Kenya

Kenya is a low income country with a per capita GNP of U.S.$270 in 1993. Population was 27 million in 1993 and population is growing at the rate of 2.9% per annum. The nutrition situation in Kenya up to around 1990 was described in the Second Report on the World Nutrition Situation, vol II, p.51-55. Results from a new nutrition survey (1993) make it possible to update the earlier report.

Recent Trends in Nutrition

The most recent survey carried out by the National Council for Population and Development and DHS in 1993 indicates static or worsening nutritional conditions amongst children compared to the 1987 national rural survey. The prevalence of stunting (less than <-2 s.d. height-for-age) in 1987 was estimated at 32.2%, and increased nationally to an average of 33.7% in 1993. These new data are an indication of reverses in gains in nutrition that were reported in the previous decade. In absolute numbers, the stunting problem now affects 1.7 million preschool children, compared to 1.3 million in 1987.

Surveys of child nutrition have been carried out in Kenya since 1977. Seasonality varies greatly across the country, so that stunting has been more often used than underweight to make comparisons through time. Calculation methods have evolved, notably moving from a cut-off of 90% for height-for-age, to <-2 SDs. An estimate of national stunting trends in children 0-59 months can be represented thus:

	1982	1987	1993
H/A <90%	27.0%	23.0%	-
H/A <-2 SDs	-	32.2%	33.7%

This indicates improvement in the mid '80s, then deterioration 1987-1993. A similar issue applies to underweight prevalences, but with recalculation the following trend in underweight seems plausible (and tells much the same story as stunting):

	1982	1987	1993
W/A <-2 SDs	22.0%	18.0%	22.3%

Trends in nutrition, assessed by stunting, have been uneven across provinces. These are shown in Figure 1.

In the Coastal province, where the highest proportion of stunting is found, there were improvements between 1987 and 1993 (from 50% to 41% - prevalences here expressed as <-2 SDs height-for-age). Similarly, the province of Nyanza experienced notable improvements (40% to 31%). Significant increases in stunting were observed in the Western province (23 to 30%), the Central province (26% to 31%). In Rift Valley province stunting increased slightly. Stunting levels are now very similar, at around 30% (<-2 SDs height-for-age), in Central, Rift Valley, Nyanza and Western provinces, with Coast and Eastern some 10 percentage points higher at about 40%.

Figure 1. Kenya: Trends in Prevalence of Stunted Children (12-59 months) by Province, 1977-1993

Note: Data for 1977, 1962 and 1987 were originally given as <90% ht/age. For 1987 these are also available as <-2 SDs (and plotted both ways) which is how 1 993 are also calculated. To facilitate viewing trends In these plots, the <-2 SD scale (right hand vertical) Is shifted +10% compared with the <90% scale.

Sources: 1977-1987 - see Second Report of the World Nutrition Situation; (1993), NCPD-CBS-DHS (1994).

Factors Affecting Trends in Nutrition

Economic Growth. Many factors may be responsible for the static or deteriorating nutritional conditions in Kenya. Whereas relatively good growth rates in the economy were experienced in the latter part of the 1980s, problems started to mount in the early 1990s. Per capita GDP growth was negative after 1990 through 1993.

External imbalances worsened due to the Gulf crisis, deteriorating terms of trade, and the withholding of balance of payments support to Kenya by multilateral and bilateral agencies since late 1991. Continuous monetary pressure has fueled inflation, from 15.6% in 1990 to 19.8% in 1991 and 29.6% in 1992.

The fiscal deficit grew to 7.1% of GDP in FY91 and is estimated to be 2.9% of GDP in FY92. The deficit target for FY92 was almost achieved through fiscal compression, but election related expenses and larger than anticipated export compensation payments threatened to swell the FY92 deficit to more than twice the 2% of GDP target. The economy is heavily dependent on agriculture, since it employs more than 80% of the labor force and contributes more than a quarter of the GDP.

Food Security. Large parts of Kenya are drought prone. A major drought in 1992/93 seriously affected the food supply situation. The food production index dropped to a historic low of 83 in 1993 (base 1979-81=100) a level even below that of the last major drought of 1984/85. Even the normally surplus regions (Rift Valley), and the marginally deficit areas (Western and Nyanza) entered maize deficit situations in 1992/93; and food security problems worsened in the chronically maize-deficient areas of the Coast, Eastern, and Northeastern provinces.

As a marginally food deficit country, Kenya is a regular importer of food grains. Historically, the government intervenes heavily in the foodgrain market, such that shortfalls in production are compensated by price supports and by imports. Food aid forms about half of total import requirements; the other half comes from commercial imports. The estimate of foodgrain production for 1993/94 was 2.2 million MT, compared to total requirements of 3.9 million MT, or a shortfall of 1.5 million MT to be filled in by imports.

The recent drought affected household food availability, and consumption was curtailed further by the rise in food prices. The ratio of the food price index to the consumer price index rose to more than 107, the first time since 1985. This rise means that households faced higher inflation in foodstuffs than other components of consumer expenditures. With 1990=100 as base, the food price index was reported at more than 240 in 1993 at the height of the drought, with a CPI of more than of 227. Moreover, wages have not been keeping up with prices.

No data on calorie consumption are available which reflect lower food availability due to the 1992/93 drought. The most recent consumption data of 2075 kcals per capita for 1992 is about the same level as 1986. Between 1986-92 there was some decline in calorie consumption.

Health, Education. The Kenyan Welfare Monitoring System data for 1992/93 indicate that the enrollment rates in Kenya are generally high by African standards. The net enrollment rates at the primary level was estimated at 73%, higher amongst higher income groups, but no significant differences between males or females. The secondary enrollment rates were, however, very low at a net of 11% for the entire population. There is high income effect in the secondary enrollment rates; the rates in the poorest income deciles were nearly 4% compared to 23% in the highest decile.

Reports on immunization coverage vary. Earlier reports were of falling coverage of, for example, measles immunization. Recent figures indicate an increase of this indicator from 60% in 1987 to 81% in 1992, this level being maintained in 1993.

KENYA

(Estimates in 1993)

Population	: 27 million
Population Density	: 43 per sq. km.
Population Growth Rate	: 2.9% per annum
Urban Population	: 26%
IMR	: 61
GNP US$ (Per Capita) (WB Atlas Methodology)	: 270
PPP estimates of GDP ($ Per Capita, in 1991)	: 1350

CHILD GROWTH AND SURVIVAL

Underweight preschool children (Percent below -2 s.d. weight for age)

Infant mortality rate (Per 1,000 live births)

ECONOMICS

GDP per capita (1987 Mkt. prices, Shillings / capita)

Debt service ratio (Debt service/exports)

FOOD

Food production index (Per caput, 1979-81=100)

Dietary energy supply (Kcals/caput/day)

Consumer price index (1980=100)

FPI/CPI ratio (1980=100)

HEALTH

Immunization coverage (Percent)

Access to local health care (Percent)

PUBLIC EXPENDITURES

Education and health expenditures (US $ per capita)

Education and health expenditures (Percent of government expenditures)