The protruding belly, swollen legs and brittle, brown hair are like something out of a textbook. At one year and four months old, baby Amodoe Ethai weighs 7.4kg, way below the expected 11kg for a child his age.
Looking at him, you would be forgiven to think he is well fed. The white patches on his skin, however, tell a different story. One of severe malnutrition.
His condition, according to Mr James Eipa, a paediatric nutritionist at Lodwar Referral Hospital, is a result of poor feeding. Ethai gets too much carbohydrates and too little protein in his diet. “When the child was brought here, he was severely malnourished. His mother tells us they mostly eat porridge,” says Mr Eipa.
Government-given complementary foods are hard to come by for the family that lives in one of the 23 arid and semi-arid counties ranked as the most food insecure.
“There are days I sell only one Sh100 mat and this is the money I budget with. The most readily available food for my children is porridge. When I do not sell any mat, we eat wild fruits,” says the mother.
With the region plagued by perennial droughts, his mother could not exclusively breastfeed him for six months as is recommended. Baby Ethai started taking porridge at three months.
He was referred to Lodwar Referral Hospital after dispensaries were unable to restore his health. At the hospital, he was fed with F75, a ready-to-eat therapeutic food, to help stabilise his organs, before graduating to F100.
Gladys Mugambi, the chairperson of UN-backed Scaling Up Nutrition global movement, tells HealthyNation children with malnutrition are categorised as those at risk, moderate and severe and each category is handled differently.
“When a baby is severely malnourished, you cannot put them on high-calorie foods until they are stable. That is why they are treated with F75 first,” explains Ms Mugambi.
Baby Ethai’s case is one among many in Turkana. Malnutrition is a prevalent problem in the 77,000 square-kilometre county.
As a result of record malnutrition rates, drought and starvation, the World Health Organisation has designated Turkana as an acute food and livelihood crisis area.
The numbers paint a paint a grim picture. Turkana is the leading county in the number of severely malnourished children. A 2019 SMART survey report shows severe acute malnutrition rates — the most life-threatening form of hunger — are up nearly four-fold in just one year, from 2.3 to 8.3 per cent in the county.
A 2018 survey by the Turkana government further reveals that one in every six children (18.1 per cent) in the county is wasted.
This means an estimated 39,093 children here are too thin for their age. Additionally, one in five children in Turkana is stunted (17.8 per cent or 38,445 children).
Stunting means too short for age and together with wasting, these are the two most common forms of malnutrition in Turkana.
Ms Mugambi says malnutrition is often made worse by cultural practices. Being pastoralists, communities in Turkana mostly eat meat.
In some of the pastoralist communities, pregnant women are forbidden from taking crucial foods such as milk, eggs and meat.
In Turkana South Sub-County, 12 per cent of children under five suffer from severe acute malnutrition.
These children are at a risk of dying from drought related hunger. Malnutrition in the sub-county increased from 19.5 per cent in 2018 to 31 per cent in 2019.
Over the same period, Loima Sub-County recorded a two per cent increase to 20 per cent in 2019.
The county’s prevalence increased from 18 to 26 per cent over the same period. The results show acute malnutrition remains an emergency.
In many cases, hunger always steals the show as the main cause of malnutrition in the country, but even when food aid is provided during a crisis, experts concur that the malnutrition levels never go down to acceptable levels.
But, Kenya should not be here. In fact, malnutrition should be unheard of in Turkana.
Going by the county’s budget allocation from the Exchequer and the number of NGOs working in the region, malnutrition should be a thing of the past. In this financial year, the county has been allocated more than Sh10 billion by the Treasury, making it the second most funded region after Nairobi.
In its own budget for the current financial year, the county allocated more than Sh600 million to address undernutrition by supporting farming.
Over the years, various stakeholders in Turkana have undertaken several projects on malnutrition. As at last week Tuesday, there were a record 43 NGOs in the county.
The NGOs have several projects ranging from malnutrition eradication, security, water, feeding to education.
But why do the numbers of those malnourished keep growing?
A county officer who sought anonymity thinks it’s not in these organisations’ best interest to end malnutrition.
“Malnutrition is like the bread and butter for organisations in Turkana and if they eradicate it, their presence will not be felt,” says the officer.
“Why is it that every year we have a number of them coming to the ground, yet there’s no change when a survey is conducted?” he asks, adding that stakeholders need to restrategise so that the problem is solved once and for all.
Statistics by the Kenya Food and Nutrition Situation Seasonal Assessment Report (March, 2019) show that a total of 54,264 children under five years are suffering from acute malnutrition in Turkana.
The report further classifies 14,420 of them as being severely malnourished, and in need of urgent treatment to avoid further deterioration.
The severity of malnutrition, according to WHO, is only acceptable if the prevalence is less than five per cent. Turkana has been teetering between 15 and 30 per cent.
Despite the complexity involved in managing cases such as Baby Ethai’s, Turkana relies on community health volunteers to detect and respond to acute and chronic malnutrition.
An inadequate number of nutritionists has presented a challenge. There are 3,066 nutritionists and dietitians, 4,430 nutrition and dietetic technologists and 813 nutrition and dietetic technicians, according to data from the Kenya National Bureau of Statistics.
Data from the Health ministry indicates there are about 1,300 nutritionists employed by the government to serve the entire country.
As of September, Turkana had employed 50 nutritionists to manage malnutrition, diabetes, HIV and Aids among other conditions.
“There are 50 nutrition centres where cases of malnutrition are handled and monitored for three months. They are enrolled in programmes and given food. The number is still very small,” says Ms Beryl Ondu, a nutrition officer at Lodwar Referral Hospital.
The Health ministry says fighting malnutrition is majorly a county government’s duty.
Ms Jane Wambugu, Deputy Director of Agriculture and Nutrition in the Health ministry, says their concern is only on policy and training.
She says the government has come up with food and nutrition security policies and strategies, for instance, the Agriculture Sector Goal, a transformation strategy for 2019-2029 on how to to improve food production.
“All the analytical causes of malnutrition have to be dealt with from the agricultural perspective,” she says.
There is also a food and nutrition working group at the national level.
“From this group, we discuss with the counties on what types of food they can grow considering the rainfall pattern, the nutritional contents of different types of foods and how to increase production,” she says.
The counties can decide on varieties to grow that can withstand the weather in their areas, can be harvested and consumed at the right time.
On training, she says the government has also come up with several documents on food including Kenya Food Composition 2018. This, she says, is on how to prepare food.
“From the meeting, train the partners on ways of creating awareness on the consumption of various foods. From production to the time the food is prepared. You find that some regions are producing food, but they are not consuming. They sell the food,” she says.
Asked why the numbers are steadily rising, Turkana Governor Josphat Nanok blames the high malnutrition rates on food shortage. This shortage, he says, cannot be plugged using the current budget.
Turkana needs more funds to end malnutrition and according to him, the problem does not exist in isolation. Factors such as insecurity majorly hinder the war against malnutrition, he adds.
“The malnutrition rates have remained stubbornly high over the years, which highlights no obvious recovery from the persistent shocks from drought, floods and conflict, among others,” he tells HealthyNation.
Mr Nanok cites poor access to water, unavailability of food, poor health and insecurity, particularly in the most productive parts of Turkana.
“Addressing this is going to help us, particularly for residents who do not move with their livestock. Since they are in one place, they can get food and water and treatment,” he says.
Dr Gilchrist Lokoel, the County Medical Director, says even though there hasn’t been much progress, the county now has programmes to end malnutrition.
He says the county has been battling the high numbers of malnutrition since 1951. There was a time hospital wards were filled with undernourished patients, he adds. “After discharge, the patients would be back with the same problem three months later,” he says.
“In this regard, I considered myself a diver saving people downstream without necessarily going upstream to check what is happening. Why these people are undernourished,” says the former medical superintendent of Lodwar hospital.
Bayer Fund is one of the players that has started a programme it feels can solve the crisis. Through Africare, the NGO that has committed $5 million (about Sh500 million) in the five-year programme dubbed Improved Approach to Community-based Nutrition in Turkana (IMPACT).
The programme hopes to improve access to healthy food for mothers and children in Turkana by improving food in two most affected sub-counties (Turkwel and Loima).
“We are going to support 3,000 beneficiaries (600 households) to improve access to diverse food and over 70 per cent of the population (17,585 households) will get nutrition education and support through community health outreach,” says Laurent Perrier, chief executive officer, Bayer East Africa during the launch last week.
Dr Lokoel is certain about the Silo intervention — IMPACT. He says this will convert the vast, dusty drylands to green crops that will cushion the community against hunger. The fields are irrigated using water from the Turkwel River.
Whether this is going to change the face of Turkana as far as malnutrition is concerned, is a question that will be answered in 2022 when the programme ends.