No abstract

A COVID-19 lockdown may impact household fuel use and food security for ~700 million sub-Saharan Africans who rely on polluting fuels (e.g. wood, kerosene) for household energy and typically work in the informal economy. In an informal settlement in Nairobi, surveys administered before (n=474) and after (n=194) a mandatory COVID-19-related community lockdown documented socioeconomic/household energy impacts. During lockdown, 95% of participants indicated income decline or cessation and 88% reported being food insecure. Three quarters of participants cooked less frequently and half altered their diet. One quarter (27%) of households primarily using liquefied petroleum gas (LPG) for cooking before lockdown switched to kerosene (14%) or wood (13%). These results indicate the livelihoods of urban Kenyan families were deleteriously affected by COVID-19 lockdown, with a likely rise in household air pollution from community-level increases in polluting fuel use. To safeguard public health, policies should prioritize enhancing clean fuel and food access among the urban poor.

Graphical abstract

Maternal and neonatal mortality are unacceptably high in developing countries. Essential nutrition interventions contribute to reducing this mortality burden, although nutrition is poorly integrated into health systems. Universal health coverage is an essential prerequisite to decreasing mortality indices. However, provision and utilization of nutrition and health services for pregnant women and their newborns are poor and the potential for improvement is limited where health systems are weak. The Community-Based Maternal and Neonatal Health and Nutrition project was established as a set of demonstration projects in 4 countries in Africa with varied health system contexts where there were barriers to safe maternal health care at individual, community and facility levels. We selected project designs based on the need, context, and policies under consideration. A theory driven approach to programme implementation and evaluation was used involving developing of contextual project logic models that linked inputs to address gaps in quality and uptake of antenatal care; essential nutrition actions in antenatal care, delivery, and postnatal care; delivery with skilled and trained birth attendant; and postnatal care to outcomes related to improvements in maternal health service utilization and reduction in maternal and neonatal morbidity and mortality. Routine monitoring and impact evaluations were included in the design. The objective of this paper is to describe the rationale and methods used in setting up a multi-country study that aimed at designing the key maternal and neonatal health interventions and identifying indicators related to inputs, outcomes, and impact that were measured to track change associated with our interventions.

Universal access to cleaner cooking fuels (including liquefied petroleum gas (LPG)) is a key target of Sustainable Development Goal 7. Currently, approximately 40 million Kenyans rely on polluting cooking fuels (e.g. charcoal, wood). While the Kenyan government aims to rapidly scale up use of LPG for cooking by 2030, COVID-19 restrictions and a 16% Value Added Tax (VAT) re-introduced on LPG in 2021 have likely hampered progress in LPG uptake. We aimed to quantify the effect of these economic shocks on food and energy security in Langas informal urban settlement in western Kenya. We further evaluated whether households most adversely affected by COVID-19 restrictions were more likely to be socioeconomically impacted by the VAT re-imposition. A cross-sectional survey (n=1,542) assessed changes in cooking fuel patterns, food security and livelihoods of primary cooks due to these two economic shocks. While under COVID-19 restrictions, 75% (n=1,147) of participants reported income declines and 18% (n=164) of participants using LPG (n=922) switched their primary cooking fuel to charcoal, wood or kerosene. Households reporting lower income while under COVID-19 restrictions had 5.3 times (95%CI:[3.8,7.4]) the odds of experiencing food insecurity as those with no change in income. Unemployment and food insecurity under COVID-19 restrictions were substantially higher among informal sector workers (70% and 60%, respectively) compared with business/government employees (45% and 37%, respectively). Following the VAT re-introduction, 44% (n=356) of households using LPG consumed less, and 34% (n=276) cooked more frequently with polluting fuels. Individuals switching away from LPG under COVID-19 restrictions had 3.0 times (95% CI:[2.1,4.3]) the odds of reducing their LPG consumption due to the VAT re-introduction as those maintaining use of LPG. COVID-19 restrictions and the VAT re-introduction disproportionately negatively affected informal sector workers’ livelihoods. A zero-rating of VAT on LPG can help alleviate deepened inequities in LPG access in Kenya.