Local Production of Small Quantity Lipid-Based Nutrient Supplements (SQ-LNS) in Kenya 1. Problem statement

Malnutrition remains a major threat around the world, manifesting in various conditions that directly and indirectly result in ill health and untimely death. Each year an estimated 45 million children under five are affected by severe acute malnutrition (SAM), putting them at direct risk of mortality if the appropriate treatment is not available. Annually, malnutrition accounts for approximately 3 million deaths globally while in Kenya approximately 35,000 deaths occur to children under the age of 5 years. To further compound this problem, it can cost approximately between $100 and $500 to treat a child with SAM (depending on the strategy used and number of follow-ups required).

In July 2023 WHO released updated guidance on the management of wasting and nutritional oedema (acute malnutrition)1 for infants and young children. The update provided focused guidance for i) infants younger than 6 months who are, or at risk, for growth faltering; ii) the management of young children with wasting, both severe and moderate; iii) post-recovery interventions; and iv) prevention of wasting (released in November 2023). The guidelines have broadened in scope to include targeted recommendations for children with moderate wasting and for the nutritional management and care of infants younger than 6 months with a focus on the mother-child pair. The prevention guidelines focus on targeting children living in vulnerable households through a multisectoral approach to prevent wasting, acknowledging that co-packaging interventions of care have more impact than standalone interventions. The guidance recommends thatmedium-quantityor small-quantitylipid-based nutrient supplements (LNS) may be given to children 6 to 23 months of age living in vulnerable households for the prevention of wasting. The broadened scope of these guidelines provide an opportunity to reach more children with appropriate nutritional interventions from birth to five years; however, these improvements will only be realized if adopted by national governments.

The local production strategy will allow for the scale-up of nutrition interventions while also contributing significantly to economic development in country. It is against this backdrop that our work is anchored as we seek to undertake an initiative to launch local production of SQ-LNS in Kenya. The program will have the overall goal of improving nutritional outcomes in Kenya and in East Africa through local production and targeted distribution of SQ-LNS; the program will further target improvements in farmers’ livelihoods through the sale of ingredients to support local production and added value to the manufacturing sector in Kenya.

2. Proposed approach

The program is a four-year program and has been split into three phases as outlined below: i.   The formative phase (6 months i.e., Jan- June 2024)

This phase of work is critical and is scheduled to take place within the first six months to build a robust strategy. The key deliverables for this phase are: a business case that will demonstrate feasibility and viability of this investment as well as a research protocol to generate evidence. This will be determined through collaborative sessions with key stakeholders including MOH and key partners. We have developed a list of questions that will aid in developing the business case. These include: identifying the SQ-LNS product (new or existing), identifying potential

1 WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) -- MAGICapp - Making GRADE the Irresistible Choice - Guidelines and Evidence summaries, 7/6/23

manufacturers, identifying potential local suppliers (e.g., of peanuts, soya, maize), identifying the target population, analyzing potential volumes, determining projected impact, etc. Identification of public health structures will also be done during this phase to ensure that the program is engrained within MOH.

ii.      Demonstration of impact (From July 2024 for 2 years)

The viability as proven in the formative phase will determine the scale up and implementation plan. During this phase of work, we will work with MOH to secure funding for scale up (related to procurement, delivery and other program costs). This funding will also aid in building the capacity of the local manufacturer as well as implementing a sourcing strategy for local ingredients.

iii.      The national scale-up phase (2.5 years)

This phase will largely focus on the integration and sustainability plan to ensure continuity of this program beyond the donor support provided.

3. Potential Impact

Through this investment, we aim to reach children living in all 23 northern Kenya arid and semi-arid lands (ASAL) counties who are plagued by very high rates of food insecurity and have a high burden of wasting. SQ-LNS provided as a preventive measure has been shown to reduce stunting among children 6-23 months of age by 12% and wasting by 14%. In the case of Rwanda, where it has been proven to work, the GoR distributes Fortified Based Foods (FBF) to the poorest and most vulnerable households thereby seeing a 27% reduction in stunting between the period of 2017 and 2021.

In Kenya, stunting prevalence is highest among children (<5) in the lowest wealth quintile (28%)2. Amongchildren6-59months ofageliving in the 23 ASAL countieswasting prevalence is also28%3. Currently the total MAM and SAM caseload in ASAL counties is 654,0004. However, the intervention is projected to reach roughly 3.2M5 children of between 6-23 months of age residing in these counties not currently suffering from moderate or severe wasting over the four-year period.

Based on these figures, in our intervention group, we’d expect a reduction in stunting from 28% at the start of the project to 25% at the end of the project period and a reduction in wasting from 28% to 24%. Translating into a reduction of stunting among children in the target group by over 107,000 cases and a reduction in wasting of roughly 125,000 cases. We would envision expanding from the ASAL counties tonational coverage of the program, leading to even greater public health impact and an improvement on the numbers.

2 Kenya DHS 2022: 2022 Kenya Demographic and Health Survey [FR380bis] (dhsprogram.com) 3 IPC Acute Food Insecurity and Acute Malnutrition Analysis, 2023: IPC_Kenya_Acute_Food_Insecurity_Malnutrition_2023_Jul2024Jan_Report.pdf (ipcinfo.org) 4 IPC Acute Food Insecurity and Acute Malnutrition Analysis, 2023: IPC_Kenya_Acute_Food_Insecurity_Malnutrition_2023_Jul2024Jan_Report.pdf (ipcinfo.org) 5 IPC Acute Food Insecurity and Acute Malnutrition Analysis, 2023: IPC_Kenya_Acute_Food_Insecurity_Malnutrition_2023_Jul2024Jan_Report.pdf (ipcinfo.org)

The numbers provided are estimates and we will continue to refine them during the formative phase of work.