Reducing maternal, newborn and child mortality in Mandera County

Reducing maternal, newborn and child mortality in Mandera County

I have already shared my experience with my female relatives that I stay with. They too are attesting to the fact that I am more energetic and vibrant, having recovered much quicker compared to my previous deliveries. My husband is also supporting me on this. I have a sister in-law who is pregnant. We have discussed about the need for her to begin visiting the facility.

Fatuma Mohamed Bulle, Thirty year old mother

CONTEXT

The overall objective of the EU health project that started in July 2016 and expected to end in December 2018 is to enhance reproductive, maternal, neonatal and child health and nutrition (RMNCH) outcomes for vulnerable communities of Mandera County by accelerating a reduction in maternal, new-born and child mortalities. Save the Children has been implementing the project in four out of seven sub-counties of Mandera, namely, Mandera West, Mandera South, Banisa and Kotulo. Traditional and cultural practices prohibited women from being attended to by male health care professionals. They would only show up at a health facility when they developed life-threatening obstetric emergencies. Maternal, new born and child health care are matters of concern to the nomadic women. The women and their children face many risks.

OBJECTIVES

  • Increase demand for quality RMNCH care for women of reproductive age, pregnant women, new-borns and children.
  • Improve access to quality RMNCH care for pregnant women, new-borns and children.
  • Improve human and institutional capacity to provide quality RMNCH care for pregnant women, new-borns and children
  • Advocacy initiatives influence policy and practice in Mandera County and at National level around harmful traditional practices and investing in RMNCH

RESULTS

  • Better quality health services: Training of 30 traditional birth attendants to re-orient them as birth companions and 60 community health volunteers (targeting influential traditional birth attendants) across the four sub-counties
  • Breaking community stereo-types of gender preference in connection with skilled birth attendance. Acceptance and ownership of the health facilities and general support to the existing health service providers irrespective of their gender.
  • Increased knowledge and improved health seeking behaviour thus increased demand for quality RMNCH care for women of reproductive age, pregnant women, new-borns and children.
  • Formation of village savings and loans association groups (Table banking), training on business skills and support with seed funds has adequately motivated the volunteers, spurred their business acumen and promoted social cohesion.
  • Mother support groups provide a good forum for knowledge and experience sharing on breastfeeding, nutrition and MNCH and also feedback from health workers.
  • Engagement of religious leaders to become advocates for MNCH is very significant as their wisdom, insight and interpretation of Islamic teachings is highly revered and accepted.
  • Baby Friendly Initiative is a good forum for knowledge and experience sharing, amongst members and from health workers.

FACTS AND FIGURES

  • 30 Traditional birth attendants trained to become birth companions
  • 60 community health volunteers trained
  • Chorogo settlement and surrounding villages have around 1 440 households with about 4 320 women of reproductive age (15-49 years)

TESTIMONY

The story of Musa Bishar's birth

We are at Choroqo village, in Guba location of Banisa sub-County in Mandera County. Thirty year old Fatuma Mohamed Bulle cuddles her three days old son; Musa Bishar Abdullahi. Musa was born on 13th September 2018 at Choroqo dispensary, assisted by the nurse in charge Dickson Mwenda. Musa is the 6th baby born to Fatuma. Her first born is fifteen years old. Like many Somali women in the North-Eastern part of Kenya, Fatuma leads a nomadic lifestyle. Her main occupation has been to care for the family’s camels, sheep and goats ever since she got married. The maximum period that Fatuma stays at one place is approximately two to three months before moving to the next region that has sufficient water and pasture for her animals. The mother of six, indicated that she had delivered other children while in the bush with the assistance of fellow female relatives; sometimes younger than herself and inexperienced. We sought to find out how she felt about the hospital delivery compared to the previous deliveries.

What influenced you to deliver at the hospital during your last pregnancy?

I visited Choroqo dispensary when I was six months pregnant; because I was not feeling well. After the ‘doctor’ examined me, I was informed that my blood was too little. I was pale. He gave me drugs that I was supposed to take daily till delivery and to continue thereafter. He then introduced me to two ladies, Ambia and Fatuma. The ladies talked to me about the importance of eating foods that would build my blood as well as visiting the hospital for ante-natal care. They also advised me to plan to deliver at the hospital because they would be present with me throughout the process. I promised them that I would try but wasn’t sure I would make it because of my frequent movements.

Can you describe to us your latest delivery experience?

In the last two weeks of my pregnancy I informed my husband that we needed to move closer to Choroqo so that I could visit the facility. I used to get verbal messages that were conveyed by Ambia and Fatuma through my relatives who visited Choroqo. I learnt that they were concerned about my wellbeing. My husband agreed to my request. We moved to Haji Hassan (approximately two kilometres from Choroqo). As soon as I felt the slight signs of labour, I began walking slowly towards the hospital, accompanied by my husband. When I arrived at Choroqo, the two ladies took me to the hospital. The doctor examined me and fixed water on my hand (syntocinon drip). Fatuma and Ambia (trained birth companions) stayed with me during labour. I felt safe and very much at peace. Two hours later, the ‘doctor’ helped me to deliver my baby safely. I was cleaned and made comfortable. My bleeding was very little. I was also given some tablets which took away abdominal pains. My baby was placed on the breast immediately. I was also given corn soya blend (CSB). My relatives prepared the porridge for me as well as soup and foods that gave me energy.

Can you tell us briefly about your previous birth experiences?

The difference is like night and day. My previous labour experiences were very difficult. However, I would persevere because my mother told me that I had to go through such challenges. I was not allowed to eat or drink anything during labour. By the time I was ready to deliver, my energy levels would be very low. I used to bleed quite a lot after delivery, with excruciating abdominal pains. I could not breastfeed my baby for at least three days. During this period, the baby would be given camel’s milk and water. This would continue even after commencing breastfeeding. As I mentioned before, the women who used to assist me were mostly young and inexperienced. They didn’t have knowledge on how to prepare food for a woman who had just delivered. I survived by the grace of God.

 

Three weeks later

Three weeks later, we visited Choroqo to follow up on the progress of Fatuma Mohamed Bulle and her son Bishar Abdullahi.

We were informed that she had moved back to the bush to join her family. The distance from Choroqo to Haji Hassan is approximately two kilometres.

From the main track path (there are no established roads) to the area where Fatuma stays, the distance was about 700ms through thickets and thorn trees.

How are you and the baby doing?

(smiles) We are fine. I left Choroqo four days ago because my children needed their mother.

Are you still breastfeeding Bishar exclusively?

Absolutely yes! I know the benefits now. It has been almost one month and my baby hasn’t had any problems. The experiences I had with my other children were different. At this time I would be dealing with diarrhoea and vomiting.

Was your baby immunised?

Yes. (She shows us the BCG scar beginning to form). He also received some drops in the mouth (polio)

How do you plan to influence other women in the bush and why?

I have already shared my experience with my female relatives that I stay with. They too are attesting to the fact that I am more energetic and vibrant, having recovered much quicker compared to my previous deliveries. My husband is also supporting me on this. I have a sister in-law who is pregnant. We have discussed about the need for her to begin visiting the facility.

How do you access post-natal care? What plans do you have in place?

Honestly speaking, the care that I received from the hospital before I left Choroqo might just be all for now. We might be moving further away from this area very soon and that will make it difficult for me to see a ‘doctor’ even if I wanted to.

How best can Save the Children work with other women of child bearing age in your context?

We need to be enlightened through training. Many of us are ignorant about the importance of staying close to the health facility especially when pregnant. If Ambia and Fatuma had not kept in touch with me, I might not have had this experience. I think I was very lucky. We need to have fellow women that we can trust to freely share the joys and agonies of motherhood, and who can provide direction on the importance of hospital services.

 

Interview conducted by Agnes Egesa