Understanding nutrition transition among internal rural-to-urban migrant women in Kenya.

Evidence suggests that urbanisation in Kenya is fueling nutrition transition culminating in increased obesity rates among the urban poor, especially women. Mechanisms underlying this transition are poorly understood. I therefore examined nutrition transition among rural-to-urban migrant women to better understand obesity in Kenya. I employed a sequential explanatory mixed methods design. In the quantitative phase I used individual and household secondary-data from the 2014 Kenyan Demographic and Health Survey (n=6,171) and the 2008/2009 Nairobi Urban Health and Demographic Surveillance System (NUHDSS) (n=5,422) to identify characteristics associated with nutrition transition and obesity risk among migrant women. The NUHDSS analysis informed the interview guide and sampling in qualitative research in three Nairobi slum neighbourhoods, with 6 key informant interviews, 7 focus groups, 28 in-depth interviews and 3 PhotoVoice groups. A mixed-methods results synthesis led to the formulation of several key meta-inferences. First, both quantitative studies showed no clear differences between rural-to-urban migrant women’s and urban non-migrants’ diets. The qualitative findings concurred with this as migrant women, despite having mixed attitudes, perceived their diets to be similar to those of local residents. While they appreciated accessibility and diversity of cheap, sweet and animal-sourced food, they had more trust in home-cooked food. Second, economic circumstances were salient on nutrition transition. Household wealth and self-employment were positively associated with having obesity. Wealthier migrant women, and those who sold obesogenic foods, consumed these in larger portions either at home or pre-prepared due to economic insecurity, time scarcity, family responsibilities and/or convenience. Lastly, repeated exposure to obesogenic food and social pressure to conform to community nutrition patterns drove nutrition transition irrespective of individual deprivation. These findings indicate the need for a local systems approach which considers the complex interplay between economic and time insecurity, and socio-cultural norms to address nutrition transition and obesity in slum neighbourhoods.