Only 25% of the population has an acceptable food consumption score. The economy is mainly pastoral, with most residents relying on livestock. Frequent droughts exacerbate food shortages, resulting in high malnutrition rates, especially among children and pregnant/breastfeeding women. Malnutrition worsens during the lean seasons, while rainy seasons bring disease outbreaks, including diarrhoea.
Since 2021, Save the Children International (SCI), with funding from USAID’s Bureau of Humanitarian Assistance (BHA), has been implementing a multisectoral project in these two counties. The project is evaluated annually to assess its impact on the population's nutritional status.
Populations affected and main drivers of undernutrition
The populations most affected by undernutrition include children under five-years of age and pregnant and breastfeeding women. According to annual surveys, key drivers include:
- Seasonal variations – Food insecurity worsens during dry months/the lean season.
- Poor infant feeding practices – Low exclusive breastfeeding rates and limited dietary diversity for young children and women.
- Disease outbreaks – Cholera, diarrhoea and measles outbreaks, worsened by limited healthcare access.
- Household food insecurity – Droughts lead to livestock loss, reducing milk availability for children.
- Poor water and sanitation – Low access to potable water and poor hygiene practices cause waterborne diseases.
- Insecurity – Local conflicts limit access to health and nutrition services.
Response delivered
The response was designed to address these drivers of undernutrition through a combination of health, nutrition and livelihood interventions targeting the most vulnerable populations in the same communities.
Screening and management of acute malnutrition: Health workers screened children (0–59 months) for malnutrition, referring severe cases for treatment. The ‘management of small and nutritionally at-risk infants under six months and their mothers’ (MAMI) programme supported at-risk infants under six-months with breastfeeding promotion and tailored counselling for their mothers. Mother-infant pairs received continuous monitoring and referrals to other services including IMCI and cash assistance.
Mental health support: Mothers of infants were assessed for mental health issues, with referrals provided for specialised care.
Integrated outreach and health services: SCI partnered with the Ministry of Health (MoH) to provide outreach services, including malnutrition screening, immunisation, and treatment of childhood illnesses. The Family Mid-Upper Arm Circumference (MUAC) approach enabled early malnutrition detection, while community health workers treated childhood illnesses through Integrated Community Case Management (ICCM). Caregivers received infant feeding counselling with practical cooking demonstrations.
Cash and livelihood support: Multipurpose cash assistance integrated with nutrition messaging was provided to food– insecure households. Livestock health programmes, including vaccination and animal feed distribution and seed distribution, helped improve access to milk and dietary diversity.
Water and sanitation support: Rehabilitation of water sources and support for water treatment improved access to clean drinking water and enhanced hygiene practices.
Hearth programme: Launched in 2024 in Wajir, this programme targeted nutritionally vulnerable and underweight children (6–59 months), using locally available foods to promote sustainable community-driven malnutrition solutions.
Nutrition outcomes
The integrated programme led to considerable improvements in nutrition and health indicators along the pathways to undernutrition in the affected communities. A comparison of baseline conducted in May 2023 and end–of–project evaluations conducted in May 2024 indicated:
- An increase in exclusive breastfeeding rates from 64% to 68%.
- A rise in the proportion of children aged 6–23 months receiving a diverse diet, from 5.7% to 24%.
- Percent of households with acceptable Food Consumption Score (FCS) increased from 1% to 64%.
- Percent of women of reproductive age consuming a diet of minimum diversity (MDD–W) increased from 1% to 36%.
- Enhanced knowledge of hygiene practices, including handwashing and proper storage of drinking water. Percent of people targeted by the hygiene promotion activity who know at least three of the five critical times to wash hands increased from 81.3% to 96%.
- Percent of households targeted by the hygiene promotion program who store their drinking water safely in clean containers increased from 83.7% to 99%.
- Enhanced knowledge of hygiene practices, including handwashing and proper storage of drinking water. Percent of people targeted by the hygiene promotion activity who know at least three of the five critical times to wash hands increased from 81.3% to 96%.
- Percent of food assistance decision–making entity members who are women increased from 34% to 36%.
These outcomes were supported by:
- Over 366,000 children 0–59 months were screened for malnutrition, with 50,575 enrolled in the community– based Management of Acute Malnutrition programme.
- Over 296,000 individuals received nutrition education through integrated health and nutrition outreach.
- 6,939 households benefitted from unconditional cash assistance with support for women–led decision-making on use of resources.
- 2,798 mother–infant pairs were admitted to the MAMI programme.
- Improved levels of immunisation with 48,302 children immunised against childhood disease.
- Improved treatment for common childhood illnesses with over 13,000 children receiving treatment for diarrhoea, fever and other illness.
Key gaps and challenges that may have affected outcomes
Challenges related to funding, geographic coverage and insecurity remain, which require ongoing attention and resources. Expanding the scope of interventions, particularly with regards to micronutrient supplementation, further improving quality of diet for pregnant and breastfeeding women and girls and young children, women’s empowerment including women’s control over assets and decision–making for improving household consumption and enhanced monitoring, could further strengthen the response and improve longer-term nutrition outcomes for vulnerable populations.
“The money I received has provided my family with the financial means to save and invest, including in the purchase of a small number of goats and sheep. In addition to generating extra income through the sale of the bigger animals, the animals have contributed to improving food security for my family, particularly for my children who are no longer malnourished because the animals have provided milk and meat for my family. This has reduced my household’s expenditures on food, allowing me to allocate more of the limited resources to other essential needs.’’
The impacts of a multisector response for one family’s health and nutrition in north eastern Kenya
Abdullahi, 39, a father of five children, lives in Garissa County which frequently experiences droughts and severe water and food shortages. Like many others in his community, he relied heavily on livestock farming for his family’s livelihood. However, due to the prolonged drought, his livestock were unable to survive, leaving him and his family without an important source of food and income. Two of Abdullahi’s children were diagnosed with severe wasting and were admitted into Save the Children supported nutrition treatment programs. Through this programme, Abdullahi was referred and registered as a beneficiary of SCI’s multi-sector programme. This provided treatment and other health and nutrition support for his wife and children, and a cash transfer that enabled him to him meet the immediate food needs of his family as well as purchase a small number of goats and sheep. Subsequently, the programme went on to provide Abdullahi with health and nutrition support for his livestock.
As a result of all this support Abdullahi and his family were not only better able to cope with the immediate effects of the drought on their health and nutrition but were also empowered to rebuild their lives and become more resilient in the face of future challenges.
References
72 This case study is based on the experience and programming of Save the Children International and partners in Kenya and was authored by Save the Children in Kenya, 2024