BackgroundMany low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya.MethodsData were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults.ResultsOf the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese.ConclusionThe findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.

Objectives To establish exclusive breastfeeding (EBF) practice, women are encouraged to initiate breastfeeding of their newborns within one hour of delivery and breastfeed exclusively for the first 6 months of the infant's life. Research in Kenya has shown evidence of a reduced rate of EBF with an increase in socio-economic class (SES). This study explores the experiences of middle-income women so as to understand their attitudes and practices of EBF and to contribute toward the Baby Friendly Hospital (BFHI) and Baby Friendly Community Initiatives (BFCI) programs in Kenya. Methods A qualitative study using nine in-depth interviews and two focus group discussions were conducted with middle-income women with a child < 2 years. Thematic content analysis was used to analyze the data. Results The majority of the women interviewed did not achieve EBF and this was attributed to many challenges that they encountered such as; inadequate workplace support including short maternity leave, lack of designated breast feeding facilities flexible hours and breastfeeding breaks. Support structures were highlighted as either inadequate or lacking while the internet was preferred by most of the women for breastfeeding information. Mass media was seen as more credible, though some women indicated that there was lack of depth in the information it provided. Conclusion The study showed that majority of women were unable to EBF for the first 6 months. Women experienced inadequate social, healthcare and workplace support and preferred online sites for information on breastfeeding than the healthcare professionals or mass media. Recommendation There is need to implement policies at the workplace that promote a breastfeeding friendly environment. There is also a need for more research on role of mass media in promotion of optimal breastfeeding practices, especially how to reach this population. There is a need for continued advocacy on social support including spousal, relatives, and other community members at the community level.

Studies in urban informal settlements show widespread inappropriate infant and young child feeding (IYCF) practices and high rates of food insecurity. This study assessed the association between household food security and IYCF practices in two urban informal settlements in Nairobi, Kenya. The study adopted a longitudinal design that involved a census sample of 1110 children less than 12 months of age and their mothers aged between 12 and 49 years. A questionnaire was used to collect information on: IYCF practices and household food security. Logistic regression was used to determine the association between food insecurity and IYFC practices. The findings showed high household food insecurity; only 19.5% of the households were food secure based on Household Insecurity Access Score. Infant feeding practices were inappropriate: 76% attained minimum meal frequency; 41% of the children attained a minimum dietary diversity; and 27% attained minimum acceptable diet. With the exception of the minimum meal frequency, infants living in food secure households were significantly more likely to achieve appropriate infant feeding practices than those in food insecure households: minimum meal frequency (adjusted odds ratio (AOR)=1.26, P=0.530); minimum dietary diversity (AOR=1.84, P=0.046) and minimum acceptable diet (AOR=2.35, P=0.008). The study adds to the existing body of knowledge by demonstrating an association between household food security and infant feeding practices in low-income settings. The findings imply that interventions aimed at improving infant feeding practices and ultimately nutritional status need to also focus on improving household food security.