Giving birth to twins at the height of the Covid-19 pandemic still ranks as one of the most difficult periods in Josephine Kericho's life.
Kericho was not only unemployed but also fighting hunger. Had she given birth at home, the 25-year-old mother of five says, she would have died together with her now 11-month-old twins. Death would have come either at childbirth or shortly after from hunger.
She developed oedema and was weak.
"My body started swelling a few weeks to delivery. I did not even know that I was carrying twins until I was taken to the general hospital by a community health volunteer," she narrated.
Kericho was admitted at the Isiolo County Teaching and Referral Hospital for several days. She was released to go home only to be readmitted one week to her due date.
"I continued having challenges at home because after delivery, my breasts failed to produce enough milk," she said.
And so began another phase in her troubled motherhood. She had to leave the twins in the care of their siblings -- nine-year-old brother and other two children, aged eight and three years -- for the forested hills, where she cut down trees and burned charcoal.
"We only depend on charcoal, without that we cannot feed. My neighbours were not available and so I used to leave the twins with the brothers," she said.
But she was unwittingly creating another problem: The little food (milk) she would leave behind to be given to the babies would be consumed by the older children.
And because not all the time she would get some income to feed them, the children would go without food.
"If I failed to eat, they would stay without feeding. I was advised on exclusive breastfeeding and so I had not introduced them to solid food because they were still below six months," she said.
In her culture, women are the ones who are supposed to provide for the family. Her husband, she said, abandoned her and the children.
Were it not for community health volunteers (CHV), her twins would have died, she explained.
Kericho was given a mid-upper arm circumference (MUAC) band to monitor the malnutrition status of her children.
"I used to measure them frequently until one day it was at the red zone (critical). I called a CHV who came and advised me to take them to the hospital where doctors gave her advice and some food supplements for the babies.
"I fed them until the MUAC turned green," she explained, expressing hope that her children will be enrolled into the cash-transfer programme.
This is because Kericho depends on charcoal to feed her children, selling a 90-kilogramme gunny bag of charcoal at Ksh1,200 ($10.90) but ends up with Ksh700 ($6.36) after subtracting expenses; hardly enough to feed a family of six.
Although the band shows that the twins' rate of malnutrition has decreased, a keener look shows they are stunted. At 11 months, they are learning how to take baby steps, quite literally.
The twins represent millions of others who have suffered pangs of malnutrition, not only in Kenya, but elsewhere.
More than 200 km away in Korbesa-Merti, Isiolo, The EastAfrican finds Rehema Mohammed and her two-year-old son Mohammed Juma in her hut.
Rehema is mourning a close relative that just passed away. Through a translator, she explains how the family MUAC saved her son from malnutrition.
Her son weighed only seven kilogrammes when she took him to the hospital in March, upon guidance of a CHV, Adan Abduba. He was given supplements and his situation improved. He now weighs 9.8 kg and doing well.
Isiolo is one of the arid and semi-arid counties of Kenya where most people depend on livestock. Isiolo is usually dry but locusts and prolonged drought made a bad situation worse as harvests decreased significantly, affecting food availability and consequently nutrition.
"People achieved only 30 percent of the total harvests meaning they were unable to get enough food at household level leading to high malnutrition," said Dancliff Mbura, a nutrition programme manager at Action Against Hunger.
A short rains assessment in February found that close to 50 percent of the households in Isiolo to be food insecure.
"According to the Health and Nutrition Survey 2020 report, 16.7 percent of children in Isiolo are malnourished," Mbura said, explaining that the percentage is classified as critical or urgent by WHO standards.
And malnutrition in all ASALs -- is expected to worsen in the coming months especially due to depressed rainfall.
'No touch' policy
Most people in ASALs depend on livestock. Drought usually sweeps away herds if they fail to move in search for pasture and water, affecting income and nutrition. In such circumstances, children are not able to access milk, which is an important source of calcium, phosphorus, vitamins, potassium, vitamin D and proteins, Mbura added.
According to the United Nations Children's Emergency Fund (Unicef), key drivers of childhood undernutrition include disease and poor diets due to food insecurity, insufficient care practices and harmful social norms.
"Drought comes with other diseases like diarrhoea, infestation of worms and other health conditions due to poor access to water. These greatly contribute to malnutrition," Mr Mbura explained.
And, coronavirus compounded the problem. "Covid-19 brought in some dynamics. The government has been promoting a 'No touch' policy at household level and so community health volunteers are not able to visit homes like they used to do," he said.
As a result, many mothers cannot tell the progression of malnutrition among their children aged under five because they also do not go to health facilities.
Consequently, mothers in Isiolo are being mentored on how to identify malnutrition in children by use of the family MUAC. "We are using community units to roll out the family MUAC. We have reached 15 community units in Isiolo Central and Merti," Mr Mbura said.
Introducing the MUAC was to scale-up programming for nutrition and reach as many children as possible in light of the long distances to traverse.
The MUAC is colour-coded and not calibrated like before, to make it easy for the mothers to understand when their children are malnourished.