Nutrition and Growth Monitoring

Malnutrition contributes to more than 1/3 of all child deaths in Kenya. Rates of malnutrition are usually highest when babies start to eat foods other than breast milk, between 6 and 23 months of age. Nutrition and malnutrition can affect health, intelligence, and productivity. Malnutrition has many levels of effects, from the individual to society. Maara Sub-County in Tharaka Nithi is not exempt from the detrimental effects of malnutrition.

The most common types of malnutrition in this area are stunting (when children are short for their age), children who are underweight, and some cases of wasting. Stunting can be permanent if not corrected. With part of Maara Sub County being arid, this has led to a lack of access to highly nutritious foods, which is then compounded by high costs of foods, as a result of poverty. Lack of knowledge of feeding practices has significantly contributed to malnutrition due to inadequate breastfeeding and offering the wrong foods to children. Infections such as diarrhea and malaria have also led to malnutrition in Maara Sub County.

Village HopeCore has been on a mission to eradicate malnutrition in Maara Sub-County through the provision of nutrition education to parents and growth monitoring services to children of 5 years and below. This is done by inviting parents and their children to various schools that we have liaised with the Sub-County for these services. Growth monitoring is when we regularly check a child’s measurements including head circumference, for children under two years of age. This can come with a light moment when parents’ visual expressions of surprise are shown and we explain that we have to check how babies brains are developing. A child can have a big head or a small head genetically like the parent and that is very normal, but through head circumference screening we can determine potential problems with the brain if any. 

Screening and recognition at an early stage are better than later. At growth monitoring the weight and height of children are taken, (at times this is a bit challenging because children are scared and scream their lungs out); thereafter, we plot this information on a growth chart. If the abnormal growth is visible, for instance, stunting, being underweight, or wasting, we advise the parent accordingly aided with the chart. In case the child has an infection that is resulting in malnutrition, we refer the child to our certified nurses for further treatment. If the charts indicate a -3 z-score (which means the child meets the criteria of acute severe malnutrition), we ask if the child is still eating, because if they get very sick they stop eating. So if this child is sick, not eating, or has both cases of sickness and not eating, we immediately refer this child to a dietician at Chogoria Hospital for possible admission. But if this child is still eating and is well, we refer this child to the dietitian urgently to be seen and managed as an outpatient, where the child is monitored and assessed for some time. At the hospital, the child is given therapeutic food supplements for free, if need be.

Therapeutic foods can help stabilizes the child’s body by provision of all needed nutrients. Furthermore, parents are given more nutrition advice on how to properly feed their children and in case of any given food supplements, they are educated on how to properly feed the right amounts. The majority of parents in Maara Sub-County believe in a diet of starchy food only, hence depriving the babies of all healthy nutrients provided by other clusters of foods. Through our education program, we teach parents to exclusively breastfeed their children for the first six months, where possible, with the continuation of breastfeeding for at least two years and beyond. HIV mothers are also taught the importance of breastfeeding their children for six months while both the mother and child are under the ARV drug. We encourage feeding the right amounts of food and the right kinds of safely prepared foods from six months and above for instance:

• At 6-8 months

  • give soft foods, 2 to 3 spoons

  • give 2 to 3 times a day

  • Uji, Mashed bananas, and mashed potatoes can be given

  • Continue breastfeeding and gradually increase food to ½ of 250 ml cup

• At 9-11 months

  • Improve the soft food,

  • Plant proteins are given e.g., dengu (lentils), beans

  • Carbohydrates are given e.g., ugali, Rice, Potatoes, uji, and millet

  • Vitamins are given e.g., mangoes, papaya, bananas, and a variety of vegetables, about ½ of 250 ml cup should be given at this stage 3 times per day, with snacks if necessary.

  • Continue breastfeeding.

• At 12-24 months

  • Plant proteins are given e.g dengu (lentils), beans

  • Carbohydrates are given e.g., ugali, rice, potatoes, uji, and millet

  • Vitamins are also given e.g., mangoes, papaya, bananas, and a variety of vegetables available, about ¾ to 1 cup of 250 ml cup should be given at this stage, the baby should be fed 5 times a day, 3 meals, and 2 snacks.

Through this initiative, we get the chance to look at children’s clinic cards and observe if they are up today with their immunizations and more specifically the Vitamin A. Many of the parents we screen fail to take their children to clinic for the Vitamin A after babies reach 1 year and 6 months and they have had all other vaccinations. So we give Vitamin A to the children and encourage parents to take their children for Vitamin A dose after every six months till they are five years of age. Through this program, we aim to reduce child mortality rates caused by malnutrition and improve the overview of nutrition in Maara Sub-County and thus make Tharaka Nithi a malnutrition-free county.