Nutrition among men and household food security in an internally displaced persons camp in Kenya

Summary of research^*

Location: Kenya

What we know: Internally displaced persons (IDP) are vulnerable to nutrition and food insecurity.

What this article adds: A 2013 study investigated the nutritional status of 251 men and their household food-security status during a pre-harvest period in an established IDP camp in Kenya. Nutritional status was comparable to non-displaced men in Kenya (the majority (68.9%) were of normal body mass index; one quarter (23.9%) were undernourished). Household food insecurity, measured using three assessment scales, was relatively high. The most common source of food was own production (63.2%). Each had access to land; a minority depended on food aid. Recommendations to improve food security include initiatives to improve access to credit and enabling investment and capacity development in agriculture.

In 2007, disputed election results led to the outbreak of ethnic violence in Kenya, centred on the Rift Valley Province where the Kikuyu minority, among others, was targeted. Up to 600,000 people were displaced from their homes and eventually settled in Internally Displaced Persons (IDP) camps. Reports suggest that access to basic needs, including food, water, sanitation and healthcare, continues to be irregular throughout these camps. To date, no study has been published on nutrition and food security among Kenya’s IDPs. The purpose of the present study was to determine the nutritional status of men and their household food-security status in an IDP camp in Kenya.

Method

The study was conducted in 2013 within an IDP resettlement camp in Rongai District, Nakuru County, for those displaced from the Rift Valley. Currently there are over 400 families residing in the study camp who have each been allocated two acres of land for agriculture and 0.25 acres of land for housing. The study was undertaken over one week in June 2013 during the pre-harvest season of high food insecurity. The study was descriptive and cross-sectional, using a questionnaire and biometric measurements. A total of 267 men aged ≥ 18 years residing within the camp were recruited via respondent-driven sampling. The questionnaire comprised 72 questions divided into three main areas: demographic characteristics, nutrition, and food security. The nutrition and food security section incorporated three assessment scales: Individual Dietary Diversity Score (IDDS) (using 24-hour recall of the consumption of different food groups); Household Food Insecurity Access Scale (HFIAS), involving recall over the previous four weeks; and Household Hunger Scale (a newly emerging measure of hunger in regions which may already be experiencing significant food insecurity, calculated using HFIAS data). The questionnaire was self-completed by participants in either English or Kiswahili with the optional use of an interpreter. Both body mass index (BMI) and mid-upper arm circumference (MUAC) were measured.

Results

A total of 251 responses were included in the analysis. The mean age of participants was 37 years, 84·5% were of Kikuyu ethnicity and 82·1% had resided in the former Rift Valley Province prior to displacement. Three fifths of participants had completed up to or more than primary education; half were married and the mean household size was seven. Half were employed, predominantly in agriculture, and the median monthly household income was 2,500 KES (US$32).

During the previous 12 months, most participants (95·2 %; n=239) consumed at least one meal every day. The most common food source was from own production (63·7%; n=160); followed by purchase (28·3%; n=71); food from friends/relatives (4.4%; n=11); and government food aid (3·6%; n=9). The majority (86·1 %; n=216) reported poor access to household fuel.

HFAIS Scale responses revealed that the majority (80.5%; n=202) of participants had to eat a limited variety of foods and reported missing out on preferred foods (79.3%; n=199).  One fifth of respondents experienced limited food variety (22.3%; n=56) or missed preferred foods (21.1% (n=53) more than ten times in the past four weeks. Half of respondents (49·0%; n=123) reported going a whole day and night without eating anything. The HFIAS score was 11.6 (potential range 0-27).

HFIAS score was associated with income. Those earning less than 2,000 KES (US$25) per month had a significantly (P< 0.001) higher mean HFIAS score (14·26), suggesting greater food insecurity. The majority of participants (71·7%) were from severely food-insecure households; 13·5% were moderately food insecure; 4·8% were mildly food insecure; while only 4·8% were food secure.

The median HHS score was 2 (SD 1·5) out of a maximum possible score of 6. The most common condition of household hunger reported was going to sleep hungry at least once in the previous four weeks (62·5 %; n=157). The condition experienced most was having no food of any kind in the household: 7.2% (n=18) experienced this more than ten times. The majority of participants were from households with moderate hunger (46·6%), followed by little or no hunger (40·2%) and severe hunger (10·0%). Men aged over 45 years and from households earning less than 2,000 KES (US$25) per month were more likely to report being in the severe household hunger category.

IDDS results show that starchy staples (e.g. thick maize porridge (ugali) and thin maize porridge (uji) were eaten by 92% of participants. Organ meat (e.g. liver, heart and kidney) was the least common (21·9%). The mean IDDS was 6 out of a possible 9 (SD 1·8). Low dietary diversity (score ≤4) was associated with income, food insecurity and household hunger.

The mean BMI of respondents was 20·3 (SD 2·5). The majority (68·9 %) had a normal BMI. One quarter (23·9%; n=60) were underweight, of whom 85% had mild thinness (BMI=17·0-18·4); 13·3% had moderate thinness (BMI=16·0-16·9); and a single participant had severe thinness (BMI ≤15·9). Being underweight was associated with being older, having less income and being married or living with a partner. The mean MUAC was 26·4cm (20.5-36.5).

Anthropometry was similar to other studies among non-displaced men in rural Kenya, which contrasts with other findings, suggesting IDPs have poorer nutritional status than comparable non-displaced populations. This may be due to the study being undertaken in a relatively stable and well-developed camp, five years post-displacement, among households with access to agricultural land and low reliance on food aid. However, levels of food insecurity among camp households are worse than those in average rural settings in the region. This may in part be due to the lack of household capital to support agriculture; community conversations suggest lack of income means that fertiliser, agricultural implements and seeds are difficult to access.

Recommendations: Recommendations to improve food security include registering land allocations under the name of the owner to provide access to credit and encourage investment in agricultural implements, as well as agricultural education programmes. Such steps will be essential to address severe food insecurity and minimise its impact on mental health, disease profiles and family wellbeing documented in other IDP settings. 

^* Singh KP, Bhoopathy SV, Worth H, Seale H and Richmond RL (2015) Nutrition among men and household food security in an internally displaced persons camp in Kenya, Public Health Nutrition, 19(4), pp. 723–731. doi: 10.1017/S1368980015001275.