Last week, I travelled from the capital city of Nairobi, Kenya, to Turkana County which is in the northern part of the country. Turkana is a largely pastoralist community with a population of 855,000 people. The county faces major problems, chief among them recurring droughts which has for years crippled the county’s economic development.
The lack of adequate rainfall continues to be a source of conflict for Turkana and her neighbours –the Pokot community, as well as the neighbouring countries of Uganda, South Sudan and Ethiopia as they fight for the scarce resources of water and grazing pasture. With the main economic activity being livestock farming, cattle raids are a frequent occurrence in Turkana, which is classified as a High Hazard Probability (HHP) of food, conflict and drought.
Actually, of the 47 counties in Kenya, Turkana is ranked as the poorest county of them all. As is characteristic of most low-income populations, health is one of the greatest challenges for the Turkana people. Many of the residents suffer ill-health as quality health care remains elusive.
Many of Turkana’s residents have to walk for tens of kilometres to reach a health center. It is a journey trod on rough, volcanic rocks under the scorching heat and humid temperatures. Residents seeking health services take days and by the time they get there they are severely dehydrated, hungry and on the verge of collapse.
You can imagine what the situation is like for a pregnant woman interested in accessing antenatal care or experiencing pregnancy complications, or in labor. It is not a trip worth investing in, many mothers say. Atleast not when there are Traditional Birth Attendants (TBAs) who can attend to them. Most of these TBAs have no medical background and do not have the required skills to handle pregnancy and childbirth-related complications or emergencies.
Due to food insecurity brought about by the persistent droughts, nutritious foods are not an option for these residents. Turkana county is among the most food insecure places and is currently classified as ‘(IPC Phase 2)’ (stressed).
The most pressing health problem for Turkana’s children is malnutrition. Malnutrition is marked by a deficiency of essential proteins, fats, vitamins and minerals in a diet. Without these nutrients, it becomes difficult for a child to achieve optimum health. Assessment reports indicate that the Global Acute Malnutrition level in Turkana is at 28 per cent, which is high considering the WHO threshold is 15 per cent
The infant mortality rate in Turkana is 60 in every 1,000. Only 54% of Turkana’s children are fully immunized by the age of five years.
Women’s health is not any better, where the maternal mortality rate is 1,500 deaths per 100,000 live births, which is three times the national average.
The HIV prevalence in this county is 6.2%, which is higher than the national HIV prevalence of 6.1%.
Lack of adequate health personnel is another great challenge in this county, where the doctor: population ratio is 1: 52,434, against the recommended 1: 1,000.
In the absence of a sufficient number of skilled health personnel in the communities, and owing to the chronic health challenges, Community Health Workers bear a great responsibility of providing health education and basic services to the population, if only to help avert some of the negative health consequences.
One of the main areas of focus for these CHWs is maternal and newborn health where on a voluntary basis, the CHWs traverse the rugged terrains under the scorching heat to walk from household to household to provide women with information on family planning, antenatal care, the need to deliver in hospitals, and the importance of immunization.
However, one of the greatest challenges these CHWs face is that of encouraging new mothers to initiate breastfeeding immediately after birth –preferably within the first hour.
Nicholas Losike, a male CHW says that many mothers in Turkana still practice the long-held tradition of naming a child and which causes them to delay breastfeeding.
“When a name is called out and the child shows no response it, it is then assumed he has rejected the name and cannot be breastfed,” said Losike.
However, when a name is called out and when upon hearing it the child immediately reaches out for the mother’s breast and places his lips on her nipple, it is assumed he has accepted the name and only can then begin breastfeeding.
According to Losike, it on average takes about two days for a child to ‘accept’ a name. Sometimes it could take longer, even a week. In the meantime, the child is fed on boiled goat or camel milk. All the while, the mother drains and discards her breastmilk, including the all important first milk –colostrum which contains lots of antibodies that offer the baby immunity against infection.
The interesting this is that even though the woman delivers her baby in a health facility and is encouraged to breastfeed her newborn, she remains adamant and if the nurses insist, she sneaks out of the hospital.
For Turkana to improve the health of its children, it needs to put in place measures that will enable newborns survive the crucial first month of life, with initiating breastfeeding within the first hour, exclusive breastfeeding and ensuring they receive the recommended immunizations being among the key strategies.
Thankfully, the Kenyan government now offers free maternity services in all health facilities, which has seen more women deliver in hospitals thus reducing the number of maternal and neonatal mortalities. The government has also recently introduced the free pneumococcal and rotavirus vaccines, which is expected to see more children celebrate their fifth birthdays.
However, with lack of access to health facilities, lack of sufficient health personnel in the community, and rising insecurity in the region, the case of Turkana needs more specialized interventions.
About the Author
Maryanne Waweru-Wanyama is a motherhood blogger from Nairobi, Kenya. She tells her motherhood stories on her website mummytales.com where she also incorporates the experiences of other Kenyan mothers. On her blog, Maryanne provides education on pregnancy, birth, delivery and infant and child care and nutrition. Maryanne is a journalist with over fourteen years experience and who has written, and still writes for various publications in Kenya including: the Daily Nation newspaper, the Star newspaper, the Standard newspaper, Parents Magazine, Healthy Woman Magazine, Healthy Child Magazine and many other publications. Her area of specialty is human interest features, maternal and child health articles. Maryanne is married with two sons.