2014 Kenya Demographic and Health Survey; Inching closer towards meeting MDG 1

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The Kenya Demographic Health Survey (KDHS) of 2014 has finally been released. Considering that this was the first under the new constitution, its release was anticipated with much interest. It has not disappointed. Apart from interesting findings on fertility rates across the counties which the media presented with a tongue-in-cheek, the survey shows the gains made by directing resources towards ending hunger.

The national prevalence of stunting (too short for age showing chronic malnutrition) is 26%, wasting (too thin for height showing acute malnutrition) is 4 %, and underweight (too thin for age showing acute and chronic malnutrition) is 11%.

Stunting

Stunting is noted to be highest (36 %) in children aged 18-23 months and lowest (10%) in children aged less than 6 months. This is a clear indicator that there needs to be more nutrition education on complementary feeding and the 1000 days (conception to two years of age) window of opportunity  needs to be fully utilised to avert malnutrition.

Stunting is also noted to be higher among boys (30 %) than girls (22 percent) and higher among rural children (29 %) than urban children (20 %). While this difference between rural and urban children may be true nationally, it is not necessarily true from one county to another.

Consider Trans Nzoia County, Kenya’s maize basket. In a study I carried out therein among children under five years from resource poor households, I found a significantly higher proportion (P=0.047) of urban children were stunted (40%) compared to rural children (19%).The prevalence rate of stunting in Trans Nzoia County according to the KDHS 2014 is 29.2 %. This is believable considering that this figure comprises of all children (urban and rural) and does not take into account the resources owned by a household.

In the KDHS, education of the care givers was also taken into account. It was found that children of mothers with secondary or higher education are less likely to be stunted (17%) compared with children whose mothers did not complete primary school (34 %) or have no education (31%). This shows that efforts directed towards the improvement of girl-child education should be encouraged and not downplayed as is usually done by groups such as Maendeleo ya Wanaume (MAWE) and the numerous heavily paternalistic communities across Kenya.

At the county level, West Pokot and Kitui have the highest proportions (46 percent) of stunted children. Others reporting high proportions of stunting include Kilifi (39 percent), Mandera (36 percent), and Bomet (36 percent). Nyeri, Garissa, and Kiambu counties have the lowest proportion of stunted children, each less than 16 percent.

Wasting

Wasting is highest among children in the age groups 6-8 months and 9-11 months (each 7 percent). This shows there is a gap in the manner in which complementary feeds are introduced. Furthermore, children at this age are quite vulnerable to infections accompanied by diarrhoea, vomiting, high fever and loss of appetite. This consequently leads to acute weight loss.

The survey further reveals that children whose mothers have no education have a higher chance of wasting (10 percent) compared with children of educated mothers. Wasting in children is inversely related to household wealth.

Garissa, Wajir, Mandera, Marsabit, Turkana, West Pokot, and Samburu Counties exhibited the highest proportions of wasting (>11%) while Siaya and Kisumu exhibited the least (<1%)

 Underweight

Children aged 24-35 months were found to have the highest levels of underweight with boys showing higher levels (12 percent) than girls (10 percent), and rural children exhibiting higher percentage (13 percent) than urban children (7 percent). It is important remember that these are national figures but the nutrition status at the county level may be far much different. Once again consider Trans Nzoia County where I found urban preschoolers exhibited slightly higher rates (22%) as compared to their rural counterparts, (17%). This shows that perhaps in high potential agricultural areas, it is the urban poor who are more vulnerable to malnutrition than the rural poor. The survey reports underweight levels in Trans Nzoia being 15.3%.

The survey correctly noted that proportion underweight decreases as mother’s education level increases or household wealth quintile increases.

In Mandera, Marsabit, Turkana, West Pokot, and Samburu, more than 25% of children are underweight while in Nyeri and Nairobi counties this figure stands at less than 4%.

All in all, the survey brings some good news; there is a marked reduction in malnutrition since 2008/9; Stunting has decreased from 35 percent to 26 percent, wasting from 7 percent to 4 percent, and underweight from 16 percent to 11 percent. Furthermore, the proportion of children younger than age 6 months who are exclusively breastfed has increased significantly from 32 percent in the 2008-09 KDHS to the current 61 percent

It is such evidence that gives us hope. Our efforts are not in vain. Perhaps we are closer towards meeting MDG 1, eradicating extreme poverty and hunger, than we think.

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