1. BACKGROUND INFORMATION:
The health of women and children is vital to creating a healthy world. Despite great progress, there are still too many mothers and children dying-mostly from causes that could have been prevented. Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. 99% of these deaths occur in developing countries.
Newborn, or neonatal, deaths account for 40% of all deaths among children under five. Pneumonia kills an estimated 1.1 million children under the age of five years every year, more than AIDS, malaria and tuberculosis combined. Each year diarrhea kills around 760,000 children under five.
1.1 CHILD AND MATERNAL HEALTH IN UGANDA:
Approximately 300 neonates and infants and 20 mothers die from preventable causes in Uganda every day. Most of these deaths occur during delivery and within the first month of life. These deaths are mainly caused by complications to the mother and child in Labour and during delivery, and in association with infectious diseases of poverty including malaria, pneumonia, sepsis and HIV/AIDS. These statistics have remained almost the same over the past 10 years, while the Ugandan government (like others in low-income countries) is grappling with low human resources for health, lack of medicines, equipment and diagnostics, weak governance, and limited funding for health. According to the study done by Maxencia Nabiryo and Lenore Manderson (2017) in Uganda, maternal mortality is mainly attributed to the "three delays": delay in making the decision to seek care; delay in reaching a health facility in time; and delay in receiving adequate treatment. The first delay is attributed to the failure of the mother, her family, or the community to recognize a life-threatening condition; in this context, lack of awareness of pregnancy-related health risks is a major reason for the low uptake of maternal health services. The second delay is associated with delays in reaching a health center due to road conditions, lack of or cost of transportation, or location of the facility. Over 40% of rural women in Uganda report distance-related barriers to accessing healthcare. The third delay occurs at the facility where, upon arrival, women receive inadequate care or ineffective treatment because most health facilities in Uganda, especially in rural areas, persistently lack the necessary medicines and equipment to care for mothers during pregnancy and at the time of and after delivery. The three delays' model reveals the complexity of maternal health challenges. To tackle these issues, there is need for multi-disciplinary and inclusive approaches that engage various stakeholders, including community members in solving these problems. Therefore, this project will focus on identification and implementation of community-based solutions for child and maternal health in Rotary District 9213.5 In addition, UNICEF posits that child mortality distribution in Uganda is highest in Karamoja, Southwest, West Nile and western regions. Rural areas are significantly higher than in urban areas, although even in urban areas rates are comparatively high. There are also substantial regional differences in under-five mortality, with significantly higher rates having been reported from the North (West Nile and North) and the South West.
Although UNICEF confirms that Uganda has over the years recorded steady decline in infant and under-five mortality, no real progress is observed in reducing neonatal and maternal deaths. The quality, coverage and uptake of maternal and child health care services are inadequate especially in rural areas and under-developed parts of the country. In the light of the above, the project will focus on promoting Maternal and Child Health.
1.2 Goal: The overall goal of the project is to promote Maternal and Child Health in 3 Sub Counties of Butayunja, Kasambya and Mpenja in Mityana, Mubende and Gomba civil districts.
1.3 The specific objectives of the project include;
i) To reduce maternal and under five mortality.
ii) To increase food security by 50% among HIV positive mothers and their families in the target area.
iii) To improve on the financial health of HIV positive mothers and their families in the target area.
Proposed Project Activities
A. Reduction of maternal and under five mortality
1. Control of Malaria. (being the commonest cause of under five mortality)
a) Creating awareness/ Sensitization. Specifically about the mode of transmission of malaria and how to prevent mosquito bites at home, recognizing the common signs and symptoms of malaria and encourage good practice of seeking early medical care. This will mainly be achieved through scheduled village sensitization meetings/gatherings
b) Distribution of long lasting insecticide treated mosquito nets (LLITNs), which we intend to distribute to approximately 1000 homesteads, with each home receiving four nets. These are known to be very effective against preventing mosquito bites.
c) Working with the already existing VHTs (Village Health Teams) through empowering them to continue malaria control programs as supported by different partners through facilitation of their movements and providing logistics such as, malaria rapid diagnostic test kits (MRDTs), carrier bags, reflector jackets. They will also be provided with the first line antimalarial drug, coartem to administer to those who are found positive.
2. HIV prevention and control
a) Elimination of Mother to child Transmission of HIV/AIDS by working in partnership with already existing programs of EMTCT such as;
• Primary prevention of HIV infection among women of reproductive age, through door to door testing of all pregnant mothers in our catchment areas and referral of the positive ones to health facilities where they can receive comprehensive care.
• Prevention of unwanted pregnancies among HIV infected women by increasing access to family planning services through linkage of women of child bearing age to facilities offering free family planning services, thereby reducing the unmet need for family planning by use of voucher tracking system aimed at reducing loss to follow up.
• Elimination of HIV transmission from HIV infected mothers to their unborn children
• Offering comprehensive HIV care to infected mothers and their family members still through linkage to health facilities offering the service.
Encouraging mothers to attend antenatal as early as possible is key in successfully achieving all the above and so our focus/key message in health education talks will be to encouraging these mothers to attend the recommended eight visits or at least make the minimum four visits per pregnancy, while also encouraging male involvement in MCH activities since they are the decision makers. This will also help in early detection of other pregnancy related complications that may turn out to be fatal to either the mother or her unborn child, hence reducing maternal and neonatal morbidity and mortality.
3. Nutrition and Food security assessment among families in the target area to identify the malnourished children (house to house visits).
a) Training mothers with malnourished children on how to prepare high energy foods using locally available commodities at home, such as cow's milk, cooking oil, sugar, soya milk and so on.
b) Linkage of severe cases to accessible health facilities for facility based management.
c) Conduct trainings/sensitization on improved farming methods i.e. sustainable agricultural practices (SAPs) like compost manure, mulching, water preservation methods, proper spacing and selection of planting materials.
d) Organize exchange visits/exposure tours between lead farmers and successful adopters.
e) Procure and distribute good varieties of high yield crop seedlings to neediest and HIV positive families. These will include 50,000 Banana suckers, 3, 000 bags of cassava cuttings, 3, 000 bags of yellow potato vines rich in vitamins, 15, 000 kilograms of beans and 3, 000 vegetable seedlings. These will be planted by the beneficiaries to help improve on their nutrition and food security.
They will also be able to have a balanced diet which is very much needed to boost their body immunity and CD4 count. Having received a variety of improved farm inputs they will be able to enlarge on their acreages and they can plant more for selling. Hence improving their financial status. This will give them hope in life, work hard and promote a positive attitude towards their life status. Hence positive living.
4. Improving on the financial health of the families living with HIV have access to income generating activities.
1, 000 families of PLHV will be clustered in 3 groups. One of the group will rare improved breeds of goats, others will rare pigs and the last cluster will be involved in poultry keeping. Improved goats will be procured and handed over to the first group. These will look after these goats and will keep on passing a kittens to all members in that group.
For the second group, Piglets will be procured and given to the members in the group. They will also pass on 2 piglets to each of the members in the group.
For the last group each member will receive 50 kroiler chicks and they will be assisted by the project with the feeds for 3 months. The kroilers received will be for commercial purposes as well as providing eggs for diet improvement. The members will be trained and equipped with more knowledge of keeping these animals.
They will also be trained in Village saving and lending. They will be trained in group marketing and this will help them get incomes from those income generating activities.
Improved life among the families of PLHV will therefore be enhanced through having access to food security and eating balanced diet. They will get access to finances and this will help in meeting their basic needs at home and caring for the people in their households.