A 3-year cohort study to assess the impact of an integrated food-and livelihood-based model on undernutrition in rural western Kenya

Reducing extreme poverty and hunger is the first Millennium Development Goal (MDG). With undernutrition contributing to one third of all child deaths, improving nutrition is a precondition for accelerating progress towards other MDG targets. While the role of technical interventions such as micronutrient fortification and supplementation in reducing morbidity and mortality has been well documented, evidence to support more comprehensive multi-sectoral approaches remains inconclusive. This chapter aims to evaluate the impact of an integrated food-and livelihood-based model on nutrition-related outcomes in rural western Kenya. A 3-year prospective cohort study was undertaken among 300 randomly selected wealth-stratified households. Detailed socio-economic and health surveys were conducted. A nutrition module assessed household levels of food security, food consumption frequency and diet diversity. This was complemented by anthropometric measurement and assessments of serum levels of vitamin A among children under 5 years old. The average food insecurity score decreased from 5.21 at baseline to 4.13 at follow-up. Average diet diversity scores for daily, weekly and monthly time periods increased from 6.7 to 7.3; from 10.7 to 11.2; and from 12.4 to 12.6, respectively. Daily consumption for 14 out of 16 food groups increased significantly. For children under 2 years of age, underweight and stunting decreased from 26.2% to 3.9% (P= 0.002) and from 62.3% to 38.3% (P = 0.014), respectively. Vitamin A deficiency as measured by serum vitamin A levels decreased from 70.0% to 33.3% (P = 0.007) for children under 5 years old. This study presents encouraging evidence that a multi-sectoral food-and livelihood-based model can improve diet quality, enhance food security and positively affect childhood nutritional outcomes. The wider application of this approach to a diversity of agro-ecological zones in sub-Saharan Africa is currently being assessed.