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Examining the Complex Dynamics Influencing Persistent Acute Malnutrition in Turkana and Samburu Counties – A Longitudinal Mixed Methods Study to Support Community Driven Activity Design (WAVE II), NAWIRI

KENYA, 2021
Health and Well-Being (HaW)
Dr. Estelle M. Sidze, Dr. Faith Thuita
Last modified December 06, 2022 Page views 30750 Metadata DDI/XML JSON

Identification

IDNO
DDI-KEN-APHRC-NAWIRI-2022-v11
Title
Examining the Complex Dynamics Influencing Persistent Acute Malnutrition in Turkana and Samburu Counties – A Longitudinal Mixed Methods Study to Support Community Driven Activity Design (WAVE II), NAWIRI
Subtitle
NAWIRI
Country
Name Country code
KENYA KEN
Abstract
Background: Acute malnutrition in infants and children less than 5 years is persistent in the arid and semi-arid lands (ASALs) of East Africa and the Sahel region despite years of investment. In the ASALs of Kenya, the situation is exacerbated by deep-rooted poverty and unequal access to basic services, sustained community conflicts, migration, poor seasonal rainfall/drought and other shocks. Nutrition specific and nutrition sensitive national and county level programs have either not been developed or not implemented effectively.

Objectives: To understand and map immediate, underlying, basic and systemic drivers of acute malnutrition for the development of overarching as well as micro-solutions for the sustainable reduction of persistent acute malnutrition (PAM) and inform pilot studies and Phase 2 (second phase of NAWIRI project implementation) activities in Turkana and Samburu Counties.

Methods: This longitudinal mixed-methods observational cohort study of children less than 3 years and their mothers and/or caregivers in Samburu and Turkana counties. The longitudinal study is collecting data every 4 months over a 2-year period for a total of 6 waves across seasons. The study sample was population-based, with stratification by sub-county. Wave 2 data collection was carried out from November 15 to December 3, 2021 in Samburu and from October 25 to November 23, 2021 in Turkana. Wave 2 anthropometric data were collected from one sampled child per household and the primary caregiver of the child in the sampled household.


Study outcomes: To develop new interventions, and to adapt and contextualize existing interventions to prevent global acute malnutrition (GAM); strengthen social and behavior change (SBC) strategies around maternal, infant and young child nutrition (MIYCN), water and sanitation (WASH), community health systems, gender dynamics, livelihoods and resilience, and to inform improvements of the current nutrition surveillance system.

Version

Version Date
2022-06-02
Version Notes
na

Coverage

Geographic Coverage
Turkana and Samburu Counties.
Unit of Analysis
Mothers and/or caregivers with at least one child less than 3 years of age at enrollment.
Universe
The survey covered household with children less than 3 years and their mothers and/or caregivers in Samburu and Turkana Counties

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
Dr. Estelle M. Sidze African Population and Health Research Center
Dr. Faith Thuita RTI International (registered trademark and trade name of Research Triangle Institute)
Producers
Name Affiliation Role
Dr. Chessa Lutter Research Triangle International Researcher and Senior Fellow
Dr. Valerie Flax Research Triangle International Senior Public Health Research Analyst
Mr. Brad Sagara Mercy Corps Deputy Director, Research and Learning
Dr. Dickson Amugsi African Population and Health Research Center Associate Research Scientist
Dr. Martin Mutua African Population and Health Research Center Associate Research Scientist (Statistician)
Dr. Calistus Wilunda African Population and Health Research Center Associate Research Scientist
Mr. Albert Webale Research Triangle International Project Manager
Mrs. Ruth Muendo African Population and Health Research Center Research Officer
Ms. Esther Anono African Population and Health Research Center Research Officer
Ms. Hazel Anyango African Population and Health Research Center Research Officer
Mr. Bonventure Mwangi African Population and Health Research Center Data analyst/manager
Mrs. Anne Njeri African Population and Health Research Center Data manager
Funding Agency/Sponsor
Name
USAID through Food for Peace
Other Identifications/Acknowledgments
Name Affiliation Role
Philip Ebei Aemun CEC - Agriculture Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Charles Lokiyoto Ewoi CEC - Agriculture Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Pauline Akai Lokuruka Chief Officer Education Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Paul Lokone Director Agriculture Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Alfred Emaniman Director Preventive and Promotive Health. Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Lucas Edete County Community Health focal person Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Javan Manga Social Development Officer (Department Social Services) Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Fred Esinyen T/Central Nutrition Coordinator Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Dr Jane Akale Deputy Director Veterinary services Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Josephat Lotwel County Drought Resilience Officer (NDMA) Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Dennis Mosioma NDMA Deputy Director of Information Turkana County – Stakeholder Consultation on NAWIRI Learning Agenda
Erastus Sinoti County Public Health Officer Samburu County – Stakeholder Consultation on NAWIRI’s Learning Agenda
Delphina Kaaman County Nutrition Coordinator. Samburu County – Stakeholder Consultation on NAWIRI’s Learning Agenda
Francis Koros Director Social Services Samburu County – Stakeholder Consultation on NAWIRI’s Learning Agenda
Mary Bett County Agriculture Nutrition Officer Samburu County – Stakeholder Consultation on NAWIRI’s Learning Agenda
Simon Lekartiwa County Livestock officer Samburu County – Stakeholder Consultation on NAWIRI’s Learning Agenda
James Kiptoon Sub County Public Health Officer Samburu County – Stakeholder Consultation on NAWIRI’s Learning Agenda
Augustine Lenomouwapi County Community Strategy Focal Point Samburu County – Stakeholder Consultation on NAWIRI’s Learning Agenda
Martin Thuranira County Director of Health Samburu County – Stakeholder Consultation on NAWIRI’s Learning Agenda
Alex Leseketeti County NDMA Drought Coordinator Samburu County – Stakeholder Consultation on NAWIRI’s Learning Agenda

Sampling

Sampling Procedure
SAMBURU

The study sample was population-based, with stratification by sub-counties grouped into three survey zones (Central, North, and East) reflecting administrative sub-counties used in the Samburu Standardized Monitoring and Assessment of Relief and Transitions (SMART) Surveys. Stratification by livelihood zones was done through post-stratification analysis. We analyzed the data by livelihood zone because it was hypothesized that undernutrition might be more related to a household's livelihood than to its physical location.

As noted, the study used mixed-method techniques with quantitative and qualitative data collection. The quantitative component included a household survey and a caregiver survey and covered 699 households. The qualitative data collection activities yielded rich and in-depth insights that will be triangulated with the quantitative survey findings in a companion report. Therefore, this report focuses only on findings from the quantitative survey component. Results are reported for global acute malnutrition (GAM), stunting, and underweight. However, the discussion focuses only on GAM because the purpose of the Nawiri program is to reduce persistent acute malnutrition.

The baseline data collection was carried out in June and July 2021 following a full household listing operation in the county to establish the sampling frame of households with children under 3 years. Subsequent data collection waves are planned for November-December 2021 (Wave 2), March-April 2022 (Wave 3), September-October 2022 (Wave 4), March-April 2023 (Wave 5), and August-September 2023 (Wave 6).


TURKANA

The study sample was population-based, with stratification by sub-counties grouped into four survey zones (Central, North, West, and South) reflecting administrative sub-counties used in the Turkana Standardized Monitoring and Assessment of Relief and Transitions (SMART) Surveys. Stratification by livelihood zones was done through post-stratification analysis. We analyzed the data by livelihood zone because it was hypothesized that undernutrition might be more related to a household's livelihood than to its physical location.
As noted, the study used mixed-method techniques with quantitative and qualitative data collection. The quantitative component included a household survey and a caregiver survey and covered 1,211 households. The qualitative data collection activities yielded rich and in-depth insights that will be triangulated with the quantitative survey findings in a companion report. Therefore, this report focuses only on findings from the quantitative survey component. Results are reported for global acute malnutrition (GAM), stunting, and underweight. However, the discussion focuses only on GAM because the purpose of the Nawiri program is to reduce persistent acute malnutrition.

The baseline data collection was carried out in May and June 2021 following a full household listing operation in the county to establish the sampling frame of households with children under 3 years. Anthropometric data were collected from all under-5 children in the sampled households. Subsequent data collection waves are planned for October-November 2021 (Wave 2), March-April 2022 (Wave 3), September-October 2022 (Wave 4), March-April 2023 (Wave 5), and August-September 2023 (Wave 6).
Deviations from the Sample Design
na
Response Rate
na
Weighting
na

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date Cycle
2021-11-04 2021-12-07 2
Mode of data collection
Face-to-face [f2f]
Supervision
Field operations supervision was done in two layers: daily supervision by team leaders, and a weekly review of activities and data quality by the data coordination team, which included a research officer, a data analyst, a software programmer, and a postdoctoral research scientist. At a higher level, a weekly report on issues arising from the field and discrepancies observed in data were shared with the senior research team, which included the co-principal investigators and co-investigators, who advised on the necessary actions to be taken. The county Nawiri team and county government officials-consisting of sub-county nutrition coordinators from Turkana East and North/Kibish, the county nutrition coordinator, representatives from Mercy Corps and RTI, the Ministry of Health Monitoring and Evaluation Officer, and NDMA staff-were also involved in the whole process, from training fieldworkers to supervising data collection activities in all four survey zones.
Type of Research Instrument
Women/caregiver questionnaire: background, informed consent, household demographics, poverty probability index (pp1), household wealth ranking (perception)), food consumption, water, hygiene and sanitation (wash) (water access, availability and seasonality, household water insecurity experiences (hwise) scale, hygiene and sanitation), household shocks experienced, social safety nets and economic safety guards, mother's/caregivers information, pregnancy and antenatal care, family planning, infant and young child feeding practices, supplementation and consumption of iron rich or iron fortified foods, maternal knowledge and attitude, on infant and young child feeding practices, caregiving practices, child feeding utensils hygiene, food safety, hygiene, and sanitation practices, child immunization, health and health seeking practices, acute malnutrition screening (community health volunteers), womens minimum dietary diversity, food insecurity experience scale (hfies), gender, women empowerment, violence and community conflict, psychological wellbeing, anthropometric measurements

Data Processing

Cleaning Operations
Data quality monitoring processes and checks were implemented throughout the data collection process, during the time of developing the data collection tools (through built-in quality control in the tablet-based platform), during training of fieldworkers, in real time during data collection (routine monitoring by the research team and periodic cross-checks against the protocols), and during the data cleaning process. During fieldwork, data quality was enhanced through regular spot checks and sit-ins by supervisors to verify the authenticity of data collected. Data were then reviewed and certified by the field coordinator before they were transferred to the server.


The quantitative data were collected using SurveyCTO, a survey platform for electronic data collection that has in-built skips and quality checks. Using this software increased efficiency and reduced the time needed for cleaning the data. In addition, the platform supported offline data capturing for regions with slow or no internet connectivity and data transmission when the internet became available. Fieldwork was conducted by trained fieldworkers using digital tablets with the questionnaire loaded in SurveyCTO. The questionnaire included the following modules: (1) identification and tracking, (2) demographics and household composition, (3) anthropometry of children <5 years and mothers, (4) socioeconomics, (5) household food security, (6) WASH, (7) health-seeking behavior, (8) MIYCN, (9) shock experience/exposure, and (10) shock preparedness and response. Data were uploaded from the tablets onto a secure African Population and Health Research Center (APHRC) server after each day of data collection. Data were synchronized automatically to a server when the tablet was in a location with network coverage. The uploaded data were then checked for quality daily by a data manager and a team dedicated to coordinate field procedures and at the APHRC head office in Nairobi.
Other Processing
na

Data Appraisal

Estimates of Sampling Error
na

Data access

Contact
Name Email
African Population & Health Research Center datarequests@aphrc.org
Conditions
APHRC data access condition

All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research.
This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners/collaborators/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained and to abide by the conditions outlined below:

1.Data Ownership:
The data remain the property of APHRC; any unauthorized reproduction and sharing of the data is strictly prohibited. The user will, therefore, not release nor permit others to use or release the data to any other person without the written authorization from the Center.

2.Purpose:
The provided data must be used for the purpose specified in the Data Request Form; any other use not specified in the form must receive additional or separate authorization.

3.Respondent Identifiers:
The Center is committed to protecting the identity of the respondents who provide information in its research. All analytical data sets (both qualitative and quantitative) released by the Data Unit MUST are stripped of respondent identifiers to protect the identity of the respondents. By accepting to use APHRC data, the user is pledging that he/she will not, under any circumstance, regenerate the identifiers or permit others to use the data to learn the identity of any individual, household or community included in any data set.

4.Confidentiality pledge:
The user will not use nor permit others to use the data to report any information in the data sets that could identify, directly or by inference, individuals or households.

5.Reporting of errors or inconsistencies:
The user will promptly notify the Head of the Statistics and Survey Unit any errors discovered in the data as soon as the errors are discovered.

6.Publications resulting from APHRC data:
The Center requires external collaborators to work with APHRC staff on all publications resulting from its data. In order to facilitate this, lead authors should send a detailed concept note of the paper (including the background, rationale, data, analytical methods, and preliminary findings) to the Principle Investigator (or Theme Leader) for the project (with a copy to the Director of Research), who will circulate the abstract to concerned researchers for possible expression of interest in participating in the publication as co-authors. Any exception to the involvement of APHRC staff should be approved by the Director of Research, APHRC.

7.Security:
The user will take responsibility for the security of the data by ensuring that the data are used and stored in a secure environment where access is password protected. This will ensure that non-authorized people should not have access to the data.

8.Loss of privilege to use data:
In the event that APHRC determines that the data user is in violation of the conditions for using the data, or if the user wishes to cancel this agreement, the user will destroy the data files provided to him/her. APHRC retains the right to revoke this agreement or informs publishers to withhold publication of any work based wholly or in part on its data if the conditions for using the data are violated.

9.Acknowledgement:
Any work/reports from this data must acknowledge APHRC as the source of these data. For example, the suggested acknowledgement for NUHDSS data is:
"This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City."Additionally all funders, the study communities that provided the data, and staff who collected and analyzed or processed the data should be acknowledged.

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The user should submit electronic and paper copies of all publications generated using APHRC data to the Policy Engagement and Communications Department, with copies to the Director of Research.

11.Change of contact details:
The user will promptly inform the Director of Research of any change in your personal details as contained on this data request form.
Citation requirement
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download

Metadata production

Document ID
DDI-KEN-APHRC-NAWIRI-2022-v11
Producers
Name Abbreviation Role
African Population and Health Research Center APHRC Documentation of the DDI
Date of Production
2022-05-02
Document version
Version 1.1 (May 2022)