In Kenya, one in every 26 children do not make it to their first birthday.
Child.org believe there is enormous potential to change that statistic. That's why we've decided to launch a brand new programme in 2018, to investigate ways to improve the prospects for mums and new babies in Nairobi, Kenya.
We will hand out baby boxes to new mothers in informal settlements ("slums") in Nairobi, Kenya. Baby boxes have been provided to new mothers in Finland for over 75 years. In Finland, a box includes everything you need for a newborn baby, all contained in a box, which is used as a cot. This baby box concept is used all over the world, from USA to Scotland, India to Mexico!
The box we're giving to mums in the pilot programme is a much more simplified version at this stage. We're mostly investigating whether the box doubling as a cot will help the mother and the baby in the first three months of the baby’s life. We're also using this pilot to find out if the baby box encourages mothers to come back for their postnatal check-up after they have given birth.
This pilot programme is all about finding out the impact that the boxes can have in a city like Nairobi. Our goals for the pilot programme are:
- To measure the impact of the baby box on the mothers' lives in the first three months
- To better understand the needs of the mothers and their babies in the first three months after birth
- 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.
What we've learned from our Baby Box baseline survey
Posted on 07th Aug 2018
This is my first month back in the Nairobi office since having my baby in January. My first day started with a meeting with Mike from Nairobi County Council, who came to talk the team through the baseline data from the baby box pilot.
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.
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.
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!
This programme is all about collecting evidence.
Does having a box to sleep in help to improve infant safety in the home for families living in urban settlements in Nairobi? Does the incentive of a beautiful baby box mean that more women attend postnatal appointments? These are the questions that this pilot will answer.
Where we work
The perfect place to test the efficacy of baby boxes is in certain areas of Nairobi, Kenya.
Here, there is a high proportion of mothers who are severely affected by poverty and living in urban informal settlements ("slums"). Infant morbidity rates are high, so it's an area that needs more protection for the health of newborns and their mums.
All our participants are mothers living in Kangemi and Westlands in Nairobi, where most mums fails to attend any postnatal care sessions at all. Our research has indicated that this group could benefit hugely from some extra, specifically targeted support, particularly around the safety of a newborn.
If the baby boxes are effective, there is potential to scale up the programme in Kenya, and beyond! Already our team are in discussions about running a similar pilot in Sierra Leone and potentially Malawi.
In this pilot programme we will be partnering with two health facilities to hand out baby boxes to around 500 women.
During their final antenatal visit to the clinic, mothers will be given a little baby hat and a voucher to collect the full box. They will then receive the box when they return to the health clinic, with the voucher, for their postnatal mother and baby check-up. In this way we will be testing to find out whether the box works as an incentive for the mothers to come back for their postnatal care check-up.
We will monitor the mothers with a full survey three months after they deliver their baby. We will also be collecting additional observations and interviews with a small group of women one month after giving birth.
Our surveys will provide us with information on:
- Usefulness of the baby box as a cot, and its contents
- If there is an increased usage of postnatal care services
- If there is an increased understanding among mums of their own and their baby’s healthcare
- If there is an increased understanding of their baby’s needs in the first three months of life
- Whether there is a need for additional training for mothers
How you can help
If our pilot is successful, we're going to want to scale this programme up. In future boxes, we would love to include items that will impact the rates of the most common child diseases in Nairobi: diarrhoea, pneumonia, malaria and malnutrition. Already, our design of the pilot has highlighted an urgent need for better postnatal care for young mothers, so we would love to design ways to tackle this gap in provision too.
We do what works. If this programme proves that baby boxes are effective, we'll want to go big. We hope to issue over a thousand boxes within informal settlements around Nairobi over a period of two and a half years.
We'll need more funding to make that happen. Each baby box currently costs us around £14.