tag:theconversation.com,2011:/ca/topics/kenyan-health-22190/articlesKenyan health – The Conversation2018-06-05T13:44:43Ztag:theconversation.com,2011:article/944282018-06-05T13:44:43Z2018-06-05T13:44:43ZSuffering in silence: how Kenyan women live with profound childbirth injuries<figure><img src="https://images.theconversation.com/files/221387/original/file-20180601-142083-1j8anm5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><a href="http://vc.bridgew.edu/cgi/viewcontent.cgi?article=1942&context=jiws">Sasha</a> is 22-years-old. She was married off when she was just nine and by the time she was 11, she was pregnant with her first child, and unprepared for childbirth. </p>
<p>So when labour came, in the middle of the night – in her geographically isolated village in rural Kenya – she was unaware of the painful fate awaiting her. </p>
<p>During childbirth, the baby’s head was too big to fit through Sasha’s pelvis, causing the baby to get stuck in her birthing canal. Traditional birth attendants tried their best to help Sasha but they were not skilled enough to handle the complications. She needed surgery, and quickly. But because she could not access emergency obstetric services, she spent the next six days trying to push out the baby that was stuck inside of her. </p>
<p>In the end, Sasha delivered a dead, rotten baby in macerated form. She was not only in grief of her lost child, but was also traumatised by her experience which left her with profound injuries and a double <a href="https://www.ncbi.nlm.nih.gov/pubmed/8873157">obstetric vaginal fistula</a>. </p>
<p>An obstetric vaginal fistula is a tear between a woman’s vagina and another body part – usually caused by obstructed or prolonged labour. It occurs when the baby’s head is trapped against the pelvic bone and cannot descend further. As the labour intensifies, the blood supply is cut and the surrounding tissues die. Shortly after the baby dies and labour continues until the baby is pushed out.</p>
<p>Across the world, there is an estimated <a href="https://www.booktopia.com.au/tears-for-my-sisters-l-lewis-wall/prod9781421424170.html">two million</a> women and girls just like Sasha who live with vaginal fistulas. There are up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937166/#B1">100 000 new cases each year</a>. In Kenya, at least 3000 new cases are reported annually but <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-13-56">research</a> shows that only 7.5% are treated.</p>
<p>But these statistics are bound to be grossly inaccurate
due to under-reporting, poor and non-existent data keeping in most African hospitals. This is made worse by women feeling internalised shame which keeps them from seeking help for their fistulas. It means that the magnitude of the problem on the continent is assumed to be much higher. </p>
<p>Sasha was one of the women I interviewed in <a href="https://www.springer.com/us/book/9789811305641">my research</a> which investigated how Kenyan women with fistulas negotiated the complexities of living with a body that leaks. This included the process of trying to get treatment as well as the journey to recovery from childbirth traumas that rendered their bodies abject, damaged and at times irreparable.</p>
<p>My research revealed a lack of resources and the structural challenges that prevent women from getting the help they need. This is particularly prevalent in remote areas, where access to health services is not available or is very limited.</p>
<p>It also reinforces what <a href="https://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Obstetric_fistula_Kenya.htm">researchers</a> and <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/ajmw.2011.5.2.95">medical professionals</a> in Kenya have established over the years. </p>
<h2>Negotiating the challenges around fistula</h2>
<p>Kenya continues to face enormous challenges as far as dealing with vaginal fistula are concerned. The biggest is the lack of resources to treat fistulas along with a <a href="https://www.reuters.com/article/us-kenya-health-fistula/as-surgeries-triple-kenya-aims-to-end-shame-of-fistula-idUSKBN18L1DN">severe shortage of fistula surgeons</a>. By 2014, Kenya only had three internationally renowned fistula surgeons and less than 10 surgeons who could perform simple obstetric operations.</p>
<p>This has made it logistically impossible to treat all the women who seek treatment every year. It also means that many are left untreated for years adding to the ever increasing backlog.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/221755/original/file-20180605-119853-19yq0q0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/221755/original/file-20180605-119853-19yq0q0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221755/original/file-20180605-119853-19yq0q0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221755/original/file-20180605-119853-19yq0q0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221755/original/file-20180605-119853-19yq0q0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221755/original/file-20180605-119853-19yq0q0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221755/original/file-20180605-119853-19yq0q0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women awaiting fistula surgery at the Gynocare Women’s and Fistula Hospital in Kenya, which is the only private facility which specifically treats fistulas for free.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/directrelief/11197145265/in/photolist-i4sibH-i4sXtH-9MdDUt-i4spDd-i4ta9P-i4sodN-i4sYRn-i4sp71-i4t9Yt-i4siDA-i4sk2B-i4t6AL-i4sidq-bsqR9F-9MgyxN-i4sg3e-i4seaM-bsqSpe-i4sfQR-i4tHbH-i4srtA-6YgpYi-i4tefW-i4sYja-i4sk2f-i4t5V8-i4tPb8-i4sozY-i4t6Tj-i4siBn-i4taUf-i4t7wo-i4t7M4-75QQSQ-i4tHVi-i4t5Ww-bVLPEU-i4tcgd-bm1xDN-bm1xCW-6YkrxW-byVqGZ-6YgrpP-6YgryX-i4tQUP-8gTYV2-6Ygqra-i4tezJ-i4t8RZ-i4sQ3o">Direct Relief/Flickr</a></span>
</figcaption>
</figure>
<p>But for most women with fistulas, the damage is not only physical, it’s also psychological. They negotiate rejection and social exclusion on a day-to-day basis which can have severe psychological consequences. This can be more destructive than the actual fistula.</p>
<p>The women I engaged with explained how their fistula diagnosis threatened their social and intimate lives. They explained how having a “leaking body” was constructed as being dirty, deviant and contaminated. </p>
<p>Many described that the way they went about their lives was primarily occupied with finding ways to protect themselves from being “outed” or shamed for the pungent smell that they carried with them.</p>
<p>Their stories revealed the structural and sociocultural challenges that explain why women in Kenya are at risk of developing vaginal fistulas and then having adequate treatment delayed or denied them. This is particularly prevalent in remote areas, where there are transport barriers, impassable roads, and limited or unavailable access to health services or emergency obstetric care. </p>
<h2>Responding to fistulas</h2>
<p>In the last decade, the Kenyan government has initiated a programme under which local health workers train traditional birth attendants working in remote areas to mitigate maternal casualties. But despite the fact that the training includes skills to manage birthing complications, some women require immediate medical intervention. </p>
<p>Kenya also rolled out other public health campaigns to end maternal deaths. One was the <a href="https://www.beyondzero.or.ke/official-launch-of-the-beyond-zero-campaign/">Beyond Zero campaign</a> which was initiated by Kenya’s First Lady, Margaret Kenyatta to raise funds and awareness on issues of safe delivery, and obstetric injuries that lead to vaginal fistulas. </p>
<p>Although the initiative was heavily <a href="https://www.pambazuka.org/food-health/beyond-zero-kenyan-first-lady%E2%80%99s-charity-can%E2%80%99t-cure-healthcare-neglect-and-theft">criticised</a> as an attempt to provide a quick fix to structural problems, it raised national awareness about vaginal fistulas and mobilised resources for free surgeries for women with the condition. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/better-maternal-care-in-africa-can-save-women-from-suffering-in-childbirth-59688">Better maternal care in Africa can save women from suffering in childbirth</a>
</strong>
</em>
</p>
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<p>The criticism reflects the importance of addressing the underlying causes of fistula. These causes have been summed by one of Kenya’s most renown fistula surgeons <a href="https://scholar.google.co.uk/citations?user=Cku3H4wAAAAJ&hl=en">Dr Weston Khisa</a>, who says</p>
<blockquote>
<p>Medically, fistula is caused by obstructed labour, but the underlying causes are obstructed transport, obstructed family planning, obstructed emergency care, and obstructed human rights.</p>
</blockquote>
<p>Ending fistulas means eradicating both cultural and structural obstacles that put women at risk of developing preventable tragedies such as fistulas. It requires a complete overhaul of health infrastructure in Kenya to ensure that maternal care and women’s reproductive health are prioritised – and that no woman has to lose her life while trying to give one.</p><img src="https://counter.theconversation.com/content/94428/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathomi Gatwiri PhD does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Each year an estimated 100 000 women have complications during childbirth which leave them with obstetric vaginal fistula.Kathomi Gatwiri PhD, Lecturer, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/951012018-04-22T09:51:18Z2018-04-22T09:51:18ZWhy Kenya isn’t winning the war against malaria in some counties<figure><img src="https://images.theconversation.com/files/215752/original/file-20180420-75114-879d0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In the past 15 years the Kenyan government has made great strides in preventing and controlling malaria. It has issued insecticide treated bed nets, sprayed people’s homes with insecticides and ensured that there is widespread diagnostic testing. These efforts have resulted in a <a href="http://www.who.int/features/2017/vector-control-kenya/en/">significant drop</a> in transmission rates. </p>
<p>But progress has not been uniform. Parts of Kenya – particularly the counties in the west of the country along the Rift Valley – are still plagued by serious seasonal cases of the deadly disease. </p>
<p>Seasonal outbreaks of malaria in these counties are most common in the wet season which runs from March to June and then again from October to December. But in years with high rainfall it also rains in January and February, which was the case this year. As a result, in February this year, for example, the arid counties of Baringo, West Pokot and Marsabit saw an outbreak where hundreds of people were <a href="https://www.standardmedia.co.ke/article/2001269063/another-malaria-outbreak-hits-baringo-county">hospitalised</a>. Most of the patients were children under the age of five – a group that’s globally considered a <a href="http://apps.who.int/iris/bitstream/10665/200018/1/9789241565158_eng.pdf?ua=1#page=47">high risk for severe malaria</a>. </p>
<p>The outbreak follows a similar one in October last year where in less than a weak more than 400 people were hospitalised and at least <a href="https://www.the-star.co.ke/news/2017/10/03/10-dead-400-admitted-after-malaria-outbreak-in-baringo-west-pokot_c1646017">10 had died</a> from malaria.</p>
<p>In Baringo county, malaria is of particular concern – accounting for 11.8% of the <a href="http://www.humanitarianresponse.info/system/files/">outpatient cases recorded</a>. This is higher than the nationwide malaria prevalence of 8%.</p>
<p>So what’s preventing <a href="http://www.e-kconsulting.co.ke/Resources%20/kenya-malaria-indicator-survey-report-2015-kmis-2015">Baringo county and other areas</a> from reducing its malaria caseload like other parts of the country? </p>
<p>A number of factors are at play. These include weak health systems, which are a common feature of the counties in the arid and semi arid areas of the country. In these areas the health facilities are sparsely distributed, have poor equipment and are understaffed. The areas also have poor road networks. On top of this, these areas are affected by conflict which in turn gets in the way of the government providing decent healthcare. </p>
<p>And finally, the environment also poses a challenge because they increase the number of larval breeding sites for the mosquitoes in the wet months, which increases the outbreaks of malaria. </p>
<h2>County challenges</h2>
<p>Health facilities in the arid and semi arid counties of Kenya are <a href="http://www.baringo.go.ke/index.php?option=com_content&view=article&id=1580:proposed-health-projects-for-the-financial-year-2016-2017&catid=10&Itemid=188">sparsely distributed</a>. On average most patients in remote villages need to walk more than 15 kilometres to the nearest facility. The facilities are also understaffed with inadequate medical equipment and insufficient anti-malarial drugs. </p>
<p>On top of this, criminal gangs have taken control in many areas in the wake of the ongoing conflict between two communities – the Pokot and Marakwet. As a result nurses regularly <a href="https://www.standardmedia.co.ke/article/2001269063/another-malaria-outbreak-hits-baringo-county">flee medical facilities</a> leaving no one in charge.</p>
<p>The fact that herding is the main economic activity in Baringo has also been a contributory factor to the higher rates of malaria. Research into the breeding habits of one of the mosquitoes that spreads malaria in the region – the <em>Anopheles arabiensis</em> – shows that it feeds on humans as well as livestock. Therefore, high livestock densities in an area where herders converge in communal grazing lands translate into more people being <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120729/">bitten</a>. </p>
<p>The seasons also play a role. In the dry season, the vector is sustained by permanent habitats like swamps and drainage canals from these swamps <a href="https://www.ncbi.nlm.nih.gov/pubmed/21352608">malaria vectors</a>. </p>
<p>During the <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Plasmodium+falciparum+transmission+and+aridity%3A+a+Kenyan+experience+from+the+dry+lands+of+Baringo+and+its+implications+for+Anopheles+arabiensis+control">rainy season</a>, the breeding sites increase when seasonal rivers and manmade habitats such as pan dams, concrete tanks, ditches and trenches get filled up with water. This increases the number of vectors and hence the outbreaks.</p>
<p>Living conditions are also a challenge. Most of the houses have thatched roofs and don’t have adequate screening on the doors and windows. This means that mosquitoes can easily enter.</p>
<h2>A few solutions</h2>
<p>The challenges in Baringo can be tackled in a few ways. But these require the resources of Kenya’s national and county governments. </p>
<p>Firstly, the national government needs to improve security so that medical staff aren’t forced to flee for their safety. </p>
<p>Secondly, the county governments need to come to the party too:</p>
<ul>
<li><p>provide adequate supplies of anti-malarials as well as enough diagnostic facilities and equipment</p></li>
<li><p>increase their distribution of insecticide-treated bednets as only 52% of the population living in malaria risk zones has been covered. </p></li>
<li><p>improve the way they manage their environments and introduce targeted larval control. This includes filling up the unnecessary ditches and trenches, draining stagnant water and applying larvicides into the irrigation canals to reduce the vector population. The highly localised nature of breeding sites in these semi-desert environments provides a good opportunity. </p></li>
<li><p>improve public health education and awareness. Pregnant women should be told of the benefits of taking antimalarial drugs during pregnancy and other residents should be encouraged to sleep under insecticide treated nets and to avoid unnecessary exposure to mosquito bites. </p></li>
</ul>
<p>There are other, more radical steps, county governments could take. Because house types have become an important <a href="https://www.ncbi.nlm.nih.gov/pubmed/21352608">factor in malaria transmission</a> they could consider encouraging people to shift from mud grass thatched huts to concrete houses with sealable windows. </p>
<p>They could also consider deploying mobile clinics and investing in ambulances to ferry patients from far-flung parts of the counties. </p>
<h2>A malaria-free Kenya</h2>
<p>Kenya is one of the three countries in Africa selected for the trials of a <a href="https://www.businessdailyafrica.com/news/Kenya-picked-for-key-global-anti-malaria-vaccine-trial/539546-3902510-9wfahcz/index.html">malaria vaccine</a> administered to infants who are five-months-old. </p>
<p>If the vaccine does prove effective during these trials it could become part of the core package of World Health Organisation recommended interventions and could provide a solution for residents in seasonal transmission zones. </p>
<p>It is clear that Kenya has made substantial progress towards eliminating malaria and other communicable diseases. If the Ministry of Health remains committed to further reducing the malaria burden in coming years, a malaria-free Kenya is possible.</p><img src="https://counter.theconversation.com/content/95101/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eunice Anyango Owino works for the University of Nairobi as a lecturer and consults with the International Centre of Insect Physiology and Ecology. She receives funds from the National Commission for Science Technology and Innovation (NACOSTI) and the International foundation for Sciences (IFS). </span></em></p>Baringo county and other areas on the western side of Kenya are struggling to reduce their seasonal malaria caseloads.Eunice Anyango Owino, Medical Entomologist at the School of Biological Sciences, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/943392018-04-12T14:10:53Z2018-04-12T14:10:53ZWhy shared toilets in informal settlements may pose a serious health risk<figure><img src="https://images.theconversation.com/files/214461/original/file-20180412-543-102jifb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Supplied</span></span></figcaption></figure><p>Informal settlements in developing countries are mostly characterised by poor housing, poverty and a lack of basic services. One of these services is sanitation. </p>
<p>Research <a href="https://theconversation.com/african-cities-arent-keeping-up-with-the-demand-for-basic-toilets-50917">shows</a> that nearly a fifth of the population in sub-Saharan Africa share their sanitation facilities. </p>
<p>Sharing toilets allows residents who do not have toilets in their individual homes to access toilets. But when these shared toilets are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295474/">poorly maintained and dirty</a>, they end up posing a health risk rather than reducing <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093300">the threat</a>. </p>
<p>Very few studies have tried to understand why and how shared sanitation facilities in informal settlements are dirty. <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-4009-6">My study</a>, which focused on the informal settlements in Kisumu, Kenya, tried to fill this gap. </p>
<p>I found that sanitation facilities in these settlements were shared by between five and ten households that lived in the same compound. These toilets were left unclean because a number of households didn’t want to take responsibility to clean a facility that was used by other people. Often times, ladies with children volunteered to clean the toilets because they didn’t want their children to fall sick. In other cases, people who understood the risks of dirty toilets also took the effort to keep the toilets clean.</p>
<p>Fixing this problem should be a priority. Proper and adequate toilets and sanitation facilities are key to <a href="http://www.who.int/mediacentre/factsheets/fs107/en/">preventing waterborne diseases like cholera</a> and diarrhoea. </p>
<h2>The health risks</h2>
<p>Kisumu, the main city in the western region of Kenya, has more than 420 000 residents. About 60% of the city’s population lives in informal settlements. Most residents in the settlements are tenants who commonly live in compounds. A compound is a group of several tenant households, living in individual housing units which are all under one landlord. These housing units share a common yard and amenities such as water and sanitation facilities. </p>
<p>These inadequate toilets have several public health consequences. But this is not limited to Kisumu.</p>
<p>Studies and reviews across the world have shown that shared toilets are linked to <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093300">poor health outcomes</a> such as diarrhoea, helminth infections, enteric fevers, faecal-oral diseases and adverse maternal or birth outcomes. Lack of sanitation is also linked to infections and <a href="http://www.trachomacoalition.org/resources/effect-water-sanitation-and-hygiene-prevention-trachoma">eye diseases such as trachoma</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214462/original/file-20180412-549-zp2wvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214462/original/file-20180412-549-zp2wvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214462/original/file-20180412-549-zp2wvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214462/original/file-20180412-549-zp2wvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214462/original/file-20180412-549-zp2wvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214462/original/file-20180412-549-zp2wvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214462/original/file-20180412-549-zp2wvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Shared toilets in compounds in Kenya remain dirty because nobody wants to clean them.</span>
<span class="attribution"><span class="source">supplied</span></span>
</figcaption>
</figure>
<p>Diseases such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080558/">diarrhoea and cholera</a> are the most common – and could in some severe cases, even result in death. <a href="http://onlinelibrary.wiley.com/doi/10.1111/tmi.12329/full">Research from 2012</a> for example, shows that more than 280 000 people died from diarrhoea as a result of inadequate sanitation. </p>
<p>In 2017, more than 4000 people were treated for cholera in Nairobi and at least two people died in the country. Poor access to proper sanitation was <a href="http://www.who.int/csr/don/21-july-2017-cholera-kenya/en/">among the reasons</a> listed for the spread of the disease. </p>
<h2>Cleaning up</h2>
<p>There are several ways in which sanitation can be improved. One is that the government takes the lead in ensuring access to clean sanitation facilities.</p>
<p>In our study we found that there were also mechanisms that communities could employ to improve the situation. We found that several compounds that had clean sanitation facilities were in this position because the toilets were shared by a smaller number of households. </p>
<p>In those compounds people were able to communicate and devise a cleaning schedule among themselves. These groups kept their toilets locked and they watched over each other to ensure that the toilets were kept clean. </p>
<p>There are other avenues for improvement. These include <a href="http://www.who.int/mediacentre/factsheets/fs392/en/">public health education campaigns</a> which play a critical role in improving the sanitation standards in informal settlements. The public should be informed about the benefits of using toilets and keeping them clean.</p>
<p>Authorities should also improve sanitation in informal settlements by working with landlords and tenants to work out strategies to keep these facilities clean. These landlords and tenants should be proactively involved. Residents should be informed about the public health consequences of toilets that are not clean.</p><img src="https://counter.theconversation.com/content/94339/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheillah Simiyu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Shared toilets have been shown to be linked to poor health outcomes.Sheillah Simiyu, Lecturer, Great Lakes University of KisumuLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/914202018-04-11T14:14:12Z2018-04-11T14:14:12ZWhy Kenya needs policies to tackle dengue and chikungunya viruses<figure><img src="https://images.theconversation.com/files/214267/original/file-20180411-577-1osrtcj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Kenya is one of several countries across the world experiencing an unprecedented outbreak of the <a href="https://www.cdc.gov/chikungunya/symptoms/index.html">chikungunya</a> and <a href="http://www.who.int/mediacentre/factsheets/fs117/en/">dengue</a> viruses. </p>
<p>Dengue fever and chikungunya are two of several arboviral diseases – which are spread to people when they’re bitten by an infected mosquito or tick. </p>
<p>Globally there’s been an <a href="http://www.who.int/mediacentre/factsheets/fs117/en/">increase in the emergence</a> and recurrence of these diseases. </p>
<p>Outbreaks have been reported in Europe – in <a href="http://www.who.int/csr/don/2012_10_17/en/">Portugal</a> in particular – as well as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578748/">South East Asia</a> and the <a href="https://vector.amsa.org.au/2017/10/26/441/">Pacific Island countries</a>. Reports of <a href="https://www.japantimes.co.jp/news/2014/09/29/national/another-type-of-dengue-virus-found-in-japan/#.Ws39sn--nIU">dengue fever in Japan</a> have arisen after a lapse of more than 70 years. </p>
<p>And in Africa, Burkina-Faso has also seen <a href="http://www.who.int/csr/don/6-november-2017-dengue-burkina-faso/en/">recurrent dengue outbreaks</a> in the last two years. In <a href="http://outbreaknewstoday.com/dengue-cases-rise-in-brazil-as-does-dengue-spending-90861/">Brazil</a> more than 1.4 million people were infected with dengue in 2016 and have suffered serious after effects. </p>
<p>Kenya’s caseload has seen more than 100 people infected with chikungunya in Mombasa since January 2018 after another 100 were infected with dengue in the seaside town last year.</p>
<p>These are not the first incidents. In the last five years, there have been several outbreak reports of the same diseases in the North Eastern part of Kenya. According to <a href="http://www.who.int/csr/don/09-august-2016-chikungunya-kenya/en/">World Health Organisation records</a>, the town of Mandera in the north east of the country recorded 1700 positive cases of chikungunya in May 2016.</p>
<p>The challenge with these two viruses are that they have no vaccines or treatment. Controlling the vector is the only way to prevent and control these diseases so that outbreaks don’t get out of control. </p>
<p>But part of the problem is that the Kenyan government has not instituted any policies that could regulate the control of these diseases. The government has done this with malaria by instituting several policies in the <a href="http://ghdx.healthdata.org/organizations/national-malaria-control-program-nmcp-kenya">national malaria control programme </a> that has helped control the spread of the disease.</p>
<p>Unless the government establishes policies to deal with dengue fever and chikungunya, like it did for malaria, it will have challenges managing the spread. </p>
<h2>Malaria vector control</h2>
<p>Policies that prevent the spread of malaria in Kenya have been in place for over a decade. There are two main methods: <a href="https://www.malariaconsortium.org/media-downloads/802/Malaria%20prevention%20through%20insecticide%20treated%20nets">insecticide treated bednets</a> and <a href="https://www.malariaconsortium.org/pages/107.htm">indoor spraying of homes</a>. In parts of the country, these methods have resulted in the disease’s caseload <a href="https://malariajournal.biomedcentral.com/articles/10.1186/s12936-017-2119-y">decreasing by over 70%</a>. </p>
<p>But these measures would do little to contain the vector that spreads dengue and chikungunya. </p>
<p>This is because unlike for the malaria vectors that bite at night and can be controlled by sleeping under bed nets, <a href="https://www.ncbi.nlm.nih.gov/pubmed/5301574"><em>Aedes aegypti</em></a> – the main vector that spreads dengue fever and chikungunya – bites during the day. Sleeping under bed nets would therefore have minimal impact in the control of the diseases. </p>
<p>The spraying of insecticides is not advocated because it targets unintended organisms and has a detrimental effect on the environment. In addition, there is the challenge of insecticide resistance. </p>
<h2>A few suggestions</h2>
<p>There are two approaches that the national and county governments could try: urban planning policies as well as policies that target land use. Some of these could be simple and easy to achieve. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/29284522">Recent research</a> on the <em>Aedes aegypti</em> – also known as the black mosquito – has shown that the mosquito prefers breeding in:</p>
<ul>
<li><p>garbage like abandoned car tyres, plastic containers and tins,</p></li>
<li><p>water tanks and pots, and </p></li>
<li><p>shady areas </p></li>
</ul>
<p>Urban planning policies that tackle these three areas could reduce the transmission risks of dengue and chikungunya. </p>
<p>One example is a policy that encourages a cleaner environment and for people to dispose their solid waste properly. This would rid urban centres of garbage lying around that provides artificial man-made habitats for the black mosquito.</p>
<p>Another would be for government to provide enough tap water to residents so that water is not stored in pots and tanks. These should be accompanied by education campaigns which sensitise citizens about the importance of covering, emptying and cleaning their domestic water storage containers weekly.</p>
<p>And a third policy could be improved environmental management. This includes better drainage systems around residential areas, and clearing bushes and shady areas. This would help destroy the breeding sites for these mosquitoes. </p>
<p>In terms of land use, <a href="https://www.ncbi.nlm.nih.gov/pubmed/26711512">novel research</a> suggests that attempts to <a href="https://parasitesandvectors.biomedcentral.com/track/pdf/10.1186/s13071-016-1675-2?site=parasitesandvectors.biomedcentral.com">intensify agricultural production</a> could be linked to a high prevalence of dengue fever and chikungunya. In Kenya this could be caused by plants that have been imported into Kenya bringing in invasive weeds like <a href="https://keys.lucidcentral.org/keys/v3/eafrinet/weeds/key/weeds/Media/Html/Parthenium_hysterophorus_(Parthenium_Weed).htm">parthenium hysterophorous</a>. This weed is the <a href="https://www.ncbi.nlm.nih.gov/pubmed/2441221">preferred source of sugar</a> for mosquitoes. Similarly to the protein mosquitoes get from blood, sugar is important for the biology and ecology of mosquitoes. For male mosquitoes, it’s the main source of energy. </p>
<p>There could be a benefit for government to turn vast areas of agricultural land into conservancies.</p>
<p>It’s clear that with proper policies and planning, dengue and chikungunya can be controlled but the government must take the first steps.</p><img src="https://counter.theconversation.com/content/91420/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eunice Anyango Owino is a medical entomologist and works for the University of Nairobi. She consults with the International Centre of Insect Physiology and Ecology and has received funding from the International Foundation for Sciences (IFS), the National Commission For Science, Technology & Innovation, Kenya. </span></em></p>Kenya must establish policies to tackle dengue fever and chikungunya, like it did for malaria.Eunice Anyango Owino, Medical Entomologist at the School of Biological Sciences, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/929362018-03-18T11:06:53Z2018-03-18T11:06:53ZKenya is paying a heavy human and financial cost for unsafe abortions<figure><img src="https://images.theconversation.com/files/210332/original/file-20180314-113465-lmt7xq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kenyatta National Hospital in Nairobi. Kenya's health system is under huge pressure.</span> <span class="attribution"><span class="source">EPA-EFE/DANIEL IRUNGU</span></span></figcaption></figure><p>One of the critical targets for countries that are trying to meet the sustainable development goals is reducing the number of mothers who die from complications during or immediately after their pregnancies. The <a href="http://www.who.int/sdg/targets/en/">target for 2030</a> is that each country will have less than 70 mothers dying for each of the 100 000 live births that happen each year. This would eliminate almost all preventable maternal deaths. </p>
<p>In Kenya, this is still a challenge. Every year <a href="http://kenya.unfpa.org/news/counties-highest-burden-maternal-mortality">for every 100 000 births 495 women die</a>. One of the major contributors to this figure are the complications that women sustain during unsafe abortions.</p>
<p>Unsafe abortions happen when a pregnancy is terminated by someone who lacks the necessary skills and in places that aren’t medically certified.</p>
<p>In Kenya, an abortion is only legal when there is a need for emergency treatment or the life or health of the mother is in danger. Permission for an abortion must be granted by a trained health professional. </p>
<p>The latest data for Kenya (from 2012) shows that there were <a href="http://aphrc.org/post/publications/incidence-and-complications-of-unsafe-abortion-in-kenya-key-findings-of-a-national-study">close to half a million</a> unsafe abortions in the country that year. At least 100 000 of those women needed to be treated in hospital. And roughly a quarter died due to complications. </p>
<p>In <a href="http://aphrc.org/post/publications/costs-treating-unsafe-abortion-complications-public-health-facilities-kenya">our study</a> we evaluated the costs – both financial and those related to human resources in health facilities – that Kenya’s public health facilities incurred treating complications stemming from unsafe abortions. </p>
<p>We calculated that in 2012 the Kenyan government would have spent an estimated US $5.1 million treating women who had developed complications from unsafe abortions. We estimated that by 2016 this figure would have gone up to US $5.2 million.</p>
<p>This is roughly what the Kenyan government spends funding free primary health care for six months of the year. And the same amount could provide effective contraceptives to about 50 000 Kenyan women who are of reproductive age. Treating these women also puts additional strain on Kenya’s already stretched health care system.</p>
<p>To manage the problem Kenya needs to take urgent action to implement policies and laws that it has in place that are designed to protect women, particularly their reproductive rights. For example, women need better access to a range of contraceptives. </p>
<p>But this kind of change requires political will to strengthen governmental institutions and agencies mandated to protect women’s health. </p>
<h2>Counting the costs</h2>
<p>For our study we analysed the national and regional distribution of abortion complications by caseload and severity along with data on the direct costs attached to these. We interviewed health care providers in panels and individually. And then we also looked at the amount of time health care providers spent with patients, the drugs they prescribed, and the supplies they required. </p>
<p>Using these details we were able to calculate the costs for treating mild, moderate and severe complications. We were also able to establish which region in Kenya spent the most to treat complications. </p>
<p>We found that most of the complications were moderate to severe. These were classified as medical emergencies, meaning they either were or could quickly become life threatening if they were not treated immediately. To treat these complications patients required extended hospital stays, intensive care, and needed to be attended by highly skilled health providers.</p>
<p>Health care workers could spend over 12 hours treating a patient with such complications. The procedures ranged from draining an abscess in the pelvis to repairing a cervical or vaginal tear.</p>
<p>About 35% of the cases were classified as severe but they accounted for more than half of the total costs. As expected, severe complications cost the most: US $2.7 million in total while treating moderate complications totalled US $1.7 million. Mild complications cost US $646,234. </p>
<p>At the per-case level, typical treatment could cost on average US $39 for mild complications to US $108 for severe complications. But our cost estimates were conservative. They exclude patients’ missed days of work, facility space, cost of referrals, and overheads. </p>
<p>Our analysis showed that facilities in Rift Valley and Western regions of Kenya had spent more than the other seven regions treating the complications of unsafe abortions. They also had the greatest numbers of women admitted. </p>
<h2>Responding to the problem</h2>
<p>To reduce the number of unsafe abortions in Kenya, the root cause of the problems need to be addressed. There are several. </p>
<p>For one, Kenya has a variety of policies around sexual and reproductive health rights through which public facilities are mandated to protect girls’ and women’s health. But in many regions women don’t have access to contraceptives. </p>
<p>If these policies are implemented it would accelerate access to contraception. Health providers, women, and communities need to be educated about these policies and what they mean for womens’ rights to contraception, the prevention of unsafe abortions, and the availability of quality post abortion care. </p>
<p>Women and men must also be able to access information about the most effective methods of contraception to reduce the number of unintended pregnancies, unsafe abortions, and the complications that arise from these procedures.</p>
<p>In addition, family planning services need to be improved and more contraceptive choices need to be offered to girls and women. And post-abortion services – both family planning counselling and access to services – need to be available. </p>
<p><em>* Hailemichael Gebreselassie, a senior research advisor at Ipas, a global non-profit that works to reduce maternal mortality, contributed to the writing of this article.</em></p><img src="https://counter.theconversation.com/content/92936/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Estelle Monique Sidze does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Kenya spends millions treating women who have complications after unsafe abortions.Estelle Monique Sidze, Associate Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/751392017-03-30T14:29:06Z2017-03-30T14:29:06ZThe Kenyan doctors’ strike is over, but there’s a lot of unfinished business<figure><img src="https://images.theconversation.com/files/162907/original/image-20170328-30782-189bog1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The end of the doctors' strike in Kenya is a truce in the fight for better health care. </span> <span class="attribution"><span class="source">Noor Khamis/Reuters</span></span></figcaption></figure><p>Kenyan doctors have <a href="http://www.bbc.com/news/world-africa-39271850">returned to work</a> after a gruelling 100-day strike, but a pressing question lingers: what are the long-term implications of their action on Kenya’s creaking health service?</p>
<p>The doctors had gone on strike to push the government to implement a <a href="https://www.standardmedia.co.ke/health/article/2000225884/details-of-the-disputed-salary-deal-signed-by-kenyan-doctors-and-nurses">collective bargaining agreement</a> signed in 2013. They ended the strike after reaching a deal with the government on salary increases of between 40% and 50% for all doctors in the public sector, signing of a collective bargaining agreement within sixty days and that there would be no victimisation of those who had been on strike.</p>
<p>A 40% salary increment is a formidable achievement for a trade union in Kenya: nonetheless other key issues that the union had raised were not fully addressed. </p>
<p>Doctors have <a href="https://www.standardmedia.co.ke/health/article/2001232422/doctors-in-nairobi-resume-work-amidst-kmpdu-threats">resumed work</a>. But the health facilities they work in remain unchanged. The long queues in public hospitals, insufficient supplies, lack of specialists in peripheral facilities and many preventable deaths are still a reality.</p>
<p>Moving forward, the health agenda should take centre stage in Kenya’s political and development debates to push for quality health care and ensure that the colossal health bills don’t continue to cripple Kenyans. </p>
<p>The end of the doctors’ strike should be viewed as a truce in the fight for better health care for all. Kenyans – including those in the health sector, the government, civil society and in communities – should make the best of it and heighten the level of cordial engagement to avoid a similar strike in future.</p>
<h2>Unfinished business</h2>
<p>The agreement to end the strike bears mixed fortunes for the heath sector. If implemented fully, it will form a good foundation for the government and doctors to pull together towards improved healthcare. </p>
<p>But the odds of this happening aren’t looking good. The process of implementing the return-to-work agreement has already hit speed bumps. This shows a lack of a goodwill which is likely to strain the relationship between the union and the employers. </p>
<p>This is a pity because the government has the opportunity to win the confidence and goodwill of the doctors’ union and other trade unions in the country by honouring the agreement. And both parties have a good opportunity to engage amicably during ‘peace-time’ which is preferable to negotiating during a strike. </p>
<p>The government needs to engage the union in major decisions that affect doctors. If this avenue is used properly, thorny issues can be sorted out in good time. This is especially important for key policy decisions on matters concerning human resource management and health facility infrastructure. </p>
<p>Over the coming weeks, both parties have an opportunity to reach a collective bargaining agreement which would be a major boost to the health sector in the country. The agreement is expected to streamline recruitment, equipping, training and retention of doctors in the public sector. </p>
<h2>The question of industrial action</h2>
<p>Another outcome of the strike is an awareness that <a href="http://www.health.go.ke/wp-content/uploads/2015/09/LABOUR_RELATIONS_ACT_2007.pdf">the laws</a> governing Kenya’s labour relations need to be aligned with the constitution.</p>
<p>The act, which predates the country’s current constitution, attempts to limit the freedom of workers to go on strike as defined in the <a href="http://www.klrc.go.ke/index.php/constitution-of-kenya/110-chapter-four-the-bill-of-rights">constitution</a>.</p>
<p>This is why many strikes in Kenya are declared unprotected by the courts which then issue orders to stop them, curtailing the freedom of employees to go on strike.</p>
<p>This issue is a common source of disagreement between trade unions and the courts and was a major point of contention in the doctors’ strike. It needs to be addressed to safeguard human rights and preserve the dignity of the courts.</p>
<h2>The reality of public health facilities</h2>
<p>The public had high expectations that the quality of health services would improve markedly once the strike was over.</p>
<p>But very little has changed at public health facilities which remain crowded, understaffed and poorly equipped.</p>
<p>Doctors need to continue persuading key decision makers to allocate more funds to the health docket to <a href="http://med.stanford.edu/careercenter/highlights/files/Weisburst.pdf">improve health </a> infrastructure, equipment and supplies. </p>
<p>But doctors can’t bring about change on their own. Civil society and the general public needs to push elected leaders and public officials to fix the health care system.</p>
<p>And community members need to be encouraged to demand that local health centres are well staffed and equipped to provide basic health care services.</p><img src="https://counter.theconversation.com/content/75139/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Moses Masika does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Kenya’s doctors embarked on a strike for a 100 days to push the government to implement a collective bargaining agreement signed in June 2013.Moses Masika, Tutorial Fellow, School of Medicine, University of Nairobi, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/584422016-04-29T04:26:55Z2016-04-29T04:26:55ZKenyans and Ugandans need to change their ways to arrest lifestyle diseases<figure><img src="https://images.theconversation.com/files/120251/original/image-20160426-1327-i6eocx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Reuters/Siegfried Modola </span></span></figcaption></figure><p>More than 90% Kenyans consume less than five servings of fruits and vegetables on most days. Nearly a quarter always add salt to their food before eating or during their meals. And 28% always add sugar to beverages. </p>
<p>More than half of the adult Kenyan population have never had their blood pressure tested. Yet one in four people has high blood pressure. Diabetes testing has even worse adherence, with only one in ten adults ever being tested.</p>
<p>The majority have never had their cholesterol levels tested, while 27% are either overweight or obese.</p>
<p>These are the results from the newly released <a href="http://aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">2015 Kenya STEPwise Survey</a>, a nationwide study that looked at how non-communicable diseases are affecting the country. </p>
<p>What the results show is that non-communicable diseases such as diabetes, cancer, heart disease and chronic respiratory illness have all skyrocketed in the country over the past ten years in the same way that they have in sub-Saharan Africa. </p>
<p>Globally, more than 16 million people die from non-communicable diseases. Of these, 80% are in low- and middle-income countries. And according to the World Health Organisation’s projections for the next ten years, <a href="http://www.afro.who.int/en/clusters-a-programmes/dpc/non-communicable-diseases-managementndm/npc-features/1236-non-communicable-diseases-an-overview-of-africas-new-silent-killers.html">28 million people</a> in sub-Saharan Africa will die from a chronic disease. </p>
<p>Responsibility to address the situation does not only lie with governments. The choices individuals make also have a huge role to play. </p>
<h2>Kenyans and Ugandans are too unhealthy</h2>
<p>Non-communicable diseases are linked to a number of risk factors, including:</p>
<ul>
<li><p>unhealthy diets;</p></li>
<li><p>smoking;</p></li>
<li><p>alcohol intake; and</p></li>
<li><p>a lack of exercise.</p></li>
</ul>
<p>These all significantly increase the individual’s risk of dying from a non-communicable disease.</p>
<p>Though the picture isn’t pretty in Kenya, the country is not alone. In Uganda, the <a href="http://www.who.int/chp/steps/Uganda_2014_STEPS_Report.pdf">2014 Uganda STEPwise Survey</a> shows figures that are as bad. </p>
<p>Here, 88% of the population consume less than five servings of fruits and vegetables on most days. And while 70% have never had their blood pressure measured, just under a quarter suffer from high blood pressure. More than 90% have never had their diabetes or cholesterol tested. And about 19% are overweight or obese.</p>
<p>The two surveys paint a shocking picture of how East Africans are exposing themselves to the mounting risks of non-communicable diseases. </p>
<p>These surveys must be a wake-up call to governments to find better solutions to the growing crisis of non-communicable illness. But they also suggest that individuals should and can be doing more.</p>
<h2>How to change behaviour</h2>
<p>So where do individuals start? </p>
<p>These days healthy food has been replaced with tasty and, most often, easy food. Grabbing food on the run means that only <a href="http://aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">6% of Kenyan adults</a> get their recommended five-a-day servings of fruits and vegetables. In <a href="http://www.who.int/chp/steps/Uganda_2014_STEPS_Report.pdf">Uganda</a> the figure is 13% for women and 12% for men. </p>
<p>Maintaining a healthy diet can help to reduce the risk of some cancers as well as the chances of being obese – which itself is a marker for all sorts of non-communicable diseases, including heart disease and diabetes.</p>
<p>A healthy diet also restricts salt intake, which for Kenyans is even more of a challenge than adding fruit and vegetables. One in four Kenyans and Ugandans add salt to their food before they even taste it. Every shake of that salt shaker carries with it a risk of high blood pressure and lasting damage to the heart, kidneys and brain.</p>
<p>High consumption of alcohol can also have an effect on weight and the organs most vulnerable to disease: the heart, the liver, the stomach and the pancreas. One in four Kenyan men <a href="http://aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">drink alcohol daily</a> and one in eight are <a href="http://aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">heavy drinkers</a>. </p>
<p>This means that half of men who are daily drinkers are daily heavy drinkers. Beyond the long-term damage of over-consumption, heavy drinking can also mean you – and others who share the road with you – are at higher risk of traffic accidents leading to serious injury or death.</p>
<p>Another risk factor is tobacco – smoking or being around smokers. The Tobacco Control Act in Kenya has been around since 2013. Yet one in four Kenyans is still exposed to tobacco in the workplace or in the home. </p>
<p>More than 13% of Kenyans currently smoke. And in Uganda 40% are exposed to second-hand smoke. Passive smoking – when a person is exposed to someone who smokes, even if he or she doesn’t smoke – is equally dangerous, as it heightens the risk of cancer, chronic respiratory conditions or <a href="http://www.who.int/tobacco/research/secondhand_smoke/en/">heart disease</a>.</p>
<h2>Taking action</h2>
<p>What all this means is that individuals have the responsibility to remove the risks from their lifestyles. </p>
<p>Governments, too, have a responsibility to develop systems to help people mitigate the risks.</p>
<p>Without concerted action at the systems level, the burden on overstretched health services will be even greater, and the costs of inaction will stymie economic growth and development.</p>
<p>Damage to a person’s health and body happens over the long term. It may manifest as a treatable condition, such as being overweight, or having high blood pressure or diabetes, but it can quickly deteriorate into a degree of suffering that can only be managed, not cured.</p><img src="https://counter.theconversation.com/content/58442/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Kyobutungi receives funding from International Development Research Centre (IDRC).
</span></em></p>Non-communicable diseases are skyrocketing in Kenya and Uganda. Though the countries’ governments have a responsibility to tackle the problem, individuals need to take action too.Catherine Kyobutungi, Director of Research, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/557782016-03-08T04:38:59Z2016-03-08T04:38:59ZBetter maternity leave laws are needed to protect African mothers<figure><img src="https://images.theconversation.com/files/114069/original/image-20160307-31281-9w7kjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Employers should provide an enabling environment at work for women to continue breastfeeding their infants.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Maternity leave for women in developing countries is still a massive problem, with many women in informal sectors not receiving adequate cover.</p>
<p><a href="http://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/publication/wcms_242617.pdf">More than 70%</a> of working women do not enjoy the full benefits of maternity leave. Only 330 million women – or 28% of working women – are fully protected, meaning they get time off and full pay. About 80% of those without adequate maternity protection are in Africa and Asia.</p>
<p>When women do not enjoy full maternity benefits, their health – and that of their children – may be affected.</p>
<p><a href="http://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/publication/wcms_242617.pdf">Discrimination</a> against women around maternity leave is pervasive throughout the world, according to the International Labour Organisation. And even where legislation does exist, ensuring it is effectively implemented remains a challenge. </p>
<p>The organisation recommends 14 weeks’ maternity leave, with six weeks of compulsory postnatal leave for women in countries that have signed the <a href="http://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_ILO_CODE:C183">Maternity Protection Convention</a>. At least 167 of the organisation’s member nations have passed some form of <a href="http://mprp.itcilo.org/allegati/en/m12.pdf">legislation</a> on maternity protection. But not all countries fully implement or enforce these laws. </p>
<p>In Kenya, for example, laws provide women in formal employment with three months of maternity leave, but in some instances this is not adhered to. And casually employed women are not entitled to maternity leave, according to <a href="http://onlinelibrary.wiley.com/doi/10.1111/mcn.12161/epdf">research</a> conducted by the African Population and Health Research Centre in Kenya. These women have to juggle staying home shortly after delivery to rest and <a href="http://aphrc.org/workplace-support-for-breastfeeding-mothers/">breastfeed</a> their babies with returning to work. </p>
<p>Even where women are entitled to maternity leave, some organisations do not adhere to the regulations and women are asked to work from home during maternity leave or return to work prematurely. Few workplaces provide appropriate policies and an enabling environment for women to combine work with breastfeeding successfully once they return from maternity leave.</p>
<h2>Maternity leave laws across the globe</h2>
<p>Legislating maternity leave is important because it transposes universally accepted principles into national laws and sets minimum national and subnational standards. The content of the legislation is determined individually by countries. </p>
<p>For example, in South Africa, domestic workers are eligible for maternity benefits because they are covered by the basic labour laws of the country. Domestic workers have the right to paid leave, overtime payments, severance pay, notice of dismissal and a written contract with their employer. </p>
<p>The Brazilian constitution grants women 120 days of maternity leave without prejudice to jobs or wages.</p>
<p>In Gabon, a pregnant woman can ask the labour inspector to examine the work she is doing before she goes on maternity leave to ensure that it is not too strenuous for her. If it is found to be dangerous, she may ask to be moved to a different position without loss of pay until three months after she returns from maternity leave. </p>
<p>The International Labour Organisation notes that its maternity leave convention applies to all employed women, including those in atypical forms of dependent work, including part-time, casual or seasonal jobs. But the organisation admits that few countries have included such a wide scope in their national legislation. </p>
<p>In reality, the percentage of women covered by the law is often quite low. Several <a href="http://mprp.itcilo.org/allegati/en/m12.pdf">sectors</a> are either excluded or poorly protected. These include:</p>
<ul>
<li><p>the private sector compared with the public sector;</p></li>
<li><p>rural workers compared with urban ones;</p></li>
<li><p>agricultural, informal economy, domestic or homeworkers;</p></li>
<li><p>migrant workers;</p></li>
<li><p>part-time, casual or temporary workers;</p></li>
<li><p>workers in small enterprises or those in family undertakings; and</p></li>
<li><p>self-employed, independent workers.</p></li>
</ul>
<h2>Why maternity leave is important</h2>
<p>Maternity leave allows mothers to breastfeed adequately, and to rest and recover from nine months of pregnancy and subsequent delivery. Research shows that the longer a mother stays on maternity leave, the more likely she is to breastfeed exclusively or <a href="http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01044-2.pdf">breastfeed at all</a>.</p>
<p>Breastfeeding is critical to good nurturing. It has enormous short- and long-term <a href="http://apps.who.int/iris/bitstream/10665/43623/1/9789241595230_eng.pdf">benefits</a>. These include:</p>
<ul>
<li><p>reduced infections and deaths among infants; </p></li>
<li><p>improved mental and physical development; and </p></li>
<li><p>improved <a href="http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70002-1/abstract">intellectual performance</a>, educational achievement and earning ability in adulthood. </p></li>
</ul>
<p>Breastfeeding improves mothers’ <a href="http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(15)70002-1.pdf">post-partum recovery</a>. It also reduces the risk of non-communicable diseases such as <a href="http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01024-7.pdf">diabetes</a>, cancer and depression, and improves birth spacing. </p>
<p>But adverse work conditions mean many mothers stop exclusive breastfeeding before six months or any breastfeeding before two years, counter to World Health Organisation <a href="http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01044-2.pdf">recommendations</a>.</p>
<h2>Improving economic activity</h2>
<p>A woman should be given the chance to exercise her right to choose both good nurture for her baby and productivity for herself. </p>
<p>Women should be supported to successfully combine work with breastfeeding so they do not have to choose one over the other. This may include safeguarding the three months’ maternity leave provided for in international labour legislation. But it should include the option of providing longer maternity leave of up to six months. </p>
<p>This would cover the World Health Organisation’s recommended six months of exclusive breastfeeding. And employers should provide an enabling environment at work for women to continue breastfeeding. </p>
<p>It is also important to consider those categories not entitled to maternity leave in many national labour laws. </p>
<p>Protecting maternity leave is not only important for the well-being of the mother and her baby; it is important for the whole society. It is the first step towards optimal child development, health and survival. It will also <a href="https://blogs.unicef.org/blog/why-nutrition-and-breastfeeding-are-crucial-to-sustainable-development/">help achieve</a> the <a href="http://www.un.org/sustainabledevelopment/sustainable-development-goals/">Sustainable Development Goals</a> and the realisation of the <a href="http://www.unfpa.org/demographic-dividend">demographic dividend</a>. Importantly, it also has an effect on women’s economic productivity.</p><img src="https://counter.theconversation.com/content/55778/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Kimani-Murage receives funding from the Wellcome Trust, NIH/USAID, Unicef, Transform Nutrition.</span></em></p>Only 28% of working women across the globe are fully protected by maternity laws that provide for time off work with full pay.Elizabeth Kimani-Murage, Research Scientist at the African Population and Health Research Center and Adjunct Assistant Professor, Brown UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/535132016-02-16T04:20:44Z2016-02-16T04:20:44ZWhy Nairobi must spread the right food message in an unhealthy environment<figure><img src="https://images.theconversation.com/files/111468/original/image-20160215-22596-gphpen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Thomas Mukoya/Reuters</span></span></figcaption></figure><p>Scientific evidence shows that consuming at least <a href="http://www.who.int/dietphysicalactivity/fruit/en/">five portions</a> of fruit and vegetables a day can prolong your life and reduce your risk of developing non-communicable diseases such as diabetes and cancer.</p>
<p>Yet not enough people across the world are consuming adequate amounts of fruit and vegetables. In low and middle income countries, over <a href="http://www.ncbi.nlm.nih.gov/pubmed/19362694">75% of adults</a> consume less than the minimum recommendation. In <a href="http://www.who.int/chp/steps/UR_Tanzania_FactSheet_2012.pdf?ua=1">Tanzania</a> more than 95% of people consume less than the minimum requirement. </p>
<p>In the slums of Nairobi, our <a href="http://onlinelibrary.wiley.com/doi/10.1111/tmi.12200/full">research shows</a> that less than half of the adult population are meeting their daily fruit or vegetable requirements. Instead, as global fast food outlets flood the Kenyan market, they prefer junk food which they see as a status symbol. </p>
<p>This could be why there are high levels of <a href="http://onlinelibrary.wiley.com/doi/10.1111/tmi.12200/full">hypertension</a> and diabetes in these slums where one in every five people has one of the two conditions. In addition, we found that less than a quarter of those who had diabetes were aware of their condition. And fewer than 5% of all people with diabetes had their blood sugar under control. </p>
<h2>Africa’s fat map</h2>
<p>The increase in non-communicable diseases such as diabetes in low and middle income countries is largely driven by rapid urbanisation and preferences for high-calorie diets with decreasing levels of physical activity.</p>
<p>In sub-Saharan Africa alone diabetes sufferers are projected to double from 12 million to <a href="http://www.ncbi.nlm.nih.gov/pubmed/20609971">24 million</a> in the next two decades. <a href="http://www.who.int/nmh/publications/ncd_report_full_en.pdf">Evidence</a> from the World Health Organisation shows type 2 diabetes will be the key contributor to this rise. </p>
<p>Several <a href="http://onlinelibrary.wiley.com/doi/10.1002/dmrr.1106/full">studies</a> from the continent show excessive body weight and obesity as risk factors for diabetes. </p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/20003478">review</a> of the Demographic and Health Survey data from seven African countries over 10 years shows that there are rising trends in overweight and obese urban women. Even more worrying is that the increase is seven times higher among the poorest urban women compared with the richest urban women.</p>
<h2>Price is not the problem</h2>
<p>Nairobi’s slums are known for their thriving <a href="https://www.bioversityinternational.org/fileadmin/user_upload/online_library/publications/pdfs/1265_Analysis_of_markets_for_African_leafy_vegetables_within_Nairobi_ant_its_environs_and_implications_for_on-farm_conservation_of_biodiversity.pdf">vegetable markets</a>. So, why are slum residents not consuming adequate amounts of fruit and vegetables? </p>
<p>Initially we thought that the price of the fruit and vegetables was prohibitive for slum residents given that the majority of them live on less than $2 a day.</p>
<p>But the price is not the main deterrent. While imported fruit such as pomegranates may, understandably, be expensive, local produce such as bananas or the trendy superfood kale – a Kenyan staple for generations known as <a href="http://www.capitalfm.co.ke/lifestyle/2013/05/13/the-amazing-benefits-of-sukuma-wiki/">sukuma wiki</a> – are affordable. </p>
<p>When we dug a bit deeper through focus group discussions, we found there was a social desirability issue: slum residents wanted junk food because it reflected a higher socioeconomic status.</p>
<p>Their aspirations are linked to a combination of clever marketing, celebrity culture and the social media frenzy around global fast food outlets opening in Kenya. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/111469/original/image-20160215-22600-ejmrra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/111469/original/image-20160215-22600-ejmrra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111469/original/image-20160215-22600-ejmrra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111469/original/image-20160215-22600-ejmrra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111469/original/image-20160215-22600-ejmrra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111469/original/image-20160215-22600-ejmrra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111469/original/image-20160215-22600-ejmrra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Several fast food outlets have opened in Nairobi in recent years, encouraging people to eat highly processed food.</span>
<span class="attribution"><span class="source">Noor Khamis/Reuters</span></span>
</figcaption>
</figure>
<p>And who could blame them? In the past few years, several major global <a href="http://venturesafrica.com/mcdonalds-to-join-growing-list-of-global-food-chains-flooding-kenya/">fast food brands</a> have set up shop in Kenya including <a href="http://usatoday30.usatoday.com/money/industries/food/story/2011-08-27/KFC-goes-to-Kenya-first-US-fast-food-chain-in-E-Africa/50108550/1">KFC</a> chicken and Pizza Hut. And more are said to be eyeing an entrance into East Africa’s largest economy. </p>
<h2>Why it’s hard to change eating habits</h2>
<p>Trying to find ways to promote fruit and vegetable consumption among slum residents isn’t easy. To add to the problem one of Kenya’s major dailies recently published a bombshell <a href="http://www.nation.co.ke/news/Nairobi-residents-eating-poison-scientists-warn/-/1056/3028510/-/7thgf5z/-/index.html">article</a> slamming fruit and vegetables.</p>
<p>According to the article, laboratory tests conducted by scientists on samples of fruit and vegetables from across Nairobi found toxic levels of various substances.</p>
<p>It argued that samples of sukuma wiki had shown high levels of lead, most likely from contaminated riverbeds where the vegetable is typically grown. And samples of bananas and oranges had high levels of calcium carbide, which is used illegally to hasten the ripening of fruit.</p>
<p>The article sparked widespread negative reaction and has exacerbated the challenge of those living in urban slums not eating vegetables.</p>
<p>The World Health Organistion’s <a href="http://www.who.int/nmh/publications/who_bestbuys_to_prevent_ncds.pdf">recommendations</a> for improving fruit and vegetable intake are pitched at a high policy level. For example, one recommendation is that marketing of food and beverages to children should be restricted. </p>
<p>But for health practitioners on the ground suggestions such as these do not necessarily translate into practical steps to change eating habits. </p>
<p>The challenge health practitioners have is what message do we pass to the residents of Nairobi’s slums? Do we ask them to eat more fruit and vegetables given the revelations in the news article? Or do we ask them to stick with junk food until the relevant authorities get their act together and halt illicit practices affecting the fruit and vegetable industry?</p>
<h2>What needs to be done</h2>
<p>Clearly this is a catch-22 situation. The newspaper article highlights the need for developing countries like Kenya to review their food and agricultural policies.</p>
<p>There is an urgent need for policies that protect the lives of people by:</p>
<ul>
<li><p>promoting access to healthy food</p></li>
<li><p>regulating the production, sale and marketing of junk food (and drinks)</p></li>
<li><p>ensuring that the food supply chain is free of toxic chemicals, drugs and other contaminants, and</p>
<ul>
<li>minimising the effects of food production on climate change and vice versa. </li>
</ul></li>
</ul>
<p>The policy environment for these interventions is currently weak. And unless the government takes urgent steps to put these policies in place, there is no way to stop people from lining up at the next fast food outlet.</p><img src="https://counter.theconversation.com/content/53513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samuel Oti receives funding from Bill & Melinda Gates Foundation. </span></em></p>Residents in Nairobi’s urban slums are opting for fast food rather than the healthy alternatives, which is increasing their risk of developing diabetes.Samuel Oti, Senior Research Officer, African Population and Health Research Center, and Millennium Promise Fellow, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/499212015-10-30T04:20:01Z2015-10-30T04:20:01ZLessons other countries can learn from Kenya’s ambitious nutrition plan<figure><img src="https://images.theconversation.com/files/100239/original/image-20151029-15358-s0odhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kenya's nutrition plan has resulted in dramatic improvements in its nutrition targets. </span> <span class="attribution"><span class="source">Reuters/Mohamed Nureldin Abdallah </span></span></figcaption></figure><p>One in every three people globally suffers from malnutrition. And nearly half of all countries in the world face multiple serious burdens of malnutrition such as poor child growth, micronutrient deficiency and overweight adults, according to the <a href="http://ebrary.ifpri.org/utils/getfile/collection/p15738coll2/id/129443/filename/129654.pdf">2015 Global Nutrition Report</a>. </p>
<p>Three years after the World Health Assembly set the 2025 goals to improve undernutrition, countries across the globe have scaled up their programs to address malnutrition. The 2015 nutrition report reveals this is not nearly enough to meet the assembly’s targets.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=650&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=650&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=650&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=817&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=817&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=817&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">WHO</span></span>
</figcaption>
</figure>
<p>The targets are to:</p>
<ul>
<li><p>reduce stunting in children under the age of five by 40%;</p></li>
<li><p>reduce anaemia in women of reproductive age by 50%;</p></li>
<li><p>reduce low birth weights by 30%;</p></li>
<li><p>reduce and maintain childhood wasting to 5%;</p></li>
<li><p>improve exclusive breastfeeding to 50%; and </p></li>
<li><p>ensure there is no increase in overweight children. </p></li>
</ul>
<p>Out of 74 countries that were analysed for the report, Kenya is the only country that is on track to meet all five targets by 2025. This is mainly based on its achievements in the last few years.</p>
<p>Kenya has reduced stunting to 26%. Its low birth weights are down to 5.6% and it has improved exclusive breastfeeding to 61.4%. Childhood wasting and obesity both sit at 4% and anaemia in women of reproductive age has been reduced to 25%.</p>
<p>Of the remaining 73 countries, only four others – Colombia, Ghana, Vanuatu and Vietnam – are on course for four targets.</p>
<p>So what is Kenya doing right, and how can it continue with its progress?</p>
<h2>A bold plan</h2>
<p>Kenya’s <a href="http://bit.ly/1G8RVz8">National Nutrition Action Plan 2012-2017</a> has been central to it combating malnutrition. There are several elements that have led to the strategy being successfully implemented. </p>
<p><strong>Strong government leadership and co-ordination</strong></p>
<p>A Nutrition Interagency Co-ordinating Committee, which was formed and is chaired by the government’s head of nutrition, has resulted in well-co-ordinated structures that implement actions around nutrition. Within these structures, all the stakeholders both inside and outside the government have clear roles and responsibilities. </p>
<p>The committee includes a network of government ministries: Health, Education, Agriculture, Planning, Labour as well as United Nations agencies, civil society, academic and research institutions, the private sector and multilateral and bilateral donors.</p>
<p>A budget of US$687 million (KES70 billion) was drawn, and the Kenyan government committed a total of US$58 million (KES6 billion) of public funds to the five-year plan.</p>
<p>Kenya has also forged international partnerships to boost the plan. Since 2012 it has been part of the global <a href="http://scalingupnutrition.org/">Scaling Up Nutrition</a> movement. The movement is made up of 55 countries committed to improving their nutrition figures. This has helped to develop an approach that works across sectors to implement nutrition-specific and nutrition-sensitive interventions and strategies. </p>
<p><strong>Support from donors</strong></p>
<p>Kenya’s network of development partners, which include the UN system and bilateral donors such as the European Union, the US, Japanese and UK governments and the World Bank, are all making commitments to support the national nutrition initiative. </p>
<p><strong>Good monitoring and research</strong></p>
<p>And to measure progress around the nutrition indicators, Kenya has incorporated strong monitoring and research and information management and sharing. It has guided how the nutrition plan is implemented and overseen by a nutrition information working group in the health ministry.</p>
<p><strong>Improved human resources for health</strong></p>
<p>The government and its implementation partners have increasingly enhanced the capacity of the healthcare staff. They support nutrition counselling by training healthcare workers on high-impact nutrition interventions such as importance of infant and young child feeding.</p>
<h2>The impact of policy changes</h2>
<p>The <a href="http://bit.ly/1G8RVz8">National Nutrition Plan</a> is part of a roadmap to success, called <a href="http://www.vision2030.go.ke/index.php/vision">Kenya Vision 2030</a>. Along with the nutrition plan, it draws on other strategies and policies:</p>
<ul>
<li><p>the maternal infant and young child nutrition 2012-2017 strategy; and </p></li>
<li><p>The <a href="http://bit.ly/1NsvuqF">Food and Nutrition Security Policy</a>.</p></li>
</ul>
<p>The infant nutrition strategy makes sure high-impact, cost-effective nutrition interventions like promoting breastfeeding and other maternal, infant and young child nutrition practices are implemented at health facilities in communities.</p>
<p>Along with Kenya’s newly promulgated <a href="http://www.lcil.cam.ac.uk/sites/default/files/LCIL/documents/transitions/Kenya_19_2010_Constitution.pdf">constitution</a>, the roadmap has brought positive changes to improve the Kenyan people’s health status.</p>
<p>One of these changes is a free maternity policy, which encourages more deliveries at health facilities. This has increased the number of babies born with a trained attendant at a facility from 43% in 2008 to 61% in 2014, based on the recent <a href="http://bit.ly/1ONxyws">national survey</a>. </p>
<p>Birthing at a facility results in care for the mother and baby after birth before going home. Mothers are taught how to adequately breastfeed and are counselled on family planning and babies get the required vaccinations.</p>
<p>Another change is the recently enacted <a href="https://extranet.who.int/nutrition/gina/sites/default/files/KEN%202012%20Thre%20Breast%20Milk%20Substitutes%20Regulation%20and%20Control%20Bill,%202012%20Arrangement%20of%20Clauses_0.pdf">Breast Milk Substitutes (Regulation and Control) Act</a>. The act protects, promotes and supports breastfeeding. Better breastfeeding practices leads to better child growth, development and survival.</p>
<h2>What next?</h2>
<p>Kenya is on track to achieve these highly ambitious but critically important global nutrition <a href="http://bit.ly/1KcGicQ">targets</a>. But more needs to be done.</p>
<p>Despite the strong commitment by the Kenyan government to raise close to 10% of the budget to implement the national nutrition plan, more government resources are critical to ensure success.</p>
<p>Although co-ordination is strong, there are still some gaps that need to be addressed, particularly around convening powers. To address these, discussions are underway to establish a Multi-sectoral Food Security and Nutrition Secretariat and a Nutrition Technical Committee. The secretariat would fall under the office of the oresident while the technical committee under the cabinet secretary for health.</p>
<p>A systematic investigation of the success factors is needed to ensure the entire country is on track to achieve these targets. But the championing of optimal nutrition is universal. </p>
<p>With sustained investment, sustainable progress towards our goal as a nation to ensure a high quality of life for everyone – beginning with the first day of their lives can be achieved.</p>
<p>As Kenya marks National Nutrition Week, promoting good nutrition as a human right, the Kenyan government must increase its support to the national nutrition plan to ensure that every child born in Kenya has a healthy start. </p>
<hr>
<p><em>Betty Samburu, programme manager at the maternal infant and young child nutrition programme within the Kenyan Ministry of Health; Marjorie Voleje from UNICEF and SUN Movement and nutritionist Grace Gitau also contributed to this article.</em></p><img src="https://counter.theconversation.com/content/49921/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Kimani-Murage previously received funding from the Wellcome Trust and is currently funded by PEER Health and Transform Nutrition. She works for the African Population and Health Research Center. She is affiliated with the Global Nutrition Report, Brown University and Glasgow University. </span></em></p>Over the last three years Kenya has seen marked improvements in its nutrition-related targets as a result of a national nutrition plan it has implemented.Elizabeth Kimani-Murage, Senior Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.