Food Security and Dietary Patterns among the Urban Poor in Africa

Persistent poverty and rapid urbanization are important development challenges in most African countries. Although the proportion of people living in extreme poverty in Africa could be reduced over the last few decades, the absolute number of people living below the poverty line continues to rise. At the same time, the share of people living in urban areas has significantly increased since the 1950s, reaching 43% of the total African population in 2017. Strong population growth and urbanization tendencies are both expected to continue in Africa over the next couple of decades. Up till now, food insecurity in Africa was often looked at primarily as a rural issue. Recent trends suggest that a closer look at urban food insecurity and dietary patterns is also warranted. More than in rural areas, urban food consumption is immediately connected to cash income earnings. Other factors that determine urban diets and nutrition include access to good infrastructure, adequate housing, healthcare, and other basic services. However, many of the urban poor live in informal settlements (slums) where they have inadequate access to basic facilities. Slum households are particularly vulnerable to food insecurity, unbalanced diets, and poor nutrition and health. A recent additional facet that may affect urban diets in Africa is the food system transformation with a rapid rise of supermarkets and other modern retailers. Previous research has shown that the modernization of the food retail sector can influence consumer nutrition, but whether or not this is already true also for the urban poor is not yet sufficiently understood. In this dissertation, we analyze food sources and consumption patterns of the urban poor in Africa. In particular, we use cross-section survey data that we collected ourselves from 600 households in the poorest neighborhoods of Nairobi and Kampala, the capital cities of Kenya and Uganda. Nairobi and Kampala are among the largest cities in East Africa. In both countries, over 50% of the urban population is estimated to live in slums. Data were collected using a carefully pretested questionnaire with various sections, including a module on household income sources and food consumption modules at household and individual levels for female adults and children. Household-level food consumption data were collected through a 7-day recall; at the individual level a 24-hour dietary recall was used. We also developed and conducted a choice experiment to elicit consumers’ preferences for nutritionally enhanced foods. The dissertation contains three essays. In the first essay, we use multiple indicators derived from the household- and individual-level data to analyze food security and dietary quality among slum dwellers in Nairobi and Kampala. Very little is known about the diets of slum dwellers as they are often underrepresented in standard household surveys. Given the breadth of data collected, we also compare different indicators. Such comparison can help, for instance, to identify which household-level indicators can be used as proxies for individual diets in situations where individual-level data are unavailable. Our analysis is based on 600 households (300 in Nairobi, 300 in Kampala), 600 children aged 6-59 months (300 in Nairobi, 300 in Kampala) and 582 women aged 15-49 years (299 in Nairobi, 282 in Kampala). Results show that in both cities around 90% of the slum dwellers are food insecure in terms of at least one of the indicators used. Thirty-one percent of the households in Nairobi and 59% in Kampala are undernourished in a calorie sense. Many more have inadequate access to food quantity and quality, at least temporarily. Moreover, a significant proportion of children and women remain below minimum recommended levels of dietary diversity. We find a strong correlation between the different dietary indicators, concluding that household-level indicators can be used as proxies for the diets of women and children when individual-level data are unavailable. Regression analyses confirm that cash income plays a significant role for food security and dietary quality irrespective of the indicator used. People with more stable salaried employment are better off than people who depend on casual employment alone. In the second essay, we pay particular attention to households’ food purchase patterns against the background of the increasing role of supermarkets in urban food retailing. Existing studies show that supermarkets may improve access to diverse foods at affordable prices, but may also encourage a switch from unprocessed to highly-processed and energy-dense foods, thus contributing to overweight and obesity. However, the use of supermarkets in developing countries is positively correlated with household income. Hence, what is true for middle- and upper-income consumers is not necessarily true for low-income consumers. Using our data from urban slum dwellers in Nairobi and Kampala we find that very few of these households actually buy any of their food in supermarkets. Supermarkets account for only 3% and 0.4% of all food expenditures by the urban poor in Nairobi and Kampala, respectively. These households buy most food items in unprocessed form from various traditional retail outlets, including mom-and-pop shops, local markets, and kiosks. We discuss reasons for the low supermarket use of these population segments, and conclude that a focus on the modern retail sector alone will not suffice to ensure food and nutrition security for all. In the third essay, we analyze poor consumers’ preferences for nutritionally enhanced foods using choice-experimental data from the slum households in Nairobi and Kampala. Previous studies have shown that micronutrient fortification and other food-based approaches, such as using more nutritious ingredients in food processing, could help alleviate micronutrient malnutrition. However, little is known about poor consumers’ attitudes towards nutritionally enhanced foods. Would poor consumers purchase foods with more nutritious ingredients, even when nutrition knowledge is limited? And are poor consumers able and willing to pay more for nutritionally enhanced products? We use the example of porridge flour, a widely purchased product among poor urban households in East Africa, to analyze the acceptance of different types of nutritional attributes. Our findings show that consumers generally welcome products that are micronutrient-fortified or include new types of nutritious ingredients. However, willingness to pay for nutritional attributes is small. New ingredients that are perceived to have little effect on taste and appearance are seen more positively than ingredients that may change the product more notably. Based on these findings, we draw several conclusions. (i) A large proportion of the urban poor are food insecure and their diets are largely characterized by consumption of starchy staples with low intake of nutritious foods like fruits and vegetables. Access to adequate and nutritious food is largely constrained by lack of income and lucrative employment. Food and nutrition programs should have a particular focus on vulnerable slum dwellers. (ii) Simple, cost-effective and easy to collect household-level food security and dietary diversity indicators can be used where more detailed individual-level dietary data are not available. (iii) A focus on the modern retail sector alone will not suffice to ensure food and nutrition security for all. The efficiency of traditional food supply chains will also have to be improved to help reduce costs along the supply chains and thus market prices for the end-consumer, (iv) Enhancing the nutrition content of foods using industrial and related food-based approaches could improve access to more nutritious foods among the urban poor. However, such foods should build on local consumption behavior and should not be associated with significant price increases

Building resilient maize production systems with stress-adapted varieties : Farmers' priorities in western Kenya

Maize cropping systems in Kenya, as is true in many other places in Africa, face multiple biotic and abiotic stressors not least climatic ones. Guided by farmers' priorities, maize breeding programs can contribute to the needed resilience against these changes by developing and mainstreaming new generations of maize varieties adapted to these challenges. Using data from 1,400 farmers and applying a multi-criteria choice analysis, this study reports on smallholder farmers' relative valuation of stress tolerance traits. The results showed that farmers were willing to pay significant premiums for tolerance to drought, striga, low nitrogen (nitrogen use efficiency) and fall army worm infestation, in that order. Large scale incorporation of these traits in legacy varieties as well as new ones, can contribute to enhancing maize system resilience and adaptation to changing growing conditions. For seed systems development, these traits can provide the basis for making strong business cases for the replacement of old varieties with new, stress-adapted ones

How important are supermarkets for the diets of the urban poor in Africa?

Many developing countries are undergoing a profound transformation of food systems and retail environments. Especially in urban areas, a rapid growth of supermarkets is observed, which can affect consumer food choices and diets. Supermarkets may improve access to diverse foods at affordable prices, but may also encourage a switch from unprocessed to highly-processed and energy-dense foods that contribute to obesity. However, the use of supermarkets is positively correlated with income. That supermarkets already play an important role for the diets of many urban consumers does not necessarily mean that this is also true for the poorest population segments that are of particular interest for development policy. This article analyzes the diets and food purchase patterns of poor urban consumers in Kenya and Uganda. Representative data were collected from households in the slums of Nairobi and Kampala. The data show that the majority of these households are undernourished. They buy most food items in unprocessed form from various traditional retail outlets, including mom-and-pop shops, local markets, and kiosks. Relatively few sample households buy any of their food in supermarkets. Supermarkets account for only 3% and 0.4% of all food expenditures of slum dwellers in Nairobi and Kampala, respectively. Reasons for the low supermarket use of these poor households are discussed. The findings suggest that a focus on the modern retail sector alone will not suffice to ensure food and nutrition security for all

Does retail food diversity in urban food environments influence consumer diets?

The food environment influences consumer diets in significant yet underexplored ways. In this study, we assess the way in which the Nairobi urban food environment—availability, accessibility, affordability, desirability, convenience and marketing—influences the dietary choices and quality of poor urban consumers, by combining market-level diversity scores (MLDS) with household and individual data collected from resource-poor (slum) neighbourhoods in Nairobi, Kenya. We find that urban-poor settings are characterized by a variety of food retail venues, including informal markets such as kiosks, mom-and-pop shops and tabletop vendors, as well as modern retail outlets such as supermarkets. Most of these food outlets predominantly sell unhealthy, highly-processed and energy-dense foods rather than nutritious foods such as vegetables, fruits and animal products. Our analyses show that supermarkets have the highest MLDS, yet they do not significantly influence the diets of resource-poor households. However, a high MLDS among informal retail outlets has a positive association with diet quality; conversely, open-air markets have a negative association. The nutritional status of urban-poor consumers can be improved by promoting the diversification of healthy, nutritious foods across traditional retail outlets and improving accessibility of the outlets to consumers

Maize variety preferences among smallholder farmers in Ethiopia: Implications for demand-led breeding and seed sector development

Among smallholder maize farmers in Ethiopia (and similar areas in Africa), yield and stress tolerance traits in maize varieties are important. While high yields remain a major objective, breeding and seed system development programs are increasingly based on the recognition that farmers also have an interest in other agronomic and consumption traits. In this paper we illustrate these issues by measuring the trade-offs farmers may be willing to make for specific traits in the mid-altitude maize markets in Ethiopia. Based on Choice Experiments among 1499 respondents, we estimate the preference for a set of agronomic and consumption traits relative to yield. by capturing farmers’ “willingness to sacrifice yield”. The results suggest a significant willingness to sacrifice yield for drought tolerance among both male and female household members, but not for early maturity per se. There was also a high willingness to sacrifice yields for plant architecture traits like closed tip and lodging resistance among male participants, but not among females. Heterogeneity in responses according to gender, education and land area under maize cultivation suggests that market segmentation is necessary for seed system development to become more demand-led and inclusive. Final and realistic segmentation will depend on the commercial viability or social impact potential of each segment

Sustainability of one-time seed distributions: a long-term follow-up of vegetable seed kits in Tanzania

The one-time distribution of vegetable seed kits containing small (2 grams) samples of improved varieties of traditional and exotic vegetables can potentially increase vegetable production and consumption among poor rural households, but evidence is lacking. This study therefore analyzed the extent to which recipients of vegetable seed kits in Tanzania have sustained the use of introduced vegetable varieties. Data came from a random sample of 796 households who directly or indirectly received seed kits between 2012 and 2018, complemented with 10 focus group discussions among seed kit recipients. The results show that 24% of direct recipients are still reproducing the seed of introduced vegetable varieties after a period of 5–10 years, with variation across varieties and the time seed was introduced. The success rate was higher for traditional vegetables than exotic vegetables and higher for women than men. Reasons for not continuing seed use were the lack of knowledge on seed saving, problems with pests and diseases, and reduced germination. Hence, the sustainability of small seed kit distributions can be enhanced by accompanying them with adequate training on seed saving and seed storage

Food Security and Dietary Quality in African Slums

More than half of Africa’s urban population lives in slums. Little is known about their nutritional situation, as slums are often underrepresented in standard surveys. This study analyzes issues of food security and dietary quality in East African slums using household-level and individual-level data collected in Nairobi and Kampala. The household food insecurity access scale (HFIAS) is used as a subjective measure of food security. Moreover, calorie availability and different dietary diversity scores are calculated based on 7-day food consumption recalls at the household level and 24-h dietary recalls at the individual level. The large majority of the slum households are food insecure and suffer from low dietary quality. Rates of undernourishment are considerably higher than what country-level statistics report, suggesting that slum dwellers deserve more explicit attention in initiatives to improve nutrition. Household-level indicators are significantly correlated with individual-level indicators for women and children. This means that household-level data, which are easier to collect, can proxy for individual nutrition up to a certain extent when individual-level data are unavailable. Regression models show that household income is one of the main factors explaining dietary patterns. Hence, facilitating access to lucrative employment is an important entry point for improving nutrition in slums

Poor consumers’ preferences for nutritionally enhanced foods

Purpose Micronutrient malnutrition is a public health problem in many developing countries, especially in the poorest population segments. Fortification and other food-based approaches, such as using more nutritious ingredients in processing, could help to address this problem, but little is known about poor consumers’ attitudes toward nutritionally enhanced foods. The purpose of this paper is to analyze whether poor consumers in Africa would purchase foods with more nutritious ingredients and the related willingness and ability to pay. Design/methodology/approach A survey and choice experiment were conducted with 600 randomly selected households in the poorest neighborhoods of Nairobi (Kenya) and Kampala (Uganda). Participants were asked to choose between various alternatives of porridge flour with different types of nutritional attributes. The data were analyzed with mixed logit models. Porridge flour is widely consumed among the urban poor, so that the example can also provide interesting broader lessons. Findings Poor consumers welcome foods that are micronutrient-fortified or include new types of nutritious ingredients. However, willingness to pay for nutritional attributes is small. New ingredients that are perceived to have little effect on taste and appearance are seen more positively than ingredients that may change food products more notably. Practical implications New nutritionally enhanced foods have good potential in markets for the poor, if they build on local consumption habits and are not associated with significant price increases. Originality/value This is among the first studies to explicitly analyze poor consumers’ preferences for nutritionally enhanced foods

Are consumers at the base of the pyramid willing to pay for nutritious foods?

Base of the Pyramid (BoP) consumers living in the urban informal settlements of developing countries spend over 60% of their income on food, yet malnutrition and micronutrient deficiency remain widespread among these populations, pointing to the inadequacy of the foods they consume in terms of quality and quantity. In this paper we examine BoP consumers’ willingness to pay (WTP) for nutritious multi-composite porridge flour (improved flour) in the informal settlements of East Africa. The analysis is based on experimental data collected from 600 households in the informal settlements of Kampala, Uganda and Nairobi, Kenya (300 in each country) in 2016. We use Tobit regression models to analyse determinants of WTP for the improved porridge flour. Results show that both Kenyan and Ugandan BoP consumers are willing to pay a premium for the improved porridge flour. In addition, providing nutrition information about the flour, characteristics of household head, economic status of the household, and presence of young children between six and 59 months in the household, influence WTP for the safe and nutritious porridge flour. The paper concludes by providing recommendations for enhancing nutrition among poor consumers in the informal settlements of developing countries

Sampled districts, villages and households.

Sampled districts, villages and households.</p