Malnutrition leading cause of death for children in Nyanza

Malnutrition has been the leading underlying cause of death in children under five in Manyatta and Karemo informal settlements from 2017 to date. This is according to postmortem data presented by the Kenya Medical Research Institute (Kemri).

The data presented in the just-concluded 13th Kemri Annual Scientific and Health Conference revealed that for over half a decade, families residing in the two settlements located in Kisumu and Siaya counties have been grappling with a distressing reality — the loss of their young children due to malnutrition-related health complications. This has been attributed to a lack of proper nutrition and inadequate access to essential health services.

The Child Health and Mortality Prevention Surveillance (CHAMPS) Network ascertained the cause of death in 976 children during the study period. Out of the number, 292 had malnutrition as the underlying cause of death— three in 10 children who had died in the two regions. Other deaths were as a result of malaria, pneumonia, HIV and sepsis. More deaths from malnutrition were reported in Manyatta at 32 per cent compared to Karemo at 23 per cent.

Dickens Onyango, co-director of CHAMPS Network, explained that from 2017, they conducted postmorterm from bodies of the children with the consent of their family members. “We conducted about 1,141 postmortems and ascertained the cause of death for about 976 children. An average of 30 per cent of all bodies had malnutrition as the underlying cause of death.

“This was an initiative of the Bill and Melinda Gates Foundation, which was trying to understand child mortality cases among children below five years. Sites where child mortality rates are high were considered. We gathered data on all causes of the deaths. The top immediate causes included malaria, pneumonia, HIV and sepsis. However, the main underlying cause of death was malnutrition,” he added.

A study that Dr Onyango co-authored states that in Kisumu County, the prevalence of child stunting is at 18 per cent and only 25 per cent of breastfed children are eating balanced diets.

Mothers interviewed said that even though they were aware that they needed to breastfeed, feed their children balanced diets and more frequently, they were hindered by limited incomes and socio and cultural factors that influence food choices.

When mothers found jobs away from their neighbourhoods, they had to rely on caregivers, who may not know how or what to feed the child. The movement also cut short breastfeeding.

“Financial and employment barriers were also perceived as directly impacting the time a mother had to focus on feeding her children. Mothers reported being busy with multiple children, informal jobs, and/or significant household duties. These also impacted the time available to follow up on their child’s health and nutrition.

The kind of food available in the neighbourhood and at home also affected how mothers fed their children. Some mothers said the foods they wanted to give their children such as bananas, fish and squash were not always found in the local markets. They mentioned that even though street foods were not good for children because they were high in fat, they were easy to get and cheap.

Different households choose what food to buy for their children based on various factors. In some, it depended on how much money the child's father gave to the mother to buy food, while in others, the father himself bought the family's food. Mothers noted that breadwinners, who had the financial power in a family setup, influenced how children were fed.

“Cultural beliefs contrary to international guidelines were also evident. Such beliefs included; ‘ children should not eat meat, fish and sweet potato due to inability to chew and digest these foods’. Mothers also described a common belief that eggs caused developmental delays.”

While mothers reported trusting and seeking nutritional information from doctors, nurses and nutritionists, they also complained that there were inconsistencies among staff members at the clinics, which impacted the quality and quantity of nutritional education they received.  Besides, they felt that community health promoters needed to support them better by providing financial aid or resources, as opposed to just providing advice.

Dr Onyango, however, confirmed that Kisumu and Siaya County governments have initiated programmes to promote breastfeeding among lactating mothers and teach parents on the importance of proper nutrition for their children.

In the meantime, the Network has partnered with trained community health promoters and equipped them with MUAC tapes – a tape used to measure the upper arm circumference of children and pregnant women to identify malnutrition - to help with screening nutrition status in children. When they find undernourished children, they refer them to the nearest hospital for medical attention.

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