1. Effect of early childhood stunting on schooling among poor urban households in Nairobi, Kenya Maurice Mutisya APHRC

2. Content Introduction Objective Study Design Results Conclusion

3. 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!

5. 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.

6. Objective and Research Question Objectives – Explore the effect of early childhood nutrition (stunting) and food security on achievement among children aged between 5 &8 years in Korogocho and Viwandani. Research Question – What is the effect of child nutrition and food security on school entry and achievement?

7. 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

8. Sampling Loss to follow up – Migration Response rate of 71% Biased sample – non-random loss? 7425 Total recruitment (IDS) 2007- 10 <5 years 7425 5+ years 7425 Lost 1235 Lost 2340 2056 1794 Migrations 121 1673 Stunting Info. not enough/available Normal 618 (36.9) Stunted 1055 (63.1) 1189 Normal 436 (36.7) Stunted 753 (63.3) 182 302 Migration; no Respondent

9. 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

10. Measurements – Key variables Outcome  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

11. Background information VariablePercentage % Stunting63.3% Not stunted36.7 Temporal stunt24.5 Stunted38.8 % food secure39.2 % Poorest (wealth index)34.7 % joined school

12. Numeracy z-scores

13. Literacy Z-scores

14. SEM Model Achievement Food security Stunting Gender ADHD Wealth Index Father Educ. Mother Educ. School years HH size Homework Sch. type Mother age Orphan hood HH: Household; ADHD = Attention Deficit Hyperactivity Disorder

15. SEM: Numeracy SEM: Numeracy - direct and indirect effects VariableDirect EffectsIndirect EffectsTotal Effects Stunting Not stunted-- Temporal-0.123*** Stunted-0.183*** Food Security Secure--- Moderate-0.035-0.003-0.037 Insecure-0.018-0.008-0.025 Wealth Index Poorest--- Middle0.122**0.0090.131** Least poor0.0960.0190.115* Controlling for other covariates; ***P<0.01; **P<0.05; *P<0.1

16. SEM: Literacy SEM: Numeracy - direct and indirect effects VariableDirect EffectsIndirect EffectsTotal Effects Stunting Not stunted-- Temporal-0.181*** Stunted-0.293*** Food Security Secure Moderate-0.028 Insecure-0.068 Wealth Index Poorest Middle0.0720.0200.093* Least poor0.209**0.044**0.253** Controlling for other covariates; ***P<0.01; **P<0.05; *P<0.1

17. 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

18. Acknowledgements Study Participants Field staff APHRC Researchers CARTA

19. mmutisya@aphrc.org www.aphrc.org