Effect of early childhood stunting on schooling among poor urban households in Nairobi, Kenya Maurice Mutisya APHRC.

Effect of early childhood stunting on schooling among poor urban households in

Nairobi, Kenya

Maurice Mutisya

APHRC

Content

• Introduction

• Objective

• Study Design

• Results

• Conclusion

Introduction

• Interest in early childhood development (Fall et al.)

– Nutrition key for the development of a child (Jyoti,

Frangillo, & Jones, 2005).

– Effects accrue to later life - low academic achievement

and lower earnings (Save the Children, 2013)

• Recent focus – growth during the first 1000 days

– Moving beyond mortality to cognitive development

– Challenge – lack of data – longitudinal studies!

Objective

Use existing longitudinal study to

determine the effect of stunting and food

security on achievement among children

aged between 5 &8 years in Korogocho

and Viwandani.

Design• Quantitative survey – Integrated:

– MCH- longitudinal study 2007 and 2010

• Secondary data on stunting during first 1000 days

– Cross-sectional survey (primary data) – achievement

– NUHDSS – Food security information

• Assessment

– Literacy and Numeracy basic skills - % score

Sampling

• Loss to follow up

– Migration

• Response rate of

71%

• Biased sample –

non-random

loss?

7425 Total recruitment (IDS) 2007-10

<5 years7425

5+ years7425

Lost1235

Lost2340

2056 1794

Migrations

121

1673

Stunting Info. not enough/available

Normal618 (36.9)

Stunted1055 (63.1)

1189

Normal436 (36.7)

Stunted753 (63.3)

182 302 Migration; no Respondent

Migration; no Respondent

Study Setting and Target population

• Nairobi Urban Demographic Surveillance System (NUHDSS)

– Two study sites – Korogocho and Viwandani

– ……. about 70,000 individuals in 23000 HHs

• Target Population

– Households participating in MCH study

– Inclusion – currently active in the NUHDSS

– Child aged between 5 and 8 years

Measurements – Key variablesOutcome Z-score on literacy and numeracy Basic skills

Stunting Height for Age during the first 2 years

Food security Items on food uncertainty, worry,

child and adult hunger

Wealth Index PCA - Assets and amenities

Background information

Variable Percentage

% Stunting 63.3%

Not stunted 36.7

Temporal stunt 24.5

Stunted 38.8

% food secure 39.2

% Poorest (wealth index) 34.7

% joined school 97.4

Numeracy z-scores

Not stunted

Temorary

Stunted

Secure

Moderate

Severely

Poorest

Middle

Least poor

Stun

ting

Food

Sec

urit

yW

ealt

h

-0.35-0.25

-0.15

-0.04999999999999990.05

0.150.25

0.35

Numeracy Z-Scores

Literacy Z-scores

Not stunted

Temorary

Stunted

Secure

Moderate

Severely

Poorest

Middle

Least poor

Stun

ting

Food

Sec

urit

yW

ealt

h

Literacy Z Scores

SEM Model

Achievement

Food security

Stunting

Gender

ADHD

Wealth Index

Father Educ.

Mother Educ.

School years

HH size

HomeworkSch. type

Mother age

Orphan hood

HH: Household; ADHD = Attention Deficit Hyperactivity Disorder

SEM: NumeracySEM: Numeracy - direct and indirect effects

Variable Direct Effects Indirect Effects Total EffectsStunting

Not stunted - -Temporal -0.123*** -0.123***Stunted -0.183*** -0.183***

Food SecuritySecure - - -Moderate -0.035 -0.003 -0.037Insecure -0.018 -0.008 -0.025

Wealth IndexPoorest - - -Middle 0.122** 0.009 0.131**Least poor 0.096 0.019 0.115*

Controlling for other covariates; ***P<0.01; **P<0.05; *P<0.1

SEM: LiteracySEM: Numeracy - direct and indirect effects

Variable Direct Effects Indirect Effects Total EffectsStunting

Not stunted - -Temporal -0.181*** -0.181***Stunted -0.293*** -0.293***

Food SecuritySecureModerate -0.028 -0.028Insecure -0.068 -0.068

Wealth IndexPoorestMiddle 0.072 0.020 0.093*Least poor 0.209** 0.044** 0.253**

Controlling for other covariates; ***P<0.01; **P<0.05; *P<0.1

Conclusion• Opportunity provided by longitudinal studies

• Early childhood stunting associated with literacy and

numeracy achievement

– Poor health

– Cognitive development?

• Food security not related with achievement

– Food security related to nutrition (Reis, 2012; Saaka &

Osman, 2013)

– Effect – could be attenuated by nutrition

Acknowledgements

• Study Participants

• Field staff

• APHRC Researchers

• CARTA

[email protected]

www.aphrc.org