By Scovian Lillian
Nairobi, Kenya: Gaudencia Alusa is uneasy, pensive, and timid when I meet her at her single-roomed house in Raila Village, in Kibra Sub-county on the outskirts of Nairobi. Just by the doorstep is a small open pit latrine, also used as a bathroom. The neighborhood has rows upon rows of makeshift wooden and iron sheet structures as far as the eye can see.
Before we begin the interview, she says: “I hope you will not take long, I had started washing clothes for someone as my daily job, but when you rang, I had to stop and come.” She is a casual worker, doing laundry and other odd jobs for a living. Her husband is a drunkard and never supports her, she lamented that he barters her.
Throughout the two-hour interview, she held and suckled her two-and-a-half-year-old daughter.
“She’s always like this even throughout the night,” she said.
Alusa lost ten children during childbirth years ago, but she doesn’t understand why they died. She has never followed up at a health facility to determine what the problem was.
“I did not see the need to do so,” she said, with an apprehensive face.
“It’s not easy to find wholesome meals daily. I do manual jobs to provide for my children. Veronica was born underweight, weak, sickly, and with a poor appetite,” said the 36-year-old mother of four, toddler also experienced frequent diarrhoea. Her children’s survival presses heavily on her heart and mind. She has lost ten children over the years. They died as babies after she gave birth over the years.
For Alusa and many Kibera residents, life is a struggle as they deal with unemployment, low income, poor sanitation, diseases, substance abuse, and poor access to healthcare. Many children are predisposed to malnutrition as households lack a diversified diet.
They are the worst affected by a context that spurred recent nationwide protests that happened between June to July. Kenyans, especially the young people lamented an ineffective and corrupt government that is poor at service delivery, worsening the living conditions of poor people.
The recently proposed finance bill that would have made life harder but has luckily been thwarted for now, high unemployment rates, and bad governance are some of the major other reasons for the protests. The finance bill would see Kenyans taxed more on basic commodities such as sanitary towels, diapers, bread, and cooking oil.
The impact that economic conditions have on ordinary people manifests in the lives of Kenya’s children, especially in the informal settlements.
An Integrated Food Security Phase Classification (IPC) analysis conducted between March and June this year on the current food insecurity situations in Kenya indicates that about 847,000 children under five are facing acute malnutrition as staple food prices remain historically high across the country driven by low local availability, dependence on high-priced cross-border imports, high production and marketing costs, and depreciation of the Kenyan Shilling (KES).
https://www.ipcinfo.org/fileadmin/user_upload/ipcinfo/docs/IPC_Kenya_Acute_Food_Insecurity_Acute_Malnutrition_Feb_June2024_Report.pdf [Link to the analysis]
The IPC is a set of tools and procedures to classify the severity and characteristics of acute food and nutrition crises as well as chronic food insecurity based on international standards. The IPC analysis aimed at informing emergency response as well as medium and long-term food security policy and programming.
Other major contributing factors for acute malnutrition according to the analysis include; high morbidity, poor childcare, inadequate feeding practices, poor Water Sanitation and Hygiene
(WASH) practices, sub-optimal coverage of multisectoral interventions such as humanitarian assistance, and multiple recurrent shocks for instance the massive floods that Kenya experienced early this year.
A few meters from Alusa’s house at a community health facility, 35-year-old Wilter Kwamboka is seated on a bench breastfeeding her one-year-old son. Her story is not different from Alusa’s. She is also a casual worker and laments the daily struggle of trying to survive on Shs.100 a day from doing tasks like cleaning for people.
Her baby was born underweight, with a poor appetite, and lacked vitality. However, his health improved after a Community Health Promoter (CHP) who was doing door-to-door visits showed up at her doorstep to discuss malnutrition and how to combat it.
“Despite the challenge of getting a full course meal every day, my child’s health improved immensely after the community health promoter gave him Vitamin A supplements and dewormers. He is now active, has a great urge for food, his immunity was boosted and he has gained weight too. I try my best to give him healthy foods with fruits. The doctor told me that the child is okay health-wise now,” Kwamboka said.
Vitamin A supplementation is part of a public health intervention to improve child health. According to the World Health Organization, a Vitamin A deficiency affects about 190 million preschool-age children, mostly from Africa and Southeast Asia. In infants and children, vitamin A is essential to support rapid growth and to help combat infections. Inadequate intake of vitamin A may lead to deficiency which can cause visual impairment in the form of night blindness. It may also increase the risk of illness and death from childhood infections, including measles and diarrhoea.
The Vitamin A supplements and dewormers target children between the ages of six months to fifty-nine months.
“After taking the Vitamin A supplements, my daughter is now active. She is due to receive her second dose in the coming month. Her appetite is really good now and her health has greatly improved. The only challenge is that she might want to eat fruits but I can’t afford them daily. We have to eat what is available,” Alusa explained, highlighting the challenges of getting the vitamins from fruits and vegetables for low-income earners and those with unstable income sources
According to Hellen Nyakundi the Coordinator of Nutrition Services at the Lang’ata Sub-County Hospital, the two children are among the over 9,000 that have benefited from the supplements given by the Hellen Keller Foundation in collaboration with the Langata Sub-County hospital.
“Together with the Hellen Keller Foundation and the Community Health Promoters, we envision routine supplementation for children in Kibera. As a Sub-County hospital WHICH IS WHAT, we are sensitizing healthcare workers to empower the slum population about the overall well-being of children.
“Vitamin A is vital for a child’s growth and development, but most parents in Kibera did not know that. We use the existing health structures to strengthen nutrition. The Foundation is supporting supplementation of Vitamin A and dewormers in the area.”
Nyakundi added, “A diversified diet is a problem for kids in informal settlements since their parents face a lot of challenges like alcoholism and unemployment. The diet in most households comprises carbohydrates. Imagine a situation where the head of the house consumes a protein dish while the children eat the remains (soup) with carbohydrates. It might sound strange but the women will tell you so.”
Patrick Mulwa, the Community Health Promoter is zealous to alleviate malnutrition in the slums. Although, the fifty-year-old survives on a stipend and not a salary, his unwavering determination to ensure vitamin A supplementation for every household is admirable. He and the other ten Community Health Promoters are committed to the task. He attends to 33 households monthly, doing house visits to ensure that children under the age of five get vitamin A supplements and dewormers, then follows up for the second dose if need be.
“My job is to map out children to be given the supplements and do door-to-door visits. Through the electronic Community Health Information System (e-CHIS-mobile phone app that keeps community data), we identify the households to visit and the children eligible for dosage,” he said.
Mulwa added that once a month, the health promoters hold a community day at the local health facility in Raila village to sensitize the community about the need for supplementation and to talk about the challenges they encounter on duty. For instance, sometimes a health promoter may not find someone at home during regular visits and this can hamper the supplementation process.
Vitamin A deficiency is a significant public health concern, with supplementation taking place in 25 out of the 47 counties to ensure optimal growth in children under the age of five.
“Vitamin A reduces mortality rates by fostering healthy growth in children. We are working as linkages between communities by strengthening the supplementation. To ensure sustainability, we do capacity building for healthcare providers in community health facilities, identify nutrition gaps, and help counties bridge them. Use our resources, such as health supplies (gloves, scissors, and sanitizers) to bridge gaps in healthcare and work with existing structures to strengthen healthcare,” said Robinson Nyaribo, the International Program Manager at Hellen Keller Foundation in Mombasa, Kenya.
He added that the foundation is engaging nationally by incorporating revised integrated guidelines at all facilities to enhance vitamin A supplements. They are also advocating with the county leadership to increase human resources to bridge the gaps in health, especially for children under the age of five.
