The Applied Nutrition Project of Eastern Kenya – an Initiative for Reducing Hunger and Malnutrition

Coll. Antropol. 25 (2001) 2: 665–672 UDC 614.2:613.24(676.2) Professional paper

The Applied Nutrition Project of Eastern Kenya – An Initiative for Reducing Hunger and Malnutrition

M. G. Leube and I. Fernandez-Abad

Saint Louis University, Madrid, Spain

»Give a man a fish and he will eat for a day. Teach a man how to fish and he will eat his whole life« Chinese Proverb

ABSTRACT

Sustainable development is the only kind of development possible for help in the third world. Due to various historical, political, geographic and climatic conditions the divergence between those countries providing and those receiving help is so vast that donations of labor an/or money is simply not enough. Rather, communities have to be taught to support and develop themselves during the receipt of aid and especially after the help pulls out. It is our goal in this article to summarize one such »sustainable development« project. As volunteers for AMREF (African Medical and Research Founda- tion), we worked with the remarkable Makueni Applied Nutrition Project in eastern Kenya in the summer of 2001. Our job was to visit the various locations in this semi- arid and arid environment and to write a report on the situation of the diverse parts of the project. The Applied Nutrition Project (ANP) started in 1984 and serves as an excel- lent example of the significant help that can be provided to needy areas of the world with a multifaceted approach.

Introduction borne rescue service in 1957. Sir Michael Wood (England), Sir Archibald McIndoe AMREF (New Zealand) and Dr. Thomas D. Rees Before outlining the Applied Nutrition (USA) founded it in order to provide to Project (ANP) we want to briefly intro- help for the miserable conditions encoun- duce AMREF. The African Medical and tered in Africa. AMREF now coexists Research Foundation (AMREF) started with The Flying Doctors and is a NGO as The Flying Doctors, a fully staffed air- functioning on donations from bilateral

Received for publication October 2, 2001.

665 M. G. Leube and I. Fernandez-Abad: Applied Nutrition Project, Coll. Antropol. 25 (2001) 2: 665–672 and multilateral institutions, private cor- school health, teenage pregnancies, porations, international organizations childhood and adolescent illnes- ses. and individuals from Africa, Asia, Europe • Thirdly, attention is given to Environ- and North America. Although its head- mental Health especially to accessibil- quarter is in Nairobi, AMREF has inter- ity of safe water and sanitation. The national offices all over Europe as well as treatment of malaria and cases of hy- in the United States1. datid, a cyst of watery fluid formed by AMREF’s bold mission is to improve and containing a tapeworm larva is es- the health of the most disadvantaged peo- pecially important in many regions of ple in Africa. Its program countries are Africa. For this program area, the tar- the Sudan, Ethiopia, Somalia, Kenya, get groups are rural and urban commu- Tanzania, Malawi, Mozambique and nities, service providers as well as pol- South Africa, but the organization also icy makers. actively helps people in other troubled re- • Health Policies and Systems Reform is gions such as Nigeria, Ghana, Sierra Le- another important area of focus for one, Namibia, Botswana, Zimbabwe and AMREF since more often then not the Zambia. AMREF enjoys a high organiza- roots of problems in the third world are tional level and is thus very effective in a lack of organization and a high level easing the suffering of countless people. of governmental corruption, especially Indeed, it was internationally recognized in the educational and health sectors. for its achievements by receiving the pre- AMREF addresses specifically govern- stigious Conrad N. Hilton Humanitarian ments and local health boards but also Award in 1999. Out of 225 nominations of service providers as well as NGOs. organizations from 53 countries, AMREF • Finally, AMREF is involved with Direct was recognized as the winner of this prize Medical Help. The Flying Doctors of 1 million, which in prestige and mone- Emergency Services serves as a high tary value is only equaled by the Nobel quality air ambulance and rescue ser- Peace Prize2. vice throughout Africa. AMREF also • In order to reach its mission, AMREF provides rural laboratories, doctors and focuses on five different program areas. nurses for troubled regions1. All five are often implemented simultaneously because it is understood that a Background of the Applied troubled area can not be helped with a Nutrition Project simple one-sided remedy but only with caring coming from several different Project location angles. The ANP was developed as a compo- • The first area of focus is Sexual and Re- nent of the Kibwezi rural health scheme productive Health. Considering that the (KRHS) in the divisions of Mtito Andei African continent was hit especially and Makindu within the Makueni dis- hard by the HIV/AIDS and tuberculosis trict, eastern province, Kenya. To be ex- epidemics, AMREF helps by targeting act, the project is located 200 km south of policy makers, service providers, com- Nairobi along the Nairobi-Mombassa highway in the arid and semi-arid lands munity members and high- risk behav- of Kenya. The area is collectively known ior groups. for its largest town Kibwezi. Rainfall in • Secondly, AMREF focuses on Child and this region is highly erratic in terms of Adolescent Health, the key activity ar- onset, distribution and intensity with the eas being child survival, nutrition, poor annual average of 500 mm, making

666 M. G. Leube and I. Fernandez-Abad: Applied Nutrition Project, Coll. Antropol. 25 (2001) 2: 665–672 the area permanently food-insecure. In- The project deed, the historical records indicate that As a result of the above causes the a good harvest can only be expected once poverty level within families in Kibwezi every three years. is high, observable indicators being hunger, malnutrition, frequent diseases, poor Population accessibility to safe drinking water, poor The peoples of this region belong housing, low educational level and high mostly to the Akamba ethnic group. Ma- percentage of female households. The kindu and Mtito Andei divisions have a ANP addresses both the immediate and total population of 106,200, almost 40% underlying causes of malnutrition in Kib- of which are women of child-bearing age wezi; again its main objective is the im- and children under five years of age. The- provement of the nutritional status of se two groups are most vulnerable to mal- children under five years of age and nutrition and for this simple reason they women of childbearing ages. In 1984, have been the project’s main target AMREF started a nine-month emergency groups from the start. The average hou- supplementary feeding program against sehold size is 7 with a male/female ratio food stress for children under five years of of 11:103. age, benefiting a total of 10,000 children. Soon after, in 1986 the ANP was created Health due to an urgent need for a long-term and There are major health problems in integrated approach. Kibwezi. The most severe ones include The objectives of the ANP are: malaria, acute respiratory tract infection, schistosomiasis, sexually transmitted di- • Improving household food security sease (STD), skin disease, diarrhea and • Increasing income at household levels of course malnutrition3. • Improving feeding practices for children under five years of age Nutrition • Increasing accessibility to water at Due to a complex web of factors, Kib- the household level wezi experiences chronic malnutrition. There – as well as in any other area of In order to achieve these objectives, malnutrition – it is difficult to say what the ANP applies a participatory approach. exactly are the causes of malnutrition but In the beginning, already existing groups it is surely associated with a collection of of the community identified their specific natural as well as man-made factors. Cli- needs and problems. They were then pro- mate conditions like unreliable rainfall, vided with education, information, advice poor soils and frequent droughts are Na- on the implementation of project activi- ture’s negative dispositions for the area. ties as well as monetary loans. From the Among the man-made factors, low level of start, the community itself functioned as infrastructure, inadequate health servi- the main decision-making body4. ces as well as socioeconomic, agro-ecologi- cal, demographic and educational charac- teristics further increase the likelihood of Objectives and Strategies malnutrition, especially for children un- Improved household food security at the der five years and women of child bearing household level ages. A recent study of the area thus showed that 39 % of the children between 1. Small livestock production 2 and 36 months were stunted and 4% Poultry and goats are more drought were wasted4. resistant than crops, more accessible to

667 M. G. Leube and I. Fernandez-Abad: Applied Nutrition Project, Coll. Antropol. 25 (2001) 2: 665–672 the household for food and income and approached AMREF for the implementa- are the main coping mechanism during tion and completion of a »seed bank«. An times of food stress. Therefore, improved initial 60 kg of green grains and 60 kg of (stronger and healthier) cockerels and cow peas were loaned to the group, the bucks have been made available by seeds were then divided among the mem- AMREF to individual women of the com- bers and planted. A fraction of the return munities for cash or credit. Besides mak- seeds were collected in a ‚seed bank’, ing improved animals available, AMREF which acts as a security system in times trained government officials, who in turn of drought. Again, AMREF provided trai- trained community members on selective ning for optimal selecting principles as breeding, management and disease pre- well as the prevention of storage pests. A vention of the animals2. Examples of the member stated that the group was easily successful introduction of stronger, more able to cope with droughts of up to three resistant goats can be seen in the Kai years. Also, as attested by another, seeds community and the Kanini Kaseo women could be sold to other non-members in the group, both in the Makindu division. An community in times of harvest failure. It improved buck can breed with up to was reassuring to see this »simple« idea thirty females, making the population of a »seed bank« to work so well. bigger and stronger after only one generation. Not only are the produced animals 3. Food storage capable of providing more milk and meat; The Kathekani food store is located in they also sell for more money at the mar- the extremely arid area of Mtito Andei di- ket place. Thus, one of the farmers stated vision and represents another measure that the selling prizes for the animals for improving food security. Due to the have doubled within one generation form type of soil in this area, the sporadic rain 1,000 to 2,000 KSH (Kenyan Schilling). that does fall cannot be absorbed and Regarding poultry improvement, changes causes soil erosion. Started by 45 people, can easily be observed with the indicators this community-based project was paid of size and quantity of the eggs. for by extensive fund raising as well as a 2. Promotion of drought resistant crops loan from AMREF. Before the ANP was started, farmers The food storage has helped the com- were growing mostly maize and beans. munity because less time has to be spent The harvest of these crops are not bad, by people searching for seeds. It is also a has cash potential and is tasty. However, way of assuring the stability of prices in these crops are much less hardy during times of drought, since they are bought at times of rainfall. With this in mind, the a cheap price and stored until severe ANP has created awareness on the im- weather conditions. Most importantly, of portance of growing sorghum, millet, cow course, the storage provides added secu- peas, green grains and cassava instead, rity in terms of adequate seeds for the all of which are more tolerant to poor area3. soils and little rainfall. Individuals and According to members of this project, women groups were trained on storage, there has not been a satisfactory harvest preservation, crop and seed husbandry in three years and the prices of grains on and community bulking. Furthermore, the market have risen dramatically. Dur- women have been supported in the estab- ing the drought of 2000, a significant lishment of »seed banks«3. amount of livestock was lost since rivers As part of our research we visited the and water sources dried up and the price Kanini Kaseo women’s group, who had of 1kg of maize increased from 8.10 KSH

668 M. G. Leube and I. Fernandez-Abad: Applied Nutrition Project, Coll. Antropol. 25 (2001) 2: 665–672 to 20 KSH. Considering that only one in The program as it stands now, covers a every thirty people has a steady income, total of six divisions, within which 43 dif- it is not surprising that Kathekani com- ferent community projects are function- munity was especially affected by the ing. ‚Food for Work’ not only alleviates drought. As a consequence, many chil- the immediate problem of hunger in dren have dropped out of school since times of food stress, but also speeds up their priorities became the acquisition of and encourages the socio-economic devel- food and the raising of money. opment and infrastructure of the respective communities. The full implementa- For the implementation of the Kathe- tion of the project is estimated to benefit kani food store, the 45 members had to respectable 10,864 households (65,000 pay an initial membership of 100 KSH. people) between the months of July and Added to that cumulative money was a December 2001. monthly membership fee of 20 KSH, a fund of 23,000 KSH raised by the mem- Increased income at household level bers and a generous loan from AMREF of Another part of ANT is based on the 200,000 KSH. The latter loan allowed the support of income generating activities purchase of 246 bags of maize. The group (IGAs) within women groups, aiming to built the structure of the building with increasing women’s income and subse- their own bricks as well as materials pro- quent purchasing power. The IGAs sup- vided by AMREF. Once the food store was ply another source of income, allowing completed, the situation within the com- members of different groups to hang on to munity changed noticeably. The people their food and livestock in times of severe are now able to sell their harvest’s sur- droughts. plus as well as buy seeds at a reasonable price in times of poor harvest. First, awareness is raised on the im- portance of income generation for already 4. Food for work formed groups. After this initial step, the groups are trained on leadership, team Before 1999, the Kenyan govern- building and decision making. Loans are ment’s strategy of coping with malnutri- given by AMREF to a group, which pro- tion and starvation was the direct supply vide collateral for members. These loans of food to needed areas. Led by AMREF in are then used by individuals as start-up February 2000, this approach now focu- capital for small businesses such as sell- ses on the most needed areas. And such ing paraffin, cereals, vegetables and live- target areas- the poorest and driest- are stock. One woman even stated that she no longer supplied with direct nourish- used the money for purchasing a plough ment but rather introduced with a new that she rents to other community mem- program called »Food for Work«. bers. Another woman of the Kanini Kaseo In April 2000, the program started by group said, »my harvest has increased sensitizing the most needy communities four times with a second ox that I was to design useful and viable projects for able to buy. Some money also went into the respective areas. The 43 projects in- my husband’s business.« With such busi- clude tree planting, rehabilitation of cat- nesses, the majority of the group was able tle dips and water sources, the construc- to easily cope with the drought of 2000. In tion of school classrooms and irrigation case of emergencies, the group has put channels as well as grain stores. The dif- aside a fund of 5,000 KSH3. ferent kinds of work, all of which benefit Furthermore, the IGAs have improved the community are rewarded with food4. the educational level of the community,

669 M. G. Leube and I. Fernandez-Abad: Applied Nutrition Project, Coll. Antropol. 25 (2001) 2: 665–672 as was attested by one group member, reduce food uptake and contribute to mal- who, with the sale of paraffin was able to nutrition. send her children to primary school and The Kai water project is a very positive pay off most of her loans. step forward and away from malnutri- With the success of some of the pio- tion. On October 22nd 1999, this project neering groups, others have been encour- was set into motion when the digging of a aged to follow the example; this is the five-kilometer trench for water pipes was case with one group called Kanini Kaseo started. The digging was finished before B. It is given direct and practical advise Christmas 1999 and clean water flowed by already existing groups. at Kai on January 25th 2000. By March 1st 2000, water was distributed to the peo- Improved feeding practices of children ple. The water originates from Makindu under five years of age town, 15 km away and is now distributed In 1986, the Kibwezi nutrition survey at three kiosks, each outfitted with a revealed very poor feeding and weaning 25-m³ water-tank. The kiosks are staffed practices in the Kibwezi area. Most of the with one attendant for each and water is mothers breast-fed for over two years and available for the price of 2 KSH for 6 li- 38.5 per cent of them supplemented ters. Besides the attendants, three arti- breast feeding either too early or too late. sans are employed for the maintenance of In addition, the weaning foods were often the trenches and pipes. low in energy and nutrient density and Over 40.300 KSH is collected from the the feeding of children was infrequent. three kiosks every month, making the Food was often prepared in unsanitary Kai water project admirable for proving conditions, exposing the children to diar- both income and employment. But most rhea, and it was common for mothers to importantly, the community based water withdraw foods such as milk during epi- project in cooperation with AMREF and sodes of measles and diarrhea. the Kenyan Government has supplied the With an awareness of such problems, region with life-essential water. Other po- information on proper breast feeding and sitive side effects are the easier irrigation weaning practices was given to mothers of plants, feeding of livestock, as well as and women groups by traditional birth improved personal hygiene. In addition, attendants (TBAs) at health facilities du- some committee members have been able ring child welfare workshops4. to start tree nurseries. Not only people from Kai, but also from Syumile, Tun- Increased accessibility to water at guni, Kilema and beyond, walking up to household level 18 km come to draw clean water at the Drinking water – one of the most basic kiosks3. human necessities – has been another priority for the ANP. Sources in Kibwezi School feeding programs are few and often very distant from the One of the consequences of drought majority of households, forcing women to periods is the decrease in the school at- spend a long time searching for water. tendance due to children’s hunger and This endeavor keeps them away from ho- search for income. In June 2000, a joint me, decreasing the quality of care and program between the Kenyan Govern- feeding for the growing child. In addition, ment and World Food Project (WFP) was there is a general problem of unsafe drin- coordinated by AMREF. It focuses on 19 king water, leading to diseases such as di- districts including arid and semi- arid ar- arrhea or schistosomiasis, which in turn eas and benefits 837 schools. The dura-

670 M. G. Leube and I. Fernandez-Abad: Applied Nutrition Project, Coll. Antropol. 25 (2001) 2: 665–672 tion of the program was set between June neys. The combined effect of these treat- 2000 and February 2002 and has as its ments would then help the person to get objective the improvement of the nutri- on his(her) feet again. Thus, each of the tional status of students as well as their ANP’s areas of focus has effectively hel- school attendance. The food supplied con- ped to reduce overall vulnerability to sists of cereals, vegetable oil and pulses4. malnutrition. We saw the effectiveness of this holistic approach to development in the described thriving community-based Conclusions projects. Since such undertakings only work with the help of many people and at The Makueni Applied Nutrition Pro- the same time provide priceless learning ject users a multi-facetted and participa- experiences, we want to encourage the tory approach for the improvement of nu- reader to volunteer and partake in simi- trition of under 5 year olds as well as lar projects. child-bearing women in Makueni Dis- trict, Kenya. Malnutrition- in any area- is a highly complex issue, dependent on ma- Acknowledgement ny different factors of the socio-economic, The information for this article was cultural and physical environment. It is gathered by Michael G. Leube and Isabel thus important to simultaneously ad- Fernandez-Abad in the summer of 2001. dress different, immediate and underly- With the help of Susan Kilobia, the ANP ing causes. Childbearing women, due to program director as a translator we con- their reproductive roles and children un- ducted interviews on location in Kenya. der five years, due to their special nutri- Furthermore, we used the following writ- tional needs for growth and development ten material provided to us by AMREF, are considered more vulnerable to malnu- Kenya: 1. Maksud, N., Mbugua, I., AMREF trition. Annual Report 1999, Information Unit, To use a sick person as a metaphor, it Nairobi, 1999 2. AMREF General Infor- is not a satisfactory treatment to only mation and Statistics, Information Unit, give that person painkiller. Much more Nairobi, 1999. 3. AMREF in Kenya, Infor- effective would be to supply specific reme- mation Unit, Nairobi, 1999. 4. AMREF’s dies for the open sore on the arm, the Kibwezi Rural Health Scheme, Informa- cough in the lung and the pain in the kid- tion Unit, Nairobi, 1998.

REFERENCES

1. MAKSUD, N., I. MBUGUA: AMREF Annual ject. Experiences and lessons learned 1986–1998. report 1999. (AMREF: Information Unit, Naurobi, (AMREF: Kenya Country Office, Nairobi, 1998). — 4. 1999). — 2. AMREF: General information and statis- AMREF’s Kibwezi rural health scheme. (AMREF: In- tics. (AMREF: Information Unit, Nairobi, 1999). — 3. formation Unit, Nairobi, 1999). NDAVU, E. (Ed.): Makueni Applied Nutrition Pro-

M. Leube

Saint Louis University (Madrid Campus), Avenida del Valle 34 y 28, 28003 Madrid, Spain

671 M. G. Leube and I. Fernandez-Abad: Applied Nutrition Project, Coll. Antropol. 25 (2001) 2: 665–672

PRIMIJENJENI PROJEKT PREHRANE U ISTO^NOJ KENIJI: INICIJATIVA ZA SMANJENJE GLADI I POTHRANJENOSTI

SA@ETAK

Odrìvi razvoj, jedini je tip razvoja koji moè pomo}i zemljama tre}eg svijeta. Zbog razli~itih povijesnih, politi~kih, zemljopisnih i klimatskih uvjeta, razlike me|u dràvama koje pruàju i onima koje primaju pomo}, toliko su velike da donacije rada i/ili novca jednostavno nisu dovoljne. Dràve koje primaju pomo} trebalo bi podu~iti kako odràti vlastiti razvoj i to ve} tijekom primanja pomo}i, a posebice nakon {to pomo} prestane pristizati. Kao volonteri za AMREF (Ameri~ki medicinski i istraìva~ki fond), tijekom ljeta 2001. godine, radili smo u sklopu zna~ajnog »Makueni projekta primijenjene prehrane« (ANP) u isto~noj Keniji. Na{ je posao bio posjetiti razli~ite loka- litete u ovom polu-pustinjskom i pustinjskom okoli{u i napisati izvje{}e o na|enom stanju, a s obzirom na razli~ite aspekte projekta. »Makueni projekt primijenjene prehrane« zapo~eo je 1984. godine i posluìo je kao odli~an primjer zna~ajne pomo}i koju ovakav vi{eslojni pristup moè pruìti u podru~jima kojima je ona potrebna.

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