Evaluation of the supplementary feeding programme targeted at moderately malnourished children aged 6 to 59 months in Baringo County, Kenya

Thesis (MNutr)--Stellenbosch University, 2018.ENGLISH SUMMARY: Baringo is a semi-arid county of Kenya faced with moderate food insecurity. The County’s global acute malnutrition (GAM) rates have been on a deteriorating trend from 9.6% in 2013 to 21.1% in 2014, with moderate acute malnutrition (MAM) being the most prevalent. A supplementary feeding programme (SFP), which aims to alleviate the condition, has been implemented in the County since 2009. Persistent high malnutrition rates may be an indication that there are factors hindering the success of the programme. To assess this, the researcher conducted an evaluation study of the SFP targeted at moderately malnourished children aged 6 to 59 months. The study objectives were to assess the availability, distribution and utilisation of SFP commodities; to determine whether nutritional counselling was part of the SFP and if the advice was adopted; to assess breastfeeding practices for the moderately malnourished SFP beneficiaries aged 6 to 23 months; to assess the influence of SFP on anthropometric status of the beneficiaries; and to compare actual and expected length of stay of beneficiaries in the programme. A descriptive cross-sectional study design was employed and random sampling used to select participants. Questionnaires were administered to caregivers and anthropometric measurements of beneficiaries taken. Secondary data from health facility records was used to determine length of stay in the programme. The study duration was three and half months. A total of 407 children aged 6 to 59 months who were beneficiaries of the SFP participated in the study. The study found that almost two-thirds (62.7%; n = 255) of the participants received ready-to-use supplementary feeds (RUSF) during the distribution that preceded the study, of which the majority received their rightful fortnight ration of 14 (92 g) RUSF sachets. The fortnight ration did not last for the recommended period for at least a third of the participants, mainly due to sharing with non-SFP-registered household members. Caregivers received nutritional counselling as part of the SFP, but inadequate food access, cultural factors and poor access to health care services limited adoption. Almost all participants were fed on carbohydrate-rich grains 24 hours before the study, with minimal consumption of animal-source proteins. Anthropometric status of beneficiaries would improve whenever there was a consistent supply of SFP commodities, which was evidenced by a reduction in prevalence of underweight and acute malnutrition based on mid-upper arm circumference (MUAC) two weeks after admission. There were frequent stock-outs of SFP commodities at health facilities, hence beneficiaries would miss their rations on some distribution days. Discharge criteria was not adhered to, as more than half of the beneficiaries (57%; n = 98) that were discharged a month before the study exceeded the recommended maximum length of stay in the programme (84 days). Lack of SFP commodities at health facilities and sharing of SFP commodities at household level were key factors limiting the success of the programme. The programme stakeholders should identify sustainable solutions to challenges leading to shortage of the commodities and should link SFP beneficiaries to other food-assistance programmes that target the whole household in order to minimise sharing.AFRIKAANSE OPSOMMING: Baringo is ’n semi-woestyn gebied in Kenia met ’n matige tekort aan voedselsekerheid. Die streek se koers vir globale akute wanvoeding het van 9.6% in 2013 na 21.1% in 2014 verswak, met matige akute wanvoeding as die algemeenste vorm. ’n Aanvullende Voedingsprogram (AVP) word sedert 2009 hier geimplementeer met die doel om hierdie toestand te verlig. Voortdurende hoe wanvoedingskoerse kan daarop dui dat daar faktore is wat die sukses van die program kelder. Om dit te evalueer, het die navorser ’n evalueringstudie van die AVP onderneem, gemik op wangevoede kinders tussen 6 en 59 maande in hierdie gebied. Die oogmerke van die studie was om die beskikbaarheid, verspreiding en verbruik van AVP-produkte te bepaal; vas te stel of voedingsberading deel uitmaak van die AVP en of die advies toegepas word; borsvoedingpraktyke in matig wangevoede kinders in die AVP (tussen 6 en 23 maande oud) te evalueer; die invloed van AVP op die antropometriese status van die begunstigdes te ondersoek; en laastens die werklike tydperk wat begunstigdes in die program moet bly met die verwagte tydperk te vergelyk. ʼn Beskrywende deursnee studieontwerp is gevolg. Deelnemers is deur ewekansige steekproefneming gekies. Versorgers is gevra om vraelyste te voltooi en die begunstigdes se antropometriese mate is geneem. Gesondheidsorgfasiliteite se rekords is as sekondere data gebruik om te bepaal hoe lank begunstigdes in die program bly. Die studie het drie en ʼn half maande geduur. Altesaam 407 AVP-begunstigdes tussen 6 en 59 maande het aan die studie deelgeneem. Die studie het bevind dat bykans twee derdes (62.7%; n = 255) van die deelnemers voor die aanvang van die studie gebruiksgereed aanvullende voedings (GGAVs) ontvang het. Die meeste het die regmatige rantsoen van 14 (92 g) sakkies GGAV vir twee weke ontvang. Hierdie voorraad het vir minstens ʼn derde van die deelnemers nie vir die aanbevole tydperk gehou nie, hoofsaaklik omdat hulle dit met nie-AVP-begunstigdes in die huishouding gedeel het. Versorgers het as deel van die AVP voedingsberading ontvang, maar onvoldoende toegang tot voedsel, kulturele faktore en swak toegang tot gesondheidsorgdienste het die toepassing daarvan beperk. Byna al die deelnemers het in die 24 uur voor data-insameling, koolhidraatryke grane en minimale bronne van dierproteien ingeneem. Die antropometriese status het verbeter wanneer daar deurlopende voorsiening van AVP-produkte was, soos gestaaf deur die verlaging in die voorkoms van ondergewig en akute wanvoeding gebaseer op bo-arm-omtrek binne twee weke na toelating. Die AVP-kommoditeite by die gesondheidsorgfasiliteite was gereeld uit voorraad en gevolglik het begunstigdes nie hul rantsoene op verspreidingsdae ontvang nie. Daar is nie aan die ontslagkriteria voldoen nie – meer as die helfte van die begunstigdes (57%; n = 98) wat ʼn maand voor die aanvang van die studie ontslaan is, het die aanbevole maksimumtydperk (84 dae) in die program oorskry. Die sukses van die program is deur twee kernfaktore beperk: ʼn tekort aan AVP-voorraad by gesondheidsorgfasiliteite en die deel van produkte op huishoudelike vlak. Die programrolspelers behoort volhoubare oplossings te vind vir uitdagings wat tot ʼn tekort aan kommoditeite lei en behoort AVP-begunstigdes met ander voedselhulpprogramme te verbind wat op die hele huishouding toegespits is, sodat onderlinge verdeling beperk word.Master