Received: 13 October 2022 | Accepted: 2 December 2022

DOI: 10.1002/fsn3.3184

ORIGINAL RESEARCH

Building forward better—­An exploration of nutrition practices,

food choice, and coping behaviors among Kenyan adolescents
during COVID-­19: Experiences and program implications

Justine A. Kavle1 | Patrick Codjia2 | Constance Gathi3 | Brenda Ahoya3 |

Lacey Ramirez1 | Stacy Katua2 | Florence Mugo4 | Laura Kiige2

1
Kavle Consulting, LLC, Washington,
District of Columbia, USA Abstract
2
UNICEF Kenya, Nairobi, Kenya This implementation research study sought to examine the impact of the COVID-­19
3
Kavle Consulting, LLC, Nairobi, Kenya pandemic on adolescent nutrition practices and related behaviors in Nairobi and Uasin
4
Ministry of Health, Division of Nutrition
Gishu Counties, Kenya. Eight focus group discussions (FGDs) were conducted with
and Dietetics, Nairobi, Kenya
adolescents 10–­19 years of age, in-­depth interviews with 10 health facility provid-
Correspondence
ers, and a combination of FGDs (n-­4) and key informant interviews with government
Justine A. Kavle, Kavle Consulting, LLC,
Washington, DC, USA. stakeholder and implementing partners (n = 9). During the pandemic, adolescents
Email: justine@kavleconsulting.com
tended to avoid commonly consumed junk foods, in favor of “immune boosting, protec-
Funding information tive” foods. Widespread unemployment and reductions in parental income rendered
UNICEF Kenya
some food items such as meat, eggs, and fruits unaffordable for families of adoles-
cents. Adolescents relayed experiences of skipping meals and reducing the amount
and variety of foods consumed. Adolescents also described employing strategies such
as working in the informal sector and selling personal items to support families fi-
nancially, in response to rising food insecurity. School closures mandated during the
pandemic likely contributed to reductions in overall physical activity. To improve the
diets of adolescents, programs should build on the healthy mindset brought on by
the pandemic, while strengthening, targeting, and improving access to social protec-
tion measures and agricultural initiatives for vulnerable families with adolescents to
cushion them from rising food insecurity as an effect of COVID-­19. Building practical
adolescent life skills to encourage healthy nutrition actions will also be key to building
forward from the COVID-­19 pandemic in Kenya.

KEYWORDS
adolescent nutrition, COVID-­19, dietary diversity, food insecurity, physical activity

[Correction added on 13 January 2023, after the first online publication: Figure 1 placement and Table 1 placement was corrected]

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2022 Kavle Consulting, LLC. Food Science & Nutrition published by Wiley Periodicals LLC.

Food Sci Nutr. 2023;11:1441–1451.  wileyonlinelibrary.com/journal/fsn3 | 1441

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1442
1 | I NTRO D U C TI O N
Adequate nutrition is critical to support accelerated physical growth
(i.e., stature), timely onset of puberty, changes in body composition
(i.e., bone, muscle, and fat), and continued development of the ma-
turing brain in the transition from childhood to adolescence (Norris
et al., 2022). Yet, in low-­resource settings, adolescent boys and
girls may be vulnerable to multiple forms of malnutrition, includ-
ing undernutrition and obesity, due to poor-­quality diets consist-
ing of high-­fat, high-­sugar, and/or energy-­dense processed foods,
which can threaten healthy growth and alter brain function (Lowe
et al., 2020; Norris et al., 2022).
Across sub-­Saharan Africa (SSA), the COVID-­19 pandemic has
put adolescents and other vulnerable groups (i.e., women of repro-
ductive age and children under 5 years of age) at risk for micronu-
trient deficiencies and deteriorating nutritional status, in the face
of rising food insecurity and worsening economic strife (Cluver
et al., 2020; UNICEF, 2021; M. Wang, 2021). In the SSA region, chil-
dren and adolescents under 19 years of age bear the brunt of un-
dernutrition (i.e., wasting and stunting), sickle cell disease, and other
chronic conditions and illnesses, such as pneumonia, diarrhea, ma-
laria, tuberculosis, and HIV (Coker et al., 2021). Country-­mandated
lockdowns intensified children and adolescents' vulnerabilities to
noncommunicable diseases (NCDs) in SSA by reducing household
income and limiting access to health services (Nachega et al., 2022).
This is particularly concerning given cohort data reveal an associa-
tion between NCDs and substantially higher morbidity and mortality
rates among children and adolescents hospitalized with COVID-­19 in
six SSA countries, including Kenya, in comparison to non-­SSA coun-
try settings (Nachega et al., 2022).
In Kenya, about one-­quarter of the population (47 million) are
adolescents, 10–­19 years of age (UNFPA, 2017). While the Africa
Center for Disease Control and Prevention noted that children
aged 0–­14 years comprise only 2.1% of confirmed cases, the det-
rimental effects of COVID-­19 have affected various dimensions
of adolescent health, yet have not been well characterized (Africa
CDC, 2020). The effects of COVID-­19 on adolescent health and nu-
trition practices and related behaviors remain limited. While a few
studies have examined knowledge and awareness of COVID-­19
among adolescents in sub-­Saharan Africa, a paucity of information
exists on adolescent's experiences during the COVID-­19 pandemic
in terms of household food insecurity, food consumption patterns,
physical activity, and coping strategies (Addae, 2021; Marotta
et al., 2021). To our knowledge, this is one of the first in-­depth
explorations of these themes using qualitative methodologies in
sub-­Saharan Africa and specifically in Kenya, which was largely col-
lected in-­person. The objectives of this study are: (1) to understand
how the COVID-­19 pandemic affected adolescents' experiences
of food insecurity, in terms of food choice, consumption patterns,
and related coping behaviors, in Nairobi and Uasin Gishu Counties,
Kenya; and (2) provide program considerations for future pan-
demic preparedness based on the adolescents' experiences during
COVID-­19 in Kenya.
20487177, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/fsn3.3184 by Cochrane Canada Provision, Wiley Online Library on [06/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
KAVLE et al.
Key messages
1. During the COVID-­19 pandemic, adolescents described
skipping meals and reduced the quality and quantity of
foods consumed, largely due to parental job loss and
families' inability to afford some foods, such as animal-­
source foods and fruits.
2. In response to rising food insecurity, some adolescents
described experiences of selling personal items, working
jobs in the informal sector, or starting businesses to sup-
port household incomes to buy food.
3. The COVID-­19 pandemic prompted some adolescents to
make better food choices due to the belief that immune-­
boosting foods provided protection against COVID-­19
and due to reductions in parents' purchasing power to
afford unhealthy junk foods.
4. School closures due to the COVID-­19 pandemic notably
reduced reported physical activity.
2 | M ATE R I A L S A N D M E TH O DS
2.1 | Study design and site
Consensus from key government, partner organization, and aca-
demic stakeholders in the country, through various national techni-
cal working groups (i.e., MIYCN Technical Working Group, Research
Technical Working Group; Ministry of Health, Kenya), was garnered
to determine criteria for study site selection. Criteria for study site
inclusion were as follows: (1) counties with the highest COVID-­19
burden based on MOH data on COVID-­19 infections/cases; (2) one
urban and one rural county; (3) one county which experienced at
least one government lockdown versus. one county that did not
experience a lockdown during the course of COVID-­19 pandemic;
and (4) counties which included persons of low socioeconomic sta-
tus who resided in informal settlements were selected in consulta-
tion with the government officials, and Ministry of Health country
data. Ultimately, Nairobi and Uasin Gishu counties had the highest
burden of COVID-­19 cases in Kenya (Ministry of Health (MoH),
Kenya, 2021) and met study criteria for selection. In Nairobi County,
urban Embakasi East and Kibra subcounties are comprised of in-
formal settlements in the country. Kibra subcounty had the third
highest number of COVID-­19 infections in the county, which was
notable. In Uasin Gishu County, rural Ainabkoi, and Turbo subcoun-
ties, accounted for almost half of the COVID-­19 infections within a
county which had not experienced a mandated COVID-­19 lockdown.
2.2 | Data collection
Fieldwork occurred between August and September 2021, and coun-
try caseloads of COVID-­19, per available Ministry of Health data were

KAVLE et al.
36,479 and 10,331 for August and September, respectively (Ministry
of Health –­Republic of Kenya, 2022). Data collection for adolescents
was part of a larger implementation research study collecting qualita-
tive information from pregnant and lactating women on dietary intake,
access, and use of health services, while also examining perspectives
from health workers, community health volunteers, and food vendors
on effects on the health and food systems (Ahoya et al., 2022). While
study participants were part of this larger implementation research
study, adolescent boys and girls were selected as an independent sam-
ple via opportunistic purposeful sampling (Patton, 1990). Data were
largely collected in-­person with adolescents, with some virtual data
collection for stakeholders, due to the COVID-­19 pandemic. Inclusion
criteria for study participation included adolescent boys and girls 10–­
19 years of age, residents of study sites for at least a 3-­year period,
and nonpregnant and/or non-­lactating individuals (i.e., adolescent girls
only).
Within each study site, local community health volunteers asso-
ciated with the nearest health facility offering maternal, newborn,
and child health services supported the identification of adolescents
for study enrollment. In-­depth interviews (IDIs) with facility health
workers and key informant interviews (KIIs) and small focus group
discussions (FGDs) with key stakeholders (i.e., national and county
government officials and key focal points from implementing part-
ner organizations) explored topics such as integration of adolescent
nutrition into health services, adolescent food choice and consump-
tion, related adolescent behaviors in response to food insecurity and
school closures, and physical activity during the COVID-­19 pandemic.
FGDs with adolescents explored the following topics: effect of the
pandemic on beliefs and perceptions of foods, decisions around food
choice, school attendance, physical activity, and coping strategies
during the pandemic.
Eight face-­to-­f ace FGDs were conducted with 54 adoles-
cents, 10–­19 years of age, and IDIs with 10 facility health work-
ers (i.e., 6 in-­p erson and 4 virtual). Virtual data collection, using
the Zoom platform, was used for all 18 stakeholders, which was
comprised of national and county government officials and im-
plementing partners (except 2 in-­p erson FGDs, see Table 1). Four
small FGDs were carried out with nine county/subcounty stake-
holders working on maternal, adolescent, infant, and young child
nutrition (MAIYCN) programs, KIIs with national-­level government
nutrition officials (n = 4), and KIIs with government officials and
implementing partners working in adolescent programming at na-
tional and subnational levels (i.e., county and subcounty) (n = 5).
COVID-­19 precautions were also followed during face-­to-­f ace
data collection—­including donning of face masks during interviews
and FGDs, use of hand sanitizers and handwashing with water and
soap, as available, and social distancing of 3 m between inter-
viewer and study participant(s).
Local ethical approval was obtained from the Institutional
Ethics Review Committee of Masinde Muliro University of Science
and Technology, Kenya, and country-­based research license was
obtained from National Commission for Science Technology and
|
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1443
Innovation. Verbal informed consent was obtained from study
participants.
2.3 | Data management and analysis
Trained interviewers audio recorded all IDIs and FGDs, which
were translated and transcribed verbatim from Swahili into
English. The quality of transcriptions was checked for accuracy
and completeness against the audio recordings by the Kenyan re-
search team members, alongside local trained transcribers. The
researchers (JK, CG, BA , and LR) conducted a preliminary review
of the data by reading a subset of the transcripts to create an
initial codebook that included major themes and subthemes that
emerged from the data. The researchers (JK, CG, BA, and LR) then
coded a subset of the transcripts and discussed, and a consensus
was reached among research team members regarding any dis-
crepancies in coding. The codebook was further refined and used
for coding (see Supplementary File S1). Once coding was com-
plete, researchers looked independently at a subset of transcripts
for verification of the themes in the codebook and to confirm any
additional emerging concepts. Transcripts were further reviewed
and triangulated with corresponding field data collection forms.
All transcripts were coded using Dedoose online software. Each
subtheme was then summarized, and illustrative quotes were se-
lected (see Table 2).
3 | R E S U LT S
Figure 1 presents the conceptual framework which characterized
the impact of COVID-­19 on aspects of adolescent nutrition prac-
tices and coping strategies in Kenya. Based on key findings from
this study, key factors which affected dietary practices (i.e., driv-
ers and beliefs surrounding food choice and consumption) were
added to the framework. The conceptual framework illustrates
how the COVID-­19 pandemic affected food, school, and health
systems, taking into account job loss, sociocultural drivers, fear
of COVID-­19 infection, and rising food insecurity, which nega-
tively affected adolescent nutrition (i.e., reduced meal frequency
and quality of diet) (See Figure 1). This study was part of a larger
overall study examining the effect of COVID-­19 on nutrition prac-
tices of pregnant women, breastfeeding women and their infants,
health service delivery, and key aspects of food systems (i.e., food
vendors).
3.1 | Characteristics of study participants
Eight FGDs were conducted separately with 54 adolescents,
stratified by age and gender, to ensure adolescents could discuss
topics openly with their peers (Table 1). Half of the adolescents
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1444 KAVLE et al.

F I G U R E 1 Conceptual framework on the impact of COVID-­19 pandemic on adolescents, via aspects of health, food, and school systems

TA B L E 1 Characteristics of study participants, by methodology and study site, Nairobi and Uasin Gishu Counties

Nairobi County Uasin Gishu County All

Adolescents focus In-­depth Stakeholder Stakeholder

group discussions interviews (IDIs)a Adolescents IDIs FGD key informant
(FGDs) n = 29 N=5 FGDs n = 25 n=5 participantsb interviews n = 9

Age—­Adolescents
15–­19 years 13 -­ 13
20–­24 years 16 -­ 12
Socioeconomic Status—­Adolescents
Informal settlements/urban 29 -­ -­ -­
Rural -­ -­ 25 -­
Occupation—­Health providers and Stakeholders
Nurse 5 -­ 5
NGO/implementing partner 1
focal point
National government officials 5
County government officials 9 3
Total 29 5 25 5 9 9
a
Facility Health Worker.
b
Four FGDs: two2 FGDs conducted in-­person and two FGDs virtually.

KAVLE et al.
were 10–­14 years of age, while the remaining were 15–­19 years of
age. Twenty-­nine adolescents were from urban informal settle-
ments (i.e., slum areas) in Nairobi County, while twenty-­f ive ado-
lescents resided in rural, agricultural areas in Uasin Gishu County.
Each FGD had between five and nine adolescents, who were a
mixture of those identified as attending school prior to the pan-
demic, while others (i.e., older) had begun working and no longer
attended school. FGDs were also conducted with a variety of
stakeholders at national and subnational levels (i.e., county and
subcounty) working as nutrition-­specific (maternal, adolescent, in-
fant, and young child programming) and as implementing partners
(nongovernmental organizations).
The themes that emerged from the qualitative analysis are dis-
cussed in Table 2.
3.1.1 | COVID-­19 guidance on implementation of
adolescent nutrition activities was limited
Facility health workers relayed that they were not trained on measures
to address adolescent nutrition during the COVID-­19 pandemic and
only received general, cross-­cutting guidance. Despite the dissemina-
tion of nutrition in COVID-­19 guidance, the majority of health workers
described not being aware of any nutritional guidance or support for
adolescents during COVID-­19 pandemic and did not feel “well-­placed
to respond” to adolescent nutrition issues, such as dietary practices
and physical activity during COVID-­19. Stakeholders, key informants,
and health workers reported that there were no specific nutrition ser-
vices during COVID-­19 directed to adolescents 10–­19 years of age,
apart from services targeted to pregnant and lactating adolescents as
part of the routine ANC/PNC package
3.1.2 | Adolescents tended to eat healthier and
avoid commonly consumed fast foods during the
COVID-­19 pandemic
Adolescents' held food preferences for chapatti (i.e., unleavened flat
bread made from wheat flour), fried/fast foods, bhajia (i.e., potatoes
dipped in flour batter and fried in vegetable oil), meat, bread, and
sweets. Yet, the majority of adolescents consumed nutritious foods
during COVID-­19, such as kale, ugali, beans, and githeri (i.e., meal
made up of a mixture of maize and bean), and traditional vegetables
(see Table 3). Most adolescents had positive perceptions of these
foods as “healthy” and “energy-­giving” as well as “cheap” and “easily
available” in their communities, which drove food choice.
“Before Corona [COVID-­19], my parents had the means
to bring us every kind of food. That time we used to eat
rice twice a week, Ugali once, and chapatti… but since
corona came, we are eating Ugali every day because that
is the meal that is available.”—­
Adolescent FGD, Uasin Gishu County
|
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1445
3.1.3 | Skipping meals was commonplace among
adolescent boys and girls
Nearly all adolescents expressed frustration with being “forced ” to
skip meals, such as lunch, in response to pandemic-­related reduc-
tions in household food availability. Some adolescents relayed that
“getting food is very difficult.” COVID-­19 largely limited their diets
to ugali (i.e., a local porridge made from stiff maize flour) and green
leafy vegetables (i.e., kale) due to parental job loss and the unafford-
ability of certain foods such as meat, eggs, and bread as expressed
by some adolescents:
“When Corona started is the day problems came… be-
cause for us we forgot about lunch. In our home, we
don't have lunch and sometimes we take tea without
anything else…. And you know, we had lockdown and
jobs reduced. So, in my experience, Corona has af-
fected me badly…”—­
Adolescent FGD, Uasin Gishu County
3.1.4 | Adolescents often reduced quantities of
food consumed during the pandemic, including fast
foods and sweets
Some adolescents expressed eating “what is available” (i.e., leftovers
from the night before) due to lack of money from their parents (see
Table 3). Adolescents also reported consuming reduced quantities of
food to ensure that there was enough food available for younger chil-
dren in the family in both Nairobi and Uasin Gishu Counties.
“Right now, there is no money, so you just share the little
among yourselves even if it is vegetables and ugali. If you
don't have money… you just cook a little ugali and some
vegetables and share it among everyone.”—­
Adolescent FGD, Uasin Gishu County
“In the morning, we usually wake up to take tea with 2
mandazis. Lunch is by chance, we may or may not eat.
Then, supper, we take what's available, although mostly
it is served in small quantities to be enough for my small
siblings and I.”—­
Adolescent FGD, Nairobi County
In both counties, some adolescents discussed how certain foods
became very expensive during the pandemic (e.g., fruits, cabbage,
tomatoes, eggs, meat, beans, green bananas, and cooking oil), which
decreased the variety of foods that they consumed during the pan-
demic. Some adolescents also mentioned increased consumption of
black tea instead of tea with milk during COVID-­19. Urban adolescents
also reported the relocation of their families to their rural homes where
there was perceived greater food availability, as a coping strategy in
response to food insecurity.
 TA B L E 2 Summary of dominant themes by study participant group, Nairobi (NC) and Uasin Gishu (UGC) Counties
| 1446

Young adolescent boys and

girls, 10–­14 years of age
Themes (n = 26) Older adolescents boys and girls, 15–­19 years of age (n = 28) Stakeholders (n = 18) Facility health workers (n = 10)

Adolescents “Before, we were being R3: “In the morning, black tea with mandazis in case its “People lost jobs, so they didn’t have enough money N/A
skipped meals served with big plates available. If it's not, we take it with leftovers from the to buy the food that they are used to. So, of
and consumed and they served them full previous night. Lunch is uncertain. We may or may not course they had to reduce the number of times
smaller to the brim [at school]. eat. Then supper, we take whatever is available and life they eat the food and also reduce the types of
portions—­in But nowadays, they continues.” foods they buy. If they normally buy maybe 3
response to serve small food with R4: “In the morning, we take tea with bread then skip lunch types of food for a meal, I believe they reduced
household food small plates, and we and wait for supper to take ugali with kale mixed with the number maybe to just now one type of food
insecurity don’t get satisfied.”—­ avocado….and then wait for the following day [to eat].” per meal or just two.”—­Key Informant, Uasin
Adolescent FGD Nairobi R6: “In the morning, we usually wake up to take tea with 2 Gishu County
County mandazis. Then lunch, it's by chance. We may or may not
eat. Then supper, we take what's available… although
mostly it's served in low quantity to be enough for my
small siblings and I.”
R7: “Whatever is there is what we take, whether it's in low or
high quantity.”—­Adolescent FGD Nairobi County
Reduced adolescent “You see, as before, we “Boys here love playing football, but now getting an “Remember people were being told to stay at home, “In our community, we did have games
physical activity [would] wake up around opportunity to play isn’t easy –­not unless you play it at irrespective of the age group that you're talking and activities. We used to offer
because of 6 a.m… You see, we your home compound with a few of your friends. But about here. So, the issue with staying at home [is challenges between churches
COVID-­19 would run up to around before corona, we could go to play at the community that] physical activity was reduced. Remember to churches, church to hospital,
lockdown and 8 a.m. But with corona… ground. But now since the pandemic, we no longer play we also used to tell them even the children are community versus another
school closures I don’t remember that there because of restrictions on social gatherings.”—­ not supposed to be in those groups playing with community, which was being handled
last day I did that.”—­ Adolescent FGD Nairobi County their neighbors and all that because everybody by the hospital committees. But
Adolescent FGD Nairobi feared the disease.”—­Stakeholder FGD Nairobi since COVID-­19 started, physical
County County activity was minimized, so we had
to minimize contact because no
one can play in a field with a mask.
You cannot run in a mask.”—­Health
Worker, Uasin Gishu County
Adolescents and/or “[My parents] lost their “Let me use myself as an example… I sold like my phone, I “One of the measures that was put in place was to “Maybe their parent lost their job.
parents worked jobs, and they were sold some of my shoes, my trouser … because during lock down Nairobi. Movement into and out of So, there is no way they could get
“casual” jobs forced to wash clothes that time my parent had nothing completely, he had even Nairobi was restricted, and for many people, this back to school, so they had to seek
(i.e., fetching for households to get come to stay home… so when I sold those things I bought really affected their livelihood because some alternatives, or else they had to drop
water and selling [money].”—­Adolescent vegetables, sugar, tea leaves… and I told her not to panic people could not get food from upcountry and out. Maybe if it is the male, they
vegetables) to FGD, Nairobi County because we don’t have… the little that we get is what we the like. And [for] some people, even going to went to at least to do some kind of
supplement will eat.”—­Adolescent FGD, Uasin Gishu County work became an issue. But at the initial point, daily work at least to meet their basic
household what I can report is mostly people lost jobs. needs.”—­Health Worker, Nairobi
income and Remember, the hotels were locked, the curfew County
purchase food hours were mainly reduced to 7 p.m. So, there
for the family are many challenges that led to food insecurity,
which was a big issue in Nairobi, affecting the
whole population—­Stakeholder FGD, Nairobi
County
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KAVLE et al. 1447

TA B L E 3 Food items and reasons for consumption among adolescents, 10–­19 years of age, Nairobi and Uasin Gishu counties, Kenya

Category Food items Reasons for consumption Illustrative quotes

Preferred Ugali, chapatti, Parents could afford to buy for “Before corona came, our parents would go for work and when
foods Fried/fast foods (i.e., adolescents. Adolescents they get money, they buy us meat, rice, and chapatti. And
eaten by chips and bhajia), liked to consume these now that there is COVID-­19, getting those things is very
adolescents meat (i.e., beef foods. hard.”
prior to with rice), bread, —­Adolescent FGD, Uasin Gishu County
COVID-­19 and fruit “Before COVID, I used to eat chips thrice in a day but now maybe
once per week because I do not have that money to buy
them.”—­Adolescent FGD, Nairobi County
Commonly ↑ Ugali Cheap/ “don’t have enough “Since covid started, the foods that we used to get for breakfast
consumed ↑ Green leafy money,” available, energy-­ [were] like maybe tea, eggs, and bread. [For] lunch maybe
foods vegetables (i.e., giving, healthy ugali, and for supper, we eat ugali and beef. But now, things
during the kale) are no longer the same with COVID. We are forced to take
COVID-­19 ↑ Traditional tea and mandazi for breakfast and wait for supper, which is
pandemic vegetables (i.e., ugali and kale every day.”—­Adolescent FGD, Nairobi County
sagas)
↑ Black tea,
githeri, ↑potatoes,
Foods avoided ↓Juice, “Don’t have enough money” “Before COVID-­19, [powdered] juice would be bought for us [by
and ↓Soda “Did not boost immunity/ our parents], but right now it is very rare for us to drink even
reduced ↓Cakes increases COVID-­19 soda. [Before], we could even buy a crate of soda, but right
during the ↓Biscuits infection” (soda only), now it costs 700, so we cannot afford to buy soda.”
COVID-­19 ↓Mandazi unhealthy —­Adolescent FGD, Uasin Gishu County
pandemic ↓Chapatti High prices of foods and loss of “Nowadays, getting foods like bhajia and chips is not easy since
↓Bread jobs/lack of money the price of cooking oil and potatoes went up because of
↓Vegetables (cabbage) COVID, unlike before the pandemic when we could easily
↓Beans access those foods at cheaper prices.”—­Adolescent FGD,
↓Rice Nairobi County
↓Milk “We were eating chapatti, beans, and fruits every week because
↓Meat then it was cheap, but now it is very expensive because a big
↓Fruits packet of flour goes for 150 [Kenyan shillings], so you would
↓Sweets rather buy potatoes and eat it twice. But chapatti is very
↓Eggs rare.”
—­Adolescent FGD, Uasin Gishu County

3.1.5 | Some adolescents consumed “immune-­
boosting” foods, claiming they were protective against
COVID-­19
Nearly all adolescents held beliefs that specific foods, such as
green leafy vegetables, ginger, fruits, garlic, and lemon, could
provide a “strong immunity” against COVID-­19 infection, and
often consumed a lemon–­g inger–­h oney concoctions alongside
traditional herbs. A few adolescents also believed that sugary
foods should be avoided, as these foods were viewed as “not
protective” against COVID-­19 infection, as relayed in the quote
below.
“Like [certain common foods like] chapatti, mandazi (i.e.
leavened deep fried dough made from wheat flour)
and special foods such as soda [we normally have], but
right now no, [we don't eat them]. To prevent COVID-­19
you don't need sugary foods because they don't protect
against COVID-­19."—­
Adolescent FGD, Uasin Gishu County
3.1.6 | Some adolescents reduced engagement in
sports and physical activity
As a consequence of school closures, lockdowns, and social distanc-
ing, adolescents discussed less engagement in sports and physical
activity, such as ball games and running.
“[Before COVID-­19], when we were at school, we would go for games.
But when COVID-­19 started, we were just at home, so we weren't doing
exercise.”—­Adolescent FGD, Uasin Gishu County.
3.1.7 | Adolescents supported their families
financially in response to household food insecurity
Older adolescent boys and girls worked to financially support their
families by starting their own small businesses, either selling char-
coal or food or engaging in casual labor like farm work. Focus group
discussants described their families' financial struggles, which went
hand in hand with food insecurity, during the pandemic, as illus-
trated below:
 |
1448
“The only time when we eat to our satisfaction is when
my siblings and I contribute some money to buy some-
thing like sardines to eat with ugali or at times my
mother would give me something like cooking pans to
sell and that's how we survived because my mother is
jobless.”
—­Adolescent FGD, Nairobi County
Some adolescents were also forced to sell their personal belongings
and clothing items to support their families to purchase food for the
household.
“Let me use myself as an example… I sold like my phone,
I sold some of my shoes, my trouser … because during
that time my parent had nothing completely, she had
even come to stay home… so when I sold those things I
bought vegetables, sugar, tea leaves… and I told her not
to panic because we don't have… the little that we get is
what we will eat.”—­
Adolescent FGD Uasin Gishu County
4 | DISCUSSION
This study sought to gain an understanding of adolescents' lived
experiences of food insecurity via food choice, consumption, and
coping strategies and provide program considerations to guide fu-
ture pandemic preparedness based on the findings reported here.
Adolescents expressed reluctantly reducing their meal frequency,
quantity, and diversity as a consequence of parents' inability to af-
ford foods routinely consumed in the household—­as a result of the
pandemic.
Importantly, most adolescents felt the brunt of parental job loss
and in response worked casual labor, started their own businesses
selling food or other goods, and sold personal items in an effort to
support their families, in response to rising household food insecu-
rity. Adolescents expressed frustration with school closures, which
reduced available play spaces and subsequent physical activity.
School closures during the COVID-­19 pandemic reduced physical
activity for most adolescent boys and girls.
Adolescents described greater financial losses when family
members and older adolescents themselves experienced loss in
employment from the informal sector in this study. A few past
studies in Ethiopia and Kenya noted that declines in household
income were often met with reductions in food consumption as
a coping mechanism (Alderman et al., 2020). In an online survey
among 2156 Kenyan youth, 18–­35 years of age, half of the par-
ticipants had a significant decline in income due to unemploy-
ment or job loss from informal sector, while one-­t hird reported
increased food prices which rendered local foods less affordable
(Karijo et al., 2021).
Importantly, this study revealed that these losses in family income
fueled food insecurity as skipping meals was commonplace among
20487177, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/fsn3.3184 by Cochrane Canada Provision, Wiley Online Library on [06/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
KAVLE et al.
adolescent boys and girls, 10–­19 years of age, during the COVID-­19
pandemic. A previous study conducted with Kenyan adolescent girls,
15–­19 years of age, and young women, 20–­24 years of age, reported
that most (59%–­72%) skipped meals during the COVID-­19 pandemic,
with the highest proportion in Nairobi County (Karp et al., 2021).
Moreover, one-­third to half of the study households experienced
total and partial income loss, respectively (Karp et al., 2021). Similar
findings were noted in a multicountry study with children and young
adolescents, 9–­13 years of age, in Nigeria, Tanzania, and Sierra Leone,
as most families expressed difficulties in getting or purchasing food,
especially among larger households with extended family members
(Kallander et al., 2021). Previous studies reveal that food insecurity
and hunger were significant challenges facing youth. For example,
62% of Ugandan adolescent boys and young men relayed difficulties
in affordability and attaining dietary diversity and “balanced diets”
(Matovu et al., 2021). While prior to pandemic, adolescents discussed
routine consumption of unhealthy “junk” foods in this study, some
adolescents also relayed that fried food, such as bhajia and chips (i.e.,
local snacks made of fried potatoes), were higher in cost and con-
sidered “unnecessary “and unaffordable by parents and adolescents,
which curbed intake of these unhealthy foods during the pandemic.
Notably, adolescents had a tendency to eat healthier, despite con-
suming less variety of foods—­which may have also been attributed to
parents' economic situation to afford desired unhealthy foods.
This study also revealed stress and fear experienced by adoles-
cents in response to COVID-­19-­fueled food insecurity and financial
difficulties, which often forced adolescents to sell personal items
and work informal labor jobs to support their families, and relocation
of urban families to rural homes to mitigate the effects of COVID-­19
food insecurity. A few studies echoed our findings, pointing to wide-
spread parental job loss which often translated to use of multiple
strategies by families to increase overall household income (Decker
et al., 2021; Karijo et al., 2021). An online phone-­based survey in
Nairobi revealed that losses in family members' earnings resulted
in borrowing loans and moving into smaller homes with extended
family members to afford basic needs, such as rent and food (Decker
et al., 2021). Formative research conducted prior to the pandemic
in Kenya, Tanzania, and Uganda shows that adolescents often car-
ried out income-­generating activities via heavy manual labor at
a detriment to their health (Hall et al., 2019; WFP, 2018, 2019).
Adolescents' engagement in these activities may have worsened
during the COVID-­19 pandemic.
Communities that rely on adolescents for income to purchase
food may limit their opportunities for future education, even prior
to COVID-­19 (Neufeld et al., 2022). Our data indicate that COVID-­
19-­mandated school closures likely negatively impacted healthy
adolescent behavior, such as physical activity, due to lack of access
and/or planned activities. Past studies corroborate our findings of
reductions in physical activity and involvement in sports reported
by adolescents during the COVID-­19 pandemic. Phone survey data
from Burkina Faso, Ethiopia, and Nigeria pointed to a 38% over-
all decrease in physical activity (D. Wang et al., 2021), while self-­
reported reductions in physical activity ranged from 12% to 45% in

KAVLE et al.
urban Nigeria and urban Ethiopia, respectively (Wang et al., 2021). In
Kampala, Uganda, more than half of the participants 10–­19 years of
age reported an increase in sedentary lifestyle with excessive televi-
sion watching during the pandemic (Matovu et al., 2021). Moreover,
adolescents who experienced school closures in Ethiopia, Burkina
Faso, and/or Nigeria ate fewer staple foods (9%–­54%), pulses (29%–­
49%), fruits (18%–­41%), vegetables (3%–­34%), and animal source
foods (11%–­29%) (Wang et al., 2021).
Other previous research studies have linked school disrup-
tions and food insecurity to additional negative consequences
that impinge on quality of adolescents' lives, including increased
feelings of anxiety and stress, loss of interest in studying, feeling
“stuck,” and loss of purpose in Bangladesh, Kenya, and South Africa
(Gittings et al., 2021; Karp et al., 2021; Oakley et al., 2020). Recent
evidence from Nairobi, Kilifi, and Kisumu Counties noted that eco-
nomic strains led to conflict and tensions in Kenyans’ households
(Karp et al., 2021). Furthermore, a recent systematic review illu-
minated that COVID-­19-­induced social isolation and loneliness ex-
perienced by adolescents increased the risk of depression, which
reverberated at 0.25 and 9 years later, impacting adolescent well-­
being (Loades et al., 2020). While not well-­characterized in SSA,
these issues merit further exploration based on the lived experi-
ences of young people.
While the stress of the COVID-­19 pandemic brought addi-
tional work burdens in the lived experiences of food insecurity
described by adolescents, most adolescents expressed a “healthy
eating” mindset and a desire to consume healthier and “immune-­
boosting” foods as a means of “protection against the virus.”
Leveraging upon these instilled beliefs and experiences shaped
by the COVID-­19 pandemic can be used to equip adolescents
as agents of change in their communities (Neufeld et al., 2022),
while recognizing that work is still needed to address the routine
intake of unhealthy, processed, and/or junk foods among young
persons beyond the pandemic. The Kenya Nutrition Action Plan
(2018–­2022) aims to: “increase nutrition awareness and uptake of
nutrition services for improved nutritional status of older children
and adolescents (10–­19 years of age)” -­ with strategies that include
advocacy and promotion for adolescent nutrition, building stake-
holder capacity on healthy diets, sensitizing communities and
stakeholders, as well as promoting consumption and marketing of
healthy foods and physical activity for adolescents (Ministry of
Health, 2018). Yet, our data suggest that specifically targeted ser-
vices and interventions for adolescents were largely absent during
the COVID-­19 response. Future pandemic preparedness efforts
should ensure that changes in adolescent nutrition practices, and
psychosocial needs during emergencies are addressed. In Kenya,
adolescents have a potential role to play by partnering with agri-
culture initiatives and/or youth-­led activities, which may provide
additional safeguards against food insecurity, by providing edu-
cation and life skills opportunities, including providing access to
foods, and other skills (i.e., saving money, safe income-­generating
skills, health behaviors, and eating habits) (Neufeld et al., 2022;
United Nations, 2020).
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1449
5 | LI M ITATI O N S
Detailed dietary data from adolescent girls and boys were not collected
during this study, although foods consumed, beliefs and perceptions,
and associated factors surrounding food choice and consumption were
derived through qualitative methodologies. Detailed educational data
from adolescents were not collected during the COVID-­19 pandemic,
however, most adolescents, aged 10 to 19, attended school and re-
layed issues related to school closures, while older adolescents dis-
cussed working to support their families rather than attending school.
Given this data collection was part of a larger study examining health
and food systems and MAIYCN practices, the original aim of this study
did not cover issues with school systems at length. Therefore, addi-
tional information on the nutrition provided in schools (i.e., school
feeding) was not collected during the course of this study, but rather
COVID-­19-­specific effects from school closures—­largely from adoles-
cents’, key informants’, and health providers' perspectives. While the
COVID-­19 pandemic limited our ability to collect all data in person,
importantly this study, one of the first in the region, had face-­to-­face
FGDs with all adolescents, health providers, and half of stakeholders.
5.1 | Program considerations for adolescent
programming in the context of future pandemic
preparedness
Build practical adolescent life skills around nutrition during pro-
longed school closures or when adolescents are not in school, such
as safe income-­generating skills, health behaviors, and eating hab-
its, and through backyard (i.e., “kitchen”) gardens in their families'
homes to cushion against household food insecurity.
1. Strengthen design and implementation of social behavior change
strategies and interventions to address unhealthy nutrition prac-
tices and associated health and coping behaviors for adolescents
whose families newly face food insecurity.
2. Strengthen community-­based platforms, such as peer and com-
munity support groups, that facilitate safety, health, and nutrition
information for adolescents, building upon the “healthy eating”
mindset that began during the pandemic (Govender et al., 2020;
Wang et al., 2021).
3. Improve access to targeted social protection measures to cush-
ion families and adolescents affected by the informal work sec-
tor, including the provision of cash transfers and food subsidies.
For example, consider use of support funds distributed per child
or per caregiver during prolonged school closures, during times
of emergency/pandemic, which can provide additional monetary
support to vulnerable families, as has been carried out in South
Africa (South African Government, 2020).
4. Monitor food shortages and support families to access social re-
lief funds (Govender et al., 2020).
5. Strengthen capacity of health workers to provide adolescent-­
responsive health services.
 |
1450
6 | CO N C LU S I O N
This implementation research study provided information on how
the COVID-­19 pandemic shaped adolescent nutrition practices and
associated coping behaviors while considering key aspects of the
food, school, and health systems in Kenya. Building forward better
from COVID-­19 requires addressing gaps in adolescent nutrition
knowledge and awareness. Supporting community-­based education
to build upon adolescents' healthy eating mindset, while address-
ing issues of meal skipping and quality of foods consumed—­which
persisted due to the pandemic—­will be key. Moving forward, it will
be critical to also strengthen social protection measures and agri-
culture initiatives, targeting families and adolescents alongside the
aforementioned nutrition-­specific measures. Equipping adolescents
with life skills may go far in addressing unhealthy nutrition behaviors
to improve dietary intake and physical activity in the face of rising
food insecurity.
AC K N OW L E D G M E N T S
We gratefully acknowledge the communities of Nairobi and Uasin
Gishu Counties that participated in this study, as well as participa-
tion from the key Ministry of Health, personnel from the national
Government of Kenya, Division of Nutrition and Dietetics, and
Nairobi and Uasin Gishu Counties. We also acknowledge the valued
contribution of Shreya Arora in aiding with initial qualitative analy-
ses for this paper.
F U N D I N G I N FO R M AT I O N
This publication is made possible through funding provided by
UNICEF Kenya.
C O N FL I C T O F I N T E R E S T
Team members from Kavle Consulting, LLC were hired for a consul-
tancy with UNICEF Kenya to carry out this study.
DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available on re-
quest from the corresponding author. The data are not publicly avail-
able due to privacy or ethical restrictions.
E T H I C A L A P P R OVA L
This study was approved by the Institutional Ethics Review
Committee of Masinde Muliro University of Science and
Technology, Kenya, and the country-­based research license was
obtained from National Commission for Science Technology and
Innovation.
I N FO R M E D C O N S E N T
Written informed consent was obtained from all study participants.
ORCID
Justine A. Kavle https://orcid.org/0000-0003-0439-6308
20487177, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/fsn3.3184 by Cochrane Canada Provision, Wiley Online Library on [06/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
KAVLE et al.
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S U P P O R T I N G I N FO R M AT I O N
Additional supporting information can be found online in the
Supporting Information section at the end of this article.
How to cite this article: Kavle, J. A., Codjia, P., Gathi, C., Ahoya,
B., Ramirez, L., Katua, S., Mugo, F., & Kiige, L. (2023). Building
forward better—­An exploration of nutrition practices, food
choice, and coping behaviors among Kenyan adolescents
during COVID-­19: Experiences and program implications. Food
Science & Nutrition, 11, 1441–1451. https://doi.org/10.1002/
fsn3.3184