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Kwale’s push to cut deliveries at home bears fruit

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Expectant mothers at a labour ward. FILE PHOTO | NMG

A 2014 United Nations Population Fund (UNFPA) report listed Kwale as one of the counties with the highest number of maternal deaths — at number 15 in Kenya— highlighting, among other factors, the negative impact of home deliveries as well as poor access to health services.

The county also has a HIV prevalence rate of 5.9 per cent, the same as the national average, according to the 2016 Kenya HIV County Profiles report, a situation that contributes not only to maternal deaths but also to newborn and child deaths.

The county had 1,067.8 incidents of new HIV infection among people aged 15 years and above.

In addition, Kwale is among the counties in Kenya “where income, education, sanitation, water, housing and lighting inequalities are evident,” according to the Kenya National Bureau of Statistics (KNBS) and the Society for International Development (SID) report published in 2013.

The report indicates that home deliveries, HIV/Aids, lack of health facilities, traditions, poverty, illiteracy, and lack of sanitation are some of the leading causes of high maternal, newborn and child deaths in the Coastal County.

However, slowly the situation is changing, thanks to introduction of health facilities and public education covering maternal, newborn and child health.

Until 2013, 69-year-old Fatuma Hasani Mwaruwa, a resident of Magaoni, Msambweni Sub-County, used to help women to deliver at home.
After delivering mothers, she gives them herbs or use some traditional methods to stop bleeding and other types of complications.

Notable, however, is the fact that she cannot remember the number of women who lost lives during or after delivery.

Some of the most common complications were miscarriage, high blood pressure, high blood sugar, premature delivery, and pre-term labour.

“After delivery, I would treat the mothers using herbs. There were so many challenges and some of them would die in the process,” she said in an interview.

The previously traditional birth attendant (TBA) at Majikuko Village has, however, changed roles and is now among 212 trained community health volunteers (CHVs) in 32 villages offering support health services.

The County Government of Kwale and the Base Titanium, a mining company, facilitated the training.

Like others, Ms Mwaruwa is a safe-delivery ambassador in Magaoni. “I refer them to health centres because I now understand the importance of delivering in a health facility,” she said.

Unsafe deliveries were common in the area before 2013, said Mr Makoti Mwazuka Zuka, a public community health officer.

A UNFPA 2014 report indicated that 203 women died at childbirth in Kwale in a period of one year.

But, since the inception of the community health volunteers, he said there have been zero home deliveries in Magaoni.

This is the case in Mivumoni, Kibuyuni, Bwiti, where the community health programme was introduced.

According to Magaoni Community Health Centre administrator Bakari Ali Kikoi, one of the reasons women would deliver at home was shortage of and accessibility to health facilities.

Initially, there were no medical personnel and facilities were few, a situation that increased maternal, newborn and child mortality rates, he said.

“There were many home deliveries, especially because residents could not access health facilities easily. This is in addition to the fact that transport was a challenge. But, that has changed because we not only have a health facility and doctors, mothers are now enlightened,” he said.

Magaoni Community Health Centre was built in 2014 by Kwale government in a Private-Public Partnership (PPP) approach.

An average of 10 mothers deliver at the centre every month, with zero home deliveries, Mr Kikoi said.

Previously, expectant women would start clinics late, probably in their last trimester, making it difficult to help them and or their babies in case of conditions like anemia, HIV or malaria, he said.

“After the training and construction of the health centre, we started collaborating with health officers to address the issue of home deliveries,” said Nafuu Kassim Mzungu, another community health volunteer.

READ: Kenya struggles to tame rising cases of newborn deaths

In addition to referring expectant mothers to health facilities, CHVs follow them in the villages to ensure that HIV-positive mothers do not default on their treatment and newborns are fully immunised.

According to Ms Mzungu, mothers were not keen on immunisation. “They used to take them for three immunisations and forget other vaccines,” she said.

In 2012, the number of children (12–23 months) who were fully immunised in Kwale was 77.55 per cent while in 2015, the percentage jumped to 82.04 against a national coverage of 67.5 per cent, according to the Ministry of Health.

Unicef, however, says “many children, women and the elderly continue to be vulnerable.  This is most evident in the rural areas where a combination of poverty, poor access to safe and clean drinking water and lack of adequate sanitation results in deaths from preventable diseases.”

According to the Kwale County Government Ministry of Health, “the five most common diseases within the county are malaria, diarrhoea, flu, respiratory diseases and stomachache.” Their prevalence rate is 37.7, 4.6, 16.4, 5, and 3.1 per cent in that order and contribute highly to the illness in the county which stands at 22.5 per cent.

It is unfortunate that the most common cause of sickness in Kwale County is preventable according to the above statistics. Except malaria, the highest percentage cause of illness results from lack of hygiene, that is diarrhoea.

Unicef adds: “Diarrhoea is a leading killer of children, accounting for nine per cent of all deaths among children under age of five years worldwide in 2015.”

Open defection is common in Kwale, making diarrhoea common among children. Before the community health programme was introduced, many homesteads lacked latrines.

READ: Antenatal clinic visits determine infant survival

But, upon introduction of the Community Led Total Sanitation (CLTS) programme, helping to reduce child mortality.

In Magaoni, for example, there were only 270 homesteads out the 945 in which had latrines in 2013. Today, the number has risen to 529 households, said Mwazuka Zuka.

Every week, the volunteers lead community members in constructing at least three pit latrines, said James Karisa, the chairman of the Magaoni community health unit.

“Less than 10 villages in Kwale County have been declared ODF (open defection free) while around 50 are waiting for certification,” said Christine Mwaka, the officer in charge of the Base Titanium Community Health Programme.

Every homestead in Nguzo B has a simple pit latrine, made of twigs and coconut leaves, with covers and hand washing kit. The village will soon be awarded an ODF certificate, the local leaders say.

“There was a cholera outbreak in the neighbouring village in 2016 but it did not affect us. We are focused on achieving sanitation goals through the local administration and the volunteers,” said Mr Dena.

The most interesting aspect of the CLTS programme is the ‘tippy-tap’, a simple hand-washing facility made of a jerrican, (two, three or five litres) hoisted on a wooden frame and connected to a stick placed on the ground with a string. All schools covered by the programme have this kind of a facility.

“If there is no soap, we have taught them to use ash to disinfect their hands,” said Mr Mwabakari.

And as they celebrate their achievements, MOH included CHVs in its policy document, recognising them as heart of health facilities work force.