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

mmutisya@aphrc.org

www.aphrc.org