Poor nutrition hurting menstruating girls

It is half past midday. The bell rings for lunch as we drive into Lake View Primary School in Naivasha.

“Our learners are currently sitting exams but their next paper is tomorrow so we can allow you to talk to them because what you will hear is very important,” Head teacher Hannah Wanjiru informs us as we walk into her office.

While we wait to speak to a few of the many girls grappling with what sub-county education director Bernard Chirchir described as a “growing problem that needs urgent attention”, Ms Wanjiru tells us that the children came back to school very different after the long break courtesy of Covid-19.

Many families in Naivasha, whose members worked as casual labourers in flower farms, lost their livelihoods when flower exports were halted due to flight restrictions. Most of the families were forced to relocate to cheaper houses that are far from schools, thus compelling children to walk long distances.

The quality of their diets also dropped, with most families eating non-nutritious and unbalanced food (mainly comprising of carbohydrates) that they could afford.

As a result, many cases of adolescent school girls aged 12-15 years fainting are now being reported in schools such as Lake View.

“My mother worked in the flower farms. When Covid-19 started, she was sacked so nowadays we go for days without food. On good days, she manages to get ugali and vegetables, and its honestly tiring to eat the same food day in day out,” says Faith Nyongesa, a 14-year-old Class Seven pupil at the school.

“We are four girls and a boy, and to be honest, we rely on school food more than what is provided at home because at school we mostly eat rice, beans, cabbage and githeri,” she told Healthy Nation.

When schools were re-opened, she started experiencing fainting spells.

Empty stomach

“All I remember about that day is that I woke up and found myself outside the classroom on the ground with the school nurse attending to me. I do not really understand what happened,” she says about the first time she fainted. “I walk five kilometres to and from school on a daily basis and mostly I do it on an empty stomach.”

Faith is not the only one.

“I live with my grandmother and she worked in the flower farms like my mother, but they both lost their jobs due to the pandemic, at the moment we are surviving by the grace of God,” says Anyango Ochieng, 12, who is in Grade Four.  The young emaciated girl says her home is 10 kilometres away from school.

“I wake up at 5am and will be on the road by 6am so as to make it to school by 9am despite my health problems. I have gastritis (a condition that inflames the stomach lining causing belly pain, indigestion, bloating and nausea) and was born with chest complications, which means I fall sick too frequently” she says.

Anyango was at home on the day she first passed out.

“I was about to set off for school when sharp pains and a stomach upset overwhelmed me after which I fainted and was rushed to the hospital where I was given lots of food to eat ,” she explains.

Michelle Narantale, 12, has also passed out before.

“I had not had anything to eat for so long. My aunt, who is my guardian, used to roast maize before the pandemic but her business collapsed.

“I started feeling dizzy and woke up later being attended to at a hospital,” she says.

Ms Ann Wanjiru Kamau, the teacher in charge of health, says most of the learners come from poor backgrounds.

“The learners we are teaching here cannot even deliver on the simple items needed in school.  Their families were recently affected by floods and so most had to relocate, which means more distances to cover for an education. All these things, plus the hunger, makes them lack concentration in class.

“Apart from the girls you spoke to, we have so far registered six other cases in just two weeks,” she discloses.

The school administration sought to find out from the parents what was happening.

“We discovered the foods they were eating lacked major nutrients. We invited Achieng’s guardian and taught her how to supplement her child’s diet after we learnt that she only prepared food rich in carbohydrates, which cooks faster,” the teacher said.

Balanced diet

“We have now started a balanced diet lunch programme where they only pay Sh20 for lunch, but still many of the learners cannot afford to part with that amount. As teachers we often have to dig into our pockets to facilitate some of these children because their lives really depend on that food.

Most of the parents, Ms Kamau says, genuinely lack knowledge on what girls experiencing menstruation need in their diet.

“Due to menstruation, they lack nutrients after bleeding a lot. As you plan meals, you have to factor in that you have adolescent girls and the nutrients they need.

“We have also realised that some of the parents still working in flower farms do not get off days and have no time for their children so they do not really know what the kids are going through,” she said.

Dr Wesley Bor, a clinical nutrition lecturer at Kabarak University explained that the menstrual period is very critical in a girl’s life.

“When there is no adequate replenishment of iron, which is lost with the blood, it causes a deficiency. This explains the fainting.  Iron is usually transported in an oxygenated form and so you find that the oxygen supply to the brain is not adequate, leading to a condition known as hypoxia (having low oxygen levels in your blood).

“The girls should be given a diet rich in iron, such as green leafy vegetables. But for that iron to be adequately utilised, it must be presented in an acidic way, that is why we add tomatoes to the vegetables,” Dr Bor explains.

He observes that most low-income families prepare vegetables only with cooking fat, thus curtailing iron absorption.

The lecturer further explains that proteins are vital.

“In the body system, the transportation of iron requires protein, so protein deficiency is a problem. This means proteins have to be on the family plate, even if it is a small amount, so as to enhance the absorption of iron.

Mr Chirchir explains that there has been a reduction in fainting cases in schools after they partnered with Nutrition International (NI), a global organisation that fights malnutrition, to distribute supplement pills that are rich in iron.

“The incidences are decreasing now that the girls have resumed their weekly iron and folic supplementation and nutrition education. We are so happy with what the partnership is delivering, but we urge everyone to prioritise children because this pandemic has taken a toll on them. We even had to take time to convince them that they are back in class after the lockdowns,” says Mr Chirchir.

 “Currently, we are feeding children in the slum areas with soya porridge courtesy of the World Food Programme (WFP) and the government,” he adds.

According to Martha Nyagaya, NI Kenya country director, the larger problem is how we prioritise and handle nutrition as a country.

Nutrition programmes

“Nutrition programmes in this country are more rehabilitative rather than preventive. If we had a stand-alone nutrition unit, then we would be able to have a comprehensive programme that prevents rather than treats malnutrition. But the fact that nutrition is under the health sector means we will sit in hospitals and wait for malnourished people to show up,” she says.

Ms Nyagaya believes the solution is to have a central nutrition system that can influence food production.

“The problem we have is that the national government has no power and mandate to give directives to the counties because a county nutrition coordinator does not report to them.

“There’s just no coordination between the county and national government, which means the national government is at the mercy of county governments, and this is to say the national government has completely failed to address policy issues at county level,” Ms Nyagaya notes.

She is of the view that if the Ministry of Health (MoH) develops a baby friendly nutrition guide, dissemination will require close coordination with the counties.

“Foods like vegetables, fruits and animal proteins will never be prioritised because for counties, their indicator for food security is the amount of maize available,” she says.

The NI team has embarked on providing nutrition supplements to school-going adolescent girls in Naivasha and believes that there’s a lot more that needs to be done.

“To create a multiplier effect, the learners are advised to pass the health messages to their caregivers, to ensure better quality diets at home. This ‘solution’ is nothing to write home about because most of the caregivers themselves are unable to afford a meal.

 “Asking children who go to bed hungry almost daily to part with Sh1,200 per term is basically trying to squeeze water from a rock,” a report by NI reads in part.

Kitchen gardens

Lake View Primary School is now farming to provide food for the learners.

“We have a nursery here where we have planted spinach, we shall be soon transplanting them. This is in addition to teaching parents and children about kitchen gardens as a way of sustaining themselves. We had started rearing rabbits but wild animals have been such a menace,” says Ms kamau.

Dr Veronica Kirogo, the nutrition director at MoH, agrees that there are challenges to be addressed. “The ministry believes that every Kenya shilling invested in high impact nutrition intervention has the potential to generate Sh2,200 in economic returns,” she says.

Last week, nutrition actors in the country, including Cabinet secretaries and legislators met in Kwale County to address what they see as urgent and long-term nutrition needs in the country, with the most critical issues for legislation including breastfeeding, food security and food safety.

What emerged as an important action point is the need to improve budget allocations towards food and nutrition security.

“The Food and Nutrition Security Bill (FNSB) 2014 was tabled in Parliament as a private member’s Bill by the African Women’s Studies Centre, and is yet to be passed into law. The bill proposes coordination structures for food security and nutrition to be set up in the Office of the President as stipulated in the Food Security and Nutrition Policy 2012 to enable all sectors to be accountable for multi-sectoral actions,” the official statement noted in part.

“The executive and both levels of government need to put their money where their mouth is. They need to not only budget for but also implement nutrition interventions,” Kwale MP Zuleikha Hassan said.

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