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FULLTEXT01.Pdf MATERNAL AND CHILD HEALTH IN KENYA Monograph of the Finnish Society for Development Studies No. 4 RICHARD NELSON OCHIENG K'OKUL MATERNAL AND CHILD HEALTH IN KENYA A Study of Poverty, Disease and Malnutrition in Sarnia. Published by The Finnish Society for Development Studies in cooperation with The Scandinavian Institute of African Studies DEDICATION Dedicated to all the malnourished mothers and Children of rural Kenya. Particularly to those Whose vision is still clouded with unawareness. Whose malnutrition is still Biologically determined in utero, At post-partum and in motherhood. Whose malnutrition is man-made, nature-ordained, Or God-conditioned. To them, the 'poor of the earth', Whose health is still in a sombre state; Whose dwelling place is still the hovel; Whose physical health is still in a Horrifying condition. Especially to them, The marginalized group, Who have always lived in a state of deprivation, With inadequate basic provisions - Food and shelter. To those who suffer With disease, hunger, and malnutrition. It is to this group This thesis is dedicated. O K'Okul R.N.O. 1991 Key words: Maternal and child -health - malnutrition-causes - Kenya ISSN 0284-4818 ISBN 9 1-7106 -320X Cover Design by Tiina Poyhonen Printing and Binding: Gummerus Kirjapaino Oy Jyvaskyla 1991 In memory of my mother, Rusalia Anyango CONTENTS iv FIGURES. MAPS. PLATES. TABLES ................................................................ ... ABBREVIATIONS AND ACRONYMS ............................................................... Vlll PREFACE ............................................................................................................. X ACKNOWLEDGMENTS ...................................................................................... xii 1 INTRODUCTION ............................................................................................ 1.1 Aims and scope of the study ........................................................................... 1.2 Terminology and concepts ............................................................................. 1.3 Conceptual framework ................................................................................... 1.3.1 Primary health care ............................................................................. 1.4 Research tools for an alternative approach ..................................................... 1.4.1 A polymorphic approach ..................................................................... 1.4.2 Participatory action-oriented research approach ................................. 2 SAMIA ............................................................................................................. 2.1. Politico-administrativestructure .................................................................... 2.2 Relief and climate ........................................................................................... 2.3 Demographic structure ................................................................................... 2.4 Social Services ............................................................................................... 2.5 Public health ................................................................................................... 2.6 State of water .................................................................................................. 2.6.1 Piped water resources .......................................................................... 2.6.2 Underground water opportunities ....................................................... 2.6.3 Unpredictable nature of surface water ................................................ 2.7 State of fuelwood supply ................................................................................ 2.8 Business and trade .......................................................................................... 2.9 Food system .................................................................................................... 2.9.1 Fertility of land .................................................................................... 2.9.2 The farm sector ................................................................................... 2.9.3 The fishing sector ................................................................................ 2.10 Traveller dietary syndrome ............................................................................ 2.1 1 Remarks .......................................................................................................... 3 PEOPLE. CULTURE AND SOCIETY .......................................................... 3.1 The Luhya ....................................................................................................... 3.2 The Abasamia and their oral tradition ............................................................ 3.2.1 Origin .................................................................................................. 3.2.2 The Great Abasarnia Trek ................................................................... 3.2.3 Cultural Universality ........................................................................... 3.2.4 A society in flux .................................................................................. 3.3 Mythology. religion and children ................................................................... 3.4 Nutrition from the olden days to modem times ............................................. 3.4.1 Social change ...................................................................................... 3.4.2 Magendo: Smuggling. corruption or illegal trade ............................... 3.4.3 Food waste and extravagance ............................................................. 3.4.4 Religiosity. superstition and food taboos ............................................ 3.5 Remarks .......................................................................................................... 4 HOUSEHOLDS EMPIRICAL ANALYSIS .................................................. 4.1 Methods and material ..................................................................................... 4.2 Composition of the data ................................................................................. 4.3 Data analysis ................................................................................................... 4.4 Results of household diagnosis ...................................................................... 4.4.1 Food calendar. preparation and eating habits ...................................... 4.4.2 State of water revisited ........................................................................ 4.4.3 Maternal feeding habits ....................................................................... 4.4.4 Child feeding habits ............................................................................ 4.4.5 Breast-feeding syndrome .................................................................... 4.4.6 Attitudes beyond family planning ....................................................... 4.4.7 Energy-protein malnutrition ................................................................ 4.4.8 Maternal and child health .................................................................... 4.4.9 Household economics ......................................................................... 4.4.10 Household food budget ....................................................................... 4.4.11 Structure of households ....................................................................... 4.4.12 Land opportunities .............................................................................. 4.4.13 Summary of the analysis results .......................................................... 4.6 Remarks .......................................................................................................... 5 MALNUTRITION BASIC CAUSES ............................................................. 5.1 Perspectives of cultural marasmus [chira] Vs kwashiorkor [akuodi] ............. 5.1.1 Cultural chira ....................................................................................... 5.1.2 Cultural akuodi .................................................................................... 5.1.3 Treatment of chira and akuodi ............................................................ 5.2 The five basic endemic disorders ................................................................... 5.2.1 Parasitic helminth ................................................................................ 5.2.2 Malaria ................................................................................................ 5.2.3 Measles ................................................................................................ 5.2.4 Diarrhoea ............................................................................................. 5.2.5 Malnutrition ........................................................................................ 5.3 Merging the complex problems ...................................................................... 5.3.1 Inadequate food intakes ...................................................................... 5.3.2 Disorders impairing absorption and increased nutrient loss ............... 5.4. Lessons from a donor support programme ..................................................... 5.4.1 Introduction ......................................................................................... 5.4.2 Case:
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