Cross-sectional study of drivers of animal-source food consumption in low-income urban areas of Nairobi, Kenya

Milk purchase and consumption patterns in peri-urban low-income households in Kenya

Milk plays an important role in the growth and development of children. In Kenya, it is one of the most produced and consumed animal-sourced foods, but often consumed in small amounts among children of low-income families, especially in urban settings. The aim of the study was to identify household milk purchase and consumption patterns of milk, with emphasis on young children, as well as estimate key determinants of such patterns to identify areas of leverage to increase milk consumption. Results showed that 98% of households purchased unprocessed fresh milk at least once during the 7 days prior to the survey, while only 17% purchased packed pasteurized milk. Findings from the Ordinary Least Squares (OLS) model of purchase behavior suggest that the amount of unpacked milk purchased by households is positively and significantly related to household income, the number of children below the age of 4, and the budget of animal-sourced food. The price and quantities of pasteurized milk purchased were negatively related to the amount of unpacked milk purchased. Consumption patterns for children below the age of 4 showed that milk and dairy products are most commonly consumed as part of dishes than as individual products. Informal markets played a key role in meeting the milk needs of children, but consumption was below recommended amounts. The clear association of income and milk intake calls for efforts from the government to support the dairy sector with policies that promote the availability and affordability of milk, especially for a sector that feeds low-income families, as it is the case with the informal dairy markets.

Gender and sociocultural factors in animal source foods (ASFs) access and consumption in lower-income households in urban informal settings of Nairobi, Kenya

Background

Gender shapes household decision-making and access for nutritious diets, including animal source foods (ASFs) that impact on child health and nutrition status. However, research shows that the poorest households in the urban informal settlements of Nairobi have low ASFs consumption. This study was conducted to explore further from a qualitative perspective the gender, sociocultural factors affecting household ASF consumption this study.

Methods

To explore further on the topic of study, an exploratory qualitative study was carried out to establish the factors that influence access, allocation and consumption of animal source foods (ASFs) by households in urban informal settings of Nairobi. Nineteen focus group discussions with men and women were conducted to enable in-depth exploration of ASFs consumption.

Results

Gender influences decision-making of household ASFs dietary intake. Gendered power dynamics prevail with men as breadwinners and household heads often determining the food access and consumption of ASFs. Women are increasingly accessing short-term waged-based incomes in urban informal settings and now play a role in food and nutrition security for their households. This enforces the idea that women’s decision-making autonomy is an important aspect of women empowerment, as it relates to women’s dietary diversity and subsequently, better household nutritional status. As evidenced in this study, if a woman has bargaining power based on accessing incomes to support their household food needs, she will not jeopardize food security. The mobile digital money platform was key in enabling access to resources to access food. Use of trust to access food on credit and purchasing smaller packaged quantities of food were also enablers to access of food/ASFs.

The geo-spatial perspective of biological, social and environmental determinants of early pregnancy anaemia in rural Sri Lanka: Need for context-specific approaches on prevention

We provide a novel approach to understanding the multiple causations of maternal anaemia in a geospatial context, highlighting how genetics, environment and socioeconomic disparities at the micro-geographical level lead to the inequitable distribution of anaemia. All first-trimester pregnant women registered for the antenatal care programme in Anuradhapura District, Sri Lanka from July to September 2019 were invited to the Rajarata Pregnancy Cohort (RaPCo), which assessed the prevalence of anaemia in early pregnancy. The combination of the prevalence of anaemia and minor haemoglobinopathy-related anaemia (MHA) with the poverty headcount index of the 22 health divisions in the district was investigated using GeoDa spatial K-means clustering. Sociodemographic and economic data at the divisional level were compared between identified clusters. Combining the analysis with the geographical and environmental characteristics of the region, further hypotheses regarding anaemia in this community were formulated. The study included data from 3,137 pregnant women in early pregnancy. The anaemia and MHA prevalence varied from 13.6 to 21.7% and from 2.6% to 5%, respectively. We identified four distinct spatial clusters. The cluster with the highest anaemia prevalence also included high poverty and the highest prevalence of MHA. The clusters had significant differences with regard to ethnic distribution, access to water, sanitation and dietary patterns. Areas supplied by major irrigation projects had significantly low levels of anaemia, probably attributable to internal migration and improved livelihood. It was evident that genetic, socioeconomic and environmental risk factors were grouped at the divisional level, and that their complex interactions make controlling anaemia with blanket interventions unsuccessful. Analysis of the distribution of heterogeneous risk factors at the micro-geospatial level helped identify context-specific approaches to tackle anaemia in pregnancy.

The potential economic benefits of insect-based feed in Uganda

Black soldier fly farming is gaining traction globally as a strategy for recycling organic waste into high-quality proteins and fat for feed and organic fertilizer for crop production. The support of governments in East Africa to integrate insect meal in livestock feed has opened opportunities for commercializing insect products. Understanding the potential value of Black soldier fly larvae meal (BSFLM) is paramount to inform policies and practices to promote insect farming and insect-based feed for livestock production. This paper uses the economic surplus method to generate evidence on the potential socioeconomic impact of replacing conventional soybean and fish meal protein sources with insect-based feed (IBF), BSFLM, in Uganda. Results indicate that substitution of IBF for existing protein sources will generate net economic benefits of USD 0.73 billion in 20 years (0.037 billion per year). The benefit-cost ratio is estimated at 28:1, and the internal rate of return is 138%, indicating that the insect-based animal feed industry is a profitable investment. Even in the worst-case scenario, when the replacement rate of IBF and its economic benefits are reduced by half, the benefit-cost ratio remains high (8:1). The estimated economic benefit can lift about 4.53 million people above the poverty line in the country. It can also create about 1,252─563,302 new jobs per annum, depending on the substitution rate of conventional protein feeds with IBF (0.1%─45%). Uganda has the potential to produce from about 3,244 tons to 1.5 million tons of IBF. Similarly, using the same replacement rates, the country can produce about 695─312,678 tons of NPK fertilizer from biowaste recycling. About 0.09-41 million tons of biowaste could be recycled, depending on the replacement rate of conventional feed sources with IBF. Our results justify that investing in the insect feed value chain can contribute to Uganda's economic, social, and environmental sustainability.

Effects of COVID-19 on dietary behavior of urban consumers in Nairobi, Kenya

The disruptions wrought by the COVID-19 pandemic on food systems worldwide have endangered food and nutrition security for many consumers. The resource-poor, especially those in urban areas, are more susceptible to pandemic-related disturbances. This study uses primary data collected from 2,465 households located in and outside of informal settlements (slums) in Nairobi, Kenya to assess how COVID-19 and related public-health measures have influenced diets of urban consumers, their purchasing patterns and overall food security. Questions about food security and consumption behavior, including household dietary diversity scores, were used to capture the pre- and mid-pandemic situation. The data show that low-income households in the informal settlements were more affected than middle-income households. About 90% of slum households reported dire food insecurity situations, including being unable to eat preferred kinds of food, eating a limited variety of foods, consuming smaller portions than they felt they needed, and eating fewer meals in a day. With a score of four food groups out of nine, household in the informal settlements have lower dietary diversity than middle-income households, whose score is five out of nine. The consumption of nutritious foods, including fruits, vegetables, and animal products, fell among people living in slums during the pandemic. In addition to assessing dietary changes, this study highlights the factors associated with quality food consumption during the pandemic period such as household income levels and male-vs-female headed households. Our research demonstrates the need to attend to slums and vulnerable, poor consumers when enacting mitigation measures or designing and implementing policy.

Behavioural drivers of suboptimal maternal and child feeding practices in Rwanda: An anthropological study

At 33% of under-5s, stunting rates in Rwanda remain stubbornly high, as do figures for maternal (25% of pregnant women) and childhood anaemia (37%). Intensive communication and education campaigns have provided caregivers with high levels of knowledge about best practices in Maternal, Infant and Young Child Nutrition (MIYCN), but this is not translating into the improved diets which could contribute to reducing rates of stunting. Deploying an anthropological approach via multi-module Focused Ethnographic Studies carried out within household case studies, the research team sought to understand drivers of suboptimal feeding practices in a sample of 30 households across all of Rwanda's districts. The sample included households with pregnant women as well as children in the 6-60 month age range. Analysed against a framework of proximal and underlying causes of under-nutrition, our results reveal gaps in the knowledge-capability-practice chain resulting from decisions and prioritisations taken by caregivers and heads-of-household. Pregnant women and mothers of young children possess high levels of knowledge about feeding themselves and their young children, but this is not reflected in decision-making and prioritisation around the acquisition and feeding of animal source foods, whose consumption is low among both groups. This was found to be true even in households which own and raise livestock. Turning to policy and programmes, we argue for a move towards incentivized human capital programming focusing on the 'last mile' behaviour change which is needed to translate knowledge and capability into better dietary choices.

Dietary Diversity and Dietary Patterns in School-Aged Children in Western Kenya: A Latent Class Analysis

Inadequate diet among children has both immediate and long-term negative health impacts, but little is known about dietary diversity and dietary patterns of school-aged children in rural Kenya. We assessed dietary diversity and identified dietary patterns in school-aged children in Western Kenya using a latent class approach. We collected dietary intake using a 24 h dietary recall among students in elementary schools in two rural villages (hereafter village A and B) in Western Kenya in 2013. The mean (SD) age was 11.6 (2.2) years in village A (n = 759) and 12.6 (2.2) years in village B (n = 1143). We evaluated dietary diversity using the 10-food-group-based women’s dietary diversity score (WDDS) and found a mean (SD) WDDS of 4.1 (1.4) in village A and 2.6 (0.9) in village B. We identified three distinct dietary patterns in each village using latent class analysis. In both villages, the most diverse pattern (28.5% in A and 57.8% in B) had high consumption of grains, white roots and tubers, and plantains; dairy; meat, poultry, and fish; and other vegetables. Despite variation for some children, dietary diversity was relatively low for children overall, supporting the need for additional resources to improve the overall diet of children in western Kenya.

Animal Source Food Social and Behavior Change Communication Intervention Among Girinka Livestock Transfer Beneficiaries in Rwanda: A Cluster Randomized Evaluation

A social and behavior change communication intervention designed to promote consumption of cow’s milk among families that received a cow from a government livestock transfer program increased mothers’ knowledge and awareness of milk consumption. Although intervention exposure was associated with increased frequency of children’s cow’s milk intake, it did not lead to increased consumption or dietary diversity.

Animal source foods (ASFs), including cow’s milk, contain essential nutrients and contribute to a healthy diet, but frequency of intake is low among children in low- and middle-income countries. We hypothesized that an ASF social and behavior change communication (SBCC) intervention implemented by community health workers (CHWs) would increase child milk consumption and dietary diversity in households that received a cow from the Government of Rwanda’s Girinka livestock transfer program. We tested the 9-month SBCC intervention among children aged 12–29 months at baseline in administrative cells randomly assigned to the intervention or control. Most mothers in the intervention group were exposed to CHWs’ home visits (90.7%) or community-level activities (82.8%). At endline, more mothers in the intervention group compared with the control group knew that cow’s milk was an ASF (90.1% vs. 81.7%, P=.03) and could be introduced to children at 12 months (41.7% vs. 18.7%, P<.001). More mothers in the intervention group compared with the control group knew they should feed their children ASFs (76.2% vs. 62.1%, P=.01) and give them 1 cup of cow’s milk per day (20.6% vs. 7.8%, P<.001). Children’s consumption of fresh cow’s milk 2 or more times per week increased in the intervention group, although not significantly (8.0 percentage points, P=.17); minimum dietary diversity was unchanged. Children in the intervention group had increased odds of consuming cow’s milk 2 or more times per week if their mothers recalled hearing that children should drink 1 cup of cow’s milk per day during a CHW’s home visit [odds ratio (OR) 2.1, 95% confidence interval (CI) (1.1, 3.9)] or a community activity [OR 2.0, 95% CI (1.2, 3.5)]. Approximately half of the children had no milk during the past week because their households produced too little or sold what was produced. In poor households receiving a livestock transfer, strategies to further tailor SBCC and increase cow’s milk production may be needed to achieve larger increases in children’s frequency of milk consumption.

Consumer perceptions of food safety in animal source foods choice and consumption in Nairobi's informal settlements

Background

Animal-source foods (ASFs) are high-quality nutrient-dense products key to reducing stunting and micronutrient deficiencies. However, their consumption among the poorest households in urban informal settlements is low. Several drivers beyond price, including health considerations have been reported to drive ASF choice and consumption among consumers. This current study explores consumer perceptions of food safety associated with animal source foods (ASFs) consumption in urban informal settlements with a view to unpacking the health considerations driving their choice and consumption.

Methods

Coupled households with children 6–59 months formed the study sample. The Food Environments Working Group (FEWG) Framework of the Agriculture and Nutrition for Health academy (ANH) was used to guide the study which utilized qualitative methods namely, 60 in-depth interviews (IDIs), 19 focus group discussions, and 19 key informant interviews (KIIs) complemented by unstructured observations. Data were transcribed and analysed according to emerging themes.

Results

Consumer perceptions of food safety are driven by concerns about food production, processing, handling, storage and the health risks associated with consumption of the ASFs. For all the ASFs, lack of traceability of source, unhygienic environments in which they were sold and health risks around consuming too much or improperly cooked products were key perceptions from the community. To mitigate against food safety risks, consumers used strategies such as boiling the ASFs, purchasing their products from trusted retailers, avoiding vendors in unhygienic environments and reducing the amount and frequency of consumption of ASFs or totally avoiding their consumption.

These consumer perceptions are increasingly influencing the ASFs choice and consumption in low-income populations besides other drivers. Notably, given limited incomes that influence their purchasing power and the need for nutritious diets that included ASFs, the dilemma of quality vis-a-vis quantity persists and consumers still accessed and consumed these ASF products to supplement their diets.

Conclusions

To enhance food safety for ASFs, as well as assure consumer access to safe ASFs from informal markets, there is need to contextualize the value chain as informed by consumer perceptions on food safety as these influence their ASFs choice and consumption.

Fish Acquisition and Consumption in the African Great Lakes Region through a Food Environment Lens: A Scoping Review

Effective actions for the fishery and aquaculture sectors to contribute toward improving nutrition rely on an understanding of the factors influencing fish intake, particularly amongst vulnerable populations. This scoping review synthesises evidence from 33 studies in the African Great Lakes Region to examine the influence of food environments on fish acquisition and consumption. We identified only two studies that explicitly applied a food environment framework and none that linked policy conditions with the contribution of fish to diets. Economic access to fish was represented in the largest number of included studies (21 studies), followed by preferences, acceptability and desirability of fish (17 studies) and availability and physical access (14 studies). Positive perceptions of taste and low cost, relative to other animal-source foods, were drivers of fish purchases in many settings; however, limited physical and economic access were frequently identified as preventing optimal intake. In lakeside communities, fish were increasingly directed toward external markets which reduced the availability and affordability of fish for local households. Few studies considered intra-household variations in fish access according to age, gender or physiological status, which represents an important knowledge gap. There is also scope for future research on seasonal influences on fish access and the design and rigorous evaluation of programmes and policies that address one or more constraints of availability, cost, convenience and preferences.

The Importance of a Food Systems Approach to Low and Middle Income Countries and Emerging Economies: A Review of Theories and Its Relevance for Disease Control and Malnutrition

Our review explores the changing food production, distribution and consumption environment in low and middle-income countries and emerging economies as a basis for framing how to study food systems in order to address public health issues of food safety and nutrition. It presents the state of knowledge on existing food systems science and its use in terms of sustainable actions for food safety and public health. The review identifies a knowledge gap in food system mapping and governance, with value chain mapping of key commodities often missing. Despite a number of initiatives, the application of food systems methods is highly variable in scope and quality. Most analyses concentrate on specific commodities, rarely taking into account the need for a whole diet approach when looking at nutrition or the assessment of a range of infectious agents and their interactions when looking at food safety. Of the studies included in the review there is a growing observation of “informal” food systems, a term used inconsistently and one that requires revision. “Informal” food systems link to the formal sector to provide food security, yet with trade-offs between economic efficiencies and food safety. Efforts to improve food safety are hampered by inadequate food safety capacities and a lack of policy coherence leading to: inadequate investment; fragmented food quality control systems; weak or non-existent traceability mechanisms; weak foodborne disease surveillance; obsolete food regulation; and weak regulatory enforcement. In-depth food systems assessments can complement risk analysis to identify risky behaviors and understand institutional settings in order to improve codes of practice and enforcement. Methods for looking at food safety from a food systems perspective are emerging, yet existing nutrition and food systems science are not advancing sufficiently in response to nutritional public health problems. There is an urgency for improved understanding of the structure and drivers of the food systems, for better planning of changes that leads to nutrients access and healthy levels of eating. It is proposed that countries and international institutions provide an atlas of food system maps for the key commodities based on an agreed common methodology and developed by multidisciplinary teams.

The Nairobi Pork Value Chain: Mapping and Assessment of Governance, Challenges, and Food Safety Issues

The Nairobi pork food system is a growing livestock sub-sector which serves as a source of food and livelihood to its inhabitants. The study aimed to map Nairobi's pork value chains, assess their governance, operational challenges and their impacts on food safety risks and management practices. Qualitative data were collected in seven focus group discussions and 10 key informants' interviews on animal movements and product flows, stakeholders' interactions, perceptions on system governance and challenges, and on their potential impact on food safety management. Quantitative data were obtained to show the importance of flows, business operations and market share. Thematic analysis was conducted to identify themes that provide understanding on the governance, challenges and food safety practices in each profile. The predominant chains identified were [1] The “large integrated company” profile which accounted for 83.6% of pork marketed through abattoirs, and was based on a well-structured supply system, with owned farms (representing 50% of their supply), contract farms and semi-contract farms and [2] Local independent abattoirs, accounting for 16.4%, are privately owned small-scale production, supplied mainly (70%) by small farmers from the immediate neighboring areas. The main challenges associated with governance themes included; (i) Inadequate/lack of enforcement of existing regulation (ii) Negative effect of devolution system of governance (iii) Pig traders' dominance (iii) Lack of association at all system nodes, and (iv) Male dominance across the pig system. The main challenges reported included; (i) Lack of capital to upscale (ii) Poor infrastructure (iii) Pig shortage (iv) Excessive regulation (v) Lack of training (vi) Diseases (v) Lack of knowledge (vi) Unfair competition. Food safety themes were associated with (i) Inadequate slaughter facilities forcing traders/farmers to undertake home slaughter (ii) Lack of knowledge on disease management (iii) Lack of training on hygienic practices in the slaughterhouse and (iv) Lack/insufficient capital to purchase equipment's to ensure proper hygiene e.g., boilers. The study provides insights into the structure of the pork system supplying Nairobi, the governance issues important to the stakeholders, challenges and food safety issues. The framework obtained can be used by policy makers and researchers to investigate and develop pork industry and for food safety and disease control programmes.

MILK Symposium review: Foodborne diseases from milk and milk products in developing countries-Review of causes and health and economic implications

Dairy production is rapidly increasing in developing countries and making significant contributions to health, nutrition, environments, and livelihoods, with the potential for still greater contributions. However, dairy products can also contribute to human disease in many ways, with dairyborne disease likely being the most important. Health risks may be from biological, chemical, physical, or allergenic hazards present in milk and other dairy products. Lacking rigorous evidence on the full burden of foodborne and dairyborne disease in developing countries, we compiled information from different sources to improve our estimates. The most credible evidence on dairyborne disease comes from the World Health Organization initiative on the Global Burden of Foodborne Disease. This suggests that dairy products may has been responsible for 20 disability-adjusted life years per 100,000 people in 2010. This corresponds to around 4% of the global foodborne disease burden and 12% of the animal source food disease burden. Most of this burden falls on low- and middle-income countries (LMIC). However, the estimate is conservative. Weaker evidence from historical burden in high-income countries, outbreak reports from LMIC and high-income countries, and quantitative microbial risk assessment suggest that the real burden may be higher. The economic burden in terms of lost human capital is at least US$4 billion/yr in LMIC. Among the most important hazards are Mycobacterium bovis, Campylobacter spp., and non-typhoidal Salmonella enterica. The known burden of chemical hazards is lower but also more uncertain. Important chemical hazards are mycotoxins, dioxins, and heavy metals. Some interventions have been shown to have unintended and unwanted consequences, so formative research and rigorous evaluation should accompany interventions. For example, there are many documented cases in which women's control over livestock is diminished with increasing commercialization. Dairy co-operatives have had mixed success, often incurring governance and institutional challenges. More recently, there has been interest in working with the informal sector. New technologies offer new opportunities for sustainable dairy development.

Review: Mitigating the risks posed by intensification in livestock production: the examples of antimicrobial resistance and zoonoses

Major shifts in how animals are bred, raised and slaughtered are involved in the intensification of livestock systems. Globally, these changes have produced major increases in access to protein-rich foods with high levels of micronutrients. Yet the intensification of livestock systems generates numerous externalities including environmental degradation, zoonotic disease transmission and the emergence of antimicrobial resistance (AMR) genes. Where the process of intensification is most advanced, the expertise, institutions and regulations required to manage these externalities have developed over time, often in response to hard lessons, crises and challenges to public health. By exploring the drivers of intensification, the foci of future intensification can be identified. Low- and middle-income (LMICs) countries are likely to experience significant intensification in livestock production in the near future; however, the lessons learned elsewhere are not being transferred rapidly enough to develop risk mitigation capacity in these settings. At present, fragmentary approaches to address these problems present an incomplete picture of livestock populations, antimicrobial use, and disease risks in LMIC settings. A worldwide improvement in evidence-based zoonotic disease and AMR management within intensifying livestock production systems demands better information on the burden of livestock-associated disease, antimicrobial use and resistance and resources allocated to mitigation.

How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the "Balanced Plate" Intervention

Social, cultural, environmental and economic factors closely regulate the selection, allocation and consumption of maternal diets. We developed a nutrition behaviour change intervention to promote a balanced diet in pregnancy through practical demonstration in rural Bangladesh and tested the impact with a cluster randomised controlled trial. This paper presents the findings of the process evaluation and describes the strategies that worked for intervention compliance. We conducted in-depth interviews with pregnant women, women who birthed recently, and their husbands; focus groups with mothers and mothers-in-law; key-informant interviews with community health workers, and observations of home visits. We identified six key areas within the intervention strategy that played a crucial role in achieving the desired adherence. These included practical demonstration of portion sizes; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women’s social networks; and harnessing community health workers’ social role. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in their kitchen or neighbours’ kitchen were the most commonly mentioned reasons for acceptance of the intervention by the women and their families. The balanced plate intervention helped women through practical demonstration to learn about a balanced meal by highlighting appropriate portion sizes and food diversity. The women needed active involvement of community health workers in mobilising social support to create an enabling environment essential to bring changes in dietary behaviours. Future implementation of the intervention should tailor the strategies to the local context to ensure optimal adherence to the intervention.

Investigation of the governance structure of the Nairobi dairy value chain and its influence on food safety

The dairy value chain of Nairobi is comprised, in its majority, of small-scale independent enterprises that operate within a complex interlinked system. In this complexity, the coordination and power structures of the system may have major influences on the management of dairy food safety. Therefore, the aim of this study was to investigate the governance structure and challenges faced by stakeholders throughout the Nairobi dairy value chain and assess their potential implications on food safety. Qualitative data were collected through focus group discussions and key informant interviews based on a dairy value chain mapping framework previously developed. Thematic analysis enabled identification of governance themes, key challenges and analysis of their implications on food safety. Themes were organized depending on their association with farmers (informal settlement or peri-urban), dairy cooperatives, dairy traders, processing companies, retailers or government officers. The identified governance themes included: i) weak linkage between government and farmers, ii) inadequate compliance with government regulations by traders and retailers, iii) emphasis on business licenses and permits for revenue rather than for food safety, iv) multiple licensing resulting in high business cost and lack of compliance, v) fragmented regulation, vi) unfair competition and vii) sanctions that do not always result in compliance. The key challenges identified included, among others: i) inadequate farmer support, ii) harassment of traders and retailers and iii) high business costs for traders, retailers, dairy cooperatives and large processors. The implication of governance and challenges of food safety were, among others: i) inadequate extension services, ii) insufficient cold chain, iii) delivery of adulterated and low milk quality to bulking centers, iv) inadequate food safety training and v) lack of policies for management of waste milk. The range of issues highlighted are based on stakeholders' perceptions and reflects the complexity of the relationships between them. Many of the governance themes demonstrate the linkages that are both beneficial or confrontational between the formal and informal sectors, and between industry and regulatory authorities, with possible direct food safety consequences. Findings obtained provide indications to decision-makers of potential governance areas that could help improve efficiency and food safety along the dairy value chain.

Paucity of Nutrition Guidelines and Nutrient Quality of Meals Served to Kenyan Boarding High School Students

Adequate nutrition is vital for the optimal growth, development, and general well-being of adolescents. A lack of nutritional guidelines for school meals poses a major challenge in the provision of nutritious meals to students in Kenyan boarding high schools. The aim of the study was to investigate the nutrient quality and portion sizes of meals served to students and the adequacy of the meals in meeting students’ health requirements. A cross-sectional study was carried out among 50 catering or kitchen managers of 50 high schools in Kenya. Data were obtained through researcher-assisted questionnaires. It was established that menus were simplistic in nature, lacked variety, and were repetitive. With regard to nutrients, menus offered to students were excessively highin dietary fiber, containing three or five times more than the recommended daily intake. In most cases, students were underfed on nutrients such as carbohydrates, vitamin A, folic acid, potassium, calcium, proteins, and vitamins B1–12, resulting in low energy provision. It is concluded that a majority ofthe Kenyan high schools studied do not provide nutritionally adequate meals. The government of Kenya should have nutrition guidelines to ensure that schools provide diets with high foodand nutrient quality to students.

Dietary behaviours in the context of nutrition transition: a systematic review and meta-analyses in two African countries

OBJECTIVE

To synthesise evidence of urban dietary behaviours (macronutrients, types of foods, dietary diversity and dietary practices) in two African countries in relation to postulated changes in the context of nutrition transition.

DESIGN

Systematic review and meta-analyses, including six online databases and grey literature, 1971-2018 (Protocol CRD42017067718).

SETTING

Urban Ghana and Kenya.

PARTICIPANTS

Population-based studies of healthy adolescents and adults.

RESULTS

The forty-seven included studies encompassed 20 726 individuals plus 6526 households. Macronutrients were within WHO-recommended ranges: mean energy intake was 1867 kcal/d (95 % CI 1764, 1969) and the proportions of macronutrients were carbohydrate 61·2 % (58·4, 64·0), fat 25·3 % (22·8, 28·0) and protein 13·7 % (12·3, 15·1). The proportion of population consuming fruit and vegetables was 51·6 %; unhealthy foods, 29·4 %; and sugar-sweetened beverages (SSBs), 39·9 %. Two-thirds (68·8 %) consumed animal-source proteins. Dietary diversity scores were within the mid-range. Meal patterns were structured (typically three meals per day), with evidence lacking on snacking or eating out.

CONCLUSIONS

Population-level diets fell within WHO macronutrient recommendations, were relatively diverse with structured meal patterns, but some indications of nutrition transition were apparent. The proportion of population consuming fruit and vegetables was low compared to healthy-eating recommendations, and consumption of SSBs was widespread. A paucity of evidence from 1971 to 2010 precluded a longitudinal analysis of nutrition transition. Evidence from these two countries indicates which aspects of dietary behaviours may be contributing to increasing overweight/obesity, namely a low proportion of population consuming fruit and vegetables and widespread consumption of SSBs. These are potential targets for promoting healthier diets.

The Nutritional and Micronutrient Status of Urban Schoolchildren with Moderate Anemia is Better than in a Rural Area in Kenya

Low diet quality is a driver of general and micronutrient malnutrition in urban and rural areas. The objective was to compare malnutrition and micronutrient deficiencies linked to dietary intake among urban and rural schoolchildren from food insecure settings in Kenya. The cross-sectional study was conducted among urban and rural schoolchildren aged 7–9 years. Height and weight were measured, venous blood samples were assessed and data on dietary intake was collected. After screening out children with hemoglobin >12.2 g/dL and moderate or severe undernutrition, a total of 36 urban and 35 rural children participated. The prevalence of moderate underweight, wasting, and stunting were lower in urban than in rural children, with significant differences in median z-scores for underweight (p < 0.001) and wasting (p < 0.001). Significantly higher values for serum ferritin (p = 0.012) and zinc (p < 0.001) were found in urban children. Yet, the median adequacy ratios were higher for vitamin C (p = 0.045), iron (p = 0.003), and zinc (p = 0.003) in rural than in urban children. General nutritional, iron, and zinc status were significantly better in slightly anemic urban children than in rural ones. Improving the nutrition of schoolchildren in urban and rural settings requires different dietary approaches.

Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study

BACKGROUND

Animal source foods provide high-quality protein and essential micronutrients within the human diet and are of particular significance for the health and development of children. Despite the availability of domestic livestock in rural households of Ethiopia, the diets of children are often monotonous and mainly cereal-based with low energy and nutrient density.

OBJECTIVE

Explore barriers and facilitators for the consumption of animal source foods among 6-23 months old children from the rural communities of Northern Ethiopia.

METHODS

A community-based exploratory qualitative study design was conducted in July through September 2018. A total of eight focus group discussions (56 individuals) and twenty-four qualitative interviews were conducted with mothers who are lactating, fathers, health extension workers, nutrition, and agriculture experts. Purposive sampling technique was used to include study participants based on their potential relevance in delivering a wealth of information. Thematic analysis strategies, a method for identifying, analyzing, and reporting themes within data, were used to code and grouped into related families and synthesize the qualitative data.

RESULTS

Consumption of animal source foods among 6-23 months old children was very low and the home-reared livestock and their products were mainly used for market purposes. Animal products are consumed during special societal occasions since they are considered as luxury food rather than an essential part of daily children's diet. Lack of nutrition knowledge, high cost of animal source foods, mothers' workload to herd livestock, low household income, low milk production, the poor linkage between health and agriculture sectors, and social norms and beliefs were identified as common barriers. While the presence of nutrition experts, cooking demonstrations, in-kind credit programs, livestock ownership, and government-led stunting reduction programs were the facilitators for the consumption of animal source foods in the study communities.

CONCLUSIONS

Reduced consumption of animal source foods inadvertently impacted dietary diversity of 6-23 months old children from the study communities. Thus, strengthening social and behavior change communication to promote the consumption of animal source foods, creating opportunities for women to own small livestock for household consumption and provide nutrition education on dietary restriction of animal source foods during religious periods among 6-23 months old children in the rural communities of Northern Ethiopia are recommended.

Dietary practices and associated factors among pregnant women in West Gojjam Zone, Northwest Ethiopia

Background

The optimal dietary practice is a critical requisite for maternal nutrition. However, the majority of Ethiopian pregnant women have inadequate nutrient intakes. These may be due to their poor dietary habits. Identifying factors affecting the dietary practices of pregnant women is crucial to design appropriate interventions. In this country, the dietary practices of pregnant women and determinants are not well studied. Therefore, the purpose of this study was to assess the dietary practices and associated factors among pregnant women in West Gojjam Zone, Northwest Ethiopia.

Methods

A community-based cross-sectional study was carried out among 712 pregnant women from May to August 2018. Quantitative data complemented with a qualitative method. Pregnant women were selected using a cluster sampling technique. Structured questionnaires were utilized for data collection. Data were entered into Epi-Info version 7.2.2 and exported to SPSS version 23 software for analysis. Data were described using frequencies and mean. A logistic regression analysis was done.

Three focus group discussions and 17 key-informant interviews were conducted for the qualitative data. Focus group discussion participants were mothers, husbands, and health professionals. Typical case and homogeneous sampling techniques were used for the key-informant interviews and focus group discussions, respectively. Thematic analysis was used for the qualitative data.

Results

Only 19.9% of respondents had appropriate dietary practices. On the multivariable logistic regression analyses, being food secure [AOR = 2.25, 95% CI: (1.1, 4.5)], having high edible crop production [AOR = 2.00, 95% CI: (1.2, 3.2)] and a favorable attitude [AOR = 1.69, 95% CI: (1.1, 2.6)] were significantly associated with the appropriate dietary practices of pregnant women. In the qualitative study, lack of knowledge on maternal diet, cultural prohibition, and knowledge gap of the professionals were barriers that interfere with dietary practices during pregnancy.

Conclusion

Pregnant women in the study area are found to have suboptimal dietary practices. Therefore, health professionals should give regular nutrition counseling using cards and role models for promoting diversified food production and consumption.

Is It Possible to Promote Egg Consumption During Pregnancy? Findings From a Study on Knowledge, Perceptions, and Practices in Kenya

Background:

Eggs are nutrient rich and have the potential to improve maternal nutrition during pregnancy and birth outcomes, but cultural beliefs may inhibit consumption during pregnancy.

Objective:

To understand knowledge, attitudes, beliefs, practices, facilitators, and barriers related to consuming eggs during pregnancy in Kenya.

Methods:

The study had 3 phases. Phase I included in-depth interviews and free-listing and pile-sorting exercises with pregnant women (n = 36), husbands (n = 12), and mothers-in-law (n = 12) of pregnant women, and health providers (n = 24). Phase II involved egg preparation exercises with pregnant women (n = 39). Phase III involved a weeklong trial of egg consumption with pregnant women (n = 24). We used thematic content analysis methods to analyze qualitative data and tabulated quantitative data.

Results:

All participants recognized eggs as nutritious for pregnant women; 25% of pregnant women consumed eggs the previous day. However, participants believed eating too many eggs during pregnancy (1 or more eggs daily) leads to a large baby and delivery complications. Unaffordability and unavailability also inhibit consumption. Health workers are the most trusted source of information on maternal nutrition. Almost all women complied with the household trial, said they would continue eating eggs and would recommend eggs to other pregnant women in moderation.

Conclusions:

Although participants believed consuming eggs during pregnancy is beneficial, cultural norms, practices, and beliefs may prevent pregnant women from eating them daily. Interpersonal communication from health workers and agricultural policies to promote affordability could lead to increased consumption.

Integrating Agriculture and Health Research for Development: LCIRAH as an Interdisciplinary Programme to Address a Global Challenge

The multiple burdens of persistent undernutrition and micronutrient deficiencies, along with the rapidly growing rates of overweight, obesity, and associated chronic diseases, are major challenges globally. The role of agriculture and the food system in meeting these challenges is very poorly understood. Achieving food security and addressing malnutrition in all its forms, a Sustainable Development Goal, requires an understanding of how changing food systems affect health outcomes and the development of new tools to design and evaluate interventions. An interinstitutional programme to address this interdisciplinary research challenge is described. Over the past seven years, the Leverhulme Centre for Integrative Research on Agriculture and Health has built a portfolio of successful and innovative research, trained a new cadre of interdisciplinary researchers in "Agri-Health," and built an international research community with a particular focus on strengthening research capacity in low- and middle-income countries. The evolution of this programme is described, and key factors contributing to its success are discussed that may be of general value in designing interdisciplinary research programmes directed at supporting global development goals.