Improving the nutrition of orphaned and vulnerable children in Kenya

Bill Okaka

Knowledge Management & Communications Officer, ASSIST Kenya

Jemimah Owande

Quality Improvement Advisor, OVC, Kenya, USAID ASSIST/URC

Contributing Authors: Lillian Atsiavula (Deputy Manager OVC Department in Ampath plus), Irene Mutea (Quality Improvement Officer - OVC), and Charles Kimani ( Monitoring & Evaluation Advisor).

26.000 children are now benefiting from community-facility linkage. Read how:

In 2013, the Kapseret community in Uasin Gishu County, Kenya formed a Quality Improvement Team to conduct Child Status Index Assessments (CSI) and identify nutrition problems affecting children in the location. The team was composed of the community Chief as chair, Villages Elders, Ministry of Agriculture, Children’s Department, the Police, Religious Leaders, Social Workers and Volunteers.

Through the assessments, the team was able to find the cause of malnutrition. The causes? A combination of individual, household, and community factors ranging from disease, cultural beliefs and customs, poor economic status and limited access to health, among others. However, in further defining the problem, the QIT unearthed specific indicators that created apathy among caretakers, leading to slow response to dealing with malnutrition among children. 

The poverty related indices were also discovered to be caused by:

  • Redirection of resources towards sick caregivers, competing with the allowable provision of basic needs for the child
  • Internal displacement of people as a result of political conflicts. Loss of property and business which were sole sources of income for caregivers.
  • Dysfunctional family units in which caregivers are entrenched in drugs and substance abuse.
  • Low utilization of large tracks of arable land, as monoculture is practiced without ploughing inputs from lessons learned that directly affect yields and financial returns.
  • Low understanding on causal relationship between food security and nutrition.

With overt consequences of malnutrition, prevention is highly pertinent as unfolded in the multi-level change idea package, entailing;

1. Linking facility to community interventions

Where a hospital and clinic build a bond with the community to provide food supplements for severe malnutrition cases. Where community health workers employ Ministry of Health procedures of: Screening of all new admissions for nutritional risks and assessment of at-risk patients to determine nutrition status → Defining the root of the problem → Providing nutritional support, evaluation and assessment of patient’s nutritional needs, and development of nutrition plans and goals → Providing monitoring nutrition support and monitoring care plan for accuracy and effectiveness.

2. Building the capacity of the caregiver

In response to improving food security, and especially for the households identified by CSI, the initiative sensitized caregivers on better farming methods – factoring in cash vis-à-vis food crops that add value to child’s nutrition. Caregivers were enrolled in saving and loaning groups that incubated business ideas, which were financed from sale of yields gotten from their improved farm. The economic strengthening groups also championed proper household budgeting – factoring equitable resource distribution that ensures a child’s nutritional needs are met.

3. Growth monitoring

Enabling the tracking of each child and in Mary’s (not her real name) illustrated case. This is equally proof that the change ideas have been operationalized and institutionalized.

Mary (not her real name*) is 10 years under the care of her uncle. Father is deceased, the mother’s ware about not known. The CHW received referral form from the clinic – social worker. The child was anemic, very weak and sad. There was no food in the household. The child was sickling with poor adherence and the caregiver did not support her in taking drugs. Missed clinic appointments. Child did not attend school. Child overworked most of the time. No reliable source of income. It took time to reach the child due to the unwelcoming caregiver. Spoke to caregiver on parenting skills, good nutrition, hygiene, drug adherence. Child attended to by nutritionist where she was given food supplements and caregiver taken through nutrition counseling. Linked the caregiver to have an income generating project. Child attends school regularly. Some improvement noted on drug adherence. Caregiver does casual work and has a small shop. This enables the caregiver to buy food for the family. More follow up is still done.

Now, with operational cascades of 35 social workers, 350 community health volunteers, and 7,000 households housing 26,000 children, the nutrition program implemented by the Ampath plus project now proves that efforts to improve nutrition assessment, counseling, and support throughout the continuum of care achieves greater success when activities at the community and health facility are linked. In fact, engaging health care workers and community health volunteers in a system of two-way referrals helps direct caregivers to the interventions that effectively address nutritional status of children.

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