The Transform Nutrition Research Consortium convened the research symposium ‘Evidence for action in East Africa’ on Thursday 8 June 2017, at the Southern Sun hotel, Nairobi, Kenya. A hundred participants from NGOs and academia working on nutrition, health, child welfare and development gathered together with government ministers from Kenya and Ethiopia, donor agency representatives and journalists to discuss the important issue of tackling undernutrition in East Africa.
While the prevalence rates for wasting and underweight have declined over the past three decades, the stunting rate has increased to over a third (35%).
Grainne Moloney, Head of Nutrition in Kenya for UNICEF and member of the Transform Nutrition Consortium Advisory Group gave her reflections on the day at the end of our meeting in Nairobi on 8 June 2017.
“Thanks to all for coming today and for your excellent participation. I do feel we are all very privileged to have been able to be here today and have access to such important and cutting edge research that we can immediately take back and apply to our work. Most of the time we are all too busy to reflect on the new papers/ evidence being published so today we had the opportunity to come together in our different communities from Government, academia, research, policy makers, programmers all with a common goal of how to improve the nutritional situation of children in Africa. We had time to openly discuss the latest findings and opportunities of application – this is rare. We also must acknowledge that most regions in the world are now seeing reductions in the absolute numbers of stunted children, with the exception of West Central East and Southern Africa so the learning from today is vital to help us all to get the numbers and indicators moving downwards by applying this learning immediately in our day to day work. The fact that you are all still here after 5pm on a weekday given we are now deep in traffic in Nairobi, also shows your interest in today’s meeting and on behalf of you all I would like to specifically thank the Transform team and the local organizing team of Save the Children for arranging and inviting us all to such an interesting and successful day.
So to provide a quick summary of the 4 sessions: Agenda here
o Session one ~ Stories of Change in Nutrition: Africa set the basis of what works in terms of success stories in stunting reduction based on a review of several case studies- we learned the key common drivers and factors that need to be in place to reduce undernutrition and the case studies illustrated a common theme over and over again. While as a community we have struggled to find the silver bullet to reduce stunting from the quantitative side – now we know the important factors that do have an impact and that it doesn’t have to take generations, that changes in the short term are possible with the right enabling environment – this is something all of us today can carry back to our countries – where we can all write our own story of change and review where we are and what areas we need to focus on more.
o Session two ~ Nutrition sensitive social protection brought the latest evidence on the very topical areas of social protection and nutrition – with 2 solid country examples from Ethiopia and Kenya as well as the review of other studies by John Hoddinott on the potential for its role in stunting reduction. We know the research from Latin America has shown good results – but we have yet to see these same results in Africa – why is that – what are the issues and learning around targeting, monitoring, transfer value and what do we need to consider when we design such programmes. The experience from Ethiopia and Kenya clearly highlighted the evolution of the large Government led programmes for the most vulnerable populations and that over time they are becoming much more nutrition sensitive. It is important to recognize these are dynamic programmes whereby we, as the nutrition community, now need to be more proactive and be at the table to advocate for increased nutrition sensitivity in the design. And let’s generate that evidence for Africa as this is a gap and let’s look at the wider welfare programmes also as an opportunity to influence — and not just cash transfers as ultimately this is the future for support to our vulnerable communities.
o Session three ~ Transform Nutrition research from Kenya and Ethiopia then highlighted several innovative research studies supported by Transform Nutrition that aim to improve nutrition outcomes. The studies ranged from technological innovation in terms of using handheld devices in nutrition programmes which looked not just at the time saving side but also on efficiency and quality assurance to new approaches in using Social Returns on Investment (SROI) and giving a new importance and value to people’s perceptions of caring for their children. Finally we heard 2 case studies that reinforced some of the earlier learning on social protection, that if we don’t make that connection to the household and the behaviors and needs of that household in the design of our programme and only focus on the supply side such as increased production, we will not have an impact on improving nutrition outcomes.
o Session four ~ Leadership in nutrition was a highly inspiring and motivating session where we had the privilege to learn from Transform’s nutrition champions who through their commitment energy and belief in their work- have made extraordinary influence and gains in their sector. Again common themes emerged through each of the stories- and we can all take something from them. The role of leader also was highlighted but not always in the traditional sense of a senior Government official but in all the work we do – we can all be champions to improve the agenda , also the stories highlighted it is not always easy , there are often conflicts of interest that we have to manoeuver but some of the key learning was the importance of getting people together, having a common vision, dealing with the challenges and being self aware of what is possible- so let’s all take inspiration from these great women and do our bit to get nutrition on the agenda in our countries.”
A research brief by colleagues at Egerton University, Kenya Agrobiodiversity and dietary diversity for improved nutritional status of mothers and children in Rongai sub-county, Nakuru is now available. The brief summarises the findings of surveys where the association between agrobiodiversity (the variety of all forms of life directly relevant to agriculture, including crop varieties and animal species) and diet diversity for children 6–23 months old and their mothers or caregivers were determined. We make recommendations on how the situation could be improved.
A mobile health application developed to help with Integrated Management of Acute Malnutrition (IMAM) which enables health workers and volunteers to identify and initiate treatment for children with acute malnutrition before they become seriously ill,was evaluated in 40 health facilities in Wajir Kenya. A research brief is now available Preliminary findings from a malnutrition mobile app randomised trial in Wajir, Kenya which summarises the findings.
Community based Management of Acute Malnutrition (CMAM) is a proven high-impact and cost-effective approach in the treatment of acute malnutrition in developing countries. However, success is limited if treatment protocols are not followed, record keeping and data management is poor and reliable data is not available in time for decision makers.
There is strong evidence that mobile device based (mHealth) applications can improve frontline health workers’ ability to apply CMAM treatment protocols more effectively and to improve the provision of supply chain management. A new Transform Nutrition working paper is now available A mobile health application to manage acute malnutrition Lessons from developing and piloting the app in five countries which we hope will inform future mobile health projects.
A new Transform Nutrition research brief A mobile app to manage acute malnutrition is now available. In this brief programme staff in Niger, Chad, Mali, Kenya and Afghanistan discuss the challenges they faced adapting a mobile health app and rolling it out in some of the most remote, hard to reach health facilities in the world and make valuable recommendations for other mobile health application developments .
From 2011-2017 Transform Nutrition has been strengthening the content and use of nutrition-relevant evidence, to accelerate the reduction of undernutrition. On 8 June Transform Nutrition is hosting a regional meeting Using evidence to inspire action in East Africa in Nairobi, Kenya.
This regional meeting will present experiential learning from other African and South Asian countries on key drivers to improve nutrition status, along with evidence on work works in nutrition-sensitive interventions, to policymakers from Kenya and international donors and NGOs in the East Africa region. It aims to inform and equip them to address the particular challenges of tackling child undernutrition in their current contexts. See agenda and press release.
This briefing Social Return On Investment Assessment Of A Baby Friendly Community Intervention In Urban Poor Settings, Nairobi, Kenya by Transform Nutrition project partners African Population Health Research Center answers that question. It outlines the impact of the Maternal Infant and Young Children Nutrition project that aimed to improve the health and nutritional status of children and inform implementation of the government’s Baby Friendly Community Initiative. The Study is now also featured in June 2016 issue of Field Exchange.
Our project partner African Population Health Research Center is working on a study looking at home based nutritional counselling interventions in urban poor settings in Nairobi, Kenya and asks whether there is a social return on investing in these initiatives? They have a blog where the progress of the initiative and its impacts are regularly recorded and updated.