Background:
The causal pathways of acute malnutrition in Africa’s drylands are complex, interlinked, and require in-depth assessment and analysis to clarify them. We aimed to understand community perceptions of factors related to acute malnutrition across livelihoods in Samburu County.

Methods:
This qualitative study was conducted in 2021 in selected villages representing three livelihoods: urban/peri-urban, pastoral, and agropastoral. Data were collected through community dialogues, focus group discussions, in-depth interviews, and key informant interviews from 331 participants including mothers and fathers with children younger than three years, and selected key informants. Question guides focused on three areas related to acute malnutrition: factors that influence maternal, infant, and young child nutrition (MIYCN) practices; use and barriers to use of health care services; and gender dynamics in household decision-making. Data were analyzed thematically.

Results:
Factors that influence MIYCN practices_: Poverty appeared to be the main barrier to affording nutritious foods, and seasonality was a key factor for food access and utilization in all livelihoods. Other barriers included maternal alcohol use in urban/peri-urban and agropastoral zones; poor water, sanitation, and hygiene practices; and cultural beliefs prohibiting the consumption of certain foods during pregnancy and lactation. Adolescent mothers faced additional challenges with breastfeeding and complementary feeding because of inadequate knowledge. Factors associated with utilization of healthcare services:_ Communities trusted healthcare services and the staff, which was attributed to health education and sensitization across livelihoods. Enrollment in the national health insurance scheme and availability of ambulances facilitated health care access. Long distances to health facilities, facility-level barriers, frequent migration, and use of traditional medicine. Gender dynamics in household decision-making_: Women were involved in low-paying manual labor and petty trade, while men controlled assets and capital across livelihoods.

CONCLUSION:
Poverty and seasonality interlinked with other factors such as nutrition, healthcare utilization, household decision-making, childcare, and sanitation practices.