Kenya: Special Pass Saving Mothers and Babies in Kitui

Every time Esther Kavoi looks at her nine-month-old baby, she remembers the night of her birth.

Blessing Chelangat was born on April 19, 2020 at Kanziko Health Centre in Kitui South at the height of the Covid-19 pandemic.

“I went into labour at around 11pm. I called a community health volunteer (CHV), who sent a motorbike to take me to the hospital,” says the 21-year-old.

When she called the CHV a night curfew was in place as a measure to control the spread of Covid-19. “But I was comforted by a small slip of paper I got from hospital during my final antenatal care visit,” she adds, referring to the special curfew pass.

The motorbike arrived and amidst labour pains, Esther set off, in the darkness, to the hospital about an hour away. Just before they got to the hospital, they were stopped by policemen on patrol at Kanziko market.

“I gave them my curfew pass and explained I was going to the hospital to deliver. They not only let me pass but they escorted us to the hospital,” she recalls.

The curfew pass – a local solution to a local problem at a time of a pandemic – came in handy for Esther.

Stay in fear

The pass allows expectant women and anyone escorting them to travel outside curfew hours.

It was developed by Catholic Medical Mission Board (CMMB), a local NGO, working with the Kitui South Security Council.

According to Jesse Kihuha, the project lead for CMMB’s programmes in South Eastern Kenya, the curfew pass helped more women give birth in hospital. Without it, women opted to stay at home for fear of being fined for breaking curfew.

“Delivering at home poses a risk of complications that arise from such delays including deliveries without skilled birth attendants,” he tells HealthyNation.

“We sensitised law enforcement officers on the need to support mothers going to deliver at night or taking a child to hospital.”

Sylvester Ngei, the in-charge at Kanziko Health Centre, says he issued the pass to 60 mothers between March 2020 and January this year.

“Due to this, the health centre has seen an increase in hospital births,” says the clinical officer.

The number of pregnant women going to hospitals declined at the beginning of the pandemic.

“This decline may be attributable to restricted access to health facilities arising from city lockdowns and curfews imposed by the government, where pregnant women and their companions fear harassment and arrest by the police,” says Rachael Kimani in a report published in the BMC, an open access publishing website.

CHVs have played a key role in increasing hospital births. “Mothers would have had to trek long distances in the scorching sun to get to a health facility. This journey on foot or on a motorbike at a cost of Sh300 one-way is tough for such women and their families,” says Ngei.

While they give services for free, CHVs get a stipend and morale boosters. For instance, in Kitui South sub-county, all CHVs have bicycles which they use to traverse the expansive area.

CMMB Director for Kenya, Dr James Kisia, says CHVs disseminated correct information about the pandemic and ways to prevent infection.

“They distributed masks to the most vulnerable community members who had pre-existing medical conditions, and pregnant women visiting antenatal clinics. They referred patients from largely isolated and far areas in Kitui South to Ikutha and Mutomo hospitals,” says Dr Kisia.

According to Kihuha, CHVs are crucial because they understand their communities’ needs and opportunities to address health issues and challenges.

Free masks

About 350 CHVs were trained. These went door to door sensitizing the community on Covid-19.

“Gradually, the numbers of those attending clinics started going up,” says Ms Beatrice Mwanthi, a public health officer at the Kitui Sub-County Hospital.

Free masks also made it easier for the women to go to hospital.

Alice Muli is a tailor known in Mutomo Market for making school. But, she is now known as Alice, the one who makes masks.

Through the CMMB programme, she produced 5,000 masks for expectant mothers, among them Esther.

Initially, mothers would skip antenatal clinics for fear of getting contracting the coronavirus and they could also not afford the masks.

“In the first month, we saw a drop in immunisation and access to other health services. We quickly brought the CHVs on board to help bridge the gap,” said Ms Mwanthi.

Reproductive, maternal and child health indicators in Kitui improved despite the pandemic.

According to data from Kitui South Sub-County, the number of pregnant women who attended at least one antenatal care clinic during the pandemic were 115, an improvement from 68 in 2019.

The number of mothers who attended the fourth antenatal care clinic in the sub-county improved from 34.4 per cent in 2019 to 52.4 per cent in 2020.

Also, the number of children under one year who were vaccinated against measles and rubella were 77 compared to 66 in 2019.

According to the Kenya Health Indicator Survey, the percentage of children who were fully immunised in Kitui was 74.6 per cent, while nationally it was 79.9 per cent.

Also, the measures put in place to control the spread of Covid-19 improved maternal and newborn indicators in the sub-county.

Handwashing and sanitising has resulted in a drastic reduction of diarrhoea cases in children and subsequently deaths, says Ms Mwanthi.

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