Public Health Nutrition: page 1 of 12 doi:10.1017/S1368980016001324
Contribution of forest foods to dietary intake and their association
with household food insecurity: a cross-sectional study in women
from rural Cameroon
Robert Fungo1,2,*, John Muyonga1, Margaret Kabahenda1, Archileo Kaaya1,
Clement A Okia3, Pauline Donn4, Tchatat Mathurin5, Obadia Tchingsabe5,
Julius C Tiegehungo2, Judy Loo2 and Laura Snook2
1School of Food Technology, Nutrition & Bio-Engineering, Makerere University, PO Box 7062, Kampala, Uganda:
2Bioversity International Forest Genetic Resources Programme, Via dei Tre Denari, Rome, Italy: 3World Agroforestry
Centre (ICRAF), Uganda Country Office, Kampala, Uganda: 4National School of Agro-Industrial Science, Agro-food
Processing, University of Ngaoundéré, Ngaoundéré, Cameroon: 5Institut de Recherche Agricole pour le
Développement, Yaoundé, Cameroon
Submitted 23 June 2015: Final revision received 16 April 2016: Accepted 3 May 2016
Abstract
Objective: To determine the contribution of forest foods to dietary intake and
estimate their association with household food insecurity.
Design: Cross-sectional survey conducted among 279 households. Using a 7 d
recall questionnaire, information on household food consumption was collected
from women and used to determine the household dietary diversity score, food
variety score and forest food consumption score (FFCS). Household Food
Insecurity Access Scale (HFIAS) score was determined and Spearman rank
correlation was used to establish the relationship between consumption of forest
foods and HFIAS score. Women’s dietary intake was estimated from two 24 h
recalls. The contribution of forest foods to women’s nutrient intakes was
calculated and women’s nutrient intakes were compared with estimated average
nutrient requirements.
Setting: Rural forest-dependent households in twelve villages in eastern and
southern Cameroon.
Subjects: Household heads and their non-pregnant, non-lactating spouses.
Results: Forty-seven unique forest foods were identified; of these, seventeen were
consumed by 98% of respondents over the course of one week and by 17% of
women during the two 24 h recall periods. Although forest foods contributed
approximately half of women’s total daily energy intake, considerably greater
contributions were made to vitamin A (93%), Na (100%), Fe (85%), Zn (88%) and
Ca (89%) intakes. Despite a highly biodiverse pool of foods, most households
(83%) suffered from high food insecurity based on the HFIAS. A significant inverse
correlation was observed between the HFIAS score and the FFCS (r 2= −0·169,
P= 0·0006), demonstrating that forest foods play an important role in ensuring
food security in these forest-dependent communities. Keywords
Conclusions: Forest foods are widely consumed by forest-dependent commu- Biodiversity
nities. Given their rich nutrient content, they have potential to contribute to food Dietary diversity
and nutrition security. Nutrient intake and forest foods
Sub-Saharan Africa, with close to 214 million under- threatened animal species(3). However, low quality and
nourished people, remains the world’s most food-insecure monotonous diets dominate the daily meals of Camer-
region(1). However, Africa has a highly biodiverse envir- oonians, raising the risk of undernutrition(1,4). The supply
onment, with valuable, but often neglected and under- of starchy staples in Cameroon and the rest of Africa is
utilized resources such as foods obtained from forest largely dependent on a small number of cultivated and
species(2). Cameroon is endowed with a rich biodiversity, imported species and varieties(1,5,6). A diet that is not
represented by about 9000 plant species and over forty diversified may result in negative consequences on an
*Corresponding author: Email rfungom@yahoo.com © The Authors 2016
Public Health Nutrition
2 R Fungo et al.
individual’s well-being and development, as this kind of Methodology
diet may not meet essential nutrient requirements(7,8).
Studies indicate that assessing the intake of traditional, Characteristics of study sites
wild or forest foods could successfully reveal how the Cameroon is located in the humid forest zone of the
consumption of locally available foods is related to the Congo Basin region, a hotspot of biodiversity(27). The
well-being of communities(8). Despite the underutilization study was conducted in the eastern and southern regions
and neglect of forest foods, studies indicate that these of Cameroon (see online supplementary material,
foods can enrich household diets, providing essential Supplemental Fig. 1). These regions have a long rainy
nutrients and bioactive compounds that can prevent season that lasts between May and November(27). The two
undernutrition and coronary diseases, and provide sources study sites can be accessed using asphalted roads over
of income for millions of people(1,9–15). These foods also 150 km from Yaoundé city. The study villages in each
act as a safety net during times of shortage of other study site can be reached only by forest tracks.
foods(16). Income-generating forest foods such as Gnetum
africanum (African wild vegetable) and Irvingia gabo-
Study population
nensis (bush mango) in Cameroon and Nigeria are being
The population around the eastern site is about 25 783,
protected and domesticated, thus increasing on-farm
composed mainly of the Kako, Pol and Baka pygmy ethnic
agrobiodiversity while contributing to greater dietary
groups, living in forty-one villages(28). The population in
diversity and improved access to essential nutrient com-
the southern site is estimated to be 79 353; all are of the
ponents in an otherwise monotonous and nutritionally
Bulu ethnic group, living in twenty-nine villages(29)
poor diet(5,17–19)
.
.
The population in the southern region comprises mainly
Undernutrition is a widespread problem in Cameroon
peasant farmers who grow both food and cash crops for
despite some improvements(18). During the last 15 years,
export to Gabon and Equatorial Guinea(28). The popula-
the prevalence of stunting in Cameroonian children below
tions in the eastern region are predominantly hunters and
5 years of age has declined from 36 to 33% and the pro-
gatherers of wild foods, with some sections of the popu-
portion of underweight children has declined from 18 to
lation engaged in the commercial farming of plantain(29).
15%. Despite the decline, the current prevalences of
stunting and underweight in Cameroon are unacceptably
high(20,21). The prevalence of wasting among children Study design, village and household selection
below 5 years in this country worsened from 5% in 1991 A two-stage cluster sampling technique involving one
to 6% in 2011(20,21). It is estimated that if measures are not stage of purposeful selection and one stage of random
taken to reduce undernutrition, affected individuals will selection was deployed in the selection of the study
experience a 10% loss of lifetime earnings and developing villages. In the first stage, districts within each site were
countries such as Cameroon will suffer a 3% annual purposefully selected on the basis of their accessibility and
reduction in gross domestic product(22). ethnicity. In the second stage, villages were randomly
Current interventions to control undernutrition in selected within the chosen districts. In the eastern site, the
Cameroon include vitamin and mineral supplementation study was conducted in six villages, namely Kouedjina,
and provision of nutrition education to mothers during the Kagnol 3, Ndembo, Petit Pol, Melambo, Nkolbikon and
prenatal period(23). However, these interventions are Bonando; while in the southern site the study was con-
provided to relatively few accessible, rural forest- ducted in five villages, namely Ngon, Bissam, Ondondo,
dependent communities(24). Complementing the existing Methyikpwale and Meyos.
interventions with food-based strategies such as nutrition The sample size was derived using Fisher’s(30) formula:
education coupled with the promotion of sustainable n ¼ ½t2 ´ pð1pÞ=m2; where n= required sample size,
utilization of forest foods can be a feasible strategy to t= confidence level at 95% (standard value of 1·96),
address undernutrition(25). However, detailed studies p= estimated proportion of the population directly
describing the contribution of forest foods to nutrient depending on the forest for food (9·9%)(31) and m=margin
intakes and food security among forest-dependent of error at 5% (standard value of 0·05). The calculation
communities of Cameroon are scarce. This has led to a resulted in a total of 276 households to be interviewed in
routine undervaluation of forest foods in diets and their the two sites. To cater for attrition during the data collection
neglect by researchers, policy makers and nutritionists(26). process, the number of households per site was increased
The present study aimed to assess the contribution by 5%, totalling 303 households. This sample size was
of forest foods to the nutrient intakes of women, as well as about 40% of the total number of households in each
to evaluate the association between the consumption village and representative of the population in the study
of these foods and household food insecurity. This infor- area. With the help of the village authorities, mapping and
mation can support the formulation of policies and listing of households in each village were done to obtain
programmes related to utilization of these foods in village lists for random selection. Households were
Cameroon. randomly selected from each village list. A total of 279
Public Health Nutrition
Dietary contribution of forest foods 3
households in the two sites were selected, resulting into a Table 1 Sociodemographic characteristics of households in
response rate of 92%. southern and eastern Cameroon in May 2012
Household characteristic n %
Data collection Age of household head (years) 277
Mean 43·7
Interviews Minimum 17·0
Enumerator-administered interviews were used to collect Maximum 82·0
data on sociodemographic characteristics and food con- Education of household head 277
No formal education 4·7
sumption from non-pregnant and non-lactating women Primary class 1–4 21·3
older than 18 years, who were married or cohabiting. The Completed primary school 42·2
study focused on interviewing women because in rural Failed to complete Form 4 22·0
Completed secondary Form 4 6·9
African settings women are responsible for food collection Completed secondary Form 6 1·1
and preparation and are custodians of knowledge on Completed Form 4 + vocational training 1·1
forest foods, that is passed on from generation to gen- Completed university 0·7
Household size group 258
eration(32). Pregnant and lactating women were excluded Low (1–4) 33·7
from the sample as their energy and nutrient needs are Medium (5–9) 56·2
different from those of other adults(33). Interviews took High (10–14) 10·1
Residence within the study area 275
place in the respondents’ homes during the month of May <12 months 2·2
2012. The long rainy season in Cameroon commences in 1–2 years 3·6
May and ends in November(27). All questionnaires and >2–<5 years 7·3
>5–<10 years 6·2
tools were pre-tested and adapted to the local context. >10 years 80·7
Residence before coming into the study area 277
Household characteristics Same area (outskirts of forest) 75·1
Another forest (not current forest site) 13·0
The interviews solicited information on the age, gender, Another part of this forest 8·7
economic occupation, education level of the head of Inside the forest 3·2
household, materials used to construct the household Energy source for cooking 276
Firewood 97·2
dwelling and household food insecurity (Table 1). Charcoal 2·2
Paraffin stove 0·8
Forest food knowledge and species identification Source of energy for lighting 277
Kitchen firewood 66·9
Focus group respondents were asked which forest plant Electricity 30·0
species they consumed, which parts of each species and in Paraffin lantern 3·3
what form. Forest food species were identified in the field Water source 276
Pond 62·0
with the help of local informants using Cameroonian River 17·0
vernacular plant names(24,34). Plant specimens were pho- Public spring 10·5
tographed, collected and taken to the Yaoundé I Uni- Bore hole 9·1
Piped 1·6
versity herbarium to be identified by an ecologist. A total Economic activities of forest-dependent 279
of forty-seven forest food species were documented (see communities
online supplementary material, Supplemental Table 1). Farming 51·8
Hunting and gathering forest foods 28·0
The species names were also verified using the Interna- Trading 7·6
tional Plant Names Index website (www.ipni.org) and Artisan works 5·3
classified into botanical families according to the APGII Salaried employment 3·2
Artisanal logging & informal timber trading 2·9
system as proposed by Termote et al.(12). Pension 11·0
Casual employment 0·4
Dietary assessment and nutrient intakes HFIAS† 279
Food secure 16·8
Quantitative assessment of nutrient intakes was conducted Mildly food insecure 47·0
using two 24h recalls, with each recall conducted in the Moderately food insecure 7·5
Severely food insecure 28·7
space of one week. Crude means of the two recalls were
used for analysis. The two 24h recalls allowed minimizing of Data presented are number of households and percentage of the total
intra-individual intake variation. Overestimated intakes in number of households.
†Household Food Insecurity Access Scale; total score (range 0–27) is cal-
one of the recall days were evaluated according to the culated from the individual scores of the nine frequency-of-occurrence
Goldberg cut-off method(35) and none were excluded. questions and categorized into four levels of household food insecurity.
Emphasis was placed on extracting as much information as
possible from women because in rural African settings Cameroon(37–39). A list was recorded of meals, dishes, food
women prepare household meals, so they have a memory of items and beverages consumed in the last 24h. Respondents
foods and can estimate portion sizes(36). The 24h recall was were asked for a full description of ingredients in mixed
validated based on previous studies conducted in dishes and amounts eaten were estimated using household
Public Health Nutrition
4 R Fungo et al.
measures and models. Respondents were also prompted for Table 2 Proportion of households from southern and eastern
specific foods such as snacks and drinks. Portion sizes were Cameroon that consumed different foods in 7 d in May 2012
estimated using a variety of different local utensils to help the Food group and food variety n %
respondents in estimating the quantities of foods or ingre-
Cereals and wheat products
dients consumed(40). In addition, two digital scales (Soehnle, Maize 277 99·6
Nassau, Germany; precision 10g) were used to estimate Rice 276 99·2
weights of corresponding utensil volumes and leftovers. Cake 264 94·9
Spaghetti 262 94·2
Bread 251 90·3
Dietary diversity scores Corn flour (farine de maïs) 209 75·2
Dietary diversity scores were obtained using a 7 d recall Roots and tubers
Cassava 274 98·6
questionnaire that was designed to capture information Taro 273 98·2
from the week preceding the survey. A total of thirteen Sweet potato 233 83·8
food groups were assessed: the twelve food groups Yam 224 80·6
Wild yam (Dioscorea spp.)† 21 7·6
specified in the FAO(41) guidelines for measuring house- Pulses and lentils
hold and individual dietary intake and an additional food Beans 266 96·0
group for nutritionally important forest foods(4). The food Soyabeans 72 25·9
Sesame 26 9·4
groups were: (i) cereals and wheat products; (ii) roots and Peas 7 2·5
tubers; (iii) legumes and lentils; (iv) nuts; (v) dairy and fats; Nuts
(vi) meat and game; (vii) poultry; (viii) fruits; (ix) fish and Groundnuts 277 100·0
Bambara groundnut (Vigna subterranea)† 2 0·7
seafood; (x) vegetables; (xi) forest foods; (xii) alcoholic Dairy, fat and their products
drinks; and (xiii) non-alcoholic beverages. Six varieties of Cooking oil 226 85·6
foods were included in the cereals and wheat products Butter 225 85·2
Milk 217 82·2
group, five in roots and tubers, four in lentils and pulses, Margarine 55 20·8
two in nuts, four in diary and fats, fifteen in meat and Meat and game
game, four in poultry, eight in fish and seafood, thirteen in Porcupine 266 95·7
Rats 264 94·9
vegetables, eight in fruits, four in alcoholic drinks, four in Pork 248 89·2
non-alcoholic beverages and seventeen in forest plant Snake (viper, python, etc.) 244 87·8
foods. A total of ninety-four food items were mentioned Goat 241 86·7
Beef 238 85·6
across these food groups (Table 2). The food items con- Snails 234 84·2
sumed were allocated among the thirteen food groups and Sheep 233 83·8
the household dietary diversity score (HDDS) was calcu- Antelope 232 83·5
Squirrel 201 72·3
lated by summing the number of unique food groups Caterpillars 184 66·2
consumed by each woman. The food variety score (FVS; Warthogs 90 32·4
the number of different food varieties consumed over the Eastern mole 86 30·9
Guinea pig 17 6·1
recall period of 7 d(39)) and the forest food consumption Rabbit 10 3·6
score (FFCS; the sum of the occurrences of consumption Poultry
incidents of forest food items) were also calculated (see Chicken 273 98·9
Eggs 265 96·0
online supplementary material, Supplemental Table 2). Wild birds 254 92·0
Duck 154 55·8
Fish and seafood
Household food insecurity assessment Catfish 260 93·9
The Household Food Insecurity Access Scale (HFIAS) was Crayfish 257 92·8
assessed following the procedure proposed by Coates Crab 251 90·6
et al.(42)
Tilapia fish 210 75·8
. A set of nine standard questions was posed to Carp 88 31·8
women, who responded on behalf of other household Nile perch 37 13·4
members. The HFIAS score is a continuous indicator Smoked fish 32 11·6
Mackerel 25 9·0
ranging from 0 (food secure) to 27 (maximum food Sardine 9 3·2
insecurity)(42), with the score categorized into four levels Vegetables
of household food insecurity: food secure (score= 0), Onions 277 99·6
Tomatoes 276 99·3
mildly (score= 1–13), moderately (score= 14–16) or Cassava leaves 274 98·6
severely food insecure (score= 17–27). Red pepper 273 98·2
Cucumber 271 97·5
Taro leaves 225 80·9
Data analysis African eggplant (Solanum nigrum)† 198 71·2
Spinach 117 42·1
Daily nutrient intakes were computed from total food intake Cauliflower 52 18·7
and from forest foods and non-forest foods separately(43,44). Sweet potato leaves 52 18·7
Cowpea leaves 3 1·1
Forest foods included forest plant foods, as classified under
Public Health Nutrition
Dietary contribution of forest foods 5
Table 2 Continued The energy and nutrient intakes and the number of food
groups consumed in the two non-consecutive 24 h recalls
Food group and food variety n % were determined. ANOVA with Tukey post hoc testing was
Pumpkin leaves 3 1·1 then used to compare results between women who con-
Amaranth (leaves) 1 0·4 sumed forest foods in this period and those who did not.
Fruits
Avocado 278 100·0 The average percentages of women with micronutrient
Plantains 278 100·0 intakes below the EAR were computed(43). Owing to Fe
Mangoes 275 98·9 requirements among premenopausal women not having a
Papaya 275 98·9
Orange 272 97·8 normal distribution, the probability approach was used to
Pineapple 269 96·8 estimate the prevalence of inadequate Fe intakes(47).
Guavas 265 95·3 To assess how forest foods contribute to food security,
Passion fruits 15 5·4
Forest plant foods logistic regression analysis and Spearman’s correlation
Bush mangoes (Irvingia gabonensis) 262 94·2 analyses were performed. Logistic regression was per-
Wild citron (Citrus spp.)† 236 84·9 formed to assess the risk of food insecurity among forest
Moabi (Baillonella toxisperma) 212 76·3
Ngoyo/boutoh/mvout (Trichoscypha abut) 207 74·4 food consumers in comparison to non-forest food con-
Ntom (Pachypodanthium staudtii) 67 24·1 sumers. Respondents were dichotomized into food secure
Noisettes (Coula edulis) 59 21·2 and food insecure, the latter including those who were
Ngong (Klainedoxa gabonensis) 58 20·9
Djansang (Ricinodendon heudolitii) 49 17·6 suffering from mild, moderate and severe food insecurity.
Mbivoe (Cola pachycarpa) 27 9·7 Crude odds ratios with 95% confidence intervals were
Cola (Cola spp.) 19 6·8 used for interpretation and reporting of results. Spearman
Mushroom (Termitomyces spp.) 16 5·8
Corrosolsauvage (Annonidium mannii) 15 5·4 rank correlation analyses were conducted to assess the
Bitter cola (Garcina kola) 14 5·0 association of forest foods with food security and the
Rondelle (Afrostyrax lepidophyllus) 13 4·7 strength of the relationship among HFIAS, FFCS, HDDS
Kana (Pogo oleosa)† 13 4·7
Ebaye (Pentaclethra macrophylla Benth) 5 1·8 and FVS. All data were analysed using the statistical soft-
Ofos 3 1·1 ware package IBM SPSS Statistics Version 21.0 and statis-
Alcoholic beverages tical significance was set at α= 0·05 for all tests.
Beer 235 97·1
Wine 195 80·1
Traditional beer 172 71·1
Spirit 161 66·5
Non-alcoholic beverages Results
Coffee 191 89·3
Chocolate 150 70·1 Respondent characteristics
Tea 123 57·5
Soya milk 26 12·1 The household heads averaged 44 years of age, with the
majority having attended or completed primary school
Data presented are number of households and percentage of the total (64%) and more than half (56%) having a large number of
number of households.
†Wild forest food varieties domesticated. household dependants (five to nine; Table 1). Approxi-
mately three-quarters (75%) of the respondents were
natives of the study area and 62% fetched water from
the 7d recall questionnaire, wild animal meat and semi-wild ponds. About 97% used firewood for cooking and 67%
vegetables, fruits, nuts, roots and tubers. Mean nutrient used kitchen firewood as their source of lighting. Despite
intakes were calculated from the quantity consumed daily, being forest-dependent communities, the majority of the
derived from an average of the two 24h recalls, using the respondents were farmers (52%) with a high knowledge of
computer program Nutrisurvey® 2013, which provides forest foods. Based on the HFIAS score, more than three-
nutrient values associated with specific quantities of foods. quarters of all households (83%) were food insecure; nearly
Nutrient compositions for foods which were not found in the half (47%) of households suffered from mild food inse-
Nutrisurvey program were derived from the West African curity, while 29% suffered from severe food insecurity.
food composition table(45), the Cameroonian foods nutrient
composition data(15,37,38,46), Democratic Republic of Congo
(DR Congo) data(12) and the US Department of Agriculture Knowledge of forest food species
nutrient database (http://ndb.nal.usda.gov/ndb/search/list). Forty-seven forest food species belonging to thirty-six
Average micronutrient intakes were compared with the families were named by respondents as important forest
estimated average requirements (EAR)(44) and the proportions food species (see online supplementary material, Supple-
of women with inadequate intake were computed. The EAR is mental Table 1). The majority (n 44) of species were cooked
the average daily nutrient intake estimated to meet the needs while only three were eaten raw. Most of the species (n 33)
of half the healthy individuals in a particular age and gender were eaten as leafy vegetables, twenty-three as fruits, three
group(43). The bioavailability of each nutrient was taken into as tubers, three as nuts, and two were kept as seed or
consideration when calculating nutrient intakes(43,44). consumed. Plant species from which leafy greens were
Public Health Nutrition
6 R Fungo et al.
consumed included Aframomun spp., G. africanum, contribute substantially to the diets of the study popula-
Canarium occidentale, Amaranthus hybridus, Coula edulis tions (Table 2). Most consumed were I. gabonensis (bush
and Afrostyrax lepidophyllus. Species whose fruits were mango), a native wild fruit, and non-native oranges, Citrus
consumed as snacks included Aframomun spp., Baillonella spp. (semi-wild oranges). Semi-wild yams (Dioscorea
toxisperma, I. gabonensis, Carica papaya and Citrus spp. spp.) and Bambara groundnuts (Vigna subterranea) made
The tubers listed as major sources of energy included Dios- substantial contributions to the food groups roots and
corea spp. and Xanthosomas agittifolium. Some sources of tubers and nuts, respectively. Greens of S. nigrum and
greens such as A. hybridus and Solanum nigrum, fruits such A. hybridus were among the widely consumed vegetables.
as Citrus spp. and Musa spp., and starchy staples such as
Dioscorea spp. are cultivated but were listed by respondents
as wild because they are harvested from the forest. In the Food variety score, dietary diversity score and
present paper they are referred to as ‘semi-wild’. Another forest food consumption score
important category of forest foods comprised native forest Respondents’ FVS for the 7 d preceding the interview ran-
tree species of which fruits and/or seeds are consumed, ged from 11 to 23 (see online supplementary material,
notably Pentaclethra macrophylla, I. gabonensis and Supplemental Table 2). Each individual consumed between
B. toxisperma. The seeds/fruits of B. toxisperma are also eleven and twenty-three foods during the 7d recall period.
used by the local communities to produce an edible oil that The majority of respondents (67%) consumed fifteen to
is used for cooking and the surplus is sold to buy basic nineteen different food items over the 7d period.
household items. Sixty per cent of the respondents ate items from all thirteen
Of the 279 women surveyed, 272 (98%) reported con- food groups during the 7d recall period (see online supple-
suming at least one forest food during the last week mentary material, Supplemental Table 2), while 94% had
(Table 2 and online supplementary material, Supplemental DDS of 12–13 (consumed food items from twelve or thirteen
Table 2). Among the plant species, I. gabonensis was the food groups). The FFCS ranged from 1 to 8, with the largest
most frequently consumed forest plant species and was group (32%) reporting having eaten three forest food items
named in 94% of the recalls. I. gabonensis (bush mango) during the 7d recall period. Four respondents (1%) reported
is popular and liked by children because of its sweet and eating eight different forest food items (Supplemental
nutritious yellow pulp(48). The nut of I. gabonensis is dried Table 2). Based on these patterns, 272 respondents (98%)
and pounded to produce edible cooking oil that is used in were considered forest food consumers and 2% did not
cooking, while surplus oil is sold. Among the forest animal consume any forest-derived foods.
species, porcupines were the most frequently consumed
and were named in 96% of the 7 d recall data.
Relationship between forest food consumption and
food insecurity
Consumption frequency of cultivated and forest Logistic regression analysis revealed that forest food
foods consumers were 7·5 times (OR= 7·5; 95% CI 0·31, 10·9;
Fruits were the only group eaten by all respondents, with P= 0·0001) more likely to be food insecure compared with
most consuming seven different fruits in the last week non-forest food consumers. Forest food consumers suf-
(Table 2). Nuts and cereals were consumed by most fered most from mild food insecurity (Table 3). Within the
respondents (99%), who reported eating six species of forest food consumers, the mean HFIAS score was found
cereal and two species of nut. The food groups with the to be significantly and inversely correlated with the FFCS
largest number of different food items were the forest food
group with seventeen unique items, vegetables with thir- Table 3 Food insecurity among forest food consumers and non-
forest food consumers in southern and eastern Cameroon in
teen unique items, and meat with fourteen unique items. May 2012
The meat food group was predominantly comprised of
various species of wild-captured animals. Percentage Percentage
among forest food among non-forest
Among the starchy staples, cereals and wheat products consumers food consumers P
and roots and tubers were consumed the most frequently. HFIAS† (n 239)‡ (n 40)§ value
The most frequently consumed staple food items were Food secure (0) 18·8 2·6 <0·0001
plantains, maize, rice and cassava. Avocado, tomatoes, Mild (1–13) 67·5 71·8 <0·0001
onions and cassava leaves constituted the main side dishes Moderate (14–16) 7·9 5·1 <0·0001
Severe (17–27) 5·8 20·5 <0·0001
for the majority of households. Groundnuts formed an
important ingredient of sauces. Under the meat and game †Household Food Insecurity Access Scale; total score (range 0–27) is cal-
category, porcupines and edible rats were the most con- culated from the individual scores of the nine frequency-of-occurrence
questions and categorized into four levels of household food insecurity.
sumed, while within the poultry, fish and seafood group, Numbers in parentheses represent the cut-off of HFIAS score for each food
chicken and catfish were the most consumed. Under the security category.
‡Eating at least one forest food in the 7 d recall period.
forest foods category, seventeen foods were found to §Did not eat forest foods in 7 d recall period.
Public Health Nutrition
Dietary contribution of forest foods 7
(r 2=−0·169, P= 0·0006). This suggests that households (>60%) to the intakes of vitamins A, E and C, Fe, Zn K, Ca,
that consumed more forest foods were less food insecure Mg and Na in the two 24h recalls (Table 5).
(Table 4). Statistically significant positive correlations
between the FFCS and the FVS (r 2= 0·091) and between
Contribution of forest foods to macro- and
the FFCS and the HDDS (r 2= 0·006) further supported the
micronutrient intakes
association between higher forest food consumption and
Among the forest food groups consumed, vegetables,
reduced risk of food insecurity.
mainly S. nigrum, and fats and oils, principally Elaeis
guineensis (palm oil), contributed remarkably high intakes
of vitamin A compared with other food groups (76 and
Micro- and macronutrient intakes of respondents 21%, respectively; Table 6). Bush meat (porcupine and
Approximately 70% of the respondents had Fe, Na, Mg, Zn, rats), roots and tubers (Dioscorea spp.) and vegetables
vitamin C and vitamin A intakes above the EAR (see online (Annonidium mannii and S. nigrum) contributed sig-
supplementary material, Supplemental Table 3). The daily nificantly to Fe and Zn intakes (Table 6). Among the forest
energy intake from forest foods compared with non-forest foods mentioned in the two 24 h recalls, within the wild
foods was low (Table 5). Despite the low energy intake from forest plant food group, notable contributions to micro-
forest foods, these foods made a substantial contribution nutrient intakes were provided by the species Dacryodes
edulis, I. gabonensis and P. macrophylla. These wild plant
Table 4 Spearman’s correlation matrix of food security indicators species accounted for 4·6% of Fe intakes, 2·5% of vitamin
for forest communities of southern and eastern Cameroon in A intakes and 1% of both energy and Zn intakes com-
May 2012 pared with the nutrients and energy provided solely by
Household food HFIAS forest foods.
security indicator HDDS FFCS FVS score
HDDS† 1 0·006* 0·560** −0·029*
FFCS‡ 1 0·091* −0·169** Discussion
FVS 1 −0·005
HFIAS score 1 Contribution of forest foods to nutrient and energy
HDDS, household dietary diversity score; FFCS, forest food consumption intakes
score; FVS, food variety score; HFIAS, Household Food Insecurity
Access Scale. In our survey of women in rural Cameroon, we found that
*Correlation is significant at the 5% level. those reporting forest foods in the 24h recalls obtained a
**Correlation is significant at the 1% level. substantial proportion of their intake of vitamins A, C and E,
†The maximum score includes thirteen food groups.
‡Only forest food species were included in the count group. Ca, Fe, Zn, Mg, K and Na from forest foods when compared
Table 5 Daily dietary nutrient intakes from forest-derived and non-forest foods by non-pregnant, non-lactating women in southern and
eastern Cameroon during two 24h recalls conducted in May 2012
Forest foods consumed in two non-consecutive 24h recalls
Yes (n 46) No (n 233)
Nutrient Mean SD % of women below EAR† Mean SD % of women below EAR† P value‡
Weight (g) 1116·9a 34·4 – 1311·3b 131·3 – <0·0001
Energy (kJ)§ 11339·1a 20656·8 51·9 7805·3b 3477·7 36·2 <0·0001
Energy (kcal)§ 2710·1 4937·1 51·9 1865·5 831·2 36·2 <0·0001
Protein (g) 79·1a 198·5 47·4 31·9b 127·5 41·3 <0·0001
Fat (g) 77·7a 249·8 35·5 20·9b 20·9 40·7 <0·0001
Carbohydrate (g) 141·2a 350·2 67·0 320·7b 909·2 41·3 <0·0001
Dietary fibre (g) 35·5a 234·9 72·0 36·2b 126·8 49·1 0·192
Vitamin A (µg) 6155·3a 4907·3 7·1 1801·7b 944·3 10·8 0·033
Vitamin E equivalents (mg) 8·4a 46·9 38·2 4·4b 15·3 48·3 0·041
Vitamin C (mg) 81·8a 255·7 21·3 228·8b 710·3 16·5 0·013
Na (mg) 448·5a 161·6 0·0 130·1b 167·5 0·0 <0·0001
K (mg) 5481·8a 3228·6 28·0 1405·9b 234·1 13·2 <0·0001
Ca (mg) 1466·4a 9313·8 11·2 541·9b 508·2 19·3 <0·0001
Mg (mg) 2110·5a 1631·9 11·4 965·8b 740·8 1·1 <0·0001
P (mg) 5681·5a 5234·6 44·9 1821·1b 2352·0 41·8 <0·0001
Fe (mg) 27·8a 116·7 15·4 13·1b 32·1 10·2 <0·0001
Zn (mg) 55·3a 418·6 12·0 42·3b 265·9 2·9 <0·0001
†Percentage of women below the estimated average nutrient requirement (EAR) for adults(39,40).
‡At P = 0·05, a Tukey post hoc test was performed, using ANOVA for comparison of means of the two food categories. Mean values within a row with unlike
superscript letters were significantly different at the 0·05 level.
§Total energy includes energy from alcoholic and non-alcoholic beverages.
Public Health Nutrition
8 R Fungo et al.
Table 6 Vitamin A, iron, zinc and energy intakes, according to food groups derived from forest foods and non-forest foods, by non-pregnant,
non-lactating women in the two 24h recalls in southern and eastern Cameroon conducted in May 2012
Contribution based on two non-consecutive 24 h recalls
Forest foods (n 46) Non forest foods (n 233)
% of total % of total % of total % of total % of total % of total Fe % of total Zn % of total
vitamin A in Fe in forest Zn in forest energy in vitamin A in non- in non-forest in non-forest energy in non-
Food group forest foods† foods† foods† forest foods† forest foods† foods† foods† forest foods†
Meat 0·7 28·0 40·0 3·8 0 0 0 0
Fish 0 0 0 0 1·9 23·9 16·2 22·9
Non-alcoholic beverages 0 0 0 0 0 3·1 0 0·1
Fruits 0 0 0 0 4·2 8·0 1·4 47·1
Roots and tubers 0 30·6 34·7 93·2 5·8 29·4 24·9 13·8
Cereals and wheat products 0 0 0 0 5·3 21·2 10·6 10·4
Pulses and lentils 0 0 0 0 1·1 1·9 0·5 0·2
Nuts 0 0 0 0 0·1 3·2 2·5 3·7
Oil, fats, milk and dairy products 20·7 0·1 0·01 0·9 0·4 0·1 0·3 1·0
Vegetables 76·1 36·5 24·2 1·1 80·2 8·6 43·6 0·3
Poultry 0 0 0 0 1·0 0·7 0·3 0·3
Wild forest plant food species‡ 2·5 46·0 1·1 1·0 0 0 0 0
†Expressed as percentage of total vitamin A, Fe, Zn and energy content among the forest foods or non-forest foods only.
‡Wild forest plant food group species are collected only from forests, while the other food groups under the forest foods category are either collected from
forests or have been domesticated.
with those who did not mention forest foods in the 24h communities of DR Congo indicated that forest foods do not
recalls. This finding is important because low intakes of provide adequate intakes of the micronutrients Fe, Zn, Ca
vitamin A, Fe and Zn are established risk factors for poor and vitamin B12, with less than 25% of women having
nutritional status in most African populations, including intakes above the RDA(12). The low contribution of forest
forest-dependent communities(49). Although having lower foods towards meeting the EAR of these micronutrients has
micronutrient intakes overall, those who ate forest foods also been reported among the Lama Forest communities of
obtained much of their vitamin A intake from forest food Benin(53). The lower nutrient contributions of forest foods in
vegetables, and much of their Fe and Zn intakes from bush Benin(53) and DR Congo(12) than in the present study may be
meat and forest food root and tuber groups. In addition, the attributable to the exclusion of nutrient-rich animal foods.
consumption of forest foods was significantly related to The findings in the present study revealed that hunting
increased dietary diversity. Previous findings(50,51) have cor- and collecting wild forest foods was an important house-
related the increased consumption of wild foods to increased hold activity among Cameroonian populations, providing
age of the household head, low education levels and a large protein and essential micronutrients to vulnerable house-
number of household dependants, characteristics also hold members. Dietary intake analysis revealed that bush
observed in the present study. The findings in the present meat provided substantial amounts of the total intakes of
study indicated that forest foods, such as bush meat includ- Fe and Zn, while wild vegetables provided the majority of
ing edible rats, porcupines and snails, and wild vegetables, vitamin A content obtained from the forest foods con-
notably A. mannii, S. nigrum and Vernonia amygdalina, sumed. Furthermore, the 24 h recall results indicated that
were widely consumed. These foods could explain the high bush meat was the only form of meat consumed the
protein, fat and micronutrient intakes from forest foods previous day among all 279 households interviewed,
among forest food consumers. Among the forest food con- while the 7 d recall data revealed that the most widely
sumers, the wild yams of Dioscorea spp. alone contributed consumed meat was that of porcupines and edible rats.
93% of the total energy derived from forest foods. Forest Similarly, communities of Yassa, Mvae and Bakola in
foods were also observed to play a complementary role to Cameroon were reported to obtain 70–80% of their pro-
non-forest foods, rather than being a substitute. Those who tein and considerable amounts of micronutrients, includ-
did not consume forest foods in the two 24h recalls in the ing vitamin A, riboflavin and niacin, from hunting(54,55).
present study did not consume meat and meat products, Keegan(56) also reported that hunting is a major source of
while bush meat was predominantly consumed by those protein for rural communities.
who consumed forest foods. This is in contrast with the Data from the two 24 h recall periods showed a
findings reported among rural populations of South Africa remarkably high contribution to energy from the roots and
which indicated that wild vegetables are consumed only tubers food group among forest food consumers. The
when meat and exotic vegetables cannot be afforded(52). semi-wild yam Dioscorea spp. was the only root and tuber
Nevertheless, the nutrient intakes from forest foods in the that contributed 93% of the total energy from forest foods.
present study are higher than those reported in similar stu- The non-forest food consumers did not consume any form
dies conducted in DR Congo(12) and Benin(53). Research of animal food, limiting their access to essential nutrients.
conducted with the Kisangani and Turumbu forest The key background informers for the present study
Public Health Nutrition
Dietary contribution of forest foods 9
reported that Dioscorea spp. acts as a source of dietary these relationships, including investigating the factors
energy for most forest families, especially the Baka pyg- affecting food security and how forest foods can be pro-
mies who do not have gardens to plant cultivated staples. moted to combat the high food insecurity levels.
The energy contribution from wild plant forest food spe- Our finding of an inverse correlation between food
cies in the present study is quite similar to that reported in insecurity and dietary diversity is in agreement with other
the Usambara forests in Tanzania(57), the Mekong delta of studies, including among children and women of Awajún
Vietnam(58) and the Kisangani forests in DR Congo(12). forest communities of Peru(10), pre-school children in
Wild forest foods contributed 2% to total energy in Tan- northern Ghana(66), rural household farmers of northern
zania and 1·1% in DR Congo. The low contribution of Ethiopia(67) and cotton-growing women farmers in Bur-
forest plant food species to energy and other nutrient kina Faso(64). Among the Awajún community of the
intakes can be attributed to the fact that forest plant foods Amazonian forests of Peru, Roche et al.(10) observed a
are consumed in very small quantities, as fruit snacks positive relationship between the traditional forest food
between meals or as vegetables or sauces. diversity score and nutrient dietary quality and food
security. The dietary intakes, food groups and food supply
were substantially high among the forest-dependent
Contribution of forest foods to food security women and children living in the lower Cenepa River
Despite logistic regression modelling revealing that region of the Awajún community(10). Most previous food
respondents who consumed forest foods were more likely diversity studies in which household food insecurity was
to be food insecure, correlation analysis revealed that also assessed have focused on overall dietary diversity
greater forest food consumption was significantly and measured by either conventional food groups or indivi-
positively related to increased dietary diversity among the dual food items over a fixed period of time(68). However,
forest food consumers. The significant inverse correlation in the present study we included forest foods (FFCS) to the
between FFCS and HFIAS, and the positive correlation list of commonly used dietary diversity indicators that
between FFCS and HDDS and FVS, indicate that forest foods assessed household food security. Inclusion of the FFCS
may play an important role in household food security. indicator was an appropriate measure for the forest com-
The measures FFCS, HDDS and FVS are useful indica- munities in southern and eastern Cameroon because of
tors of household food security(8,59,60) and good proxies of the biodiversity of forest foods used in local diets and the
overall dietary quality(61,62). In north-west Benin, a higher high nutrient content of several of these foods(15,39,63).
diversity score was reported among the populations
residing near or inside the government-owned wild fruit
tree reserves than among the populations in urban centres, Knowledge of forest foods
and this was attributed to increased consumption of forest The findings in the present study corroborate the previous
tree foods(60). The high prevalence of food insecurity findings in DR Congo(12), Benin(53), Tanzania(57), Ethiopia(69)
among the study respondents may be due to the high and Cameroon(70) that indicated a wide gap between the
proportion of respondents (~50%) relying on illegal log- number of traditionally known and the number of commonly
ging, hunting and poaching for income, the majority consumed forest foods. The focus group respondents in the
having low levels of education and having a large number present study revealed a list of forty-seven forest plant foods,
of household dependants. Also, the observed low volumes of which only seventeen were observed to be consumed
of forest foods consumed in the present study and sea- during the 7d recall period in the study. We expected forest
sonality(10) may be additional factors contributing to the foods to be consumed more frequently and in larger quan-
high incidence of food insecurity among forest food con- tities, given that 100% of the interviewed respondents
sumers. Levang et al.(63) also reported that the forest food reported that they often consumed forest foods. However,
hunters and gatherers in southern and eastern Cameroon the study was limited by the seasonal availability of forest
suffer worse food insecurity than those practising agri- plant foods. Among the Lama Forest community of Benin(53),
culture. Similar studies conducted among the forest com- eight of the sixty-one known wild species were found to be
munities of DR Congo(12) and Benin(53) revealed that prepared in the local diets. Among the local residents of
despite the communities having access to an environment Hamar and Konso regions of Ethiopia, fifteen wild edible
rich in forest foods, low dietary intake and high food species were identified and reported to be important(69),
insecurity were rampant. The seasonality of forest foods, while in DR Congo(12), only fifteen forest food species were
the annual and regional variations in food availability, and consumed daily. Among the Usambara forest communities of
the small portion sizes of forest foods consumed were Tanzania, ninety-two wild edible species were described, of
reported to be major contributors to food insecurity in DR which twenty-six were consumed and exclusively obtained
Congo(12), Benin(53) and Burkina Faso(64). Other scholars from forests(57). Among the Guiziga tribe in the far north of
have observed that dietary fat and other energy sources Cameroon, twenty-four forest and wild foods were identified
are limited in Congo Basin forest communities, leading to as being important, but few of these foods were eaten
food insecurity(65). Further studies are needed to clarify daily(66). Previous studies indicate that forest food consumers
Public Health Nutrition
10 R Fungo et al.
in southern and eastern Cameroon appreciated forest foods generation through forest commercialization and/or par-
for being tasty, healthy, nutritious, part of their forest com- ticipatory domestication of priority forest foods.
munity culture and also that many forest foods had market
and commercial potential(15,63). However, advocating for an
increase in knowledge and consumption of forest foods Acknowledgements
alone will not suffice to tackle the nutritional problems
encountered by the local populations in southern and east- Acknowledgements: The authors wish to thank the field
ern Cameroon. The potential of forest foods to contribute to assistants and the village key informants for assistance with
food and nutrition security has been neglected for decades data collection in forest concessionaires of the southern site
and needs crucial reorganization(24). National and regional (FIPCAM) and eastern site (SCTB). Financial support: The
policy makers, researchers, development agencies, authors wish to thank the Congo Basin Forest Fund (CBFF)
community-based organizations and local populations need of the African Development Bank and the CGIAR Research
to invest in agroforestry and agrobiodiversity. Integration of Programme on Forests, Trees and Agroforestry for funding
traditional fruit trees, vegetables, wild edible animals, tubers support. The funders had no role in the design, analysis or
such as wild yam and others into agroforestry systems writing of this article. Conflict of interest: None declared.
and home gardens for better food and nutrition security, Authorship: R.F. led the data collection process, performed
sustainability and biodiversity conservation should be statistical analysis and drafted the manuscript. J.M., M.K.,
promoted. A.K., C.A.O., P.D., O.T., J.C.T., J.L. and L.S. contributed to
conception and design of the protocol, supervised the study
and revised critically the manuscript. All authors read and
Conclusions approved the final manuscript. Ethics of human subject
participation: This study was conducted according to
As a result of the high incidence of food insecurity (83·5%) guidelines laid down in the Declaration of Helsinki and all
among our sample populations, food and nutrition inse- procedures involving human subjects were approved by the
curity was not alleviated by access to a large number of ethical committees of the forestry and health departments of
nutritious forest foods from a highly biodiverse forest Bertoua City, the capital of the east region, and Ebolowa City,
environment. However, those who consumed forest foods the capital of the south region. The thirty-six chiefs of the
obtained substantial amounts of the essential nutrients selected villages approved the research protocol. Informed
vitamin A, Fe, Zn and Na from forest foods. Forest foods, if oral consent was also obtained from the participating
consumed in adequate quantities, have the potential to household heads.
improve dietary diversity, food security and nutrient ade-
quacy for forest communities in Cameroon. Supplementary material
Given that more than 52% of the study population
depends on farming as the major household economic To view supplementary material for this article, please visit
activity, investing resources in agricultural interventions http://dx.doi.org/10.1017/S1368980016001324
and policies alongside promotion of the use of nutrient-
rich forest foods to complement the diet would improve
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