Advertising ultra-processed foods around urban and rural schools in Kenya

Marketing of ultra-processed foods (UPFs) can influence children's food preferences and consumption patterns. However, limited data exist on the extent and nature of UPF marketing around schools in low- and middle-income countries, including Kenya. This study assessed the extent, type, and content of food and beverage advertising near schools in urban and rural settings in Kenya. We conducted a cross-sectional study in June-July 2021 across three Kenyan counties-Nairobi (urban), Mombasa (coastal urban), and Baringo (rural). Each county was stratified by socioeconomic status (SES), and schools were randomly selected. Food and beverage advertisements within a 250-meter radius of schools were documented. Data collected included the type of product, location, and promotional techniques used. Advertised products were categorized using the NOVA classification and the INFORMAS framework. Descriptive statistics were used to summarize advertisement patterns, and Poisson regression was applied to identify factors associated with UPF advertising. A total of 2,300 food and beverage advertisements were documented around 500 schools. Urban areas had a higher median number of advertisements (median = 25, IQR: 25-160) compared to rural areas (median = 10, IQR: 4-13). Nearly 48% of all advertisements featured UPFs. The most frequent promotional strategy involved cartoon and company-owned characters, while price discounts were the most common premium offers. In multivariate analysis, Baringo County showed a higher rate of UPF advertisements compared to Nairobi (PRR: 1.17, 95% CI: 1.01-1.36), as did lower versus higher SES areas (PRR: 1.10, 95% CI: 1.01-1.20). UPFs are commonly advertised around schools in Kenya, often using strategies that appeal to children. Regulatory efforts are needed to limit the marketing of unhealthy foods in school environments.