Determinants of dietary diversity and drivers of food choice among low-income consumers in urban Kenya, Malawi and Zimbabwe

IntroductionRapid urbanisation affects lifestyle and eating habits, predominantly causing a dietary shift that adds challenges to meet dietary recommendations within a complex food system. This research investigated dietary diversity and food choice drivers among low-income consumers in three urban settlements (Nairobi, Kenya; Bulawayo, Zimbabwe and Lilongwe, Malawi, representing rapid, moderate and slow urban growth patterns, respectively) as a first step towards improving diets across cultures and geographies.MethodsMixed methods data collection was employed for this study. Qualitative methods such as rapid foodscape appraisal workshops and food stories in selected low-income settlements in Nairobi, Bulawayo and Lilongwe were utilised to collect information on the food environments (food balances, infrastructure, safety, policies and institutions). Quantitative data such as socio-demographic characteristics and dietary diversity were collected via structured questionnaires using Cognitive Edge's SenseMaker (R) (n = 890, 450 and 440 for Nairobi, Bulawayo and Lilongwe, respectively). The dietary intake of respondents was assessed using a 24-h recall, which was then converted to the food group diversity score (FGDS).ResultsDifferent levels of compounded stress affected dietary diversity and quality, including high food prices, concerns about sanitation and hygiene and the role of food standards regulation bodies. The mean FGDS across all locations was lower than the recommended cut-off of 5 (4.5, 2.8 and 2.6 across Nairobi, Zimbabwe and Lilongwe, respectively). Additionally, in Nairobi, there were gender differences in diet diversity, with men having a higher dietary diversity score than women (4.6% vs. 4.3%; p = 0.004). The majority of respondents in Lilongwe (65%) reported price as the most important driver of food choice, compared to 38% in Nairobi and 42% in Bulawayo.Discussion/ConclusionsOur observation of poor-quality diets provides further evidence of the need for food policies that are cognisant of the nutrition and health of the growing population of the urban poor. Such policies would focus on lowering the costs of nutritious foods as well as ensuring food safety within the complex food system observed in the urban low-income environment. Using a theoretical framework that assessed demographic characteristics and various food environments, we determined drivers of diet diversity and food choice in selected low-income settlements in Nairobi (Kenya), Bulawayo (Zimbabwe) and Lilongwe (Malawi). Overall, all respondents identified their change in attitude as an important driver of dietary diversification. From the Nairobi responses, convenience (40% of respondents) was the main factor influencing food choice, whereas price was the most important factor in Bulawayo (31% of respondents) and Lilongwe (67% of respondents). Price and convenience are important factors to consider for improving diet diversity in urban low-income settlements. Our findings can potentially guide future nutrition interventions and dietetic practice towards stimulating healthier eating behaviour and sustainable diets more appropriately.image An investigation conducted in contrasting food environments in three urban low-income settlements in Lilongwe, Bulawayo and Nairobi suggests low consumption of nutrient-dense foods, such as fruits and animal-source foods.Several drivers of dietary diversity and food choice, as well as perceptions, were identified. Price and convenience were identified as key drivers of food choice, with gender differences reported in dietary diversity.Policies and programmes need to consider steering diets towards higher consumption of nutrient-dense foods while taking into account price, convenience and environmental sustainability.