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Time to think urban.....Kenya

By Linda Beyer, Valerie Wambani and Koki Kyalo

Linda Beyer is Nutrition Specialist (Infant and Young Child Nutrition and HIV/AIDS) with UNICEF Kenya and is based in Nairobi.

Valerie Wambani, is Programme Manager for Food Security and Emergency Nutrition, Division of Nutrition, MOH Kenya.

Koki Kyalo is the Nutrition Manager for urban programming, Concern Worldwide, Kenya.

This article shares the approach and vision for urban nutrition programming in Kenya from the national perspective. It reflects collaborative work by the Ministry of Health Kenya, UNICEF Kenya and Concern Worldwide.

Understanding the challenges of urban nutrition and food security in Kenya

In Kenya, close to 1 in 3 children live in urban areas (5.2 million) with 1.7 million of these children living in poverty. Households spend up to 75% of their income on staple foods, with price shocks and over reliance on markets resulting in negative coping mechanisms and heavy reliance on street foods. Malnutrition and anaemia rank 4th out of the top 10 causes of mortality for children under 5 years in Nairobi and account for 8.4% years of life lost1. Stunting affects more than one in two children in urban slums (see Figure 1). Emerging issues are rickets, severe stunting in young children (severe stunting in children under one year of age has doubled over the past six years2), co-morbidities (diarrhoea and HIV/AIDS) and challenges for care practices in early childhood care settings. The difference in child malnutrition between the wealthiest and poorest households is twice as great in urban areas compared to rural locations, highlighting a number of inequities.

Policy framework

There is a strong policy framework for urban nutrition action in Kenya. Recent innovations in urban policy and strategy guidance are:

Kenyan government priorities

A key area of action is strengthening information systems and analysis in urban areas, to identify who and where are the most vulnerable. Table 1 outlines the target vulnerable groups and severe acute malnutrition (SAM) caseload faced in informal urban settlements in Nairobi, Kisumu and Mombasa. Since 2008, the Ministry of Health Kenya (MOH) with support from UNICEF and Concern Worldwide has accelerated nutrition interventions in urban contexts, addressing barriers to vulnerable populations, strengthening health systems and ensuring a package of evidence based high impact nutrition interventions (HINI) reach children and mothers.

Table 1: Urban population, target groups and acute malnutrition caseloads

Nairobi (100% urban)

Kisumu (52% urban)

Mombasa (100% urban)

Total population of informal settlements

1,992,237

300,672

563,622

Children under five years

258,996

64,173

44,102

Pregnant and lactating women

119,534

18,040

33,817

Severe acute malnutrition caseload

8,701

2,875

917

Assessing coverage for HINI has involved strengthening Health Information Systems (HIS) indicators and Community Based Indicators. Further strengthening of analysis of urban vulnerability has involved:

A second key area of action is acceleration of systems/coverage of HINIs to address disparities in malnutrition in urban informal settlements/slums of Nairobi. Progress in health system strengthening is reflected in improved coverage for Nairobi and Kisumu facilities where HINIs implementation has increased from 26 facilities in 2008 to 102 facilities in 2012, reaching 89% of target health services in urban slums. Coverage for outpatient treatment for acute malnutrition has also improved, with coverage reaching 40 to 50% of target (see Table 2) and achieving global Sphere standards (defaulter rate, recovery rate and mortality rate). Coverage assessments have highlighted barriers to future programming that will inform efforts.

The area of Infant and Young Child Nutrition (IYCN) has seen improved strategies and focus on community level support5. Results included improvement in complementary feeding practices (see Table 2). Main strategies have included Trials for Improved Practices (TIPs) which used formative assessment for improved complementary feeding of young children, Mother to Mother Support Groups (MtMSG) and Community Capacity Enhancement (CCE); these approaches have been integrated together to mobilise communities and empower caregivers with knowledge and skills for better practices.

Table 2: High Impact Nutrition Interventions, national targets and achievements in Nairobi and Kisumu (2010-2012)

Focus of Nutrition Programme Support

High Impact Nutrition Intervention

National Target

Nairobi 2010

Nairobi

2012

Kisumu 2010

Kisumu 2012

Infant and Young Child Nutrition

Early initiation of breastfeeding

> 70 %

56 %

71 %

61 %

66 %

Exclusive Breastfeeding

> 80 %

46%

59 %

46 %

44 %

Dietary Diversity

> 70 %

38 %

74 %

42 %

73 % *

Feeding Frequency

> 80 %

4 %

46 %

5 %

81 % *

Micronutrient  Deficiency Control

Vitamin A

> 80 %

76 %

73 %

N/A-

86 %

Zinc treatment

> 50 %

14.6 %

40 %

N/A

43 %

Deworming

> 80 %

48.6 %

52 %

30.6 %

53 %

Iron/Folate

> 50 %

3.6 %

N/A

5.1 %

N/A

IMAM

SAM coverage

> 70 %

32%

39 %

50%

46%

Challenges and constraints

Challenges and constraints to urban nutrition programme support in Kenya include:

In order to take urban programming to the next level and strengthen nutrition responses in vulnerable urban areas, Kenyan government priorities are:

For more information, contact: Linda Beyer, email: lbeyer@unicef.org

Show footnotes

1APHRC, 2008. http://www.aphrc.org/

2APHRC, 2013. http://www.aphrc.org/

3Semi-quantitative Evaluation of Access and Coverage

4APHRC and Concern Worldwide, 2009

5Concern Worldwide, UNICEF, MoH, 2010

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Linda Beyer, Valerie Wambani, Koki Kyalo (2013). Time to think urban.....Kenya. Field Exchange 46: Special focus on urban food security & nutrition, September 2013. p49. www.ennonline.net/fex/46/urbankenya

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