Evaluation of the Supplementary Feeding Programme carried out in Marsabit District, Kenya, April-November 1997
Vincent Brown (Epicentre), Sylvia Carbonell
(Médecins Sans Frontières)
MSF implemented a nutrition rehabilitation
programme in Marsabit District between April and November 1997, in response
to the drought that affected north eastern Kenya in 1996. The primary aim
of the programme was to prevent further nutritional deterioration amongst
the affected population. The programme catered for over 17,000 children
under five years of age and just under 3000 pregnant and lactating women.
Children were screened using MUAC measurements. Those with MUACs under
135 mm had weight for height measurements taken and were admitted to the
supplementary feeding programme (SFP) if these fell between 70-80%
of the reference median (NCHS tables, CDC, Atlanta, USA).
The SFP was designed to account for factors
like access to feeding centres and whether beneficiaries were pastoralist
or sedentery farmers. Thus, at somefeeding
centres the programme was offered as a dry take home ration programme
(1,480 kcals per day per child), and at others as either
on-site feeding or take home (700 and 1400 kcals/child/day
respectively) . Children were discharged on attaining a weight for
height of over 85% weight for height on two consecutive fortnightly weighings.
The programme was implemented at health centres by MOH or NGO staff and
was evaluated mid-term by Epicentre in August 1997.
Programme data were analysed monthly -
from April to July 1997, in ten areas of the intervention by the
evaluation team. As it was not possible to conduct a cluster sample survey
due to security/logistic factors the prevalence of global acute wasting
was estimated by screening all children in the health facilities of the
ten areas. A total of 7,082 children were screened. Children with MUAC
measurements below 125 mm were identified as wasted while those under 110
mm were classified as severely wasted.
During this period, monthly prevalence
of malnutrition decreased from 15.7% (408/2,596) to 5.2% (47/898) and severe
malnutrition from 1.5% (40/2,596) to 0.2% (2/898). Programme coverage was
measured at 72% for the district. Between May and July 56.3% of children
were discharged while 40.6% defaulted. Deaths and transfers were recorded
at 0.4% and 2.7% respectively.
At the end of May a total of 1400 children
were registered while the number had dropped to 365 at the end of October.
Average duration of stay was 67 days in the take home centres and 71 days
in the wet/dry feeding centres.
The Drought Preparedness, Intervention
and Recovery Programme (DPIRP) had produced data showing the severity of
the situation in north eastern Kenya. MSF's decision to intervene was based
partly on these findings. The DPIRP collect several types of data including
MUAC measurements, livestock growth rates, cereal/meat price ratios and
milk intake. The results MSF obtained for MUAC measurements were similar
to those obtained by DPIRP, even though the latter measured children between
12-59 months, while MSF measured children from 6 months onwards. The evaluation
report recognised that some authors have argued that use of a single
cut off point for MUAC will lead to an over-estimation of prevalence of
wasting in younger age groups.
The evaluation found that MUAC screening
proved an easy way to follow nutritional trends, and was the preferred
method due to problems in carrying out a random weight for height survey.
It was further contended that this type of screening assessment was particularly
applicable to the situation as the population were so dispersed. Furthermore,
screening was considered as more or less reliable as 33% of children were
checked. Also the decreasing trend in malnutrition was consistent
with the decreasing trend in admissions at the feeding centres.
The report pointed out that, although
levels of malnutrition rapidly declined in the district there were marked
differences between malnutrition rates in different areas. The evaluators
also drew attention to the high proportion of defaulters which in their
view could be explained by displacements of pastoral groups in search of
better grazing areas. Another type of feeding, 'blanket feeding',
was implemented for these groups.
By November 1997 the nutrition programme
in Marsabit district was gradually coming to an end. The evaluation concluded
that the overall programme objectives had been met in a short space of
time - seven months, without causing settlement of nomadic groups. Also,
as food scarcity and drought is a chronic problem in this area the experience
gained with field partners has been very useful for future interventions.
However, authors cautioned, that because
of imprecise food relief data it has been difficult to evaluate fully the
SFP impact, and that for the pastoralist groups the increase in livestock
production registered in recent weeks would also have played a key role
in improving the nutritional situation.
Addendum (05/1998) : From November 1997
to April 1998, north eastern Kenya has been badly hit by Rift Valley Fever
and malaria epidemics ; this was aggravated by severe climate disturbances
(El Nino). As a result, some population groups were again threatened by
precarious food security and were severely affected by acute malnutrition.
For these groups, Médecins Sans Frontières and other NGOs
are currently providing targeted nutrition assistance.
For further information contact: Epicentre,
8 rue St Sabin, 75011, Paris, France. Tel: 40 21 28 50, Fax : 140212803,
Taken from Field Exchange Issue 4, June 1998