:341–55. pmid:16621665
  92. 92. Carter MR, Maluccio JA. Social Capital and Coping with Economic Shocks: An Analysis of Stunting of South African Children. World Development. 2003;31(7):1147–63.
  93. 93. Misselhorn A. Is a focus on social capital useful in considering food security interventions? Insights from KwaZulu-Natal. Development Southern Africa. 2009;26(2):189–208.
  94. 94. Owen G, Goldin J. Assessing the relationship between youth capabilities and food security: a case study of a rainwater harvesting project in South Africa. Water SA [Internet]. 2015; 41(4):[541–8 pp.]. Available from: http://reference.sabinet.co.za/webx/access/electronic_journals/waters/waters_v41_n4_a13.pdf http://dx.doi.org/10.4314/wsa.v41i4.14.
  95. 95. Mudzinganyama TC. A livelihood analysis of the contribution of community gardens to food security in Msunduzi and uMngeni Municipalities in KwaZulu-Natal, South Africa: University of KwaZulu-Natal; 2012.
  96. 96. Ngidi MSC. Measuring the impact of crop production on household food security in KwaZulu-Natal using the coping strategies index (CSI): University of KwaZulu Natal; 2007.
  97. 97. Madlala PJ. The role of food gardens in providing sustainable livelihoods in the Msunduzi Municipality: University of KwaZulu-Natal; 2012.
  98. 98. Beery M, Adatia R, Segantin O, Skaer CF. School food gardens: Fertile ground for education. Health Education. 2013;114(4):281–92.
  99. 99. Tembo R, Louw J. Conceptualising and implementing two community gardening projects on the Cape Flats, Cape Town. Development Southern Africa. 2013;30(2):224–37.
  100. 100. Botha JJ, van Rensburg LD, Anderson JJ, Hensley M, Baiphethi MN. Alleviating household food insecurity through in-field rainwater harvesting. Irrigation and Drainage. 2012;61(SUPPL.2):82–94.
  101. 101. Thornton A. Pastures of plenty?: Land rights and community-based agriculture in Peddie, a former homeland town in South Africa. Applied Geography. 2009;29(1):12–20.
  102. 102. Trixie-Belle N. Urban food gardens and community development: a case study of the Siyakhana initiative, Johannesburg: University of Witwatersrand; 2011.
  103. 103. Faber M, Laubscher R. Seasonal availability and dietary intake of β-carotene-rich vegetables and fruit of 2-year-old to 5-year-old children in a rural South African setting growing these crops at household level. International Journal of Food Sciences & Nutrition. 2008;59(1):46–60. PMID: 27979551.
  104. 104. Letts EM. Urban agriculture and various food sourcing strategies: How can they mitigate food insecurity amongst the urban poor in Cape Town, South Africa? [M.S.]. Ann Arbor: Queen's University (Canada); 2013.
  105. 105. Lunga VA. The impact of Siphalaza food security project in alleviating poverty: University of Zululand; 2011.
  106. 106. Pillay A. Urban agriculture in the Durban unicity: a case study of Demat: University of Durban Westville; 2002.
  107. 107. Thornton AC, Nel E. The significance of urban and peri-urban agriculture in Peddie, in the Eastern Cape province, South Africa. Africanus [Internet]. 2007; 37(1):[13–20 pp.]. Available from: http://reference.sabinet.co.za/webx/access/electronic_journals/canus/canus_v37_n1_a3.pdf.
  108. 108. Ndlovu MM. Towards an understanding of the relationships between homestead farming and community gardens at the rural areas of Umbumbulu, KwaZulu-Natal: University of KwaZulu-Natal 2007.
  109. 109. Mthethwa MN. Urban agriculture in Kwamsane, KwaZulu-Natal community and home gardens as an option for food security and poverty reduction: University of KwaZulu-Natal; 2012.
  110. 110. Van Averbeke W. Urban farming in the informal settlements of Atteridgeville, Pretoria, South Africa. Water SA. 2007;33(3 SPECIAL EDICTION):337–42.
  111. 111. van Averbeke W, Khose TB. The contribution of smallholder agriculture to the nutrition of rural households in a semi-arid environment in South Africa. Water SA. 2007;33:413–8.
  112. 112. Esterhuyse P. Social capital in a rainwater-harvesting project in rural south Africa. Irrigation and Drainage. 2012;61(SUPPL.2):95–105.
  113. 113. Ruysenaar S. Reconsidering the 'Letsema Principle' and the Role of Community Gardens in Food Security: Evidence from Gauteng, South Africa. Urban Forum. 2013;24(2):219–49. pmid:87516881.
  114. 114. Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, et al. South African National Health and Nutrition Examination Survey (SANHANES-1): 2014 Edition. Cape Town: HSRC Press, 2014.
  115. 115. Reuther S, Dewar N. Competition for the use of public open space in low-income urban areas: the economic potential of urban gardening in Khayelitsha, Cape Town. Development Southern Africa. 2006;23(1):97–122.
  116. 116. Mjonono M. An investigation of household food insecurity coping strategies in Umbumbulu: University of KwaZulu-Natal; 2008.
  117. 117. Bryceson D. Deagrarianization and Rural Employment in sub-Saharan Africa: A Sectoral Perspective. World Development. 1996;24(1):97–111.
  118. 118. Shackleton R, Shackleton C, Shackleton S, Gambiza J. Deagrarianisation and forest revegetation in a biodiversity hotspot on the Wild Coast, South Africa. PloS one. 2013;8(10).
  119. 119. Sinyolo S, Mudhara M, Wale E. Water security and rural household food security: Empirical evidence from the Mzinyathi district in South Africa. Food Security. 2014;6(4):483–99.
  120. 120. Mfundo MM. The Effects of Infrastructural and Institutional Services on Food Security in Ntambanana Rural Area: University of Zululand; 2013.
  121. 121. Drimie S, Germishuyse T, Rademeyer L. Agricultural production in Greater Sekhukhune: the future for food security in a poverty node of South Africa. Agrekon. 2009;48(3):245–75.
  122. 122. Dovie DBK, Shackleton CM, Witkowski ETF. Conceptualizing the human use of wild edible herbs for conservation in South African communal areas. Journal of Environmental Management. 2007;84(2):146–56. pmid:17045732.
  123. 123. Lewu FB, Mavengahama S. Utilization of wild vegetables in four districts of northern KwaZulu-Natal Province, South Africa. African Journal of Agricultural Research. 2011;6(17):4159–65.
  124. 124. McGarry DK, Shackleton CM. Children navigating rural poverty: Rural children's use of wild resources to counteract food insecurity in the Eastern Cape, South Africa. Journal of Children & Poverty. 2009;15(1):19–37.
  125. 125. Twine W, Moshe D, Netshiluvhi T, Siphugu V. Consumption and direct-use values of savanna bio-resources used by rural households in Mametja, a semi-arid area of Limpopo province, South Africa. South African Journal of Science. 2003;99:467–73.
  126. 126. Rasethe MT, Semenya SS, Potgieter MJ, Maroyi A. The utilization and management of plant resources in rural areas of the Limpopo Province, South Africa. Journal of Ethnobiology & Ethnomedicine. 2013;9(1):27–34. pmid:87952566.
  127. 127. Tibesigwa B, Visser M, Collinson M, Twine W. Investigating the sensitivity of household food security to agriculture-related shocks and the implication of social and natural capital. Sustainability Science 2015. Epub
  128. 128. Akpalu DA. Response scenarios of households to drought-driven food shortage in a semi-arid area in South Africa: University of the Witwatersrand; 2005.
  129. 129. Hunter LM, Twine W, Patterson L. "Locusts are now our beef": Adult mortality and household dietary use of local environmental resources in rural South Africa. Scandinavian Journal of Public Health. 2007;35:165–74. pmid:2009662407. Language: English. Entry Date: 20080822. Revision Date: 20091218. Publication Type: journal article.
  130. 130. Schroeder E-A. The impact of HIV/AIDS on food security—a study of orphan adoption in rural Ingwavuma, KwaZulu-Natal: University of KwaZulu-Natal; 2003.
  131. 131. Majake MP. Evaluation of the impact of a household food security programme in QwaQwa using a coping strategy index2011. Available from: http://hdl.handle.net/10413/4097.
  132. 132. Modi M, Modi AT, Hendricks S, Sheryl H. Potential role for wild vegetables in household food security: A preliminary case study in Kwazulu-Natal, South Africa. African Journal of Food, Agriculture, Nutrition and Development. 2006;6(1):1–. NATCHA-1056405. Author Affiliation: [2006]—Food Security Programme, School of Agricultural Sciences and Agribusiness, University of KwaZulu-Natal, Private Bag X 01, Scottsville 3209, South Africa 1.
  133. 133. Cloete PC, Idsardi EF. Consumption of Indigenous and Traditional Food Crops: Perceptions and Realities from South Africa. Agroecology & Sustainable Food Systems. 2013;37(8):902–14. pmid:92759749.
  134. 134. Thandeka N, Sithole N, Thamaga-Chitja JM. The role of traditional leafy vegetables in household food security in rural KwaZulu-Natal. Indilinga. 2011;10(2):195–209.
  135. 135. Dweba TP, Mearns MA. Conserving indigenous knowledge as the key to the current and future use of traditional vegetables. International Journal of Information Management. 2011;31:564–71.
  136. 136. Quinn CH, Ziervogel G, Taylor A, Takama T, Thomalla F. Coping with multiple stresses in rural South Africa. Ecology and Society. 2011;16(3):10.
  137. 137. Vorster HJ, Stevens JB, Steyn GJ. Production systems of traditional leafy vegetables: challenges for research and extension. South African Journal of Agricultural Extension. 2008;37:85–96.
  138. 138. Zobolo AM, Mkabela QN. Traditional knowledge transfer of activities practised by Zulu women to manage medicinal and food plant gardens. African Journal of Range and Forage Science. 2006;23(1):77–80. PMID: 1061406. Author Affiliation: [2006–2007]—Department of Botany, University of Zululand, Private Bag X1001, KwaDlangezwa 3886, South Africa 1.
  139. 139. Ruiters M. Food insecurity in South Africa: Where does gender matter? 2012.
  140. 140. Patel RC. Food Sovereignty: Power, Gender, and the Right to Food. PLoS Medicine. 2012;9(6):1–4. pmid:77669394.
  141. 141. Trefry A, Parkins J, Cundill G. Culture and food security: a case study of homestead food production in South Africa. Food Security. 2014;6:555–65.
  142. 142. Tlhompho G. African Indigenous Food Seurity Strategies and Climate Change Adaptation in South Africa. Journal of Human Ecology. 2014;48(1):83–96.
  143. 143. Dlamini DH. Moving towards sustainable food security: a case study of Umsinga food security programme: University of KwaZulu-Natal; 2005.
  144. 144. Raidimi EN. The Roles and Activities of Women in the Six Selected Agricultural Projects in Thulamela Local Municipality of Vhembe District Municipality in the Limpopo Province. South African Journal of Agricultural Extension. 2014;42(2):10–23.
  145. 145. Nkosi BC. Household food security and health behaviors in rural communities of KwaZulu Natal, South Africa [Ph.D.]. Ann Arbor: University of Minnesota; 2005.
  146. 146. V.Reddy SM, F.Timol, S.Goga. The gendered dimensions of farming systems and rural farmer households in the context of food security: a pilot study of small-scale livestock farmers in Marble Hall and Rhenosterkop. Final Technial Report. Pretoria: Human Sciences Research Council, 2014.
  147. 147. Dlamini NE, Tabit FT. Coping strategies of households in the Timane community of Idutywa, Eastern Cape, South Africa. Journal of Family Ecology and Consumer Sciences = Tydskrif vir Gesinsekologie en Verbruikerswetenskappe [Internet]. 2014; 42:[39–46 pp.]. Available from: http://reference.sabinet.co.za/webx/access/electronic_journals/famecs/famecs_v42_a4.pdf.
  148. 148. Sharaunga S, Mudhara M, Bogale A. The Impact of ‘Women's Empowerment in Agriculture’ on Household Vulnerability to Food Insecurity in the KwaZulu-Natal Province. Forum for Development Studies. 2015;42(2):195–223.
  149. 149. Murugani VG, Thamaga-Chitja JM, Kolanisi U, Shimelis H. The Role of Property Rights on Rural Women's Land Use Security and Household Food Security for Improved Livelihood in Limpopo Province. Journal of Human Ecology. 2014;46(2):205–21.
  150. 150. Cross C, Altman M. "For us women, working is an unfulfilled dream": Womens’ wage work and food security. Agenda. 2010;86.
  151. 151. Hart T. Some considerations for supporting household food production in South Africa. Agenda. 2010;24(86):78–93.
  152. 152. Misselhorn A. What Drives Food Insecurity in Southern Africa? A meta-analysis of household economy studies. Global Environmental Change. 2005;15:33–43.
  153. 153. Eakin H, Luers AL. Assessing the Vulnerability of Social-Environmental Systems Annual Review of Environment and Resources. 2006;31:361–94.
  154. 154. Lushaba V. Coping strategies of low-income households in relation to HIV/AIDS and food security. Pietermaritzburg: University of KwaZulu-Natal; 2005.
  155. 155. Msaki MM. Measuring and validating food insecurity in Embo, using the food insecurity scale and index: University of KwaZulu-Natal; 2010.
  156. 156. Grobler WCJ. Food insecure household coping strategies: The case of a low income neighborhood in South Africa. Mediterranean Journal of Social Sciences. 2014;5(13 SPEC. ISSUE):100–6.
  157. 157. Oppong BB. Mopane worms and household food security in the Limpopo Province, South Africa: University of KwaZulu-Natal; 2013.
  158. 158. Nyakurimwa M. Analysis of the local understanding of food insecurity and the socio-economic causes of food insecurity in Ward three of the Jozini Municipality, KwaZulu-Natal: University of KwaZulu-Natal; 2011.
  159. 159. Charlton KE, Kolbe-Alexander TL, Nel JH. Micronutrient dilution associated with added sugar intake in elderly black South African women. European Journal of Clinical Nutrition. 2005;59(9):1030. pmid:16015273
  160. 160. Dewing S, Tomlinson M, le Roux IM, Chopra M, Tsai AC. Food insecurity and its association with co-occurring postnatal depression, hazardous drinking, and suicidality among women in peri-urban South Africa. Journal Of Affective Disorders. 2013;150(2):460–5. pmid:23707034.
  161. 161. Munro N, Quayle M, Simpson H, Barnsley S. Hunger for knowledge: food insecurity among students at the University of KwaZulu-Natal. Perspectives in Education [Internet]. 2013; 31(4):[168–79 pp.]. Available from: http://reference.sabinet.co.za/webx/access/electronic_journals/persed/persed_v31_n4_a13.pdf.
  162. 162. Eaton L, Cain D, Pitpitan E, Carey K, Carey M, Mehlomakulu V, et al. Exploring the Relationships Among Food Insecurity, Alcohol Use, and Sexual Risk Taking Among Men and Women Living in South African Townships. Journal of Primary Prevention. 2014;35(4):255–65. pmid:24806889.
  163. 163. Oketch JA, Paterson M, Maunder EW, Rollins NC. Too little, too late: Comparison of nutritional status and quality of life of nutrition care and support recipient and non-recipients among HIV-positive adults in KwaZulu-Natal, South Africa. Health Policy. 2011;99(3):267–76. pmid:20884072
  164. 164. Audain KA, Kassier SM, Veldman FJ. Adolescent food frequency and socio-economic status in a private urban and peri-urban school in Hilton, KwaZulu-Natal: original research. South African Journal of Clinical Nutrition [Internet]. 2014; 27(4):[201–7 pp.]. Available from: http://reference.sabinet.co.za/webx/access/electronic_journals/m_sajcn/m_sajcn_v27_n4_a5.pdf.
  165. 165. Hattingh Z, Walsh CM, Veldman FJ, Bester CJ. Macronutrient intake of HIV-seropositive women in Mangaung, South Africa. Nutrition Research. 2006;26(2):53–8.
  166. 166. Sheehy T, Kolahdooz F, Mtshali TL, Khamis T, Sharma S. Development of a quantitative food frequency questionnaire for use among rural South Africans in Kwa Zulu- Natal. Journal of Human Nutrition & Dietetics. 2014;27(5):443–9. pmid:98419699.
  167. 167. Phometsi M, Kruger A, Van't Riet H. Nutrition knowledge and barriers to good dietary practices among primary school children in a farming community. Development Southern Africa. 2006;23(4):529–39. pmid:22909531.
  168. 168. Khanyile KN. Food security at eQhudeni (Nkandla): a case study of the 'One home one garden' campaign as a poverty alleviation strategy: University of KwaZulu-Natal; 2012.
  169. 169. Kolahdooz F, Spearing K, Sharma S. Dietary Adequacies among South African Adults in Rural KwaZulu-Natal. PLoS ONE. 2013;8(6):1–6. pmid:88910037.
  170. 170. Vorster HH, Venter CS, Wissing MP, Margetts BM. The nutrition and health transition in the North West Province of South Africa: a review of the THUSA (Transition and Health during Urbanisation of South Africans) study. Public Health Nutrition. 2005;8(5):480–90. pmid:16153329.
  171. 171. Matjokana E. Socio-economic impact of Agricaltural food security and poverty alleviation programs in Mopani District, of Limpopo Province: University of Limpopo (Turfloop Campus); 2013.
  172. 172. Maliwichi LL, Oni SA, Sifumba L. AN EVALUATION OF SMALL—SCALE AGRIBUSINESSES AND HOUSEHOLD INCOME GENERATING ACTIVITIES IN VHEMBE DISTRICT OF LIMPOPO PROVINCE, SOUTH AFRICA. African Journal of Food, Agriculture, Nutrition & Development. 2010;10(9):3080–99. pmid:55119684.
  173. 173. Swaans K, Broerse J, Meincke M, Mudhara M, Bunders J. Promoting food security and well-being among poor and HIV/AIDS affected households: lessons from an interactive and integrated approach. Evaluation And Program Planning. 2009;32(1):31–42. pmid:19004496.
  174. 174. Raidimi EN. The participation and role of women in selected agricultural projects in the Limpopo Province of South Africa2013. Available from: Raidimi, EN 2010, The participation and role of women in selected agricultural projects in the Limpopo Province of South Africa, PhD thesis, University of Pretoria, Pretoria, viewed yymmdd (http://upetd.up.ac.za/thesis/available/etd-06152011-105958/) D11/368/ag http://hdl.handle.net/2263/30911 http://upetd.up.ac.za/thesis/available/etd-06152011-105958/.
  175. 175. Lorathu K. An investigation into the challenges of food security policy implementation: a case study of the Barolong Boora Tshidi people of the North West Province (South Africa) / Kego Lorathu. University of the North West Province2005.
  176. 176. de Silva U. The survival of peri-urban agrarian livelihoods in transitioning spaces of KwaZulu- Natal, South Africa [M.A.]. Ann Arbor: University of Ottawa (Canada); 2011.
  177. 177. Earl A. Solving the food security crisis in South Africa: how food gardens can alleviate hunger amongst the poor: University of Pretoria; 2010.
  178. 178. Arko-Achemfuor A. Teaching Permaculture to Ensure Food Security in Rural South Africa: The Case Study of Tiger Kloof. Journal of Human Ecology. 2014;47(3):251–5.
  179. 179. Tlhompho G. African Indigenous Food Security Strategies and Climate Change Adaptation in South Africa. Journal of Human Ecology. 2014;48(1):83–96.
  180. 180. van der Hoeven M, Osei J, Greeff M, Kruger A, Faber M, Smuts CM. Indigenous and traditional plants: South African parents' knowledge, perceptions and uses and their children's sensory acceptance. Journal of Ethnobiology & Ethnomedicine. 2013;9(1):78–89. pmid:92885574.
  181. 181. Maxwell S. The Evolution of Thinking About Food Security. In: Devereux S, Maxwell S, editors. Food Security in Sub-Saharan Africa. ITDG Publishing London; University of Natal Press, Pietermaritzburg: Pietermaritzburg; 2001. p. 13–27.
  182. 182. Maxwell D, Vaitla B, Coates J. How do indicators of household food insecurity measure up? An empirical comparison from Ethiopia. Food Policy. 2014;47:107–16.
  183. 183. Misselhorn A. Food Insecurity in Southern Africa: causes and emerging response options from evidence at regional, provincial and local scales: University of the Witwatersrand; 2006.