Women’s Participation in Household Decision-Making, Dietary Diversity and Nutritional Status of Children in Smallholder Farming Households in Kakamega County, Kenya

Abstract
Addressing malnutrition in under-five children remains a global priority due to its association with long-term adverse health and economic implications at all levels in society. While huge disparities in progress towards nutrition targets for SDGs exist across the globe, sub-Saharan Africa particularly lags despite the intensity of nutrition and health programmes ongoing in the region. There is a need to explore new paradigms in the etiology and epidemiology of child malnutrition paying attention to the socio-economic and cultural dynamics associated with unique contexts. Evidence shows that allocation of resources towards a child's health and nutrition inputs like child feeding and treatment hung on household decision-making patterns. However, there is limited evidence on the level of women’s participation in household decision-making and its implication on the nutritional and health outcomes in children. This study adopted a cross-sectional analytical design to determine women’s participation in household decision-making and its influence on nutritional status of children aged 6-59 months of age in rural smallholder farmer households in Kakamega County. Lugari Sub-County was purposively chosen based on the high prevalence of malnutrition and large population of smallholder farmers. Simple random sampling method was used to select Chevaywa out of the 6 Wards making up Lugari Sub-County while 330 households randomly selected from a sampling frame of smallholder farming households with children 6-59 months old from the 3 Sub–locations in the ward participated. A researcher-administered questionnaire was used to collect data on demographic and socio-economic characteristics of the participants, household decision-making patterns, child dietary diversity and nutrition status. Data collected was coded and analyzed using STATA version 15.1 and presented using measures of central tendency, frequency tables and graphs. Regression analysis was used to model the relationship between predictor variables (socio-economic characteristics, level of women’s participation in household decision making, child dietary diversity) and the outcome variable (nutritional status). Significance was tested at α=0.05, 95% confidence interval. The findings show that in majority (90%) of the households, decisions were predominantly made jointly by the women and their spouses. The prevalence of wasting, stunting and underweight was 4.5%, 20.6% and 6.4%, respectively. Women who made fewer unilateral household decisions (<=50%), were more likely to have wasted (odds ratio=1.38, p=0.003), stunted (=odds ratio= 1.77, p=0.010), and underweight (= odds ratio =1.11, p=0.044) children compared to those who made > 50% unilateral decisions. Based on the study findings, participation of women in household decision-making is critical to the realization of optimal nutritional outcomes in under-five children in rural smallholder farming contexts as it enhances dietary diversity and nutritional status of children aged 6-59 months. Cognizant of the importance of women in decision making, policies should that seek to empower women socio-economically should be promoted at all levels in the society. Similarly, nutrition programmes implementers should integrate social behavior change and communication interventions in their projects to address culturally propagated and encouraged gender stereotypes and biases that deny women the decisional space at the household level.
Description
Fulfillment of the Requirements for the Award of Degree of Master of Science (Food, Nutrition and Dietetics) in the School of Health Sciences, Kenyatta University, August 2023.
Keywords
Women’s Participation in Household Decision-Making, Dietary Diversity, Nutritional Status, Children in Smallholder Farming Households, Kakamega County, Kenya
Citation