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Nutritional profile of the population in a food-for-work project area: A case study from Samburu District, Kenya
A. A. Kielmann, N. S. Kielmann, A. A. J. Jansen, D. N. Njama, G. K. Maritim, R. Mwadime, and K. Saidi
Before discussing our findings, it is important to point out once more the major limitations inherent in this investigation—namely, the method of sampling and the different coverage of the population in the various locations—and to determine to what extent these limit the potential use of the collected information.
Although it was originally planned to identify the survey population through random (cluster) sampling throughout the geographical boundaries of Wamba Division, this could not be done, primarily because of a number of demographic features, socio-cultural practices, and characteristics peculiar to the area but also because of time and cost constraints. As noted, the population density is low. Aside from the few trading centres, there are no major population aggregations. The people generally live in small manyattas widely dispersed throughout the division, with as few as three and rarely more than fifteen huts. This would make it extremely time-consuming as well as costly to accumulate a study population through random sampling.
Even if such a procedure were followed, there is no guarantee that the sample would be any more representative of Samburu communities, with two of the major age and social groups spending hardly any time at the manyatta. Many school-age children, in some places most, are away all day herding goats. Although most of them return at dusk, some stay out for several days at a time. Depending on the season, morani may be absent from the manyattas altogether, because traditionally they tend the cattle in distant pastures. Alternatively, and nowadays equally commonly, they may wander about in or outside the division in line with tradition but without a specific role because their former responsibilities have shrunk as a result of the diminution of the herds, and protecting the homeland against cattle raiders and other invaders is no longer necessary or has been taken over by government agents, the police, military, and paramilitary.
Regardless of the above, participation in our survey varied considerably between the locations. Unexpected (to us) was the low level of participation among the population from the work centres. The residents of the input villages were aware that our survey would not and could not influence project activities, since it was unrelated to and independent of the project's main objectives. By contrast, expectations of future project activities, with the accompanying provision of food and work, may explain the heavy turn-out of women with their preschool children in the control manyattas. This hypothesis gains support from the observation of minimal participation in Lodungokwe, where there were more opportunities to earn a living than in any other input location.
Equally limiting for subsequent use of the data was the fact that we had no baseline information on the nutrition status of the communities before the programme against which to compare our results. Even though the input villages appeared to be nutritionally better off, one may postulate that in the control location the survey attracted mostly the needier families, expecting some future food aid, whereas in the input locations those who stayed at home were better off to begin with and hence did not feel the need to participate in the food-for-work programme. As a result, they were available to take part in the survey. This explanation is strengthened by the observation that significantly more able individuals took part in the input locations.
Because of these problems and considerations, one can only speculate whether the programme affected the nutrition status of the participating groups. The results may, however, provide information on the overall nutritional profile of the surveyed population, on the prevalence of specific nutrient deficiencies among them, and, to a limited extent, on their health status.
The population is clearly malnourished. By conventional anthropometric standards, we found a substantial prevalence of wasting, especially among school-age children and elders. Not only weight for height but also haematocrit levels were very low among all the age and social groups, especially preschoolers and women, suggesting both a dietary and perhaps a parasitic aetiology.
The finding that socio-economic status (able versus unable) had generally no bearing on nutrition status is rather puzzling. This might be due, as explained by a knowledgeable Samburu, to the custom of sharing, which is still widely practiced in the manyattas. Predominant participation of poorer families in the WFSP might also be an explanation in the input locations but not in the control location. Only in Lodungokwe were the unable nutritionally worse off than the able. Perhaps the social support system no longer prevailed there to the same extent as in the rural areas.
There was evidence for both iodine-deficiency disease and vitamin A deficiency. The age differential for the former suggests that, though iodized salt is available, its supply is still not regular. Although the more serious sequelae of vitamin A deficiency were relatively rare, there is little doubt that the condition is a potentially serious problem. Indications to that effect are the three children with xerophthalmia and those who developed unilateral blindness after having measles, as well as the high frequency of post-traumatic eye lesions resulting from running into sticks; some of these accidents might well have been caused by diminished vision as result of night blindness.
One possible explanation for the differences in the prevalence of eye pathology, specifically conjunctivitis, between the input and control locations might be that all the control manyattas were quite close to the Samburu River. Increased access to water, and hence improved personal hygiene, may well have made the difference.
What evidence, aside from the difference in nutrition status between the input and control groups, supports the hypothesis of the WFSP having brought about that difference? If we assume that those who received more food should also be better nourished, individuals from Oro Model should have been best off. There on average 349 additional kcal and 10 g of additional protein were made available per capita per day over more than three years, a sufficiently long time. We would expect the least effect in Lodungokwe, where on average only 138 kcal and 4 g of protein were provided, with L'Kisin and Niri Mirimo, with around 160 kcal and 5 g of protein, taking intermediate positions. Whereas this seemed to be the case prior to adjustment for different distributions by sex and socio-economic status, it was no longer so after such adjustment.
The inhabitants of Niri Mirimo had the highest probability of being above 80% of the reference weight-for-height median and also had the highest haematocrit levels. L'Kisin was worst off in terms of weight for height and also, next to the control location, of haematocrit levels. On the other hand, given the rather substantial food inputs (the project supplied on average 17% of the RDA for calories and 28% for protein), there should have been a discernable nutritional effect. If there was not, one would have to assume that most of the rations replaced rather than supplemented the diet or, less likely, that they were not consumed for some reason. That some such mechanism, replacement or non-consumption, may have taken place is suggested by our finding that, despite the improvement in nutrition status of the supplemented populations, a large proportion of individuals, even among women and preschoolers, still remained malnourished and undernourished (i.e., anaemic and wasted).
While a nutritional effect resulting from the programme cannot be proved, neither can it be ruled out [3]. The observation that at 80% or less of the median weight for height there was no longer any difference between the input and control locations suggests that programme benefits, if real, reached more of those with relatively less need than of those with serious or greater need for nutritional assistance. From among the five age and social groups, the rations would seem to have had an overall positive effect on the nutrition status of the most vulnerable segments of the population but not to have affected the growth performance of school-age children. Their diet would have been affected only marginally if at all by the additional food brought home by either a work-participant family member or neighbour for reasons inherent in their responsibilities and circumstances.
Although, among the three eligible age and social groups, the proportion of morani taking part in the work programme was highest, only 37 of them were available for physical assessment at the time of the survey, all from input locations. Thus no conclusions can be drawn as to whether and to what extent earned rations influenced their nutrition status (i.e., anthropometric and blood status). From the few we did examine, it seems that generally they were not too badly off to begin with. Their relatively good nutrition may be a reflection of their status within the community. Even now, when their former role has largely changed, they still tend to be given both food and shelter during their Wanderjahre by the communities and specifically by mothers of other morani.
From these findings, together with the knowledge that the Samburus presently have only limited access to their traditional diet (milk and blood), have not as yet adopted agriculture to any significant extent, and have few if any means to generate enough cash income to buy food regularly, one may conclude that the programme is indeed justified even in the absence of clear nutritional effects, the more so as systematic efforts are made to promote self-sufficiency through land reclamation and the improvement of livestock.
A number of recommendations can be made, both general and project-specific. The most important general recommendation seems to be that baseline assessments of nutrition status, at least of vulnerable populations, should be an integral part of all projects aimed at improving the food security or, more directly, the nutrition status of a community. This recommendation holds regardless of whether the activities are primarily for research or are purely service-oriented. This represents a basic prerequisite as well as the simplest means for subsequently establishing project effects. The cost associated with a baseline survey is well spent in light of the information obtained and the benefits gained for future undertakings.
For the food-for-work programme itself, the following recommendations are made. Even though the nutrition status of the population is quite marginal, we do not believe that the food rations should be increased. We found only one case of marasmus and no kwashiorkor among preschool children, suggesting that they are coping reasonably well, especially since the mean heights of adults does not suggest that stunting is a major problem. They benefit from the rations as well as from the prolonged breast-feeding that is customary among the Samburus. The current composition of their staple foods, maize and beans, provides an excellent protein-amino acid content and ratio, with fat increasing the energy density. Increasing the rations (or the amount of money) might tend to make the population even more dependent on external assistance than they currently are. If anything, better targeting of the project to the nutritionally needy and to the deprived groups within families through nutrition and health education might render programme inputs both more effective and efficient.
The transition from the traditional nomads' diet of milk and blood to that of agriculturist maize and beans may have consequences. Neither of these items is grown in the area, and imported beans from other parts of the country are expensive. Cow's milk will remain the main source of necessary protein in the future unless the Samburus are willing to take up agriculture. However, agriculture would almost certainly depend on irrigation, at least in certain areas, requiring extensive external (national and international) aid. If that is not available, the Samburus will remain dependent on their livestock.
Having no other source of cash, they may be tempted to sell their animals to buy storable foods, especially in view of their changing food habits. Under these circumstances, selling an animal may appear more profitable than slaughtering one, since the necessity of disposing of the meat rapidly will result in few days of feast followed by many more of hunger. Such a practice was feasible in the past when herds were large and continuously replenished. At present, selling or slaughtering livestock without replacement will cause their numbers to become even smaller, unless the continuing programme of livestock improvement proves effective.
The considerably more important question, whether this particular strategy of regenerating the environment and improving livestock through a food-for-work programme will ultimately make for food security, clearly cannot be answered by this investigation, nor was it the subject of the investigation. Even if the amount of reclaimed land ultimately expands from a few hectares to all of the division or the district, if the new mix of livestock does become popular and take hold, and if a market for livestock can be created that is large enough to supply the communities with the minimally required cash funds, there are many other factors vital to achieving food security that must be taken care of as well. Most important among these are curbing Kenya's and, to a lesser extent, the Samburus' rapid population growth, providing some basic health services, and putting an end to the encroachment of agriculturists on the nomads' lands. These areas suggest themselves for comprehensive, integrated development schemes that might provide solutions to many questions of feasibility, cost, and sustainability that cannot be answered through a mono-sectoral approach.
The potential danger of creating long-term food dependency must not be overlooked. As soon as tracts of land large enough to maintain the new mix of livestock have been reclaimed, the project should move on to other areas, yet continue to monitor whether positive results can be maintained in the absence of external aid. This would require very close collaboration with and support from the central and local governments to ensure that such reclaimed territory is used for the intended purpose only, providing a livelihood for the nomads, and that effective health services including family planning are made available.
Finally, the question arises whether this combination of land reclamation through a food-for-work programme is replicable and thus realistic. In our opinion it definitely is. Considering the immense amounts developing countries currently spend on defence, a cost of around US$1,600US$2,000 (approximate the cost of three AK-47 assault rifles) for the regeneration of one hectare of land does not seem too high to pay as a long-term investment.
A community survey such as the one carried out in Wamba requires assistance from people in many disciplines. Field investigators from Embu, Ms. Anisia W. Nyaga, Ms. M. Josephine Ruria, and Ms. Rose W. Njagu, and our translators from Samburu, Ms. Gladys Lydia, Ms. Naomi Lekaldero, and Mr. E. Leria, helped us establish rapport, conducted the interviews, and measured and weighed the subjects. Mr. Charles Letumogan, transport officer of the WFSP, not only kept our vehicles intact but provided us with rather profound insights into Samburu culture. In Nairobi, Mr. 1. Muttunga guided the data analysis, and Mr. D. Kinyingi and Mr. M. Serunjogi, graduate students in our department, as well as Ms. Jane Chesang and Ms. Selina Chepkoech, were responsible for entering and cleaning the data. Finally, we would not have been able to carry out the investigation without the help of the chiefs and sub-chiefs of the various locations and, most important, the co-operation of the Samburu communities concerned. Their assistance is greatly appreciated.