HCU's Impact



Healthy Child Uganda's Impact

Healthy Child Uganda reaches approximately 15,000 Uganda Children under five annually.  Culmulatively we have reached over 25,000 children since project inception.  In addition, familiy members of under fives also benefit from health education and referrals.    In fact, whole villages where HCU works benefit from community initiatives such as micro projects and community action planning.  HCU estimates that 95,500 people live in HCU communities.

Healthy Child Uganda tracks and monitors at risk children up to 18 years of age who are chronically ill, disabled, orphaned, malnourished, neglected or abused.  Often all that is needed to help a disabled child is funding for transportation to a hospital where a much needed operation can be had for free.  Some times malnourished children just need a few months of food support until the next crop is ready.  This is where Healthy Child Uganda comes in and helps through its 'Special Child Program'.  Currently over 300 children are currently registered with the program. 

Healthy Child Uganda has:

  • Trained more than 140 health workers on topics such as Integrated Management of Childhood Illnesses (IMCI)
  • Trained more than 30 trainers to train and support CORPs
  • Supported 86 students in mandatory community placements as part of their educational training
  • Sent 33 students on elective multi-disciplinary community placements
  • Trained 60 faculty on research methods
  • Trained over 220 students on IMCI
  • Maintained CORP retention of over 95% 
  • 352 Active CORPs in 174villages in 18 parishes
  • Won Second Place Award in I@MAK, a National Innovation Award from Makerere University, Kampala (2006)
  • Selected to Host 65 international and national visitors as part of the Towards Unity For Health Post Conference Excursion (2007)
  • Won First Place Award in Outreach and Community Relations from The Association of Commonwealth Universities (2007), presented in Durban, South Africa, July 2008
  • Won Second Place Award in the National  'Best Practice' awards from The Civil Society Capacity Building Programme of Uganda (2008)

CORPs have:

  • Assessed more than 18,600 children
  • Referred more than 10,300 Children to health centres for care
  • Done more than 41,400 Health Talks
  • Done more than 66,100 Home Visits
  • Registered and Monitored more than 25,000 Children
  • Distributed more than 12,000 bed nets


Measuring Impact Through Research

In April 2006, a team of researchers and trained research assistants from Mbarara University of Science and Technology (MUST) surveyed 39 communities in Rugazi, Bwizibwera, and Kinoni Health Sub-Districts.  This was done to determine child health needs to plan future activities of Healthy Child Uganda (HCU). The objectives of HCU are to promote the health of children under 5 years of age and to decrease childhood mortality. Baseline data will also help HCU measure the impact of the project as this data will be compared with an end-line survey to be conducted in 2010. 


Child being weighed during the baseline survey


Summary of key quantitative findings: 

 INDICATOR DENOMINATOR %
Percentage of children age 0–23 months who are underweight (-2 SD from the median weight-for-age, according to the WHO/NCHS reference population) 116522
Percentage of mothers who report using ORS packets or home-made ORS to treat last episode of child’s diarrhea  47511
Percentage of mothers whose last delivery occurred at a health centre or hospital 112328
Percentage of children under 6 months old who received breast milk during the past 24 hours 25398
Percentage of children aged 18-23 months who are still breastfed24358
Percentage of mothers who report current use of a method of family planning 112322
Percentage of mothers who would choose the government health centre or hospital as their first choice for care if their child was sick 112134
Percentage of children age 12-23 months who received vitamin A within the past 12 months 52333
Percentage of children age 18-23 months who received deworming medicine within the past 12 months 24315
Percentage of children age 0–23 months whose births were attended by skilled health personnel 112330
Percentage of children age 0-23 months with a child health card (seen by interviewer) 118753
Percentage of children taken for weighing/immunization within the first week (7d) after birth 112336
Percentage of mothers who attended antenatal care 4 or more times during their last pregnancy 112339
Percentage of mothers with children age 0–23 months who received at least two tetanus toxoid injections before the birth of their youngest child 112351
Percentage of children age 6–9 months who received breast milk and complementary foods during the last 24 hours 19471
Percentage of children age 12–23 months who are fully vaccinated before the first birthday (as documented on a child health card) 52328
Percentage of children age 12–23 months who received a measles vaccine by maternal report 52360
Percentage of households where a mosquito net was seen hanging112314
Percentage of children age 0–23 months who slept under a mosquito net  the previous night  11234 

METHODS 

1. Household survey of 1123 homes using a standardized questionnaire of mothers living with their children under five years of age.  Data was collected on child health knowledge of mothers, common household practices related to health, access to health care, recent child illness and child deaths in the family. Children were also weighed to determine malnutrition rates. 

2.  Qualitative surveys with focus groups of mother and fathers and interviews of community leaders, health workers and traditional health practitioners helped identify priority areas of concern and strengths related to child health.3. An audit of the resources, staffing and child health needs of 14 levels II, III and IV health centres in the HCU communities. 


RESULTS (Key Findings) 


General: 

  • Most mothers give birth outside of health facilities (72%);
  • Sickness by recall in the last 2 weeks was very common- for example 43% of children had diarrhoea
  • 22% of infants weighed were underweight
  • Only 60% of children under 1 year of age had been vaccinated against measles.
  • Most child deaths (62%) occur at home. Over 25% of households had at least one previous child death.
  • Causes of mortality were Malaria (36%) and newborn complications (25%)
  • Resources in healthcare facilities are limited and may be difficult for families to access due to distance and cost of travel.
 
Malaria
  • Percentage of child deaths where most likely cause was fever/malaria: 36%
  • Percentage of children reported to have been ill with ‘fever/malaria’ within the past two weeks: 29%
  • Percentage of households where a mosquito net was seen hanging: 14%
  • Percentage of children age 0–23 months who slept under a mosquito net  the previous night: 1%
 



Newborn Health 

  • Percentage of child deaths which occurred in the first month of life: 21%
  • Percentage of mothers who attended antenatal care 4 or more times during their last pregnancy: 39%
  • Percentage of children taken for weighing/immunization within the first week (7d) after birth: 36%
  • Percentage of children age 0–23 months whose births were attended by skilled health personnel: 30%
  • Percentage of mothers whose last delivery occurred at a health centre or hospital: 28%
 
Safe Water Access/Sanitation/Diarrhea 

  • Percentage of children reportedly ill with diarrhea within the past two weeks: 39%
  • Percentage of mothers who report using Oral Rehydration Salts (ORS) packets or home-made ORS to treat last episode of child’s diarrhea was 11%
  • Percentage of children age 18-23 months who received deworming medicine within the past 12 months: 15%
  • Length of time to water source was 30 minutes (median)


Malnutrition 

  • Percentage of children age 0–23 months who are underweight (-2 Standard Deviation (SD) from the median weight-for-age, according to the WHO/National Center for Health Statistics (NCHS) reference population): 22%
  • Percentage of children age 0-23 months with a child health card (seen by interviewer):53%
  • Percentage of children taken for weighing/immunization within the first week (7d) after birth: 36%

 

Access to Health Care 

  • Percentage of mothers whose last delivery occurred at a health centre or hospital: 28%
  • Percentage of mothers who would choose the government health centre or hospital as their first choice for care if their child was sick: 34%

Poverty 

This was a common theme in the qualitative survey. Focus groups identified lack of financial resources as a major contributor to their inability to access health care for their children.

CONCLUSIONS & RECOMMENDATIONS 

Healthy Child Uganda is one small team amongst the numerous teams working to improve child health in South western Uganda. We would like to partner with all of you to MAKE THINGS HAPPEN. We hope that all of us together will be able to improve the lives of our youngest and most important citizens. This survey has allowed us to understand what communities identify as their biggest challenges for health of young children in south western Uganda.  HCU will use the six major challenges identified here as a focus for future programming and interventions: malaria, water scarcity/diarrhea, malnutrition/food security, Antenatal Care (ANC)/newborn health, poverty, and health system access.   

Malaria 

Fever/Malaria is the biggest killer of children under five in this region.  Few homes have bed nets and, of those that do, it is usually a parent who sleeps under the net rather than the youngest child.  Malaria also accounts for a very high burden of illness. 

Plan of HCU
  • Partner with organization that provides bed nets to children under five and pregnant mothers.  Distribute bed nets and education regarding bed net use and Malaria prevention. 
  • Emphasize importance of the child/pregnant mother sleeping under the net.
  • Encourage community members to prioritize net purchase in order to have more than one net per home.
    For model home competitions emphasize reducing bushy areas and stagnant water and importance of bed nets.
  • Malaria focused education using puppets, health talks, school talks, health talks.
  • Community Owned Resource Persons (CORP)s teach parents about danger signs, not delaying care and importance of seeking medical (versus traditional) treatment for Malaria 

Newborn Health 

Complications in the first month of life result in the second biggest killer of children.  Unless we target interventions aimed at newborn health and antenatal care, the rates of child mortality can not be reduced.  Most children are born at home without a trained attendant and are not always seen at the health centre promptly after birth. Plan of HCU.
  • ANC training for Health workers and refresher for CORPs
  • ANC course for MUST Masters students, mentoring MUST faculty on ANC   



Safe Water Access/Sanitation/Diarrhea 

Clean and accessible water is a big issue.  Most people have to walk long distances to collect water and often that water is not clean.  Unclean water and poor sanitation causes diarrhea and other illnesses.  Diarrhea is the largest burden of illness amongst children under five. Plan of HCU
  • Train project members on use and building of bio sand filters, implement pilot bio sand project in selected communities.  If successful, expand.
  • Emphasize good latrine design in model homes comp,
  • Focus on deworming at Child health days
  • Focus on latrine problems in Rugazi, develop model latrine
  • Explore partners and options for water supply.
  • Emphasize importance of clean water through model homes and explore cheap alternatives for clean water.

Malnutrition 

Despite being a fertile farming area, malnutrition is still common in this part of south western Uganda.  Education is needed regarding good weaning habits, methods of feeding small children and the types of food to be grown.  Malnutrition exacerbates other illnesses and has many severe complications including learning and developmental delays.  

Plan of HCU 
  • Special growth monitoring days/outreach in high risk communities,
  • Provide wall growth charts made of locally available materials to all health centres in project areas
  • Provide weighing scales to health centres
  • Encourage CORPS to maintain model gardens by CORPs and provide education, about weaning foods
  • Develop Malnutrition guidelines for field staff to reference for advice on breastfeeding, types of foods, weaning, alternatives when breast milk is unavailable etc…
  • Require present children to be weighed and have Child Health Cards (provide them) before parent receives bed net. 

Access to Health Care 

Many people are unable or unwilling to access health intervention due to issues such as lack of transportation and lack of trust in health care providers.    

Plan of HCU

  • Health centre competitions
  • Involve health care workers in project
  • Involve Health Centre IIs and IIIs in teaching and use CORPs to link with Health Centres
  • Work closely with District to target Health Centre areas of need
  • Paint colourful paintings in health centres in order to create more child friendly spaces
  • Explore community transportation plans and health worker community outreach plans including use of bicycles.  Link to other organizations already targeting transport issues

Poverty 

Poverty in rural south western Uganda is pervasive and affects all aspects of child health.  Child health interventions can not be created without considering poverty alleviation. 

Plan of HCU
  • Build internal capacity to manage community development component.
  • Add community development program to project.
  • Build capacity of groups undertaking Income generating projects
  • Implement and monitor a community action planning process
  • Community training related to income generating projects
Help create linkages between community groups and micro-finance organizations, cooperatives, government bodies and small business support service provider

 
For an electronic copy of the full Baseline Survey Report please email HCU@ucalgary.ca