18 Jul 2014

The Nutrition Paradox in Kenya: What Are We Doing?

Elizabeth Kimani African Population and Health Research Centre, Kenya

When one thinks of malnutrition in Kenya or any other African country, what usually comes to mind is stunting, underweight, wasting, and possibly micronutrient deficiencies. Hardly ever do thoughts of over-nutrition, in countries so poor, cross people’s minds, but Kenya, like many other African countries, grapples with two heavy burdens of malnutrition: the burden of the traditional under-nutrition and the burden of over-nutrition.

At the national level, 35 percent of children under five years are stunted, 16 percent  are underweight, and 7 percent  are wasted [1]. While the levels of wasting and stunting have remained almost constant in the last 20 years: between 6 percent  and 7 percent for wasting and 30 percent and 35 percent for stunting, there has been a slight decline in underweight from 22 percent in 1993 to 16 percent in 2008 [2]. The prevalence of under-nutrition is particularly high in urban slums where, for example, stunting among children under five years is more than 40 percent [3].

The high level of undernutrition is occasioned by food insecurity (especially due to frequent droughts), poor access to water and sanitation, infections (especially from diarrhoea, HIV, and malaria), poor maternal nutrition, and poor child feeding practices. The persistence of high levels of malnutrition, particularly stunting, may also reflect poor prioritisation and commitment to nutrition by the government and development partners, hence low budgetary allocation in the past. For example, the government allocated only 0.5 percent of its limited health budget to nutrition in the 2010/2011 financial year [2].

UNICEF-Trends-in-stunting-underweight-and-wasting.jpg

Image: KDHS=Kenya Demographic and Health Survey

Source:  UNICEF 2011 [2]

Despite the high levels of under-nutrition, substantial levels of overweight and obesity have also been documented in Kenya.  At the national level, 25 percent of women of reproductive age (15-49 years old) are either overweight or obese. The prevalence is even higher in urban areas where 40 percent of women are either overweight or obese [1]. Surprisingly, over a third of women aged 18 years old and older in urban slums are also either overweight or obese [4]. Social and environmental factors are at play, including dietary and lifestyle changes, catalysed by processes such as the rapid urbanisation occurring in Kenya, like in many other African countries – and a good share of negligence.

Malnutrition is clearly a complex problem with multiple causes. Addressing it therefore calls for innovative strategies, as well as political commitment if we are to achieve global targets such as the Millennium Development Goals (MDGs) for 2015 or the World Health Assembly (WHA) goals for 2025. There is need to take a multisectoral approach to both nutrition specific and nutrition sensitive interventions.

Nutrition is no longer just a health problem, but a social and development problem that needs to be addressed collaboratively by different actors, including the government ministries (health, agriculture, gender, sports, culture and social services, finance, education, and water, among others), the private sector, civil society, researchers, and development partners. To accompany the multisectoral action on nutrition should be an effective coordination mechanism, only possible in the presence of strong political commitment, to reap the best out of the efforts. Countries such as Senegal and Rwanda that have implemented multisectoral action in nutrition programming are closer to meeting the MDG nutrition target than Kenya [5].

In an effort to address the double burden of malnutrition, Kenya, like many other African countries, signed up (in 2012) to the Scaling up Nutrition (SUN) Movement [6] which brings together governments, civil society, the private sector, researchers, the United Nations and donors in a collective effort. SUN implements both nutrition-specific and nutrition-sensitive interventions/strategies to address malnutrition.  In line with SUN’s objectives, Kenya has drawn up a national nutrition action plan for 2012 to 2017 [7] that outlines 11 strategic objectives tackling both under and over-nutrition. Among these objectives include:

  • Improving the nutritional status of women of reproductive age which entails nutrition education on consumption of healthy foods during pregnancy and strengthening iron and folate supplementation during pregnancy
  • Improving nutritional status of children under five years which entails enhancing exclusive breastfeeding, timely introduction of complementary feeding and micronutrient supplementation;
  • Reducing the prevalence of micronutrient deficiencies in the general population through food fortification and supplementation;
  • Improving knowledge, attitudes and practices on optimal nutrition;
  • Improving prevention, management and control of diet-related non-communicable diseases (NCDs)  to reduce the burden of NCDs;
  • Enhancing evidence-based decision-making through operations research; and,
  • Strengthening coordination and partnerships among key nutrition actors including partners in water, sanitation and hygiene (WASH), education, health, and livelihood sectors.

To potentially achieve the objectives outlined in the national nutrition action plan 2012-2017, a budget of approximately KES 70 billion (US$ 824 million) was drawn. Kenya has committed to spending KES 6 billion (US$70 million) over five years to scale up nutrition interventions outlined in the action plan, shared across various ministries including health, agriculture, water and irrigation, fisheries development, and national planning and development [6]. The rest of the money is being sourced from development partners including UNICEF, WFP, ECHO, JICA, EU, UK Aid, World Bank, MI, GAIN and USAID.

To hold the government accountable to ensuring achievement of the objectives laid out in the action plan, there is need for the civil society including the media, non-governmental organisations and human rights advocacy groups to engage and put pressure on the government. With the devolution of government since 2013 in the context of Kenya’s new constitution, whereby 96 percent of nutrition activities are handled by the county governments, there is even greater need for advocacy at each of the 47 counties to ensure that nutrition is prioritised. For civil society to effectively function, there is need for strong monitoring and evaluation and engagement of users with the findings, which is a key role of the research community.

In conclusion, Kenya, like many other African countries, has to put in more and more effort to curtail the heavy double burden of malnutrition before it gets out of hand. Within the wider national policy framework outlined in the ‘Kenya Vision 2030’ [8], which aims to transform the country into a middle income country and ensure a high quality of life for its people, Kenya may be on track to curtailing this double burden of malnutrition. However, continued government commitment as well as that of other actors including the development partners and the civil society to the outlined national nutrition action plan is critical.

References

1.            Kenya National Bureau of Statistics (KNBS) and ICF Macro, Kenya Demographic and Health Survey 2008-09. 2009: Calverton, Maryland: KNBS and ICF Macro.

2.            UNICEF. Nutrition strategies and programmes in Kenya. 2011; Available from: http://www.unicef.org/nutritioncluster/files/Kenya_nutrition_strategy_leaflet_2011.pdf.

3.            Abuya, B.A., J. Ciera, and E. Kimani-Murage, Effect of mother's education on child's nutritional status in the slums of Nairobi. BMC Pediatr, 2012. 12: p. 80.

4.            Ettarh, R., et al., Overweight, obesity, and perception of body image among slum residents in Nairobi, Kenya, 2008-2009. Prev Chronic Dis, 2013. 10: p. E212.

5.            Garrett, J. and M. Natalicchio, eds. Working multisectorally in nutrition : principles, practices, and case studies. ed. J. Garrett and M. Natalicchio. 2011, IFPRI: Washington, D.C.

6.            SUN Movement. Scaling Up Nutrition Available from: (http://scalingupnutrition.org/.

7.            Kenya, R.o. National Nutrition Action Plan 2012-2017. Available from: http://scalingupnutrition.org/wp-content/uploads/2013/10/Kenya-National-Nutrition-Action-Plan-2012-2017-final.pdf.

8.            Kenya, R.o. Kenya Vision 2030. Available from: http://www.vision2030.go.ke/index.php/vision.