By Linda KHABEKO
Islamic Relief Kenya Nutrition Program supports the Ministry of health in Wajir West, Wajir North and Eldas sub-counties in the implementation of High impact Nutrition Intervention programme (HINI).This programme incorporates 11 components from the Scaling Up Nutrition movement (SUN) these include:Exclusive Breastfeeding (EBF)promotion, complementary feeding for infants after the age of six months, improved hygiene practices, vitamin A supplementation, therapeutic zinc supplementation for diarrhea management, de-worming for children, iron folate supplementation for pregnant women, salt iodization, iron-fortification of staple foods, prevention of moderate under nutrition and treatment of Acute malnutrition.
These components of HINI are transformed into services offered to the community through the rural health facilities, outreach services as well as County and Sub-county hospitals. The programme’s success is measured through indicators such as cure rate, death rate, defaulter rate, coverage. Health education is one of the services conducted at all the sites where HINI activities are offered. This is done by the Nurses, Community Health workers, Mother support group facilitators as well as IRK Nutrition Officers and Nutrition Promoters. Various health and nutrition topics are covered through the health education sessions including: Exclusive breast feeding, complementary feeding, hygiene and sanitation, importance of ante-natal and post-natal clinics, care of a sick child, cooking demonstrations, nutrition in pregnancy,nutrition in HIV etc.
Markaba Gelle is a mother of one, Yusuf Bishar 8 months. She is married to Abdiaziz Bishar a casual labourer. The three live in Gurar village in Wajir North sub-county. Markaba and her husband were not privileged to attend school; they rely on Yusuf’s earnings from his casual engagements for their daily needs. It is Monday morning at around 9:00am and I meet Markaba at Gurar health centre amongst the women waiting to be served.Siyaad Mohamed the community health worker calls out loud in Somali “Waa wakhtigh taclinta caafimmadka isu imaadho” meaning the mothers should converge for a health education season. With excitement, Markaba and her friends move closer to the CHW ready to listen with a lot of expectation as I could read from their faces.
The CHW goes on and educates the mothers on complementary feeding specifically on feeding children with variety of foods to ensure their diet is balanced with all the nutrients their growing bodies require. He goes on and invites me for a cooking demonstration exercise. We engage in a participatory cooking demonstration exercise and the mothers enjoy the learning experience. Today we cook “Kunde” an indigenous vegetable grown at the mother support group kitchen garden.
After the session I notice Markaba leaving carrying her son on her back, I quickly call her and ask why she is leaving without seeing the Nurse. She tells me she and her son are all well and Yusuf is not due for vaccination or weighing, all she come for was to listen to the health education session because she has learnt a lot. Markaba says she did not have experience on how to raise a child since she grew up with her grandmother as the only child in the homestead and Yusuf is her first child.
“When I was two months pregnant my husband’s friend Siyaad Mohamed who is the CHW at Gurar health centre visited us one morning and informed us on the importance of visiting the hospital every month during and even after pregnancy. The following morning I woke up early and came to the hospital. The Nurse talked to me about very many important issues like,hygiene,eating a balance diet, taking iron tablets, visiting the hospital not only when am sick but every month for weighing, vaccination and checking on the baby. I was happy to know someone was available to ensure both me and my baby are ok”
Markaba was able to exclusively breastfeed her son for six months, with support from the hospital she was able to handle breast complications and practise breast feeding on demand. Currently she is practising responsive complementary feeding on Yusuf, she is also able to balance the diet at her home, to ensure her family is healthy and Yusuf is able to get all the nutrients he requires. She goes on to explain that every other time she came to the hospital, especially at around 9:00am or 2:00pm; she noticed that the CHW or the Nurse would call everyone to listen to education on health and nutrition.
“This information has changed my life and that of my family a lot” she says.
By Caroline SANG
Health outcomes in remote areas remain poor, including high rates of avoidable complications which could be reduced with better primary health care. According to the Kenya demographic and Health Survey (2009), Northern Kenya continues to showcase poor health statistics. The maternal mortality ratio (MMR) is estimated at more than 1,000 deaths per 100,000 live births, more than double the national average. There are huge disparities in the country in regards to maternal mortality with North Eastern counties having a Maternal Mortality Rate of 1000/100,000 live births against a national average of 488 and under-five child mortality approximated at 142/1,000 live births live births is also far too high, and has virtually remained unchanged.
To this end, Islamic Relief has initiated a health outreach program which is a useful vehicle to deliver maternal and child health care to hard-to-reach women and children and thereby extending medical services to the rural-poor community. The outreaches are regular and done on a single-day visit by qualified staff from a health facility to populations located about 5–40 km from the health facility. 29 Year old Anab Mohamud, mother of five, is one of the beneficiaries of this initiative. She says,
“I am happy that the nurse comes to our community at least four times in a month to treat our children. He /she is able to offer us treatment for minor illnesses and the community is really appreciative of these services. This was not the case before. This place is quite remote and we have no facility here, therefore many women do not access care during pregnancy or child birth, unless during the outreach session when a health worker visits us from Buna facility which is located about 35 km from here.”
Despite the ignorance about the importance of immunizations and other health services compounding the problem of poor health, the strategies undertaken have aimed to deliver the much needed health services to the immediate rural population. Anab tells us that,
“When Adan and Suleiman (two of my children) were born, they used to get ill every so often, but since the nurse started visiting our community, they received drugs and they are now much better. I can see a big improvement with my children’s health status. I never attended Ante natal clinics during my previous pregnancies with Adan and Suleiman and they also received their immunization late; I think that is what used to cause their illnesses.
However, since the nurse(s) started regularly visiting this village, all my other three children have been able to received their immunizations on time. They have not had many episodes of illnesses as compared to Adan and Suleiman. Since having my three children after Adan and Suleiman, I have managed to practise exclusive breastfeeding for them and they have also received Vitamin A; I believe this has contributed to their general well-being”.