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Saving children from severe malnutrition in Kenya's semi-arid lands

© UNICEF Kenya/2015/Ayisi
A worried Purity breastfeeds her 9 month old son Benjamin at Kitui County Hospital. He is being treated at the hospital for severe acute malnutrition complicated with pneumonia; he also has a heart murmur.

By Ruth Ansah Ayisi

KITUI, Kenya, 15 May 2015: Purity Benson, 21, wipes away stubborn tears as she watches over her baby son, Benjamin, who, linked up to an oxygen machine, lies listlessly on a table in the hospital ward. His tiny body is wrapped in a blanket; his eyes are wide, determined to survive.

Purity’s fear is palpable and, for now, she is inconsolable. The news has just been broken to her that 9-month old Benjamin is not only suffering from severe acute malnutrition and pneumonia, but that he also has a heart murmur.

The clinical nurse, Sylvester Sila, tries to reassure her. Sila points out that Benjamin has shown marked improvement since he was admitted to the hospital five days ago.

“He was so sick, and dehydrated as he had been unable to breastfeed.” 

Nutritionally, the nurses have managed to stabilise Benjamin and today his treatment changes from the less concentrated F75 therapeutic milk to the highly fortified F100, which is provided by UNICEF. If they had given F100 straight away, Benjamin was so severely malnourished that he would not have been able to tolerate the high amounts of protein, sodium and fat, and could have died, explains Betty Muthoni Kilonzo, the Nutrition Assistant at Kitui County Hospital.

Too many lives lost

Malnutrition is widespread in Kenya. As many as 19,000 children’s lives are lost every year because they are underweight, according to official Government of Kenya statistics. 

UNICEF’s Head of Nutrition in Kenya, Grainne Moloney, points out, “Many chronically malnourished children who survive will suffer irreversible cognitive and physical stunting if left untreated during the first two years of their lives. Recent official data estimates that 2.8 million or one third of Kenyan children under the age of 5 are chronically malnourished also referred to as stunted.”

In a renewed effort to combat both acute and chronic malnutrition, the Government of Kenya, the European Union and UNICEF launched a four-year maternal and child health programme on 18 February 2015; it is part of SHARE, a larger resilience building programme covering the horn of Africa. The programme aims to reinforce health systems and empower mothers and communities to prevent and treat malnutrition.

“As well as having a detrimental impact on the economy, malnutrition hinders efforts to reduce poverty,” says EU Chargé d'Affaires, Mrs. Marjaana Sall.  “In addition, recurrent and prolonged droughts have exposed Kenya’s arid and semi-arid counties to repeated food and nutrition crises. This programme will contribute towards building resilience and protecting the economy against these types of shocks.”

© UNICEF Kenya/2015/Ayisi
A health worker at the hospital prepares therapeutic milk for Benjamin.

Empowering mothers to make healthy decisions

The programme also aims to ensure that mothers adopt healthy practices, including early initiation and exclusive breastfeeding for six months.

Purity had to have a caesarean section and she says she only started to breastfeed her baby after three hours, but she did exclusively breastfeed for the first six months. Thereafter it seems that Benjamin’s diet was mainly starch.

“I don’t know what you mean by a balanced diet,” concedes Purity, who lives with her mother-in-law as her husband has to work in Mombasa. 

She is a subsistence farmer and only has a small plot of maize and beans. However, the crops performed poorly again this season due to the reliance on rainfall; this semi-arid land of Kitui is one of the nine priority counties targeted by the new programme.

However, there are many challenges to fighting malnutrition in the drought-prone areas of Kenya. Emiliana Mbelenga, the Nutrition Support Officer for UNICEF who works in Kitui, highlights the progress as well as the challenges.

Plumpy’Nut, a peanut paste fortified by micronutrients and supplied by UNICEF to health centres, has proved to be extremely effective when treating severe acute malnutrition. It has the added advantage that it can be administered at home, meaning that children do not need to go to hospital unless they have complications.

Usually, within 16 weeks the child should have fully recovered. While being treated at home they are monitored regularly by the nurses at the rural health centres. However, sometimes the mothers share the Plumpy’Nut with other siblings.

“They will tell us, ‘How can I give it just to this one when our crops have failed and the siblings are hungry?’” Mbelenga says that they try to convince the mothers that the fortified peanut paste is ‘medicine’ and only for the severely malnourished child who is in danger of dying. “But it is particularly difficult during these lean months.”

Overcoming the challenges

Mbelenga also points out that although the prevalence of HIV is relatively low in these arid and semi-arid areas, at around 3 per cent, it is still an issue.

“There is only limited nutritional support for those living with HIV who live far away. For example, if they live over 15 kilometres away, they will find it difficult to come to the main hospitals where nutritional support is available.”

Meanwhile, there is hope for Benjamin. He has successfully taken to F100, which Purity will give to him every three hours throughout the day and night. The clinical nurse says that he may be discharged within a few days and Purity can give him Plumpy’Nut at home.

“She will also be counselled by the nutritionists about how to prepare a balanced diet and its importance in building up his immune system,” says the clinical nurse.

Benjamin drinks the F100 milk thirstily as Purity, who is no longer crying but looking drained, cradles him in her arms.



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