Can the determinants of obesity and under-nutrition be captured in the same model? Evidence from Valparaiso Chile

and Mombasa Kenya

Pat Pridmore and Roy Carr-Hill

Nutritional Improvement for Children in urban Chile and Kenya (NICK)

A 3year study funded by ESRC/DFID (http://nick.ioe.ac.uk)

NICK team researchersNICK team researchersPridmore, P., Carr-Hill, R., McCowan, T., Lango, D.,

Nyamongo, M., Charnes, G., Salgado, B.

Rapid, unplanned urbanization

has led to an urban health divide in many cities with higher rates of child malnutrition in poor areas.

Rationale for the study

Central Research QuestionCentral Research Question

Can child malnutrition amongst families living in

poverty in informal urban settlements be reduced

through broadening stakeholder participation to

change the social determinants?

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Four-phase strategyFour-phase strategy

Phase 1 (0-8 months) Situational analysis and Phase 1 (0-8 months) Situational analysis and working group formationworking group formation

Literature reviews and situational analyses to identify social determinants;

Selection of ‘quasi experimental’ intervention and control groups. Randomisation into experimental and control groups;

Baseline data collection (anthropometry and HH survey);

Establishment of a multisectoral urban nutrition working group in each study city - to tackle child undernutrition in Mombasa and over-nutrition in Valparaiso.

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Phase 2 (10-28 months) Participatory Action ResearchPhase 2 (10-28 months) Participatory Action Research

Facilitation of the working groups through three, six-monthly cycles of action and reflection to plan, implement, evaluate and re-plan small scale interventions.

Valparaiso: Strengthening intersectoral work and supporting nursery school teachers to change the obesogenic environment.

Mombasa: Collaborating with the leaders of three women’s self-help groups to strengthen income-generation, promote urban farming and nutrition education and improve sanitation and waste disposal. Enabling each group member to establish and support another group to do similar activities.

Phase 3 (29-36 months) Impact and Phase 3 (29-36 months) Impact and process evaluationprocess evaluation

Follow-up data collection (anthropometry and HH survey)

Data analysisWriting up and learning lessons.

Mombasa - Urban farming, managing Mombasa - Urban farming, managing domestic waste and compostingdomestic waste and composting

Key findingsKey findings

An action research process using the social educational process known as PLA can effectively build the capacity of multisectoral teams to take coordinated actions and also build the capacity of communities to sustain them.

Four factors were crucial for creating the enabling environment needed for effective intersectoral action:

1. supportive government policy 2. broad participation and capacity building 3. involving policy makers as advisors and establishing the credibility of the

research 4. strengthening community action.

The impact on child nutrition in Mombasa was inconclusive and needed to be interpreted within the context of economic collapse in the intervention area.

http://nick.ioe.ac.uk http://www.esrc.ac.uk/my-esrc/grants/RES-167-25-0461/read

Can the determinants of obesity and under-nutrition be captured in the same model? Evidence from Valparaiso Chile and Mombasa Kenya