Psychosocial Care and Support from the Womb through Adolescence: Lessons Learned from Kakinga Child Development Centre (KCDC), North Kigezi Diocese-Rukungiri, Uganda

Mugabe Alex Nathan PSS Forum, Victoria Falls,

Zimbabwe 1st-3rd , September 2015

Children in Uganda have had devastating effects from poverty, armed conflicts, HIV and AIDS.

It is estimated that 14% children in Uganda are orphans. Out of estimated 2.7 million orphans by 2009,1.2million were orphaned by HIV/AIDS (UDHS,2011)

Realizing the overwhelming needs of orphans and vulnerable children, Kakinga Church of Uganda started Kakinga Child Development Centre (KCDC) in 1999 to address the problem.

Lessons learnt from previous Projects revealed a need to enroll children into the Project right from the womb as opposed to previous ages (5-9 years ) of enrollment.

Some of the children who enrolled at the age of 5-9 years were in poor health, malnourished and had experienced some form of violence

Introduction

Evidence shows that 1,000 days from conception to the second birthday are very critical to a person’s growth and development (UNICEF,2013)

KCDC started a Child Survival Programme(CSP) targeting children right from the womb up to 3 years of age

CSP is funded by Compassion international and USAID

The CSP was developed to build a foundation for child development through sponsorship programme.

It was anticipated that providing PSS to a child right from the womb would enhance their growth and development and have a lasting impact on their productivity.

Introduction Cont’d

The CSP is a maternal, new-born & child health programme including integrated management of childhood illnesses.

CSP targets vulnerable women in reproductive age-group, including those who are HIV positive. Prevention of Mother to Child Transmission of HIV (PMTCT) is one of the priority areas

Expectant mothers are given nutritional support; supported to attend antenatal care, deliver in a health facility, attend postnatal care & immunize their babies fully.

They are further supported to breastfeed exclusively, start their babies on appropriate supplementary diet at a right time

Mothers meet regularly for fellowship to enhance their spiritual wellbeing

(1) Child Survival Programme (CSP)

(a) Nutrition Evidence shows that a mother’s nutrition has the greatest

impact on a child’s first 1,000 days (Regueio & Bhutta (2015)

Recognizing this and basing on lessons learnt from previous completed Projects, KCDC designed nutrition interventions targeting pregnant mothers and their children after birth

Mothers are taught the importance of a balanced diet, food preparation to preserve nutrients and preparing and maintaining kitchen gardens

These mothers are given vegetable and fruit seeds to grow in their own gardens

CSP Programme Cont’d

A mother is being taught about nutrition by CSP staff during home visit

CSP continued

CSP Programme Cont’d

CSP Care givers together with their newly born babies after a training

CSP continued

CSP Care givers together with their children

CSP continued

(b) Skills Development Care givers are trained in income generating

skills like tailoring, baking, bead making and Knitting.

This has built their capacity to earn an extra income to supplement earnings from sell of agricultural produce and provide for their children.

This has enhanced care givers ability to provide material needs for their children.

CSP Programme Cont’d

Skills development At the Project, mothers learn income generating

skills like tailoring, knitting

(C) Child socialization

The infants are started on socialization through participation in childhood games and sports organized at KCDC every Thursdays during school holidays and every Sunday

These infants are supported up to the age of three years and thereafter enrolled into child development through Sponsorship Programme.

Annet, a mother of three had this to say about a child who was supported right from the womb:

“ I have realized this child is different from my other children who did not benefit from CSP. She started walking at 10 months. She started speaking early, she seems to be very happy, she is very active and fast unlike the other children.”

Programme Cont’d

Child Growth MonitoringDuring home visits, a child’s growth is monitored.

Children who are underweight are given supplementary foods like baby Soya, olive oil, milk

and groundnuts

Children under CSP singing and praising

Enhancing the spiritual wellbeing of children is at the core of child survival programme

(d Child survival Programme (CSP) caregivers’ sessions CSP caregivers’ sessions are conducted regularly at the Project The sessions target both male and female care-givers

These sessions cover a wide range of topics including family strengthening; child protection, care and support; HIV prevention including PMTCT; harmful cultural practices like child marriages; child rights including property rights for widows & orphans and prevention of violence against children

Sensitization sessions about child growth, behavior and development, child nutrition, personal hygiene & sanitation are also conducted.

Care givers are also sensitized about maternal health

CSP cont’d

Football match for male caregiversThis has improved their ability to relate to

each other and their families. Thus, enhancing family relations for the wellbeing of

children

Success Story Amon was from a dysfunctional family when he enrolled into

the Project. The family had no latrine, kitchen, utensils rack, bathroom and Amon’s father was a drunkard. He did not support the family. After enrollment, Amon’s mother and father started attending CSP sessions for caregivers. The Project Staff visited Amon’s home regularly, supported and counseled the family. There has been a remarkable improvement in the home with attendance of child survival sessions and home visits. The family has constructed a latrine, bathroom, utensil rack and sanitation has improved. Amon used to fall sick regularly but he is now health. Amon’s father got a job as a casual laborer. He  is now working and providing for his family. Amon is now better cared for and meets his age growth milestones.

CSP Programme cont’d

This Project supports children aged three years up to when they become self-sufficient, usually during adolescence or up to the age of 22 years. Currently, 1430 children are being supported. There are several Projects under this programme:

(a) Parenting project- we train parents in psycho-social support; child protection; child growth, behaviour and development; food security through demonstration gardens; proper nutrition and food preparation

(b) Orphans and Vulnerable Children Project- Using cost sharing we top up school fees for OVC, through networking, we link OVC to other organisations like Compassion international, Private Health Sector, Joint Clinical Research Centre, The AIDS Support Organization.

(c) Economic strengthening Project- we strengthen caregivers through training in IGAs and business management skills

(2) Child Development through sponsorship programme

Support to pregnant mothers enabled them to have better pregnancies and birth outcomes.

Mothers initiated early antenatal care (ANC) attendance which is done at least four times during pregnancy, got diagnosis and treatment for infections (including PMTCT) that would have been fatal to the mother and the development of the baby, delivered from health facilities and attended postnatal care.

In turn, all the babies had normal birth weight, were fully immunized against killer diseases and those who needed ART started it on time

There are improved family relations among couples who attend CSP care givers’ sessions

Outcomes

Maternal health & wellbeing are fundamental for child wellbeing

PSS improves education outcomes of both girls and boys in-terms of retention in school, achievement & completion

PSS through early childhood education prepares children for school

Regular group meetings enhances social connectedness which is a form of social support and creates a sense of belonging. Group members have a “we feeling”

Lessons Learnt cont’d

To have a significant impact on the holistic development of a child, it is important to offer psychosocial care and support right from the womb through adolescence

THANK YOU

Conclusion

Church of Uganda, North Kigezi Diocese-Rukungiri

Compassion International

USAID

REPSSI Secretariat

Acknowledgement

(1) UNICEF Report (2013): critical importance of first 1,00days of life. Available at www.pncius.org/update.aspx?id=79, on 26/08/203

(2) Kakinga Child Development Center, Annual report 2014/2015

(3)The state of Uganda population report (2013). Population and social transformation: addressing the needs of special interest groups, The Republic of Uganda & UNFPA

(4) Regueio JH, Bhutta ZA(2015). The post-2015 agenda: staying the course in maternal and child survival. Archives of Disease in childhood 2015;100:576-581. Doi:101136/archdischild-2013-305737

(5) Uganda Demographic and Health Survey, 2011

References