Food Security

, Volume 8, Issue 2, pp 427–442 | Cite as

Improved food quality, quantity and security among Kenyan orphans and vulnerable children: associations with participation in a multisectoral community-based program, age, gender, and sexual risk

  • Michael L. Goodman
  • Beatrice J. Selwyn
  • Robert O. Morgan
  • Linda E. Lloyd
  • Moses Mwongera
  • Stanley Gitari
  • Philip H. Keiser
Original Paper


The present study evaluates factors associated with improved food quantity, quality and diversity among participants in a 3-year multisectoral program targeting sibling families of orphans and vulnerable children in rural Kenya. This cross-sectional study evaluates food adequacy and diversity using the World Food Programme’s Food Consumption Score, food access over the previous year, and food dependence on outside-household resources among 1060 families of orphan or vulnerable siblings. The primary comparison group was program-enrolled households who had not yet received any program inputs. Mixed effects logistic models were used to assess the association of food quantity, quality and security with program participation, program inputs and respondent characteristics. Increased time in the program was significantly associated with improved food quantity, quality and security. Other covariates significantly predicting improved food quantity, quality and security included using program-funds to cultivate small-holder farms, increased monthly income, self-efficacy and the number of partners in previous year. After adjusting for monthly income and other covariates, duration of program participation remained a significant predictor of improved food consumption, quality and security. The study presents a unique community-based intervention, hybridizing insights from multiple disciplines that warrants further study to improve the food quantity, quality and security of orphans and vulnerable children across sub-Saharan Africa.


Food consumption Food security Orphan and vulnerable children Kenya Community-based empowerment program 



The generous donors who support the program evaluated in this paper are essential to its ongoing success and existence. Without their support, there would be no program to evaluate. The staff of ZOE/Giving Hope and its open policy to researchers also deserve appreciation for their permission to poke and prod along its operational corridors, allowing the scientific community access to its programmatic design and associated outcomes. The field team that collected and entered data made the study possible. Lauren Raimer-Goodman provided important editorial feedback on the manuscript.


  1. Aberman, N. L., Rawat, R., Drimie, S., Claros, J. M., & Kadiyala, S. (2014). Food security and nutrition interventions in response to the aids epidemic: assessing global action and evidence. AIDS and Behavior, 18(5), 554–565.CrossRefGoogle Scholar
  2. Adato, M. & Bassett, L. (2008). What is the potential of cash transfers to strengthen families affected by HIV and AIDS? A review of the evidence on impacts and key policy debates. JLICA. Retrieved from:
  3. Anema, A., Vogenthaler, N., Frongillo, E. A., Kadiyala, S., & Weiser, S. D. (2009). Food insecurity and HIV/AIDS: current knowledge, gaps, and research priorities. Current HIV/AIDS Reports, 6(4), 224–231.CrossRefPubMedGoogle Scholar
  4. Asenso-Okyere, K., Aragon, C., Thangata, P., & Mekonnen, D. A. (2010). HIV and AIDS and farm labor productivity: a review of recent evidence in Africa. Journal of Development and Agricultural Economics, 2(12), 406–415.Google Scholar
  5. Bicego, G., Rutstein, S., & Johnson, K. (2003). Dimensions of the emerging orphan crisis in sub-Saharan Africa. Social science & medicine, 56(6), 1235–1247.Google Scholar
  6. Case, A., Paxson, C., & Ableidinger, J. (2004). Orphans in Africa: parental death, poverty, and school enrollment. Demography, 41(3), 483–508.CrossRefPubMedGoogle Scholar
  7. Cluver, L., Orkin, M., Boyes, M. E., Sherr, L., Makasi, D., & Nikelo, J. (2013). Pathways from parental AIDS to child psychological, educational and sexual risk: developing an empirically-based interactive theoretical model. Social Science & Medicine, 87, 185–193.CrossRefGoogle Scholar
  8. De Waal, A., & Whiteside, A. (2003). New variant famine: AIDS and food crisis in southern Africa. The Lancet, 362(9391), 1234–1237.CrossRefGoogle Scholar
  9. Dworkin, S. L., Grabe, S., Lu, T., Hatcher, A., Kwena, Z., Bukusi, E., & Mwaura-Muiru, E. (2013). Property rights violations as a structural driver of women’s HIV risks: a qualitative study in Nyanza and Western Provinces, Kenya. Archives of Sexual Behavior, 42(5), 703–713.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Edström, J., & Samuels, F. (2007). HIV, nutrition, food and livelihoods in Sub-Saharan Africa. Report for UK-DFID, London.Google Scholar
  11. Foster, G. (2007). Under the radar: community safety nets for AIDS-affected households in sub-Saharan Africa. AIDS Care, 19(S1), 54–63.CrossRefGoogle Scholar
  12. Handa, S., Huang, C., Hypher, N., Teixeira, C., Soares, F. V., & Davis, B. (2012). Targeting effectiveness of social cash transfer programmes in three African countries. Journal of Development Effectiveness, 4(1), 78–108.CrossRefGoogle Scholar
  13. Headey, D., & Ecker, O. (2013). Rethinking the measurement of food security: from first principles to best practice. Food Security, 5(3), 327–343.CrossRefGoogle Scholar
  14. Heymann, J., & Kidman, R. (2009). HIV/AIDS, declining family resources and the community safety net. AIDS Care, 21(S1), 34–42.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Hilmers, A., Cullen, K. W., Moore, C., & O’Connor, T. (2012). Exploring the association between household food insecurity, parental self-efficacy, and fruit and vegetable parenting practices among parents of 5-to 8-year-old overweight children. Journal of Applied Research on Children: Informing Policy for Children at Risk, 3(1), 5.Google Scholar
  16. Jomaa, L. H., McDonnell, E., & Probart, C. (2011). School feeding programs in developing countries: impacts on children’s health and educational outcomes. Nutrition Reviews, 69(2), 83–98.CrossRefPubMedGoogle Scholar
  17. Kaschula, S. (2011). Using people to cope with the hunger: social networks and food transfers amongst HIV/AIDS afflicted households in KwaZulu-Natal, South Africa. AIDS and Behavior, 15(7), 1490–1502.CrossRefPubMedGoogle Scholar
  18. Kimani-Murage, E. W., Holding, P. A., Fotso, J. C., Ezeh, A. C., Madise, N. J., Kahurani, E. N., & Zulu, E. M. (2011). Food security and nutritional outcomes among urban poor orphans in Nairobi, Kenya. Journal of Urban Health, 88(2), 282–297.CrossRefPubMedCentralGoogle Scholar
  19. Kollannoor-Samuel, G., Vega-López, S., Chhabra, J., Segura-Pérez, S., Damio, G., & Pérez-Escamilla, R. (2012). Food insecurity and low self-efficacy are associated with health care access barriers among Puerto-Ricans with Type 2 diabetes. Journal of Immigrant and Minority Health, 14(4), 552–562.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Lachman, J. M., Cluver, L. D., Boyes, M. E., Kuo, C., & Casale, M. (2014). Positive parenting for positive parents: HIV/AIDS, poverty, caregiver depression, child behavior, and parenting in South Africa. AIDS Care, 26(3), 304–313.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Larson, B. A., Wambua, N., Masila, J., Wangai, S., Rohr, J., Brooks, M., & Bryant, M. (2013). Exploring impacts of multi-year, community-based care programs for orphans and vulnerable children: a case study from Kenya. AIDS Care, 25(1), S40–S45.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Lee, V. C., Muriithi, P., Gilbert-Nandra, U., Kim, A. A., Schmitz, M. E., Odek, J., Mokaya, R., & Galbraith, J. S. (2014). Orphans and vulnerable children in Kenya: results from a nationally representative population-based survey. JAIDS Journal of Acquired Immune Deficiency Syndromes, 66, S89–S97.CrossRefPubMedGoogle Scholar
  23. Lucas, A. M., & Mbiti, I. M. (2012). Does free primary education narrow gender differences in schooling? Evidence from Kenya. Journal of African Economies, ejs021.Google Scholar
  24. Magadi, M. A. (2011). Household and community HIV/AIDS status and child malnutrition in sub-Saharan Africa: evidence from the demographic and health surveys. Social Science & Medicine, 73(3), 436–446.CrossRefGoogle Scholar
  25. Martin, K. S., Wu, R., Wolff, M., Colantonio, A. G., & Grady, J. (2013). A novel food pantry program: food security, self-sufficiency, and diet-quality outcomes. American Journal of Preventive Medicine, 45(5), 569–575.CrossRefPubMedGoogle Scholar
  26. Maxwell, D. G., Parker, J. W., & Stobaugh, H. C. (2013). What drives program choice in food security crises? Examining the “response analysis” question. World Development, 49, 68–79.CrossRefGoogle Scholar
  27. Miller, C. L., Bangsberg, D. R., Tuller, D. M., Senkungu, J., Kawuma, A., Frongillo, E. A., & Weiser, S. D. (2011). Food insecurity and sexual risk in an HIV endemic community in Uganda. AIDS and Behavior, 15(7), 1512–1519.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Moore, A. M., Biddlecom, A. E., & Zulu, E. M. (2007). Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa: original research article. African Journal of Reproductive Health, 11(3), 44–61.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Müller, T. R. (2010a). AIDS mitigation through agriculture‐based interventions in rural contexts: junior farmer field and life schools and future livelihoods in central Mozambique. Singapore Journal of Tropical Geography, 31(3), 330–342.CrossRefGoogle Scholar
  30. Müller, T. R. (2010b). Changing resource profiles: aspirations among orphans in Central Mozambique in the context of an AIDS mitigation intervention. The Journal of Development Studies, 46(2), 254–273.CrossRefGoogle Scholar
  31. Munyua, H. M., & Stilwell, C. (2013). Three ways of knowing: agricultural knowledge systems of small-scale farmers in Africa with reference to Kenya. Library and Information Science Research, 35(4), 326–337.CrossRefGoogle Scholar
  32. Mutangadura, G. B. (2005). Gender, HIV/AIDS and rural livelihoods in Southern Africa: addressing the challenges. JENDA A Journal of Culture and African Women Studies, 7, 1–19.Google Scholar
  33. Owen, H., Nyamukapa, C., Beasley, M., Wambe, M., Jukes, M., Mason, P., & Gregson, S. (2009). Contrasting causal pathways contribute to poorer health and nutrition outcomes in orphans in Zimbabwe. Vulnerable Children and Youth Studies, 4(4), 312–323.CrossRefGoogle Scholar
  34. Owusu, V., Abdulai, A., & Abdul-Rahman, S. (2011). Non-farm work and food security among farm households in Northern Ghana. Food Policy, 36(2), 108–118.CrossRefGoogle Scholar
  35. Rawat, R., McCoy, S. I., & Kadiyala, S. (2013). Poor diet quality is associated with low CD4 count and anemia and predicts mortality among antiretroviral therapy–naive HIV-positive adults in Uganda. JAIDS Journal of Acquired Immune Deficiency Syndromes, 62(2), 246–253.CrossRefPubMedGoogle Scholar
  36. Robinson, J., & Yeh, E. (2011). Transactional sex as a response to risk in Western Kenya. American Economic Journal: Applied Economics, 35–64.Google Scholar
  37. Schwarzer, R., & Jerusalem, M. (1995). Generalized self-efficacy scale. In J. Weinman, S. Wright, & M. Johnston (Eds.), Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35–37). Windsor: NFER-NELSON.Google Scholar
  38. Scrimshaw, N. S., & SanGiovanni, J. P. (1997). Synergism of nutrition, infection and immunity: an overview. American Journal of Clinical Nutrition, 66, 464S–477S.PubMedGoogle Scholar
  39. Scriven, M. (2010). Evaluation bias and its control*. Journal of MultiDisciplinary Evaluation, 7(15), 79–98.Google Scholar
  40. Seguino, S., & Were, M. (2014). Gender, development and economic growth in Sub-Saharan Africa. Journal of African Economies, 23(suppl 1), i18–i61.CrossRefGoogle Scholar
  41. Seidenfeld, D., Handa, S., Tembo, G., Michelo, S., Harland Scott, C., & Prencipe, L. (2014). The impact of an unconditional cash transfer on food security and nutrition: the Zambia child grant programme.Google Scholar
  42. Sellen, D. W., & Hadley, C. (2011). Food insecurity and maternal‐to‐child transmission of HIV and aids in Sub‐Saharan Africa. Annals of Anthropological Practice, 35(1), 28–49.CrossRefGoogle Scholar
  43. Shively, G. E., & Ricker-Gilbert, J. (2013). Measuring the impacts of agricultural input subsidies in Sub-Saharan Africa: evidence from Malawi’s farm input subsidy program. Global Policy Research Institute (GPRI) Policy Briefs, 1(1), 4.Google Scholar
  44. Singh, D., Chaudoir, S. R., Escobar, M. C., & Kalichman, S. (2011). Stigma, burden, social support, and willingness to care among caregivers of PLWHA in home-based care in South Africa. AIDS Care, 23(7), 839–845.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Stover, J., Bollinger, L., Walker, N., & Monasch, R. (2007). Resource needs to support orphans and vulnerable children in sub-Saharan Africa. Health Policy and Planning, 22(1), 21–27.CrossRefPubMedGoogle Scholar
  46. Swidler, A., & Watkins, S. C. (2007). Ties of dependence: AIDS and transactional sex in rural Malawi. Studies in Family Planning, 38(3), 147–162.CrossRefPubMedGoogle Scholar
  47. Taylor, B., Bukenya, D., van Asten, P., Agol, D., Pain, A., & Seeley, J. (2011). The impact of HIV on agricultural livelihoods in southern Uganda and the challenges of attribution. Tropical Medicine & International Health, 16(3), 324–333.CrossRefGoogle Scholar
  48. Thurman, T. R., Snider, L., Boris, N., Kalisa, E., Nkunda Mugarira, E., Ntaganira, J., & Brown, L. (2006). Psychosocial support and marginalization of youth-headed households in Rwanda. AIDS Care, 18(3), 220–229.CrossRefPubMedGoogle Scholar
  49. Thurman, T. R., Jarabi, B., & Rice, J. (2012). Caring for the caregiver: evaluation of support groups for guardians of orphans and vulnerable children in Kenya. AIDS Care, 24(7), 811–819.CrossRefPubMedGoogle Scholar
  50. Tsai, A. C., Bangsberg, D. R., Frongillo, E. A., Hunt, P. W., Muzoora, C., Martin, J. N., & Weiser, S. D. (2012). Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Social Science & Medicine, 74(12).Google Scholar
  51. UNICEF. (2014). The state of the world’s children 2014 in numbers: Every child counts–revealing disparities, advancing children’s rights. New York: United Nations Children’s Fund.Google Scholar
  52. Van de Mortel, T. F. (2008). Faking it: social desirability response bias in self-report research. Australian Journal of Advanced Nursing, 25(4), 40.Google Scholar
  53. Van Rooyen, C., Stewart, R., & de Wet, T. (2012). The impact of microfinance in sub-Saharan Africa: a systematic review of the evidence. World Development, 40(11), 2249–2262.CrossRefGoogle Scholar
  54. Wang, J. S. H., Ssewamala, F. M., & Han, C. K. (2014). Family economic strengthening and mental health functioning of caregivers for AIDS-affected children in rural Uganda. Vulnerable Children and Youth Studies, (ahead-of-print), 1–12.Google Scholar
  55. Weiser, S. D., Young, S. L., Cohen, C. R., Kushel, M. B., Tsai, A. C., Tien, P. C., Hatcher, A. M., Frongillo, E. A., & Bangsberg, D. R. (2011). Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. The American Journal of Clinical Nutrition, 94(6), 1729S–1739S.CrossRefPubMedPubMedCentralGoogle Scholar
  56. Wiesmann, D., Bassett, L., Benson, T., Hoddinott, J. (2009). Validation of world food programme’s food consumption score and alternative indicators of household food security. IFPRI Discussion Paper 00870. Accessed April 3, 2014:

Copyright information

© Springer Science+Business Media Dordrecht and International Society for Plant Pathology 2016

Authors and Affiliations

  • Michael L. Goodman
    • 1
    • 3
  • Beatrice J. Selwyn
    • 1
  • Robert O. Morgan
    • 1
  • Linda E. Lloyd
    • 1
  • Moses Mwongera
    • 2
  • Stanley Gitari
    • 2
  • Philip H. Keiser
    • 3
  1. 1.University of Texas School of Public HealthHoustonUSA
  2. 2.Maua Methodist Hospital / Zoe Orphan Empowerment MinistryMeruKenya
  3. 3.University of Texas Medical BranchGalvestonUSA

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