Consumer Demand for Milk and the Informal Dairy Sector Amidst COVID-19 in Nairobi, Kenya

Background

The coronavirus disease 2019 (COVID-19) pandemic has had large negative effects on countries' economies and individual well-being throughout the world, particularly in low- and middle-income countries. Pandemic-related changes in behavior and government restrictions in Kenya may have negatively affected food supply chains and household food access; however, the empirical evidence is currently limited.

Objectives

The study explored changes in informal milk markets, dairy consumption, and food insecurity among low-income households in urban and periurban Nairobi, Kenya, following the start of the COVID-19 pandemic in the country.

Methods

Baseline data on milk sales and consumption were collected in late 2019 from dairy vendors operating in the informal sector and their dairy customers. We conducted 2 longitudinal telephone surveys with the same study participants in July and September-October 2020, respectively.

Results

At the first follow-up, the volume of milk sold by informal vendors had dropped by 30% compared with their baseline level, and the volume of milk from informal markets consumed by households decreased by 23%. By the second follow-up, the volume of milk sold and consumed had recovered somewhat but remained lower than the volume observed 1 y prior in the same season. Large reductions in the consumption of other animal-sourced products were also observed. The rate of food insecurity increased by 16 and 11 percentage points in the first and second follow-up periods, respectively, compared with baseline.

Conclusions

The evidence, therefore, suggests that the timing of the pandemic and the related restrictions were associated with a decrease in the supply and consumption of milk from informal markets in Nairobi and a decrease in the food security of periurban consumers.

Stunting and Wasting Among Indian Preschoolers have Moderate but Significant Associations with the Vegetarian Status of their Mothers

BACKGROUND

India has high rates of child undernutrition and widespread lactovegetarianism.

OBJECTIVES

The objective of this study was to examine how nutrition outcomes varied among Indian preschool children in relation to the vegetarian status of their parents.

METHODS

The 2015-2016 National Family Health Survey (NFHS) and the 2011-2012 National Sample Survey (NSS) were used to explore associations between parental vegetarian status and child stunting and wasting at ages 0-59 mo and anemia at ages 6-59 mo. In the NFHS, self-reports on usual consumption of foods were used to classify maternal diets, whereas in the NSS lactovegetarianism was defined at the household level.

RESULTS

Compared with children of nonvegetarian mothers, children aged 24-59 mo of lactovegetarian mothers were 2.9 percentage points (95% CI: -4.0, -1.9) less likely to be stunted and children aged 6-23 mo were 1.6 points less likely to be wasted (95% CI: -3.0, -0.03), whereas children aged 6-23 mo with vegan mothers were 5.2 points more likely to be stunted (95% CI: 0.1, 9.4). When compared with nonvegetarian households, lactovegetarian households had better socioeconomic status and were more likely to consume dairy frequently. Children in nonvegetarian households consumed nondairy animal-sourced foods (ASFs) with relatively low frequency. The frequency of maternal dairy consumption was significantly associated with lower risks of child stunting and wasting.

CONCLUSIONS

Anthropometric outcomes differed by maternal vegetarian status, which is itself strongly associated with socioeconomic position, location, religion, and caste.

Vegetarianism and Child Growth: Within-District Evidence from the 2015–2016 Indian National Family Health Survey (P10-032-19)

Objectives

Most research on stunting in India ignores the role of diets, including the unusually high prevalence of lacto-vegetarianism (LVG). LVG is a concern in India because nutrient-dense animal-sourced foods (ASFs) are highly recommended in early childhood. We therefore explore how parental LVG is associated with linear growth and child dietary patterns in India.

Methods

We use the 2015–2016 National Family Health Survey-4 from India. Our primary outcomes are height-for-age Z scores (HAZ) and stunting (HAZ <-2) (n = 214,165) for children 0–59 m. We use 24-hour recall measures of whether a child consumed a specific food group in the past 24 hours both as a secondary outcome variable and as an explanatory variable in HAZ/stunting regressions. Our main explanatory variable is whether the child's mother reports never consuming non-dairy ASFs (LVG). We use descriptive statistics to report patterns of LVG by state, rural/urban location, caste and wealth quintile, and patterns of HAZ, stunting and dietary outcomes by LVG status. We then use multivariate linear regression models to test for associations between our outcome variables and LVG, stratified by child age, and controlling for district fixed effects and an extensive array of child, parent, household and community controls.

Results

Approximately 30% of mothers in India are estimated to be LVG, although LVG in some states is as high as 70%. Descriptive and regression evidence suggests that children of LVG mothers are much less likely to consume non-dairy ASFs, but more likely to consume dairy and pulses. In multivariate regressions for children 12 months and older, children of LVG mothers are 3.0 percentage points less likely to be stunted, and have 0.09 SDs higher HAZ, on average. Multivariate regressions also show that stunting/HAZ is strongly associated with a child consuming dairy products, but not with consumption of other ASFs.

Conclusions

Despite the widespread concern that children of LVG parents are more likely to be stunted, we find the opposite to be the case, seemingly because LVG children are more likely to consume dairy, and dairy is much more strongly associated with linear growth than other ASFs. From a policy perspective the results strongly emphasize the importance of dairy in both the LVG and non-LVG Indian diet.

Funding Sources

Bill & Melinda Gates Foundation through ARENA, led by International Food Policy Research Institute.

Supporting Tables, Images and/or Graphs

Water, Sanitation, and Child Health: Evidence From Subnational Panel Data in 59 Countries

Water, sanitation, and hygiene (WASH) investments are widely seen as essential for improving health in early childhood. However, the experimental literature on WASH interventions identifies inconsistent impacts on child health outcomes, with relatively robust impacts on diarrhea and other symptoms of infection but weak and varying impacts on child nutrition. In contrast, observational research exploiting cross-sectional variation in water and sanitation access is much more sanguine, finding strong associations with diarrhea prevalence, mortality, and stunting. In practice, both literatures suffer from significant methodological limitations. Experimental WASH evaluations are often subject to poor compliance, rural bias, and short duration of exposure, while cross-sectional observational evidence may be highly vulnerable to omitted variables bias. To overcome some of the limitations of both literatures, we construct a panel of 442 subnational regions in 59 countries with multiple Demographic Health Surveys. Using this large subnational panel, we implement difference-in-difference regressions that allow us to examine whether longer-term changes in water and sanitation at the subnational level predict improvements in child morbidity, mortality, and nutrition. We find results that are partially consistent with both literatures. Improved water access is statistically insignificantly associated with most outcomes, although water piped into the home predicts reductions in child stunting. Improvements in sanitation predict large reductions in diarrhea prevalence and child mortality but are not associated with changes in stunting or wasting. We estimate that sanitation improvements can account for just under 10 % of the decline in child mortality from 1990 to 2015.

Microcredit and willingness to pay for environmental quality: Evidence from a randomized-controlled trial of finance for sanitation in rural Cambodia

Low willingness to pay (WTP) for environmental quality in developing countries is a key research question in environmental economics. One explanation is that missing credit markets may suppress WTP for environmental improvements that require large up-front investments. We test the impact of microloans on WTP for hygienic latrines via a randomized controlled trial in 30 villages in rural Cambodia. We find that microcredit dramatically raises WTP for improved latrines, with 60% of households in the Financing arm willing to purchase at an unsubsidized price, relative to 25% in the Non-financing arm. Effects on latrine installation are positive but muted by several factors, including a negative peer effect: randomly induced purchases by neighbors reduce a household's probability of installing its own latrine. On methodological grounds, this paper shows that a "decision-focused evaluation" can be integrated into academic analysis to provide insight into questions of general interest.

Cost-benefit analysis of a micronutrient supplementation and early childhood stimulation program in Nicaragua

This paper estimates the cost-benefit ratio for an integrated early childhood development program in Nicaragua (PAININ). Using longitudinal data, we estimate the average treatment effects of PAININ including micronutrient sprinkles on the prevalence of anemia and hemoglobin levels among disadvantaged children aged 6-36 months. We also estimate the effects of PAININ excluding sprinkles on cognitive outcomes among children aged 2.5-5 years. In the younger age group the program reduced anemia by 4 percentage points after 8 months and nearly 6 percentage points after 1 year; the latter is a 26% decrease in anemia. In the older age group, the program improved verbal and numeric memory after a year and a half, but the effects were modest (0.13 SD). When analyzing its potential impact on earnings, we conclude that the discounted annual costs of the program per child are less than the discounted annual increase in beneficiary earnings. Specifically, we estimate a cost-benefit ratio of 1.50 from the PAININ plus sprinkles package. Our sensitivity analysis suggests a range for this ratio between 1.30 and 2.30.