Kenya: community surveillance key to malnutrition response

05 Jan 2023

As the drought continues in the Horn of Africa, the Médecins Sans Frontières (MSF) team has been responding to a malnutrition crisis in Illeret, Marsabit county, Kenya.

With one third of Illeret’s children under five years of age malnourished, since mid-March MSF has been working with community health educators and volunteers in support of the Kenyan health authorities to strengthen the integrated management of acute malnutrition. 

From March to December 2022, MSF has screened 24,182 children under five for acute malnutrition, newly screening 4,923 children from the community and enrolling 1,354 malnourished children in the malnutrition program while referring three to the nearest higher-level facilities. This has allowed thousands of patients to access prompt care while reducing the number of malnourished children not responding to treatment.

Outreach and Community surveillance

MSF has been carrying out weekly active case-finding and surveillance activities in the community to reach children who would otherwise be missed despite being malnourished. Underlining the dire situation, 117 of the 137 malnourished children admitted in the inpatient therapeutic feeding centre in Illeret Health Centre were identified during outreach and surveillance activities. 

We reinforced community surveillance and education beyond the outreach activities through community health educators, increasing early detection and management of malnutrition ...

Edi Atte
MSF country director

Health promotion messaging by community health educators and volunteers has enhanced medical outcomes. Health education topics include personal hygiene, the benefits of good nutrition, safe drinking water, proper waste disposal, immunisation, and the importance of medical care such as referrals and hospital care for those admitted to inpatient therapeutic feeding centres.

Accessing a variety and the right quantity of food remains a challenge for families as they continue to lose livestock due to failed rains. Therefore, both the medical and broader humanitarian response must continue and grow. "With not enough food in the households, families share the therapeutic foods given to [specific] children, hindering their progress. Therefore, food distributions must be sustained to reach the most vulnerable households using more inclusive selection criteria,” says Edi.

Uri Arnier

Uri Arnier comforts her nine month old son Arongor Airmir as she awaits her turn during a ward round in Illeret health center. © Njiiri Karago/MSF

Drought affecting malnourished children

Due to the drought there is very little water infrastructure. There is an urgent need for improved water access and sanitation through accessible, clean and non-contaminated water supply. This will reduce water-borne diseases such as diarrhoea and dysentery, and other skin and eye infections, which are among the most common diseases affecting every four out of ten malnourished children.

“The lake is salty and polluted, forcing most of the community to collect water in the shallow wells dug along the seasonal riverbeds. Women and children are tasked with water collection, having to wait for over two hours, and must make many trips for enough water. Children sometimes drink the salty water as [it] is, while not getting food, contributing to malnutrition,” reports Daniel Faerner, MSF Environmental Health Manager in Illeret.

As MSF transitions the medical management to the Ministry of Health, community surveillance must be sustained to preserve the current gains in managing malnutrition.
Qualified medical personnel like nurses, clinical officers and nutritionists should also be increased both at the hospital and within outreach activities, to enhance screening, management, follow-up and review of children’s progress in the program, both at the health facility and in the community. 

About MSF’s Response

Since mid-March 2022, an 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 Ffeeding centre (ITFC) for children with severe acute malnutrition and medical complications at Illeret Health Centre.

By first week of December 2022, the MSF team had screened 24,182 children aged 6-59 months, newly enrolling 1,354 children identified with malnutrition. Underlining the dire situation, outreach-based community surveillance and sensitisation sessions identified 117 of the 137 children admitted in the ITFC in Illeret Health Centre. 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.

Additionally 3,219 pregnant and lactating mothers were screened and received supplements, with 1,467 women receiving antenatal clinic consultations during community outreach.