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Kenya: Community surveillance and sensitization must continue for fast identification of malnutrition

Zeitun Yussuf is one of the Médecins Sans Frontières (MSF) community health educators (CHEs) whose work includes carrying out community surveillance and health education. CHE’s are based in the community and have been actively identifying, observing and reporting malnutrition cases from the community. Their work is critical for early detection, enrolment and management of malnutrition cases. She shares her experience as a community health educator and her personal experiences with the drought.

Zeitun Yussuf(centre) and Fiona Mutindwa (right) speak to a mother during an outreach in Illeret

"I am 29 years old, married with two children. I live in Illeret with my family and work with MSF as a community health educator in the malnutrition response. I have always wanted to serve my community. My work includes community surveillance, and health education by simplifying medical terms between medical staff and the community while sensitizing the community on hygiene, nutrition and uptake of medical services.

The health messages include malnutrition, balancing locally available foods, supplements and other items like clothes, the community-based outpatient feeding programme, immunizations and vaccinations, use of family planning, and support available for caregivers of children not responding to treatment.

Through health education during outreaches and community meetings, we empower the community and caregivers to facilitate the identification and referral of malnourished children. These caregivers are the focal persons representing the various villages who cascade health information within the community. Explaining to families why not to share the supplements, with added food distribution from other agencies, has lowered the sharing of children’s supplements reducing the malnutrition rates. But this must continue.

Ambrose Nyakoo community health educator gives a talk in an outreach [ © Njiiri Karago/MSF]Ambrose Nyakoo, community health educator, gives a talk during an outreach session with the community [ © Njiiri Karago/MSF]

As the drought intensifies, food remains scarce. I witnessed high rates of malnutrition among children in the beginning of the year. Pregnant and lactating mothers do not eat well too, increasing diseases and dependency on relief food. Women sell wood or charcoal to survive- and sometimes they come home late in the evening unable to cook a meal for the family, leaving children home alone most of the time. Besides looking for pasture for their animals, the men sometimes go fishing but have no luck most times.

We do home visits for children who do not respond to treatment (non-responders). These children stay in the nutrition program for a long time mostly because besides the supplements provided, they do not eat. I have seen children sharing supplements and families eating them as the main food, it is disheartening. Few people in the community have identification cards or mobile phones which are the main criteria used for the food distributions. When they miss out, families who receive are forced to share what they get – meaning the food is never enough.

Families keep moving to look for pasture for their livestock and water. Sometimes the whole village moves, and if we are unable to trace them, follow-up for non-responders is impacted. Getting water at the shallow well- dug-up holes along dry riverbeds is work for the women. My mother, sister and I are lucky as we live two kilometres away from one another, taking us at least two hours per trip. With no water treatment available, we use the water as is and boil some for drinking.

Most livestock has died. We sell the remaining livestock to be able to buy food in Ethiopia. The market is twenty-six kilometres away from where I live and is a whole day affair. We must leave at six in the morning, for a slow nine-hour walk to the market with livestock to sell. Most of the animals are weak from hunger, making the journey painfully slow. We then scout for the best buyers since the market days are not as promising as before. We buy as much food as we can with the money from the sale, leaving for home around five in the evening with the donkeys carrying the food.

During one of the outreaches, the focal persons alerted us about four children from different villages who were very ill. They had been identified as already dead in the community. We picked them up with an MSF car and rushed them to the health facility, where they were admitted for several weeks until they got better and were discharged.

Outreaches enable people who cannot access care, maybe due to distance, or fear of hospitals get early medical attention. Most people here believe that when one goes to the hospital they must be injected- and this is because most come to the hospital when children are in a critical condition and the local remedies have failed. Therefore, community education is still crucial.

Community surveillance and sensitization must continue to ensure the rates of malnutrition reduce. Early detection, enrollment, management and lowering of malnutrition rates depend on this.


About the Response

Since mid-March 2022, MSF team has been supporting county health authorities in Illeret Ward in Marsabit County in responding to the malnutrition crisis by strengthening the medical component of Integrated Management of Acute Malnutrition (IMAM) through outreach activities and screening and setting up an Inpatient Therapeutic Feeding center (ITFC) at the Illeret health centre.

By first week of December 2022, MSF team had screened 24,182 children aged 6-59 months, newly enrolling 1,354 children identified with malnutrition. Outreaches Community surveillance and sensitizations conducted identified 117 of the 137 malnourished children admitted in the ITFC in Illeret Health Center, showing the dire situation underreported within the community. Three children were referred to the nearest higher-level facility.

MSF carried out 6,438 medical consultations and supported the Ministry of Health in the routine vaccination of 3,041 children under 5 years.

3,219 pregnant and lactating mothers were screened and received supplements with 1,467 women receiving anti-natal clinic consultations during the community outreaches.

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