1) Dietary diversity scores increased across households, women of reproductive age, and children in the six counties assessed, with children seeing the highest gains. Consumption of crops like finger millet and production of pearl millet increased substantially. 2) Commercialization rates rose for most crops except finger millet and groundnuts. Green grams had the highest commercialization levels. 3) A photovoice study in Tharaka Nithi county found higher dietary diversity scores and smarter food utilization in the treatment area compared to the control, indicating the interventions' positive impact.

1. Assessing the Impact of Behavior
Change Nutrition Activities in Kenya
1

2. 1. Improving dietary diversity
2. Changing perceptions
3. Improving commercialization
4. Improving consumption
Objective
2

3. 1. Household survey (baseline & annual): 2016 and 2017
2. Urban Consumer survey: 2016
3. KAP: Focused Group Discussions (FGDs) with rural
women: 2016
4. Photovoice: 2018
Studies
3

4. 1. USAID-AVCD program
2. Analysis covers six Counties : Tharaka Nithi, Makueni,
Kitui, Elgeyo Marakwet, Siaya and Busia counties
3. Changes in DDS, consumption levels and
commercialization rates
Household Survey
4

5. 1. qualitative measure, proxy for nutrient adequacy
2. Simple count of food groups consumed last 24 hours.
3. Analysis household (HDDS), Women of reproductive age (WDDS) and
children aged 6-23 months (CDDS)
4. 12 food groups for HDDS, 9 for WDDS and 7 groups for CDDS (FAO,
2011; WHO, 2008)
Dietary Diversity Score Analysis
5

6. HH Survey Results: Dietary Diversity Scores
6.34
4.08
2.88 2.75 2.94
7.55
4.71
5.17
3.93
5.12
0
1
2
3
4
5
6
7
8
Household (HDDS) Women of
reproductive age
(WDDS)
Children Dietary
score (<2yrs)
Children not
Breastfeeding
(<2yrs)
Breastfeeding
children (<2yrs)
2016 2017
6

7. CDDS reported the highest
increase, 80%.
WDDS generally lower.
Recorded lowest changes
Highest increases in HDDS
and WDDS in Elgeyo
Marakwet. EMC 3rd highest
increase among children.
Lowest DDS increases for
HDDS, WDDS, CDDS
reported in Busia County.
Dietary Diversity scores
7

8. Consumption
4.57
10.17
1.9
11.86
8.74
14.49
4.97
1.52
9.85
6.44
12.83
28.79
0
5
10
15
20
25
30
35
Groundnuts Pearl millet Finger millet Pigeon peas Green grams Sorghum
2016 2017
8

9. finger millet- highest
increases in consumption:
four times
consumption of sorghum
doubled.
Pearl millet and pigeon
pea reduced consumption
by 85% and 46%
Only finger millet, a 28.5%
drop in production.
Pearl millet: Highest jump
in production, 473%
Consumption
9

10. Commercialization rates
18.4%
28.5%
12.9%
10.7%
15.6% 15.3%
41.7%
7.2%
18.3%
28.9%
18.9% 18.3%
35.9%
43.8%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Finger Millet Groundnut Pearl Millet Pigeon pea Sorghum Cowpea Green grams
2016 2017 10

11. green grams: highest
commercialization rates in
2016 & 2017;40%
Highest increment:
cowpeas 23% followed by
pearl millet at 11%.
Fingermillet and gnuts
reduced
Pigeonpeas sales increased;
EMC, Makueni & Kitui
Groundnut- EMC highest seller,
0.77t
green grams –Kitui, 0.3t
Cowpeas- EMC, 0.36t
Commercialization
11

12. 1. Using social media, Key influencer on Facebook
2. a total of 2, 628 respondents filled in online questionnaire
3. The completion response rate was 99% (25 respondents did
not complete the survey).
4. Analysis of Perception and consumption of smart foods
Urban consumer survey
12

13. Results: Consumption by education levels
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sorghum Fingermillet Pearlmillet pigeonpeas Groundnuts Cowpeas Greengrams
%ofrespondents
College/polytechnic Primary Secondary University
13

14. Consumption frequency
Daily (%) Every other
day (%)
Once a
week (%)
1-2 times a
month (%)
Weighted
score (%)
Finger millet 16.6 22.1 28.2 16.9 17.7
Sorghum 10.3 14.5 27.3 22.3 15.2
Pearl millet 7.4 8.5 13.5 24.5 10.8
Pigeonpea 0.1 9.9 24.4 55.5 16.8
Groundnut 8.4 30.8 35.8 15.0 18.8
Cowpea 0.2 12.2 44.5 23.6 15.8
Green grams 2.1 22.9 57.1 12.6 19.3
14

15. Consumption reasons
Healthy
benefits (%)
I love it
(%)
Easy to prepare/
convenient (%)
Affordable
(%)
Sorghum (n=1466)
8.9 56.1 22.2 12.8
Finger millet (n=1878)
5.5 61.6 24.6 8.3
Pearl millet (n=1068)
9.3 54.4 19.5 16.9
Pigeon peas (n=1318)
2.7 78.8 18.5 -
Groundnuts (n=1964)
4.2 76.8 14.1 5.0
Cowpea (n=1647)
3.5 47.4 36.1 13.1
Green grams (n=2058)
1.8 13.7 67.2 17.3
All
5.1 55.5 28.9 12.2
15

16. Knowledge on smart foods
A lot
(%)
Not much (%)
need more information
Barely
Anything (%)
Weighted
score
Sorghum 35.2 63.8 1.0 46.7
Finger millet 29.0 68.3 2.7 46.3
Pearl millet 13.2 67.2 19.6 44.7
Pigeon peas 17.6 73.6 8.8 45.4
Groundnuts 44.3 54.7 1 47.2
Cowpea 21.6 66.6 11.8 45.5
Green grams 35.2 63.9 0.9 46.7
All 28.0 65.4 6.5 46.0
16

17. 1. conducted in six Counties: Makueni, Kitui, Siaya, Busia &
EMC
2. 3 FGDs in every County; mothers>24 years, 25-35 years,
<35 years : each 5-10 mothers. with children <5 years.
1. Largely qualitative with counts data
2. Assess Perception and consumption
FGDs
17

18. Consumption reasons
• Smart foods are healthy
• Doctors recommend them
• Readily available except for some
Non consumption reasons
• some not available
• they are expensive
• Don’t know how to prepare
Reasons for consumption
18

19. Children consumption Frequency
Finger
millet
Pearl
millet
Sorghum Pigeon
pea
Ground
nuts
Green grams
Busia Twice
daily
- once
daily
- Once
weekly
-
Siaya 3-4 times
daily
- 2 times
daily
- Once
weekly
Once weekly
Makueni
Once
daily
2 times
daily
2 times
daily
Once
daily
- Once weekly
Kitui 2 times
daily
2 times
daily
2 times
daily
2 times
weekly
- 2 times
weekly
Elgeyo M.
19

20. Smart food sources
Finger millet Pearl millet Sorghum Pigeon pea Groundnuts Green grams
Busia Farm
(100%)
- Farm
(100%)
- Farm
(78.3%)
Market
(100%)
Makueni Farm
(64.3%)
Market
(82.1%)
Farm
(71.4%)
Farm
(71.4%)
Market
(100%)
Farm
(71.4%)
Kitui Market
(83.3%)
Farm
(56.7%)
Farm
(66.7%)
Farm
(100%)
- Farm
(100%)
Siaya Market
(78.3%)
- Farm
(69.6%)
- Market
(52.2%)
Market
(95.7%)
Elgeyo M.
20

21. • Perception of smart foods as traditional crops and poor man’s crop
• younger women do not know how to prepare smart foods
• Women below 24 years prefer to buy from the market processed
products, older women get from their farms, blend and process
• Older women feed children frequently with smart foods
• lack information about smart foods
Perception and myths of smart foods
21

22. Siaya-first wife must plant before all other women in the homestead
Busia- finger millet is considered as a component in local brewery
Kitui-Pigeon pea believed not to be nutritious when dry
EMC - groundnuts bad for children because of its high protein
-groundnuts only consumed by men to help with libido.
-Pigeon peas used as fencing material and windbreakers
Pigeonpea causes mental disorder - Kichaa
Perception and myths of smart foods
22

23. Consumption patterns among urban and rural
FGDS (rural households) Urban survey (Urban consumers)
Main reasons for consumption
they are nutritious They love it
Most are readily available Easy/Convenient to prepare
Smart food Crops consumed
Consumption high on crops grown in the region
Siaya/Busia – Sorghum, Finger millet, Gnut
Kitui/Makueni – Greengrams, ppeas, pearlmillet
highly consumed: Greengrams,
groundnuts, finger millet
Least consumed: Pearl millet, sorghum
High cereal consumption High legume consumption
-F.millet & greengrams consumption cuts across counties
23

24. • Assessed impact for DDS, Consumption and
Commercialization rates from HH survey
• Moving forward: 2nd round urban survey to
assess changes after intervention
:2nd round KAP FGDs
From the assessments..
24

25. Innovative tool for nutritional
assessment
Smart Food’s Photo Voice
25

26. Tharaka Nithi County
Determine study sites, treatment (Marimanti) & control (Gatunga).
Sample: 30 respondents each, mixed gender and ages
Photovoice Approach
26

27. a one day photography
training by a canon certified
trainer.
respondents told to take
photos of all foods consumed
by the household and its
members in the next 24 hours
as an assignment.
Photovoice Approach
27

28. Images of foods consumed printed
captioned images of foods
consumed used as data source for
nutritional analysis.
Photovoice Approach
28

29. 3 data clerks with nutrition
background entered data from
images into SPSS
analysis of DDS for the HH, WRA
and children.
Photovoice Approach
29

30. County nutritionist assessed
general nutritional status from
images, one-one training
1 day agri nutritional training for
gatunga -control
Photovoice Approach
30

31. Given the photos to go home with
Issued certificates- photography
and agri nutrition training
Photovoice Approach
31

32. Photography training: a
skill they will use beyond
the project lifetime.
Nutritional assessment
and training: A
participatory process
Photovoice approach
1
2
3 Data collection for
assessing DDS and
utilization levels: Real time
photos as data source
Photo exhibitions and
documentary
4
32

33. Photovoice Results: Dietary Diversity Scores
Treatment Comparison
site
difference
Household 8.1 6.0 2.1
Women of
reproductive age
5.5 3.7 1.8
Children below
24 months
6.0 2.0 4.0
33

34. Utilization of smart foods: Control
• Consumption largely cereals particularly pearl millet.
• Two thirds of the participants brought images of smart foods
• Legume consumption was extremely low
34

35. Utilization of smart foods: Treatment
• All the participants consumed smart food
• diverse products of smart foods made from cereals and legumes.
• 100% had cereals, 87% consumed legumes.
35

36. Control-Gatunga
ratio of legumes to maize was
low:1 to 3, and 1 to 4
consumption of vegetable is
very low, mainly carbohydrates
complementary feeds for infants
made from 2-3 food groups
Emerging themes- nutritionist
Treatment-Marimanti
legume to cereal was well
balanced in 1 to 2 or 1 to 1.
Consumption of vegetable
was higher with diverse
food groups
consumed more food
groups
36

37. • Multiple benefits
• Increases beneficiaries at the
same time conducting
evaluations
• Approach averts recall
challenges
• Validate results for HH survey
Photovoice
37

38. Photovoice and HH survey depict similar trends
Positive changes in DDS for WRA, HH & children
Children-highest changes
WRA- Lowest changes
Take away: Dietary Diversity Scores
1
2
3
4
38

39. Driven by production
Commercialization increased for all crops except
finger millet and groundnut
Green grams – most highly commercialized
Take away: Commercialization
1
2
3
39

40. Consumption volumes increased for all except pearlmillet and pigeonpeas
reduced. change perception and knowledge
Tasty and convenient products for urban consumers
Targeted messages to younger women
various products from smart foods encourage high utilization in treatment.
Training and knowledge on cooking methods on diverse products
Need for training on maternal infant and young child nutrition (MIYCN)
Take away: Consumption & perception
1
2
3
4
5
40

41. For more about Smart Food Kenya activities,
please follow us on:
@smartfoodkenya #SmartFood
41

42. Thank You
42