Qualitative accounts of school-aged children’s diets during the covid-19 pandemic in rural, central, kenya

Nutrients, Volume 13, No. 10, Year 2021

Interpretation

The COVID-19 pandemic has caused disruption to food security in many countries, including Kenya. However, the impact of this on food provision to children at an individual level is unknown. This small study aimed to provide a qualitative snapshot of the diets of children during the COVID-19 pandemic. During completion of 24-h food recalls, with 15 families with children aged 5–8 years, caregivers were asked about changes they had made to foods given to their children due to the pandemic. Food recalls were analysed to assess nutrient intakes. Qualitative comments were thematically analysed. Most of the families reported making some changes to foods they provided to their children due to COVID-19. Reasons for these changes fell into three themes, inability to access foods (both due to formal restriction of movements and fear of leaving the house), poorer availability of foods, and financial constraints (both decreases in income and increases in food prices). The COVID-19 pandemic has affected some foods parents in rural Kenya can provide to their children. Participants included 15 families of children aged between 4.8 and 7.6 years. Families were recruited from two rural communities in Laikipia East in central Kenya. Both communities (Chuma and Matanya) are located about 15 km south-west of Nanyuki, the nearest town. Participants were recruited as part of a larger ongoing study funded by the UKRI Global Challenges Research Fund (via ESRC, see funding sources), with 80 families taking part in multiple mealtime observations at home and school in Kenya and Zambia. Researchers used existing contacts to local primary schools, whose preschool teachers verbally invited eligible families to take part. Where families were interested in the study, they were given more details about the procedures by local researchers who shared information sheets and consent forms with participants, reading out and explaining items whenever necessary. The study team have a long-standing relationship with these communities which aided participation. Participating parents gave written informed consent, either by signing or providing a thumb print, depending on literacy levels. For the measures reported in this study, parents provided details in interviews, prior to local COVID-19 lockdown restrictions, or over the telephone after lockdown restrictions. Child anthropometric data were collected in schools by trained teachers and research assistants after the lockdown restrictions were lifted (March 2021). Parents were asked open-ended questions about the impact of the pandemic on the child’s food provision. In particular, as part of each 24-h recall, parents were asked whether the child’s food was typical on that day (and if not, what was different and why), and for each food/drink item whether there was any specific impact of COVID-19 on what the child had consumed (i.e., on the food which the family was able to provide). Data were entered into NViVo version 12 [5] for analysis. The Kenyan Demographics and Health Survey Tool (https://dhsprogram.com/ accessed on 1 June 2020), education and poverty indicators were adapted and used to gain information about maternal and paternal education and family demographics. The dietary recall procedure was adapted to local standards in line with recommendations from the GloboDiet-Africa team [6] and extensively piloted with a team of local preschool teachers and research assistants. Parents completed the 24 h recalls on behalf of their child. Parents completed a 24-h dietary recall over the telephone with a local, trained, researcher. Recalls were completed on three separate days (two weekdays, and one Sunday) in the course of two weeks. Three-repeated 24-h recalls has been shown to yield similar nutrient intakes as three days of prospective weighed food diaries in children in rural Kenya [7], furthermore a review of use of 24 h recalls in low-income countries shows that fewer days of reporting is needed due to the limited variability in individual dietary intakes [8]. Parents provided information about all foods that their child had consumed in the 24-h period preceding the interview. In addition to the information concerning the time and location of snacks and/or meals, the foods consumed (including foods, beverages, condiments, sauces and spreads), brand information, preparation methods, and portion sizes were collected. Grams/day of each food item was calculated for each child and the Food Composition Tables from Kenya [9] were then used to calculate mean daily nutrient intakes. These were compared to nutrient intake recommendations as outlined in the joint FAO/WHO 2002 report [10] and each child was identified as having an adequate or inadequate intake for their age category. The joint FAO/WHO 2004 report on energy requirements [11], was used to determine those with adequate or inadequate energy (kcal) intakes, based on age, sex and weight. Child height and weight were collected in schools by a team of teachers/research assistants trained in using measuring materials. The scales used were Ramtons RM304, which were re-calibrated before each measurement. Height was measured using a yardstick after marking the child’s height on a wall. All measures were taken by one team member and confirmed by a second member of the team. Children were weighed in their school uniforms with shoes removed. Child height and weight were converted to weight for height for age Z scores (WHZ), and height for age (HFA) Z scores, using the WHO AnthroPlus software version 1.0.4 [12]. Children were classed as underweight if their WHZ z scores were ≤−2SD. Having overweight or obesity were defined as >2SD and >3SD, respectively. Stunting was defined as HFA ≤ −2SD. The qualitative data were collected by local, trained fieldworkers in the language requested by the participant (either Kikuyu, Kiswahili, or English). The fieldworkers were fluent in all three languages, and they translated the data from the local language into English. The qualitative data were then analysed by two UK researchers (RC and MJ) through a process of data familiarisation, independent and inductive coding, and grouping of codes into themes. Codes and themes emerging from the data were discussed with researchers in Kenya (PW and HZ) to ensure that results were not biased by cultural assumptions. Consensus on coding and theme generation was reached through discussion. Reports of particular food/drink items that were altered in the diet were extracted from the statements to produce a list of commonly excluded foods. The summary statistics of the quantitative data (n, percentages, mean (sd)) were analysed in Stata version 14.0 [13].

AI Digest

Study Justification:

The study aimed to investigate the impact of the COVID-19 pandemic on the diets of school-aged children in rural, central Kenya. The COVID-19 pandemic has disrupted food security in many countries, including Kenya, but the specific effects on children’s food provision at an individual level were unknown. This study sought to provide a qualitative snapshot of the changes made to children’s diets during the pandemic.

Highlights:

– The study included 15 families with children aged 5-8 years from two rural communities in central Kenya.
– Caregivers were interviewed about changes made to their children’s diets due to the pandemic, and 24-hour food recalls were analyzed to assess nutrient intakes.
– Three main themes emerged from the qualitative analysis of the data: inability to access foods, poorer availability of foods, and financial constraints.
– Most families reported making changes to the foods they provided to their children due to COVID-19.
– The study provides valuable insights into the challenges faced by parents in rural Kenya in providing adequate diets for their children during the pandemic.

Recommendations:

Based on the findings of this study, the following recommendations can be made:

1. Improve access to food: Measures should be taken to ensure that families have easier access to food, both in terms of physical access and affordability.
2. Enhance food availability: Efforts should be made to improve the availability of nutritious foods in rural areas, particularly during times of crisis such as the COVID-19 pandemic.
3. Address financial constraints: Strategies should be implemented to support families in overcoming financial constraints that limit their ability to provide nutritious diets for their children.

Key Role Players:

To address the recommendations, the following key role players are needed:

1. Government agencies: Government departments responsible for food security and nutrition should play a leading role in implementing policies and programs to improve access to food and address financial constraints.
2. Non-governmental organizations (NGOs): NGOs working in the field of nutrition and food security can provide support and resources to implement interventions at the community level.
3. Local communities: Community members, including parents, teachers, and community leaders, should be actively involved in identifying and implementing solutions to improve children’s diets.

Cost Items:

While the actual costs will vary depending on the specific interventions implemented, the following cost items should be considered in planning the recommendations:

1. Infrastructure and logistics: Costs associated with improving physical access to food, such as transportation and storage facilities.
2. Education and awareness campaigns: Costs related to raising awareness about nutrition and providing education on healthy food choices.
3. Subsidies and financial support: Budget allocation for providing financial assistance to families in need, such as cash transfers or food vouchers.
4. Capacity building: Investment in training programs for community members and healthcare professionals to enhance their knowledge and skills in nutrition and food security.
Please note that the above cost items are general considerations and may vary based on the specific context and interventions implemented.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study used qualitative methods to gather data from 15 families in rural Kenya, providing insights into the changes in children’s diets during the COVID-19 pandemic. The researchers used existing contacts with local primary schools to recruit participants and collected data through interviews and anthropometric measurements. The qualitative data were analyzed thematically, and nutrient intakes were assessed. The study provides valuable information about the impact of the pandemic on food provision to children in rural Kenya. However, there are a few limitations that could be addressed to improve the strength of the evidence. First, the sample size is small, which may limit the generalizability of the findings. Increasing the sample size would provide a more representative picture of the situation. Second, the study relied on self-reported data from parents, which may introduce bias. Including objective measures, such as dietary assessments or biomarkers, would enhance the validity of the findings. Finally, the study did not include a comparison group, making it difficult to determine the extent to which the changes in children’s diets were specifically due to the pandemic. Adding a control group would allow for better interpretation of the results. Overall, while the study provides valuable insights, addressing these limitations would strengthen the evidence.

Abstract

Participants included 15 families of children aged between 4.8 and 7.6 years. Families were recruited from two rural communities in Laikipia East in central Kenya. Both communities (Chuma and Matanya) are located about 15 km south-west of Nanyuki, the nearest town. Participants were recruited as part of a larger ongoing study funded by the UKRI Global Challenges Research Fund (via ESRC, see funding sources), with 80 families taking part in multiple mealtime observations at home and school in Kenya and Zambia. Researchers used existing contacts to local primary schools, whose preschool teachers verbally invited eligible families to take part. Where families were interested in the study, they were given more details about the procedures by local researchers who shared information sheets and consent forms with participants, reading out and explaining items whenever necessary. The study team have a long-standing relationship with these communities which aided participation. Participating parents gave written informed consent, either by signing or providing a thumb print, depending on literacy levels. For the measures reported in this study, parents provided details in interviews, prior to local COVID-19 lockdown restrictions, or over the telephone after lockdown restrictions. Child anthropometric data were collected in schools by trained teachers and research assistants after the lockdown restrictions were lifted (March 2021). Parents were asked open-ended questions about the impact of the pandemic on the child’s food provision. In particular, as part of each 24-h recall, parents were asked whether the child’s food was typical on that day (and if not, what was different and why), and for each food/drink item whether there was any specific impact of COVID-19 on what the child had consumed (i.e., on the food which the family was able to provide). Data were entered into NViVo version 12 [5] for analysis. The Kenyan Demographics and Health Survey Tool (https://dhsprogram.com/ accessed on 1 June 2020), education and poverty indicators were adapted and used to gain information about maternal and paternal education and family demographics. The dietary recall procedure was adapted to local standards in line with recommendations from the GloboDiet-Africa team [6] and extensively piloted with a team of local preschool teachers and research assistants. Parents completed the 24 h recalls on behalf of their child. Parents completed a 24-h dietary recall over the telephone with a local, trained, researcher. Recalls were completed on three separate days (two weekdays, and one Sunday) in the course of two weeks. Three-repeated 24-h recalls has been shown to yield similar nutrient intakes as three days of prospective weighed food diaries in children in rural Kenya [7], furthermore a review of use of 24 h recalls in low-income countries shows that fewer days of reporting is needed due to the limited variability in individual dietary intakes [8]. Parents provided information about all foods that their child had consumed in the 24-h period preceding the interview. In addition to the information concerning the time and location of snacks and/or meals, the foods consumed (including foods, beverages, condiments, sauces and spreads), brand information, preparation methods, and portion sizes were collected. Grams/day of each food item was calculated for each child and the Food Composition Tables from Kenya [9] were then used to calculate mean daily nutrient intakes. These were compared to nutrient intake recommendations as outlined in the joint FAO/WHO 2002 report [10] and each child was identified as having an adequate or inadequate intake for their age category. The joint FAO/WHO 2004 report on energy requirements [11], was used to determine those with adequate or inadequate energy (kcal) intakes, based on age, sex and weight. Child height and weight were collected in schools by a team of teachers/research assistants trained in using measuring materials. The scales used were Ramtons RM304, which were re-calibrated before each measurement. Height was measured using a yardstick after marking the child’s height on a wall. All measures were taken by one team member and confirmed by a second member of the team. Children were weighed in their school uniforms with shoes removed. Child height and weight were converted to weight for height for age Z scores (WHZ), and height for age (HFA) Z scores, using the WHO AnthroPlus software version 1.0.4 [12]. Children were classed as underweight if their WHZ z scores were ≤−2SD. Having overweight or obesity were defined as >2SD and >3SD, respectively. Stunting was defined as HFA ≤ −2SD. The qualitative data were collected by local, trained fieldworkers in the language requested by the participant (either Kikuyu, Kiswahili, or English). The fieldworkers were fluent in all three languages, and they translated the data from the local language into English. The qualitative data were then analysed by two UK researchers (RC and MJ) through a process of data familiarisation, independent and inductive coding, and grouping of codes into themes. Codes and themes emerging from the data were discussed with researchers in Kenya (PW and HZ) to ensure that results were not biased by cultural assumptions. Consensus on coding and theme generation was reached through discussion. Reports of particular food/drink items that were altered in the diet were extracted from the statements to produce a list of commonly excluded foods. The summary statistics of the quantitative data (n, percentages, mean (sd)) were analysed in Stata version 14.0 [13].

Materials

N/A

Innovations

Based on the provided description, here are some potential innovations that could improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can provide remote access to healthcare professionals, allowing pregnant women to receive prenatal care and consultations without having to travel long distances.

2. Mobile health applications: Developing mobile applications that provide information and resources on maternal health, including prenatal care guidelines, nutrition advice, and appointment reminders, can help improve access to essential maternal health information.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care, education, and support to pregnant women in rural areas can help bridge the gap in access to maternal health services.

4. Transportation solutions: Improving transportation infrastructure and implementing transportation services specifically for pregnant women in remote areas can help overcome geographical barriers and ensure timely access to maternal health facilities.

5. Maternal health clinics: Establishing dedicated maternal health clinics in rural areas can provide comprehensive prenatal care, delivery services, and postnatal care closer to where women live, reducing the need for long-distance travel.

6. Mobile clinics: Setting up mobile clinics that travel to remote communities can bring essential maternal health services directly to pregnant women who may have limited access to healthcare facilities.

7. Health education programs: Implementing community-based health education programs that focus on maternal health, including prenatal care, nutrition, and hygiene practices, can empower women with knowledge and promote healthier pregnancies.

8. Public-private partnerships: Collaborating with private healthcare providers to expand access to maternal health services in underserved areas can help increase the availability of quality care for pregnant women.

9. Financial incentives: Providing financial incentives, such as subsidies or cash transfers, to pregnant women in rural areas can help alleviate the financial burden of accessing maternal health services and encourage utilization.

10. Maternal health awareness campaigns: Conducting targeted awareness campaigns to educate communities about the importance of maternal health and the available services can help increase demand and utilization of maternal health services.

It’s important to note that these recommendations are general and may need to be tailored to the specific context and needs of rural communities in Kenya.

AI Innovations Description

The study described in the provided text aimed to understand the impact of the COVID-19 pandemic on the diets of school-aged children in rural Kenya. The study used qualitative methods, including interviews and food recalls, to gather information from 15 families with children aged 5-8 years. The findings revealed that most families made changes to the foods they provided to their children due to the pandemic, primarily due to the inability to access foods, poorer availability of foods, and financial constraints.

Based on these findings, a recommendation to improve access to maternal health could be to develop innovative solutions that address the challenges faced by families in accessing nutritious foods during times of crisis, such as the COVID-19 pandemic. This could include:

1. Strengthening local food production: Supporting and promoting community-based agriculture initiatives can help increase the availability of nutritious foods within rural communities. This can be done through training, providing resources, and creating networks for farmers to share knowledge and resources.

2. Improving food storage and preservation: Developing and promoting appropriate technologies for food storage and preservation can help families maintain access to nutritious foods during times of limited availability. This can include techniques such as drying, canning, and fermentation.

3. Enhancing food distribution systems: Establishing efficient and reliable food distribution systems can help ensure that nutritious foods reach families in remote and underserved areas. This can involve collaborations between local farmers, community organizations, and government agencies to improve transportation, storage, and delivery of food.

4. Promoting nutrition education and behavior change: Providing education and resources on nutrition, meal planning, and cooking skills can empower families to make informed choices and optimize the use of available resources. This can be done through community workshops, mobile applications, or radio programs.

5. Strengthening social safety nets: Implementing or expanding social safety net programs, such as cash transfers or food assistance programs, can provide temporary relief to families facing financial constraints and food insecurity. These programs can be designed to specifically target vulnerable populations, including pregnant women and young children.

By implementing these recommendations, it is possible to develop innovative solutions that improve access to maternal health by addressing the challenges faced by families in accessing nutritious foods during times of crisis.

AI Innovations Methodology

Based on the provided description, the study aims to understand the impact of the COVID-19 pandemic on the diets of school-aged children in rural Kenya. The study collected qualitative data through interviews with parents and analyzed nutrient intakes based on 24-hour food recalls. Here are some potential recommendations for improving access to maternal health:

1. Mobile Health Clinics: Implementing mobile health clinics that travel to rural areas can improve access to maternal health services. These clinics can provide prenatal care, vaccinations, and health education to pregnant women and new mothers who may have limited access to healthcare facilities.

2. Telemedicine: Introducing telemedicine services can enable pregnant women to consult with healthcare professionals remotely. This can be particularly beneficial for women in remote areas who may have difficulty traveling to healthcare facilities. Telemedicine can provide prenatal check-ups, counseling, and support, reducing the need for physical visits.

3. Community Health Workers: Training and deploying community health workers can help improve access to maternal health services. These workers can provide basic prenatal care, health education, and referrals to healthcare facilities. They can also conduct home visits to monitor the health of pregnant women and provide postnatal care.

4. Health Education Programs: Implementing health education programs targeted at pregnant women and their families can improve maternal health outcomes. These programs can focus on topics such as nutrition, hygiene, breastfeeding, and birth preparedness. Providing accurate and culturally appropriate information can empower women to make informed decisions about their health.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify key indicators to measure the impact of the recommendations, such as the number of prenatal visits, maternal health knowledge, and maternal health outcomes (e.g., maternal mortality rate, infant mortality rate).

2. Data collection: Collect baseline data on the selected indicators before implementing the recommendations. This can include surveys, interviews, and existing data sources.

3. Implement the recommendations: Introduce the recommended interventions, such as mobile health clinics, telemedicine services, community health worker programs, and health education programs.

4. Monitor and evaluate: Continuously monitor the implementation of the recommendations and collect data on the selected indicators. This can involve tracking the number of women accessing maternal health services, assessing changes in knowledge and behavior through surveys, and analyzing maternal health outcomes.

5. Compare data: Compare the data collected after implementing the recommendations with the baseline data to assess the impact. This can involve statistical analysis to determine if there are significant improvements in the selected indicators.

6. Adjust and refine: Based on the evaluation results, make adjustments and refinements to the recommendations as needed. This can involve scaling up successful interventions, addressing any challenges or barriers identified, and continuously improving the programs.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and assess their effectiveness in addressing the specific needs of the population in rural Kenya.

Author

Dima Health

Statistics:

Citations: 2

Identifiers:

DOI: 10.3390/nu13103543

Research Areas:

COVID, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Social Determinants

Study Countries:

Kenya, Multi-Countries, Zambia

Study Design:

Cohort Study, Cross Sectional Study, Exploratory Study

Study Approach:

Mixed-methods, Qualitative, Quantitative