Hunger and malnutrition stalk Nairobi’s urban poor
By Phyllis Nyambura
In a tiny one roomed mud-walled cubicle in Soweto East, one of the villages in Nairobi’s Kibera slum, Esther Mueni rocks her tiny eight week-old baby. A basin of soiled baby clothes sits at one corner of the room, where she had been working, a three-stone-fireplace located in the middle of the earthen floor, embers burn low, while a tattered curtain divides the room on which a thin mattress lies.
Karibuni (welcome),” the 25-year-old says weakly.
We jump over the open drainage by the door, and make our way into the dim, low-roofed room, where two plastic buckets “are turned into seats for me and community health worker Philemona Wanjohi.
Esther, is on a supplementary feeding programme designed by AMREF for lactating mothers and children under five. Philomena discovered her a few weeks after birth, starving and unable to produce any milk for her infant. “The baby was crying constantly, I didn't have any milk, since I didn't have money to buy food for myself. I was given Unimix at the health centre, which I take twice daily. Most times that’s all I survive on,” says Esther, who had her baby at home.
Kenya is battling a severe drought that has caused a serious food shortage in most parts of the country. While the Horn of Africa has been fronted as bearing the brunt of the hunger crisis, many urban poor are faced with severe food shortages as inflation runs amok and unemployment bites hard. Faced with starvation back in the rural areas, large numbers have migrated to informal settlements like Kibera, in the hope of securing casual work in the city. But as Esther has discovered, it is tough even in the city.
The single mother of six children, between the ages of 10 years and two months, including a set of twins, moved to Kibera three months ago from Kitui in Eastern Kenya, after she was unable to find casual work on the farms because of the ongoing drought. “I brought my children with me because if I left them behind, they would have suffered. They are better off with me. If all I can afford is water, that is what we will drink,”
“I was pregnant when we came to Nairobi. A friend found us this house. I started washing clothes for people, and would earn enough money to buy clothes and food.”
On a good day, Esther would make Sh300 (USD 3.2), of which two hundred would go towards food. “I would buy maize flour for Sh150 [USD 1.60], then Sh50 [USD 50 cents] would be for paraffin [for cooking and lighting] and vegetables. I would pay the rest to my landlord for rent – Sh1,000 [USD 10.75] per month.”
But things changed when she gave birth and was too weak to work. She could no longer afford to feed her children, and the family now depends on a kind neighbour for food.
“When there is nothing to eat, we share the Unimix that I get from the AMREF clinic. If I am lucky, I get Sh50 [USD 50 cents] shillings from a good Samaritan and buy githeri [a mix of beans and maize] for them. My biggest worry now is that we might be evicted from the house.”
Kenya's casual workers survive on about Sh200 (USD 2.15) daily for an average household of seven. But the cost of living has been spiraling month after month, with August 2011 alone registering a 24% inflation rate up from a year earlier, while general inflation rose to 16.7 per cent ,according to The Kenya National Bureau of Statistics. The prices of basic commodities such as maize flour and paraffin shot up by 1.25 per cent in August alone.
It is no wonder, then, that malnutrition levels have been on the rise. Surveys have continued to show reduced intake of meals among the urban poor. According to a KEMRI/CDC nutrition survey in two villages in Kibera, 90% of urban slum households were reducing meal frequency and quantities.
“We are diagnosing more cases of malnutrition and underweight children in our clinic,” says Deborah Kioko, a nutritionist at the Kibera Community Health Centre, where AMREF has set in motion activities to mitigate the effects of drought among children under five, people living with HIV, and pregnant and lactating mothers among the urban poor. The monthly averages of severe malnutrition at the centre have increased from an average of 35 patients a year ago to 84, and there are indications that the figure will grow.
Feed The Children has been holding feeding clinics at AMREF’s Kibera Community Health Centre, a facility that is co-owned by government and AMREF. The clinics, held every two weeks, are for the severely malnourished children under five years old. During routine medical camps held regularly within the slum, most of the children screened have been found to be underweight. “We see close to a hundred and more than 85% are undernourished. Most suffer from protein deficiency so we enrolled them for supplementary feeding,” confirms Timothy Mwanzia, a nutritionist at the AMREF health facility.
Mwanzia says the problem was noted from September last year, and is attributed to the high cost of living, the impact of HIV infection on bread winners, lack of spacing between births and ignorance of nutritional matters among mothers. “Most of the mothers aged between 20 and 40 years have more than five children each, are either single mothers or have partners who are casual labourers, and their children do not breastfeed for long because the mothers either lack the food to enable them to breast-feed for the minimum recommended period, or the deliveries are too close to each other. Starch makes up most of the family diet,” Mwanzia notes.
Such is the case of 36-year-old Elizabeth Ngui, a mother of five children between the ages of 13 years and 10 months. Her two youngest children have been enrolled in the supplementary feeding program. When we visit her at her one roomed tin shack in Kibera, she is preparing lunch for her family. The ugali (a dish made from maize meal) and kale will be the only meal for the day. The children sit on sacks spread out on the hard ground. These serve as the family bed at night. A strong stench of urine obscures the smell of food being cooked on a charcoal stove.
“If it was possible I would have put all the children on the feeding program. They too are malnourished. But the program only covers children under five,” offers Philomena, who identified the family as one of those in the community most vulnerable to starvation.
Elizabeth, like Esther, was forced out of her rural home in Kitui because of the drought. Unable to meet her family’s food needs, she chose to join her husband, a construction labourer, in the city.
“He used to send me Sh500 [US$5.40] every week, but then food prices went up and this only lasted a few days. The rest of the time we would have to survive on whatever little I could find. That's why I decided to bring the children here so that when he gets paid all of us can get something to eat,” says Elizabeth. Her husband earns an irregular Ksh 1, 500 (US$16.10) on a good week.
“He uses a large percentage on rent, and the rest for food. But it isn't enough because sometimes he is not paid for weeks,” Elizabeth explains. She confesses that at times, they are forced to share the supplementary food given to the children because there is nothing given to the parents, yet they too also need food.
She has been here for close to two months, and although life is far from rosy, she would rather tough it out here than go back to Kitui, where there is no relief food for even her young children.
“When it rains I plan to go back, but I will leave the children here, so that they can go to school.” None of the children goes to school because she cannot afford the cost of uniforms and books.
“My son is bright. He is very creative and makes a lot of interesting things. I wish he could get a sponsor,” Elizabeth says, adding that the boy has reduced their lighting costs by making electricity using old batteries.
Most of the slum's 170,000 people migrated to the city in search of greener pastures. But with unemployment rates in Kenya soaring above the 40 per cent mark, many semi-illiterate people find themselves barely able to afford a decent meal. It doesn't help that the majority are averse to family planning.
Judy Wanjiku, 27, came to Kibera from her home district of Kinangop after dropping out of primary school. She has six children all less than 10 years old, three hers and three her late sister’s. She had her first child while still in school.
“I came to Nairobi in 2007 to look for work as a house help. A friend directed me to an eatery in Kibera, where I got a job, but the hotel soon closed and I started washing clothes to make some money.”
As she tried to survive the harsh city life, she had two more children, and then her sister’s children came to live with her. She is currently living with a man who is keen on making sure that she bears a child for him.
“We fight about it. I use family planning secretly because I can't cater for another child. But he doesn't want to listen,” she whispers, as the man makes his way into the tiny shack.
Her youngest child was diagnosed with chronic malnutrition five months ago. “He needed admission into hospital, but I couldn't afford it, so he was given multivitamins and supplements”.
Her sister’s children have school sponsorship from a church, but her own do not go to school. For now, though, her biggest pre-occupation is how to put food on the table. “I wash clothes 2-3 days a week and make around Sh150 [US$1.60] per day. My husband is a wheelbarrow loader; he brings home Sh100 [approximately US $1] per day. But it's not enough for food, leave alone for rent,” she muses. On most days, Wanjiku says, they make do with plain ugali, and when she can afford it she serves some kale or beans with it.
“Sometimes we all share the food given at the clinic for the baby, because there is no way I can give the food to her only and not the others,” she explains. As a result, the two-year-old is still severely malnourished.
Sharing of the supplementary food by other family members is a common hurdle that the AMREF team has been grappling with. “We have noticed that most children are failing to improve because their rations are being shared out. If we had enough funds, we would give out ‘protective rations’ – food for the rest of the family so that they do not eat the nutritional supplement for the children enrolled for food support and managing malnutrition. As it is, we are not even able to cater for all the malnourished children” explains Ann Gitimu, a public health specialist who is in charge of AMREF’s school feeding programme in Kibera.
And as children return to school for the final term this year, Ann has observed a new trend – an exodus of children from schools that have no feeding programmes to those that do. Levels of truancy have also risen.
“They either stop going to school altogether, or go where they can get food,” notes Ann. She adds that those who drop out are most likely to end up living on the streets as they try to fend for themselves.