NAIROBI: Kenya, like other African countries, is grappling with two heavy burdens of malnutrition: The traditional under-nutrition and over-nutrition often seen in instances of being overweight and obese.
At the national level, 26 per cent of children under five years are stunted and too short for their height, meaning they will never attain their full physical and mental potential; 11 per cent are underweight, and 4 per cent are too thin for their height. While the levels of wasting and stunting has remained nearly constant in the last 20 years: there was a slight decline in underweight from 22 per cent in 1993 to 16 per cent in 2008.
The prevalence of under-nutrition is particularly high in urban slums where, for example, stunting among children under five years is more than 40 per cent. The high level of under-nutrition is occasioned by food insecurity (especially due to frequent droughts), poor access to safe water, infections (especially from diarrhoea, HIV and malaria), poor maternal nutrition and poor child feeding practices.
The persistence of high levels of malnutrition, particularly stunting, may also reflect poor prioritisation and commitment to nutrition by the Government and development partners, hence low budgetary allocations in the past. For example, the Government allocated only 0.5 per cent of its limited health budget to nutrition in the 2010-2011 financial year.
Despite the high levels of under-nutrition, substantial levels of overweight and obesity have also been documented in Kenya. At the national level, 25 per cent of women of reproductive age (15-49 years old) are either overweight or obese. The prevalence is even higher in urban areas where 40 per cent of women are either overweight or obese. Surprisingly, over a third of women aged 18 years and older in urban slums are also either overweight or obese.
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Social and environmental factors are at play, including dietary and lifestyle changes catalysed by processes such as the rapid urbanisation occurring in Kenya - like in many other African countries – and a good share of negligence.
Malnutrition is clearly a complex problem with multiple causes. Addressing it therefore calls for innovative strategies, as well as political commitment if we are to achieve global targets such as the Millennium Development Goals (MDGs) for 2015 or the World Health Assembly goals for 2025.
Nutrition is no longer just a health problem but a social and development problem that needs to be addressed collaboratively by different actors, including Government ministries (health, agriculture, gender, sports, culture and social services, finance, education and water among others), the private sector, civil society, researchers and development partners.
To potentially achieve the objectives outlined in the national nutrition action plan 2012-2017, a budget of approximately Sh70 billion was drawn. Kenya has committed to spending Sh6 billion over five years to scale up nutrition interventions outlined in the action plan, shared across various ministries including health, agriculture, water and irrigation, fisheries development, and national planning and development. The rest of the money is being sourced from development partners.
This is a drop in ocean compared to what is required over the same period.
Kenya must put in more effort to curtail the heavy double burden of malnutrition. Within the wider national policy framework outlined in ‘Kenya Vision 2030’, which aims to ensure a high quality of life for citizens, Kenya may be on track to curtailing the double burden of malnutrition.
However, continued commitment by Government and other actors, including development partners and civil society is critical.
With devolution in the context of Kenya’s constitution, in which 96 per cent of nutrition activities are handled by the county governments, there is even greater need for advocacy in each of the 47 counties to ensure that nutrition is prioritised.
For civil society to function effectively, there is need for strong monitoring and evaluation, and engagement of users with the findings, which is a key role of the research community. As leaders, we have everything to gain from getting it right, and everything to lose if we ignore the issue. The county governments have a choice - to lose valuable revenue fighting the disease burden caused by under-nutrition, or to benefit from the increased revenue that comes from a healthy and productive workforce. It’s not a difficult choice.
What makes it even easier is the fact that we know what needs to be done. A new series of studies in The Lancet has revealed that 10 simple interventions could save close to one million lives every year. Action must be taken at both national and county level to ensure effective co-ordination and maximum impact. The Global Nutrition Report highlights the simple steps required to improve nutrition.
Critical points include the need for greater spending on nutrition, greater accountability in the implementation of nutrition programmes, and more and better data about nutrition.