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

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.

2013: Year in Review

It is that time of the year when we must take stock of the year passed and measure our hopes for the New Year. 2013 was without a doubt a year of pivotal events, especially in my homeland Kenya. We had a peaceful general election in March- the first under the new constitution. We celebrated 50 years of independence hence joining a throng of other African nations that have achieved the same in the recent past. However, in spite of these positive developments, Kenya and other African nations are still bedevilled by hunger, corruption, disease, ill-governance, conflict and poverty.  This is reflected in the global reports of 2013. I will elaborate on some that focus on hunger.

The Global Hunger Index (GHI) 2013

The GHI measures and tracks hunger globally and by region and country. It is computed by the international Food Policy Research Institute (IFPRI) and employs three main indicators i.e. undernourishment, child underweight and child mortality. In 2013, the worst performing regions were South Asia and Africa South of the Sahara.  South Asia had the highest GHI score and this was attributed to social inequality and the low nutritional, educational, and social status of women.

The Sahel region was noted to be prone to hunger due to a number of factors. These included sporadic rainfall, locust infestation, crop shortages, and high and volatile food prices. These affected the food and nutrition security of the region negatively. Furthermore, conflict in countries such as Mali and Northern Nigeria exacerbated the situation. However, despite this grim picture, Ghana stood tall as it was among the top ten best performers in terms of improving her GHI score since 1990. It goes without saying that Ghana is one of the most stable democracies in Africa. Studies have proved there is a very strong positive association between democracy and food and nutrition security. Perhaps this is why Ghana attracts an even rosier review in The State of Food Insecurity in the world, 2013. However, I am anticipating. We will come to that later.

Some countries exhibited significant increases in their GHI scores, the worst performers, all of them in Africa, are Burundi, Comoros and Eritrea. The report attributes increased hunger in Burundi and Comoros since 1990 to prolonged conflict and political instability.

The following are excerpts of what the report says of some African countries:

• The three countries with extremely alarming 2013 GHI scores—Burundi, Comoros, and Eritrea— are in Africa south of the Sahara.
• Burundi, Comoros, and Eritrea currently have the highest proportion of undernourished people—more than 60 percent of the population
• The Democratic Republic of Congo, with a population of more than 60 million, still appears as a grey area on the map because reliable data on undernourishment are lacking and the level of hunger cannot be assessed- High-quality data for the Democratic Republic of Congo, as for other likely hunger hot spots such as (Afghanistan) and Somalia, are badly needed.
• Mali, Sierra Leone, and Somalia have the highest under-five mortality rate, ranging from approximately 18 to about 19 %.
• The HIV and AIDS epidemic, along with high income inequality, has severely undermined food security in Swaziland despite growth in national income. Because of drought, more than one-quarter of the population depended on emergency food aid in 2006–2007, and the country’s GDP per capita declined between 2007 and 2010. High unemployment, overgrazing, soil depletion, and the risk of future droughts and floods pose persistent challenges.

 

The State of Food Insecurity in the World; the multiple dimensions of food security, 2013

This annual report communicates progress made towards achieving the 2001 Millennium Development Goal (MDG) on Hunger i.e. halve the proportion of hungry people in the total population and the even more ambitious 1996 World Food Summit(WFS) goal on hunger i.e. halve the number of hungry people. It should be noted that both goals have 1990 as the starting year and 2015 as the target year. However, the WFS goal is harder to achieve because of the high rates of population growth in many hunger-affected countries. The report estimated that to meet the WFS target, the number of hungry people in developing regions would have to be reduced to 498 million by 2015, a goal that is out of reach at the global level.

In 2011-2013, 842 million people i.e. 12 % of the total world’s population were unable to meet their dietary requirements. This means that one in eight people were likely to have suffered from chronic hunger.

Africa remained the region with the highest prevalence of undernourishment (on in four people) within which the sub-Saharan region had the highest (24.8%) prevalence of undernourishment.  The report concludes that Africa is not on track to achieve the MDG hunger target. Nonetheless, Ghana goes against the grain. It had met its 2015 MDG hunger target by 2000–02. By 2011-2013, less than 5 % of its population were undernourished. It was also well on track to meet its MDG poverty target before 2015. This impressive record in a region not known to post such is attributed to a robust economic growth (its GDP grew by an average of 4.5% a year since 1983 and by an impressive 14 % in 2011), market reforms and favourable terms of trade and investment climate. However, all this would not be possible without the peace and political stability that Ghana enjoys. In fact, I dare say, this is the impetus that fuelled Ghana to meeting the MDG hunger target by 2000-02.

In stark contrast to Ghana, Uganda records a dismal performance on its progress to meet the MDG hunger target. Firstly, the prevalence of undernourishment has been increasing since the early 2000. This is attributed to discordance between food production and population growth. Uganda has an annual population growth of 3.2%, one of the highest in the world. This rate combined with a declining food production per capita, unequal distribution and access to food have rendered one third of Uganda’s population to be chronically undernourished.

Conclusion

African countries performance in regard to ending hunger leaves a lot to be desired. While the continent boasts of having the largest tracts of unused arable land, it also holds the unenviable title of the continent with the highest number of hungry people. Much has been said of this discrepancy and quite a number of recommendations have been suggested. Despite of all these efforts, the changes over the years do not merit the investment made into bringing about those changes. As we measure the hopes that we have for the New Year, it is my sincere hope that we see much more political commitments made towards ending hunger globally and especially in Africa. It is also my sincere desire that we witness significant changes in the indicators of hunger in the foreseeable future. Perhaps approaching the year 2015, measuring of progress made towards MDGs and post-2015 development agenda will fuel efforts towards eliminating hunger. Meanwhile, remarks made by José Graziano da Silva (FAO Director-General), Kanayo F. Nwanze( IFAD President) and Ertharin Cousin (WFP Executive Director) in the foreword to The State of Food Insecurity in the world, 2013 ring ever so true…

“Ultimately, political stability, effective governance and, most importantly, uninterrupted long- term commitments to mainstreaming food security and nutrition in policies and programmes are key to the reduction of hunger and malnutrition”

NB: A more concise review of 2013 can be found at http://www.hunger-undernutrition.org/blog/2013/12/happy-new-year-a-look-back-at-2013.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+Hunger-undernutritionBlog+%28Hunger-Undernutrition+Blog%29

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