Mwanajuma Ali Magadi, a nurse in Kwale County, Kenya, created the first "Mother-Baby Pair Register" to better monitor mothers and babies from HIV transmission. The register tracks health information for both the mother and baby as a pair, such as growth, immunizations, treatment adherence, and breastfeeding. This level of integrated tracking allowed Mwanajuma to identify at-risk pairs early and provide targeted counseling. The register has since been adopted more widely in Kenya and contributes to prevention of mother-to-child HIV transmission.

1. 27th July 2016 - Circulation 009
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witchcraft contributes significantly in the transmission
of HIV. This presents a huge barrier to access and utili-
zation of PMTCT services at the facility, hence derailing
the eMTCT effort. Smartly, using the Mother-Baby pair
register that I created, beyond the national require-
ment for immunization and monitoring of HIV infection
through 18 months, I managed to introduce variables
that provide potential early warning signs for possible
infections. By knowing when weaning will start, moni-
toring growth of the baby, and by ensuring adherence
to treatment for the mother, I was able to initiate tar-
geted information provision and counseling, which
ultimately ended in the creation of a support group
where mothers enrolled at will,” narrated Mwanaju-
ma.
When a self-activated urge blazed through the passion of a
mother with the desire to reach-out-to mothers who are at
risk of transmitting HIV to their babies before, during and
after birth, the circumstance became the cradle of the moth-
er-baby pair register.
“The idea blossomed in my mind after attending train-
ing on Prevention of Mother to Child Transmission
(PMTCT). The universal drive to give prominence a
HIV free generation kept sending a ping to one part
of my mind, while the other was confronted with a
HIV Exposed Infant (HEI) register that limited the
development of adequate information and
knowledge on both mother and baby.”
According to Mwanajuma Ali Magadi, the 2012 PMTCT training
triggered the capturing and tracking babies for Polymerase
Chain Reaction (PCR) after 6 weeks through to 18 months.
However, factoring the socio-cultural issues of Kwale resi-
dents, Mwanajuma’s 14 years of service as a nurse intuitively
demanded for a closer monitoring of mothers and babies –
fulfilling part of the four-pronged strategy on elimination of
mother-to-child transmission (eMTCT), that is, preventing
transmission from a woman living with HIV to her infant, and
providing care and treatment to women living with HIV and
their children.
With three decades of practice as a nurse, using materials at
her disposal, Mwanajuma converted an old Tetanus data book
to a homemade register – this became the first ‘Mother-Baby
Pair Register’ which tracks both mother and child as pairs in
Kenya.
“I expanded my tracking to include weaning of the
baby, measles check, growth monitoring, admin-
istration of Vitamin A, and a component to help
check adherence to clinic appointments. It is im-
portant to notice that the original register did not
pair the mother and baby, which presented a precar-
ious situation that possibly led to high rates of cli-
ents lost to follow-up.”
As an innovation, the birth of ‘Mother-Baby Pair Register’
evolved through early adoption by the USAID ASSIST funded
program, after the Nursing Officer (Mwanajuma) registered
100% success rate in reaching both mother and child on each
appointment and address emerging issues at each millage
through the integrated approach of having the pair visit clinic
on same day.
“At a national level, Kwale is equally hard hit by HIV.
Culturally, residents of the sub-County have a belief
Saving Mothers and Babies in Kenya: Meet the Innovative
Woman Behind the First Mother-Baby Pair Register
Photo shows original register and printed one, currently being piloted in Kenya - USAID
ASSIST takes pride in transforming Mwanajuma’s innovation to reality. Photo by: B. Okaka.

2. The views in this publication do not necessarily reflect the opinion and position of URC, USAID, or the MoH. For queries, comments and any other form of feedback, kindly communicate directly to bokaka@urc-chs.com
Other health workers have testified to having
enjoyed and gotten fulfilled by engaging and
monitoring real-time success of paired moth-
ers and babies.
“Initially I feared increase in work load
resulting from number of registers to be
filled. However, what keeps me going is
the fact that many children are now
turning HIV negative… thanks to the
register,” said Peace Ambetsa Chitechi,
a nurse doing her third month at Waa
Dispensary.
In its very essence, Mwanajuma’s innovation
is a pillar of quality improvement; embedded
in Applying Science to Strengthen and Im-
prove Systems (ASSIST) which improves the
quality and outcomes of health care. The soft
spoken lady is basically unstoppable as a
piece of pinned paper on her wall indicates
that she is curving another path on how to
capture (data wise) babies who have not re-
ceived their 9 months Anti-Body test or PCR
done and the ones who have reached 18
months and need to get their anti-body test
in the next visit.
Today, Mwanajuma holds her original draft
register as a memoir, and the new version
being piloted by NASCOP which has material-
ized to include an additional 30 months moni-
toring of both mother and baby. Evidently,
the USAID ASSIST project is building the capacity of host country (in this case Kenya) service
delivery system to improve the effectiveness, efficiency, client-centeredness, safety, accessi-
bility, and equity of the health and family services they provide. Also, this a clear path to
institutionalization of the innovation by host country governments is promising. ##
Written by: Bill Okaka (Knowledge Management and Communi-
cation Officer) Contributors: Prisca Muange (Senior QI Advisor),
Kevin Kinyua (QI Advisor) and Linda Chebet (M&E Officer).
Above:
Admiring her mentor, Peace Ambetsa Chitechi
joins the iconic photo iconic where Mwanaju-
ma holds her original draft register.
Middle:
Mwanajuma’s notes on tracking babies who
have not received their 9 months Anti-Body
test or PCR done and the ones who have
reached 18 months and need to get their anti-
body test in the next visit.
Below:
% of HIV exposed mother- baby pairs (0-24
months) in active care* in 1 site in Waa HC-
Kwale County, January, 2014 – June, 2016