In-depth: Another Kenya - The humanitarian cost of under-development

KENYA: The role of culture in child nutrition

Children in North Eastern Kenya are especially vulnerable to malnutrition.
MOYALE, 18 December 2009 (IRIN) - Two-year-old Safia Emoi is weak, thin and listless. She has just arrived at the Heillu Health centre with her mother Amima Mohammed, who set off early to make the 4km trek to the clinic in the outskirts of the upper Eastern Province town of Moyale. Safia is enrolled in a programme for severely malnourished children.

“Up until recently, things were a bit better for me and my family,” Amima Mohammed, 35, said. However, a prolonged drought has killed livestock, in turn affecting children’s nutrition and milk consumption.

“We are hungry most of the time. I make some strong tea in the morning and then we have one meal of maize during the day,” said the mother of six.  
 
There are dozens of children enrolled in a supplementary feeding programme run by Concern Worldwide in Moyale; in the past three months, the NGO recorded an average of 70 to 80 admissions per month. “I have seen other children getting better when given ready-to-eat therapeutic food, so I know Safia will too,” said her mother.

According to the Arid Lands Resource Management Project (ALRMP), agro-pastoral and pastoral communities are among the worst affected by food insecurity after four consecutive rainy seasons failed.

Despite ongoing mid-October to December short rains, drought-related stress, such as inadequate food and pasture, remains high in Moyale and other Eastern Province Districts such as Isiolo, Garbatulla, and Marsabit.

The proportion of children classified as “at risk” of malnutrition (mid-upper-arm circumference, MUAC, less than 135mm, in ages 6-59 months) in October remained higher than respective five-year averages in the districts, according to ALRMP surveillance data, stated a Kenya Food Security Update for November.

An MUAC of less than 110mm indicates severe acute malnutrition; between 110mm and 125mm moderate acute malnutrition, while one between 125 and 135mm shows that the child is at risk of acute malnutrition and should be followed up for growth monitoring.

Food security

In a study of almost 2,000 children in 15 sites in Isiolo District conducted by the ALRMP in October, between 30 and 46 percent of children were found to be at risk of malnutrition.
 
The nutrition status of children is worse in areas with high livestock deaths and extreme poverty, a community officer at Isiolo’s ALRMP office, Lordman Lekalkalai, told IRIN, adding that although water stress had gone down with the rains, food insecurity had not eased.

According to government figures, rates of stunting among children are much higher in such areas - 42 percent in Eastern Province, compared with 29 percent in Nairobi.


Photo: Concern Worldwide
Amima Mohammed with 2 year old Safia Emoi, Moyale
Lekalkalai suggested that interventions such as the provision of Unimix, a fortified maize meal, to children under five and livestock off-take programmes should be extended in the short term.

Abdi Shukri, a resident of Kampi Wachole in Isiolo, told IRIN that his five children often became sick due to poor nutrition but he could not afford to buy vegetables, fruit or milk. Now working as a porter after fleeing conflict in his Gambella area farm, he said:  “A kilogramme of beans is selling at 140 shillings [about $US2]. I cannot afford it because that is the amount of money I earn in a day.”

Paul Kimeu, Isiolo District Drought Management Officer, noted that the pastoralist lifestyle and a lack of dietary diversity predisposed residents to under-nutrition. “Supplementary feeding even where available is also inadequate to meet the number of those in need,” he added.

The wrong kind of food

Another nutritional problem in this region is a widespread tendency not to breastfeed babies during their first six months. According to the UN Children’s Fund, exclusive breastfeeding is the perfect way to provide the best food for a baby’s first six months as breastfed infants are much less likely to die from diarrhoea, acute respiratory infections and other diseases.

But Humphrey Mosomi, a nutritionist with World Vision Kenya in Marsabit district, said some 60 percent of mothers gave their babies additional food as well as water within two weeks of birth.

Improving pastoral community awareness of better child-feeding practices was vital, Mosomi told IRIN.  

“For example, boys may be introduced to camel milk early as a rite of initiation so they will like the animals they will herd in future,” he said. “The belief is that if the male child is first introduced to his mother’s milk, he will become a useless boy.

“There is also influence from grandmothers. They say the children are dying of thirst and that they must be given water,” he said. In an effort to improve the situation, traditional birth attendants, who, as older women, enjoy respect in the community, are being educated about the importance of exclusive breastfeeding.

Challenges

Cultural beliefs also fuel poor child health, noted Mosomi. “It takes a long time to convince someone to sell a cow or a goat to buy food. [People refuse] to sell so as not to be viewed as poor or to look cowardly. If, as a leader, you sold off your cows during the drought, people may refuse to vote for you.

“Sometimes, the cows are there, the milk is there, but it is not available to the children. The herders are ‘favoured’ and allocated the bigger share of milk, for instance,” he noted, adding that there was a need for advocacy.

In May 2008, Marsabit recorded a global acute malnutrition (GAM) rate of 16 percent; the World Health Organization’s emergency threshold is 15 percent.

Poor access to far-off supplementary feeding programme sites and low literacy are other factors. “Some mothers take the children for immunization but they don’t understand why this is important. They go because the doctor said return on a certain date,” he said. “The [nurses] may also not have the time to explain to the mothers about the interventions.”

In Marsabit’s Korr Division, for instance, there is one health facility with about three nurses serving a population of 8,000.

An update by the USAID Famine Early Warning Systems Network (FEWS Net) for November stated: “Pastoral food security remained poor in October, as livestock productivity remained low due to the poor body conditions, while livestock prices declined…

“While generally high ‘risk of malnutrition’ rates are attributed mainly to a lack of food as a result of low purchasing capacities and low milk supply at the household level, diseases such as cholera and malaria, and poor hygiene and childcare practices have also accentuated the higher than normal rates of child malnutrition, ” said FEWS Net.

Children who are sick are not able to feed well, while poor childcare practices such as diluting breastmilk with water, and other unhygienic practices expose children to diseases such as diarrhoea and worm infestation for instance, preventing proper nutrient absorption and retention.

Through a European Commission Humanitarian Aid contribution, the UN World Food Programme (WFP) will provide special supplementary rations to 450,000 children under the age of five, as well as to pregnant and nursing mothers, in the northern districts of Mandera, Marsabit, Samburu, Turkana and Wajir.

"Children under five are always hit hardest by a crisis and suffer the most," said Burkard Oberle, WFP Country Director. "Given the high levels of malnutrition in these five districts, this additional support will effectively help curb malnutrition levels."

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[This article is part of a special package "Another Kenya". For more reports: http://www.irinnews.org/IndepthMain.aspx?InDepthID=83&ReportID=87469 ]