“We don’t eat what we want, we eat what get”: Understanding household drivers of stunting and its implications for improving Kenya’s human capital

Abstract

Abstract Background: There is low progress towards reducing malnutrition among children under five years in Kenya. Given the layered effects of stunting on human capital development, there is need to examine the cross-interaction of drivers of stunting at the household level often examined individually. We explored the cross interaction of drivers of stunting during the early years of children at household level and how it sustains high levels of stunting in five diverse counties of Kenya. Methods: We explored the social context influencing nutrition with 30 stakeholders from four sub-sectors at the sub-national level using in-depth interviews. Twenty-one Focus Group Discussions were conducted to identify persistent drivers of stunting, and opportunities for improving nutrition during early years. Case narratives with 144 selected household members were conducted with families with a stunted child and those without any form of malnutrition. Results: Livelihood and economic context perpetuate poverty affecting food intake. Persistent bad weather patterns threaten food availability while unfavorable market systems impact household nutrition status. High cost of farm inputs force farmers to sell high-quality produce leaving those that cannot meet market quality for household consumption. Inability to plant variety of crops and use modern methods of farming partly due to knowledge gaps and financial constraints perpetuates small scale farming. This compounded with land ownership and adjudication process limits communities to use their farms effectively for maximum economic outputs. Low income affects ability to access and prepare adequate and nutritious food limiting dietary diversity. Poor community understanding of stunting limiting timely remedial action while superstition, stigma, shame delay early detection. Inherited practices facilitate feeding patterns based on value and taboos associated with certain foods. Family structure interacts with livelihood patterns affecting child-feeding while perception of food adequacy and quality affect dietary diversification. Finally, institutional interactions with children before school generates a gap for early action where an intervention window is missed. Conclusion: The first 1000 days are pivotal period in a child’s development and confer multi-layered health and economic benefits in a child’s future life and therefore to the society at large. Stunting, a marker of chronic undernutrition, impedes not only the physical health of the child but also capacity for full education, skills development, and therefore future earnings. This study illustrates unique perspectives from the household level as to why stunting persists in Kenya with practical solutions to inform pragmatic and policy design to ensure comprehensive responsiveness to household realities.