New natal health facility and Care

1. Community Perspective on Newborn
Health in Bungoma County
Alice Natecho - Fountain Africa Trust
Dissemination Seminar – 30th April 2019

2. Outline of Presentation
• Project site and newborn status
• Methodology
• Key findings
• Intervention programs
• Project outcomes
• Challenges

3. Project Site and Newborn Status
Site - Bungoma County Map Newborn status (KDHS 2014)
• Neonatal mortality in
Bungoma - 32 per 1000 live
births (vs national average
of 22 per 1000 live births).
• Only 2 facilities in Bungoma
offered differentiated
neonatal services - systemic
barriers.
• About 50% of mothers
deliver at home. Incoherent
community referral system.

4. Methodology
• To understand community perspectives on newborn
health, the project interviewed mothers at household
level and key informants in health system.
• Both qualitative and quantitative data collection
tools were used.
• Approval from MKU Ethical Review Committee, and
concurrence of Bungoma County government.
Data collection tool Sample size
Provider-client observation tool 353
Health providers interview 104
Household questionnaire 317
KII with policy makers and health
managers
20

5. Key Findings - Household Survey
• Education: Highest proportion of mothers are
primary school level (54%), and 37% did not own a
mobile phone.
• CHV coverage: 43% of women are not reached by a
CHV.
• ANC attendance: 99% indicated having attended
ANC at least once.
• Danger signs-mothers: Only 2.3% of women
recognized malaria as danger sign in pregnancy;
blurred vision and swelling of hands and face 9.0%;
and those who did not know any danger sign were
11.3%.

6. Key Findings (2) - Baseline
• Place of delivery: Facility Delivery (57%), At home
(18%), with TBA (7%).
• Danger signs-newborns: Low knowledge of
danger signs in newborns, only 12.3% mentioned fast
breathing; 3.5% mentioned severe chest in-drawing,
and 1.3% mentioned severe umbilical infection.
• Birth preparedness: Only 39% of the mothers had
prepared in case of an emergency during pregnancy,
delivery and after delivery (Finance 91%, Transport 32%,
Facility 26%, Clothes 2%)

7. Key Findings (3) - Baseline
Negative Practices in care of newborn:
• Poor cord care: Mothers often apply mud (15%);
powder (26%); animal droppings (8%); and spirit (5.2%)
to ‘hasten cord stump healing’.
• Mixed feeding: 95.1% feed infants on breast milk. In
addition, mothers also give 21.1% water, 28.9% cow milk,
and 22.1% porridge to babies within 3 days of life.
• Baby clothes: Only 34.2% of mothers buy baby clothes
before delivery, 65.8% do not. Most mothers (84.2%)
cover newborns in a lesso or old clothes (28.7%).
• Traditional care practices: Wash baby with cold
water (9%); wash baby with herbs (17%).

8. Negative Practices
• First born twins are killed by family
• Delays in breastfeeding after delivery
• Teenage mothers and neonates at high risk (over
20%) (Mt. Elgon, Bumula, Kimilili)
• Poor male involvement in new born care
• Fear of going to Health facility

9. Key Findings (4) - Baseline
• Source of newborn info: Most significant sources of
info on newborn health were:
• nurses (37%);
• CHVs (36%); and radio (23%).
• Most believable source of info: Mothers identified
the following as most believable source of information on
newborn health:
• Nurses (60%);
• CHVs (32%);
• Doctors (26%).

10. Intervention programs
Community mobilization strategy to address identified
cultural barriers, myths and misconceptions, poor
health seeking behaviour:
• Call Centre for real-time counseling of mothers,
individualized education and consultation with
health provider on phone, and follow-up on infants,
etc.
• Meetings with Chiefs and community leaders
• Radio program

11. Project Outcomes
• Over 10,000 mothers followed-up through the
call centre
• New born admissions in Bungoma County
increased by 40%
Challenges
Industrial action disrupted project implementation
Newborn deaths during the strikes high

12. Respondents’ Place of Most Recent Delivery
0
10
20
30
40
50
60
70
%numberofResponents
Place of Birth
Baseline
Current

13. Way Forward
• New born care education is still needed –
behaviour takes time to change
• Young mothers below 18 years
• Male involvement is an opportunity to use
• Birth Preparedness still low
• Call Centre an innovation that the county could
consider keeping alive by all means
• Male breastfeeding should be investigated further