**2.1 Economy, agriculture and social development**

Although the agricultural sector continues to dominate Kenya's economy, only 15–20% of Kenya's total land area has sufficient fertility and rainfall to be farmed, but only 7–8% of the land can be classified as first-class agricultural land. A considerable number of Kenyans make their living off the land, but this trend has continued to decline from the 1980s for various reasons including: rural–urban migration, the low economic gains from the sector, population growth and conversion of agricultural land to residential land, and, sub-division for purposes of inheritance, etc.

Agriculture is the second largest contributor to Kenya's gross domestic product (GDP) after the service sector and fundamentally drives the country's economy, as about 75% of Kenyans earn all or part of their income from the sector. Agriculture generally accounts for 33% of the nation's GDP, but its contribution to the country's GDP has continued to fluctuate over the years as agricultural productivity has either stagnated or declined. This has been observed for major food crops such as wheat and rice. Furthermore, the 15–20% of Kenya's land area that is regarded as suitable for farming is not also utilized efficiently.

Recurrent crises such as drought add to the agriculture-related challenges which largely contribute to the high malnutrition levels in the country. In 2005, agriculture, including forestry and fishing, accounted for 18% of wage employment and 50% of revenue from exports. For decades, the principal cash crops have remained tea, horticultural produce and coffee, with horticultural produce and tea being the major earners of foreign exchange. Horticultural produce and tea accounted for 23% and 22% of total export earnings, respectively. Coffee which has declined in importance due in part to depressed world prices and the decline of land under the crop, accounted for just 5% of export receipts in 2005. The production of major food staples such as maize is subject to sharp weather-related fluctuations. Declines in maize production often times leads to the need for Government to appeal for food aid, as was witnessed in 2004, and even lately in 2016–2017, when as many as 1.8–2.0 million people needed food relief. The expansion of credit to the agricultural sector by the financial sector has enabled farmers to better deal with the large risk of agriculture based on seasonal rainfall and dramatic fluctuations of the prices of agricultural commodities. The expansion of the area under irrigation is another major food policy issue for government as it works to find ways of increasing food production.

**97**

*Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges…*

Tea, coffee, sisal, pyrethrum, maize, and wheat are grown in the fertile Kenya highlands, which is one of the most successful agricultural production regions in Africa. However, the production of sisal and pyrethrum is declining to levels where there may be no production of these two crops in the near future for various reasons

Local livestock breeds (Boran and Zebu) predominate in the semi-arid savanna

Kenya Vision 2030, the development blue print for the country, was initiated in 2013 by Emilio Mwai Kibaki, the 3rd President of Kenya. It has the economic, social and political pillars as its anchors; the economic pillar aims at improving the prosperity of all Kenyans through an economic development programme, covering all the regions of Kenya. It aimed to achieve a GDP growth rate of 10% per annum beginning in 2004, but the country has consistently fallen short of the target every subsequent financial year. However, to work towards achieving the target, Kenya is continuing with the tradition of macro-economic stability that has been established since 2002. The New Administration of President Uhuru M. Kenyatta has picked up some key economic deliverables in the Vision, in what in 2018, it has characterized

Through the economic pillar and strategy, Kenya aims to build a just and cohesive society with social equity available to all its citizens and enable them live in a clean and secure environment. The vision presents comprehensive social interventions for improving the quality of life of all Kenyans and Kenyan residents. The strategy contains special provisions to help persons living with various disabilities and previously marginalized communities, who may lack a good education, are unemployed and experience poor nutritional status due to high poverty prevalence among them. These policies (and those in the economic pillar) are equally anchored on an all-round strategy of adopting science, technology and innovation (STI) as the implementation tool. The STI concentrates in certain areas for it to contribute to

to the north and east of the country, but exotic dairy breeds such as Friesian, Ayrshire, Sahiwal and crosses of the exotic and local Zebu cattle are kept in the highlands and mid altitudes, with the latter region sustaining the beef breeds. Cash and food crops including coconuts, pineapples, cashew nuts, sugarcane, and maize

*DOI: http://dx.doi.org/10.5772/intechopen.95036*

are grown in most parts of the country.

as "The Big Four." These are:

1.Universal Healthcare,

3.Affordable Housing and

the success of the initiative, including:

• Education and vocational/technical training

2.Manufacturing,

4.Food Security,

• Healthcare

• Water and sanitation

• Housing and urbanization

• The environment

which are outside the realm of the current discussion.

*Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges… DOI: http://dx.doi.org/10.5772/intechopen.95036*

Tea, coffee, sisal, pyrethrum, maize, and wheat are grown in the fertile Kenya highlands, which is one of the most successful agricultural production regions in Africa. However, the production of sisal and pyrethrum is declining to levels where there may be no production of these two crops in the near future for various reasons which are outside the realm of the current discussion.

Local livestock breeds (Boran and Zebu) predominate in the semi-arid savanna to the north and east of the country, but exotic dairy breeds such as Friesian, Ayrshire, Sahiwal and crosses of the exotic and local Zebu cattle are kept in the highlands and mid altitudes, with the latter region sustaining the beef breeds. Cash and food crops including coconuts, pineapples, cashew nuts, sugarcane, and maize are grown in most parts of the country.

Kenya Vision 2030, the development blue print for the country, was initiated in 2013 by Emilio Mwai Kibaki, the 3rd President of Kenya. It has the economic, social and political pillars as its anchors; the economic pillar aims at improving the prosperity of all Kenyans through an economic development programme, covering all the regions of Kenya. It aimed to achieve a GDP growth rate of 10% per annum beginning in 2004, but the country has consistently fallen short of the target every subsequent financial year. However, to work towards achieving the target, Kenya is continuing with the tradition of macro-economic stability that has been established since 2002. The New Administration of President Uhuru M. Kenyatta has picked up some key economic deliverables in the Vision, in what in 2018, it has characterized as "The Big Four."

These are:

*Food Security in Africa*

Sudan.

**2. Kenya**

inheritance, etc.

potential and are associated with high poverty indices and therefore poor food and nutrition security. Nomadic pastoralism based on livestock keeping is the major mode of production and livelihood in these semi-arid areas. The region's vegetation is composed of thick woodlands and grassland in the high and wetter elevations, to scanty, thorny shrub and vegetation to desert terrain in the arid and semi-arid plains, respectively. South Sudan is hot with seasonal rainfall as influenced by the annual shift of the Inter-tropical Convergence Zone. Rainfall is heaviest in the southern highlands and reduces towards the north as it merges into the Republic of

This chapter examines the economic, food and nutrition security situation in Kenya, Uganda and Tanzania. For each country, some recommendations that are likely to improve food and nutrition security in the long-term are provided.

Although the agricultural sector continues to dominate Kenya's economy, only 15–20% of Kenya's total land area has sufficient fertility and rainfall to be farmed, but only 7–8% of the land can be classified as first-class agricultural land. A considerable number of Kenyans make their living off the land, but this trend has continued to decline from the 1980s for various reasons including: rural–urban migration, the low economic gains from the sector, population growth and conversion of agricultural land to residential land, and, sub-division for purposes of

Agriculture is the second largest contributor to Kenya's gross domestic product (GDP) after the service sector and fundamentally drives the country's economy, as about 75% of Kenyans earn all or part of their income from the sector. Agriculture generally accounts for 33% of the nation's GDP, but its contribution to the country's GDP has continued to fluctuate over the years as agricultural productivity has either stagnated or declined. This has been observed for major food crops such as wheat and rice. Furthermore, the 15–20% of Kenya's land area that is regarded as suitable

Recurrent crises such as drought add to the agriculture-related challenges which largely contribute to the high malnutrition levels in the country. In 2005, agriculture, including forestry and fishing, accounted for 18% of wage employment and 50% of revenue from exports. For decades, the principal cash crops have remained tea, horticultural produce and coffee, with horticultural produce and tea being the major earners of foreign exchange. Horticultural produce and tea accounted for 23% and 22% of total export earnings, respectively. Coffee which has declined in importance due in part to depressed world prices and the decline of land under the crop, accounted for just 5% of export receipts in 2005. The production of major food staples such as maize is subject to sharp weather-related fluctuations. Declines in maize production often times leads to the need for Government to appeal for food aid, as was witnessed in 2004, and even lately in 2016–2017, when as many as 1.8–2.0 million people needed food relief. The expansion of credit to the agricultural sector by the financial sector has enabled farmers to better deal with the large risk of agriculture based on seasonal rainfall and dramatic fluctuations of the prices of agricultural commodities. The expansion of the area under irrigation is another major food policy issue for government as it works to find ways of increasing food

**2.1 Economy, agriculture and social development**

for farming is not also utilized efficiently.

**96**

production.


Through the economic pillar and strategy, Kenya aims to build a just and cohesive society with social equity available to all its citizens and enable them live in a clean and secure environment. The vision presents comprehensive social interventions for improving the quality of life of all Kenyans and Kenyan residents. The strategy contains special provisions to help persons living with various disabilities and previously marginalized communities, who may lack a good education, are unemployed and experience poor nutritional status due to high poverty prevalence among them. These policies (and those in the economic pillar) are equally anchored on an all-round strategy of adopting science, technology and innovation (STI) as the implementation tool. The STI concentrates in certain areas for it to contribute to the success of the initiative, including:


### **2.2 Food and nutrition security**

Kenya has a current population of 47.6 million [4] and is generally regarded as water-deficient and food and nutrition insecure. It suffers from frequent droughts and famines with as many as 2–3 million people affected every time a famine or drought occurs, and, about 10 million suffering from chronic food insecurity and poor nutrition. Most of those affected live in the pastoral, semi-arid and arid areas of the country located in the North, Northeast and Northwest of the country, although parts of the Upper Eastern that include the Counties of Kitui, Makueni and Tana River County in the Coastal Region (**Figure 2**), are often also affected. Some of these arid and semi-arid zones receive as little 5–30 inches or more of rain annually. The other category of consumers that is often affected by food and nutrition insecurity is the slum dwellers, who constitute a considerable percentage of the country's population, and, live in the inner cities of the major urban settlements. The Cities of Nairobi, Mombasa, Kisumu, Nakuru and Eldoret hold about 20% of the country's population and will therefore require significant attention in the effort to reduce food and nutrition insecurity in the country. Malnutrition is a public concern and is the single most important contributor to child mortality which stood at 30.6% in every 1000 births by 2018 down from 33.3% in 2015. Malnutrition is mainly due to inadequate food intake and disease, with the underlying factors being poor child care practices, household food insecurity, and inadequate sanitation and health care services, among others. Most of the indicators on food availability, access and affordability, poverty levels and nutritional status are obtained through statistics generated from the Integrated Household Budget Surveys (IHBS) and the Kenya Household and Dietary Surveys (KHDS). The latest IHBS and KHDS were done in 2011 and 2014, respectively. The IHBS surveys show different levels of food poverty across the former eight Kenyan Administrative Provinces, which were abolished after the promulgation of the new Kenya Constitution in 2010 [5].

**99**

businesses.

*Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges…*

They were replaced by 47 Counties, which came into being in March 2013. The IHBS of 2011 showed food poverty levels of 31, 45, 46, 50, 51, 64 and 66% for the then Central, Eastern, Nyanza, Rift Valley, Western, Coast and Northeastern Provinces, respectively. It is likely that the indicators have declined in some of the regions between then and now. Low indicators are normally apparent in the Provinces where nomadic pastoralists are a significant percentage of the population. The pastoralist, semi-arid and arid areas that compose about 70% of the country's land mass and hold about 30% of the human population, are some of the poorest regions of the country, with the worst food poverty, nourishment, health and sanitation indicators. In the counties where nomadic pastoralism dominates as a form of resource use and production, the factors that seem to be major drivers of food and nutrition insecurity include weather anomalies, water scarcity, ethnic resource-based conflicts and displacements, high food prices, depressed livestock sales prices, hardships associated with migration in search of water and pasture for livestock herds by the nomads, cross-border conflicts and livestock pest and disease outbreaks. Climate variability is an ongoing phenomenon that is affecting food production. The rest of the country falls under the agrarian belt, where arable farming is practised. In the agrarian belt, the major drivers for food and nutrition insecurity include poor transport infrastructure, poor market access for farm produce, climate variability, late arrival of government subsidized fertilizer and agro-chemicals, late payments to farmers for crop delivered to depots of the National Cereals and Produce Board, poor management of farmers' cooperatives, depressed food sales prices and crop pests and livestock diseases. Grossly inadequate storage facilities and poor handling and storage practices for cereal grain, pulses and oil seeds, also contribute to food and nutrition insecurity as considerable amounts of produce is lost through microbially-mediated deterioration and pest infestation. Poor purchase prices, delayed payments of deliveries to National Government grain depots, often encourage sales of surplus harvest to middlemen, who despite offering modest prices compared to government agencies have the advantage of on-the-spot cash payments for produce bought. It is envisaged that the provision of storage facilities through the National Cereals and Produce Board, Co-operatives, improvement in road infrastructure, the expansion of rural electrification programmes, adoption of climate-smart agriculture, diversification of the food supply and diets, especially an increase in consumption of fruits and vegetables will lower food and nutrition

security indicators and improve consumer nutritional status and health.

The mortality rate of Kenyan children under age five has fallen steadily since 2000 [6], but remains of grave concern. On the positive side, the level of undernourishment among Kenya's children fell in 2001–2003 and again in 2013–2015, but recurring droughts have led to a noticeable rise in levels. A decline was also recently observed after the 2016–2017 drought which affected Kenya and her neighbors, and which resulted in drops in agricultural production, increases in food prices [7, 8], and the consumption of inadequate food of low calorie and protein content. The impact of the current COVID-19 pandemic is expected to be disastrous as agricultural production is expected to fall arising from the lengthy lockdowns and restrictions of movement of goods, people, the imposed curfews and the closing down of

Kenya's child stunting and child wasting levels have also fallen considerably,

with the stunting rate dropping from 35.2–26.0%, and the wasting rate falling from 7.0–4.0% in 2008–2009 and in 2014 [9, 10]. Levels vary substantially between regions and counties, with some having values significantly higher than the national averages. The highest child stunting percentages were found in Kitui County and West Pokot at 45.8% and 45.9%, respectively [10]. Although these Counties have high poverty levels (48 and 57%, respectively, based on national

*DOI: http://dx.doi.org/10.5772/intechopen.95036*

**Figure 2.** *GHI for Kenya's regions.*

#### *Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges… DOI: http://dx.doi.org/10.5772/intechopen.95036*

They were replaced by 47 Counties, which came into being in March 2013. The IHBS of 2011 showed food poverty levels of 31, 45, 46, 50, 51, 64 and 66% for the then Central, Eastern, Nyanza, Rift Valley, Western, Coast and Northeastern Provinces, respectively. It is likely that the indicators have declined in some of the regions between then and now. Low indicators are normally apparent in the Provinces where nomadic pastoralists are a significant percentage of the population. The pastoralist, semi-arid and arid areas that compose about 70% of the country's land mass and hold about 30% of the human population, are some of the poorest regions of the country, with the worst food poverty, nourishment, health and sanitation indicators. In the counties where nomadic pastoralism dominates as a form of resource use and production, the factors that seem to be major drivers of food and nutrition insecurity include weather anomalies, water scarcity, ethnic resource-based conflicts and displacements, high food prices, depressed livestock sales prices, hardships associated with migration in search of water and pasture for livestock herds by the nomads, cross-border conflicts and livestock pest and disease outbreaks. Climate variability is an ongoing phenomenon that is affecting food production. The rest of the country falls under the agrarian belt, where arable farming is practised. In the agrarian belt, the major drivers for food and nutrition insecurity include poor transport infrastructure, poor market access for farm produce, climate variability, late arrival of government subsidized fertilizer and agro-chemicals, late payments to farmers for crop delivered to depots of the National Cereals and Produce Board, poor management of farmers' cooperatives, depressed food sales prices and crop pests and livestock diseases. Grossly inadequate storage facilities and poor handling and storage practices for cereal grain, pulses and oil seeds, also contribute to food and nutrition insecurity as considerable amounts of produce is lost through microbially-mediated deterioration and pest infestation. Poor purchase prices, delayed payments of deliveries to National Government grain depots, often encourage sales of surplus harvest to middlemen, who despite offering modest prices compared to government agencies have the advantage of on-the-spot cash payments for produce bought. It is envisaged that the provision of storage facilities through the National Cereals and Produce Board, Co-operatives, improvement in road infrastructure, the expansion of rural electrification programmes, adoption of climate-smart agriculture, diversification of the food supply and diets, especially an increase in consumption of fruits and vegetables will lower food and nutrition security indicators and improve consumer nutritional status and health.

The mortality rate of Kenyan children under age five has fallen steadily since 2000 [6], but remains of grave concern. On the positive side, the level of undernourishment among Kenya's children fell in 2001–2003 and again in 2013–2015, but recurring droughts have led to a noticeable rise in levels. A decline was also recently observed after the 2016–2017 drought which affected Kenya and her neighbors, and which resulted in drops in agricultural production, increases in food prices [7, 8], and the consumption of inadequate food of low calorie and protein content. The impact of the current COVID-19 pandemic is expected to be disastrous as agricultural production is expected to fall arising from the lengthy lockdowns and restrictions of movement of goods, people, the imposed curfews and the closing down of businesses.

Kenya's child stunting and child wasting levels have also fallen considerably, with the stunting rate dropping from 35.2–26.0%, and the wasting rate falling from 7.0–4.0% in 2008–2009 and in 2014 [9, 10]. Levels vary substantially between regions and counties, with some having values significantly higher than the national averages. The highest child stunting percentages were found in Kitui County and West Pokot at 45.8% and 45.9%, respectively [10]. Although these Counties have high poverty levels (48 and 57%, respectively, based on national

*Food Security in Africa*

• Gender, youth and vulnerable groups

• Equity and poverty elimination, and,

**2.2 Food and nutrition security**

• National reconciliation, integration and cohesion

Kenya has a current population of 47.6 million [4] and is generally regarded as water-deficient and food and nutrition insecure. It suffers from frequent droughts and famines with as many as 2–3 million people affected every time a famine or drought occurs, and, about 10 million suffering from chronic food insecurity and poor nutrition. Most of those affected live in the pastoral, semi-arid and arid areas of the country located in the North, Northeast and Northwest of the country, although parts of the Upper Eastern that include the Counties of Kitui, Makueni and Tana River County in the Coastal Region (**Figure 2**), are often also affected. Some of these arid and semi-arid zones receive as little 5–30 inches or more of rain annually. The other category of consumers that is often affected by food and nutrition insecurity is the slum dwellers, who constitute a considerable percentage of the country's population, and, live in the inner cities of the major urban settlements. The Cities of Nairobi, Mombasa, Kisumu, Nakuru and Eldoret hold about 20% of the country's population and will therefore require significant attention in the effort to reduce food and nutrition insecurity in the country. Malnutrition is a public concern and is the single most important contributor to child mortality which stood at 30.6% in every 1000 births by 2018 down from 33.3% in 2015. Malnutrition is mainly due to inadequate food intake and disease, with the underlying factors being poor child care practices, household food insecurity, and inadequate sanitation and health care services, among others. Most of the indicators on food availability, access and affordability, poverty levels and nutritional status are obtained through statistics generated from the Integrated Household Budget Surveys (IHBS) and the Kenya Household and Dietary Surveys (KHDS). The latest IHBS and KHDS were done in 2011 and 2014, respectively. The IHBS surveys show different levels of food poverty across the former eight Kenyan Administrative Provinces, which were abolished after the promulgation of the new Kenya Constitution in 2010 [5].

**98**

**Figure 2.**

*GHI for Kenya's regions.*

poverty indicators), stunting in Kenya is not perfectly associated with poverty levels. Rather, it seems to be influenced by a complex set of factors that include dietary diversity, feeding and caregiving practices, access to appropriate sanitation and disease prevalence [11, 12]. Wasting is highest in Kenya's northernmost counties: with a value of 22.9% in Turkana, 16.3% in Marsabit, 14.8% in Mandera, 14.3% in West Pokot, and 14.2% in Wajir [10]. These Counties are arid or semi-arid, and are dominated by pastoralism as a form of livelihood and production and therefore have high poverty levels [13, 14]. Moreover, rates of contraception use and women's education levels in these counties are low and fertility rates are high [10]. It has been observed that children's nutritional status is associated with mothers' education and literacy rates [15], both globally and in Kenya, specifically. A study from urban settlements of Nairobi found that maternal education strongly predicts children's nutritional status, when controlling for other socio-economic and demographic factors [16]. Some recent data from Kenya shows that the stunting rate of children whose mothers had no formal education was 31%, while that of children whose mothers had secondary education or higher was 17% [10]. Children's nutrition is also associated with mothers' nutritional status and therefore income. A study from rural Kenya showed a positive correlation between maternal nutrition and children's nutritional status in terms of anthropometric measures [17]. As Kenya attempts to further reduce child undernutrition, albeit with persistent challenges, any gains will be achieved if it addresses infant and young child feeding practices in the Counties. Breastfeeding practices have improved substantially in Kenya, with 61% of children under 6 months exclusively breastfed in 2014, compared with just 32% in 2008–2009 [10, 9]. Meanwhile, in 2014, just 22% of children between 6 and 23 months of age received a minimum acceptable diet [10]. **Figure 2** gives global hunger indicators (GHI) for Kenya's regions.

Although most food and nutrition analyses of Kenya have traditionally focused on rural areas, where rates of child undernutrition tend to be higher than in urban areas, Kenya's population is increasingly urbanizing, and urban food insecurity and undernutrition, are emerging concerns [10, 18, 19]. Urban dwellers are highly vulnerable to food price spikes, which affect their access to affordable food, especially the unemployed, casual labourers who mainly live in the sprawling informal settlements of Nairobi, Kisumu, Nakuru, Mombasa and Eldoret, and increasingly in every major urban centre in the country. Moreover, urban populations live in crowded, poor accommodation, and often lack adequate water, sanitation and therefore live in unhygienic conditions are subject to illness and disease [18, 19]. Child mortality declined much more slowly in urban than in rural areas of Kenya between 1993 and 2008, perhaps because of the deplorable living conditions in urban settlements [20]. In 2014, Nairobi had the second highest child mortality rate among Kenya's regions (**Figure 2**).

Agriculture is considered to have considerable potential to increase household food security and nutrition. Although evidence of the impact of agricultural technologies on relevant outcomes is limited, some studies have shown promising results in Kenya [21]. Dairying and pastoralism play important economic roles among Kenyan smallholder farmers, with significant implications for nutrition. Roughly a quarter of Kenyan households engage in small-scale dairy activities. Studies of pastoralism in four of Kenya's northern, and arid counties–Mandera, Marsabit, Turkana, and Wajir (**Figure 3**) showed that livestock is the main source of livelihood for not less than 57% of households [13, 22]. For pastoralist households, the animals provide the milk consumed by families, and as livestock assets decrease, so does milk consumption affecting children's nutritional status and well-being. Milk consumption at the household level was found to be positively associated with higher body mass index among Samburu youth [23]. Consumption

**101**

**Figure 3.**

*The counties of Kenya.*

the current Counties of Kenya.

*Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges…*

of animal-source foods by Kenyan schoolchildren has also been shown to be positively associated with height and weight gains. A school-feeding programme that tested the effect of different types of snacks given to children found that meat and milk snacks contributed the most to children's arm muscle growth. **Figure 3** shows

Kenya is engaged in cash transfer initiatives as a way to lift the poor out of food and nutrition insecurity. The unconditional cash transfer programme for Orphans and Vulnerable Children increased households' food expenditures and dietary diversity, and the consumption of food produced by households themselves. The unconditional cash transfer programme in rural Kenya also increased households' food security and food expenditures, particularly when the transfers are made monthly rather than in a lump sum [24]. Kenya's Hunger Safety Net Programme, an

*DOI: http://dx.doi.org/10.5772/intechopen.95036*

*Food and Nutrition Security in East Africa (Kenya, Uganda and Tanzania): Status, Challenges… DOI: http://dx.doi.org/10.5772/intechopen.95036*

*Food Security in Africa*

hunger indicators (GHI) for Kenya's regions.

among Kenya's regions (**Figure 2**).

poverty indicators), stunting in Kenya is not perfectly associated with poverty levels. Rather, it seems to be influenced by a complex set of factors that include dietary diversity, feeding and caregiving practices, access to appropriate sanitation and disease prevalence [11, 12]. Wasting is highest in Kenya's northernmost counties: with a value of 22.9% in Turkana, 16.3% in Marsabit, 14.8% in Mandera, 14.3% in West Pokot, and 14.2% in Wajir [10]. These Counties are arid or semi-arid, and are dominated by pastoralism as a form of livelihood and production and therefore have high poverty levels [13, 14]. Moreover, rates of contraception use and women's education levels in these counties are low and fertility rates are high [10]. It has been observed that children's nutritional status is associated with mothers' education and literacy rates [15], both globally and in Kenya, specifically. A study from urban settlements of Nairobi found that maternal education strongly predicts children's nutritional status, when controlling for other socio-economic and demographic factors [16]. Some recent data from Kenya shows that the stunting rate of children whose mothers had no formal education was 31%, while that of children whose mothers had secondary education or higher was 17% [10]. Children's nutrition is also associated with mothers' nutritional status and therefore income. A study from rural Kenya showed a positive correlation between maternal nutrition and children's nutritional status in terms of anthropometric measures [17]. As Kenya attempts to further reduce child undernutrition, albeit with persistent challenges, any gains will be achieved if it addresses infant and young child feeding practices in the Counties. Breastfeeding practices have improved substantially in Kenya, with 61% of children under 6 months exclusively breastfed in 2014, compared with just 32% in 2008–2009 [10, 9]. Meanwhile, in 2014, just 22% of children between 6 and 23 months of age received a minimum acceptable diet [10]. **Figure 2** gives global

Although most food and nutrition analyses of Kenya have traditionally focused on rural areas, where rates of child undernutrition tend to be higher than in urban areas, Kenya's population is increasingly urbanizing, and urban food insecurity and undernutrition, are emerging concerns [10, 18, 19]. Urban dwellers are highly vulnerable to food price spikes, which affect their access to affordable food, especially the unemployed, casual labourers who mainly live in the sprawling informal settlements of Nairobi, Kisumu, Nakuru, Mombasa and Eldoret, and increasingly in every major urban centre in the country. Moreover, urban populations live in crowded, poor accommodation, and often lack adequate water, sanitation and therefore live in unhygienic conditions are subject to illness and disease [18, 19]. Child mortality declined much more slowly in urban than in rural areas of Kenya between 1993 and 2008, perhaps because of the deplorable living conditions in urban settlements [20]. In 2014, Nairobi had the second highest child mortality rate

Agriculture is considered to have considerable potential to increase household

food security and nutrition. Although evidence of the impact of agricultural technologies on relevant outcomes is limited, some studies have shown promising results in Kenya [21]. Dairying and pastoralism play important economic roles among Kenyan smallholder farmers, with significant implications for nutrition. Roughly a quarter of Kenyan households engage in small-scale dairy activities. Studies of pastoralism in four of Kenya's northern, and arid counties–Mandera, Marsabit, Turkana, and Wajir (**Figure 3**) showed that livestock is the main source of livelihood for not less than 57% of households [13, 22]. For pastoralist households, the animals provide the milk consumed by families, and as livestock assets decrease, so does milk consumption affecting children's nutritional status and well-being. Milk consumption at the household level was found to be positively associated with higher body mass index among Samburu youth [23]. Consumption

**100**

of animal-source foods by Kenyan schoolchildren has also been shown to be positively associated with height and weight gains. A school-feeding programme that tested the effect of different types of snacks given to children found that meat and milk snacks contributed the most to children's arm muscle growth. **Figure 3** shows the current Counties of Kenya.

Kenya is engaged in cash transfer initiatives as a way to lift the poor out of food and nutrition insecurity. The unconditional cash transfer programme for Orphans and Vulnerable Children increased households' food expenditures and dietary diversity, and the consumption of food produced by households themselves. The unconditional cash transfer programme in rural Kenya also increased households' food security and food expenditures, particularly when the transfers are made monthly rather than in a lump sum [24]. Kenya's Hunger Safety Net Programme, an unconditional cash transfer programme, boosted beneficiaries' food consumption relative to controls and increased dietary diversity for poorer households in the project [25, 26].

Nutrition education can also help improve diet quality for children and adults in Kenya. A pilot study in western Kenya showed that providing nutrition education to fathers and grandmothers on proper complementary feeding practices for children raised social support for mothers, and, resulted in the adoption of beneficial child feeding practices [27]. Despite the need to continue addressing malnutrition in the country, micronutrient deficiencies of Vitamin A, Folic acid, Iron, Zinc and Iodine are widespread, with the re-emerging rise in rickets. However, the iodization of salt and fortification of many processed foods, especially the staples with most of the above micronutrients will alleviate the problem. Emerging issues include child obesity, where female children appear more obese and overweight than their male counterparts.
