Exploring the role of maternal routine and problem-solving actions in promoting child health and nutrition in Kenyan drylands: a qualitative study

In the drylands of northern Kenya, mothers strive to promote the health and nutritional wellbeing of their children, but face many challenges. Most studies, especially those focusing on (agro-)pastoralists, use a problem-lens, with recommended standard interventions to improve child nutrition that do not necessarily fit the local conditions. This study aims to explore (agro-)pastoral caregivers’ knowledge and their practical solutions in child nutrition and care, uncovering their routine and problem-solving actions. The Activity Knowledge Analysis tool maps caregivers’ practices aimed at achieving their goals (routine actions), and identifies the challenges they face, underlying causes, and the problem-solving actions. We used this participatory tool in 18 Focus Group Discussion sessions with caregivers from Rendille, Burji and Borana communities in Marsabit County, Kenya. The discussions were recorded, transcribed and analysed using MAXQDA software. Mothers explained their routine actions which included age-appropriate feeding practices, maintaining hygiene, and facilitating the child’s developmental milestones to achieve their goal of having a healthy child. Some of the routine actions include providing special diets, responsive feeding; personal, food and environmental hygiene; massage, engagement in play and interaction to facilitate development. The challenges that mothers face include maintaining their own health, difficulties with feeding and delayed developmental milestones. These challenges are further compounded by contextual factors; poverty, time constraints and lack of support. To overcome the challenges, mothers used a range of problem-solving actions, including enriching their children’s diets, diversifying their income sources, borrowing food or money, and seeking social support from family members and the community. Participatory approaches, such as the use of the Activity Knowledge Analysis tool, have proved useful in exploring caregivers’ knowledge, highlighting their problem-solving actions. These insights can be used to contextualize existing government and stakeholder interventions by incorporating community-led solutions and leveraging local structures for knowledge exchange and dissemination. This approach promotes the use of locally available resources and ensures cultural appropriateness, enhancing the adoption of practices to improve children’s health and nutritional status.