Every pregnancy is unique and needs utmost antenatal care, but most second or third time mothers usually ignore this fact.
They seem to believe in the old myth that the first pregnancy is the best experience. Some delay antenatal visits while others would choose to go in the last two months, which threatens the life of the unborn baby as the mother misses on out onTetanus immunization (TTV) and other medications such as iron supplements and anti-malaria drugs taken earlier in the pregnancy. This is on top of the Blood Pressure and routine pregnancy checks that a woman undergoes on their pregnancy journey.
The advent of the coronavirus (COVID-19) pandemic has contributed to this complication as women have taken the disease as an excuse for not attending antenatal clinics and for skipping their children’s routine immunisation schedules for fear of contracting the virus from the facilities.
Considering the role that community elders could play in improving maternal and child health, Malawi Health Equity Network's (MHEN), CSO platform is implementing the Health Systems in Immunization Strengthening (HSIS) Project with financial support from GAVI the Vaccine Alliance, through Ministry of Health (MoH). Though this project, the organisation groomed community women, known as Mother Care Groups to coordinate child immunisation attendances and antenatal clinics. They have also been following up children who have missed their vaccine, to have them vaccinated.
The mother care groups have been key in urging the ‘relaxed’ expectant women to attending antenatal clinics as per Ministry of Health requirement. They have also been working in liaison with Health Surveillance Assistants (HSAs).
The Mother Care Groups have sensitised comunitities on the importance of routine immunisation and antenatal care even amid the COVID-19 pandemic. MHEN has 169 voluntary Mother Care Groups in all nine GAVI priority districts of Blantyre, Lilongwe, Mchinji, Dowa, Ntchisi, Kasungu, Mzimba south, Mzimba North and Chitipa.
Blantyre District Health Office Health Promotion Officer, Chrissy Banda confirms that some mothers have not been immunising their children for fear that they may contract COVID-19, a thing which is bringing fears of occurrence of other pandemics later on.
“If other children are not getting vaccinated, there is a possibility of other outbreaks as different antigens are given to prevent different types of ailments for example Polio, Measles, Pneumonia among others.
“We still want these mothers to bring their under five children for immunisation. We don’t want to come out of COVID 19 and get into other pandemics because children aren’t being immunised. Children should still be immunised amid the pandemic,” she tells.
According to MoH in year 2020, (January to December) there was a one percent routine immunisation drop. The drop was first experienced in the month of April 2020 when the country had the first case of COVID-19. This called for community HSAs and other community structures including Mother Care Groups to ensure that mothers continue to bring their Children for vaccinations, this worked wonders.
Chairperson for Chikondi Mother Care group (based in Chilomoni Township) Blantyre, Gertrude Msamanyada, says her group members have a good working relationship with HSAs under Chilomoni Health Centre, a thing which assists in achieving desirable results.
“We check on women’s health passports to ensure that they are going for antenatal clinics. If we follow up on expectant mothers until they give birth, it becomes easier for us to also follow up on the babies’ under five health needs,” she tells.
Msamanyada says some women deliver at private hospitals even after they have gone through their care and monitoring during pregnancy. But most of them still take their babies to Chilomoni health centre for under five care. Much as the majority of women being followed up by mother care groups are small scale business people, the mother care groups also reach out to working class mothers who have also responded positively to their routine checks and advice.
“Each member is responsible for door to door follow up on all children who have missed immunisations and have them jabbed. We meet as a grouping to share notes and find solutions to the problems encountered once a month,” says Msamanyada whose grouping has 30 members operating under Chilomoni health centre catchment area.
Mother group members in a brainstorming session. Photo courtesy of Mhen
Stella Tambala, Tikondane Mother Care Group Chairperson based in Soche, Blantyre (Southern Malawi) says the immunisation of children has been a challenge amid the COVID-19 pandemic.
“Some women were already hard to have their children immunised. They had all sorts of excuses including; poverty and religious belief restrictions while others just embracing obstacles. COVID-19 just increased the number of defaulters,” she says.
Tambala says the default rate increased in March 2021 when Malawi government launched the COVID-19 vaccine, “the women were afraid that their children will be given COVID-19 vaccine.”
Just like all Mother Care Group members, Tambala’s duty is to follow up on all children who are eligible for immunisations and identify those that have missed and link them up to two under five clinics, Khola remote clinic and Mpalika health centre the numbers at both centres were low. For instance on average, a normal under five clinic day immunizes 80 to 90 children but the figure dropped to 40 children or less in the month of March.
“After noting this, we as Mother Care Group members went door to door to engage the mothers and explain to them the difference between child immunization and Covid 19 vaccines, with an emphasis that Covid 19 is not given to children but only adults. There has been an improvement ever since,” Tambala explains, adding that the same clinic hesitancy has been among expectant women.
Chilomoni Health Centre HSA, Selina Zomba-zomba says there is an improvement in the under-five immunization coverage owing to Mother Care Group assistance.
“Normally, turn up varies whether its mid-month or month end, with many mothers turning up during month end. But At the peak of the COVID-19 pandemic, the figures were flat low. On average, we have 50 children and during the pandemic the figures were less than 50,” she says.
Zomba-zomba adds that all COVID-19 preventive measures such as hand washing, mandatory mask wearing to all mothers attending the clinic and health care workers providing the jabs and social distancing among other measures.
She says the involvement of Mother Care group members has assisted in bringing the numbers back to the normal figures, amid the COVID-19 vaccine confusions.
“They are very good at community mobilization. They are part of the community therefore likely to have a more positive impact which we have already seen. They are reaching to places where we cannot reach as Health Care Workers,” Zomba-zomba notes.
MHEN Executive Director, George Jobe says the overall goal of the HSIS project is to contribute towards the achievement of Goal three for Sustainable Development Goals (SDGs) target that states the need to end preventable deaths of newborns and children under 5 years of age by year 2030.
“MHEN is responsible for demand promotion and community mobilization component. HSIS is a MoH project funded by GAVI but has different players including Unicef, which is responsible for procurement and logistics,” he says.
Ministry of Health spokesperson, Adrian Chikumbe admits that Mother Care groups are one of the village level groupings that have assisted in improving maternal health and child survival.
“They are very influential since they are volunteers elected by the people themselves. They have been the voice of the people and have reached to places where health care workers or the ministry could not reach out to,” he says.
Chikumbe says the ministry ensures to recognise mother care groups whenever they are having national activities for them to feel that they are part of the Malawi Health system.
Unfortunately, we have observed, the mother care group members sacrifice a lot in line of their duties. They are not on a salary but only receive allowances in areas where Non-Governmental Organization projects are operating. They lack resources to operate such as transport to aid in their duty mobility, airtime for their communication among other basic things.
But Chikumbe indicated that much as the ministry appreciates the role they are playing, it is the Mother care groupings are under Councils of particular districts they are operating in and not the MoH.