Warm greetings from Mothers’ Initiatives Africa in Mbale here. It’s been a long time of silence. I hope this email finds you in perfect health.
Am writing this to extend our sincere appreciation for the support that Kitchen Table Charities Trust gave to MIA in a project that has contributed to the reduction of Maternal and Child Mortality in Manafwa and Mbale Districts in Eastern Uganda.
Similarly, am glad to inform you that the project impact report is ready and please find it below. Any comments and questions are welcome.
Also attached is an update of pictures of some of the activities that Mothers’ Initiatives Africa has been doing. Looking forward to hearing from you.
With thanks,
Mothers’ Initiatives Africa
REDUCING MATERNAL AND CHILD MORTALITY WITH TRADITIONAL BIRTH ATTENDANTS, VILLAGE HEALTH TEAMS AND MOTHER MENTORS IN MBALE AND MANAFWA DISTRICTS
Background
With Financial support of £11,000 (46,576,607 Uganda Shillings) from Kitchen Table Charities Trust, Mothers’ Initiatives Africa (MIA) implemented a project entitled “Improving the Health of Rural Women and Young Girls in Manafwa and Mbale Districts of Eastern Uganda”. The one year project started in April 2017 ended in December 2017. The overall Goal of the project was “Contributing to a reduction of Maternal and Child Mortality among women of reproductive age in rural areas of Manafwa and Mbale Districts The specific objectives were:
- To increase access and availability of health kits for women of reproductive age and children under 5 years old.
- To Increase knowledge on correct use of health kits, including misoprostol for PPH prevention and Family Planning availability among 2,500 Women in Reproductive Age and their partners, as well as of diarrhoea prevention & treatment and nutrition for children under five among care takers.
- To raise awareness about dangers of early pregnancy among school going young girls aged between 13 to 19 years.
Outputs
On receiving the grant, MIA started implementing the project with procuring and distributing 600 mama kits in six sub counties of Bupoto, Bubutu, Bumwoni, Busukuya, Butiru and Wesswa in Manafwa District, while 400 mama kits were distributed in Northern Division in Mbale District.
In Manafwa District, 36 Traditional Birth Attendants were trained and 150 Community Health workers in Mbale District, who included: Mama Ambassadors, Village Health Teams, Mother Mentors, Traditional Birth Attendants and women local council leaders, all these were trained about safe motherhood, increased health facility access through referrals as a way of contributing to a reduction to Maternal and child Mortality.
2,562 students of Hamdan Girls High School, Manafwa High School, Nabuyonga Primary School, Kiwata Primary School, Buyonjo Primary School and Bumasokho Primary School have been reached through school health clubs and carrying out school health education sessions which included topics such as: causes and dangers of early pregnancies and child marriages, ways of preventing child marriages, practicing good hygiene, puberty, proper menstruation management and sexually transmitted diseases. Other topics that were covered during the health education sessions were: Menstrual Hygiene and Reproductive Health issues and Re-usable Sanitary Pads kit making even with a hand needle, this itself creating a great impact to the community.
The peer educators` health clubs are running in the six secondary school targeting female students and have been a highly successful vehicle for mobilization, awareness and Interpersonal communication. The Peer Education program will continue to focus on delayed sexual debut, career planning, life skills and professional development. MIA will continue to work with the trained female peer educators but will recruit at least two male peer educators from each of the seven secondary schools. The peer educators will be responsible for the continuous health education sessions and peer counselling.
Similarly, through the continuous sensitization in schools about Water, Hygiene and Sanitation in the community and schools, incidences of common diseases such as diarrhea have reduced, absenteeism in schools has reduced after MIA distributing re-usable sanitary pad kits, raising awareness about proper Menstrual Hygiene and illustrating the value of education to students and pupils.
Challenges faced
Inadequate office equipment such as cameras, laptops and motorcycles for transport.
The poor road network and a lot of rainfall in Manafwa District sometimes frustrates our work when roads become slippery, bridges break and even busting of river bunks rendering MIA staff and volunteers unable to reach some heard to reach areas.
Impacts
With a social element of door to door visits giving knowledge on parenting skills, proper nutrition, proper hygiene and sanitation practices, encouraging mothers go for antenatal services and seek medical attention from health facilities, Community Health Workers and TBAs have substantially made a reduction in Maternal and child mortality rates in Mbale and Manafwa Districts. There’s improved health seeking behavior and knowledge, preventative care measures, and an increased number of visits that Community Health Workers give to households.
As a result of the safe motherhood project mothers in the areas of intervention who received the Mama Kits have reported that the Mama kits were of great help to them and they are in position to better understand the use of the kits. One Muyama Tabitha, a mother from Busukuya Sub-county had this say:
When I received a Mama kit, Mosquito net, aqua safe, Oral Rehydration Salts and Zinc tablets from MIA, these Items were of great help to me when I delivered my baby, I had what to use, and there were gloves, cotton and razorblades). My baby has not suffered from malaria, she is now one year and 7 months even me I know am safe from Malaria.
Similarly, in Bupoto Sub-county, the number of mothers who attended ante-natal services between August 2017 to August 2018 has increased from 187 to 265 mothers and 93% of these have delivered at the health centre. Mothers are also knowledgeable about basic nutritional practices, they are also aware about the importance of family planning and where to access it from.
This gave us an impression that Traditional Birth Attendants are conducting more referrals than before and they are encouraging and accompanying mothers to the health centers for proper medical attention. Khaukha Alice a TBA in Bumwoni Sub-county had this to say;
Since the training by MIA at Manafwa District, am very knowledgeable about the proper use of Mama Kits and the benefits of referring mothers to the health facility. These days’ mothers suffer a lot of Hemorrhage and obstructed labor, but we can’t handle these in our shrines. These days mothers who over bleed are saved at the facility. We are so grateful to MIA and KTCT. God Bless you abundantly.
It was also found out that treating water with water guard is a safe way of preventing water borne diseases. This has been realized in the areas where MIA has worked, Sr. Stella Nalwada, a Nursing Officer at Bugobero Health Center III had this to say;
Amongst the mothers who received water guard, their families have not had any diseases such as diarrhea, cholera and dysentery in the last 10 months, they have also practiced good hygiene, proper use of latrines, mothers and child nutrition has improved, therefore there have been few cases of diarrhea compared to what it was before amongst the families that were trained and were Community Health Workers have reached.
With regard to adolescents, students and several young people whom we talked to, we discovered that young people have goals and dreams, after MIA giving knowledge about dangers of early pregnancy. Students told us how avoiding early pregnancies is beneficial to them. One Namataka Juliet of Bumbo Senior Secondary school had this to say;
“If I avoid early pregnancy, I will stay in school and attain my certificate, I will go and do my course at Makerere University and I want to become a lawyer in future and this will help me advance personally”.
Mothers’ Initiatives Africa, with support from Kitchen Table Charities Trust created a team of Community Health Workers (Traditional Birth Attendants, Village Health Teams, and Mother Mentors) program with the aim of improving access to and adoption of simple, proven health interventions in rural areas in of Eastern Uganda with the intension to reduce maternal and Child mortality in this region. The program was carried out in partnership with Manafwa and Mbale District Local Governments were these local health workers went door-to-door educating their communities about ways to improve their Sexual and Reproductive Health, practicing proper Hygiene and Sanitation to keep away preventable diseases/illnesses, supporting pregnant women
The Community Health Workers programme also improved health knowledge and people in villages reported taking more preventative health measures and precaution than those in the other sub-counties where the project did not reach. In addition, households with newborns in program villages have significantly received and are still receiving follow-up visits, to ensure the babies are immunized, nutrition standards are maintained such that mothers and babies are disease free. One Alice Wemesa a midwife at Magale Health Center IV had this to say:
“ Am impressed with the work that trained TBAs are doing especially in this community, were mothers have been referred to health facilities for safe delivery services, and if this training could be carried out in the whole District, it would help us more to attain a reduction in the number of maternal and child mortality rates”
Way Forward
At Mothers’ Initiatives Africa, we are dedicated to transforming our communities
We hope to give these findings to policymakers and funders to scale up this model, enabling us to expand the program to reach millions of people in Eastern Uganda and to bring the successful model to the entire country, which provides promising insight into strengthening community health systems.
Special thanks goes to Kitchen Table Charities Trust for the financial support rendered to us, the District Health Office at Manafwa District Local Government Headquarters for the technical support well delivered, and in the same spirit, we call for more support in reaching out to and transforming the lives of many Ugandans in the public health realm through a spectrum of interventions, therefore, the sky is the limit.
