Using cross-sectional data from the poorest neighborhoods of Nairobi (Kenya) and Kampala (Uganda), we have described the food security situation and dietary quality among slum dwellers using multiple indicators. We have also analyzed the association between household- and individual-level food security and dietary indicators –something which had not been done before with a focus on the urban poor. Multiple regression analyses were used to identify factors that influence food security and dietary quality. We have also examined factors that influence slum dwellers’ opportunities and decisions to participate in different employment activities, given that employment income is a major factor in explaining food security and dietary quality. In addition, we have analyzed the dietary patterns of the urban poor and the role of supermarkets and traditional retail outlets for their food purchases. Lastly, we have analyzed poor consumers’
preference for nutritionally enhanced foods and the related willingness to pay, an important element when looking at interventions to control micronutrient deficiency. Our analyses are focused on the urban poor living in informal settlements (slums), as these as often underrepresented in standard household surveys, even though they are most vulnerable to food insecurity and poor diets.
To describe the food security situation and dietary quality of the urban poor, we used multiple indicators derived from the household- and individual-level data. Household-level data were collected using a 7-day dietary recall, while a 24-hour dietary recall was used for individual-level data. Individual-level food consumption data were collected for children aged 6-59 months and women aged 15-49 years. Our results show that a high proportion of the urban poor are food insecure. Based on the household food insecurity access scale (HFIAS), 87% and 93% of households in Nairobi and Kampala are food insecure. The household food consumption data suggest that 31% of the household in Nairobi and 59% in Kampala suffer from calorie deficiencies. This means that the rates of undernourishment in these slum areas are higher compared to those reported in national statistics, as one would expect. Our results also show that irrespective of the indicator used, the majority of the slums dwellers are generally food insecure.
Individual dietary indicators show that 23% and 31% of children in Nairobi and Kampala are below the minimum threshold of four food groups consumed per day. Similarly, 40% and 54% of
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women in Nairobi and Kampala are below the minimum threshold of five food groups. Compared to rural households, one would expect dietary diversity to be relatively higher for urban households. However, the proportion of women consuming below the minimum dietary diversity in the slums is higher than what is reported in most studies carried out in rural areas. This underlines that a particular focus on slum areas is warranted. For children, the situation is similar.
Correlation analyses show high levels of association between the different food security and dietary indicators. For instance, HDDS, which is based on 7-day food consumption data, is a good proxy for household energy consumption and HFIAS. At the individual level, the positive and significant correlation between CDD and MDD-W implies that child indicators can be used as a predictor of women indicators, and vice versa, when complete data for all household members are unavailable. Moreover, HDDS, energy consumption, and HFIAS at the household level are all positively and significantly correlated with individual-level CDD and MDD-W.
These associations hold even after controlling for socio-economic characteristics. We conclude that household-level indicators can be used as proxies for individual-level dietary quality of women and children among the urban poor in Africa.
Regression estimates show that food security and dietary quality are influenced by a number of socio-economic characteristics. Notably, income plays a significant role in urban food security and dietary quality irrespective of the indicator used. This is expected, as urban households are largely dependent on market purchases for food. Yet, it is evident that most households rely on low-wage income generating activities. Although individuals engage in diverse earning activities, their participation in more lucrative income opportunities is contingent on their level of education. For instance, individuals with higher levels of education are more likely to engage in salaried employment - which is positively associated with food security and dietary quality. The majority of the household heads in our sample only have primary levels of education or less, which is generally not sufficient to access more lucrative types of jobs.
We also analyzed the diets and food purchase patterns among the urban poor and found that supermarkets do not yet play an important role for most of these households. Only a relatively small proportion of sample households tend to use supermarkets at all: 21% in Nairobi and 4% in Kampala. The average food budget shares spent in supermarkets are even smaller: 3% in Nairobi and only 0.4% in Kampala. In both cities, poor consumers buy most of their foods in traditional
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retail outlets, especially mom-and-pop shops, local markets, and kiosks. The main reason for the low use could be that most foods sold in supermarkets come in larger packaging sizes, whereas poor households prefer buying smaller quantities of food whenever cash resources are available.
Supermarkets also offer no credits, which some of the traditional retailers do. This does not mean that the urban poor would not consume processed and packaged food items. While unprocessed foods make up the largest share of these people’s regular purchases, some of the cereals and other food groups are also purchased in processed form. But processed foods are also sold by traditional retailers. Hence, it would be wrong to assume that supermarkets kicked off the consumption of processed foods in Africa. We also found that richer households consume more processed foods and also more foods from supermarkets. Hence, the role of supermarkets will likely increase when poor households are gradually getting richer. But even in the highest expenditure tercile of our sample, the food budget shares spent in supermarkets remain well below 10%, suggesting that the supermarket growth in poor urban neighborhoods may be slower than often assumed.
Finally, we used choice-experimental data from 600 households to identify poor consumers’
preferences for nutritionally enhanced foods. Would poor consumers purchase foods with more nutritious ingredients, even when their nutrition knowledge is limited? And are the poor willing and able to pay more for nutritionally enhanced products? These are important questions given that these household are most vulnerable to micronutrient deficiencies. We used the example of porridge flour, a widely purchased product among poor urban households, to analyze the acceptance of different types of nutritional attributes. Regression analyses showed that poor consumers generally welcome porridge flour that is micronutrient-fortified or includes new types of nutritious ingredients, in spite of their low nutritional knowledge and awareness. However, the willingness and ability to pay for the new nutritional attributes is small. In other words, poor consumers are open to purchase nutritionally enhanced foods, but only if the new products are introduced without a significant price markup. In terms of concrete product attributes, new and more nutritious food ingredients that are perceived to have little or no effect on taste, texture, and appearance of established products are judged more positively than ingredients that consumers feel could have more notable changes on product characteristics.
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