|dc.description.abstracteng||Persistent poverty and rapid urbanization are important development challenges in most African countries. Although the proportion of people living in extreme poverty in Africa could be reduced over the last few decades, the absolute number of people living below the poverty line continues to rise. At the same time, the share of people living in urban areas has significantly increased since the 1950s, reaching 43% of the total African population in 2017. Strong population growth and urbanization tendencies are both expected to continue in Africa over the next couple of decades. Up till now, food insecurity in Africa was often looked at primarily as a rural issue. Recent trends suggest that a closer look at urban food insecurity and dietary patterns is also warranted. More than in rural areas, urban food consumption is immediately connected to cash income earnings. Other factors that determine urban diets and nutrition include access to good infrastructure, adequate housing, healthcare, and other basic services. However, many of the urban poor live in informal settlements (slums) where they have inadequate access to basic facilities. Slum households are particularly vulnerable to food insecurity, unbalanced diets, and poor nutrition and health. A recent additional facet that may affect urban diets in Africa is the food system transformation with a rapid rise of supermarkets and other modern retailers. Previous research has shown that the modernization of the food retail sector can influence consumer nutrition, but whether or not this is already true also for the urban poor is not yet sufficiently understood.
In this dissertation, we analyze food sources and consumption patterns of the urban poor in Africa. In particular, we use cross-section survey data that we collected ourselves from 600 households in the poorest neighborhoods of Nairobi and Kampala, the capital cities of Kenya and Uganda. Nairobi and Kampala are among the largest cities in East Africa. In both countries, over 50% of the urban population is estimated to live in slums. Data were collected using a carefully pretested questionnaire with various sections, including a module on household income sources and food consumption modules at household and individual levels for female adults and children. Household-level food consumption data were collected through a 7-day recall; at the individual level a 24-hour dietary recall was used. We also developed and conducted a choice experiment to elicit consumers’ preferences for nutritionally enhanced foods.
The dissertation contains three essays. In the first essay, we use multiple indicators derived from the household- and individual-level data to analyze food security and dietary quality among slum dwellers in Nairobi and Kampala. Very little is known about the diets of slum dwellers as they are often underrepresented in standard household surveys. Given the breadth of data collected, we also compare different indicators. Such comparison can help, for instance, to identify which household-level indicators can be used as proxies for individual diets in situations where individual-level data are unavailable. Our analysis is based on 600 households (300 in Nairobi, 300 in Kampala), 600 children aged 6-59 months (300 in Nairobi, 300 in Kampala) and 582 women aged 15-49 years (299 in Nairobi, 282 in Kampala). Results show that in both cities around 90% of the slum dwellers are food insecure in terms of at least one of the indicators used. Thirty-one percent of the households in Nairobi and 59% in Kampala are undernourished in a calorie sense. Many more have inadequate access to food quantity and quality, at least temporarily. Moreover, a significant proportion of children and women remain below minimum recommended levels of dietary diversity. We find a strong correlation between the different dietary indicators, concluding that household-level indicators can be used as proxies for the diets of women and children when individual-level data are unavailable. Regression analyses confirm that cash income plays a significant role for food security and dietary quality irrespective of the indicator used. People with more stable salaried employment are better off than people who depend on casual employment alone.
In the second essay, we pay particular attention to households’ food purchase patterns against the background of the increasing role of supermarkets in urban food retailing. Existing studies show that supermarkets may improve access to diverse foods at affordable prices, but may also encourage a switch from unprocessed to highly-processed and energy-dense foods, thus contributing to overweight and obesity. However, the use of supermarkets in developing countries is positively correlated with household income. Hence, what is true for middle- and upper-income consumers is not necessarily true for low-income consumers. Using our data from urban slum dwellers in Nairobi and Kampala we find that very few of these households actually buy any of their food in supermarkets. Supermarkets account for only 3% and 0.4% of all food expenditures by the urban poor in Nairobi and Kampala, respectively. These households buy most food items in unprocessed form from various traditional retail outlets, including mom-and-pop shops, local markets, and kiosks. We discuss reasons for the low supermarket use of these population segments, and conclude that a focus on the modern retail sector alone will not suffice to ensure food and nutrition security for all.
In the third essay, we analyze poor consumers’ preferences for nutritionally enhanced foods using choice-experimental data from the slum households in Nairobi and Kampala. Previous studies have shown that micronutrient fortification and other food-based approaches, such as using more nutritious ingredients in food processing, could help alleviate micronutrient malnutrition. However, little is known about poor consumers’ attitudes towards nutritionally enhanced foods. Would poor consumers purchase foods with more nutritious ingredients, even when nutrition knowledge is limited? And are poor consumers able and willing to pay more for nutritionally enhanced products? We use the example of porridge flour, a widely purchased product among poor urban households in East Africa, to analyze the acceptance of different types of nutritional attributes. Our findings show that consumers generally welcome products that are micronutrient-fortified or include new types of nutritious ingredients. However, willingness to pay for nutritional attributes is small. New ingredients that are perceived to have little effect on taste and appearance are seen more positively than ingredients that may change the product more notably.
Based on these findings, we draw several conclusions. (i) A large proportion of the urban poor are food insecure and their diets are largely characterized by consumption of starchy staples with low intake of nutritious foods like fruits and vegetables. Access to adequate and nutritious food is largely constrained by lack of income and lucrative employment. Food and nutrition programs should have a particular focus on vulnerable slum dwellers. (ii) Simple, cost-effective and easy to collect household-level food security and dietary diversity indicators can be used where more detailed individual-level dietary data are not available. (iii) A focus on the modern retail sector alone will not suffice to ensure food and nutrition security for all. The efficiency of traditional food supply chains will also have to be improved to help reduce costs along the supply chains and thus market prices for the end-consumer, (iv) Enhancing the nutrition content of foods using industrial and related food-based approaches could improve access to more nutritious foods among the urban poor. However, such foods should build on local consumption behavior and should not be associated with significant price increases.||de