MICRONUTRIENT MALNUTRITION IN KENYA

Micronutrient malnutrition, particularly vitamin A deficiency (VAD), iron deficiency anaemia (IDA), and iodine deficiency disorders (IDD) are major public health concerns globally [1]. They pose a serious threat to the vulnerable members of the society especially in developing countries. These vulnerable groups of the population are mostly infants, preschool children, school-age children, and women of child-bearing age. In fact, over the last decade, several global meetings such as the World Summit for Children, 1990, The International Conference for Nutrition, 1992 and The World Food Summit, 1996 have made commitment to reduce malnutrition and have also called for global action to address these deficiencies [2]. Despite this call, 800 million people worldwide are still chronically malnourished [3]. In Kenya, apart from these three, Zinc and Iron have also been identified as priority micronutrient [4].

Iodine deficiency anaemia affects 1.5 billion people; VAD is estimated to affect at least 250 million children in the developing world. At least 230 million preschool children are vitamin A deficient; 2 billion people are estimated to be living in areas at risk of iodine deficiency [3, 1]. The figures worldwide are disturbing, despite the effort to fight the problem of micronutrient deficiency by major international organizations. In Kenya, 16% and 60% are iodine and iron deficient respectively, while the prevalence of acute and moderate VAD are 14.7% and 61.2% among children and 9.1% and 29.6% among mothers respectively. For zinc, high risk of its deficiency occurs in about half of the men, children and mothers, however, its magnitude in the Kenyan population is not clear due to insufficient research data from the nutritional surveys [5].

Micronutrient malnutrition remains a major problem facing Kenya’s poor and needy population. Its impact in this population is worsened by the HIV/AIDS pandemic. Recent studies have found that HIV/AIDS is associated with vitamin A deficiency in developing countries [6, 7]. Positive response has also been reported on the complications associated with HIV when vitamin A supplementation is administered [8]. Micronutrient deficiency has severe consequences namely stunted growth, blindness, reduce the human capacity to work, cause high maternal mortality, miscarriages and still-births in deficient mothers, just to name a few. Virtually, this would translate into poor economic development. If left unchecked, these deficiencies will set a vicious cycle effect that will take many generations to correct.

Vitamin A deficiency and IDA are primarily caused by dietary inadequacy, while IDD is determined by iodine content of soil and water in the environment. According to the 1999 National Micronutrient Survey Report done in Kenya [5], it is clearly evident that certain actions need to be taken to address micronutrient deficiency if Kenya is to realize any viable economic development by the year 2020.

Strategies to combat micronutrient deficiency in Kenya include:

Nutrition Education
In January this year (2003), the Kenyan government introduced Free and Compulsory Primary Education, a universally accepted concept to all school going-age children. Children are better “tools” for change. Therefore, nutrition education should be introduced as a subject of its own in primary schools’ education curriculum. As per now, Nutrition is taught as part of science or other subjects; as such they (children) do not realize how important it is to their health. Since nutrition education is concerned with changing an individual’s behavior [9], it will be worthwhile to use pupils as change agents. However, the methods employed in dissemination must be appropriate from both social and cultural points of view.

The other strategies include extensive training of key community personalities as change agents, as well as social mobilization and community participation. These key figures include sub-chiefs, chiefs, and leaders of development groups-men, women, youth (in rural and urban areas), teachers and any other person that members of the society hold in high esteem. These will serve as very good change agents as members of the society will always be ready to listen to them and implement what they tell them (members of the society). This way the message will always reach the intended target and create widespread impact in the Kenyan society.

Social mobilization and community participation would entail involving the community at all levels and steps from planning to evaluation of the nutritional programmes. This way members of the community will develop confidence in these programs, thus eliminate any suspicion from their side, as they are not always ready to adopt any new idea they do not understand for fear of “conspiracy”. Their full involvement in these programmes will ensure their full participation and openness. When they are involved, the approach adopted should be that which helps identify unique problems to each and every community and help them prioritize their own needs [10].

Nutrition education should also be geared towards establishing existing levels of nutrition knowledge, attitudes and practices. This should primarily target women, as they are the ones who mostly make the important decision of what to be eaten at every mealtime in their households. This way, the voids and gaps in nutritional knowledge, attitudes and practice will be identified. These include taboos, food beliefs and superstition. Then concerted efforts should be taken to address these gaps adequately. In most communities in Kenya, food beliefs, preferences and habits of the whole family are usually passed on from one generation to another and thus become customs or traditions. They thus dictate how the community or family select their foods and prepare them. However, without knowing, some of these practices are what lead to poor nutrition and health problems in the first place. Hence nutrition education should be used as a tool and technique to sensitize and create awareness at community level.

Food-based approach
In Kenya, most of the communities have traditional staple crops, which are rich in micronutrients. These include the indigenous vegetables, fruits, tubers and roots, most of which have been under utilized due to lack of information on their nutritional value. Most of them just grow as wild plants. These traditional staple food crops if tapped or exploited are likely to be a more sustainable means as well as long-term solution to micronutrient deficiency elimination. The focus therefore, should be laid on programmes that intend to increase the production of micronutrient–rich foods and introduction of high nutrient density varieties of staple food crops. The rural folk should be encouraged to set up small-scale vegetable and fruit gardens in, on and around their buildings. Indigenous staple crops are widely used and acceptable in many communities, moreover, most of the necessary required technical knowledge already exists among the villagers. In addition, these traditional staple crops adapt well to the local soil and climate. Intercropping of vegetables among the tree varieties whose fruits or leaves are consumed like mangoes and pawpaw must be encouraged. To ensure wider impact, group-based and school-based gardening programmes need to be accorded priority. School-based approaches will accord the children the chance to practically participate in the cultivation as well as understanding why good nutrition is important. In these programmes, the production of those food crops that are frequently consumed and those that are favored by children like yellow variety of sweet potato, carrots, green leafy vegetables, pumpkins, guavas, wild fruits and berries should be encouraged as a means to increase bioavailability of micronutrients from staple foods. Varieties with high levels of vitamin C, vitamin A and provitamin A should be selected and given more attention[5].

Fortification
Today, fortification is increasingly recognized as a medium- to long-term strategy for improving micronutrient status in large populations in the third world countries [1]. Despite its importance, it is a very costly venture thus the Kenyan government should give sufficient incentives to the industries that engage in food fortification programmes to stimulate active and sustained fortification. In implementing fortification programmes, the available capacity in our local universities, research institutions and industries should be tapped for better results. Fortification is favored because it does not require dietary habit changes, can be implemented relatively quickly and is sustainable if managed well. Since in Kenya, most people use salt, sugar and flour, they will serve as perfect food vehicles to reach the vulnerable population. However, enforcement of fortification regulation is very difficult, as it requires effective quality assurance, which requires highly qualified personnel [1].

Changing Food Policy Environment
For many Kenyan citizens, the installation of a new government was the birth of a new era; however, the major challenge facing Kenya’s population today is micronutrient malnutrition and food insecurity. Despite the fact that significant progress has been made in increasing food production and reducing the food insecurity in the world over the last thirty years [11], in Kenya achieving sustainable food security for all still remains an elusive goal. This is clearly evident from the food aid that the country still receives from the developed world [12], thus even achieving the Millennium Development Goal of eliminating hunger and reducing undernutrition too, will remain a dream. The President Honorable Mwai Kibaki on his Madaraka Day speech called for, the concept of a working nation [13]. Even though, the people may be or are willing to work hard, a malnourished person cannot be productive. The government thus has to rapidly change her food policy environment, structure and authorities in dealing with food security and nutrition issues. She has to set priorities for her research, capacity building and policy communication activities based on comparative advantage. Furthermore, she has to encourage new technological developments in the field of food, agriculture, nutrition, biotechnology, information and communication technology, as well as rural development.

Supplementation
The government should set up continuing micronutrient supplementation programmes for provision of vitamin A capsules, iron tablets and iodine capsules to the vulnerable groups of the population. This is a more feasible way of addressing micronutrient malnutrition where food-based and fortification programmes cannot be carried out in the short term.

Conclusion
For Kenya to industrialize by the year 2020, and achieve economic recovery outlined in the recently released economic recovery blue print, concerted and focused effort to combat micronutrient malnutrition (both integrated and multi-sectoral approaches) must be given priority. Concomitantly, the implementation of practical and effective surveillance of micronutrient deficiency is essential.

REFERENCES

1. ILSI/FAO. International Life Sciences Institute/ United Nations Food and Agriculture Organization. Preventing Micronutrient Malnutrition: A Guide to Food-based Approaches - A Manual for Policy Makers and Programme Planners. 1997.

2. Philip J, Norum RK, Smitasiri S, Swaminathan MS, Tagwireyi J, Uauy R and MU Haq Ending Malnutrition by 2020: An Agenda for Change in the New Millennium. Final Report to the ACC/SCN on the Nutrition Challenges of the 21st Century. 2000.

3. IAEA. International Atomic Energy Agency. Nutrition Notes for Quick Reference. Issues and Perspectives. Reflecting the UN Thinking on the Global Scenario and Its Relevance to the Activities of NAHRES/ NAHU. IAEA, Vienna, 2000.

4. Republic of Kenya. National Plan of Action for Nutrition. Food and Planning Unit. 1994.

5. MoH/ KEMRI. Ministry of Health/ Kenya Medical Research Institute. Anaemia and the Status of Iron, Vitamin-A and Zinc in Kenya. The 1999 National Micronutrient Survey Report.

6. Semba RD, Graham NM, Caiaffa WT, Margolick JB, Clement L and D Vlahov Increased Mortality associated with Vitamin A Deficiency during Human Immunodeficiency Virus Type 1 Infection. Arch. Intern. Med. 1993; 153: 2149-54.

7. Courtsoudis A The Relationship between Vitamin A Deficiency and HIV Infection: Review of Scientific Studies. Food and Nutrition Bulletin 2001; 22: 3.

8. Gerawal HS, Ampel NM, Watson RR, Prabhala RH and CL Dols A Preliminary Trial of Beta-carotene in Subjects Infected with the Human Immunodeficiency Virus. J. Nutr. 1992; 122: 728-32.

9. Smith B Past Experiences and Needs for Nutrition Education for the Public. Summary and Conclusion of Nine Case Studies In: FAO. Nutrition Education for the Public. Discussion Papers of the FAO Expert Consultation. FAO, Rome, 1997.

10. Stuart HT and C Achterberg Education and Communication Strategies for Different Groups and Settings In: FAO. Nutrition Education for the Public. Discussion Papers of the FAO Expert Consultation. FAO, Rome, 1997.

11. IFPRI. International Food Policy Research Institute. IFPRI’s Strategy: Toward Food and Nutrition Security. Food Policy Research, Capacity Strengthening, and Policy Communication. IFPRI, Washington, D. C. 2003.

12. Stevens D, Araru P and B Dragudi Outbreak of Micronutrient Deficiency Disease: Did we respond appropriately?

http://www.ennonline.net/fex/12/fa15.html 5/27/2003.
13. President’s Madaraka Day Speech East African Standard. May 2, 2003.