Makena became a young mother at nineteen years old. Her son Murithi is now four months old and wants to eat uji (porridge) like his older two-year-old cousin. Makena has been only breastfeeding, like her mother instructed her to do when Murithi was first born, but now that her son is getting bigger and stronger, she is thinking of giving him solid food at four months. She attends a maternal and under-5 health and education clinic after hearing about it from her neighbor who is also a mother of a young child, and she learns from a community health worker that before Murithi is six months old, his digestive system isn’t fully developed and he hasn’t gotten full immunity from her breast milk. She learns that, because of these things, giving him uji before he turns six months old may cause infections in his stomach, so she decides to continue only breastfeeding until he is older.
Nyawira is 30 years old and a mother to five children. Her youngest child is one year old, and she has been having one child every one to two years since she was 22 years old. She has noticed that she is having more and more difficulty caring for her growing family. Nyawira attends a maternal and under-5 health and education clinic with her one year old, and there, she learns about the importance of family planning and advantages of child spacing from a community health worker. No one had ever spoken to her about how more years between having children can decrease infant mortality. Nyawira decides to have a conversation with the nurse at the maternal and under-5 clinic to figure out what type of family planning method is best for her. After deciding what method is best from her, she acts as a champion on her community and encourages other women to access family planning methods as well. [ Updated 6 Jan]
Faith is the mother of three-year-old twin girls and a seven-year-old boy in primary school. She hears about a maternal and under-5 health and education clinic from her son’s primary school head teacher and attends the clinic with her twin daughters. After the health education portion of the clinic, she takes her daughters to be seen by the nurse and realizes that they both show signs of early stage ringworm. The nurse gives her deworming cream and hygiene advice for keeping ringworm-free. Faith now plans to purchase shoes for all of her children and wash their bedding weekly to keep her children healthy and happy.
Update [15 Dec.]:
Murimi is the husband to Karimi and the father of four children under the age of 7 years. His wife asks him to attend a health education lecture at the children's primary school. He reluctantly attends the clinic with his wife and two youngest children. While at the lecture he learns the importance of keeping clean drinking water in the house, so as to reduce the chances his children have diarrhea. Also, he learns about the variety of family planning options available to his wife, the importance of spacing any future children for the health of his wife, and the importance of open communication with his wife on these topics. After the lecture, Murimi and Karimi have a conversation about family planning options and go to see the nurse together to make sure she has the appropriate family planning method for them. The whole family is happy to be drinking clean water and to know they can plan for their next child.
Our idea is to leverage our existing relationships with 72 area schools to engage parents and under-5 children, to improve the health of mothers and children. We currently conduct mobile clinics at each of these partner schools and offer free basic health care to pupils and teachers, as well as malaria education for parents insecticide-treated anti-malarial bed nets for lower primary school students. We would expand these clinics by inviting parents and under-5 children in the nearby community to come to the school on a specified day for target health and education clinics.
Update [15 Dec.]: Although previously we said we would invite mothers and under-5 children, we recognize the importance of involving the men and fathers as well. Therefore, in order to include the men and fathers in the community, we will invite both mothers and fathers to received educational lectures. We also recognize, that some topics and some women are more comfortable having open discussions without men, therefore some of the designated breakout sessions may be conducted targeting either men or women, and would have only one gender attending the specific session. [ Updated 6 Jan]
Update (18 Dec): Many women and men have expressed interest in learning together with their spouses. Therefore, we will hold the educational sessions together and allow for single-sex breakout sessions after if we find it is necessary.
These clinics will include the following six components:
- Health education lectures specific to mothers and fathers and under-5 children on topics such as: breast feeding, early childhood nutrition, family planning, child spacing, oral rehydration therapy, danger signs of malaria, clean water in the homes, and hygiene;
- Breakout sessions on similar topics to those listed above during the health education lectures, but incorporating hands-on activities such as making oral rehydration salts or structured play activities with children [Updated 6 Jan];
- Clinical services for children, including growth monitoring, malnutrition screenings, immunization checks, and more, from our community health nurse, as well as volunteer partner professionals who specialize in the fields of pediatrics and female health;
- Clinical services for mothers, including family planning modalities, HIV testing and counseling, the importance of pre-natal vitamins, and screening for iron deficiencies;
- Mother-to-mother and father-to-father forum discussions led by our community health workers, during which parents can share experiences and learn from each other; and
- Structured play for under-5 children who attend the clinics with their mothers led by community health workers and public health fellows, during which play activities will encourage creativity, peer communication, and critical thinking (potentially using a pre-designed curriculum, depending on connections we make with organizations that may have one).
What will the clinics look like? [ Updated Dec 27]
We will notify the parents of an upcoming clinic through word-of-mouth leveraging our relationships with the schools to communicate with parents.
At each clinic, we will hold a large educational session for all parents, then after the large educational session, we will have breakout sessions, allowing parents to engage in smaller discussions on various health topics. Some of the breakout sessions will be hands on to engage the parents as much as possible. An example of one of these potential sessions is making oral rehydration salts.
During these breakout sessions, parents will be bringing their children to the nurse and clinicians for the growth monitoring and immunzation checks.
Each school will host a clinic once per term (every three months) so parents will have the opportunity to participate in all health lectures and breakout sessions they would like throughout the year, without it being too burdensome on their schedules.
Why this will work
We feel this idea can succeed because we already have relationships with the schools where we plan to hold the maternal and under-5 clinics. We have been recognized by the Sub-County Ministry of Health and Sub-County Ministry of Education for our contirbution to the health and wellbeing of the children in the Maara Sub-County, and therefore feel that these new programs are a natural next step. Our pre-existing relationships with the school and the community make us uniquely qualified to take on a maternal health and under-5 health clinic. In the past, we have seen a high turnout when we offer health education lectures to parents on topics such as malaria and hygiene.
We have observed that mothers are keen to learn more about their own health and the health of their children. The health education lectures will be taught by our trained community health workers on topics such as nutrition, breastfeeding, weaning, immunizations, danger signs of diarrhea and malaria, importance of clean drinking water in the home, hygiene, family planning and sexual and reproductive health.
Furthermore, in September, we piloted a very limited version of this program. We invited mothers to come to two schools to hear a health education lecture, and have their children seen by a clinician. At the time, we did not have the resources for growth monitoring or malnutrition screenings, and we had a limited curriculum for the mothers, as we were not sure what topics were most important to them, but still, we were able to achieve some impressive results.
- 116 children under-five were treated, or given deworming or Vitamin A doses
- 225 Mothers attended the health education lecture
- 17 mothers received some form of family planning from our nurse
Parent Networking [ Updated based on feedback from community]
We also plan to make connections with exemplary parents, identified by our partner schools’ teachers, who will help advertise our clinics, follow-up with parents if they have questions after our clinics, and participate in education, which introduces a peers-teaching-peers component and helps make the program more sustainable.
Targeted Health Services
For the children, our qualified nurse and visiting pediatricians will be available to treat any common illnesses affecting the children, as well as offer malnutrition screenings, growth monitoring, and immunizations.
With the addition of requesting parents to bring their child's growth monitoring chart and immunization record, we will be offering a one-on-one opportunity to these parents to ask any questions they may have, or follow up on missed immunizations.
Structured play for children [Updated Dec. 22]
Children will also be able to participate in structured play while their parents receive health education. This structured play component will be hosted by HopeCore’s global public health fellow who has taken courses on early child development and will focus on developing an age-appropriate curriculum.
This component will focus on six main activities that have been shown to help children under-five years old develop and strengthened the motor skills, coordination, and physical and mental strength necessary for children to thrive and grow. The six main activities are: underarm ball rolls, running, jumping & hopping, side-stepping, ball skills, and following directions games. We will design and modify traditional childhood games, such as hopscotch and “Simon Says,” that focus on these activities to create games that will both transcend cultural and communication barriers so as to facilitate easy explanation to our target group of children, and be simple enough for children to replicate at home on their own. We will also explain the games that we play during each session to our parents so that parents may also participate in play with their children.
While it will be difficult to evaluate the outcomes of our structured play curriculum at the start of our program, we will be able to assess improvements in child development as soon as our second visit to any specific community. We plan to collaborate with volunteer pediatricians and pediatric nurses to develop an appropriate motor skill and development assessment checklist to use to assess individual children’s development from their first structured play session. By using this checklist, which will include “milestones” for children in each year of their life (e.g. “can balance on one foot,” “can roll a ball towards a target,” “can catch an object,” “can follow simple instructions”), community health workers and global health fellows will be able to track each child’s growth and development in a more objected and targeted way.
- Underarm Ball Rolls
- Purpose: To help develop hand-eye coordination and whole body coordination
- Games: bowling, “Bucket Balls”
- Purpose: To provide exercise, strengthen the cardiorespiratory system, and develop coordination between arms and legs
- Games: “Red light, green light,” “Animal run,” weaving run
- Jumping & Hopping
- Purpose: To develop leg strength, leg coordination, and balance when landing
- Games: potato sack race, hopscotch, “Kangaroo Course”
- Purpose: To develop agility and whole body coordination
- Games: “Ring around the rosy,” “Crab Race”
- Ball Skills
- Purpose: To develop hand-eye coordination and arm strength
- Games: “Human Basketball,” “Group Catch”
- Following Directions Games
- Purpose: To develop executive control and self-regulation skills
- Games: “Freeze Dance,” “Simon Says”
User Feedback [Updated 18 Dec]
Throughout this week we have been seeking feedback from potential mothers and fathers who may attend the lectures. Because schools are currently on vacation, we were unable to organize parent's meetings at the schools, but through our microenterprise department, we met with loan clients who have children under the age of 5.
We had the opportunity to ask 9 individuals (7 women and 2 men) for feedback on this program. All 9 people had at least one child under the age of five, and ages of their other children ranged from 5 years to 18 years old. The number of children each respondent had ranged from 1 to 6.
All 9 people questioned said they would like to attend a health and education lecture, and they would attend if they were called by an area school to attend.
First, we asked what topics they would be interested in learning about at one of these clinics. Responses were as follows, breastfeeding (4), family planning (4), nutrition (2), healthy living (2), common child illnesses (1), family life (1), and academic motivations (1).
Next we asked, "are you interested in learning about breastfeeding, nutrition, family planning, immunizations, and/or hygiene?” and the responses were all "yes".
Finally, to address the question of involving men and fathers, we asked how each person would feel if their spouse was in the room, and would they prefer men and women to be educated together or separately. 8 out of the 9 respondents said they would prefer to be taught together; one said "together as a family."
The feedback from these people was very positive, and it leads us to believe we are on the right course with the program, and there would be interest in it. Similarly, the topics we had previously identified seem important to these parents, and now we have additional topics to add to our list.
Questions for the community
- How can we make this idea better?
- Do you see any potential problems we have not yet thought of?
- What low-cost, but effective, activities can we add to our structured play component?
- For those who have had experience communicating with people in rural areas to advertise events, what has been the most effective means of communication?
- Update [15 Dec.]: Does anyone have suggestions of indicators that we could use to demonstrate the impact of this program?
Updated 6 January