Systems for evidence-grading being used in this study. SSRD=Singel Subject Research Design, RCT=Randomized Controlled Study
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 179 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 252 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
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The study, including 20 reviews and 27 primary studies, specifically focus interventions targeting children with diagnosis within the autism spectrum being on an early communicative level.
Major advances have been made over the two past decades in understanding the social-communication difficulties of children with ASD, resulting in greater emphasis on early social-communication features in the diagnostic criteria. Most parents of children with autism first begin to be concerned that something is not quite right in their child’s development because of early delays or regressions in the development of speech [1]. Problems with communication, in terms of both understanding and expression, are often said to be one of the main causes of the severe behaviour problems that are common among persons with severe autism and mental retardation [2]. The lack of meaningful, spontaneous speech by age five has been associated with poor adult outcomes [3,4,5,6]. Certainly, communication and communication problems are at the heart of what ASD is all about.
Although all persons diagnosed with autism have problems with communication, their type and degree vary a lot and the work of identifying different subgroups has just begun. It has been estimated that between one-third [7] and one-half [8] of children and adults with autism have no speech. However, more recent research results indicate that the proportion of non-speaking children with ASD is much smaller, approximately 14% to 20%, among those who received very early intervention [9].
Two phenotypes of speaking children with ASD were identified by Tager-Flusberg and Joseph [10]: children with normal linguistic abilities (phonological skills, vocabulary, syntax, and morphology) and children with impaired language that is similar to the phenotype found in specific language impairment. Another potential subgroup may experience verbal dyspraxia or dyspraxia of speech [11; 12; 13]. Voluntary motor control is disturbed in children with dyspraxia, which also affects their ability to imitate. The new research on the role of the ‘mirror neurons’ in the parietal and frontal lobes may provide some answers on the relationships between motor control and imitation but also on the possible link with the development of intersubjectivity [11].
In spite of the heterogeneity of language abilities in children with ASD, social-communication or pragmatic impairments are universal across all ages and ability levels [14]. According to Wetherby [15], the social-communication deficits in children with ASD can be organized into two major areas: (1) the capacity for joint attention and (2) the capacity for symbol use. Since joint attention emerges before words, this deficit may be more fundamental and a number of longitudinal studies provide evidence of a relationship between joint attention and language outcomes [16, 17]. According to Wetherby [15] p. 11, ‘deficits in initiating and responding to joint attention have a cascading effect on language development since language learning occurs within the context of the modelling by the caregiver of words that refer to objects and words that are jointly regarded’. Wetherby [15] states that deficits in imitation and observational learning are other main causes of the problems with symbol use experienced by children with ASD. Learning shared meanings, imitating and using conventional behaviours, and being able to decontextualize meaning from the context constitute the symbolic deficits in children with ASD [13].
Because autism is usually not diagnosed until age three or four, there is relatively little information about language in very young children with autism [10]. Retrospective studies using parent reports and/or videotapes collected during infancy, together with studies of children considered likely to develop autism, show severely delayed language acquisition with respect to both receptive and expressive skills [18, 19, 20]. Another typical phenomenon described by 25% of parents of children with ASD is language loss after initially developing some words [21]. Lord, Schulman, and DiLavore [22] found that this language regression is unique to autism and does not occur in other children with developmental delays. Chawarska et al. [21] hypothesize that these early-acquired speech-like productions are lost by children with ASD because the link between these expressions and a network of symbolic communication fails. There is significant variability in the rate at which language progresses among children with ASD who do acquire speech.
The few longitudinal studies of language acquisition in children with ASD suggest that progress within each domain of language follows similar pathways as it does in typically developing children [9, 12]. However, the speech of children with ASD is also characterized by some typical deviations. One of the most salient aspects is the occurrence of echolalia, which can be either immediate or delayed. Although some echolalia seems to be self-stimulating, both types of echolalia can serve communicative purposes for the speaker [12]. At an early stage of language development, this may be the only way in which the child can actually produce speech. Tager-Flusberg et al. (1990) found that, over the course of development, echolalia rapidly declined for all the children with ASD and Down’s syndrome in their study. Another prominent feature of language in children with ASD is general problems with deixis, which are most often manifested as pronoun confusion [10]. Features such as vocal quality, intonation and stress patterns often result in problems for persons with ASD, although there is a lack of research in this field. Taken together, the findings suggest that the difficulties are due not only to problems in social intent but also to problems affecting a more basic aspect of vocalization [12].
Less research attention has focused on the comprehension skills of individuals with ASD although deviations in response to language and comprehension have been found to be strong indicators of ASD [18]. According to Tager-Flusberg et al. [14], it seems that ASD children ‘not only may have limited ability to integrate linguistic input with real-world knowledge but also may lack knowledge about social events used by normally developing children to buttress emerging language skills and to acquire increasingly advanced linguistic structures’ [12, p. 350].
The pragmatic aspects of language have been studied in numerous ways. Children with autism share important similarities across different language levels [12]. The speech acts that are missing or rarely used in the conversations of children with autism often concern social, rather than regulatory, uses of language [22]. Ramberg, Ehlers, Nydén, Johansson, and Gillberg [24] found that children with ASD were impaired in taking turns during dyadic conversations. A higher proportion of initiations rather than responses was found in a study [25]. Although the basic intention to communicate often exists, the person with autism has impaired skill in participating in communicative activities involving joint reference or shared topics [12, p. 354].
The first reports on language interventions were published in the mid-1960s. The intervention at that time built on the operant tradition developed by Skinner during the 1950s. The teaching sessions in this method, referred to as discrete trial teaching or didactic teaching, are marked by a high level of adult control and direction, massed-practice periods for preselected tasks, and precise antecedent, teaching, and reinforcement practices. The learner is in a responder role, and the teacher has a directive role [11]. The strength of the didactic behavioural approach is primarily that it has demonstrated efficacy in many studies, using a variety of treatment settings and treatment deliverers, with both single-subject and group designs [11]. Limitations on this approach as a language-training method were recognized early on, with the children’s lack of generalization being a core problem [26].
The pragmatic understanding of communication was fully developed after the operant teaching methods were first developed [11]. The current scientific understanding of communication and language development stems from the 1970s and 1980s, when it was demonstrated that language develops from the preverbal social exchanges of infants with important others (Bates, 1976). According to Rogers [11 p. 149], ‘current research, building primarily on the work of Wetherby [13, 15, 23], Prizant [13], and Mundy, Sigman and Kasari [17], has demonstrated that young children with autism lacked these early building blocks of communication, involving social initiative, joint attention, social and emotional reciprocity, and the use of gestures to co-ordinate social exchanges.
In 1968, an important study was published by Hart and Risley [27]. Very positive results were obtained with an intervention in which the principles of operant teaching were applied in the child’s natural environment. The term ‘incidental teaching’ was used for this approach, in which the natural environment is deliberately structured to highlight the function of the targeted language form. This intervention produced much better results with respect to maintenance and generalization and stimulated development and research in the field [11]. According to Rogers [11, p. 153], the effectiveness of this approach results from four factors: (1) child language functions to achieve child-chosen goals and child-chosen reinforcers, which strengthen their power; (2) the focus is on child communication skills that are functional in all settings; (3) the social functions of language are highlighted; (4) emphasis on child motivation and natural reinforcers adds a positive element to the interactions, which may enhance memory for learning.
The third major approach in the field of communication intervention for children with ASD is the developmental pragmatic approach. The most elaborated programme for treatment, the SCERTS (Social-Communication, Emotional Regulation, Transactional Support) model [28] focuses on functional communication. This approach bears many resemblances to the behavioural naturalistic teaching methods. More emphasis is, however, placed on developing nonverbal behaviours prior to verbal communication and on the use of Augmentative and Alternative Communication (AAC) systems to assist in the development of verbal communication [11]. Today many models combine behavioural techniques and social-interactionist approaches, such as Enhanced Milieu Teaching, developed by Kaiser and colleagues [29], The Denver Early Start [30], Caregiver Mediated Joint Engagement Intervention for Toddlers with Autism [31], Focus parent training for toddlers with autism [32]. The strength of the developmental model is its strong basis in the science of communication development. Its weaknesses include the lack of treatment manuals and the fact that it requires considerable knowledge on the part of the therapist [11].
Several new research findings point to the importance of an early start of communication intervention. The most essential of these are:
Difficulties in understanding and expressing communication is very closely linked to the development of challenging behaviors in individuals with autism [2].
Communication and language are pivotal for the development of several other cognitive constructs or competencies, such as:
Reading and writing.
Theory of Mind [33].
Communication ability predicts outcome with respect to functioning and quality of life in adults with autism spectrum disorders [3].
The severity of communication difficulties in preschool-aged children is correlated to the perceived level of stress in their parents [34].
Communication is one of the most important factors for the participation in daily activities of young disabled children [35].
According to several guidelines, among these NRC (National Research Council) in the United States, functional communication and social interaction should be prioritized in early intervention programs given to children with ASD.
Furthermore, interactional research done on children with communicative impairments and their parents has shown that the responsive communication style that characterizes parents of typically developing children is often replaced by a more directive style in parents of children with communicative impairments. Besides this impact on quality, quantity is also affected, in that the rate of communication occasions in these families tend to decrease. This adds a cumulative negative effect on the communication development due to less stimulation and experience [36]. Research has also shown that children with ASD whose parents used a responsive style during preschool years in general had better communication and languages skills when they were followed up as teen-agers [37].
There are many intervention programs for children with ASD that focus on communication. Some of these are more specifically aimed at communication whilst others include communication and language as a part of a comprehensive early intervention program. Some programs (indirect interventions) focus on the parent or partner usually by guiding and teaching parents, individually or in groups (courses). Other intervention programs focus more on the training of the child (direct interventions). Today it is common that early intervention programs include both indirect and direct aspects: education and tutoring of parents and training of the child.
Another dimension of great importance in early communication intervention concerns the degree of child focus. To have a child focus means that the motivation of the child and the developmental level is decisive in what is done during intervention. The adult follows the lead of the child and the place for training is where the child is, often the floor. In this way it’s not necessary to use reinforcements or rewards since the child is already interested and motivated. To get the child to train and focus the intended skills or functions different behavioural techniques are often used. At the other end of this dimension we find the more traditional didactic training situation where the adult trainer or therapist follows and uses a predefined set of activities and materials during a training session. The specific behavioural techniques; prompts and reinforcements used during the session are often also specified or planned. The child is expected to follow the lead of the adult and it is typical that the training is held the child and the adult sitting face-to-face at a table. It is more typical that child-focused interventions are provided during daily activities in the natural environment of the child; at home and/or in pree-school, whilst didactic training is provided at a clinic, at least during the introduction of new materials and training activities.
Still another difference between programs that might be seen as a dimension is the degree to which augmentative and alternative communication (AAC) is included. In some programs these strategies, in the form of manual signs, symbols and pictures and speech-generating devices (SGDs, today often Apps used on an iPad, smartphone or other platform), are included already from the start to promote communication and build language, whilst in other programs AAC strategies are not included, but instead seen as a last resort when training of speech has failed.
The most common intervention of this type is parental education. The internationally most wide-spread parental education programs most probably are the courses developed by the Canadian Hanen Centre [38]. The course being developed for children within the autism spectrum is called More Than Words and includes eight group sessions for the parents and three “home-visits” by the Speech-language pathologist. During these visits the interaction between the child and the parent is videotaped and the parents are given feed-back and further guidance how to improve communication and use of the strategies being taught during the course. The Hanen courses is a developmental approach and teaches responsive strategies to the parents adding some behavioural techniques to stimulate communication learning within the frames of child-focused natural interaction in the home [38]. A new parental course called ComAlong has been developed in Sweden and now is spreading in northern Europe [39]. ComAlong include eight group sessions focusing on responsive strategies and environmental teaching but also puts a large focus on the use of augmentative communication strategies in the home setting [39]. The parents are provided with picture boards so they can use aided language modeling in their homes [39, 40].
Training of communication, language and speech is most often an important part in the different comprehensive programs, addressing different skills and problems, that has been developed for young children within the autism spectrum. Some of these are built on behavioural theories, others on developmental pragmatic approaches. There seems to be a trend that the programs being developed and researched during the last decade, specifically for young children with autism, are more eclectic. The background theories are often described as developmental pragmatic whilst ABA (Applied Behavior Analysis) techniques are used to strengthen the teaching practices. Most often these comprehensive programs include both direct training to the child and indirect intervention parts in that parents and/or staff in the close network of the child are given education, training and/or guidance.
AAC comprises different methods and modes of communication such as body communication, concrete objects, manual signs, graphic symbols or speech-generating devices. Historically, the first studies describing AAC techniques being used for individuals with autism appeared in the 1970s; they reported on the use of sign language to improve communication [41]. These studies appeared at the same time as the unsatisfactory results of spoken-language-training programmes were being published. Studies by, for example, Lovaas et al. [26] reported little change after many hours of intensive treatment, and the results were particularly poor for the children whose comprehension and vocal skills were most impaired [41]. Initially, most signing programmes were built on formal sign language systems, but it became evident that these were often too complex and abstract, and so specially adapted systems were developed and implemented. Sign-based programmes spread rapidly in schools for children with autism in many countries.
During the 80’s and the 90’s a gradual change in AAC intervention for persons with autism, was seen, as visual-graphic communication was more in focus. Mirenda and Erickson [42] explain that the shift away from the use of signing to visual-graphic communication occurred as a result of research findings in three main areas: imitation, iconicity, and intelligibility. In addition to the evidence of a generalized imitation deficit in autism, there were also studies showing that some children with ASD had extremely poor sign imitation skills [43] due to difficulties with motor planning, control and execution [44]. According to Howlin [41], the shift from the use of manual signs to visual methods was also due to the fact that visual methods had proven to be effective in enhancing general skill acquisition, mainly within the TEACCH programme (Treatment of Education of Autistic and related Communication-handicapped CHildren; [45]) developed during the 1970s. A variety of symbol systems were also developed, beginning with Blissymbolics and Rebus followed by Pictogram and Picture Communication Symbols. The improvements in computer technology made these symbol sets easily available in the form of practical software packages. The development of digital cameras during the 1990s also increased the possibility of including personal photos in AAC systems, which, according to clinical reports, seemed to increase motivation and facilitate understanding of pictures, particularly for individuals with ASD [46].
There are, however, also reports of problems in teaching symbols to children with ASD, mainly in teaching them to use the pictures spontaneously and for communicative functions other than requesting [41]. It was precisely these problems that led Bondy and Frost [47] to develop the method called Picture Exchange Communication System (PECS). PECS is a systematic approach to communication training specifically developed for children with autism. The elements that make PECS different from other visual-graphic techniques are the use of the concrete hand-to-hand exchange of the picture and also the highly prescriptive user manual with its six levels to follow in sequence.
Historically, the use of speech output technologies with individuals with ASD has not been a matter of course [48]. Computer technology was introduced into educational settings for children with autism late, not only in North America, but also in other countries. Professionals feared that people with ASD would become even more aloof if they were encouraged to sit in front of a computer screen. Concerning speech-generating devices (SGDs), a common view was that they would only stimulate echolalia in children with ASD, and that there would be too much noise in the classroom. By the end of the 1990s, scepticism had decreased. This was probably due to reports of some studies of successful computer-assisted instruction (CAI) carried out. The introduction of “app technology “has meant a revolution to the field of speech-generating devices and the first studies of the effects of apps are now being published.
The term evidence-based used as a prefix and a denominator of interventions and methods comes from medicine. The term evidence based means that the choices of interventions and assessments are based on a research literature not simply professional experience or previous practice. Evidence-based practice has been important within the area of early communication intervention. The behavioural intervention tradition with its roots in the research clinic has produced a lot of high-quality research during the years. Other types of interventions has been less researched and sometimes have used methods and produced data that are different so that comparisons of effects are hard or impossible to do. This has also led to an interesting discussion of how to do EPB within the field of communication intervention. Ralph W. Schlosser, professor at NorthEastern University, USA, has been of great importance in this respect. Partly because he is spreading knowledge about evidence-based practise (EBP) and due to the many thorough compilations of research that he has done, but also in demonstrating the problems and shortcomings using EBP in relation to the field of augmentative communication intervention [49]. One of these problems concerns the use of the Randomized Controlled Trial or Study (RCT) as the golden standard, as RCTs are almost non-existent within the AAC field. There are many reasons to this but the main ones are that (1) children with communicative disabilities are so heterogeneous and (2) that randomization is extremely difficult to put through due to ethical reasons. Schlosser has therefore suggested an alternative evidence hierarchy placing the meta-analysis on top [49, 50]. Schlosser and several other prominent authors within the field of communication intervention research designs recommend the use of well-controlled single-subject research designs that can form the base for systematic meta-analyses.
The review of research within the field of early communication intervention that is presented in this study was initiated by the Swedish association of Habilitation directors as part of a project concerning EBP that was started 2002. Within the frames of this project several reports have been produced with respect to interventions for children and adults with disability. The author of this chapter was appointed scientific leader for a group of five speech-language pathologists and one special educator in Sweden, that applied for taking part in the project. The group has worked together during recurrent two-day-sessions and in between, work has also been done separately and in pairs.
The group decided to use the EBP-model of Ralph Schlosser [49]. As mentioned above the hierarchy of evidence of Schlosser is a bit different compared to the traditional ones, in that it places the meta-analysis on top of the hierarchy beside the RCT-study. Schlosser also includes perspectives of the stakeholder and the influence of environment into his model of EBP and defines EBP as follows: “The integration of best and current research evidence with clinical/educational expertise and relevant stakeholder perspectives to facilitate decisions for assessment and intervention that are deemed effective and efficient for a given stakeholder”. The classical model of formulation of a evidence question shortened PICO - Problem, Intervention, Comparison, Outcome - has accordingly been revised into PESICO - Problem, Environment, Stakeholders, Intervention, Comparison, Outcome [49]. The question that was formulated in this review was: A young child with severe communicative disability, living with his/her parents and being placed in a pree-school group: which intervention is most effective; indirect or direct interventions.
When the clinical question had been formulated the group identified search terms to use. These were: Early Intervention, Communication, Communication Disability/ies, Direct intervention, Indirect intervention, Early childhood, Kindergarten, Pree-school, AAC, Augmentative Communication, Alternative Communication, Early Communication, Language, Meta-analysis, Review. The terms were searched separately and in combinations using four scientific data bases: PubMed, PsycInfo, CINAHL and ERIC. It was seen that CINAHL generated significantly more results than the other three. All abstract were browsed and the studies considered as relevant were downloaded. The reference lists of these studies led to some new findings. A few studies and book chapters were found through the group’s different contacts and readings of literature. The studies were read and reviewed using a protocol and a manual that was developed. The factors that were examined in each study were: Research methods, participants, environment, intervention, results, evidence grading and a final category called notes. This column included judgements of (a) ICF domain/s that the study involved, (b) validity: internal, external, social and ecological, (c) importance of discussion and suggestions of future studies.
Each study was first reviewed by two group members separately and then discussed and graded by the group altogether. The group graded the studies according to three systems: Schlosser [49], Nordenström [51] and Golper [52]. Schlosser’s system was seen as the most important for this study due to the fact that it was developed for the field of communication intervention for people with disability. Nordenström represent the classical medical evidence hierarchy whilst the Golper was included for its ambition to catch or grade the level or depth of evaluation that the study represents.
\n\t\t\t\tSystem\n\t\t\t | \n\t\t\t\n\t\t\t\tLevel\n\t\t\t | \n\t\t\t\n\t\t\t\tDefinition\n\t\t\t | \n\t\t
Schlosser | \n\t\t\t1 | \n\t\t\tMeta-analyses of SSRD /RCT | \n\t\t
2 | \n\t\t\tWell designed non-RCT group study SSRD – one intervention SSRD – several interventions Subgroups to/variants of the types above | \n\t\t|
3 | \n\t\t\tNarrative quantitative reviews (except of meta-analyses) | \n\t\t|
4 | \n\t\t\tNarrative reviews | \n\t\t|
5 | \n\t\t\tPre- experimental group studies (i.e. before-after) and case studies | \n\t\t|
6 | \n\t\t\tExpertise: educational books, journals, expert opinion | \n\t\t|
Nordenström | \n\t\t\tA | \n\t\t\tStrong scientific evidence (meta-analysis, well-done and large RCT) | \n\t\t
B | \n\t\t\tModerate evidence (smaller or non-randomized studies, cross-sectional studies, case studies, cohort studies) | \n\t\t|
C | \n\t\t\tWeek evidence (expert opinion, concensus reports, case studies and other descriptive reports) | \n\t\t|
D | \n\t\t\tNon-existent scientific evidence (No studies of sufficient quality exists). | \n\t\t|
Golper | \n\t\t\tPhase I | \n\t\t\tHypotheses about treatment efficacy are being developed for later testing. Often this involves experimental manipulations to test potential benefits or activity of a particular treatment. | \n\t\t
Phase II | \n\t\t\tThe goals are to formulate and standardize protocols, validate measurement instruments, optimise dosage of treatment, and so on. Includes case reports and small group studies with no control groups or treatment comparisons. | \n\t\t|
Phase III | \n\t\t\tTreatment efficacy of a specified protocol is formally tested either with SSRD or group studies with controls such as control groups or treatment comparisons. | \n\t\t
Systems for evidence-grading being used in this study. SSRD=Singel Subject Research Design, RCT=Randomized Controlled Study
\n\t\t\t\tAuthor&year\n\t\t\t | \n\t\t\t\n\t\t\t\tStudy design\n\t\t\t | \n\t\t\t\n\t\t\t\tIntervention\n\t\t\t | \n\t\t\t\n\t\t\t\tEvidence grading\n\t\t\t | \n\t\t
Aldred, Green & Adams, 2004 [54] | \n\t\t\tRCT | \n\t\t\tEducation and guidance of parents in the use of responsive strategies | \n\t\t\tSchlosser: 1 Nordenström Golper. III | \n\t\t
Callenberg och Ganebratt, 2009 [56] | \n\t\t\tPre-experimental group-study | \n\t\t\tComAlong parental education; responsive strategies and AAC | \n\t\t\tSchlosser: 5 Nordenström: B Golper. II | \n\t\t
Drew, Baird, Baron-Cohen, Cox, Slonims, Wheelwright, Swettenham, Berry & Charman, 2002 [32] | \n\t\t\tPilot RCT | \n\t\t\tFocus parent training; joint attention | \n\t\t\tSchlosser: 1 Nordenström: A Golper. III | \n\t\t
Elder, Valcante, Yarandi, White & Elder, 2005 [57] | \n\t\t\tLarge-scale SSRD | \n\t\t\tEducation and guidance of fathers: imitation and responsive strategies | \n\t\t\tSchlosser: 2 Nordenström: B Golper. III | \n\t\t
Ferm, Andersson, Broberg, Liljegren & Thunberg, 2011 [55] | \n\t\t\tGroup study; mixed methods | \n\t\t\tParents and course leaders’ experiences of the ComAlong augmentative and alternative communication early intervention course | \n\t\t\tSchlosser: 5 Nordenström: B Golper. II | \n\t\t
Girolametto, Sussman & Weitzmann, 2007 [58] | \n\t\t\tCase study, Interaction analyses | \n\t\t\tHanen More than Words parental education and guidance: responsive strategies | \n\t\t\tSchlosser: 5 Nordenström: C Golper. III | \n\t\t
Howlin, Gordon, Pascoe, Wade & Charman, 2007 [59] | \n\t\t\tRCT | \n\t\t\tPECS – training of pree-school teachers (and also some older children) | \n\t\t\tSchlosser: 1 Nordenström: A Golper. III | \n\t\t
Jonsson, Kristoffersson, Ferm & Thunberg, 2011 [40] | \n\t\t\tPre-experimental group study; mixed methods | \n\t\t\tComAlong parental education; responsive strategies and AAC | \n\t\t\tSchlosser: 5 Nordenström: B Golper. II | \n\t\t
Karlsson & Melltorp, 2006 [62] | \n\t\t\tPilot group study, mixed methods | \n\t\t\tComAlong parental education; responsive strategies and AAC | \n\t\t\tSchlosser: 5 Nordenström: B Golper. I | \n\t\t
Lennartsson och Sörensson, 2010 [60] | \n\t\t\tGroup study, small control group | \n\t\t\tComAlong parental education; responsive strategies and AAC | \n\t\t\tSchlosser: 5 Nordenström: B Golper. II | \n\t\t
McConachie, Randle, Hammal & LeCouteur, 2005 [61] | \n\t\t\tControlled group study | \n\t\t\tHanen More than Words parental education and guidance: responsive strategies | \n\t\t\tSchlosser: 2 Nordenström: B Golper: III | \n\t\t
Oosterling et al., 2010 [63] | \n\t\t\tRCT | \n\t\t\tFocus parent training; joint attention | \n\t\t\tSchlosser: 1 Nordenström: A Golper. III | \n\t\t
Seung, Ashwell, Elder & Valcante, 2006 [64] | \n\t\t\tGroup study | \n\t\t\tVerbal outcomes after training of fathers as analyzed by video interactions | \n\t\t\tSchlosser: 2 Nordenström: B Golper. III | \n\t\t
Sharry, Guerin, Griffin & Drumm, 2005 [65] | \n\t\t\tGroup study | \n\t\t\tEvaluation of the parental plus progam including responsive strategies | \n\t\t\tSchlosser: 5 Nordenström: B Golper. II | \n\t\t
Studies of education and guidance to parents or staff
The results were analysed and grouped primarily according to the formulated search question but also according to the identified areas of intervention and methods being evaluated in the studies. Building on these results, recommendations and a model for early communicative intervention was suggested. These results were documented in a report being published on the website of the Association of Swedish Habilitation directors [53]. A new literature search using the same procedure as described above led to some revision of results and recommendations in a new version of the report that was recently published [53].
The results that will be shared in this book chapter concerns the studies that specifically involved children on the autism spectrum, which in total involved about half of the studies, or exactly 47 studies. The data from both literature searches was used: 30 studies from the review published in 2011 and 16 studies from the updated version of 2012.
The number of studies that were included in the review totalled 106. Of these, 39 were reviews, while the other 67 were primary studies. 46 of the studies involved children diagnosed within the autism spectrum. This means that about half the research on interventions for children with communicative disabilities have focused children with ASD. 31 of the studies were included in the report published 2011 while 14 were added in the review done 2012. 20 of the publications were reviews while 27 were primary studies. There were comparatively more primary studies, often of high research quality, to be found in the more recent search (2012). Only publications where the children were clearly described as having ASD were included in this review. There were most probably even more studies of the 106 that included children with ASD since sometimes participants were described according to type and/or severity of disability (such as severe communicative disability), and not diagnose..
14 primary studies were found. The evidence is moderately to strong since there are also some studies with a high level of scientific control. Many of the studies were noted as showing high validity with respect to external validity as well as social and ecological validity. In several studies the parents were involved in the evaluation procedure and measures of natural interactions were included.
In general the results of education and guidance to parents and staff are very positive although this review shows that there seems to be a lack of research when it comes to education and guidance of staff. Only one study was found where pree-school teachers were educated and guided how to use the PECS-method [32]. The results of the parental interventions indicate that they are effective in that positive results can be seen very quickly with respect to different areas and with comparatively little amount of intervention. This is also probably one of the reasons behind the trend that parental education seems to be included as a part of the more recently developed intervention programs. In the second literature search in this study more interventions were found that included guidance of parents (for example 31, 63, 74, 75, 81). Several of these interventions included education that was combined with home-visits when the therapist interacted with and trained the child during natural play situations. The parents observed these play activities and the therapist’s use of behavioural strategies, which were then discussed an practiced during the sessions. The results of these comprehensive programs are included in the section of direct interventions below (table 3), but it is important to also recognize the fairly large amount of indirect instruction in these programs.
In several studies of the interventions more specifically aimed at parental education, it was seen that the parent’s use of responsive strategies increased [54, 58, 60, 61, 62] and some studies showed that interaction between the parent and the child was positively affected [57, 58, 62, 65]. Some studies report that the development of communication and language in the child seems to be increased when the parents are provided with education and guidance [32, 54, 56, 61, 62, 64]. Several studies have tried to measure parental stress and other family related parameters that are expected to be affected, also out from parental interviews [54, 55, 56, 61, 65]. Most studies failed in proving effects in this respect, at least on a level of statistical significance. In some studies the researchers speculate that the questionnaires given before and after an intervention seems to fail in catching an effect. In qualitative studies parents report that they can see the problems of the child more clearly after the course and can be more open about the family problems [55]. This means that items related to family issues even might “get worse” comparing questionnaires filled in blindly before-after intervention.
So far very little is known of the long-term effects of indirect intervention. The few studies with this focus show that the effects seem to fade over time. Both clinicians and researchers hypothesize that there probably is a need to do follow-ups and/or provide booster interventions to maintain the intervention effects over time. There are also indications that the effects of a parental education on the development of the child seems to be further enhanced when the education is complemented with direct intervention to the child.
19 studies were found of which 10 were reviews (1 meta-analysis) and the rest primary studies. The scientific level of evidence varies, but the recently published primary studies being of high quality certainly strengthen evidence in the area of direct communication intervention.
Direct interventions or training of the child has proved to have a positive impact on the development of the child with ASD as is stated in most, but not so sure in all, of the studies in the table. Exactly what is described to be affected differs in different studies, depending on the focus of the study, but to a large extent also on what have been measured in a particular study. It is more common that classical didactic programs report outcomes within the function- or activity-domain, often by the use of measures of intelligence (IQ) or language (different language tests). The child-directed naturalistic interventions more often describe outcomes in terms of activity or participation and use data of communication or interaction from video analyses, parental questionnaires and interviews.
\n\t\t\t\tAuthor&year\n\t\t\t | \n\t\t\t\n\t\t\t\tStudy design\n\t\t\t | \n\t\t\t\n\t\t\t\tIntervention\n\t\t\t | \n\t\t\t\n\t\t\t\tEvidence grading\n\t\t\t | \n\t\t
Charman, 2010 [76] | \n\t\t\tReview | \n\t\t\tReview of developmental approaches to understanding and treating autism | \n\t\t\tSchlosser: 4 Nordenström: C Golper. I | \n\t\t
Corsello, 2005 [66] | \n\t\t\tReview | \n\t\t\tReview and discussion of interventions 0-3 years | \n\t\t\tSchlosser: 4 Nordenström: C Golper. I | \n\t\t
Dawson et al, 2010 [30] | \n\t\t\tRCT | \n\t\t\tStudy of the effects of : The Early Start Denver Model for toddlers with ASD | \n\t\t\tSchlosser: 1 Nordenström: A Golper. III | \n\t\t
Delprato, 2001 [67] | \n\t\t\tReview | \n\t\t\tComparison of discrete trial interventions and naturalistic language interventions | \n\t\t\tSchlosser: 4 Nordenström: B Golper. II | \n\t\t
Diggle & McConachie, 2009 [68] | \n\t\t\tReview Cochrane-report | \n\t\t\tReview of parent-mediated intervention/training of children with ASD | \n\t\t\tSchlosser: 3 Nordenström: B Golper. III | \n\t\t
Fernell et al, 2011 [77] | \n\t\t\tComparative group study | \n\t\t\tComparison of effects of 1) intensity and form of intervention 2) intelligence on adaptive behaviour on children with ASD | \n\t\t\tSchlosser: 2 Nordenström: B Golper. II-III | \n\t\t
Goldstein, 2002 [69] | \n\t\t\tReview | \n\t\t\tReview and comparison of communication intervention to children with ASD | \n\t\t\tSchlosser: 4 Nordenström: B Golper. II | \n\t\t
Kasari et al (2010) [31] | \n\t\t\tRCT | \n\t\t\tStudy of the outcomes of an intervention for joint attention | \n\t\t\tSchlosser: 1 Nordenström: A Golper: III | \n\t\t
Kasari, Paparella & Freeman, 2008 [70] | \n\t\t\tRandomized group study | \n\t\t\tComparison of interventions for play and joint attention in children with ASD | \n\t\t\tSchlosser: 2 Nordenström: A Golper. III | \n\t\t
McConkey et al, (2010) [74] | \n\t\t\tControlled group study | \n\t\t\tEvaluation of the impact of home-based intervention to promote communication | \n\t\t\tSchlosser: 2 Nordenström: B Golper. III | \n\t\t
McConnell, 2002 [71] | \n\t\t\tReview | \n\t\t\tReview of interventions to promote social interaction in young children in educational settings | \n\t\t\tSchlosser: 4 Nordenström: B Golper. I | \n\t\t
Paul & Roth , 2011 [78] | \n\t\t\tNarrative review/expertise | \n\t\t\tCharacterizing and Predicting Outcomes of Communication Delays in Infants and Toddlers: Implications for Clinical Practice. | \n\t\t\tSchlosser: 6 Nordenström: C Golper. I | \n\t\t
Rogers, 2006 [11] | \n\t\t\tReview | \n\t\t\tReview of and historic description of communication intervention to young children with ASD | \n\t\t\tSchlosser: 6 Nordenström: C Golper. I | \n\t\t
Schuit et al, 2011 [79] | \n\t\t\tControlled group study (small groups) | \n\t\t\tEvaluation of a program aimed at stimulate language learning in disabled children | \n\t\t\tSchlosser: 5 Nordenström: B Golper. III | \n\t\t
Spreckley & Boyd, 2009 [80] | \n\t\t\tMeta-analysis | \n\t\t\tMeta-analysis of discrete-trial-interventions for children with ASD | \n\t\t\tSchlosser: 1 Nordenström: A Golper. III | \n\t\t
Vismara et al, 2009 [81] | \n\t\t\tGroup study Non-concurrent multiple baseline design | \n\t\t\tEvaluation of the effects of “start-kit” of 12 individual sessions teaching parents communicative strategies | \n\t\t\tSchlosser: 2 Nordenström: B Golper. I | \n\t\t
Wong & Kwang, 2010 [75] | \n\t\t\tRCT (small groups) | \n\t\t\tEvaluation of Autism 1-2-3-progam | \n\t\t\tSchlosser: 1 Nordenström: B Golper. III | \n\t\t
Woods & Wetherby, 2003 [72] | \n\t\t\tReview, clinical report | \n\t\t\tReview of methods of identification and intervention for young children at risk of ACD | \n\t\t\tSchlosser: 4 Nordenström: C Golper. II | \n\t\t
Yoder & Stone, 2006 [73] | \n\t\t\tRandomized comparison | \n\t\t\tComparison of RPMT and PECS on spoken communication | \n\t\t\tSchlosser: 2 Nordenström: B Golper. III | \n\t\t
Studies of direct interventions and comprehensive programs
As mentioned in earlier paragraphs generalization and maintenance has been a big issue within the field of communication and language intervention for years. Generally the child-focused interventions show better generalization and maintenance in younger children with ASD [67, 72, 76]. These studies discuss that the use of the inborn motivation of the child and the use of natural context and natural play context make the difference – all according to current theories of development of cognition and communication. Proponents of didactic training hold that the use of learned words and phrases might be a start of a positive social spiral where the child gets more response and is treated differently. Some reviews come to the conclusion that we still do not have enough evidence to tell which type of program is best, didactic or child-focused, but that the important factors seem to be early start and intensity [66, 69]. According to the meta-analysis of six RCT studies of didactic interventions [80] these however fail in reporting better outcomes than the control groups when it comes to cognition, language and adaptive functioning. Generally the children in didactic training programs also were older [68]. Didactic training in its intensive and comprehensive form seems less effective on younger children and children at early communicative levels [77]. The involvement of the parents in recurrent didactic training activities in the home is also questioned in some studies [68]. There are indications of a high degree of stress in these parents and a comparative study showed that parental stress was lowered when the training was done by others and furthermore that the results with respect to communication development was enhanced [68].
Several recent studies report outcomes from eclectic comprehensive interventions [30, 31, 74]. These programs are built upon current theories of cognitive, communicative and neurophysiological development but also adds knowledge from the behaviourist tradition or rather Applied Behavior Analysis (ABA) in optimizing the learning situation. More concretely this means that these programs are child-focused in that it makes use of the child’s motivation and interests and focus the communication between the parent and the child and are often implemented in the home setting, sometimes after some introductory sessions on a clinic. An analysis of the child’s communication development forms the decision of what is going to be focused during interaction. Prelinguistic competencies such as imitation, joint attention and use of symbol play and symbols are seen as basic and pivotal. The behavioural techniques are used to arrange the environment and chose strategies to refine and enhance learning in the natural interaction. The trainer serve as model to the parent and then guide and coach the parent, often in the home.
The majority of the primary studies in the table above report excellent outcomes [30, 31\n\t\t\t\t\t70, 73, 74, 75, 81]. In general the research quality of evaluations of these interventions were high since many were of RCT type or Randomized Group studies. External, social and ecological validity was also considered as generally high partly due to the use of more interactional data and information from the stakeholders. The studies show that these interventions seem to be very effective in proving positive outcomes with respect to interaction, parental communication style and child development. Some of these intervention programs are of comparatively low intensity and short, which is interesting and important, as high intensity traditionally have been said to be essential to success in children with autism
Some articles compare interventions and discuss recommendations with respect to different needs of the child or family. A comparison of the AAC-method PECS and RPMT (a comprehenesive program containing parental education in the use of responsive strategies and training of the child and guidance to parents in their home) showed interesting results with respect to communication outcomes in the children [73]. The children at the earliest communicative stage, not yet being interested in objects, seem to develop more with RPMT. At the next communicative stage when the children has an interest of objects, an understanding of cause and effect and some emergent understanding of joint attention PECS is more effective. When joint attention is more established the Prelinguistic Mileu Teching strategies (behavioral techniques implemented in natural interaction) in the RPMT seems to be more operant. It was also seen that the PMT-training had better effect for those children whose mothers used a responsive communication style. The focus on development of joint attention is emphasized as the primary goal in this study with a successive introduction of symbol play as joint attention is being established [73].
Finally, one review studies the effect of different types of interventions to promote social interaction in pree-school settings and conclude that there is good evidence that it is important to work both with the child with disability as well as with his/her friends in the school environment [71].
The field of AAC is a fairly new field of knowledge that has gradually grown as there is a increasing interest in functional communication and in ensuring the communicative rights of individuals with disability. There has also been an explosion of available communication technologies and methods that can support and improve communication for individuals with autism. We have probably and hopefully only seen the dawn of these new options. It is also possible to see that we are moving from using one technique or approach at the time to working with multimodal techniques or approaches where different tools and methods combined with an understanding of communication and use of interactional strategies build a total system of communication.
\n\t\t\t\tAuthor&year\n\t\t\t | \n\t\t\t\n\t\t\t\tStudy design\n\t\t\t | \n\t\t\t\n\t\t\t\tIntervention\n\t\t\t | \n\t\t\t\n\t\t\t\tEvidence grading\n\t\t\t | \n\t\t
Binger, Berens, Kent-Walsh &Taylor, 2008 [82] | \n\t\t\tReview | \n\t\t\tThe impact of AAC-intervention on use of AAC, symbolic gestures and speech | \n\t\t\tSchlosser: 4 Nordenström: B Golper. II | \n\t\t
Bopp, Brown & Mirenda, 2004 [83] | \n\t\t\tReview | \n\t\t\tReview of FCT and use of visual strategies and discussion of the role of speech-language pathologist in working with challenging behaviors | \n\t\t\tSchlosser: 4 Nordenström: B Golper. I | \n\t\t
Brady, 2000 [84] | \n\t\t\tCase study | \n\t\t\tStudy of the impact of use of SGDs on the understanding of speech | \n\t\t\tSchlosser: 5 Nordenström: C Golper. I | \n\t\t
Branson & Demcak, 2009 [85] | \n\t\t\tMeta-analysis | \n\t\t\tEvaluation of AAC interventions for toddlers and infants with disability | \n\t\t\tSchlosser: 1 Nordenström: A Golper. III | \n\t\t
Ganz, Simpson & Corbin-Newsome, 2008 [86] | \n\t\t\tSSRD – Multiple baseline | \n\t\t\tImpact of PECS on requesting and speech | \n\t\t\tSchlosser: 2 Nordenström: B Golper. III | \n\t\t
Mancil et al(2009) [95] | \n\t\t\tSSRD – multiple baseline | \n\t\t\tStudy of the effects of a picture-exhange-intervention using milieu teaching in the home | \n\t\t\tSchlosser: 2 Nordenström: B Golper. III | \n\t\t
Millar, Light & Schlosser 2006 [87] | \n\t\t\tMeta-analysis | \n\t\t\tThe impact of AAC-interventions on speech development | \n\t\t\tSchlosser: 1 Nordenström: B Golper. I | \n\t\t
Papparella & Kasari, 2004 [88] | \n\t\t\tReview | \n\t\t\tStudy of the relationship between joint attention and language – manual signing | \n\t\t\tSchlosser:4 Nordenström: C Golper. I | \n\t\t
Preston & Carter, 2009 [89] | \n\t\t\tMeta-analysis | \n\t\t\tStudy of the effects of PECS | \n\t\t\tSchlosser: 1 Nordenström: B Golper. III | \n\t\t
Schlosser &, 2006 [90] | \n\t\t\tQuantitative review | \n\t\t\tThe impact of AAC on children with developmental disabilites | \n\t\t\tSchlosser: 4 Nordenström: B Golper. II | \n\t\t
Schlosser & Wendt, 2008 [91] | \n\t\t\tMeta-analysis | \n\t\t\tEffects of different types of AAC on speech in children with ASD | \n\t\t\tSchlosser: 1 Nordenström: B Golper: II | \n\t\t
Sigafoos, Drasgow, Reichle, O´Reilly & Tait, 2004 [92] | \n\t\t\tReview | \n\t\t\tStudy of the effectiveness of training of rejecting using AAC | \n\t\t\tSchlosser: 4 Nordenström: B Golper. I | \n\t\t
Snell, Chen, Lih-Huan & Hoover, 2006 [94] | \n\t\t\tReview | \n\t\t\tReview of AAC-interventions to children with severe communicative disabilities | \n\t\t\tSchlosser: 4 Nordenström: B Golper. I | \n\t\t
van der Meer et al, 2011 [93] | \n\t\t\tControlled group study | \n\t\t\tEvaluation of a program using AAC (not further described) | \n\t\t\tSchlosser: 5 Nordenström: B Golper. II | \n\t\t
Studies of education and guidance to parents
The research base with respect to AAC used by young children with autism has grown in recent years. This research mostly consists of singe-subject-design studies and case studies, with very few controlled group studies being done. On the other hand there are some well-done meta-analyses published that compile results from singe-subject research studies. Due to the difficulties of conducting RCT studies within the field of AAC-intervention the meta-anlyses are important and can be seen as the golden standard. In total 14 studies were identified as focusing the use of AAC and of these 10 were reviews or meta-analyses.
In conclusion, meta-analyses and other studies show that AAC-interventions are cost-effective and give fast results and furthermore tend to stimulate speech development [82, 84, 85, 86, 87, 91]. The best results seem to be reached when the social network surrounding a child is given support and resources, to be able to use responsive strategies and provide communication opportunities and direct training using AAC in natural daily interactions. AAC intervention should be started as soon as communication difficulties are displayed or suspected since AAC promotes communication, language and speech. AAC-intervention has also been proved to effectively decrease challenging behaviour [83]. There is today no mode of AAC that is known to be better than any other for young children with autism. Instead multimodal approaches seem to be the most effective [93]. However, graphic AAC seem to be acquired at a faster rate and also easier to generalize to other situations [90]. PECS has been proved to be an effective AAC method, specifically at early stages of communication and with respect to the first three phases of the method [89].
Model for early communication intervention
The conclusion of this chapter is presented in the form of eight recommendations and of a model for early communication intervention answering the question that was initially formulated in this study: “A young child with autism and severe communicative disability, living with his/her parents and being placed in a pree-school group: which intervention is most effective; indirect or direct interventions?“\n\t\t\t
A combination of indirect and direct interventions. There is strong evidence that the combination of education and guidance to the parents and direct child-focused intervention to the child in a naturalistic context leads to good outcomes with respect to several parameters such as: development of communication and language, interaction between the parent and the child where the parent uses a responsive communication pattern,
Parental education should include knowledge of and training in the use of responsive strategies and behavioural/environmental teaching techniques within the frames of natural interaction in the home. Several studies show that parents change their communicative style after a few education sessions and that this positively affect the interaction pattern with the child and enhance language development in the child. Guidance or coaching of the parents in natural interactions in the home environment is included in most of the recently presented studies and show very good results in short time.
Direct interventions provided to children on early communicative stage should be child-focused and implemented in daily natural interactions. The intervention should focus imitation, joint attention and symbol use (speech, symbols, manual signs). Didactic intervention is not effective for young children since maintenance and generalization of training is low.
Interventions need to be continuous and include follow-ups and possibilities of booster-intervention. The few long-term follow up-studies all show that interventions (of different type) tend to wear off by time. The recent published studies show that low-intensity interventions also could yield good results. The engagement of the parent also might be an important success factor.
Children at early communicative stages should be provided with AAC as early as possible. There is no age-limit or prerequisites that need to met before AAC is introduced. There is strong evidence that AAC decreases challenging behaviour. There is moderate to strong evidence that AAC facilitates development of speech.
AAC-intervention should ideally be multimodal. All modes of AAC are effective. There is some evidence that symbols (specifically combined with speech output) are learned faster than manual signs and that iconic symbols are learned faster.
PECS (Picture Exchange Communication System) is an effective AAC-method for children at early communicative stages. There is strong evidence that PECS has a positive effect on interaction and behaviour and that functional communication is increased.
The AAC-modes should be used and modelled by the child’s communication partners (aided language stimulation or modelling) to promote learning and spontaneous use of the symbols.
These recommendations means that the child in our formulated question should be provided with intervention according to the model below.
Since the end of the Cold War and the dissolution of the former Union of Soviet Socialist Republic (USSR) in 1991, Africa as a region has undergone a major structural transformation in social, political, demographic, and economic spheres. In political sphere, the region has gone from a one-party state governance to a multiparty democratic system ([1], p. 300). In social sphere, social governance is slowly but steadily being shared by the rising civil society and the NGOs that have now become copartners at addressing and debating social, economic, and political challenges in Africa. In demographic sphere, the region has seen a twofold increase in its population growth in the last quarter century. And finally, as regards to the economic sphere, whether voluntarily or involuntarily, since the 1990s, Africa has become a full participant in the economic and commercial globalization spurred by the West and led by the United States. And because of the abovementioned structural transformation of the continent, the region has nonetheless grown economically and registered stellar economic numbers in the last decades or so. That is, through the decade of the 2000s to the year 2013, for instance, the global boom in commodity prices propelled natural resources and oil- and gas-exporting African countries to register incredible economic growth and empower Africa into the twenty-first-century global economy [2]. As a result, Africa as a region is now a full member of the world economy and a coveted actor in the international economic arena.
However, despite the impressive recorded economic growth mainly by the energy and commodity-exporting African countries as stated above, as a region, Africa is still facing serious local and transnational challenges such as youth unemployment, climate change threats, rapid population growth, undernourishment, domestic terrorism, drug trafficking, maritime piracy, protracted political crises and low-intensity short-lived wars, and conflict-induced famines like the one we are witnessing in South Sudan today. Consequently, those challenges stand in the way against Africa’s pursuit to achieve food security and eradicate hunger.1 Therefore, if these above-cited challenges are not properly addressed and seriously tackled by the African political leadership, it is probably fair to say that achieving food security and meeting nutrition needs and targets as established by the Millennium Development Goals (MDGs) (2000–2015) and Sustainable Development Goals (SDGs) (2015–2030) will simply be another elusive quest for Africa among many other policy objectives and goals. In addition, if that happens to be so, the continent will unfortunately continue to languish behind other regions of the world in socioeconomic and human developments.2 And consequently, it will be nowhere near attaining the SDG goals and targets just as it failed to meet the past MDG goals and targets. As a case in point, despite its modest registered economic growth and well-intentioned international policy initiatives such as the cited MDGs and SDGs aimed at fighting hunger and overcoming nutrition deficits [4] among many other human and development policy objectives, only few African countries managed to meet the MDGs 1c [5]. With that being said, this chapter sets out to present the state of Africa’s food insecurity and nutrition deficits and addresses the potential impacts of the above-cited challenges, widely regarded today as the real barriers against successful eradication of food hunger and achieving food security in sub-Saharan Africa.
In this chapter, we use the definition of food security as stated by the United Nations Food and Agriculture Organization (UNFAO). The FAO’s definition is our guiding principle and upon which our analysis of Africa’s food security challenges is based. The FAO defines food security as “When all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life [6].” Nonetheless, achieving food security however requires that:
Sufficient quantities of appropriate foods are consistently available.
Individuals have adequate incomes or other resources to purchase or barter for food.
Food is properly processed and stored.
Individuals have sound knowledge of nutrition and child care that they put to good use and have access to adequate health and sanitation services [7].
To begin with, it is worth pointing out from the onset that food insecurity is a multidimensional problem. It is a problem that is linked to healthcare, conflicts, policies, politics, leadership, strategic vision, trade and economic interests, agricultural production, food system, global food industry trade politics, and the environment (mother nature). As an example, in the sphere of healthcare, one can see a direct link between food insecurity, malnutrition, and a global pandemic like the HIV/AIDS. That is to say, if a member of a given family, for instance, is affected by the AIDS epidemic, the family of that patient will automatically lose a breadwinner and financial income generator. That is, the person affected by the disease will no longer be able to engage in any remunerative physical activity whether for themselves or for a third party in order to earn a living. Consequently, he or she will financially no longer contribute to his or her family well-being since they will not be able to generate any income whatsoever. And if and when that situation were to occur, the family of the patient in question would begin to eat less. The body of the affected person will by then have become vulnerable and weak to engage in any remunerative activity. As a result, food insecurity will then have set in, and poverty trap will have taken over and affected everyone within that family.
At the time of writing this chapter, Africa’s state of food insecurity relative to other regions of the world, except for West Asia, is troubling and non-promising. Hence, understanding and accepting this reality should be of a concern for all Africans regardless of their socioeconomic and political status. That is to say, this said reality should be of a concern for the African political leadership, the mayors of mega African cities,3 the NGOs, the civil society, the media, the farmers, the business community, the youth, the academia, the churches, the mosques and other faith-based organizations, and the consumer organizations alike. And according to the FAO 2015 State of Food Insecurity in the World IN BRIEF, Africa scores poorly in all indicators regarding food security and nutrition targets. For example, in 2015, only 18 out of 54 African countries have reached the MDG 1C hunger target (Millennium Development Goals 1C).
Furthermore, two of the many reasons why food security keeps evading millions of Africans are the never-ending conflicts and incessant political instability on the continent. Often, in many sub-Saharan African countries, foods are available and plentiful but not accessible to everyone. Poor families, for example, disproportionately pay the brunt of conflicts and wars. Farmers cannot bring their staple crops to the markets because of the lack of security even if and when they wanted to do so. Put it simply, conflicts disrupt markets and affect development policies that are put in place to assist the neediest of the population. And as a consequence of conflicts and wars, food prices rise, and poor families and their children can no longer have access to healthy and balanced dietary foods (utilization). Conflicts make food production drop since no one will risk their lives to work in the fields and bring foods to the markets while killings are raging. In the Central African Republic, for instance, the short-lived war of 2013 and its aftermath caused a drastic reduction in food production (availability) and engendered the rise of food commodity prices (accessibility). In fact, poor families and anyone else who could not have access to the foods in the markets were simply forced to live in subsistence. Consequently, thousands of Central Africans became nutrition-challenged because whatever was available for them to eat was obviously not meeting their nutrition needs and targets. Furthermore, widespread insecurity across the entire country made it more difficult to import foods from the neighboring countries or even receive foods from aid donors and the international community (stability) for that matter. As a result, food insecurity, and in many instances, the lack of foods thereof, became the daily reality of untold Central African families. And additionally, this added existential threat exacerbated an already desperate and deteriorating economic condition caused by years of protracted conflicts and political and economic mismanagement [9].
There are a lot of reasons as to why Africa and sub-Saharan Africa in particular is suffering from food insecurity and failing to meet its nutrition needs and targets. Though it is true that one cannot put their fingers at one specific reason as for why food shortages, insecurity, and prevalence of malnutrition uninterruptedly afflict sub-Saharan Africa, one can however identify a number of failed internal economic policy tools and international policy prescriptions as the culprit or underlying causes of systemic food insecurity in Africa. That is to say, on the internal front, for example, fewer among many reasons as for why food insecurity has been chronic in many African countries are the following: (1) the never-ending political instability and crises; (2) the short or long protracted civil conflicts and wars; (3) the endemic, persistent, and institutional corruption; (4) the misdirected economic policies and mismanagement; (5) the lack of committed political leadership; (6) the sheer neglect towards the farmers; and (7) the lack of clear financial and economic investment into the agricultural sector. On the external front, however, economic policy prescriptions mainly written and formulated by the World Bank (WB) and the International Monetary Fund (IMF) in the 1970s, 1980s, and the latter part of the 1990s directed at the African countries made an already difficult economic situation worse. This is because the architects of the alluded policies advised sub-Saharan African governments and leaders to cut aid and slash subsidies to their farmers. The economic policy rationale was that African countries should pull the plug under their parastatals (government-owned enterprises) and let the markets take care of everything. In addition, respective African governments were told that Africa should privatize and liberalize their economic policies in order to align them with the prevailing international trade, investment, and economic principles. Those economic recipes were said to modernize Africa and speed up its incorporation into the liberal-based global market economy. Consequently, because of those policy prescriptions, African farmers lost income supports from their respective governments, and millions of low-income African families became victims of food insecurity and nutrition deficits. In essence, the IMF and the World Bank, and to a certain extent the US Treasury Department promoting and owning the so-called Washington Consensus, should be held responsible for those failed policies. For, they were the ones that devised, concocted, and directed them. As a matter of fact, they actively promoted or better said imposed them upon weak and hopeless African governments. And in turn, hapless African leaders implemented the said policies without truly understanding their future potential consequences on the farmers and their societies at large ([10], pp. 369–370).
So, with the benefit of hindsight today, one can say that those structural adjustment programs (SAPs) as they were known then, and devised by the above-cited international institutions and encouraged by the US Treasury Department, contributed to the demise of many farmers in Africa. They exacerbated the food insecurity and the existing precarious economic plights of millions of African families. And with the passing years, it has now become clear to any astute observer of the recent history of the social and economic development of Africa that African leaders of that time were not wise enough to reject and outrightly oppose those policies [9]. Actually, in fairness, many of them heartily and readily adopted the said policies and imposed them on their beleaguered poor populations. In fact, soon after they did so, many African countries began to import foods in huge quantity. And unfortunately, this situation has now lingered for decades. And honestly, as of today, there is no end in sight as to when the recurring food shortages and massive food imports in sub-Sahara Africa will either abate, subside, or end altogether. And for that, African countries constantly face food shortages now despite all the good and well-intentioned policies of the international community, the African Union, and African countries themselves intended to address rampant food insecurity, eradicate hunger, and bring food security to millions of low-income African families. So, as a consequence of all that, sub-Saharan Africa today is heavily dependent on food imports than at any time in its history. And as a result of that, it is sadly subjecting millions of its populations to the mercy of foreigners, commodity speculators, foreign exchange fluctuations, food aid giving nations, and the geopolitics of global food trade [11]. In actuality, this is the state of Africa’s food security today. And as a matter of fact, when one looks back at the genesis of this episode, one can say without a doubt that this unfortunate situation could have easily been avoided. That is to say, had the African political leadership shown true leadership, heavily invested in agricultural sector and adopted economic nationalist policies, the early food production crisis, and insecurity beginning in the early 1970s would have been dealt with more effectively. Indeed, past African governments could have substantially invested in food production, assisted the small farmers with more aid and subsidies, and created policy resilience that would have saved thousands of African lives and farmers. And this may have possibly transformed and modernized the entire African food production system. In short, had the political leaders displayed true political courage to undertake such policies as stated, and shown true care for their respective populations, the concerns about the potential socioeconomic catastrophe of the rapid population growth in Africa will not have been as alarming and challenging to us as they seem today. To say the least, Africa suffers from food insecurity today and has been suffering from it for so long simply because of the utter failure and lack of vision, political courage, and sound economic policies of the African leaders and economic decision-makers of all political and ideological stripes on the Continent.
In 1990, Africa’s population was 635 million people. And, in 2018, the population of Africa stood at 1.2 billion people (see Figure 1 below). However, except for the oil exporting African countries (see Table 1), sub-Saharan Africa has, on average, grown a meager 1.1% GDP in the last quarter century [15]. Now, considering Africa’s demographic explosion in the last two decades, this underperforming GDP per capita growth is not sustainable for its long-term economic transformation. And clearly it will not help it either to meet the needs of millions of its young people that are reaching working age and expected to enter the labor market [16] in great numbers every year till the year 2030. This somber forecast is in addition to the fact that Africa’s population is projected to double by 2050 (see Figure 2 and New African March 2019 Guest Commentary by Peter Estlin, the Lord Mayor of London). Therefore, these serious challenges and threats are to be factored into any discussion about Africa’s long-term economic transformation. That is to say, every social, political, and economic actor in Africa should seriously ponder upon them and properly address these threats and challenges. As the youngest continent, Africa has tremendous challenges ahead of it. At the same time, it also has great opportunity to unlock its economic potential that will benefit hundreds of millions of its peoples. However, this can only be done if African political leadership and economic decision-makers unselfishly invest into the youth and give it access to quality health and education and skills of the twenty-first century. And assuming that that warning is heeded, a vibrant, healthy, and educated young population will undoubtedly take upon itself to resolve the issues of food insecurity and nutrition deficits, among many other challenges. As a matter of fact, a great number of economic experts and development economists agree with this economic proposition. They claim that quality health and education are the only engines of economic development that will help unleash the African potential, create inclusive prosperity for all, and economically transform the continent. (For further comments on the subject, see New African March 2019 Guest Commentary by Bill and Melinda Gates).
Evolution of Africa’s population 1960–2019 (Source: [12]).
Africa’s population forecast 2020–2050 (Source: [12]).
Furthermore, Africa’s political leadership, youth, and civil society shall all understand that without some sort of family planning, albeit a voluntary one, the rapid unplanned population growth will never make Africa be food and nutrition secure. Therefore, understanding this reality, and taking also into account the cultural and religious sensitivities of several African communities, Africa’s political leadership, and faith-based organizations of all denominations, should not have any problems investing in women, youth, and young girls. That is to say, in doing so, they will be able to properly educate mothers and future mothers and common people about the consequences of food insecurity and nutrition deficits on the future of their well-being and for Africa as a whole. That’s because an uncontrolled rapid population growth, alongside the climate change threats and its effects, will be a formidable challenge for Africa to overcome if African people are not implicated in seeking solutions for their problems and challenges themselves. In our view, not adopting this policy approach will render the search for Africa’s meaningful economic transformation unattainable just as many other unfulfilled African economic dreams (beginning since the years of its political independence in the 1950s, 1960s, and 1970s). The said contemplated family planning could also be managed through community programs, school programs, and after church and mosque services programs. And by devising such social program plans, educating people in major cities and the rural areas to understand what is truly at stake, and encouraging them to participate into the programs, it will be safe to say that Africans will take upon themselves the transformation of their agricultural production and adopt policies that will help them achieve food security on their own. And as such, they will be able to meet their nutrition needs and targets in line with their burgeoning population growths.
Climate change debates pit true believers of climate change against those that oppose it. They also confront those who are skeptical of its existence or outwardly deny it against those who are fervent believers in it. However, the debates about whether climate change exists or not are beyond the intended purpose of this chapter. In it, we base our analysis on the existence of the climate change threats and its effects as an added challenge to Africa’s existing agriculture commodities’ production, food security, and nutrition needs and targets. In fact, as of today, changes in rainfall, soil quality, weather patterns, and precipitations in many regions of Africa have become the drivers for the food challenges and insecurity in all regions of the continent. And as a result of all that, climate change threats, effects, and stress are now the multiplier for the multitude of the daily challenges that Africans face. Furthermore, it is worth recalling that many countries in the world recognize today that climate change impacts on the temperature, precipitation, and droughts on a given community adversely affect the food security of that community. And consequently, many members of the said affected community are forced to leave and migrate to other communities. That is so because adverse or abrupt climate conditions and threats stress an entire community. And more often than not, they push their younger members to mass migrate. In addition, negative effects of the climate change event like floods and droughts destroy the agricultural production capacity and inputs of the impacted community. So, as an example, communities that have experienced events like droughts and floods whether in the Sahel, the Lake Chad Basin, or East African region [17] have all seen themselves abandoning their homes and villages and moving to neighboring communities or urban cities where they have no adequate resources to help themselves cope with their new surroundings and adapt to their new-found challenges. Many members of the said displaced communities become victims of food insecurity themselves. That is because by abandoning their villages and towns and moving to the new ones, they compete for scarce resources such as water and other daily living amenities in order to survive. Moreover, their sheer presence in their new hometowns or cities swells the pockets of the already established urban poor and makes life more miserable for themselves and everyone else. In short, climate change impacts and its effects have become existential threats to vulnerable communities. And one of the visible effects of climate change today is that climate change impacts turn members of the climate-impacted communities into climate refugees within their new adopted communities.
According to the Fund for Peace, in 2017, the three most fragile states in the world were in Africa. Those states were the Central African Republic (CAR), South Sudan, and Somalia [18]. And each one of them has now become fragile because of the protracted crises that have kept it unstable since the 1960s. In the case of the Central African Republic, the years of the trouble started in the 1960s. In the case of Somalia, the disintegration of its state apparatus and the advent of its successive social, political, and economic challenges came after the fall of the regime of Siad Barre in 1991. In the case of South Sudan, the country has been in political turmoil, standoff, low-intensity warfare since it gained its independence from the Republic of the Sudan in 2011. However, it is worth noting that those three cited-above countries are not the only fragile countries in Africa. There are many other African countries that are also fragile and politically unstable because of the protracted conflicts and never-ending political crises. This is in addition to other crippling challenges such as governance deficiencies, corruption, decades-long underperforming economies, weak institutions, flagrant human rights violations, and living resources scarcity that have kept them from creating an inclusive and shared prosperity for millions of their citizens.4 Indeed, food insecurity and nutritional deficits and the lack of quality health and education are the direct results of the said never-ending challenges that Africa as a whole confronts ever since it gained its political independence from the former colonial powers.
In effect, the persistent lack of peace and security in many sub-Saharan African countries today, coupled with the never-ending political instabilities and crises, is mainly the underlying reasons why African countries seem incapable of tackling and overcoming existential challenges and threats such as food shortages and insecurity and widespread malnutrition on their own. As a case in point, since 2010, a number of civil wars and political crises have broken out in several African countries from Algeria all the way to Kenya. In addition, newer political instabilities and short-lived civil wars have also occurred or unfolded in places like the Lake Chad Basin, Nigeria (Boko Haram), Libya (the bloody ousting of Muammar Kaddafi and the ensuing civil war), Egypt, Tunisia, the Central African Republic (CAR), Kenya, Cameroon, Mali, Burkina Faso, Burundi, South Sudan, Algeria, and Sudan as of late [20]. Moreover, countries such the Democratic Republic of the Congo (DRC), Sudan, and Somalia where decades-long conflicts have weakened and rendered their respective governments inept and unable to assume the administration of their territorial security and come up with sound national economic management policies, transnational threats such as terrorism, mass migration, pandemics such as Ebola and HIV/AIDS, and maritime piracy consume and divert their meager state resources away. Because of all that, their depleted resources are never sufficient to help them successfully fight institutional corruptions, rein into drug trafficking, curb hunger and other social woes, and effectively run their day-to-day administrative affairs. And as a result of the said overwhelming challenges, food insecurity and nutrition challenges currently affect and threaten the lives of millions of South Sudanese, Central Africans, Somali, Nigerians, and million more Africans today. For further illustration of how many African countries are afflicted and overwhelmed by conflicts and protracted crises, and why food security challenges have become existential threats not just to one or two countries in Africa, see Cases of countries affected by food insecurity and acute malnutrition stemming from protracted conflicts, crises, and political unrests and Table 2.
African countries in protracted crises, conflicts, and fragile situations (Source: Data extracted and compiled from [21]).
Nigeria. This country has been grappling with severe security threats from Boko Haram and ISIS West Africa (ISIS-WA). Consequently, these threats have caused massive internal displacement of the population in the northeast region of the country and made thousands of Nigerians domestic refugees. In addition to the displaced Nigerian citizens, thousands more refugees from Niger, Cameroon, Chad, and the Central African Republic have flocked into the region, and consequently swelled the overrun refugee camps and made matters worse for everyone involved in the camps. As a result, they all have become victims of food and nutrition insecurity.
South Sudan. Due to the clashes between the South Sudanese Government and armed opposition groups, millions of South Sudanese have become the largest displaced population in their own country and been made refugees in the neighboring countries. As a consequence, this situation has created a severe case of food insecurity and malnutrition challenges in South Sudan today.
Somalia. This country is another case in Africa where protracted conflicts since 1991 have made it impossible for the Somali population at large to escape from poverty, misery, and the never-ending threats and real cases of food insecurity and chronic malnutrition that have for years affected both the youth and general Somali population.
The Central African Republic. This country is the latest case of food insecurity and widespread malnutrition in Africa. This has been the case since the short-lived Civil War of 2013 and the ensuing political unrest, rebellion, and ongoing sectarian aggressions between the Christian and Muslim communities.
The international community heretofore understood as international institutions; private sector; multinational and transnational corporations (MNCs and TNCs); civil society; private foundations such as the Bill & Melinda Gates Foundation, the Clinton Foundation, and NGOs; leading nations such as the United States, China, India, Russia, and Brazil; the Global South; the European Union (EU); and celebrities like George Clooney, Angelina Jolie, Madonna, Bono, and many others are all stakeholders in food security and hunger debates. However, the United Nations (UN) system has thus far been the leading multilateral institutional voice that addresses and shapes the policy debates and proposes policy prescriptions for the food insecurity and malnutrition challenges that Africa and other regions of the world face.
Within the United Nations system, however, the Food and Agriculture Organization (FAO) which was established as an intergovernmental body is the organization mandated to address the agricultural issues such as food security, nutrition, and malnutrition challenges of its member countries. And as an intergovernmental body, the FAO was formed to promote the “common welfare by furthering separate and collective action for the purpose of raising levels of nutrition and standards of living of the peoples under their respective jurisdictions; securing improvements in the efficiency of the production and distribution of all food and agricultural products; bettering the conditions of rural populations; and thus contributing towards an expanding world economy and ensuring humanity’s freedom from hunger [22].”
Though the FAO has had the mandate to tackle agricultural issues and concerns of its member countries, from its inception, the governments of its member countries were primarily the major actors that formulated and addressed the issues of agriculture within the United Nations’ system. However, since the end of the Cold War, other actors and stakeholders such as the NGOs, CSOs, and a multitude of transnational corporations have also become relevant actors in policy formulations addressing hunger, food issues, and nutrition security governance in Africa. This has especially been so since the establishment of the MDGs covering the year 2000–2015 and the SDGs in place from 2015 to 2030. Nevertheless, this proliferation of stakeholders and actors in food security governance that is now being shared among the UN agencies and the private sector, civil society, NGOs, and the concerned governments has led to an increase in collaboration and partnerships among all the stakeholders that address and formulate policies dealing with the food and nutrition challenges in Africa today. As an example, transnational corporations such as Unilever have now jumped into global threats issues such as world hunger and food security and malnutrition challenges. This is becoming common in corporate governance because leading global corporations have now realized that those aforementioned issues are global threats in nature and no longer local per se. And therefore, they affect everyone and every country in this age of economic, political, technological, and cultural globalization [23]. Furthermore, corporations such as Unilever and many others like it have also understood that addressing those issues as a company or private sector is actually adhering to social corporate responsibility which is increasingly aligned with the interests of a business in this globalized and interdependent world. In fact, this new social-business approach has become the new modus operandi of socially responsible companies everywhere in the world today. In other words, it’s good business to be a global corporate citizen. In effect, big corporations and brand-name companies now understand that consumers want them to also be social citizens while pursuing their economic and business profits and interests [24]. And as a response to all these new developments, in 2013, the FAO published its new strategic framework with a new focus on “governance, creation of enabling environments, and policy support in member countries is the direct outcome of its adaptation and repositioning process.” This new framework was conceived to officially help the FAO collaborate and share policy spaces with other actors and stakeholders in food and nutrition security governance in Africa [25] and anywhere else for that matter.
Africa’s responses to the food security challenges can at best be summarized as ineffective and inefficient thus far, to say the least. However, since the advent of the new millennium and the food crisis of 2007–2008, there has been a somewhat sincere and renewed commitment by the African leaders, the African Union, the Regional Economic Communities, the national governments, civil society, private sector, and all the stakeholders in Africa in support of food security. This new-found engagement in food security challenges is aimed at supporting agricultural production, replacing the prevalence of undernourishment, eradicating hunger, achieving food security, and meeting nutrition needs and targets. This has been so since the 2008 food price hikes and the subsequent social unrest and disturbances that took place in several African capitals and shook the sitting governments of that time. As a result of those vivid developments, the national security implications of food and nutrition insecurity were in plain view for all to see. In addition, the increased awareness of climate change threats and the rising awareness of the unforeseeable consequences of the rapid population growth on the food production system and on the stability of the state made African leaders take note and entice them to initiate various national policies to support food and nutrition security. Soon thereafter, as a result of those political events, several respective African governments devised new policy strategies in line with their national economic policies in support to food production, transformation, and security. For example, countries like Ghana, Nigeria, and Kenya partner more now with the private sector and the civil society in administering and managing their food systems. They basically have shifted their schemes towards private-public partnerships and involved wider private sector(s) in their food production and transformation policies. In contrast, countries like Ethiopia, South Africa, Angola, and Mali have integrated more of their food policy programs in recent years as well. That is, they have aligned them with their national economic strategies to support their food production, combat their food shortages, and replace their prevalent malnutrition. Nevertheless, what remains to be accomplished to date is the transformation of the said renewed political commitments into concrete policy actions such as (1) a visible and sustainable high-level leadership and effective governance, (2) an increase in public-private partnerships (PPPs) and shared co-leadership in fighting against hunger and food insecurity, (3) a supportive and enabling environment by the sitting governments and their decision-makers, and (4) a comprehensive and clear policy approach with all stakeholders involved in support of food production and security. Furthermore, at the continental and regional levels, it is worth highlighting also that the leading voices in formulating policies to combat food insecurity and curb the nutrition challenges in recent decades have been the African Union Commission (AUC), the NEPAD, and the Regional Economic Communities (RECs) such as ECOWAS in West Africa and ECCAS in Central Africa.
The current state of food security and widespread malnutrition in Africa is not as ideal as Africans would like it to be. That is to say, as of today, a good number of African countries are food deficit and insecure. This has been so because food insecurity and widespread malnutrition as stated in this chapter are a multidimensional problem. Challenges that are directly tied to healthcare, misdirected policies and politics, trade and economic interests, weak institutions, failed leadership, and many other variables make it hard and difficult for many African countries to achieve food security. In addition to the internal causes previously discussed as of why a good number of sub-Saharan African countries are not food secure, the chapter also highlighted that there are also external reasons as for why sub-Saharan African countries have been struggling to secure foods for their respective populations and meet their nutrition needs and targets. The chief among those external reasons as discussed and analyzed were economic policy prescriptions that the World Bank and the IMF prescribed for Africa in the 1970s, 1980s, and the latter part of the 1990s. The said policies were devised to help Africa align its economic development policies and strategies with the market-based liberal principles and practices. And as previously explained, the economic conditions of those countries later showed that those policy prescriptions did not provide the intended and expected economic results. Instead, they worsened the food insecurity in Africa. That’s because by advising and encouraging African governments to cut their aid, subsidies, and assistance to their farmers in the name of the market-based principles, food insecurity in sub-Saharan Africa worsened dramatically. Moreover, the chapter also acknowledged that, save the commodities and natural resources exporting African countries, the economic growth of the majority of African countries has not performed as expected either. That is, the GDP growth rates of many sub-Saharan African countries have not kept pace with their rapid respective population growths, especially the rapid urban population growth that many African countries have experienced in recent years. In addition to the mentioned economic policy challenges, new challenges such as climate change and its effects and the internal displacements and migrations pushed many sub-Saharan African countries to depend more on food imports and foreign aid. Consequently, in actuality, many of them are unable to feed their populations today, and food insecurity and malnutrition have become the daily staple of millions of their citizens. Last but not least, the food price hikes of 2008 and their direct political consequences thereof, namely, riots and protests in many African cities, also exposed in plain view the economic policy failures of the African countries to the whole world to see. The rioting and protests showed how inept and incompetent many African leaders had for years been in failing to provide food security to their low-income and respective vulnerable citizens. Also, one of the visible consequences of the failure of African leaders in food security management has thus far been the continuous rise of import food bills in Africa year after year [26, 27, 28, 29, 30, 31, 32, 33, 34], while agriculture dependence has remained high. In sum, the combined reasons as analyzed above are the real reasons why sub-Saharan African countries have for years seemed unable to eradicate hunger, achieve food security, and meet nutrition targets and needs for their people(s). In essence, this is fundamentally why African countries struggled to meet the MDGs targets (2000–2015) despite the assistance and resources granted to them by the international community. With that in mind, if recent history is any indication, sub-Saharan African countries are going to struggle again in order to meet a few targets of the SDGs (2015–2030). In summary, hopefully African leaders will prove their skeptics and all of us wrong this time around.
The diagnostics of Africa’s food security and malnutrition challenges has been thoroughly examined in this chapter. The international community, the African Union and respective African governments and anyone else interested in the issues of food insecurity, climate change threats, and protracted conflicts and wars in Africa have all launched policies against food insecurity in Africa. However, in order for Africa as a whole to achieve food security and lower its dependence on food imports and aid, African political leaders and economic decision-makers will have to surmount in true sense each one of the challenges mentioned in this chapter. For as those challenges are extensively analyzed in this chapter, they have been shown to be the real culprit of Africa’s never ending socioeconomic and political problems. For decades now, they have been the challenges that have crippled Africa and hijacked the well-being and welfare of its citizens. Below are the specific policy proposals that if implemented could contribute to help overcome the challenges of food insecurity and nutrition deficits and many other challenges that have kept Africa for years from meaningful economic transformations beneficial for all its citizens.
African political leadership and economic decision-makers should strive to formulate economic development strategies that are inclusive and people-centered rather than elites and upper middle-class cosmopolitan-driven. That is to say, Africa needs inclusive shared prosperity and constructive policies focused on Africa’s youth and women and solely addressed against the challenges of a population set to double by the year 2050. Employment and job creation policies ought to also be the top priority beyond anything else for the African political leadership. Those are the real challenges that Africa will be facing in the next coming decades.
African political leadership and economic decision-makers should make agriculture a strategic sector and provide African farmers with all kinds of assistance and aid regardless of how unpopular they may appear to the international community and economic experts, and how contrary they may be when evaluated against the market-based principles and policies. In addition, credit and insurance schemes for farmers should also be part of any economic development policy and strategy in any sub-Saharan African country if food security were to ever be achieved. Instituting smart credit and insurance schemes for farmers will inevitably help create robust financial resilience that will protect them from market uncertainty and shocks and keep them focused on food production. Furthermore, civil society organizations, producer organizations, and wider private sector alike should also be allowed to participate in and be part of any policy scheme devised to support food production, combat food insecurity, and curb nutrition deficits.
African political leadership and economic decision-makers should institute and establish social protection programs or food safety net in the likes of cash transfer programs whose objectives should solely be to promote food security and nutrition and provide quality healthcare and education for the youth and women in particular whether in urban centers or in the rural areas. The programs should also serve against food price shocks for low-income citizens that are vulnerable to the market prices’ volatility. Distribution programs and food banks in every neighborhood, town, and city across sub-Saharan Africa should also be established and aggressively promoted while implicating Africans of higher economic and financial means in the programs. The unscathed and seemingly unconcerned wealthy African families should also be invited to co-own the schemes and programs since they are resource-blessed and better off than the majority of their fellow citizens. That is to say, whatever incentive in the likes of tax break or any other financial schemes that may be attractive to them should be on the table for them to consider. Simply put, well-to-do Africans should be reminded of the famous African solidarity and the responsibility that comes with it in assisting their less-blessed brethren.
African political leadership and economic decision-makers should make all kinds of efforts to increase investment in food production and processing and physical transportation infrastructure that will connect rural areas with the growing urban centers where food demands are concentrated. Modern food storage facilities should also be built around major cities and link them to the four geographical corners of the back country. And this can be achieved only if food transportation networks within the country and across the immediate subregions are modernized and resourced.
African political leadership and economic decision-makers should understand once for all that without a sustained political stability and zero tolerance of any sort of institutional or personal (family-induced) corruption, agricultural production and food relief efforts that are badly needed to combat hunger, decisively tackle food insecurity, and achieve the nutrition needs and targets in Africa will never be possible. Peace therefore should be at the center of any national policy and be made the highest priority if Africa does not want to forever be dependent on the good will of foreigners, continuously import foods, and forever beg for development aid and largesse.
JEL Code: N57, Q1, Q5, F63
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\\n\\nAs a gold Open Access publisher, an Open Access Publishing Fee is payable on acceptance following peer review of the manuscript. In return, we provide high quality publishing services and exclusive benefits for all contributors. IntechOpen is the trusted publishing partner of over 118,000 international scientists and researchers.
\n\nThe Open Access Publishing Fee (OAPF) is payable only after your full chapter, monograph or Compacts monograph is accepted for publication.
\n\nOAPF Publishing Options
\n\n*These prices do not include Value-Added Tax (VAT). Residents of European Union countries need to add VAT based on the specific rate in their country of residence. Institutions and companies registered as VAT taxable entities in their own EU member state will not pay VAT as long as provision of the VAT registration number is made during the application process. This is made possible by the EU reverse charge method.
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