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REPUBLIC OF KENYA

MINISTRY OF HEALTH

NUTRITION SITUATION REPORT FOR ARID AND

SEMI ARID AREAS, FEBRUARY 2018

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For feedback please contact Veronica Kirogo, Head Nutrition and Dietetics Unit at

[email protected], Lucy Kinyua at [email protected], Lucy Gathigi -Maina at [email protected] and

Victoria Mwenda at [email protected]

For more information about us visit us on: www.nutritiohealth.or.ke

mailto:[email protected]



http://www.nutritiohealth.or.ke/

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Contents CHAPTER 1: INTRODUCTION ......................................................................................................................... 4

1.1 Background ......................................................................................................................................... 4

1.2 Analysis period .................................................................................................................................... 4

1.3 Scope and Unit of Analysis .................................................................................................................. 4

1.4 Analysis team ...................................................................................................................................... 5

1.5 Objectives............................................................................................................................................ 5

CHAPTER TWO: METHODS ............................................................................................................................ 6

2.1 Analysis protocols ............................................................................................................................... 6

2.2 Data sources and quality ..................................................................................................................... 7

CHAPTER 3: RESULTS ..................................................................................................................................... 8

3.1 National Nutrition Situation – summary ............................................................................................. 8

3.2 Children 6-59 months and pregnant and lactating women requiring treatment for acute

malnutrition .............................................................................................................................................. 9

3.3 Key ongoing interventions ................................................................................................................ 10

3.3.1 Coverage of integrated outreaches ........................................................................................... 10

3.3.2 IMAM program coverage and admissions ................................................................................. 11

3.3.3 Blanket Supplementary feeding program .................................................................................. 12

3.3.4 Cash Transfer Program ............................................................................................................... 13

3.4 Key recommendations ...................................................................................................................... 13

3.5 Factors to monitor: ........................................................................................................................... 13

3.6 Cluster nutrition situation ................................................................................................................. 14

3.6.1 Pastoral North West (Marsabit, Turkana and Samburu Counties) ................................................. 14

3.6.2 Pastoral North East Cluster (Wajir, Mandera, Garissa, Isiolo, Tana River) ................................... 17

3.6.3: Agro-Pastoral Cluster (West Pokot, Narok, Kajiado, East Pokot, Kieni (Nyeri), Laikipia) ........... 19

3.6.4 South Eastern Marginal Cluster (Meru North, Tharaka Nithi, Embu- Mbeere, Kitui and Makueni)

............................................................................................................................................................ 23

3.6.5 Coastal Marginal Cluster (Kwale, Kilifi, Lamu and Taita Taveta Counties) ................................. 25

Appendix ..................................................................................................................................................... 32

Appendix 1: Prevalence of Acute Malnutrition in Selected Counties, January/February 2018 ............. 32

Appendix 2: Prevalence of Acute Malnutrition in Selected Counties, May to July 2017 ....................... 33

Appendix 3: Summary of Caseloads ........................................................................................................ 35

Appendix 4: Summary of contributory factors by analysis area ............................................................. 36

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CHAPTER 1: INTRODUCTION

1.1 Background

The Kenya Food Security Steering Group (KFSSG) undertakes biannual seasonal assessments i.e. Long Rains Assessment (LRA) and Short Rains Assessment (SRA) every year to assess food and nutrition security situation following the long and short rains season. The analysis also takes into account the cumulative effect of previous seasons. Recommendations for possible response options based on the situation analysis are developed. During the assessment, secondary data from different sources such nutrition surveys, DHIS, NDMA early warning system is collated and analyzed.

Teams composed of Kenya Food Security Steering Group (KFSSG) members and County Steering Group (CSG) members make transect drives, carry out interviews, hold focus discussions and do market surveys in order to get a picture of the ongoing situation. Analysis is conducted using the IPC for Food Insecurity and IPC for Acute Malnutrition. Nutrition team through the Nutrition Information Technical Working Group (NITWG) supports in the health and nutrition analysis and conducts the IPC for acute malnutrition to determine the severity of acute malnutrition, geographical areas that are most affected and the contributing factors to acute malnutrition. This helps to determine immediate, intermediate and long term response actions to address acute malnutrition.

The resulting food and nutrition security situation updates including the number of children and pregnant and lactating women requiring nutritional support informs the nutrition response plan and the integrated contingency plan in the National Drought Management Authority.

1.2 Analysis period

Integrated Phase Classification (IPC) for Acute Malnutrition was conducted from 19th to 28th February alongside the Food Security Integrated Phase Classification during the 2017 Short Rains Assessment (SRA) Report Writing Workshop. The analysis workshop was preceded by field level visits by KFSSG and CSG members from 5th to 16th February 2018. Integrated SMART surveys have been conducted in January and February as part of the SRA in Turkana, North Horr, Laisamis, Kajiado, Narok, Wajir North, Tana River and Isiolo.

1.3 Scope and Unit of Analysis

The assessment covered 23 counties classified as arid and semi-arid (Figure 1.1). These counties are also considered to be most vulnerable to acute malnutrition. They include: Mandera, Garissa, Tana River, Wajir, Isiolo, Turkana, Samburu, Marsabit, Baringo, Laikipia, West Pokot, Kajiado, Narok, Kitui, Makueni, Nyeri (Kieni), Meru (Meru North), Embu (Mbeere), Tharaka Nithi (Tharaka), Kwale, Taita Taveta, Kilifi and Lamu. The unit of analysis was dependent on homogeneity or heterogeneity of the prevalence of acute malnutrition in a county. Turkana and Marsabit Counties therefore had four units of analysis each, Wajir had 2 units of analysis while all the other counties were considered as single units of analysis.

Urban areas usually report low prevalence of acute malnutrition but high case-loads of acute malnutrition. This is due to higher populations living in these areas especially in the informal settlements. Children and PLW are also more vulnerable to acute malnutrition. In this regard, to ensure urban needs are met and ensure coordinated resource mobilization, calculated caseload for urban areas have been included in this report.

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1.4 Analysis team

The IPC for acute malnutrition analysis team comprised participants from the national and county governments, line ministries, UN agencies, Civil Society Organizations and academia. The analysis team was trained on IPC for acute malnutrition before analysis (See agenda and participants list in the appendix).

1.5 Objectives

● To conduct training on IPC for acute malnutrition in order to reinforce skills of analysis team to conduct quality analysis

● To assess the severity of acute malnutrition by referencing against international standards and identify areas that are most affected by acute malnutrition

● Identify the main contributing factors to acute malnutrition ● Determine the number (caseloads) of children 6 to 59 months and Pregnant and Lactating

Women PLW to inform response ● Identify the major priority response objectives ● Disseminate assessment results:

● Develop communication materials - infographic, communication brief, situation report updated website and survey dashboard

● Present findings at the Kenya Food Security Meeting (KFSM) and Emergency Nutrition Advisory Group

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CHAPTER TWO: METHODS

2.1 Analysis protocols The analysis applied the global protocols for Integrated Phase Classification for Acute Malnutrition released (November 2016). The IPC for Acute Malnutrition classified the severity of acute malnutrition into five Phases which was done based on the prevalence of GAM. A higher prevalence of acute malnutrition characterized the most severe phases as shown in Figure 2.1.

Figure 2.1: IPC for Acute Malnutrition Reference Table

The analysis resulted to a current situation update and projection of the situation (February to April 2018). Key contributing factors both food security and non-food security related factors were identified using the UNICEF conceptual framework (Figure 2.2) as laid out in the analysis work sheet (Appendix 4.5). Since both IPCs were conducted simultaneously, results from the IPC for acute malnutrition were included Food Security analysis and results from Food Security IPC were also included in the IPC for acute malnutrition analysis. Finally response actions were identified. A one page summary of the situation including maps was developed.

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Figure 2.2: UNICEF Conceptual Framework

2.2 Data sources and quality

Data on Global Acute Malnutrition (GAM) used in the IPC for Acute Malnutrition were from representative surveys (GAM by WHZ) and the National Drought Management Authority sentinel sites (GAM by MUAC). Only data of acceptable quality was used in the analysis. Reliability scores were also assigned. Only areas with reliable information from the same season of analysis were classified for current classification while secondary information was used for the projection. Secondary data was gathered from multiple sources including the DHIS, small and large scale survey reports, sentinel surveillance, rapid assessments etc.

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CHAPTER 3: RESULTS

3.1 National Nutrition Situation – summary

While nutrition situation has improved in selected counties according to the Integrated Phase Classification (IPC) for Acute Malnutrition

conducted in February 2018 (Figures 3.1, 3.2 and 3.3), the levels of acute malnutrition remain at Critical levels (Phase 4; GAM WHZ 15.0 -

29.9 percent) in Turkana Central, North, West and South, Tana River, Wajir North, North Horr and Laisamis sub-counties. In addition,

Isiolo and Kajiado reported a Serious nutrition situation (Phase 3; GAM WHZ 10.0 -14.9 percent). Narok county was classified as Alert

(Phase 2; GAM WHZ ≥ 5 to 9.9 percent) while Kilifi, Kwale, Kitui, Makueni, Mbeere and Tharaka were Acceptable (Phase 1; GAM WHZ

<5%). The nutrition situation is projected to remain in the same phase in Turkana and Wajir North while a deterioration is expected in

Isiolo, North Horr, Laisamis, Tana River and Kilifi due to the scale down of emergency response interventions including Blanket

Supplementary Feeding Program (BSFP) and integrated health and nutrition outreaches during the projection period.

Figure 3.1: Nutrition Situation Map, July 2017 Figure 3.2: Nutrition Situation Map, January 2018 Figure 3.3: Projected Nutrition Situation Map, February to April 2018

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Compared to the 2017 LRA, the overall nutrition situation has significantly improved in Turkana

South, North & Central and North Horr from the very critical (Phase 5; GAM WHZ ≥30 percent)

to critical situation (Phase 4; GAM WHZ 15.0 - 29.9 percent). The improvement is mainly attributed

to improved food access indicators including milk availability in arid counties, large scale

implementation of key emergency response interventions including BSFP, improved access to health

and nutrition services through the scale up of integrated outreaches and key food access

interventions including cash transfers and food assistance across the arid and semi-arid areas (ASAL)

and counties. Major improvements were observed in 2012 after 2011 Horn of Africa crisis as seen in

2018 following the crisis of 2017; illustrated using malnutrition trends in Turkana county in figure

3.4. The biggest challenge remains; sustaining the gains as the counties are still highly vulnerable and

prone to shocks despite a lot of effort to build resilience of the most affected communities.

Figure 3.4 Trends of Global Acute Malnutrition for Children 6 to 59 months, Turkana County

3.2 Children 6-59 months and pregnant and lactating women requiring

treatment for acute malnutrition

The total number of children 6 to 59 months requiring treatment for acute malnutrition in ASAL

areas is 337,290 (MAM-282,430; SAM-54,860) and 34,140 pregnant and lactating women while in

urban is 62,530 children (MAM-45,830 and SAM-16,700) and 3,020 pregnant and lactating women

(Table 3.1). County caseloads are presented in figure 3.5.

Table 3.1: Children 6-59 Months and Pregnant and Lactating Women (PLWs) Requiring Treatment for Acute Malnutrition

Total caseloads Target

Area GAM

6 to 59 m

SAM

6 to 59 m

MAM

6 to 59 m PLWs

GAM

6 to 59 m

SAM

6 to 59 m

MAM

6 to 59 m

PLWs

ASAL 337,288 54,857 282,430 34,140 182,358 41,143 141,215 34,140

Urban 62,534 16,704 45,830 3,020 35,443 12,528 22,219 3,020

Total Caseload

399,822 71,561 328,260 37,160 217,801 53,671 164,130

37,160

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Figure 3.5: Estimated Total Caseloads of Children 6-59 months requiring treatment for Acute

Malnutrition - ASAL and Urban counties, February 2018

3.3 Key ongoing interventions

3.3.1 Coverage of integrated outreaches

Integrated health and nutrition outreaches covering 5,657 sites were implemented in 2017 with Marsabit and Turkana counties with the highest number of outreaches (Table 3.6).

Figure 3.6: Number of Reported Outreaches by County, January to December 2017

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3.3.2 IMAM program coverage and admissions

Generally, most counties assessed were found to have a satisfactory single coverage estimator of above 50% both OTP and SFP in rural setups as per SPHERE guidelines (Table 2) except East Pokot of Baringo, Tana River County and Wajir North Sub-county as indicated below. The low coverage was attributed to unstable security situation in the regions, poor health seeking behaviors by the community, competing activities prioritized over health seeking, migration of families leading to early defaulting from IMAM Program, little or lack of IMAM program awareness and sharing of the nutrition rations among other barriers (Table 3.2). Table 3.2: IMAM Coverage Assessment for Selected Counties, 2017/2018

County Single Coverage estimate, OTP % 95% CI

Single Coverage estimate, SFP % 95% CI

Baringo (East Pokot) County 29.7 (21.9 - 38.7) 45.9 (34.3 - 58.5)

Garissa County 62.7 (51.3- 72.7) 63.1 (52.1-72.7)

Tana River County 48.0 (36.0- 60.1) 50.5 (40.6 - 60.1)

Turkana West Sub-county 67.5 (55.4 – 77.0) 66.2 (57.7 – 73.7)

Turkana Central/Loima Sub-county 60.4 (48.3 – 71.6) 65.9 (55.6 – 74.8)

Turkana East Sub-county 59.6 (47.4 – 70.3) 61.0 (49.4 – 71.2)

Turkana South Sub-county 62.2 (50.3 – 72.6) 81.4 (73.9 – 87.3)

Turkana North Sub-county 71.9 (60.5 –80.9) 64.9 (53.7 –74.8)

Wajir North Sub-county 59.6 (48.0 - 70.1) 47.3 (34.9 - 60.2)

Mandera County 66.3 (56.8 - 74.4) 65.1 (53.6 - 75.1)

A total of 80,829 children 6 to 59 months were treated for sever acute malnutrition which was 102% of the ASAL annual target while a total of 160,147 children 6 to 59 months were treated for moderate acute malnutrition which was 82% of target (Table 3.3). Figure 3.7 and 3.8 show trends of admission over time.

Table 3.3: IMAM Coverage Assessment, 2017/2018

Target group 2017 Target ASAL

2017 Achieved ASAL

Percent Achieved ASAL

Children 6 to 59 months with severe acute malnutrition (SAM)

54,474 60,046 110.2%

Children 6 to 59 months with moderate acute malnutrition (MAM)

148,322 125,168 84.4%

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Figure 3.7: SAM Admission Trends for Children 6 to 59 months, ASAL counties

Figure 3.8: MAM Admission Trends for Children 6 to 59 months, ASAL counties

3.3.3 Blanket Supplementary feeding program

A total of 458,639 pregnant and lactating women and children 6 to 59 months (Table 3.4) were covered through blanket supplementary feeding that was implemented in the most affected counties/sub-counties which included: Turkana, Mandera, East Pokot, North Horr, Laisamis and Isiolo. BSFP was a major pull factor and it offered an opportunity to reach more women and children through integrated outreach services (nutritional screening and treatment of acute malnutrition, treatment of common illnesses, vaccination, VAS supplementation, IYCF and other health messaging).

Table 3.4: Coverage of Blanket Supplementary Program in Selected Counties

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Number targeted Number achieved Percent achieved

Turkana 233,546 164,845 71%

Marsabit 36,685 43,507 119%

Isiolo 37,311 24,417 65%

E. Pokot 40,489 42,292 104%

Mandera 170,668 183,578 108%

Total 518,699 458,639 88%

3.3.4 Cash Transfer Program

Cash transfer program were scaled during the review period with some targeting children with acute malnutrition, TB and HIV.

3.4 Key recommendations

● Maintain current levels of response to sustain the gains made in the nutrition outcomes, given the risk of deterioration

● Undertake county led multi-sectoral planning to identify and implement key activities to prevent malnutrition

● Closely monitor household milk production and consumption and prioritize livestock support interventions to household with children under 5 years

● Scale up current levels of health and nutrition interventions in Kajiado, Tana River, Narok and Kilifi counties

● Increase surveillance in counties where the nutrition situation is projected to deteriorate

● Transition the integrated outreach programmes progressively into regular health system in a sustainable manner

● Strengthen the community referral mechanism for acutely malnourished children

● Ensure nutrition is well articulated in county integrated development plans for longer term resilience building

● Update national/county nutrition sector response plans

● Continued support to effective coordination for monitoring of the emergency response plan

● Support multi-year multi-sectoral resilience building efforts focusing on sustaining the gains in reducing acute malnutrition

3.5 Factors to monitor:

● Worsening malnutrition in selected counties (Lamu, Kilifi, Marsabit, Isiolo, Kajiado, Narok, Tana River)

● Performance of the 2018 March – May long rains especially in the North-East cluster

● Staple food prices

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3.6 Cluster nutrition situation

3.6.1 Pastoral North West (Marsabit, Turkana and Samburu Counties)

Nutrition status and dietary diversity According to the Integrated Phase Classification (IPC) for Acute Malnutrition conducted between January and February 2018, Turkana Central, Turkana South, Turkana North, Turkana West in Turkana County and Laisamis as well as North Horr in Marsabit counties were classified in Critical Nutrition situation (phase 4; Global Acute Malnutrition 15.0 -29.9 percent) with potential of remaining stable (with some hotspot: Kerio, Lapur, Lokiriama/lorengipi and Kaalong Kalkor in Turkana and North Horr and Dukana wards in Marsabit Counties) in the next three months due to the ongoing blanket supplementary feeding program. In Samburu County and Saku and Moyale sub counties in Marsabit there was no current data but according to the secondary information, the nutrition situation is projected to be in critical phase (phase 4; Global Acute Malnutrition 15.0 -29.9 percent) in Samburu and Alert (alert GAM WHZ ≥ 5 to 9.9 percent) in Moyale and Saku Sub Counties in the next three months. Compared with June 2017, improvement in the nutrition situation was noted in all the areas in the cluster with malnutrition levels in Laisamis, Turkana west, Turkana Central and Turkana South remaining critical, while North Horr and Turkana North moved from extreme critical situation to critical nutrition situation. The improvement were as result of improved food security especially improved milk availability following the short rains and a robust emergency response strategy mounted by partners led by Ministry of Health through Blanket Supplementary Feeding Program (BSFP), Integrated health and nutrition outreaches, hunger safety net and other cash transfer programs, General Food Distribution (GFD) implemented by National and County Governments, Water and Sanitation (WASH) interventions among others in Marsabit and Turkana Counties. The nutrition situation is expected to deteriorate after the projected period across all the counties in the North-West cluster as blanket supplementary feeding program, protection rations and cash transfer program in the counties are coming to an end by the end of February. Detailed analysis of contributory factors shows that although the nutrition situation was good it was still critical across all the Counties in the North-West cluster which is majorly due to poor dietary intake as a result of household food insecurity. This is further compounded by limited access to the quality health care services, market to get commodities due to poor road network and also low literacy level on different foods groups required for the body, low handwashing and water treatment practices and low latrine coverage which aggravate the high malnutrition rates. The percentage of children under five at risk of malnutrition based on analysis of mid-upper-arm circumference (MUAC <135 mm) surveillance data from sentinel sites within the cluster was high compared to the LTA in Samburu County throughout the year except the month of December, while in Turkana County it was below the LTA (Figure 3.9).

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Figure 3.9: North West Pastoral Cluster Trends for Proportion with MUAC <135mm-2017

In terms of admission trends across the cluster, there was increased admissions trend for both severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) children into outpatient therapeutic program (OTP) and supplementary feeding program (SFP) compared with same period last year. The increase in the number of admissions was attributed to the scaling up of nutrition response activities such as mass screening, increasing the coverage of outreach sites and integrating blanket supplementary feeding program (BSFP) with integrated management of acute malnutrition (IMAM) services. Morbidity and Mortality patterns Diseases are a major factor that can adversely affect malnutrition. Across the cluster, there was notable decline in reported cases of diarrhea from July to December 2017 with an increase in the month of November and December. This could probably be attributed to poor WASH practices, where handwashing at 4 critical times, water treatment and access to water were very low across the cluster. In Addition, there was notable increase in malaria cases across the cluster from July to December 2017 with a sharp increase in November 2017. The cases of malaria increased in number compared to the same period the previous year. The increase in malaria cases was attributed to above average short rains and poor environmental sanitation. Overgrown bushes near households resulted in accumulation of stagnant water that led to breeding of mosquitos coupled with low usage of mosquito nets in most households. Marsabit County experienced high intensity of rainfall and subsequent flooding that aggravated Malaria outbreak. Cholera outbreak was reported in Turkana County with five Cholera cases being confirmed and treated with no deaths. No outbreak was reported in Samburu County. Immunization and vitamin A supplementation Routine Vitamin A Supplementation coverage reported through the DHIS was generally poor across the cluster, with none of the counties achieving the national target of 80 percent. Turkana recorded the highest proportion of children under one year who are fully immunized at 82.6 percent, while Marsabit had the lowest 33.1% for the period under review. In Marsabit County, according to the latest survey in Laisamis and North Horr Sub Counties, Vitamin A Supplementation coverage for 12-59 was 48.0 and 43.5 percent respectively, which is a decline comparing with the same period last year. This was attributed to health workers strike that halted critical health care services namely vaccination and micronutrient supplementation programs that closed for six months. This was reflected in low documentation in maternal child booklets, facility registers monthly summary tools and subsequent low numbers being captured in the DHIS. Poor health seeking behavior was also a

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major contributor. In Samburu and Turkana Counties an increase of vitamin A supplementation was noted at 80.4% and 70.1% respectively which could be attributed to enhanced Malezi bora activities. In terms of routine immunization, across the cluster, all the counties recorded above the national target of 80% except Samburu County which recorded the lowest with Measles and Polio coverage being 58.8% and 61.5% respectively.

Water sanitation and Hygiene The main water Source across the cluster was surface water (water pans, shallow wells) which is contaminated due to sharing of water between livestock and humans posing a great health risk hence diarrhea cases reported across the cluster. Proportion of household treating water was very low across the cluster with Turkana being 10.2%, 9.2% in Samburu and 10% in Marsabit. Contamination of open water sources was prevalent as livestock shared open water sources with humans. Latrine coverage remains below recommended level across the cluster with Turkana at 29.0%, Samburu at 15.2% and Marsabit at 10.0% and this is associated with negative cultural practices and movement of pastoral communities. Most households practice open defecation across the cluster which poses a health risk during rainy season. Hand washing at the four critical times was very low across the cluster with Turkana being 15.1%, Samburu at 5% and Marsabit at 16.9%.

Short term recommendations for the Cluster ● Continue screening of malnourished children and treatment through existing health facilities and

mapped outreaches. ● Enhance mobilization and community engagement to further improve coverage and attendance

across the health and nutrition programs by convening and enhancing community dialogues as a strategy to promoting good practices.

● Food sector to review and roll out general food distribution in the most affected sub counties in the cluster to complement the existing social safety net programs that are ongoing

● Ensure nutrition commodities are prepositioned and supply chain monitoring is routinely done to avoid stock outs

● Short term Emergency safety nets could consider using a food voucher to complement cash to cushion populations from the increased food prices and control the proportion of the allocations that goes directly to food purchase.

● Due to the increased SAM, the county departments of health to procure additional routine antibiotics used in treatment and management of malnourished children.

● Distribution of water treatment chemicals and Jerri cans in areas where unprotected water sources are used.

● Strengthen Capacity of Health care system to improve quality of Integrated Management of Acute Malnutrition (IMAM) and IMAM surge.

● Strengthen information systems including target setting, documentation and reporting for Vitamin A.

Medium to Long term Recommendations for Cluster ● Investment in water infrastructure and WASH interventions including Community Led Total

Sanitation ● Develop intervention to promote behavior change to improve health seeking behavior ● Social behavior change communication and nutrition education addressing improved maternal,

infant and young child nutrition ● Enhance and strengthen resilience strategies by supporting the county’s technical capacities to

formalize a harmonized approach to response analysis and program preparation (e.g. how to

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decide which benefits (food, cash, quantities) beneficiaries should receive, how to establish eligibility criteria, and how to target, select and register beneficiaries).

● Strengthen and enhance community level accountability actions including advocacy capacities for articulation of their needs and priorities.

3.6.2 Pastoral North East Cluster (Wajir, Mandera, Garissa, Isiolo, Tana River)

According to the Integrated Phase Classification (IPC) for Acute Malnutrition conducted between

January and February 2018, Tana river and Wajir North (Agro-pastoral) reported critical nutrition

situation (IPC phase 4; Global Acute Malnutrition 15.0 -29.9 percent) while Isiolo county reported

serious nutrition situation (IPC phase 3; Global Acute Malnutrition 10-14). Garissa, Mandera and

Wajir Pastoral did not have current county level data which could allow for current classification

using IPC protocols. However, analysis of secondary data project the nutrition situation in these

counties to remain in critical phase. The proportion of children at risk of malnutrition with MUAC

< 135mm was high in Isiolo and Mandera compared to Long Term Average (LTA), however the

proportion in Garissa and Tana River remained almost the same.

Morbidity trends

The most common diseases affecting children under five years and the general population across the

cluster were; diarrhea, upper respiratory infection and malaria/fever. Garissa and Tana River further

reported cholera outbreak with 105 and 74 cases respectively while Chikungunya was reported in

Mandera County.

Vitamin A and immunization coverage

Routine immunization and vitamin A supplementation coverage was below the national target of

80% (Figure 3.10). Sixty seven percent of children in Isiolo were fully immunized (Figure 3.11), the

highest in the cluster, followed by Garissa (62%), Tana River (61.4%), Wajir (56.4%) and Mandera

(22.7%). The poor performance could be attributed to insecurity in the region resulting to closure of

health facilities, health workers’ strike, long distances to health facilities and low demand of the

services by the community. The situation could be further complicated by the anticipated dry spell

during the projected period and escalation of the already fragile security situation.

Figure 3.10: Vitamin Supplementation Coverage among Children 6 to 59 Months, North East

Pastoral Cluster, July to December 2017

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Figure 3.11: Routine Immunization Coverage, North East Pastoral Cluster, July to December 2017

INFANT AND YOUNG CHILD NUTRITION (IYCN) PRACTICES

Exclusive breastfeeding rates across the cluster was below the national target of 80% with Isiolo at

74.1% and lowest rates recorded in Tana River at 49.6% and Garissa 43.4%. Access to food remains

a big issue with most Counties having low prevalence of children who had adequate meals as

analyzed using Minimum Adequate Diet (MAD) with Mandera at 7.3%, Wajir at 12.9% and Isiolo at

24%.

Hygiene and sanitation

Only 6.1 % of HH used treated water in Garissa followed by Mandera, Isiolo and Tana River at 20%

and 25% respectively. This puts these counties at risk of water borne diseases. Wajir north and south

have improved consumption of treated water. Generally there is low hand washing practices the

lowest being wajir south (4.1%) and Mandera (20.1%). Wajir south and Wajir north have the lowest

latrine coverage of (14%) and 42% respectively. Cholera outbreak and upsurge of diarrheal diseases

is attributed to poor hygiene and sanitation.

IMAM admission trends

The admission trend of children and pregnant/lactating women has been on upward movement

during the period under review across the cluster. This could be attributed to response activities

including outreaches that have been ongoing in these areas.

Coverage of IMAM program

The IMAM program coverage across the cluster was above the threshhold of 50% (Table 3.5) with exception of SFP progrma in Wajir North (47.3%).

Table 3.5: IMAM Program Coverage for Selected Areas in North East Pastoral Cluster County/Area Moderate Acute Malnutrition Outpatient therapeutic Program

Garissa 63.1 62.7

Mandera 65.1 66.3

Tana River

Wajir north 47.3 59.6

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Outreaches

Outreaches are carried out in the hotspots that are identified per County, the table below shows the

reported outreaches that were carried out from October 2017 to January 2018 (Table 3.6).

Table 3.6: Number of Reported Outreach Visits

County/Area Conducted outreaches

Garissa 157

Isiolo 39

Tana river 26

Wajir 95

Recommendations

Immediate/short-term response objectives:

- Re-mapping and operationalize outreach so as to increase health and nutrition coverage and ensure all identified hotspots and hard to reach areas are well covered.

- Scale up integrated outreaches as well as nutrition screening to areas not covered. This is especially so for Mandera and Isiolo where response actions have to be scaled up as the food security situation is expected to deteriorate.

- Integrate nutrition interventions into County Integrated Development Plan

- Scale up Unconditional cash transfers and other social safety net programs to vulnerable groups in Isiolo, Mandera and Wajir Counties.

- Scale up HiNi interventions in all the Counties.

- Capacity building on cholera case management for health workers and community health volunteers in Cholera prone counties of Tana River and Garissa.

- Strengthen Community Led Total Sanitation by the government and partners in all the Counties in the cluster in order to improve access to sanitation facilities.

- Scale up hygiene promotion activities as well as water treatment through procurement and distribution of water treatment chemicals

- Water trucking to enhance access to water in Mandera, Garissa, Tana River and Wajir South. Medium to Long term response objectives:

- Prioritize access to safe and sufficient water to households and increase investment in sanitation services/programs

- Increase investment in sanitation

- Improve infrastructure to improve access to health facilities, market and household food security.

- Increased investment in education of all children (and especially the girl child)

- Sustain and scale up the peace building efforts by county to improve security and sustain livelihoods.

3.6.3: Agro-Pastoral Cluster (West Pokot, Narok, Kajiado, East Pokot, Kieni (Nyeri), Laikipia)

Nutrition status and dietary diversity According to the Integrated Phase Classification (IPC) for Acute Malnutrition conducted between January and February 2018, Narok county reported serious nutrition situation (IPC phase 3; Global Acute Malnutrition 10.0 - 14.9 percent) while Kajiado county reported poor nutrition situation (IPC phase 2; Global Acute Malnutrition 5.0 – 9.9 percent). In the other Agro-pastoral counties, there

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was no sufficient data for current IPC classification of acute malnutrition. However, based on the past GAM prevalence and expected trend of contributory factors in the projection period, level of acute malnutrition is likely to be Critical (IPC Phase 4) in West Pokot and Baringo counties and Serious (IPC Phase 3) in Laikipia county. Overall deterioration in nutrition situation is expected in these counties during the projection period due to reduced food access in the lean period, increased disease prevalence especially diarrhea linked to reduced access to quantity and quality water in dry period which will compromise hygiene in the households. Figures 3.12 and 3.13 below shows the trends of acute malnutrition in Agro-pastoral clusters based on early warning system surveillance data.

Figure 3.12: Trends of Proportion of children with MUAC <135mm, 2017

Figure 3.13: Proportion of Children with MUAC <135 mm Dec 2017 versus Dec LTA

Agro pastoral counties have poor food consumption practices with proportion of children meeting minimum dietary diversity and minimum meal frequency respectively at: 33.2 and 70.6 percent respectively in Baringo and 36.9 and 24.5 percent respectively in West Pokot counties. Dietary diversity was equally poor among women of reproductive age with proportion consuming diets that meets minimum dietary requirement being 22.2 percent in West Pokot, 48.2 percent in Kajiado and 35.3 percent in Narok counties. These predispose the population to poor nutrition status. Morbidity trend

21

The prevalence of diarrhea and confirmed malaria in Agropastoral cluster is high and has been increasing from September to December 2017. Malaria cases are expected to decrease during the dry period with reduction of breeding ground for mosquitoes but diarrhea is expected to remain high and peak at the onset of rainfall season. Acute respiratory infections remained high and has been increasing from 70,764 cases in August to 107,339 in December 2017. Morbidity is a key contributory factor to acute malnutrition in these counties. Water Sanitation and Hygiene (WASH) Water scarcity and use of open and unsafe water sources have led to below optimal hand washing practices, resulting to increased incidences of water borne related diseases like diarrhea, a key driver of acute malnutrition. Access to safe drinking water ranges from 11.1% in West Pokot to 63.3% in Kajiado. While majority of household in this zone are aware of good hygiene practices, the proportion of households washing hands at four critical times ( after visiting the toilet, before cooking, before eating and after taking the baby to toilet) is extremely low ranging from 1.7% in Narok, 2.2% in West Pokot, 1.9% in Laikipia to 15% in Kajiado. Recent data further shows that latrine coverage is also very low with 47% relieving themselves in the bush in West Pokot, 59% in Kajiado, 10% in Nyeri North, 27.2% in Laikipia, 16% in East Pokot and 47.3% in Narok. This practice increases the risk of contamination of water sources and cases of water borne diseases. With a marginal proportion of households treating their drinking water by either boiling, pot filters or use of treatment chemicals, the incidence of waterborne diseases is bound to increase with West Pokot reporting an active cholera outbreak in February 2018. Immunization and Vitamin A supplementation Routine immunization coverage reported through the DHIS in 2017 was generally below the national target of 80% across all counties in the agro pastoral zone except for Narok County. Coverage of fully immunized children in Nyeri County was at 59.5%, 79.9% in Kajiado, and 82.1% in Narok, 66.3% in Laikipia, 50% in East Pokot and 75.6% in West Pokot. Further, in 2017, routine Vitamin A supplementation coverage was very poor with Nyeri County reporting coverage of 23.4%, 39.5% for Baringo, 24.3% in Kajiado, 48.6% in Laikipia, 10.5% in Narok and 10.9% in West Pokot counties. This is also well below the national target of 80%. Recommendations: Immediate/short-term response objectives:

● Strengthen the health and nutrition service delivery platforms especially community level functions to improve on demand and utilization coverage of immunization and vitamin a supplementation services by local communities. Including using a cost-effective and sustainable outreach strategy.

● Conduct nutrition surveillance activities such as mass screening, active case finding, identification, referral and management of acutely malnourished cases (women and children) in hot spot areas.

● Scaling up vitamin A and IFAS supplementation among children and women of reproductive age.

● Scale-up disease surveillance, referral and treatment of Diarrhoea, URTI, measles and other notifiable diseases of public health importance

● Establish an IMAM programme in Nyeri North at facility level to cater for the needs of malnourished children identified in communities.

● Conduct peace building initiatives for cohesion building during expected influx of pastoral communities to neighbouring areas in search of water and pasture.

● Improved sanitation, hygiene promotion-hand washing and response initiatives geared toward building communities capacity on good sanitation and hygiene using the Community-Led Total Sanitation (CLTS) strategy

22

● Nutrition education on dietary diversification linked to micronutrient supplementation. Special focus on iron and Vitamin A deficiency

● Promotiion of Maternal Infant and Young Child Nutrition through the BFCI/BFHI and IMCI

● Conduct Capacity development of health staff in the Management of Acute Malnutrition ● Establish and/or maintain secure and stable nutrition commodity supply chain and storage

including the strengthening the KEMSA LMIS. ● Scale up access to safe water drinking water at household, health facility and schools levels

through water tracking where possible, provision of water storage facilities and rehabilitation of existing water sources

● Increase household access to food through scale up of conditional cash transfers, GFD and any other in kind support.

● strengthen/expand School feeding programs to ECD centers where children under five access including in hot-spot areas

Medium to Long term response objectives: ● To improve nutrition security through increased production of nutrient dense foods. This

should be linked with WASH for sustainable production and nutrition education on food preservation to enhance availability of nutrient dense perishable foods during lean seasons

● Improved animal nutrition for milking herds linked with WASH and nutrition education on preservation of animal products to enhance nutrition security in pastoral livelihood zones of the county

● Build resilience in the WASH sector through capacity building of communities and increase sustainable access to safe water sources among hard to reach communities by establishing piped water systems, boreholes and springs, intensify roof and surface water harvesting to improve availability of water for domestic and livestock use

● Expand community resilience nutrition specific and sensitive strategies such as Community Led Total Sanitation, BFCI, IMAM surge, Livestock Marketing Systems, irrigation schemes, women economic empowerment programmes such as VSLA among others.

● Conduct advocacy, communication and social mobilization (ACSM) utilization various channels of communication (community dialogues, radio talk shows, market advocacy, peer support groups) for positive behaviour change towards optimal MIYCN and address the harmful cultures which affect overall health and nutritional status

● Intensify efforts in harvesting, preserving and stock piling hay in strategic reserves located along the Pastoral and Agro Pastoral livelihood zones for use during the dry season – action, livestock department.

● Sustain and scale up the peace building efforts by county to improve security and sustain livelihoods.

● Improve infrastructure to open up access to markets e.g. roads. ● Increased investment in education of all children (and especially the girl child) as a long term

measure ● Intensify asset building using various approaches cash transfers, grants, soft credit schemes

among others ● Enhance advocacy for increased investment in nutrition specific and sensitive programming

targeting the new leadership and through the ongoing CIDP development process. ● Support livelihoods and environmental conservation programmes in the water catchment

areas to enhance sustained access to water for domestic, animal and agricultural use.

23

3.6.4 South Eastern Marginal Cluster (Meru North, Tharaka Nithi, Embu- Mbeere, Kitui and

Makueni)

Nutrition Status and Dietary Diversity The nutrition situation according to Acute Malnutrition IPC based on GAM by MUAC from sentinel data was in Phase 1 (acceptable) in all the Counties with Meru North recording the highest MUAC at 2.5 percent. Tharaka Nithi recorded 0.8 percent, Mbeere (0.3 percent), Kitui (0.5 percent) and Makueni (0.3 percent). The proportion of children at risk of malnutrition (with MUAC< 135mm) showed a decreasing trend in Tharaka Nithi County with highest being recorded in October 2017 (8.1 percent) and lowest in December (8.1 percent). In Mbeere, Embu County, the proportion of children at risk of malnutrition was 6.4 percent in January compared to LTA of 9.4 percent. In Kitui County. In Kitui County, the trend of children at risk of malnutrition assumed a decreasing trend. The proportion of children at risk of malnutrition remained relatively low compared to 2016 and long term average. The proportion of children at risk was 7.6% in December compared to 8.26 percent (2016) and 8.6 (LTA). In Makueni County, the proportion of children at risk was higher than 2016 but lower than LTA in the reporting period with December recording 8.1 percent compared to 6.9 percent in 2016 and 8.9 percent (LTA). Maternal Infant and Child nutrition (MIYCN KAP) survey was done in Kitui County during the analysis period. From the survey, the minimum dietary diversity was 32.1 percent, minimum meal frequency was 79.9 percent while the minimum acceptable diet was 28.1 percent.

Figure 3.14: Proportion of Children at Risk of Malnutrition, December 2017 Compared to Dec. LTA

Morbidity and Mortality trends The major disease recorded in the South-Eastern cluster were URTI, Malaria and diarrhea. All Counties recorded high cases of URTI although the trends were fluctuating in Tharaka Nithi, Makueni and Meru North Sub County. In Mbeere and Kitui, URTI was relatively low but gradually increasing. Diarrhea cases remained low across the cluster and the trend was stable. Malaria also remained low compared to 2016 across the cluster. In Tharaka Nithi County the rate of infections remained low and stable between September and November with a slight increase in December. In Mbeere, there was notable increase of malaria cases in December. Cholera cases were reported in Tharaka Nithi and Meru North.

Immunization and Vitamin A supplementation

24

The routine immunization coverage for both polio and measles were above 70 percent during the period of analysis in Meru North while vitamin A supplementation status for all the 3 age categories (6-11months, 12-59 months and 6 -59months) was less than 30 percent. In Tharaka Nithi County, 55.6 and 53.8 percent of the children received OPV3 and measles at nine months respectively while there was an impressive performance of vitamin A supplementation at 97.8 percent. The percentage of fully immunized children (FIC) for Mbeere Sub-county was 70.3 percent. This was attributed to the health workers strike in 2017. In Kitui County, the immunization coverage remained low with routine polio coverage at 65.5 percent, measles at 69.9 percent while vitamin A was at 44.8 percent. In Makueni County, measles coverage at nine months was 78 percent. Drastic rise in the proportion of children supplemented was noted in November due to Malezi bora campaign.

Water Hygiene and Sanitation In Meru-North, water situation is currently not normal with majority of the seasonal rivers having dried up. There was increased distance to water sources by households from 9.9km to 11.4km - return distance. Furthermore, the county has insufficient sewerage system, and only 2 percent of population has access to piped water which may lead to an increased diarrhea cases and consequently contribute to acute malnutrition. The major sources of water for livestock and domestic use in Tharaka Nithi County were Traditional river wells, Rivers and Boreholes. In Mbeere, there was an increase of dysentery, watery diarrhea during the season of analysis compared to the previous season. This is attributed to contamination of drinking water reported in the sub-county where Thiba River, Makima and Kamurugu well samples confirmed contamination with E.coli, Bacteria. Cholera outbreak was also reported in Mbeere.

Recommendations for the Cluster Immediate/short-term recommendations

• Scale up community health and sanitation promotion initiatives for Cholera prevention

• Scale up Vitamin A supplementation interventions for all relevant target groups

• Scale up IMAM programs at health facility level

• Ensure availability of health care staff to enhance access to health care services and strengthen routine facility data collection

• Provision of water treatment chemicals

• Provide nutrition education to promote dietary diversity

• Scale up activities to improve vitamin A supplementation and immunization of BCG, polio and Measles to reach the national target of 80 percent.

• Conduct integrated nutrition SMART surveys to assess the nutrition situation and IYCN KAP assessments to determine IYCF practices in the county and WASH assessments to better understand hygiene practices in the cluster

Medium to Long term recommendations

• Increase sustainable access to safe water to households

• Strengthen multi-sectoral linkages for nutrition sensitive programming (health, agriculture, WASH and social protection)

• Strengthen and expand MIYCN education to promote healthier maternal and child care practices

• Invest in resilience building programs

• Invest in nutrition sensitive agriculture taking into consideration drought resistant crop varieties

25

• Develop and implement a Social Behavior Change Communication (SBCC) strategy for WASH and Nutrition.

3.6.5 Coastal Marginal Cluster (Kwale, Kilifi, Lamu and Taita Taveta Counties)

Nutrition Status and Dietary Diversity The nutrition situation according to Acute Malnutrition IPC in all the cluster counties was acceptable (Phase 1). Kwale and Kilifi were classified using GAM by MUAC from representative surveys (KABP survey, 2018) at 5 and 5.8 percent respectively, while Lamu was classified using GAM by MUAC from Sentinel Sites at 5.3 percent. Taita Taveta County did not have sufficient data for the current IPC classification of Acute Malnutrition, However, based on the previous classifications, triangulation of other indicators and expected trend of contributory factors in the projection period it was classified at Phase 1. The proportion of children with MUAC less than 135 mm increased in January 2018 in Kwale, Kilifi and Lamu Counties at 7.1, 5.8 and 5.3 percent respectively compared to December 2017 at 7.0, 4.6 and 5.0 percent respectively (Figure 3.15). The increment is also reflected in Figure 3 for December 2017 versus December LTA (Figure 3.16). For Taita Taveta County the proportion of children at risk of malnutrition remained within the normal range.

Figure 3.15: Trends of Proportion of Children with MUAC <135mm

26

Figure 3.16: Proportion of Children with MUAC <135mm Dec 2017 vs Dec LTA

Dietary diversity situation for the region shows that in Kwale, 45.2 percent of women of reproductive age consumed less than 5 food groups and only 30.5 percent of children aged 6-23 months received a minimum acceptable diet (KABP, 2017). The food consumption score has been on an improving trend as from October 2017 up to January 2018. In Kilifi County minimum dietary diversity was 35.5 percent, minimum meal frequency was 65%, while minimum Acceptable diet was at a low of 25.1 percent (Figure 3.17). In addition, minimum dietary diversity for women was 26.1 percent. Lamu County had agro-pastoral livelihood zone with highest number of households with poor dietary diversity. Nevertheless, this is an improvement from the previous month. On long term average, proportion of households with poor, borderline and acceptable food consumption score was 25, 35, and 40 percent respectively in January 2018 compared to 12 poor, 30 borderline and 58 percent acceptable reported in the previous season (Jan 2017). Comparatively, households with poor food consumption score increased by 53 percent from the previous season. This deterioration in food consumption is attributed to cumulative effects of failure of both short and long rains in 2017, terror related insecurity and political tension that caused displacement of households and affected the livestock market trade resulting in reduced incomes and purchasing power, hence reduced food availability. In Taita Taveta County the proportion of households with borderline and poor food consumption scores were 31.2 and 3.3 percent respectively.

27

Figure 3.17: Key IYCN Indicators in Kwale and Kilifi County, December 2017

Morbidity and Mortality: Malaria, diarrhea and Upper Respiratory Tract Infections (URTIs) were the most common diseases

reported in the cluster. There were incidences of increase in URTIs and diarrhea cases in Lamu in

September 2017, diarrhea in Kwale and URTIs in Taita Taveta (Figure 3.18, 3.19, 3.20, 3.21). Malaria

disease is under control in the cluster due to various interventions done earlier on including free net

distribution, massive campaigns on household spraying and drainage of the Mosquito breeding

areas. Lamu County has reported 178 cases of chikungunya with 4 confirmed cases - all from Lamu

East Sub-county. There is need for the county disease surveillance team to continue monitoring

chikungunya infestation and also dengue outbreak reported in Mombasa County.

0 10 20 30 40 50 60 70 80 90 100

Ever Breastfed

Initiation of breastfeeding within one hour of birth

Baby given colostrum

Baby given prelacteals

Exclusive breastfeeding for first six months

Continued breast at 12 months

Breastfeeding on demand

Proportion of infants 6-8 months who received solid,…

Minimum Dietary Diversity (MDD)

Minimum Meal Frequency (MMF)

Minimum Acceptable Diet (MAD)

Children who receive Iron-Rich Foods

Kilifi Kwale

28

Figure 3.18: Morbidity Trends in Kwale County

Figure 1.19: Morbidity Trends in Taita Taveta

Figure 3.20: Morbidity Trends in Lamu

29

Figure 3.21: Morbidity Trends in Kilifi

Immunization and Vitamin A supplementation Vitamin A Supplementation for children 6-59 months across the coastal cluster was low and below the national target of 80 percent with Kwale, Kilifi, Lamu and Taita Taveta Counties recording 32.4, 62.4, 16.4 and 12.1 percent respectively (Figure 3.22). The Fully Immunized Coverage, which is the proportion of children less than one year who are fully immunized, was also below the national target for all the counties where Kwale, Kilifi, Lamu and Taita Taveta Counties recorded 53, 56.8, 71.5 and 62.1 percent respectively.

Figure 3.22: VAS in Coastal Marginal Cluster, Semester 2 (Jul-Dec 2017)

The low coverages of VAS and immunization within the cluster are attributed to the industrial action by health workers which lasted from June to November 2017, poor documentation at the service delivery point, insecurity (in Lamu County) and children not attending the child welfare clinic after measles vaccination at 9 months.

0

500

1000

1500

2000

2500

3000

0

5000

10000

15000

20000

Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

Co

nfi

rme

d M

ala

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/U

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Is

Morbidity Trends in Kilifi

Diarrhoea URTIs Malaria

30

Water Sanitation and Hygiene The major water sources for domestic use in Kwale County are rivers, dams, boreholes, springs and

piped water in kiosks. Most of the households rely on pans and dams with most of these currently at

70 percent replenished and expected to last for 3-4 months. Kwale County had the lowest latrine

coverage at 57.2 percent. In Kilifi County there was no serious water shortage reported. However,

the cost of water was relatively higher than normal in most of the livelihood zones. The average

distance to water sources for households during the month of January 2018 was recorded at 4.2km.

This is an increase of 40 percent compared to the previous month. The average latrine coverage in

the county was 67 percent as a result of increased health promotion through community units.

Coverage and utilization is low in the pastoral areas due to low sensitization, nomadic lifestyle and

cultural beliefs. In Lamu County the proportion of households that used water from protected

sources was at 83%. Twenty one (21) percent treated water; while 18.0% practiced hand washing at

all critical times using soap. Overall, latrine coverage in the County stood at 82.3%. For Taita Taveta

County, latrine coverage has increased from 91.3 in December 2017 to 92.7 percent in January 2018.

However, in areas of Mwaroko, Kachero and Mwakitau, the latrine coverage is low at approximately

40 to 50 percent as recorded during the community interviews.

Ongoing Interventions for Coastal Marginal Counties

• Routine Immunization services in the health facilities across the cluster

• Routine activities including vitamin A supplementation in the health facilities across the cluster

• Excavation of dam and expansion of the Kwa-Diki water pan in Kinango sub-county with support from European Union through NDMA in Kwale County

• Zinc supplementation in diarrhea management in the health facilities across the cluster

• Deworming for children 12-59 months in the health facilities across the cluster

• Management of acute malnutrition in the health facilities across the cluster

• MIYCN Intervention through promotion of exclusive breastfeeding and appropriate complementary feeding in the health facilities across the cluster

• Health Hygiene promotion services in the health facilities across the cluster

• Iron and folic acid supplementation to pregnant women at the health facilities

• Cash transfer supported by Kenya Red Cross Society and County government through the Department of Social Development in Kwale, Kilifi and Lamu Counties

• CFA program ongoing in Taita Taveta marking the onset of lean months Multi – Sectoral

• Provision of traditional high value crops seeds for farmers in Taita Taveta County

• Mainstreaming EDE to CIDP II plus integrated planning through public participation

Recommended interventions for the Cluster Immediate/short-term recommendations

• Carry out mass screening and integrated outreaches in the identified hot spots

• Conduct integrated outreaches to improve immunization coverage

• Upscale IMAM Program Sites

31

• Procurement and prepositioning of RUTF and RUSF

• Enhance health and nutrition surveillance

• Provide MNPs at the facilities

• Strengthen malnutrition screening and active case search as well as strengthen integrated management of acute malnutrition

• Sustainable management of water practices e.g. rain water harvesting.

• Procure and distribute water treatment chemicals in Kilifi County

• Scale up HiNi intervention in all the Counties

• Train CHVs and CHEWS on Community Nutrition Module.

• Enhance disease and nutritional surveillance.

Medium to Long-term recommendations

• Continuous Public health education, promotion of hygiene and sanitation practices through strengthening of Community Led Total Sanitation

• Diversify livelihoods in Kwale County

• Conduct periodic Coverage and Integrated SMART surveys

• Strengthen multi-sectoral coordination which will include health, agriculture, Education and other sector to address nutrition issues

• MNP supplementation to address chronic malnutrition

• Redesign programming to suite the affected areas (Lamu and Taita Taveta) in terms of accessibility for essential services by the communities and also supervision by the county and sub-county management teams

32

Appendix

Appendix 1: Prevalence of Acute Malnutrition in Selected Counties, January/February 2018

Survey Area Survey date GAM WHZ children 6 to 59 months (%, 95% CI)

SAM WHZ children 6 to 59 months (%, 95% CI)

GAM MUAC children 6 to 59 months (%, 95% CI)

SAM MUAC children 6 to 59 months (%, 95% CI)

Plausibility Score

Turkana Central Jan/ Feb 2018

17.2 (13.8 - 21.1) 2.5 (1.6- 3.9) 4.9 (3.3- 7.2) 0.6 (0.2- 2.0) 4%

Turkana North Jan/ Feb 2018

15.9 (11.7-21.1) 1.9 (0.9- 3.9) 6.7 (4.7- 9.6) 0.6 (0.2- 1.9) 9%

Turkana South Jan/ Feb 2018

16.2 (13.3 - 19.5) 2.1 (1.1- 3.8) 5.8 (4.2- 8.1) 0.8 (0.3- 2.0) 3%

Turkana West Jan/ Feb 2018

15.3 (12.4-18.7) 2.2 (1.3- 3.6) 7.1 (4.7-10.7) 0.6 (0.2- 1.5) 12%

Marsabit (Loiyangalani/ Laisamis

Jan-18 21.2 (17.3-25.7) 3.3 (2.1- 5.1) 6.8 (4.5-10.3) 0.6 (0.2- 1.7) 0%

Marsabit North Horr

Jan-18 21.8 (18.0-26.1) 5.2 (3.4- 7.9) 3.4 (1.9- 5.8) 0.2 (0.0- 1.7) 1%

Wajir Agro-pastoral

Feb-18 16.0 (13.0 - 19.5.) 2.2 (1.4 - 3.4) 3.3 (2.1 - 5.1) 0.4 (0.1 - 1.2) 2%

Isiolo Feb -18 13.8 (10.9 - 17.3) 2.6 (1.6 - 4.2) 4.8 (3.3 - 6.8) 1.8 (1.0 - 3.2) 10%

Tana River Feb -18 15.6 (11.6 – 20.6) 2.2 (1.2 – 4.0) 5.9 (3.7 – 9.4) 0.5 (0.2 – 1.4) 9%

Kajiado Jan -18 10.0 (7.3 - 13.5) 1.4 (0.7 - 3.0) 2.6 (1.7 - 4.1) 0.2 (0.0 - 1.1) 5%

Narok Jan-18 6.8 (4.8 - 9.5) 1.1 (0.4 - 3.2) 3.0 (1.7 - 5.1) 0.3 (0.1 - 1.4) 1%

33

Appendix 2: Prevalence of Acute Malnutrition in Selected Counties, May to July 2017

Survey Area

(County or Sub

County)

Survey date

GAM WHZ

CHILDREN 6 TO 59

MONTHS

(%, 95% CI)

SAM WHZ

CHILDREN 6 TO 59

MONTHS

(%, 95% CI)

GAM MUAC

CHILDREN 6 TO 59

MONTHS (%, 95% CI)

SAM MUAC CHILDREN

6 TO 59 MONTHS

(%, 95% CI)

Under-five

Mortality Rate

Crude

Mortality Rate

Plausibility Score

Laikipia June/July 2017

11.4 (8.8-14.7) 2.2 (1.1-4.6) 5.2 (3.3-8.0) 0.6 (0.2-1.8) not done not done 7%

Garissa July 17 16.3 (13.2-20.0) 1.5 (0.9-2.5) 3.5 (2.2-5.7) 0.4 (0.1-1.2) 0.239 0.854 4%

Mandera Jul-17 24.6 (21.6-27.8) 5.2(3.8-7.0) 7.4 (5.7-9.5) 0.8 (0.4-1.7) not done not done 1%

Turkana Central

Jun-17 31.4 (27.5-35.6) 8.0 (5.8-10.8) 12.3 (9.4-16.1) 1.7 (0.9-3.2) 0.6 (0.18-1.95) 0.48 (0.28-0.84) 5%

Turkana South

Jun-17 37.0 (32.3-41.9) 12.0 (9.6-14.9) 13.2 (10.4-16.5) 1.9 (1.2-3.2) 0.17 (0.02-1.23) 0.45 (0.24-0.85) 10%

Turkana North

Jun-17 34.1 (30.1-38.3) 8.6 (6.4-11.5) 15.1 (12.0-18.9) 2.5 (1.5-4.2) 0.42 (0.10-1.79) 1.18 (0.72-1.92) 4%

Turkana West

Jun-17 23.4 (18.4-28.9) 6.4 (4.4-9.4) 12.2 (9.0-16.5) 3.4 (2.0-5.8) 0.39 (0.10-1.55) 0.73 (0.38-1.41) 7%

Samburu Jun-17 18.3 (14.6-22.7) 3.8 (2.4-6.1) 5.1 (3.5-7.4) 0.6 (0.2-1.8) not done not done 6%

West Pokot

Jun-17 20.4 (16.5-24.9) 3.2 (1.9-5.5) 5.7 (3.9-8.4) 0.6 (0.2-1.7 not done not done 5%

Marsabit - Laisamis

Jul-17 24.8 (20.3-29.9) 5.3 (3.4-8.1) 8.3 (5.1-13.2) 2.0 (0.7-5.1) not done not done 0%

34

Survey Area

(County or Sub

County)

Survey date

GAM WHZ

CHILDREN 6 TO 59

MONTHS

(%, 95% CI)

SAM WHZ

CHILDREN 6 TO 59

MONTHS

(%, 95% CI)

GAM MUAC

CHILDREN 6 TO 59

MONTHS (%, 95% CI)

SAM MUAC CHILDREN

6 TO 59 MONTHS

(%, 95% CI)

Under-five

Mortality Rate

Crude

Mortality Rate

Plausibility Score

Marsabit North Horr


Marsabit – Moyale

Jul-17 5.4 (3.2-9.0) 0.3 (0.0-2.1 2.5 (1.2-5.1) 0.3 (0.0-2.1) not done not done 7%

Marsabit – Saku


Wajir pastoral

Jul-17 16.4 (12.8-20.7) 2.5 (1.4-4.5) not done not done 8%

Wajir Agro-pastoral

Jul-17 16.8 (13.4-20.9) 2.5 (1.3-4.6) not done not done 3%

Nairobi May-17 4.6 (3.4-6.3) 0.1 (0.0-0.9) 2.6 (1.5-4.3) 0.3 (0.1 -1.1) not done not done 10%

Baringo (East Pokot) Rapid SMART

Jul-17 25.2 (19.7 - 31.7)

5.8 (3.4 - 9.7)

10.8 (6.9 - 16.5) 2.7 (1.4 - 5.3)

Not done Not done 0%

35

Appendix 3: Summary of Caseloads

Global acute malnutrition,

Children 6 to 59 months

Severe Acute Malnutrition,

Children 6 to 59 Months

Moderate Acute Malnutrition,

Children 6 to 59 Months

Pregnant and Lactating women

County Total Caseload

Target Total Caseload

Total Target

Total Caseload

Total Target

Target

Baringo 11,483 6,113 1,485 1,114 9,998 4,999 987

Embu 1,363 704 91 68 1,272 636 162

Garissa 26,324 13,768 2,422 1,817 23,902 11,951 3,665

Isiolo 5,720 3,130 1,078 808 4,643 2,321 713

Kajiado 19,703 10,541 2,758 2,069 16,945 8,472 3,702

Kilifi 22,564 12,393 4,444 3,333 18,119 9,060 1,651

Kitui 7,470 3,878 575 431 6,895 3,447 566

Kwale 6,842 3,473 207 156 6,635 3,317 954

Laikipia 11,872 6,509 2,291 1,718 9,581 4,791 1,503

Lamu 1,342 734 252 189 1,091 545 152

Machakos 808 420 62 47 746 373 80

Makueni 6,316 3,279 486 364 5,830 2,915 515

Mandera 63,391 35,045 13,400 10,050 49,991 24,996 4,725

Marsabit 11,131 6,213 2,591 1,943 8,539 4,270 2,550

Meru 6,183 3,429 1,352 1,014 4,830 2,415 909

Narok 20,270 10,955 3,279 2,459 16,991 8,495 474

Nyeri 854 442 61 46 793 397 112

Samburu 13,775 7,602 2,860 2,145 10,914 5,457 1,088

TaitaTaveta 2,218 1,126 67 50 2,151 1,075 405

Tana River 13,365 7,154 1,885 1,414 11,480 5,740 819

TharakaNithi 966 536 211 158 755 377 134

Turkana 28,403 15,159 3,831 2,873 24,572 12,286 4,499

Wajir 26,302 14,055 3,617 2,712 22,686 11,343 2,407

West Pokot 28,624 15,700 5,551 4,163 23,073 11,536 1,371

ASAL Total 337,288 182,358 54,857 41,143 282,430 141,215 34,143

Kisumu 3,859 2,342 1,651 1,238 2,208 1,104 480

Mombasa 4,301 2,746 2,381 1,786 1,920 960 688

Nairobi 54,374 30,355 12,672 9,504 41,702 20,851 1,848

Urban Total 62,534 35,443 16,704 12,528 45,830 22,915 3,016

Grand Total 399,822 217,801 71,561 53,671 328,261 164,130 37,159

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Appendix 4: Summary of contributory factors by analysis area

Agro-pastoral livelihood Zone (West Pokot, East Pokot, Laikipia, Kajiado and Narok)

SUMMARY CONTRIBUTING FACTORS BY AREA

Major contributing factor

Minor contributing factor

Not a contributing factor

NYERI /N

LAIKIPIA

BARINGO

W/POKOT

AKAJIADO

NAROK

Inadequate dietary intake

Minimum Dietary Diversity (MDD) Minimum Meal Frequency (MMF) Minimum Acceptable Diet (MAD) Minimum Dietary Diversity – Women (MDD-W) Others

Diseases

Diarrhoea Dysentery Malaria HIV/AIDS prevalence Acute Respiratory Infection Disease outbreak Others

Inadequate access to food Outcome of the IPC for Acute Food Insecurity analysis

Inadequate care for children

Exclusive breastfeeding under 6 months Continued breastfeeding at 1 year Continued breastfeeding at 2 years Introduction of solid, semi-solid or soft foods Others

Insufficient health services & unhealthy environment

Measles vaccination Polo vaccination Vitamin A supplementation Skilled birth attendance Health seeking behaviour Coverage of outreach programmes – CMAM programme coverage (SAM, MAM, or both)

Access to a sufficient quantity of water Access to sanitation facilities Access to a source of safe drinking water Others

Basic causes

Human capital Physical capital Financial capital Natural capital Social capital

37

Policies, Institutions and Processes Usual/Normal Shocks Recurrent Crises due to Unusual Shocks Other basic causes

Other nutrition issues

Anaemia among children 6-59 months

Anaemia among pregnant women

Anaemia among non-pregnant women

Vitamin A deficiency among children 6-59 months

Low birth weight Fertility rate Others

38

Coastal Marginal (Kwale, Kilifi, Lamu and Taita Taveta Counties)


Major contributing factor Minor contributing

factor Not a contributing factor

KILIFI T/TAVETA KWALE LAMU


Minimum Dietary Diversity (MDD) Minimum Meal Frequency (MMF) Minimum Acceptable Diet (MAD) Minimum Dietary Diversity – Women (MDD-W) Data not

available Others

Diseases



Inadequate care for children Exclusive breastfeeding under 6 months Continued breastfeeding at 1 year Continued breastfeeding at 2 years Introduction of solid, semi-solid or soft foods Others


Measles vaccination Polo vaccination Vitamin A supplementation Skilled birth attendance Health seeking behaviour Coverage of outreach programmes – CMAM programme coverage (SAM, MAM, or both) Access to a sufficient quantity of water Access to sanitation facilities Access to a source of safe drinking water Others No Data No Data No Data No Data

Basic causes

Human capital Physical capital Financial capital Natural capital Social capital Policies, Institutions and Processes Usual/Normal Shocks Recurrent Crises due to Unusual Shocks Other basic causes No Data No Data No Data No Data

Other nutrition issues Anaemia among children 6-59 months

39

Anaemia among pregnant women Anaemia among non-pregnant women Vitamin A deficiency among children 6-59 months Low birth weight Fertility rate Others No Data

40

North East cluster (Wajir, Mandera, Garissa, Isiolo, Tana River)


Major contributing factor

Minor contributing factor

Not a contributing factor

WAJIR

SOUTH WAJIR

NORTH MANDERA GARISSA ISIOLO T/RIVER



Diseases




Exclusive breastfeeding under 6 months Continued breastfeeding at 1 year Continued breastfeeding at 2 years Introduction of solid, semi-solid or soft foods Others




Basic causes

Human capital Physical capital Financial capital Natural capital Social capital Policies, Institutions and Processes Usual/Normal Shocks

41

Recurrent Crises due to Unusual Shocks Other basic causes







42

North West Cluster (Marsabit, Turkana, Samburu)

SUMMARY OF CONTRIBUTING FACTORS

Major contributing Factor Minor Contributing Factor Not a contributing Factor

Moyale

North Horr

Saku

Laisamis

Turkana North

Turkana Central

Turkana West

Turkana South

Samburu


Minimum Dietary Diversity (MDD)

Minimum Meal Frequency (MMF)

Minimum Acceptable Diet (MAD)

Minimum Dietary Diversity – Women (MDD-W)

Others Diseases Diarrhoea

Dysentery

Malaria

HIV/AIDS prevalence

Acute Respiratory Infection

Disease outbreak

Others Inadequate access to food

Outcome of the IPC for Acute Food Insecurity analysis


Exclusive breastfeeding under 6 months

Continued breastfeeding at 1 year

Continued breastfeedin

43

g at 2 years

Introduction of solid, semi-solid or soft foods

Others Insufficient health services & unhealthy environment

Measles vaccination

Polo vaccination

Vitamin A supplementation

Skilled birth attendance

Health seeking behaviour

Coverage of outreach programmes – CMAM programme coverage (SAM, MAM, or both)

Access to a sufficient quantity of water

Access to sanitation facilities

Access to an improved source of drinking water

Others Basic causes

Human capital

Physical capital

Financial capital

Natural capital

Social

44

capital

Policies, Institutions and Processes

Usual/Normal Shocks

Recurrent Crises due to Unusual Shocks

Other basic causes






Low birth weight

Fertility rate

Others

45

South East Marginal Cluster (Mbeere, Tharaka, Kitui, Makueni, Meru North


Major contributing

factor Minor

contributing factor

Not a contributing

factor

MBEERE

THARAKA KITUI MAKUENI MERU/N



Diseases



Inadequate care for children Exclusive breastfeeding under 6 months Continued breastfeeding at 1 year Continued breastfeeding at 2 years Introduction of solid, semi-solid or soft foods Others




Basic causes

Human capital Physical capital Financial capital Natural capital Social capital Policies, Institutions and Processes Usual/Normal Shocks Recurrent Crises due to Unusual Shocks Other basic causes

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Anaemia among children 6-59 months Anaemia among pregnant women Anaemia among non-pregnant women Vitamin A deficiency among children 6-59 months


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