The distribution and healthiness of foods sold around urban and rural schools in Kenya

Background: Urbanization and globalization of food production and marketing are two important factors fuelling the rise in the prevalence of obesity and non-communicable diseases in LMICs. The availability of food retail outlets around schools has been shown to influence food choices among school children. We estimated the density of food retail outlets around schools and the availability of healthy and unhealthy food options sold in the retail outlets in Kenya. Methodology: This was a cross-sectional study conducted in three Kenyan counties (Nairobi-urban, Mombasa-urban, and Baringo-rural) from July 2021 to August 2021. Through multi-stage and population proportionate sampling approach,500 schools were selected from the three counties each stratified into high and low socio-economic status based on poverty indices from the Kenya National Bureau of Statistics All the food retail outlets within a radius of 250 meters around each school was mapped and the characteristics of all the foods sold in them were collected. NOVA classification was used to classify the foods according to healthiness into four categories (ultra-processed, processed culinary ingredients, and unprocessed foods). Results: A total of 7792 outlets were mapped around the schools with a density of 25 (1-110), 19(1-47), and 3(1-17) for Nairobi, Mombasa, and Baringo counties, respectively. The most common types of outlets in the three counties were vegetable food stands at (30.21%), shops (25.19%), kiosks (13.6%), local vendors (13.4)%, and restaurants (7.34%). According to the NOVA classification, the unprocessed/minimally processed food category was the most common, n=15,657, (71.59%), followed by ultra-processed foods n=5483, (25.1%), processed culinary ingredients n=565(2.6%), and processed foods n=166, (0.8%). Conclusion: Retail food outlets are common around schools in Kenya with a higher density in urban than in rural counties. Most of the foods sold around schools are healthy but there was also a substantial proportion of unhealthy food options such as ultra-processed foods. There is a need to develop policies to regulate the zoning of food retail outlets around schools to prevent exposure to unhealthy food options.