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Initiative keeps Kawangware mothers breastfeeding

By Clifford Akumu
Monday, August 30th, 2021 00:00 | 6 mins read
Janet Mukabwa, a resident of Kawangware. She has exclusively breastfed for one year and a half thanks to the baby friendly community initiative. Photo/PD/CLIFFORD AKUMU

When Janet Mukabwa, a mother of two living in Muslim area, Kawangware, gave birth to her second child, in early 2020, she made a vow to feed her daughter with only breastmilk for six months.

Until then, Mukabwa had little knowledge on the benefits of  exclusive breastfeeding. Her first born son, now seven years old, did not enjoy the fruits either.

Mukabwa, a casual labourer, who does household chores to put food on the table had been trained on breastfeeding by Community Health Volunteers (CHVs). She was also trained on how to get prepared before the baby’s arrival. With all this prerequisite training, she had little worries when she finally gave birth.

 “When I gave birth, I had no problem,” Mukabwa, a single mother opens our conversation while her one-and-a-half -year-old daughter tries to lift a jerrycan nearby.

“Many people think my daughter is over two years! Anytime, I am asked that question I just tell them, it is because of exclusive breastfeeding,” she says.

Three months after giving birth, Mukabwa went back to work. By this time, she had left her daughter with the cousin, but under instructions on the breastfeeding schedule. 

“Every time I was away at work, I could express milk and store it for my daughter. The expressed milk stays fresh for eight hours and by that time I’m always back to continue breastfeeding her,” she explains.

Always express enough breastmilk to serve the baby the whole day, she advises. The milk should not be subjected to direct boiling as this will affect the nutritional value.

“I use warm or boiled water and put the bottle of milk to get warm for the baby,” she says.

Her daughter is among the beneficiaries of the baby friendly community initiative led by the Ministry of Health that aims to promote, protect and support breast feeding and general optimal feeding among children.

In Dagoretti area, the initiative started in March 2018 at the community level in Muslim, Kanugaga and Precious villages with training of healthcare workers. 

It is one of the initiatives rolled out in several counties to promote exclusive breastfeeding during the first six months of a baby’s life. It recognises that many women deliver at home and need continued support after delivery.

The initiative’s main aim, explains Susan Kagia, Dagoretti South and North sub-county Nutrition Officer, is to equip primary healthcare workers and CHVs with skills to help mothers breastfeed and feed their infants and young children. 

It also empowers other family and community members to support breastfeeding mothers.

“Before implementation of the programme, we trained healthcare workers from Riruta Health Centre (a link facility to the three villages). It was then followed by the community healthcare volunteers and mother support groups,” says Kagia.

The second phase of the programme involved mapping of pregnant mothers, children below two years.

Mukabwa explains that even after being discharged from the hospital after giving birth, the CHVs still checked in with her to monitor her progress.

According to the World Health Organisation (WHO), exclusive breastfeeding (where the infant receives only breast milk) in the first six months is vital for child growth and survival.

 “Breast milk has adequate amounts of nutrients and water required for healthy growth as well as immune factors required for the development of the infant’s immune system,” explains Kagia. Other benefits include protection against common childhood illnesses such as diarrhoea and pneumonia, and infant death.

Studies have shown benefits in mothers too. It reduces risk of breast and ovarian cancer, improve spacing between births and reduce the risk of diabetes.

Globally, the average exclusive breastfeeding rate stands at 43 per cent, according to the WHO’s global breastfeeding scorecard, 2019. In Kenya, exclusive breastfeeding rates have increased over the years from 13 per cent in 2003 to 32 per cent in 2008 and 61 per cent in 2014, according to the Kenya Demographic and Health Survey. 

Community solutions

Women like Mukabwa were also taught how to breastfeed exclusively for six months without any food supplements, and on diet that could help them achieve high amount of milk during their lactating period.

Hellen Makungu is a CHV from Dagoretti North covering Kanugaga, Good Hope, White House areas and is part of the programme. She has been a healthcare volunteer since 2000.

 “We were required to visit mothers in their homes and provide support through community mother support groups and mother-to-mother support groups,” she explains.

Makungu says beneficiaries received standard maternal, infant and young child nutrition counselling and support from trained CHVs.

The groups consist of 10-14 pregnant, lactating women. They meet monthly to discuss issues around pregnancy and young child feeding and nutrition. A CHV and or a lead mother (who acts as the leader of the group) facilitates the meeting, notes Makungu.

“These groups help them share their experiences and challenges during pregnancy, delivery and discuss and find solutions. We teach women what to eat to get breastmilk, how to position when breastfeeding and how to plan their birth and their right on when to breastfeed,” notes Makungu. 

Each village has one mother-to-mother support group, and each gets new admissions to occupy the space left with those who have finished the first 1,000 days of their child’s life. 

Some groups have ended up starting some income generating activities such as table banking or merry go rounds to help sustain their livelihoods.

As a CHV, Makungu also follows up on people living with HIV and AIDS or Tuberculosis. Some key activities include tracking of those infected and teaching them on the importance of taking drugs and other nutrition aspects.

On some occasions, they train fathers and grandmothers on the importance of supporting a breastfeeding mother. 

“We teach fathers to help their wives with other household chores when it comes to breastfeeding time,” she says.

One of the biggest challenge for breastfeeding mothers, says Mukabwa, is lack of awareness of its impact by many employers or society in general. 

“Many people have not yet embraced the value of breastfeeding. You still find people looking at you with questionable eyes when you are breastfeeding in public, market places,” notes Mukabwa.

She calls upon the government to help breastfeeding mothers have several ‘breastfeeding zones’ to help them achieve the optimal growth for their young ones.

Shadrack Werunga, community health officer, Dagoretti North notes that government has initiated programmes where people get services at the household level.

Pregnant mothers do not miss ante natal clinics, emphasis on exclusive breastfeeding and total body hygiene.

Thanks to such programme several organisations across the country have set up breastfeeding corners for their employees.

The chief’s camp now has a breastfeeding corner that serves mothers who come to seek services at the administrative block.

“Most women CHV’s have visited have adopted exclusive breastfeeding. And those who are working are able to express milk for their babies to enjoy their breastmilk while they are away,” adds Werunga.  

Werunga says there is need to invest in primary healthcare now more than ever to tackle the challenges that still stand in the way of Kenya achieving its national target of getting 80 per cent of women to breastfeed.

“CHV’s are doing an excellent job in the communities. However, they do not have partners on board to help them realise their goals.

We are urging other partners to come on board and help the CHV’s achieve their mandate in the communities” he notes.

Covid-19 and Breastfeeding

The advent of the pandemic affected gains made on optimal nutrition across the villages.

“People lost jobs. Everybody was afraid of employing casual workers. And school feeding programmes where children used to get food were also cut short.

Many families could not stick to the schedule. They had to adjust to make ends meet,” recalls Kagia.

The pandemic also halted home visits by the CHVs.

“But after eight to nine months when we realised that this disease is here, we looked for a strategy where the CHVs could visit homes ,but not enter the house.

Have a talk with mothers in open places with good aeration and not to touch them even when showing them how to position the babies during breastfeeding,” she adds.

Another strategy was to meet mothers from the same plot in an open space in masks and with hand sanitisers as per the ministry of health protocols.

Since Covid-19 broke, there has been a lot of misinformation around breastfeeding.

WHO states that “transmission of active Covid-19 through breast milk and breastfeeding has not been detected to date. There is no reason to avoid or stop breastfeeding”. 

The global health body, however, says before breastfeeding, a mother should wash their hands for at least 20 seconds with soap and water.

In case water is unavailable, one can use a hand sanitiser with at least 60 per cent alcohol content. One should always wear a mask during any contact with the baby, including while feeding.

During this year’s World Breastfeeding week celebrations held annually in the first week of August, WHO and United Nations Children’s Fund called on the government, partners and community members to ensure that breastfeeding mothers receive Covid-19 vaccinations and are encouraged to continue breastfeeding after vaccination.

Breastfeeding counselling to all mothers and caregivers of children is still vital even during the pandemic period.

Clifford Akumu

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