Overview of nutrition status and MIYCN programming.ppt

nutrition situation in kenya

1. Overview of nutrition status and
MIYCN programming
Caroline K. Kathiari
Division Of Nutrition and Dietetics

2. Why Nutrition?
•The Constitution of Kenya (2010) guarantees
every person the right to be free from hunger and to have adequate
food of acceptable quality (article 43)
every child the right to basic nutrition (article 53)
•Good nutrition is essential for health development, survival, dignity and economic productivity
•Better nutrition is related to improved infant, child and maternal health, stronger immune
systems, safer pregnancy and childbirth, lower risk of non-communicable diseases and
longevity.
2

3. Trends in stunting, wasting and underweight in Kenya
33 33
30.3
29.6
35.3
26
18
22 22
19.9 20.3
16.1
11
10
6.1 6 5.6 5.8
6.7
4
5
0
5
10
15
20
25
30
35
40
1993 KDHS
(NCHS)
KDHS 1998
(NCHS)
KDHS 2003
(NCHS)
2008 KDHS
(NCHS)
2008 KDHS
(WHO)
2014 KDHS
(WHO)
2022 KDHS
(WHO)
% of children 0 to 59 months
Stunting Underweight Wasting
• Nationalreductionof8.4%instuntingprevalencefrom26to17.6%
• HigheststuntingimprovementreportedinKitui,UasinGishu,Kakamega,Mandera,NandiandLaikipia
counties
• Wastinghasmarginallyincreased:attributedtodrought

4. Turkana
23%
Marsabit
19%
Mandera
21%
Wajir
12%
Garissa
9%
Isiolo
14%
Samburu
31%
Lamu
16%
Tana River
21%
Kitui
25%
Kilifi
37%
Mombasa
14%
Kwale
23%
Taita Taveta
19%
Makueni
20%
Kajiado
14%
Narok
22%
Machakos
16%
Meru
25%
Thakara Nithi
21%
Embu
20%
Kiringaya
11%
Nyeri
13%
Nakuru
19%
Nyandarua
18%
Nairobi
11%
Kiambu
15%
Bomet
22%
Migori
15%
Kisii
16%
Nyamira
14%
Homa Bay
13%
Siaya
19%
Uasin Gishu
14%
Elgeyo
Marakwet
22%
Bungoma
19%
Trans Nzoia
21%
Baringo
21%
Laikipia
13%
Muranga
10%
West
Pokot
34%
Kericho
19%
Busia
15%
Kakamega
12%
Nandi
15%
Vihiga
17%
Kisumu
9%
Kenya
18%
Stunting by County
Percent of children
under age 5 who are
stunted (too short
for their age)

5. Stunting Among Children <5 years by county
HugevarianceatcountylevelwithKilifi,WestPokotandSamburureporting37,34and31percent
respectivelywhileGarissaandKisumuhavereportedalowof9percent
2014 2022

6. Regional disparities in stunting , wasting and underweight
TOP 10 Counties on
stunting
TOP 10 Counties on Wasting
TOP 10 Counties on
underweight
Majority of the ASAL counties have high burden of three types of malnutrition

7. 7
12 12.7
22.5 22.8
18.7
11.9
0
10
20
30
40
50
60
70
80
90
100
<6 6–11 12–23 24–35 36–47 48–59
% Stunted
Age in months
% Stunting disaggregation among children under five

8. 8
3.6
4.7 4.4 4.2 5.2
6.4
0
10
20
30
40
50
60
70
80
90
100
<6 6–11 12–23 24–35 36–47 48–59
% Under five wasted
Age cohort
% Wasting

9. Infant and Young Child Feeding indicators trends
•IncreaseinMinimumacceptabledietispartiallyduetoinclusionofnon-breastfedchildrenfedwithaminimummilkfeeding
frequency.
•Unhealthyfeedingpracticesshouldbeavoidedbecausetheycanpromoteunhealthyweightgainandreplacenutritiousfoods

10. Impact of Malnutrition on Brain Development
10

11. Malnutrition contributes
to 45% of all under five
child deaths
(5 in every 10 children die
due to malnutrition)
45%
Effects of malnutrition on child deaths
Lancet 2013
Poor breastfeeding
and complementary
feeding practices
contribute 19% of
these deaths

12. Impact of IYCF (BF & CF) in child survival3%
3%
4%
4%
5%
6%
7%
13%
0% 2% 4% 6% 8% 10% 12% 14%
Antenatal steroids
Water, sanitation, hygiene
Clean delivery
Hib vaccine
Zinc
Complementary feeding (with
continued BF)
Insecticide treated materials
Excl. breastfeeding for 6m &
continued BF to 12m
BF & CF = single
largest impact on
child mortality of all
preventive
interventions : 19%
Source: Lancet Child Survival
Series 2003/2013
Slide1.1/12

13. Window of opportunity: pregnancy to 2 years-2
-1.75
-1.5
-1.25
-1
-0.75
-0.5
-0.25
0
0.25
0.5
0.75
1
1 4 7
10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58
Age (months)
Z-scores (WHO)
Weight for age (WAZ)
Weight for length (WHZ)
Height for age (HAZ)
BF+CF
Exclusive BF
Mean anthropometric z-scores by age for 54 studies, based on WHO
standards
Source: Victora et al. Pediatrics, 2010 Mar;125(3) 13

14. Economic impact of under nutrition
Economicimpactassociatedwith
undernutritionisquitesignificantwithfar
reachingeffectson;health,education
andproductivity
Kenya COHA Study 2019

15. Nutrition Specific
Actions
Nutrition sensitive
actions
Enabling Environment
Kenya nutrition action plan interventions
The Government has adopted a multisectoralapproach to addressing malnutrition as
outlined in the KNAP (2018-2022)
KRA 1
Maternal,
newborn,
Infant and
Young Child
nutrition
scaled up
15
KRA 14.
Nutrition
in Social
Protection
Promoted
KRA 15
Multisectoral
Nutrition
Governance &
coordination

16. WHO Recommendations for Breastfeeding & Early Feeding
Immediate initiation of Breastfeeding within
the first hour of birth
Exclusive
breastfeeding for first
six months of life
Sustained breastfeeding for 2 or beyond
alongside appropriate, adequate and safe
complementary feeding from 6 months
Optimal maternal
nutrition, social
and community
support
16

17. What works for improving young children’s diets
Nutrition counselling and Social BehaviourChange Communication
Improved availability and accessibility to diverse and nutritious complementary foods
Use of MNPsas part of IYCF interventions to improve quality of diets
Improved accessibility & affordability of nutritious foods through Social Protection programmes
Improved accessibility to fortified and nutritious commercial complementary foods (aligned with the BMS Act, 2012
& WHA)
Improved accessibility & use of safe complementary food, water & clean household environment
Counselling and education on responsive parenting, responsive feeding, and stimulation
1
2
3
4
5
6
7

20. WHO Recommendations for Breastfeeding & Early Feeding
Immediate initiation of Breastfeeding within
the first hour of birth
Exclusive
breastfeeding for first
six months of life
Sustained breastfeeding for 2 or beyond
alongside appropriate, adequate and safe
complementary feeding from 6 months
Optimal maternal
nutrition, social
and community
support
20

21. Components of MIYCN Programme
Baby Friendly
Community
Initiative
Baby friendly
Hospital
Initiative
Workplace
support
BMS Act
Implementation
2012
MIYCN in
emergency
Routine MIYCN
services
21

23. What is the BFCI? –Platform for SBCC
•Community-based intervention to
improve maternal & IYCF practices
•Focuses on preventive with some
curative aspects:
•Maternal nutrition
•Exclusive breastfeeding
•Complementary feeding
•Feeding in special circumstances
•Feeding of sick children
•Growth monitoring & promotion
•Household food security
•It is a strategy for delivery of High
Impact Nutrition Intervention (HINI) for
Kenya
•It also includes nutrition sensitive
interventions:
•Environmental sanitation and hygiene
•Nutrition sensitive programmes-
education, social protection,
Agriculture
•Early childhood stimulation
•Referral and linkages
•HIV services
•Works through:
•Formation and training CMSG,
MTMSG and
•Closely linked to Health facilities and
local authorities.
•Home visitation
•Community campaigns for MIYCN
•Focuses on support for MIYCN at
community level
•Focuses on the first 1000 days
23

24. Orientation of national policy makers
Orientation of County HMT/Nutrition sensitive
stakeholder
Training of BFCI trainers
Training of CHEWs & HWs
Orientation of CHC,PHC and Community leaders
Mapping of households
Establishment of CMSGs
Training of CMSGs
Establishment of MTMSGs
Orientation, done
by master and
county trainers
Mobilization
for BFCI
support
Identify the
target for
counselling
Stakeholders to
support
implementation
Peer
Support
Process of BFCI
establishment
Conducted by the
national master
trainers together
with county TOTs
Training of cBFCITOTs
Training of CHVs

25. BFCI implementation package
Slide1.1/25

26. 26
1.Strengthenlinkagesandreferralsystems
betweenfacilitiesandthecommunitylevel
2.Advocateforfinancialallocationfor
nutritionservices
3.Advocateforandparticipateincapacity
initiativesforimprovedMIYCNoutcomes.
4.Recruitnutritioniststooffernutrition
servicesatalllevels
5.Screenallchildrenformalnutrition
6.Advocateforoptimalcomplementary
feeding(frequency,amountsanddiversity)