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Cambridge Institute for Sustainability Leadership

Nutrition in the first 1,00

The “first 1,000 days” of life (from conception to two years of age) sets the foundation for a child’s health and development and is a recognised window of opportunity for preventing childhood malnutrition and its long-term adverse consequences. Despite progress made on improving child nutrition in sub-Saharan Africa (SSA), less than 15% of children aged 6-23 months receive nutritionally adequate diets, micronutrient deficiencies are widespread, and over half of children with wasting are below two years of age.  

SSA is undergoing rapid urbanisation and shifts towards more '​ultra-processed' foods that are high in sugar, fat, salt, and low in fibre, contributing to the growing consumption of unhealthy foods and obesity in children. In urban areas in SSA, undernutrition (wasting, stunting, underweight and micronutrient deficiencies) and overnutrition (overweight and obesity) now co-exist, sometimes in the same household or individual – a scenario previously described as the double burden of malnutrition.  

To inform strategies for achieving sustained improvement in children’s diets in the first 1000 days in SSA, there is need for improved understanding of not only what households eat in each context but also how they eat, and factors underlying decisions on diets, with a special focus on urban environments. 


Applications in practice

  • Business strategies and models
  • Culture, capacity and leadership
  • Social and political change

 

Contribution to CISL’s core research themes

Inclusive and resilient societies

 

About the project

This research aims to understand drivers of food consumption behaviour in urban environments in Kenya, and to identify the best combination of strategies for achieving sustained improvement in diets of children aged 6-23 months at the lowest financial cost and environmental impact.  

The research takes a systems approach, based on the HPLE framework for sustainable food systems, combining nutrition linear programming, evidence synthesis, and stakeholder engagement techniques with primary data collection on diets, food environments, consumer behaviour, and food supply chains. Data will be collected in two secondary cities at different stages of urbanisation and nutrition transition in Kenya:  Kisumu, the third largest city in Kenya with about 400,000 inhabitants in 2019; and Busia, a rapidly growing border town in Western Kenya with about 100,000 inhabitants. This design will enable the project to gain a better understanding of the linkages, trade-offs, and synergies required to achieve desired food system outcomes (including diets, nutrition and environmental sustainability) in rapidly urbanising environments. 

The food systems approach also provides opportunities for bringing together various groups of stakeholders, including businesses and policy makers, to co-develop strategies for achieving sustainable healthy diets in the contexts of ongoing rapid urbanisation and climate change.

 

Impact and relevance  

This is an inter-disciplinary project involving academic experts, non-academic actors, and policy makers to generate evidence, practical insights and recommendations on:  

  1. The best combination of strategies for achieving sustained improvement in diets of children aged 6-23 months. 
  2. Actions for businesses and policy makers to increase availability, affordability and consumption of healthy diets in the first 1000 days in city environments.  
  3. The need and potential approach (es) for tracking progress towards sustainable healthy diets in secondary city environments in Kenya.  

The project plans to collaborate with internationally recognised research and development organisations working in Kenya for synergies between projects, inter-disciplinary thinking, and learning and engagement with policy makers and non-academic actors. We are currently exploring collaborations with Save the Children, Sight and Life, and the University of Nairobi (departments: Agricultural Economics; Food Science, Nutrition and Technology); and partnering with a consumer company to gain an in-depth insight on drivers of food consumption behaviour in these urban settings. We are also engaging with national and regional government officials in Kenya, with the aim of involving them in research development, implementation, and knowledge translation to inform practical solutions. 

 

Workstreams and outputs

WP1: Urban Food Environments 

WP1 will follow the Cost of Diet Method to assess the availability and affordability of preferred local, nutrient-rich foods for children in Busia town and Kisumu city, Kenya, and estimate the minimum cost of meeting nutrient requirements for children aged 6-23 months and their households. Collaborator: Save the Children. 

  • Outputs: a report providing an in-depth analysis on availability and affordability of healthy diets for complementary feeding in Busia and Kisumu.  

WP2: Consumer Behaviour and Diets 

WP2 will conduct qualitative studies (market scans, household ethnographies, household diaries, and shop-along observations) in Busia and Kisumu, Kenya to gain insights on consumer behaviour, drivers of food choice, and primary barriers to consuming nutritious foods in the first 1000 days. Collaborators: Dalberg Research, and the University of Nairobi (dept. Food Science, Nutrition and Technology). 

  • Outputs: (1) a paper providing an in-depth analysis on consumer behaviour and factors underlying decisions on diets of children aged 6-23 months in secondary city environments; (2) supervision of one MSc dissertation (Applied Human Nutrition).  

WP3: Food Supply Chains and Environmental Impacts 

WP3 will map supply chains for nutritious foods identified as critical for improving diets of children aged 6-23 months in Busia and Kisumu, Kenya and engage stakeholders to understand current food production systems and identify potential actions to increase sustainable production and affordability. Collaborator: University of Nairobi (dept. Agricultural Economics). 

  • Output: (1) a paper providing an in-depth analysis on the nature of supply chains for selected priority foods, strengths, weaknesses, opportunities and threats, and recommendations for policy makers and businesses. (2) supervision of one MSc dissertation (MSc. Agricultural Economics). 

WP4: Strategies for Optimising Diets in Urban Environments 

WP4 will use linear programming techniques to test potential strategies for improving diets in the first 1000 days of life, developing models of interventions that might enable households to meet their nutrient requirements at the lowest financial cost and environmental impact in Busia and Kisumu. The modelling will be conducted in consultation with stakeholders to identify the best combination of strategies for improving diets. Collaborator: Save the Children. 

  • Outputs: (1) a paper providing an in-depth analysis of potential strategies for improving diets in the first 1000 days within the broader context of household nutrition in Busia and Kisumu; (2) a report outlining key strategies and recommendations for policy makers and business to promote sustainable healthy diets for all, in the context of urbanisation in secondary cities in Kenya. 

 

Collaborators and funding

This work is supported by a philanthropic gift from Royal DSM through the Brighter Living Foundation.

Contact

Dr Florence Nabwire

Prince of Wales Fellow in Public Health Nutrition in Sub-Saharan Africa supported by Brighter Living Foundation

Email: florence.nabwire@cisl.cam.ac.uk

"Undernutrition is a long-standing public health problem in sub-Saharan Africa and overnutrition is an emerging issue especially in urban areas. To develop innovative strategies for addressing this growing double burden of malnutrition and micronutrient deficiencies, there is need to understand not only what people eat but also how they eat, and the drivers of food choice in each context. “Without good data, we’re flying blind” – Kofi Annan."

Dr Florence Nabwire