In Kenya, only 51% of mothers and 36% of newborns receive postnatal care within the first 48 hours of birth. One of the goals of Child.org's baby box programme is “To find out if the baby box is a successful incentive for mothers to access postnatal care services in a health facility with the help of a skilled health professional." While they've been handing out the boxes and conducting the research, the Child.org Nairobi team have noticed an added difficultly in providing more mums with postnatal care. We realised that when mothers arrive at health clinics for postnatal check-ups and to receive their baby boxes, health professionals are prioritising pregnant women or those in labour instead of mothers with newborns.

The team realised that in order for the baby box pilot to be effective, we needed to offer some additional training for nurses and Community Health Volunteers (CHVs). The day's session has been designed to improve postnatal care by delivering in depth training on how to help mothers with breastfeeding and how to identify warning signs for mothers and babies, as well as providing more information about the baby box programme. This epitomises Child.org’s motto of We Do What Works.

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What happened during the day?

The programming team were so pleased that Dorcas, Senior Nursing Officer of Nairobi City Council, was able to attend to deliver sessions on general postnatal care for the nurses and community health volunteers (CHVs). Dorcas recently went to a three day national training course on postnatal care, so it was great for her to have the opportunity to cascade her knowledge so soon! Jo Aubrey, a lactation nurse and breastfeeding expert facilitated a breastfeeding session. Eight nurses and seven CHVs were able to attend and they were split up so that content could be tailored to their specific roles. 

Dorcas’ session with the nurses and CHVs provided information on what to look out for in mothers and babies after delivery. She also tested them on their knowledge, which made the session more interactive. Dorcas’ justified that postnatal care is important because it provides “a continuum of care” from pregnancy through to maternal and neonatal health.

Jo’s sessions were designed to train nurses and CHVs in how best to support breastfeeding mothers, through a combination of discussion, videos and role playing to provide information for mothers on topics such as latching and expressing breast milk. The interactive session was clearly very useful, as several participants said the information on effective breastfeeding was one of the most important things they got out of the day. 

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Why was the day a success?

John*, one of the nurses said that one of the most important things he learnt was that postnatal care should last for at least six weeks. Previously he thought postnatal care only lasted for two weeks. This was amazing to hear as it is a really important outcome from the training. Extended postnatal care means more women and babies will receive healthcare and potentially life-saving treatment. 

It was also great to see Child.org’s new nurse volunteer interns, Herine and Teresiah, at the training day after only being interviewed the day before! Herine really enjoyed the session as she is keen to specialise in maternal health and has her own 4 month old baby. She told us she learnt, “the importance of attachment during breastfeeding so that the baby feeds properly.”

The training day gave Child.org more insight into the realities of maternal care in the clinics. Nurses and CHVs told us about their real experiences in clinic. During the breastfeeding session, the nurses said that most mums do breastfeed and it is normally a neighbour or a family member rather than a healthcare professional who shows them techniques. Jo’s session was able to provide information to show mothers how to effectively and safely breastfeed.

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Several of the nurses and CHVs were keen to give us feedback and tell us how important the session was for them. Boaz one of the nurses working in Westlands clinic where Child.org gives out baby boxes said, “Very impressive presentations. Now we know the services we were giving were not completed without the important postnatal care.” 

The CHVs agreed that after the training they will be more observant and ask mothers more questions to identify warning signs. Chris, a CHV at Kangemi Health Centre, said the training was especially worthwhile and useful in providing information on how to check the breathing rate of a baby, and other signs that urgent medical treatment is required. Margaret, a CHV coordinator, was particularly impressed by the information on baby boxes as it will now be easy to explain to mothers about how they might use the box. 

Phoebe, who is the Ministry of Health appointed coordinator for CHVs in Westlands and Kangemi clinics, had a lot of praise for the training. She highlighted that she would like more Community Health Volunteers to undergo similar training so that, in her words, “more lives can be saved”. 

Amelia and Rona are on a Charity Fast-Track placement in Nairobi with the Child.org programming team. They will learn about how our comms team collects and uses stories and other content from our programmes, while they collect valuable content for Child.org. They're also taking over the Child.org Instagram for two weeks! Follow their posts at instagram.com/childdotorg and see all thier blogs here.

We’ve landed! On Sunday for Rona, and early Monday morning for Amelia we arrived in Nairobi to start our placement in Content and Communications with the Kenyan Child.org team. We’ll be gathering communications material for the Baby Box programme and the upcoming Team Mum campaign. Given that we’re staying in a flat about three minutes from the office you’d think it would be quite a smooth commute on Monday morning - you’d be wrong. We ended up going to the wrong office building and turning up late for our first day, just getting into the culture of ‘Kenyan Time’.
 

We met the lovely Marti, Doreen and Faith, who briefed us on our plan for the next two weeks and explained more about Child.org’s programming work in Nairobi, and Kenya more broadly. Our time here will be spent in a combination of visiting clinics where the baby boxes are handed out and postnatal checks take place, and going out into communities with Doreen and Faith while they conduct follow-up surveys.  

Part of our first afternoon was also spent sourcing Kenyan sim cards so we can stay in touch on the go, and exploring the local supermarket. We returned to our flat with a selection of Kenyan delicacies to try, including maize flour to make ugali, a traditional Kenyan carbohydrate based dish that goes with stew or curry.  With the help of our bemused airbnb host, Jane, we assembled our first Kenyan dish and enjoyed it while watching the August Charity Fast-Track webinar (what else?).

Today was a public holiday so we had the chance to explore Nairobi and get to know a bit more about the city and its culture. Evans, who drives all the Nairobi Child.org staff around, was our tour guide for the day. We visited the top attractions in Nairobi, which include the giraffe centre and the baby elephant orphanage! It was amazing to get so up close and personal with our new friend Stacey the giraffe and 18 baby elephants. Whilst driving to our next location, the Kitengela glass centre, we stumbled upon a herd of zebras on the side of the road (when we say road, more of a dirt track). At the glass centre we crossed a thin wire bridge across a large ravine, something we’d talked to Marti about but she’d been too nervous to do herself!

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Now we’ve had the chance to acclimatise a bit, we are really excited to get stuck in and start gathering content from the woman at the clinic tomorrow. We’ll talk to them about their stories and experience with the baby boxes and collect quotes for our Team Mum appeal.

Amelia and Rona are on a Charity Fast-Track placement in Nairobi with the Child.org programming team. They will learn about how our comms team collects and uses stories and other content from our programmes, while they collect valuable content for Child.org. They're also taking over the Child.org Instagram for two weeks! Follow their posts at instagram.com/childdotorg and see all thier blogs here.

The baseline is an in-depth survey we conducted right at the start of a programme - to find out more about what the situation is like for families before we provide them with a box. The data will help us see the impact of the pilot more clearly, and it also helps us identify other opportunities - other problems we can solve to keep babies safer.

It was an enlightening day and incredibly helpful for me to catch up with what we’ve learned by speaking to women directly. I wanted to share some of our findings because there is some surprising and frankly quite shocking content that will inform our activities from here. 

What the team did

This is the summary of the baseline collection activity in numbers:

• 200 mothers interviewed
• 4 research assistants
• 5 different areas in Westlands, Nairobi
• 8 days
• 8 ministry of health staff trained by the Child.org team
• 1 digital platform used to collect and summarise the data

What we learned 

We asked the women a lot of questions so we learned a great deal, but the most interesting findings were around safe sleeping practices and access to health information. 

Safe Sleeping

The boxes are designed as an incentive for women to access postnatal care from their local health facilities.

What the pilot is also helping us to achieve is a better understanding of safe sleeping practices. UK readers might recognise safe sleeping campaigns, designed to reduce Sudden Infant Death Syndrome (SIDS), sometimes referred to as "cot death". We know that education around safe sleeping in the UK reduced SIDS by half between 1989 and 1992 during the ‘Back to Sleep’ campaign but in Kenya there’s very little information on SIDS or how much of a problem unsafe sleeping practices are for small babies.

From our pilot, we’ve learned that there is a significant gap in knowledge about how to keep your baby safe while they sleep. 

92% of women told us that they bedshare with their babies. Only 51% of the women interviewed had received any information about how to safely co-sleep. We wanted to check whether women could correctly answer some questions about safe sleeping and shockingly only 7% told us that the safest way to put a baby to sleep is on its back. 

21% of mothers put their baby to sleep in a bed with a parent (them or their partner) who had been drinking, meaning a significant number of babies face an increased risk when they go to sleep at night.

Health Information 

43% of women told us that it’s not easy to find out info on their family’s health. We saw strong correlations with location here: unsurprisingly where there were health centres that provided decent services, the rate was much higher. Using a digital platform with geo-location analysis will help us to identify where the most significant gaps and where Child.org can focus on supporting mothers. 

Less than 1% said they access health information from Community Health Volunteers (CHVs). This is hugely significant - CHVs are Ministry of Health positions that community members volunteer in. They are supposed to be trained and supplied with information, in order to help bridge the gap between the community and health facilities. They are vital for encouraging women to access the healthcare they need, and are entitled to, during pregnancy and beyond. 

In a similar vein, almost 30% of the new mothers we spoke to hadn’t received the Antenatal Care Booklet they’re supposed to get on their first visit to hospital. This is the equivalent of the UK's maternity notes and red book for babies, combined into one accessible booklet by the Kenyan government. It’s a great resource, full of content to assist mothers in understanding what danger signs to look out for in pregnancy, breastfeeding and their child’s growth and development. 

According to Mike, there is a problem with the distribution of these booklets from the ministry to the health centres, causing long delays with restocking when a facility runs out. This is a huge waste of a great resource and the gap can be plugged very simply by ensuring that Community Health Volunteers have a constant stock, so that every woman we work with has access to the booklet.

Other notable gaps in health education are that only 5% of women said they have access to information on water and sanitation. Our researchers witnessed people washing clothes next to open sewers so some simple health information could have a significant impact on the spread of disease in these regions. Also, under 1% of women had received information on nutrition and 27% hadn’t received any advice or education on family planning. 

How it’s going to impact what we do

As we’ve said, the key driver of the Baby Box pilot is to assess the impact of the box as an incentive to improving access to postnatal care. We’re learning about this over the course of the pilot but we’re also learning about what other gaps and problems there are that we’re already beginning to help solve, or how we might tweak our activities to plug gaps we’ve discovered. 

For example, Child.org are already providing safe sleeping information on the boxes themselves but we’re talking with the ministry of health about how we can arm Community Health Volunteers with more health information to disseminate to the women they meet.

Collecting valuable data is a key part of our work and the Baby Box baseline is a prime example of how knowing our audience can shape and improve our work. Funding such studies ensures that we’re developing the best possible solutions to real problems.

I’m so excited to be back in the office and working on this project again. In an environment where the international recommendation of putting a baby to bed in a crib next to mum isn’t feasible, because access to a crib is unobtainable, a baby box offers a mum a safe alternative to bedsharing. Perhaps most important though, is the information provided alongside the box - the knowledge of how to keep mum and baby safe and well.

You can read more about our Baby Box programme here. If you like the way Child.org do things, please consider supporting us with a donation, so we can reach more mums and babies. We'll use your donation to do what works. Thank you!

It was an extremely exciting week for our Nairobi office last week, as we completed our baseline survey and began registering mums to take part in our baby box programme!

The baseline survey has been an enomous undertaking for the team, they have interviewed hundreds of women about their experience of prengancy, birth and postnatal care. The data from this survey will be compared to one taken at the close of the programme, so we can see what difference it makes to these families. 

Doreen, our programme support assistant, has been sending me the stories of some of the women she's met, who are happy for Child.org to share them with you. During her research, she met Evelyn, Mercy and baby Brighton.

Evelyn, Mercy and Brighton

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Evelyn's last pregnancy, six years ago, ended in tragedy. At eight months pregnant she had an accident at home and started bleeding. She was taken to hospital, where she says nurses were slow to respond but eventually said she was OK and left her to be looked after by medical students. However, when Evelyn came to give birth the doctors found she had lost too much blood, and water from her womb. Evelyn says that she had lost so much blood that the doctors could not locate her veins. She fell asleep in the hospital and later woke to be told that her baby had died. 

Later Evelyn had to return to hospital to treat blood clotting in her legs, she has wounds in her legs that are still not completely healed. This has forced her to quit her job, which has hit her family hard.

Seven months ago, Evelyn's teenage daughter Mercy gave birth to baby Brighton, making Evelyn a grandmother. Mercy found the pregnancy difficult and motherhood stressful, with no support from the baby's father. Money is extremely tight for this young family - but Evelyn knew how important it was to support Mercy fiercely and asked her to move back in with her for a while after Brighton was born. We asked Evelyn what advice she would pass on, as a mum and grandmother. She said "If you have a problem during pregnancy, see a doctor every time. When doctors were on strike, I had to see a Traditional Birth Attendant as I could not afford a private doctor. If you have a teenage daughter who is pregnant, stand by her, or else she will lose hope."

Mercy told us that she would love to see more support given to teenage mums like herself. She added, "I would like my child to get educated and to get a good job."

What's happening now?

Now the baseline research and training is complete, we have started registering pregnant women to receive baby boxes! The team will hand out 500 boxes in Nairobi. Mums are registered when they attend the Health Centre for an antenatal check-up, and given a voucher and a baby hat.

When the mum returns to the health centre after the baby is born, they will be able to collect their baby box. This is how we investigate whether the box works as an incentive for more women to attend their postnatal appointments, in an area where attendance of postnatal care is very low. 

Of course, we'll also be following up with a survey of these mums a few months later, to discover if the box and accompanying advice is proving useful for the new family. 

Below are some photographs from Cherio, our Programming Officer in Kenya, of the vouchers and baby hats being handed out last week. I love how the team have packaged the hats and voucher with ribbon - to make them feel like valuable gifts for the mums who receive them! In our Child.org team meeting yesterday morning, Cherio told us that 66 of 500 mums had already been registered - a really promising sign that women are keen to take part and believe the box will be useful for them. 

Research pays

I think it's important to understand that all this research around the programme is expensive. Each in-depth interview with a mum takes an hour of staff time. Child.org could choose to do less research, collect less data and give boxes to more mums, or fill each box with more gifts. 

The reason we don't do that is because we believe that discovering the impact of our Baby Box programme has the potential for a wider impact beyond a few hundred families. We want to arm ourselves, and others with the information we need to make informed descisions and make our work more effective in the long term. Thanks to you, we're discovering what works - and we are enormously grateful to all our donors who have the foresight to support this approach.

If you agree, please do consider donating regularly to help us do more great work like this. Our team know the names of every Core supporter and are so grateful to have you behind us.

She is spearheading Child.org’s move to project-manage our programmes more directly.

Cherio works in collaboration with our long-standing partners to manage our HealthStart programme, to ensure it is delivered in full and we are able to report our success comprehensively to our partners at Comic Relief.
 
Cherio is passionate about the health education of pupils. She recently saw an opportunity to improve pupils’ health education by creating a School Health Training Guide. The new guide is based on Government School Health Policy, but designed to be used by teachers and Student Health Clubs to foster a culture of student advocacy and peer-to-peer learning. It covers everything from clean water and nutrition to sexual health and healthy relationships, and was distributed to all HealthStart schools. Read more about the guide here!

Child.org. For the Brilliant.

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The school is in an area of rural Kisumu that is stricken by poverty. But despite the obstacles he faces, Walter has a vision - a school where every child is able to learn, regardless of their disability. 

Two of Walter’s pupils are wheelchair users, so Walter has made sure that every classroom is accessible by a ramp. He has started separate classes for children with hearing disabilities and secured government funding for specialist, trained teachers. 

Child.org’s HealthStart programme is strengthening the governance structures at Ng'eny - giving Walter, his staff and his pupils the power to drive forward health improvement initiatives in their school and wider community.

Ng'eny Primary might have very few resources, but they are moving forward - and Walter is determined that no child should be left behind. 

Child.org. For the brilliant. 

Thanks to your generous donations to our first ever Christmas campaign (£4884 raised so far!), we're kicking off the work to launch this brand new Child.org programme.

Charity Apprentice Alumnus Anne-Liese has joined the Child.org team to work one day a week on the programme planning and she has put together an initial plan proposal. This is still likely to be subject to further iterations and changes - but we wanted to share with you the basic plan so far!

The aim of this pilot is to find out just how effective the baby box is for mothers living in informal settlements ("slums") in Nairobi. We know that encouraging mums to attend antenatal sessions will have an impact on a baby's health, there's plenty of evidence for that already! So the Child.org team have been deciding on what to measure during this pilot - as handing out 500 boxes is a great opportunity to get some really useful data.

Between February and July we'll be giving out the boxes, and measuring health outcomes of the babies. We'll be monitoring three groups of young mums:

• Group 1: A control group of mums who have not been given a box
• Group 2: Mums who are provided with a box
• Group 3: Mums who are provided with a box and attend an extra educational session

Each group will be monitored for three months with surveys. We'll also be collaborating with a student from Bristol university who is conducting her own additional research on Sudden Infant Death Syndrome and the impact the box can have on babies in informal settlements.

The questions we want to answer as a result of the pilot include:

• Are the mums using the box as intended, for their baby to sleep in?
• If they are - is that having the desired impact upon the health of the baby?
• What added impact does an educational session have on the health of the baby?

We expect to gain a fantastic amount of research and data from this pilot, and very much look forward to sharing the results! When you consider how useful that information will be, to Child.org and other organisations too, it's clear that the long-term impact your donations will have is going to be pretty impressive.

(The photo on this blog was taken at one of the workshops we ran last month in Nairobi, where we consulted with many young mums on the design and contents of the box.)

We still need more donations to reach our target and fund this important new programme. Please consider donating to fund this pilot.

If you donate before the end of January, every penny you give will be matched by our friend Dr Mike Marks and the The Bush Hospital Foundation. So when you pay for one box, we can actually buy two!

Read more about our baby box programme.

Read about our plans for HealthStart in 2018.

Read about our plans for the Meru Women's Garden Project in 2018.

What is HealthStart?

Thanks to the support of our biggest donor, Festival Republic, for the past three years we’ve been running HealthStart, an innovative school health and nutrition programme, with our Kenyan partners at the Ogra Foundation.

HealthStart is unique because we address the holistic health of children at school by providing multiple health interventions as we believe that they improve the effectiveness of each when delivered together.

By providing a combination of interventions, including nutrition, clean water, malaria nets, de-worming, health education and school health policy development, we believe that the positive effects of each of these interventions has a longer-lasting impact on the health and educational outcomes of the children.

What was the pilot?

Over the past three years, provided HealthStart to over 2,000 children in two schools in Western Kenya. We’ve gathered lots of data on the health and performance of the children, which we use to measure the impact of our work.

The data we’ve recorded is one of the things that makes HealthStart particularly unique and I’m working with the HealthStart team at Ogra to make sure we have everything we need to evaluate the impact of the pilot programme and to tell the story of what HealthStart really means to the children, staff and wider communities.

What next?

Last week I met with the community members, including the schools’ Boards of Management and local government representatives to discuss what will happen when the pilot closes at the end of term.

There were some concerns about the programme coming to an end but the schools made promises to continue supporting the feeding programme with the help of the community. KOP and Ogra will be monitoring changes over the next few months.

I also facilitated a workshop with the HealthStart team. As the programme is closing, we’ll sadly be losing some team members and we wanted the chance to share all of our experiences and suggestions for the future of the programme. It was an interactive and fun session where we shared ideas, challenges and successes from all aspects of the pilot programme.

As we gather more feedback and the data comes in, we’re preparing a review of the pilot and starting to look at what the next phase of HealthStart might look like.

Once we’ve collated all of this information, we’ll be telling you all about it…and there’s plenty to get excited about!

Delivering innovative programmes like HealthStart, and supporting our children’s centres in Kisumu requires a huge amount of input, management and expertise. To do this we work really closely with our excellent partners in Africa. However, we’ve realised that for us to be able to ensure the impact of the work we do, and the money our supporters raise, we need to have someone dedicated to just that.

In a huge step for KOP we’ve recruited someone with great experience of working with partners in Africa, with a strong understanding of our organisational objectives and with a vision for the most vulnerable children in the world that mirrors ours exactly… our very own Martina Gant.

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Marti will be between Bristol, London and Kenya for the next few months, and potentially spending much more time in Kenya after that. She’ll be reviewing, assessing and evaluating all our current programmes, as well as identifying new opportunities to transform the lives of vulnerable children. Marti will make everything we do through our partners work better.

It’s another step forward for KOP and one that will directly improve the lives of the most vulnerable children in the world – and it’s a step that’s only been possible because of the incredible support you all give us.

Child.org trustee Sam Mason talks about her experience of the 2014 ride.

We’d done a little training and bought the kit that until then we’d never heard of – SPDs, sleeves, chamois cream. In all truth I felt fairly under-prepared and pretty apprehensive. Most of us had never cycled in that sort of climate. Personally, I’d naively assumed that commuting by bike in London would be the perfect training ground for cycling in Africa.

The ride itself covered 460km, from Kampala, Uganda through to Kisumu in Kenya – a route that skirted the edge of Lake Victoria and took us both on and off-road.

Tough, but worth it

I hadn’t considered the constant searing heat, how my bottom might feel after 3 days of riding or the possibility that we might have to cover a whole day in persistent headwind. I didn’t think about roads simply being so broken that my bike bounced around, or that when our guides told us “just two more hills” what they really meant was 15 more hills. But I’m glad of every moment, and happy about every well managed lie. It was one of the most exceptional things I’ve ever done. Even when my thighs burned, my back knots screamed, and the kilometres kept coming like a never ending snake – there were always scores of screaming children, men and women cheering “JAMBO! JAMBO! JAMBO! How are you?” to lift us. That we had such amazing support and encouragement through all bar none of the land we travelled through was so humbling.

An incredible experience

A beautiful country, filled with exceptional people – it was such a privilege to be there. As well as the locals around us, within the group of riders I witnessed so many other extraordinary things. Every hour people were supporting one another, a hand on a back up a punishing hill, distracting stories on the longest (140km) day and pelotons in headwinds with front position dominated by the strongest amongst us. These little acts bonded us all minute by minute, in a way I don’t think any of us fully appreciated until the end.

Flying down a spectacular mountain we arrived in Kisumu, 15km of pure descent with breathtaking views of thick green jungle and Lake Victoria. It was a truly awesome site. Breathless and the best kind of overwhelmed, we had arrived and were met in true Kenyan style – music, dancing, cheering and a wonderful presentation!

Visiting the projects

The following day we took everyone to see three of the KOP projects. I’ll never forget this day. One of the main criticisms people have with donating to charitable causes is the lack of transparency. There’s no way of seeing the impact you’re having or knowing what you’re really supporting. On this day, 50 riders got to meet hundreds of children they were directly supporting through their fundraising efforts.

At Rabour school a mass game of football broke out on the pitch (where we took more Western casualties in ten minutes than during the whole ride!). At Kochogo feeding centre, just after lunch, music was blasted and a group of us danced with 140 children between the ages of 1 and 11…(we were shown up horribly, in case you were wondering). And at HOVIC shelter we listened to a brilliantly charming and eloquent teacher reveal the journey he had been on – from the street to the classroom. We all hung on to his every word and left feeling so much. Respect, humility, awe at his courage. It was a hugely emotional day, chased by 5 days of physical and mental exertion, every barrier within us had come down.

Tell me about cycling opportunities