Household food (in)security and nutritional status of urban poor children aged 6 to 23 months in Kenya

Background Millions of people in low and low middle income countries suffer from extreme hunger and malnutrition. Research on the effect of food insecurity on child nutrition is concentrated in high income settings and has produced mixed results. Moreover, the existing evidence on food security and nutrition in children in low and middle income countries is either cross-sectional and/or is based primarily on rural populations. In this paper, we examine the effect of household food security status and its interaction with household wealth status on stunting among children aged between 6 and 23 months in resource-poor urban setting in Kenya. Methods We use longitudinal data collected between 2006 and 2012 from two informal settlements in Nairobi, Kenya. Mothers and their new-borns were recruited into the study at birth and followed prospectively. The analytical sample comprised 6858 children from 6552 households. Household food security was measured as a latent variable derived from a set of questions capturing the main domains of access, availability and affordability. A composite measure of wealth was calculated using asset ownership and amenities. Nutritional status was measured using Height-for-Age (HFA) z-scores. Children whose HFA z-scores were below −2 standard deviation were categorized as stunted. We used Cox regression to analyse the data. Results The prevalence of stunting was 49 %. The risk of stunting increased by 12 % among children from food insecure households. When the joint effect of food security and wealth status was assessed, the risk of stunting increased significantly by 19 and 22 % among children from moderately food insecure and severely food insecure households and ranked in the middle poor wealth status. Among the poorest and least poor households, food security was not statistically associated with stunting. Conclusion Our results shed light on the joint effect of food security and wealth status on stunting. Study findings underscore the need for social protection policies to reduce the high rates of child malnutrition in the urban informal settlements

Intention to use contraception and subsequent contraceptive behavior

Abstract Context: Estimating demand for contraception from married women only may misrepresent unmet need for family planning; given that unmarried women, who are often young, are equally if not more exposed to unwanted pregnancy and have good reasons to practice contraception. Past studies mainly focused on married women, which limits the ability to estimate demand among all women; specifically it is unclear if intention to use contraception among married women predicts use among all women. Methods: The study site is a rural, marginalized district in northern Ghana, where contraceptive use is low based on the complex interplay of culture, preferences and contraceptive availability. The district is a site under demographic surveillance since 1993. Using data collected longitudinally from 1995 to 2003, this study examines if intention to use contraception among all women can be used to predict their actual use. The study also describes the main contraceptive methods used and reasons for non-use in the district. A panel survey was introduced to monitor changes in fertility and contraceptive use following the introduction of a community health and family planning intervention project. Data from the 2001 and 2003 panel survey were used for the analysis. The sample consisted of 2827 non-users of contraception in the baseline year (2001). Logistic regression analysis was used to calculate the adjusted effect of contraceptive intention on future use. Results: About two thirds (65%) of the respondents were in a marital union while 23% had never been married. Among all women, those who expressed the need to use contraception were more than twice as likely to have used contraception when compared with those without such intentions (OR 2.04; CI: 1.47; 2.82). Among the married women, those with intention to use contraception were close to two times as likely to have used contraception compared to those without (OR 1.88; CI: 1.31; 2.72). The main family planning methods used were injectables (55%) followed by prolonged abstinence (22%) and the pill (10%). More than half of the women not using a method reported not being at risk as the main reason for non-use. Results for all women and for married women alone demonstrate that, in this setting, intention can be used to predict future use. Conclusion: Stated contraceptive intention is a significant determinant and measure of future family planning needs when the needs of unmarried women as well as married women are considered. Unmarried women and not only married women should therefore be a focus in family planning studies for their intentions count in determining who is in need of contraception and the nature and scale of that need

The effect of education on household food security in two informal urban settlements in Kenya: a longitudinal analysis

Poverty and food insecurity continue to feature prominently in the global agenda, with particularly close attention being paid to the determinants of food insecurity. However, the effect of education is mixed and remains understudied in low income countries. Using longitudinal data collected between 2007 and 2012 in Kenya, we investigated the effect of household education attainment on food security among poor urban households. Household food security was constructed from a set of four key items while education was the average years of schooling for individuals aged 18 years and above in a household. To determine the association between education attainment and food security, we fitted a random effects generalised ordered probit model. The prevalence of severe food insecurity ranged from 49% in 2008 to 35% in 2012. The ordered probit results showed a significant effect of education on food security. The probability of being food insecure decreased by 0.019 for a unit increase in the average years of schooling for a given household. The effect of education, remained significant even after controlling for household wealth index, a more proximate determinant of food security in a cash-based economy such as the urban slums. The findings highlight the need to focus on the food security status of the urban poor. Specifically, results suggest the need for programs aimed at reducing food insecurity among the urban poor and enhancing household livelihoods. In addition, investment in the education of the slum households may, in the long term, contribute to reduction in the prevalence of food insecurity

The Adoption of Massive Open Online Courses in Selected Sub-Saharan African Countries: The Experiences of Urban Learners

MOOCs is slowly gaining traction in the education provisioning in SSA. Much of this is attributed to governmental and institutional aim of providing quality and affordable universal education to all learners. This chapter explores how MOOCs is affecting access to learning in SSA, with particular bias to urban education context. Evidence adduced in this chapter was adduced from secondary sources, involving review of relevant literature available from internet sources. In the internet sources visited, key search terms that were used in obtaining the relevant resources included but not limited to: ‘MOOCs and education’, ‘MOOCs in Africa’, ‘Education technologies AND MOOCs in Africa’, ‘MOOCs, OERs adoption and adaptability in Africa’, and ‘MOOCs’ challenges in Africa’ among others. It emerged that while MOOCs is gaining the needed traction in the SSA education space, the pace of its development is slow and calls for a more concerted effort from concerned education stakeholders

Predictors of Early Childhood Developmental Outcomes: The Importance of Quality Early Childhood Development and Education (ECDE) Services

Few studies have established the influence of different aspects of early childhood development and education (ECDE) quality on children’s outcomes in low-resourced settings in sub-Saharan Africa. We examined the impact of different aspects of ECDE quality on school readiness in a low-income context. The current study is a cross-sectional sub-study of the Tayari preschool pilot program evaluation. Baseline data were collected from public ECDE centers. Multiple linear regression analysis was used to establish predictors of school readiness, that is, 4-6-year-old children being mentally, physically, socially and emotionally ready to start and succeed in primary school. Teaching experience, availability of textbooks and school facilities were significant predictors; learners’ school readiness scores decreased with each additional year of teachers’ experience, and were higher where school facilities were better, and in schools where textbooks were available. On the other hand, school enrolment, classroom resources, head teacher support, educational attainment and teacher training did not predict school readiness. Promoting quality preschool programs has important implications for policy as it can lead to improved school readiness and later success for children in disadvantaged settings

Improving early childhood development in the context of the nurturing care framework in Kenya: A policy review and qualitative exploration of emerging issues with policy makers

Introduction: The Nurturing Care Framework (NCF) describes “nurturing care” as the ability of nations and communities to support caregivers and provide an environment that ensures children's good health and nutrition, protects them from threats, and provides opportunities for early learning through responsive and emotionally supportive interaction. We assessed the extent to which Kenyan government policies address the components of the NCF and explored policy/decision makers' views on policy gaps and emerging issues.Methods: A search strategy was formulated to identify policy documents focusing on early childhood development (ECD), health and nutrition, responsive caregiving, opportunities for early learning and security and safety, which are key components of the NCF. We limited the search to policy documents published since 2010 when the Kenya constitution was promulgated and ECD functions devolved to county governments. Policy/decision-maker interviews were also conducted to clarify emerging gaps from policy data. Data was extracted, coded and analyzed based on the components of the NCF. Framework analysis was used for interview data with NCF being the main framework of analysis. The Jaccard's similarity coefficient was used to assess similarities between the themes being compared to further understand the challenges, successes and future plans of policy and implementation under each of the NCF domains.Results: 127 policy documents were retrieved from government e-repository and county websites. Of these, n = 91 were assessed against the inclusion criteria, and n = 66 were included in final analysis. The 66 documents included 47 County Integrated Development Plans (CIDPs) and 19 national policy documents. Twenty policy/decision-maker interviews were conducted. Analysis of both policy and interview data reveal that, while areas of health and nutrition have been considered in policies and county level plans (coefficients >0.5), the domains of early learning, responsive caregiving and safety and security face significant policy and implementation gaps (coefficients ≤ 0.5), particularly for the 0–3 year age group. Inconsistencies were noted between county level implementation plans and national policies in areas such as support for children with disabilities and allocation of budget to early learning and nutrition domains.Conclusion: Findings indicate a strong focus on nutrition and health with limited coverage of responsive caregiving and opportunities for early learning domains. Therefore, if nurturing care goals are to be achieved in Kenya, policies are needed to support current gaps identified with urgent need for policies of minimum standards that provide support for improvements across all Nurturing Care Framework domains