AJFNS
Volume 2 No. 2 July 2002
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About
the Fund
Christian Children's Fund (CCF) is a child development agency, which for
over 60 years has been working towards promoting the well being of children
from needy communities in over 30 countries. CCF works in Latin America,
Asia and Africa. In Africa, the organization works in West Africa, South
Africa and East Africa. The East African countries where CCF works are
Uganda, Ethiopia and Kenya.
CCF
Kenya
CCF-Kenya has been in operation in the country for close to 3 decades,
with a mission to promoting growth and the well being of children by empowering
families and communities to utilize available resources and opportunities
for sustained benefits. Currently, CCF-Kenya supports 43,000 enrolled
children, and impacts an additional 200,000 children through 48 community
based projects located in 30 districts in the country. CCF-Kenya has two
core programs - Health and Education - which have various components.
Health
Program Components include: morbidity control, food security, micro enterprise
development initiatives (MEDI), malaria, reproductive health, HIV/AIDS,
water and sanitation, nutrition, early childhood development, and peace
and conflict resolution
Education Program Components are: quality basic education, non formal
education, living values program and youth program
Strategies
for 2001-2004
The organization has placed itself to realize its vision through key strategies
as outlined below:
· Developing capacities of the target community, recognizing that
educating and empowering communities leads to sustainable development
· Designing programs to address the target community core problems
· Collaborating, partnering and networking with pertinent agencies,
in order to share experiences and expand its knowledge base through shared
learning, thereby reducing duplication of resources as well as building
strong alliances for advocating for children's rights
· Mobilizing additional resources and expanding CCF-Kenya's reach
to more needy children
· Enhancing human resource development.
CCF-Kenya
Nutrition Program
CCF nutrition program seeks to ensure well being of children and their
families through integration of health, food security, micro enterprise
initiatives, adequate dietary intake and proper care.
Malnutrition
rates in the country have been on the increase due to a poor performing
economy, unfavorable food policies, increasing levels of morbidity especially
malaria, pneumonia, diarrhoea, measles and HIV/AIDS, and frequent droughts
and floods. CCF-Kenya AIMES (Annual Impact Monitoring
and Evaluation Systems) data for 2001 showed the underweight rates among
target underfives as 12%.
CCF-Kenya
has responded to the rising levels of malnutrition by implementing both
long- and short-term nutrition interventions targeted mainly at vulnerable
groups such as children 0-5 years, pregnant and lactating women, HIV/AIDS
infected and directly affected persons and adolescents. CCF-Kenya currently
has ten nutritionists working in all the 30 districts where CCF-Kenya
is. Each of the 48 community-based projects also have technical staff
who coordinate the health and nutrition activities.
The
activities/interventions in the integrated community-based nutrition program
include:
·
Carrying out studies to identify the health and nutrition needs of the
target community
·
Growth monitoring of underfives on a monthly basis by trained volunteer
parents. Growth monitoring is done using three indices: weight-for-age,
weight-for-height and height-for-age to determine underweight, wasting
and stunting rates.
·
Children who are identified as underweight or wasted (with more than -2
standard deviation) are medically assessed and put on supplementary/therapeutic
feeding using locally available nutritious foods. The caregivers of such
children are counseled to tackle the underlying cause of malnutrition.
·
Training of the target beneficiaries on health components that include:
maternal child health, nutrition, reproductive health, disease control
and management especially malaria, diarrhoea and pneumonia.
·
Training of parents/caregivers on good practices in early child stimulation,
development of early childhood development (ECD) play and learning materials,
and identification of child development milestones using CCF child development
guide.
·
Training of target families on appropriate food security initiatives in
crop and animal husbandry. Supporting families with food production and
animal husbandry inputs so that they can undertake agricultural activities.
The inputs include: dairy goats/cows/poultry, seeds, farm implements and
drip irrigation kits.
·
Training of the target beneficiaries on the identified micro enterprise
development initiatives especially in the area of book keeping and resource
management to ensure prudent utilization of resources and profit making.
·
Supporting provision of health services to the targeted vulnerable groups.
In collaboration with the ministry of health facilities, CCF-Kenya provides
immunization to children and antenatal mothers on a continuous basis and
also supports screening, effective diagnosis, management and treatment
of malaria among other diseases. Quarterly deworming is also carried out.
·
HIV/AIDS training and sensitization among target communities. This is
carried out through trained community behavior change promoters and training
of CCF-Project staff and volunteer parent representatives in counseling.
In collaboration with the MOH health facilities in CCF project areas,
voluntary counseling and testing is accessed to willing community members.
CCF projects also promote formation of AIDS support groups and AIDS clubs
(in schools and among youth), and they also support home-based care (HBC)
for HIV infected persons.
·
Micronutrient supplementation (especially Vitamin A and iron/folic) is
provided to identified vulnerable groups who include children 0-5 years,
pregnant/lactating mothers and HIV infected persons.
·
Assessment of child development milestones of under-8-year old children
using CCF ECD assessment guide. Five development areas addressed by the
guide include: gross motor, fine motor, cognitive, social/emotional and
language.
·
Development and/or acquisition of IEC materials: CCF-Kenya has developed
a comprehensive nutrition manual which is utilized in all projects. CCF
projects also utilize acquired IEC materials such as FANTA nutritional
guidelines for people living with HIV/AIDS (PLWA) and Pathfinder curriculum
on home-based care for PLWA.
·
Monitoring and evaluation by project implementers. This is mainly carried
out by parent representatives in focus groups (which are groups of 20-25
parents/caregivers/youth who are neighbors and meet monthly for common
activities) together with the technical personnel using CCF AIMES. The
information derived from this tool enables all the project implementers
to plan needed interventions to curb identified problems.
Impact of Health and Nutrition Interventions
The
health and nutrition program has realized significant improvements in
the health and nutrition status of target community members. This is demonstrated
in the table below where key indicators have been used (CCF-Kenya AIMES
data)
| Health
Components |
1999 |
2000 |
2001 |
Safe
water access
Safe sanitary disposal
Immunization
TT Coverage
Malnutrition status
Infant mortality rate
Under 5 mortality rate
|
48%
Population: 16,050
56%
69%
73%
15%
36/1000
89/1000
|
50%
Population: 16,792
57%
73%
69%
23%
42/1000
88/1000
|
49%
Population: 18,033
57%
73%
73%
12%
35/1000
76/1000
|
(1)Program
Manager, Health and Nutrition, CCF-Kenya. Email: oliverk@ccfkenya.org
(2)Nutritionist, CCF-Kenya. Email: estherw@ccfkenya.org
CCF
Health tool for monitoring and evaluating program impact
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Helen
Keller International, the international division of Helen Keller Worldwide,
was founded in 1915 as the American Foundation for Overseas Blind, by
the deaf-blind crusader, Helen Keller, and a group of American businessmen
in Paris, to educate and rehabilitate soldiers who lost their sight in
World War I. After Helen Keller's death in 1968, the agency was renamed
in her honor. The agency re-oriented its focus to blindness prevention
in the 1970s, which led to intensive involvement in controlling vitamin
A deficiency, the leading cause of childhood blindness. From the outset,
we have recognized that controlling vitamin A deficiency requires addressing
broader food and nutrition issues. In 1992, our mandate was specifically
modified to include combating other micronutrient deficiencies, to fulfill
our mission: "Save the sight and lives of the most vulnerable of
the human family and educate and rehabilitate the blind."
Historically
our programs had been concentrated in Asia, and in 1997, the agency made
the decision to strengthen our programs in Africa. We currently have country
programs in Burkina Faso, Cameroon, Côte d'Ivoire, Guinea, Mali,
Morocco, Mozambique, Niger, Nigeria, Sierra Leone, South Africa and Tanzania.
We pursue a range of strategies to combat micronutrient deficiencies including
supplementation, dietary diversification, promotion and protection of
breastfeeding, food fortification and evidence-based nutrition advocacy.
As a technical assistance agency, all of our programs are based on partnerships
with host country governments, local and regional institutions and other
non-governmental organizations.
For more
information, contact: Shawn K. Baker, Regional Director for Africa,
skbaker@hki.ci or Víctor M. Aguayo, Regional Nutrition and
Child Survival Advisor for Africa, vaguayo@hkimali.org.
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Lack
of adequate, timely, and country- and region-specific information is a severe
constraint to decision-makers who strive to improve policies that influence
food security, poverty alleviation, and sound management of natural resources.
In 1998, the International Food Policy Research Institute (IFPRI), under the
auspices of its 2020 Vision Initiative, launched the 2020 Vision Network for
East Africa. This Network comprises of six countries: Ethiopia, Kenya, Malawi,
Mozambique, Tanzania, and Uganda.
Its
immediate objectives are to (i) generate policy-relevant information through
collaborative research - modalities include a competitive grants program to
support individual researchers or teams as well as a student affiliation program
which supports Masters' students undertaking thesis research; (ii) strengthen
the capacity to undertake and communicate policy research and analysis - modalities
include training workshops on preparation of proposals and on communicating
research to policymakers; and (iii) improve the dissemination and use of information
- modalities include a website and electronic list-serve as publications (forthcoming).
The 2020 Vision Network was set up and operates through a collaborative process.
For more information,
contact Ms. Rajul Pandya-Lorch, Head, 2020 Vision Initiative, IFPRI, 2033
K Street, NW, Washington, DC 20006, USA
Email: r.pandya-lorch@cgiar.org
Web: http://www.ifpri.org/2020/nw/intro.htm.
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Aventis
CropScience is a major crop protection and crop production company, also involved
in top-ranking environmental and public health activities. Committed to developing
sustainable agriculture worldwide, Aventis CropScience focuses on researching,
developing and marketing innovative solutions that meet the needs of today's
farming - increased yields, improved crop and food quality - whilst constantly
striving to meet the needs of the environment.
Aventis
CropScience was bought by Bayer AG, Leverkusen, Germany.
The new company, named Bayer CropScience, is incorporated in Germany with
its headquarters in Monheim. It has a strong global presence, with three distinct
business groups: Crop Protection, BioScience and Environmental Science. The
aim of the new company is to lead the world in the provision of innovative
products and integrated solutions and services.
Aventis
CropScience (in future: Bayer CropScience)
Industrial Park Höchst, K607 D-65926 Frankfurt/Main, Germany
Email: Manfred.Kern@BayerCropScience.com
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Study:
Supplementation helps TB treatment
Supplementation
with a combination of zinc and vitamin A enhances treatment for TB in the
first two months of treatment, according to a recent Asian trial.
Subjects: 80
patients from Indonesia with newly diagnosed TB.
Method: Randomized,
placebo-controlled trial in which both groups received active TB treatment
and the intervention group also received 6 months of a supplement containing
vitamin A (retinyl acetate 5000 IU) and zinc (15 mg as zinc sulfate).
Results: A significant
proportion of the subjects had evidence of some malnutrition prior to treatment.
The prevalence of underweight (BMI <18.5) was 64%, whilst a third had low
levels of vitamin A (32% with plasma retinol concentration < 0.70 µmol/L),
and a similar proportion had low zinc (30% had plasma zinc concentrations
< 10.7 µmol/L).
Supplementation
did not significantly raise mean zinc levels but did raise plasma retinol
(p < 0.05). Regarding TB status, the supplemented group had a significantly
earlier resolution of X-ray lesion area (p < 0.01) and
sputum conversion (p < 0.05).
For example,
it took 5 weeks for 80% of the supplemented patients to be sputum converted,
compared with 8 weeks for the unsupplemented group. There was a correlation
between increases in vitamin A status and radiological resolution after 6
months of treatment.
Karnofsky scores
(a measure of quality of life) improved in both groups, but were significantly
higher in the supplemented group than the placebo supplemented group after
6 months (p < 0.05).
Reference: Am
J Clin Nutr 2002;75:720-7.
COMMENTS by Arbor Clinical Nutrition Updates Team
Although this
study involved only relatively small numbers of subjects, it is of great interest
because of the enormous public health impact of TB throughout the world.
Mortality and
morbidity from TB are strongly linked to poverty. Two of the mechanisms through
which this association operates are malnutrition and the inability to afford
TB medication.
The poorest patients
are also more likely to be lost to adequate follow-up, typically because they
cannot afford the time to stay at or travel to medical centres.
For all these
reasons, any affordable nutritional supplement that can speed up resolution
of TB lesions will be very welcome. We know that vitamin A deficiency is a
widespread problem in those countries where TB is most prevalent, and that
patients with TB are often malnourished (reference 1). A number of studies
have already shown that TB patients are likely to be specifically deficient
in vitamin A (reference 2) and zinc (reference 3).
There are also
theoretical reasons to believe that zinc and vitamin A might be a useful combination
in patients with TB. Low zinc status adversely affects immune function, and
vitamin A supplementation has been shown to improve mortality in HIV infection
(reference 4). Zinc and vitamin A are also synergistic in many respects (reference
5).
The impact of
supplementation in this study was not particularly large. With or without
supplementation almost all the patients responded to treatment within the
first two months. The increase in speed of response by the supplemented patients
was only a matter of a week or two.
But one week
or two could still be of considerable public health significance. Earlier
response is likely to mean less infectivity from the patient within their
families and communities. A week or two might also
mean a lot to those patients who cannot access longer term medical follow
up.
This study is
one that should definitely be repeated using a larger patient sample. We look
forward to seeing such results.
References:
1. J Nutr 2000;130:2953-8
2. J Pediatr 1997;131:925-7
3. Int J Tuberc Lung Dis 1998;2:719-25
4. Pediatr Infect Dis J 1999;18:127-33
5. Am J Clin Nutr 2002;75:92-8.
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(c) This Update
is copyright Arbor Communications PTL 2002. Email: <MD@arborcom.com>
*AJFNS has received
permision to carry this information, thanks to Dr. Tony Helman - Editor-in-Chief,
Arbor Clinical Nutrition Updates
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