By  Lorraine Anyango.

Six weeks old Sharon and her twin brother Shadrack, suffering acute malnutrition are admitted to the Therapeutic Feeding Room at Obama ward, Jaramogo Oginga Oginga Teaching and Referral Hospital (JOOTRH) in Kisumu.

The duo is under the care of their grandmother as their teenage mother is admitted to a different room at the same hospital after complications following the rapture of her healing wound accosted by the Cesarean procedure she had.

As the doctors and nurses attended to Sharon, they discovered that she also has sickle cell. The next bed to Sharon and her brother is occupied with Ochieng, his face is puffed, and his limbs have edema a sign of severe malnutrition which is Kwashiorkor.

18-months Ochieng’s grandmother is the one nursing him at the hospital as his teenage mother is away in school. The grandmother was not aware of the puff on his grandson’s face was a result of Kwashiorkor.

The puffiness is an indication that the organs in the body are failing, and the body electrolytes are not functioning to ensure the water is circulated within the body system as expected.

From Ochieng’s file next to his bed, he was feeding on Rice and black tea severally being the only meal his grandmother could afford.

Between the two beds is a heater to warm the children because of water retention, the children are often cold due to the acuteness of malnutrition condition.

Counting one by one the emaciated and wasted children admitted in this ward are mothered by teenagers, some with mental challenges and hence unable to feed their young ones properly.

A lot of the children come in sick with varied conditions, however, the underlying condition remains malnutrition.

There are two types of severe malnutrition, one is acute and kwashiorkor, where the infants’ feeds on carbohydrate-rich foods without including proteins that are essential for organ development. The other is wasting where the patient goes without food for long till the body gets into shock.

“We receive children in shock due to malnutrition at the High Dependency Unit (HDU), we introduce feeds to stabilize them after which we transfer them to the Therapeutic Feeding Room.” Dr. Ogola Don, a pediatrician at Obama said.

This grim reality of malnutrition is what welcomed a delegation from the National Government, Ministry of Health, division on Nutrition and Ministry of Agriculture, Agri Nutrition division accompanied by ‘Advancing Nutrition’ Kenyan team as they visited JOOTRH.

The delegation included Mrs. Veronica Kiragu, Head of the division of Nutrition and Dietetics, Mrs. Jane Wambugu, Head of Agri nutrition department, USAID funded ‘Advancing Nutrition program’ Chief of Party Dr. Peter Milo, and Mrs. Leila Adhiambo Assistant Director Nutrition and Dietetics among others.

It takes approximately Ksh 12,000 to fully treat a single child with malnutrition as an outpatient, and the treatment takes about eight to 12 weeks. A child with severe malnutrition is an admission case and it cost approximately 25,000 to treat them.

The infants are fed with expensive commodities that are not high protein diet, they are fed with F75 and F 500 which are specialized milk with high electrolytes concentration and nutrients to help the body excrete the water.

This feeding is done every three hours for days, until the infants are stable and can be graduated to other recommended feeds, upon discharge, the caregivers get nutrition counseling, and the children can transit to the family diet or be on ready-to-use therapeutic foods (RTF).

During management, the children lose weight at the onset, because the water is removed then they later gain weight, during this period they are supposed to exclusively feed on the specialized milk.

“Annually Kenya requires about 5 billion for nutrition, 3 billion goes towards commodities alone, specifically therapeutic feeds for the infants, When the feed is administered, they cannot do mix feeding until the stipulated amount is fully consumed.” Mrs. Odhiambo said.

The ministries of Health and Agriculture, both at the National and County government have in the recent past come together in a Multi-Sectoral Approach under the ‘Advancing Nutrition’ program to address nutrition issues across the board.

“If such children get in the wrong management they will not survive, they will be no more in  a day or two.” Mrs. Odhiambo cautioned.

Often children are referred to JOOTRH because other facilities do not have the specialized milk, we are always in need of these commodities yet these are the counties that have food.” Mrs. Odhiambo said.

“We need a business unusual approach, dealing with malnutrition at the hospital level is very costly and the recourses are not always available, the government procures the commodities however if the households can be empowered then the cases will not be served.” Mrs. Odhiambo said.

The underlying causes of malnutrition are a result of the family setup, some families do not have food, while in some the level of education of the mother helps in opening one’s mind in decision making and seeking care.

Agriculture is a potential intervener, even without money families can grow iron-rich vegetables among other food plants.

In the Arid and Semi-Arid areas in Kenya that have experienced five failed seasons due to the drought cycle, they have wasting in children because of lack of food, yet they do not die easily like Kwashiorkor.

The team also visited Kisumu County Referral Hospital (KCRH) where the facility has put up conical gardens to not only ensure access to green leafy vegetables grown organically but to serve as demonstration sites for learning and motivating the populace to start growing their vegetables.

Since the setting up of the site the vegetables are harvested every Thursday and are used to feed children in the pediatric ward.

The culmination of the visit was at the Kibuye breastfeeding room, set up with support from Kidogo CSO to encourage women to practice exclusive breast even when they have to go back to work by providing a safe place for that.

The interventions by the Advancing nutrition program and others have only done so much, there are still gaps, while the Country needs five billion the government has only allocated Ksh 80 million, the gap needs further interventions especially procurement of commodities for nutrition.