Why Nairobi must spread the right food message in an unhealthy environment

Why Nairobi must spread the right food message in an unhealthy environment

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Scientific evidence shows that consuming at least five portions of fruit and vegetables a day can prolong your life and reduce your risk of developing non-communicable diseases such as diabetes and cancer.

Yet not enough people across the world are consuming adequate amounts of fruit and vegetables. In low and middle income countries, over 75% of adults consume less than the minimum recommendation. In Tanzania more than 95% of people consume less than the minimum requirement.

In the slums of Nairobi, our research shows that less than half of the adult population are meeting their daily fruit or vegetable requirements. Instead, as global fast food outlets flood the Kenyan market, they prefer junk food which they see as a status symbol.

This could be why there are high levels of hypertension and diabetes in these slums where one in every five people has one of the two conditions. In addition, we found that less than a quarter of those who had diabetes were aware of their condition. And fewer than 5% of all people with diabetes had their blood sugar under control.

Africa’s fat map

The increase in non-communicable diseases such as diabetes in low and middle income countries is largely driven by rapid urbanisation and preferences for high-calorie diets with decreasing levels of physical activity.

In sub-Saharan Africa alone diabetes sufferers are projected to double from 12 million to 24 million in the next two decades. Evidence from the World Health Organisation shows type 2 diabetes will be the key contributor to this rise.

Several studies from the continent show excessive body weight and obesity as risk factors for diabetes.

A review of the Demographic and Health Survey data from seven African countries over 10 years shows that there are rising trends in overweight and obese urban women. Even more worrying is that the increase is seven times higher among the poorest urban women compared with the richest urban women.

Price is not the problem

Nairobi’s slums are known for their thriving vegetable markets. So, why are slum residents not consuming adequate amounts of fruit and vegetables?

Initially we thought that the price of the fruit and vegetables was prohibitive for slum residents given that the majority of them live on less than $2 a day.

But the price is not the main deterrent. While imported fruit such as pomegranates may, understandably, be expensive, local produce such as bananas or the trendy superfood kale – a Kenyan staple for generations known as sukuma wiki – are affordable.

When we dug a bit deeper through focus group discussions, we found there was a social desirability issue: slum residents wanted junk food because it reflected a higher socioeconomic status.

Their aspirations are linked to a combination of clever marketing, celebrity culture and the social media frenzy around global fast food outlets opening in Kenya.

Several fast food outlets have opened in Nairobi in recent years, encouraging people to eat highly processed food. Noor Khamis/Reuters

And who could blame them? In the past few years, several major global fast food brandshave set up shop in Kenya including KFC chicken and Pizza Hut. And more are said to be eyeing an entrance into East Africa’s largest economy.

Why it’s hard to change eating habits

Trying to find ways to promote fruit and vegetable consumption among slum residents isn’t easy. To add to the problem one of Kenya’s major dailies recently published a bombshell article slamming fruit and vegetables.

According to the article, laboratory tests conducted by scientists on samples of fruit and vegetables from across Nairobi found toxic levels of various substances.

It argued that samples of sukuma wiki had shown high levels of lead, most likely from contaminated riverbeds where the vegetable is typically grown. And samples of bananas and oranges had high levels of calcium carbide, which is used illegally to hasten the ripening of fruit.

The article sparked widespread negative reaction and has exacerbated the challenge of those living in urban slums not eating vegetables.

The World Health Organistion’s recommendations for improving fruit and vegetable intake are pitched at a high policy level. For example, one recommendation is that marketing of food and beverages to children should be restricted.

But for health practitioners on the ground suggestions such as these do not necessarily translate into practical steps to change eating habits.

The challenge health practitioners have is what message do we pass to the residents of Nairobi’s slums? Do we ask them to eat more fruit and vegetables given the revelations in the news article? Or do we ask them to stick with junk food until the relevant authorities get their act together and halt illicit practices affecting the fruit and vegetable industry?

What needs to be done

Clearly this is a catch-22 situation. The newspaper article highlights the need for developing countries like Kenya to review their food and agricultural policies.

There is an urgent need for policies that protect the lives of people by:

  • promoting access to healthy food
  • regulating the production, sale and marketing of junk food (and drinks)
  • ensuring that the food supply chain is free of toxic chemicals, drugs and other contaminants, and
  • minimising the effects of food production on climate change and vice versa.

The policy environment for these interventions is currently weak. And unless the government takes urgent steps to put these policies in place, there is no way to stop people from lining up at the next fast food outlet.

 

Article originally posted by Samuel Oti on the Conversation-Africa website, available at: https://theconversation.com/why-nairobi-must-spread-the-right-food-message-in-an-unhealthy-environment-53513

WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations

WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations

WHO statement: 1 February 2016

Source: http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/

The first meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding clusters of microcephaly cases and other neurologic disorders in some areas affected by Zika virus was held by teleconference on 1 February 2016, from 13:10 to 16:55 Central European Time.

The WHO Secretariat briefed the Committee on the clusters of microcephaly and Guillain-Barré Syndrome (GBS) that have been temporally associated with Zika virus transmission in some settings. The Committee was provided with additional data on the current understanding of the history of Zika virus, its spread, clinical presentation and epidemiology.

The following States Parties provided information on a potential association between microcephaly and/or neurological disorders and Zika virus disease: Brazil, France, United States of America, and El Salvador.

The Committee advised that the recent cluster of microcephaly cases and other neurologic disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern (PHEIC).

The Committee provided the following advice to the Director-General for her consideration to address the PHEIC (clusters of microcephaly and neurologic disorders) and their possible association with Zika virus, in accordance with IHR (2005).

Microcephaly and neurologic disorders

  • Surveillance for microcephaly and GBS should be standardized and enhanced, particularly in areas of known Zika virus transmission and areas at risk of such transmission.
  • Research into the etiology of new clusters of microcephaly and neurologic disorders should be intensified to determine whether there is a causative link to Zika virus and/or other factors or co-factors.

As these clusters have occurred in areas newly infected with Zika virus, and in keeping with good public health practice and the absence of another explanation for these clusters, the Committee highlights the importance of aggressive measures to reduce infection with Zika virus, particularly among pregnant women and women of childbearing age.

As a precautionary measure, the Committee made the following additional recommendations:

Zika virus transmission
  • Surveillance for Zika virus infection should be enhanced, with the dissemination of standard case definitions and diagnostics to at-risk areas.
  • The development of new diagnostics for Zika virus infection should be prioritized to facilitate surveillance and control measures.
  • Risk communications should be enhanced in countries with Zika virus transmission to address population concerns, enhance community engagement, improve reporting, and ensure application of vector control and personal protective measures.
  • Vector control measures and appropriate personal protective measures should be aggressively promoted and implemented to reduce the risk of exposure to Zika virus.
  • Attention should be given to ensuring women of childbearing age and particularly pregnant women have the necessary information and materials to reduce risk of exposure.
  • Pregnant women who have been exposed to Zika virus should be counselled and followed for birth outcomes based on the best available information and national practice and policies.
Longer-term measures
  • Appropriate research and development efforts should be intensified for Zika virus vaccines, therapeutics and diagnostics.
  • In areas of known Zika virus transmission health services should be prepared for potential increases in neurological syndromes and/or congenital malformations.
Travel measures
  • There should be no restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission.
  • Travellers to areas with Zika virus transmission should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites.
  • Standard WHO recommendations regarding disinsection of aircraft and airports should be implemented.
Data sharing
  • National authorities should ensure the rapid and timely reporting and sharing of information of public health importance relevant to this PHEIC.
  • Clinical, virologic and epidemiologic data related to the increased rates of microcephaly and/or GBS, and Zika virus transmission, should be rapidly shared with WHO to facilitate international understanding of the these events, to guide international support for control efforts, and to prioritize further research and product development.

Based on this advice the Director-General declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005). The Director-General thanked the Committee Members and Advisors for their advice.


For further information please contact:

Gregory Hartl
Telephone: +41 22 791 4458
Mobile: +41 79 203 6715
E-mail: hartlg@who.int

Christian Lindmeier
Telephone: +41 22 791 1948
Mobile: +41 79 5006552
E-mail: lindmeierch@who.int

Tarik Jasarevic
Telephone: +41 22 791 5099
Mobile: +41 79 367 6214
E-mail: jasarevict@who.int

Proceedings of Pathways Kenya 2016

Proceedings of Pathways Kenya 2016

Pathways Kenya 2016-3The conference Pathways Kenya 2016 (http://sites.warnercnr.colostate.edu/pathways), took place from January 10-13, 2016 in Nanyuki, Kenya. This conference and training program was designed to address the myriad of issues that arise as people and wildlife struggle to coexist in a sustainable and healthy manner. Their mission is to increase professionalism and effectiveness in the human dimensions of fisheries and wildlife management field.

One of the session titled,”Holistic approaches to livestock–wildlife-environment management”

Livestock, wildlife and environment management is a challenging scenario in the integration of development and environmental conservation. The conflicts over natural resources are increasing with wildlife losing their habitat to competing claims for land. Land degradation is also increasing at an alarming rate in Sub-Sahara Africa. Due to the continued increase in the human population, previously sparsely populated biodiversity rich areas continue to lose resources at an unsustainable rate. As human settlements increase and continue to expand with changing land tenure systems, the livestock wildlife interface is becoming restricted in scope but more complex and problematic. Conflicts result from competition of existing resources especially water and pastures, with implications to disease transmission and predation. Holistic approaches play a central and crucial role in the support of sustainable management and conservation of the livestock-wildlife environments. Specifically, sustainable co-existence between livelihoods and wildlife is of critical importance to conservation of the biodiversity. The session highlighted approaches to one health as an integrative effort of multiple disciplines working at various scales to attain optimal health for people, animals and the environment.

The schedule, associated abstracts and proceedings are available online (schedule:http://programme.exordo.com/pathways2016/).

Nourishing livelihoods: the food vendors sustaining Nairobi’s slums

Nourishing livelihoods: the food vendors sustaining Nairobi’s slums

Selling food in Nairobi’s informal settlements can provide cheap meals and create vital livelihoods, especially for women, but these providers are usually ignored and remain invisible.

Food vendors give people living in Nairobi's informal settlements easy access to fresh food (Photo: Grace Githiri)

Food vendors give people living in Nairobi’s informal settlements easy access to fresh food (Photo: Grace Githiri)

Food vendors play a key role in nourishing their fellow residents in informal settlements, offering ready access to fruit, vegetables, snacks, and cooked foods. But unlike food vendors in markets or downtown streets, vendors in informal settlements are often hidden and overlooked by policymakers.

The Kenyan slum-dweller federation, Muungano wa Wanavijiji, has explored why vendors sell in informal settlements, and revealed the benefits of their accessible, affordable foods. Additionally, Muungano and its partners have uncovered how vendors cope with challenges such as rising food prices, government neglect, and environmental hazards. 

For vendors in Nairobi’s informal settlements, it is always a struggle to earn a livelihood and maintain food safety. Refrigeration is rare, and many water taps are contaminated or far away. Rubbish collection, drainage, and sanitation may be non-existent.

Heavy rains bring muddy footpaths that paralyse mobile vendors and force traders to close their stalls. Preparing, displaying, and storing foods are a constant challenge for vendors (see photos below). 

Environmental hazards for vendors in Viwandani, Nairobi (Photos: Grace Githiri)

Environmental hazards for vendors in Viwandani, Nairobi (Photos: Grace Githiri)

 Muungano has partnered with food vendors to create a new organisation and supportive interventions, which may achieve official recognition and better conditions in their settlements. In turn, vendors and consumers alike should benefit from safer foods and more secure livelihoods.

Shared learning, training, and advocacy

Grassroots-led research in Nairobi‘s informal settlements has highlighted the importance of food vendors and helped develop new ways to support them.

Muungano and the Akiba Mashinani Trust (AMT), which offers financial and technical assistance to the federation, have previously analysed vending in three of Nairobi’s informal settlements (also, see the ‘Cooking up a storm: community-led mapping and advocacy with food vendors in Nairobi’s informal settlements briefing paper).

The partners have now explored vending in two other settlements of Korogocho and Viwandaniusing surveys, maps and focus group discussions with food vendors. 

Korogocho is a large informal settlement located 12km from the city centre, while Viwandani is found in Nairobi’s industrial area. Thanks to an upgrading project that recently improved Korogocho’s roads, water, and other infrastructure, vendors rarely experience the floods, dust, fires, and other hazards that remain common in Viwandani. 

But both settlements have entrenched poverty and elevated risks of violent crime, especially Korogocho. This insecurity makes food vendors vulnerable to theft and may lead them to sharply reduce their operating hours. 

In response, the project has created a Food Vendors’ Association (FVA) to develop supportive interventions and amplify traders’ voices beyond their settlements. Additionally, FVA leaders are organising training for vendors in food handling and hygiene, supported by partners at IIED, the International Livestock Institute, and the African Population Health and Research Centre

Nancy Njoki, an FVA leader, said these initiatives have enhanced environmental awareness among vendors, who have also begun advocating for food markets in their settlements. The project “has helped us redefine advocacy approaches for upgrading sanitation and infrastructure in the informal settlements,” she said.

Benefits, challenges, and women’s roles

A potato seller being surveyed in Korogocho (Photo: Grace Githiri)

A potato seller being surveyed in Korogocho (Photo: Grace Githiri)

Focus groups uncovered several benefits to selling inside informal settlements. Compared to vending in town, these vendors experience less harassment from the city council. Costs for transport and rented stalls are lower, and they can attract higher numbers of customers. 

One result is cheaper food prices, benefiting low-income customers in informal settlements. 

According to one Korogocho food seller, vendors can feed local families for a whole day for just a few shillings (GBP£1 is equivalent to 150 shillings): “For beans, we start selling at 10 shillings. If you have a family, and you have 50 shillings, you can buy rice and soup for 10 shillings [for five people]. And that can cover a day.”

We also found that women are the majority of food vendors, comprising 63 per cent and 81 per cent of food vendors surveyed in Viwandani and Korogocho, respectively. Men predominate as butchers and sell other foods such as roasted corn or chapatti. But women are the main providers of cooked food and vegetables, the two most commonly-sold items (see chart).

Vending near home can offer big advantages to women since they enjoy lower childcare and transport costs; they can better combine their livelihoods and household chores.

Gender and types of food vended in Korogocho

Gender and types of food vended in Korogocho

Alongside these benefits, vendors face political, economic, and environmental challenges. Food prices are rising sharply, but vendors cannot increase their selling prices (due to customers’ low incomes).

They also feel abandoned by Nairobi’s government. Some vendors pay fees to the city council, but receive no services in return. During Nairobi’s periodic cholera epidemics, local officials often scapegoat food vendors and close down their businesses.

As a Viwandani vendor declared: “We feel like there is no government because there’s nothing that we’ve seen done by the government.”

Wider benefits of supporting food vendors

Vendors argued for improving food storage facilities, and they also require adequate water, sanitation, and rubbish collection to reduce floods or other hazards. Many vendors sell along footpaths or main roads, underscoring theneed for upgraded roads to support livelihoods in informal settlements. Providing hygiene training to vendors, as the FVA has recently done, will also improve access to safe foods.

Additionally, vendors require broader initiatives to enhance relations with local government, tackle crime, and create livelihood opportunities for youth.

Korogocho’s vendors consistently identified youth unemployment and insecurity as their major challenges. But with improved livelihoods, they argued that young people would buy from vendors instead of stealing. 

When upgrading informal settlements, food vendors can be a key entry point and spark improvements across their settlements. The same interventions that vendors identified to ensure food safety (roads, water, sanitation and so on) can create wider gains for their fellow residents.

Strategies to help vendors will not only facilitate access to safe foods, but can also bolster livelihoods and well-being in informal settlements more generally.

By nourishing these workers’ livelihoods, policymakers can finally recognise the pivotal role of street foods for the urban poor. With greater policy support and inclusive organisations like the FVA, vendors can lead the way towards healthy food and more equitable development in informal settlements.

Alice Sverdlik is a PhD student in city planning at the University of California, Berkeley, and a former research assistant at IIED. This blog was written with the support of the paper’s co-authors, Grace Githiri, Regina Ngugi and Patrick Njoroge. We gratefully acknowledge FVA and Muungano wa Wanavijiji members, who have inspired and spearheaded this project.

The post originally available at the IIED website on 15 January, 2016 authored by Alice Sverdlik

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Download the working paper (click image) 
Working paper

URBAN ZOO PROJECT: The 99 Household Study

URBAN ZOO PROJECT: The 99 Household Study

The 99 households study is now well under way, with sampling being carried out across a range of neighbourhoods in Nairobi. Each week the team targets a different sub-location, where three house-holds are recruited; two with different types of livestock and a third which does not keep any livestock species. Our team of clinical officers and vets collect samples from all human members of the house-hold, along with samples from livestock present, from the general household environment and from any animal source foods in the home. In addition, the wildlife team trap and sample rodents, wild birds, bats, primates and small carnivores in the vicinity.

Sampling a household is intensive, and participants not only consent to donate their faeces to the study, but also give up a good portion of their time, answering questionnaires, aiding the sampling by handling their livestock, and providing access to their property at all hours to allow checking of rodent traps. As such, only three households are sampled in a week, but after 8 weeks more than 400 samples have already been collected.

All samples are sent to our two collaborating laboratories at KEMRI and the University of Nairobi, where they are cultured to grow E.coli bacteria, the primary focus of the study. Multiple individual bacterial colonies are selected from the first culture to go forward for purification and further testing. This means that each animal, human or environmental sample taken in the field can generate up to five subsequent bacterial isolates, and so the number of colonies in the collection is increasing rapidly.

Genetic data from the bacterial samples will allow us to study similarities and differences between these normal bacteria carried by individuals, and how they can be shared between humans, animals and the environment. The questionnaire data collected, among other things, builds on the project’s previous work on value chains, and will allow us to assess how these consumers from a range of social strata are connected to the various value chains that exist in Nairobi for meat and animal products.

A great deal of work has led up to the start of this study, including developing strate-gies for finding participants to represent a diverse section of the city, developing sampling and laboratory protocols, and designing the electronic data capture sys-tems used in the field and laboratories. Everyone involved is delighted that things are now up and running and our colleagues in the UK are eagerly waiting for the first shipment of bacterial DNA to arrive. Watch our blog space!

The 99 Households Study is part of the Urban Zoo Project http://www.zoonotic-diseases.org/project/urban-zoo-project/ which is a joint project between scientists from Kenya and the UK. We are interested in how diseases can be transmitted between animals and people living in close contact in a city environment. The 99 Household study aims to collect in-depth information from 99 families from 33 different neighbourhoods stratified by socio-economic status across the whole of Nairobi. We are testing humans, animals and the home environment for bacteria that can be shared and spread between them.

This article has been written by Judy Bettridge (Post Doc under the 99HH Study, based jointly between the University of Liverpool, UK and International Livestock Research Institute (ILRI) in Kenya).

Using tablet to collect data

Sampling a rabbit in Makongeni

Field team in one of the sampling sites

Sampling the environment

Microbiology plates in readiness for culturing samples

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