Will new global goals alleviate child nutrition problems?

NAIROBI: As Kenya works to have children breastfed exclusively for six months, Baringo County has only 47 per cent of mothers exclusively breastfeeding according to a research done in November 2013 and released last year by World Vision Kenya in collaboration with the Ministry of Health with support from UNICEF.

This is a reality that comes at a time when the world is gearing for new goals that will determine how the world tackles issues over the next 15 years after the expiry of the Millennium Development Goals (MDGs).

The county targets to achieve over 50 per cent exclusive breastfeeding but there are challenges mainly cultural which are hindering any meaningful progress. Breastfeeding mothers have no control over their children who are introduced to other forms of feeding early. They also have to use belts to get rid of baby fat.

Nancy Kiru, a mother of four children, says that she has faced untold challenges with breastfeeding her children. Kiru who lives in Poi area of Baringo North says she has always weaned her children early due to pressure from the family.

"Breastfeeding has always been an issue pitting my matrimonial family against me and culturally I am expected to listen to them," says Kiru.

The 32 year-old woman says it was no surprise her mother-in-law turned against her when she decided to exclusively breastfeed her last born who is about one year old and accused her of "destroying our child" when she refused to follow their manual not to breastfeed exclusively.

For thus reason women have to balance farm work and caring for children the extended family intervenes to feed children who should exclusively be breastfeeding. But her mother-in-law insists "children cannot survive on milk alone because they will grow into weak adults."

"When I go to the farm, the child is introduced to other food because while in the farm, I leave them at home to be taken care of by those at home," she says.

Dr Keis Muruka, the medical superintendent at the Kabarnet Hospital, acknowledges that the county's cultural challenges are barriers to exclusive breastfeeding.

"Some areas like East Pokot have a very serious cultural challenge and children there end up not being exclusively breastfed, which leads to loss of children at an early age.”

Millennium Development Goal Number Four talks about reducing infant mortality which is yet to be achieved. One of the ways of reducing deaths of children under the age of five is in proper nutrition.

“Children who are weaned early have their guts disturbed and this leads to early problems for the children," says Dr Muruka.

With the expiry of the MDGs, a new set of goals are set to be ratified in New York in 2015, question is how responsive will these new set of 169 goals be achieved.

Some of these poor cultural habits contribute to stunting which is rather high in Kenya with one out of every four children chronically stunted in Kenya. There are about 1.8 million undernourished children in the country.

The Kenya Demographic and Health Survey 2014 shows that despite there being improvements over the past ten years, stunting, wasting and the underweight problem among children is still high in Kenya.

For instance in 2014 stunting stood at 26 percent while one out of every 25 children wasted due to poor nutrition with one out of 10 children being underweight.

While these improvements are impressive, a 25 percent prevalence of stunting is unacceptably high. There are an estimated 1.8 million children in Kenya who are chronically undernourished. Redressing this is both intrinsically and instrumentally valuable. It is intrinsically valuable because all children have the right to grow up healthy and well-nourished.  It is instrumentally valuable because the effects of stunting persist into adulthood. These arise because stunting has long term physical and neurological consequences notes Prof John Hoddinott, a professor of food and nutrition economics and policy at Cornell University.

The World Health Organisation (WHO) says under-nutrition is associated with 45 per cent of child deaths, while globally the growth of 162 million children under five is stunted as a result of poor feeding. The global health body also states that worldwide only two out of five children are exclusively breastfed; about 800,000 children's lives could be saved every year among children under five, if all children 0–23 months were optimally breastfed.

Mary Monari, a nurse at Salawa in Pokot East says that lack of education largely contributes to a clash between health workers and locals. She says that mothers are always caught in the middle not knowing whether to listen to advice from the facilities or to the elderly women.

For these reasons, Baringo County still lags behind the national average. While about six in every ten women breastfeed exclusively nationally, less than five exclusively breastfeed in Baringo. The national target is to have eight out of every ten newborns exclusively breastfed.

Some of the conditions that come without exclusive breastfeeding include diarrhoea, pneumonia, upper respiratory tract infection and malaria. These conditions are not caused directly but if the immune system is not strong enough, then the children become more susceptible, says Jardine Ngolo, a nutrition officer with World Vision Kenya. Exclusive breastfeeding highly increases a child immunity thus reducing the probability of the child dying under the age of five.

The world is set for another meeting in September to ratify the new Sustainable Development Goals (SDGs) that I expected to solve some of these problems that face children like these in Baringo.

Even as 193 countries in the world are negotiating targets that will determine the next 15 years, many Kenyans have no idea of the negotiations as much as they are unaware of what is being discussed.

With a development aid that would total 2.5 million dollars, the SDGs should be the best bet ever but that seems not to be viable as Prof Bjorn Lomborg notes.

Lomborg argues that while the world wants decide what it thinks is best for the people, there lies a problem because people from different regions would need different ways to solve their unique problems.

Research has also shown that the top five needs of the world include a good education, better healthcare, better job opportunities, a honest and responsive government as well as affordable and nutritious food.

But Lomborg who heads the Copenhagen Consensus, a global think tank argues that not all the 169 targets being proposed by the UN are equal. He therefore says there is a need to prioritise on goals that will be lead to the best possible outcome for the least amount spent.

“Not all regions have the same needs hence the need to look into the targets and identify the most pressing ones that need to be addressed, otherwise these next 15 years will not count much,” says Lomborg.