Effectiveness of Community Health Promoters in Mitigating Malnutrition Among Children Under 5 Years During Drought Periods in Isiolo County, Kenya

Abstract

Malnutrition remains a leading cause of child morbidity and mortality, particularly in drought-prone, low-resource settings such as Isiolo County, Kenya. Despite national efforts through the Integrated Management of Acute Malnutrition (IMAM) and the IMAM Surge strategy, malnutrition rates in the county continue to surpass national averages. Community Health Promoters (CHPs) are critical frontline actors in detecting, referring, and educating communities on child nutrition; however, evidence on their effectiveness during emergencies remains limited. This study assessed the capacity and challenges of CHPs in mitigating child malnutrition during drought periods. A cross-sectional mixed-methods study was conducted among 380 CHPs selected through multistage sampling. Data were collected using semi-structured questionnaires and analyzed through descriptive statistics and thematic analysis. Findings revealed that although most CHPs had received basic nutrition training, only half had undergone refresher or Surge-specific training, and 43.4% expressed confidence in identifying malnutrition cases. Referral mechanisms were widely practiced, with caregiver acceptance rates reaching 97.4%, yet logistical, financial, and supervisory challenges hindered consistency. High workloads some CHPs covering over 100 households further reduced service quality and morale. Socio-cultural barriers, including traditional beliefs, gender dynamics, and language differences, also limited program uptake. The study concludes that CHPs are indispensable in combating malnutrition during droughts but are constrained by systemic, operational, and cultural barriers. Strengthening their effectiveness requires continuous capacity building, equitable workload distribution, logistical and financial support, culturally responsive community engagement, and integration of CHPs into formal health systems through mentorship and supportive policy frameworks.