Building forward better-An exploration of nutrition practices, food choice, and coping behaviors among Kenyan adolescents during COVID-19: Experiences and program implications.

This implementation research study sought to examine the impact of the COVID-19 pandemic on adolescent nutrition practices and related behaviors in Nairobi and Uasin Gishu Counties, Kenya. Eight focus group discussions (FGDs) were conducted with adolescents 10-19 years of age, in-depth interviews with 10 health facility providers, and a combination of FGDs (n-4) and key informant interviews with government stakeholder and implementing partners (n = 9). During the pandemic, adolescents tended to avoid commonly consumed junk foods, in favor of "immune boosting, protective" foods. Widespread unemployment and reductions in parental income rendered some food items such as meat, eggs, and fruits unaffordable for families of adolescents. Adolescents relayed experiences of skipping meals and reducing the amount and variety of foods consumed. Adolescents also described employing strategies such as working in the informal sector and selling personal items to support families financially, in response to rising food insecurity. School closures mandated during the pandemic likely contributed to reductions in overall physical activity. To improve the diets of adolescents, programs should build on the healthy mindset brought on by the pandemic, while strengthening, targeting, and improving access to social protection measures and agricultural initiatives for vulnerable families with adolescents to cushion them from rising food insecurity as an effect of COVID-19. Building practical adolescent life skills to encourage healthy nutrition actions will also be key to building forward from the COVID-19 pandemic in Kenya.

How COVID-19 affected food systems, health service delivery and maternal and infant nutrition practices: Implications for moving forward in Kenya.

This implementation research study sought to examine the impact of the COVID-19 pandemic on maternal and infant nutrition practices, and related aspects of health and food systems in Nairobi and Uasin Gishu Counties, Kenya. The study triangulated in-depth interviews with 16 pregnant women, 31 lactating women (including COVID-19 positive), 10 facility health workers, 10 community health volunteers, 6 focus group discussions (FGDs) with food vendors, 4 FGDs and 15 stakeholder interviews with government and implementing partners. Trends from Kenyan Health Information System indicators (i.e., exclusive breastfeeding and initiation of breastfeeding, antenatal care) were also examined. During the COVID-19 pandemic, a decline in attendance of antenatal care, and maternity facilities was observed, and corroborated by Kenyan Health Information System data. Lack of clarity among health workers on COVID-19 breastfeeding guidance and fear of COVID-19 infection early in the pandemic were key drivers of early infant formula use, mother-child separation following delivery and delayed initiation of breastfeeding. Most women exclusively breastfed due to Government of Kenya restrictions in movement. Unemployment and job loss was linked to food insecurity and worsened by increased food prices and limited social protection measures. In response, pregnant and lactating women resorted to skipping meals and reducing quantity and variety of foods consumed. Efforts to build forward from COVID-19 in Kenya should include facility and community health education to prevent disruptions in breastfeeding and to support maternal dietary intake, and in the provision of targeted social protection measures alongside other multisectoral interventions (i.e., psychosocial support) for Kenyan pregnant and lactating women.

Mid-term evaluation of Maternal and Child Nutrition Programme (MCNP II) in Kenya.

BACKGROUND: Kenya is faced with a triple burden of malnutrition which is multi-faceted with health and socio-economic implications. Huge geographical disparities exist, especially, in the arid and semi-arid lands exacerbated by inadequate resource allocation to the nutrition sector and challenges in multi-sectoral coordination and nutrition governance. UNICEF's Maternal and Child Nutrition Programme is a four-year (2018-2022) resilience-building, multi-sectoral program focused on pregnant and lactating women, mothers of children under five years and children under five years. The objective of the mid-term evaluation was to establish the relevance, effectiveness, efficiency, and sustainability of the programme. METHODS: The field evaluation conducted between June and July 2021, adopted a concurrent mixed-methods approach, where qualitative information was gathered through 29 key informant interviews and 18 focus group discussions (6 FGDs per population group; women of reproductive age, adolescent girls and men). Quantitatively, data were obtained through desk review of secondary data from programme reports, budgets, and project outputs where descriptive analysis was undertaken using Excel software. Qualitative information was organized using Nvivo software and analyzed thematically. RESULTS: The findings provide evidence of the relevance of the Maternal and Child Nutrition Programme II to the nutrition situation in Kenya and its alignment with the Government of Kenya and donor priorities. Most planned programme targets were achieved despite operating in a COVID-19 pandemic environment. The use of innovative approaches such as family mid-upper arm circumference, integrated management of acute malnutrition surge model, Malezi bora and Logistic Management Information Management System contributed to the realization of effective outputs and outcomes. Stringent financial management strategies contributed toward programme efficiencies; however, optimal utilization of the resources needs further strengthening. The programme adopted strategies for strengthening local capacity and promoting ownership and long-term sustainability. CONCLUSION: The programme is on track across the four evaluation criteria. However, a few suggestions are recommended to improve relevance, effectiveness, efficiency, and sustainability. A formal transition strategy needs to be developed in consultation with multi-stakeholder groups and implemented in phases. UNICEF Nutrition section should explore a more integrated  programming mode of delivery through joint initiatives with other agencies under the Delivery as One UN agenda, along the more gender transformative approaches with more systematic involvement of males and females in gender-based discussions.