Tufts – Feinstein International Center

Acute malnutrition in northern Kenya

High rates of global acute malnutrition (GAM) are a continuing problem in Kenya’s arid and semi-arid lands (ASALs) despite ongoing humanitarian and development efforts. Elsewhere in Kenya wasting rates are much lower, and rates of stunting and underweight are generally improving, which puts the situation in the Kenyan ASALs in sharp contrast. Part of the failure to sustainably address persistent acute malnutrition is that stakeholders lack evidence on and understanding of the drivers of acute malnutrition, which limits their ability to find solutions to address it. Internationally, there is increasing recognition of the problem of persistent acute malnutrition and the need to increase efforts to prevent child wasting as part of the Sustainable Development Goals (SDGs).

The Nawiri Project

Nutrition in ASALs Within Integrated Resilient Institutions (Nawiri)  is a five-year evidence-based development project in four of Kenya’s northern counties. Catholic Relief Services (CRS) leads a consortium of partners in Isiolo and Marsabit Counties, and Feinstein provides research and capacity-building support to CRS. The project is funded by USAID’s Bureau for Humanitarian Assistance.

Nawiri uses a unique two phased approach. In the first phase (years 1 – 2), Nawiri is using a collaborative learning process involving local actors including communities, county systems and institutions, civil society, and the private sector to  increase project and stakeholder understanding of the drivers of persistent acute malnutrition. The learning will be used to jointly design evidence-based, context-sensitive, systems-driven, multi-sectoral approaches to sustainably reduce acute malnutrition, which will be implemented in the second phase (years 3 – 5). The phase 2 program will be managed locally to ensure systems strengthening.

Conceptual framework for acute malnutrition in drylands

Under Nawiri, Feinstein’s research and learning agenda is based on the conceptual framework for addressing acute malnutrition in drylands  pictured below. This framework is discussed in “Improving the way we address acute malnutrition in Africa’s drylands” which appeared in the May 2021 issue of the Field Exchange.

The Feinstein team is undertaking a series of desk studies, stakeholder analyses, and formative research studies to help Nawiri use the framework to design and implement a context specific program.

Under the Nawiri project, Feinstein is completing desk studies, stakeholder analyses, and formative research projects.

Desk studies:

At the start of the project, Feinstein undertook a series of desk studies to explore a variety of questions related to the causal framework for addressing persistent acute malnutrition. The studies explored the following research questions: 

Conceptual Framework Level	Research Question	Desk Study
Immediate and underlying drivers	What are the immediate and underlying causes of acute malnutrition and what is their relationship to nutritional status of children and women?	Drivers of child malnutrition in the Kenya arid and semi-arid lands (Marshak and Venkat 2021)
Basic/ systemic drivers	How do livelihood systems operate as part of the basic causes of malnutrition?	Livelihood systems in Isiolo and Marsabit counties (Stites 2021)
	What are the evidence gaps on the intersection of gender and acute malnutrition in Isiolo and Marsabit counties?	Gender gap analysis in Isiolo and Marsabit counties, Kenya (Stites and Dykstra-McCarthy 2021)
	What are the systems and institutional arrangements for accessing and managing natural resources?	Natural resource management and nutrition (Birch 2021)
	What is the relationship between patterns of acute malnutrition with environmental trends, climate, and conflict shocks, in the two counties?	Climatic variability and disasters in Kenya’s arid and semi-arid lands (Marshak and Venkat 2021)

Each of these studies is available in the publications tab.

Stakeholder Analyses:

Understanding stakeholder knowledge and perspectives on the problem of persistent acute malnutrition and its drivers is central to the design and implementation of stakeholder-driven, sustainable approaches. Therefore, Feinstein and CRS are working to understand stakeholder perspectives through surveys, conversations, and learning events. A report on the first stakeholder survey is available in the publications tab.

Participatory epidemiology:

In 2018, Feinstein piloted participatory epidemiology (PE) to look at the causes and seasonality of malnutrition in pastoralist and agro-pastoralist communities in Karamoja, Uganda. That study demonstrated that analysis using PE can generate a wealth of rigorous, technically plausible information within a matter of weeks or months. It also yielded detailed information on the causes of malnutrition and the relationship between these causes and seasonality and livelihoods and identified new seasonal patterns of malnutrition missed by biannual nutrition surveys. The results of the Karamoja study encouraged the Nawiri partners to further pilot and test the PE approach in the context of the Kenyan ASALs. The reports of PE exercises in Isiolo and Marsabit counties are available in the publications tab.

Longitudinal study:

While the effects of seasonality on malnutrition are widely recognized, assumptions rather than evidence frequently inform programs and policies to address persistent acute malnutrition. Previous research conducted by Feinstein in the Sahel has found a more complex and nuanced seasonal pattern of acute malnutrition than previously identified. To build an evidence base on the seasonality of malnutrition and its drivers for Nawiri, Feinstein, CRS, and Kenyatta University are carrying out a two-year mixed methods longitudinal panel study that includes quantitative data collection every other month, qualitative inquiry once a year, and an annual survey. The study will be done across three sentinel sites in Isiolo and Marsabit, each roughly representing pastoralist, agropastoralist, and peri-urban households.

The evidence collected through this study will help promote a shared understanding of the causes of malnutrition among stakeholders, enabling local, national, and international stakeholders to better design and target prevention and treatment strategies and approaches.

View the survey instrument.