Constraints and opportunities for implementing nutrition-specific, agricultural and market-based approaches to improve nutrient intake adequacy among infants and young children in two regions of rural Kenya

Christine Hotz, Gretel Pelto, Margaret Armar-Klemesu, Elaine F Ferguson, Peter Chege, Enock Musinguzi, Christine Hotz, Gretel Pelto, Margaret Armar-Klemesu, Elaine F Ferguson, Peter Chege, Enock Musinguzi

Abstract

Several types of interventions can be used to improve nutrient intake adequacy in infant and young child (IYC) diets, including fortified foods, home fortification, nutrition education and behaviour change communication (BCC) in addition to agricultural and market-based strategies. However, the appropriate selection of interventions depends on the social, cultural, physical and economic context of the population. Derived from two rural Kenyan populations, this analysis combined information from: (1) a quantitative analysis to derive a set of food-based recommendations (FBRs) to fill nutrient intake gaps in IYC diets and identify 'problem nutrients' for which intake gaps require solutions beyond currently available foods and dietary patterns, and (2) an ethnographic qualitative analysis to identify contextual factors posing opportunities or constraints to implementing the FBRs, including perceptions of cost, convenience, accessibility and appropriateness of the recommended foods for IYC diets and other social or physical factors that determine accessibility of those foods. Opportunities identified included BCC to increase the acceptability and utilisation of green leafy vegetables (GLV) and small fish and agronomic interventions to increase the productivity of GLV and millet. Value chains for millet, beans, GLV, milk and small fish should be studied for opportunities to increase their accessibility in local markets. Processor-level interventions, such as partially cooked fortified dry porridge mixes or unfortified cereal mixes incorporating millet and beans, may increase the accessibility of foods that provide increased amounts of the problem nutrients. Multi-sectoral actors and community stakeholders should be engaged to assess the feasibility of implementing these locally appropriate strategies.

Keywords: Kenya; behaviour change communication; food value chains; food-based recommendations; fortification; infant and child nutrition.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2015 John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Conceptual framework for the identification of constraints and opportunities to implement food‐based recommendations through nutrition‐sensitive and nutrition‐specific interventions based on dietary assessment and linear programming analysis and focused ethnographic studies examining infant and young child feeding practices, behaviours and beliefs among caregivers.

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