Since 2010, the NICK study has sought to help two project countries, Chile and Kenya, reduce urban malnutrition in young children by facilitating intersectoral actions to change the social determinants. In urban Kenya chronic stunting is an endemic problem jeopardizing children’s physical and mental development. In urban Chile child overweight and obesity is a serious public health problem associated with increased risk of morbidity and mortality from chronic diseases such as diabetes mellitus and coronary heart disease.
The 2010 and 2013 Lancet Series on Maternal and Child Nutrition identified the need for increased inter-sectoral action to address the complex causation of child malnutrition. The 2013 Series called for more studies to strengthen the evidence base for ‘nutrition sensitive’ programming to address the social determinants and find out what works and how programmes should be designed in specific country contexts. Now that more people worldwide are living in cities than rural areas, there have also been calls for more attention to be paid to the poorest and most vulnerable families living in urban informal settlements. The NICK study responds to these calls by addressing the question: Can child malnutrition amongst families living in poverty in informal settlements in the cities of Mombasa in Kenya, and Valparaíso in Chile, be reduced through broadening community and stakeholder participation to change the social determinants of nutritional status?
Findings from the situational analysis confirmed that the social determinants of child malnutrition in the study areas were a broad range of social, economic and environmental factors operating at local, municipal, provincial and central levels. They included education, income, working conditions, housing, neighbourhood and community conditions, the status of women and level of social inclusion. These determinants impacted child nutrition through influencing access to nutritious foods, child care practices and access to basic services.
Key lessons learnt: What works? What does not work?
- creating supportive environments for intersectoral actions: support is needed to enable group members to begin to think differently about the causes of child undernutrition and how to tackle them, to decide and implement mutually agreed co-ordinated action plans and to negotiate with line managers on the need for ensuring that group membership remains relatively stable. The in-country researchers in Kenya are continuing to be supportive of the urban nutrition working group as it now prepares to transform and transition into a county level nutrition working group
- strengthening community action: in Mombasa, three community self-help groups were identified, trained and supported to implement the action plans made by the working group. They too became part of the planning meetings to engender ownership. The community members began to appreciate the benefits of the interventions in their lives, and some decided to take further the actions to improve the material and nutritional status of their families. Some of the actions proposed and implemented to tackle domestic violence emerged from the community itself
- developing personal skills and growth: the NICK study has documented the development of personal skills and growth from both the nutrition working group and from the community groups. There has been a transition from initial awareness raising within the nutrition working group and the three community groups on the link between seemingly unrelated social determinants of poor nutrition to actively seeking new ways of co-ordinating actions to tackle them. Linkages related to tackling poor child nutrition have been created, relationships at household level have been impacted and new possibilities have opened
- policy environment: it is clear that there is a need to review and/or formulate and implement policies that support multi-sectoral engagement in child nutrition. The key sectors, including agriculture, urban planning, water and sanitation, health and education are critical to tackling this problem in a sustainable manner. It is also important to address policies on the sale and advertisement of unhealthy foods to children
- access to healthy choices: in both intervention areas, the availability of fresh fruits and vegetables was limited due to the cost (especially for poor people) and availability near to homes. Increasing access to healthy choices would require making it easier to access them and ensuring that the unhealthy choices are more difficult to access (affecting supply side factors)
- developing small-scale initiatives: the Nick study build partnerships focused on taking action to implement small-scale initiatives to tackle the social determinants of child malnutrition. These actions were designed through multisectoral planning activities, stakeholder’s analysis and local Action Plans. In Valparaiso, the urban nutrition working groups developed a comprehensive approach to malnutrition oriented to eventually addressing both dietary habits and physical activity patterns of the population of the research intervention site
- developing and implementing a capacity building programme: this programme was based on proven transformational processes, systems tools, and collaboration and relationship building as core strategies. The impact of this programme ranged from a strategic shift from broad coalition-building and broad focus on the political, social and environmental determinants of malnutrition, to introducing a governance lens and strengthening low income communities by empowering stakeholders, families and communities in relation to food and nutrition. The new knowledge that has been developed is part of an “integral” learning and change processes that considers “inner” and “outer” change, and are both deeply personal and inherently collective
The research team renamed this study the NICK Project :Nutritional Improvement for children in urban Chile and Kenya.