Mali: Babies Born Too Soon Can Survive and Thrive

Written by By Fatoumata Namandou Traore and Nathalie Gamache
This blog was originally published on Healthy Newborn Network

 

At 23, Fatoumata Coulibaly, a mother of two, added to her family when she gave birth to twins at the community health center of Didieni, Mali, in April 2017. Born in this rural village, 40km from a district hospital and 180km from the capital city of Bamako, the babies (a girl and a boy, weighing 1860g/4.1lbs and 1910g/4.2lbs, respectively) were small. So small, in fact, that the family did not believe they could survive.

“When my mother-in-law saw the babies, she told me we should go home, that they were too small and not viable. She did not want us to stay at the facility as she thought it would just be wasting time,” Fatoumata recalls.

Despite her family’s reticence, Fatoumata wanted to give her babies a chance, and was willing to try Kangaroo Mother Care (KMC)  1 as advised by the health center nurse. Fatoumata practiced KMC for two weeks at the health center and then was discharged to continue KMC at home, with follow-up appointments at the health center. When the family tried to leave the facility early, without an official discharge, the President of the health center management committee intervened with Fatoumata’s husband, mother-in-law and father-in-law, to convince them to stay. Two and half years later, Fatoumata is proud of her twins, who are alive today in great part to the KMC Services offered at the Didieni community health center.

Fatoumata’s story is one of many in Mali, where babies born too soon or too small are proving that they can survive and thrive.

In Mali, neonatal mortality is alarmingly high at 33 per 1,000 live births (DHS 2018). Prematurity accounts for 33% of the causes of these deaths (Lancet 2012). Among 440,688 births registered in health facilities in Mali, between January and September 2019, 5% of newborns (23,814) were recorded as low birth weight, or under 2,500 grams (Mali National DHIS2).

Although being born too soon or too small might be seen as a death sentence in Mali, stories of success are changing the norms in the country.

Since January 2019, half (46%) of low birthweight (LBW) babies benefited from KMC in the regions of Kayes, Sikasso, and Koulikoro where the USAID-funded Services de Santé à Grand Impact (SSGI) project intervenes. This is a notable increase from 30% in the same regions in 2018 (Mali National DHIS2).

Save the Children has supported the Ministry of Health and Social Affairs since 2002, seeking to understand newborn health challenges and establish actionable plans to eliminate preventable deaths in Mali. In 2006, KMC was integrated into national policies, norms and procedures as a recommended intervention for management of LBW babies, followed in 2007 by the initiation of KMC services at the Gabriel Toure University teaching hospital located in Bamako. However, access to the hospital is incredibly limited for most LBW babies such as Fatoumata’s twins.

Efforts to introduce KMC services in district referral hospitals began in 2008 through the Saving Newborn Lives program. Subsequently, the USAID-funded MCHIP, MCSP and SSGI programs – all led by Save the Children in Mali – supported service expansion. Gradually, KMC was brought closer to families and made available at community health centers (CSComs). Currently, 931 providers in 430 health facilities in 30 health districts supported by Save the Children through the USAID/SSGI project have been trained and equipped to deliver KMC services.

As evidenced by Fatoumata’s story, bringing care closer to communities is the key to saving premature and low birthweight babies. It requires not only health provider training, but also behavior change interventions among providers, families, and community leaders to recognize and support mothers practicing KMC as the primary intervention for preterm and low birthweight management.

As Mali celebrates World Prematurity Day, we salute premature babies like Fatoumata’s twins, who survived, mothers like her, who accepted to practice KMC, family members that support the mothers and even practice KMC themselves, and health workers who have integrated this practice into everyday service delivery.

 

1. Kangaroo Mother Care (KMC) involves continuously carrying a premature or low birthweight baby on the chest, using early and prolonged skin-to-skin contact, combined with exclusive breastfeeding (direct suckling or cup). This practice helps improve health and prevent the death of premature and small newborns by protecting them against infection, regulating body temperature, breathing, and brain activity, and supporting bonding between mother and baby. Once the baby is stable and gains weight, and the mother is confident she can continue KMC at home, mother and baby are discharged. They return to the health facility for monitoring of weight gain, feeding practices and to ensure that there are no signs of infection or other health complications, till the baby graduates from KMC. 

Amina Was Almost A Child Bride

By: Simone Jussar, Quality Communication Coordinator, Save the Children Mozambique

Save the Children Mozambique’s adolescent development programs have been implementing activities about sexual and reproductive health, and non-formal education in order to provide opportunities and improve the life conditions of adolescents. We have worked with education and health partners and community radios station. Since implementation, the program has been successful in reducing cases of early pregnancy, early school leaving, and premature marriages in our impact communities through awareness lectures, plays with messages to discourage early marriages and early pregnancy, and demonstrative sections about the use of contraceptives, like condoms.

In Nacala-a-velha in the Muendaze community, lives the adolescent Amina, a 15-year-old student of the 7th grade. We learned that she escaped from an early marriage situation. Everything started when a gentleman who lives in Nampula city went to Amina’s home to talk to the adolescent parents. “He came in my home and told my parents that he was interested in marrying me and my father didn’t accept. He insisted and my parents forced me to accept. I refused saying that I don’t want to marry,” said Amina.

Amina’s father continued to pressure his daughter and went to the school to ask for a transfer, claiming that his daughter would study in another city where Amina’s relatives lived so that the school principal would provide him with Amina’s transfer documents.

However, STC field staff, teachers, and the school principal intervened and the transfer of the school was denied. They worked to convince the adolescent’s father to refuse the marriage proposal, and after many meetings with community leaders and the brother of a girl who lives in the other city that Amina was going to transfer to, it was possible to convince the father to let the adolescent continue studying in order to fulfil her dream of becoming a teacher one day. Amina’s teacher said, “Early marriages make the adolescent waste time, it’s important to study first”. Despite the significant reductions in cases of early marriages in the impact community as a result of Save the Children intervention in past years, there is still some cases of early marriage and it is necessary to continue sensitizing and mobilizing the communities to discourage early marriage, since some families prefer that their children marry instead of continue studying.

Amina with her family in the Muendaze community

Currently to avoid early marriage Amina, and other adolescents have been actively participating in SCT awareness campaigns doing theater-teens. Amina has been sharing her story with other adolescents. “I only cried because my father was serious to marry me and if I didn’t try to find help I wouldn’t be here today, so I thank Save the Children”, said Amina. The adolescent program has been implemented in 36 communities involving 18,953 adolescents with 7,731 boys and about 11,222 girls.

Persistent Work Leads to Positive Change

By: Cheeko Garcia, Media and Communications Officer

A graduate of Social Work, Stanley has been with Save the Children for five years now. He works as Sponsorship Assistant, his task requires him to work closely in rural communities. Over time, he has witnessed how the organization’s programs have improved the welfare of children.

Stanley, Save the Children Sponsorship Assistant

When Stanley first worked with Save the Children, he noticed that majority of Save the Children partner schools needed assistance even in the most basic things. Located in remote, mountainous, and hard-to-reach communities, these schools barely receive government support. “There were schools which do not have clean water for children to drink, children do not receive dental and health check-ups, there were not enough books to read, and other students go to class hungry,” he recalls. As a result, children often go to school weak, untidy, and distracted while others lose interest and chose not to attend school anymore. “I have also witnessed some parents who punished their children for misbehavior either by pinching or scolding them in front of other people,” he added.

Stanley devotes much of his time working in the field particularly with children and parents. Stanley travels to remote villages both in coastal areas and in highlands. Spending hours of travel through deep rivers, muddy roads, or rough terrain is common to him. Upon arriving in the communities, he walks through farmlands and around villages with huts made of dried nipa leaves and bamboo to look for children. As the bridge between sponsors and the children, he talks to the children to know how they are doing and have their photos taken. He also delivers to and collects letters from children.

Stanley conducts a workshop for volunteers from Maitum, Sarangani Province. The training is part of the organization’s commitment to capacitate its partners in delivering programs for education, health, and child rights, among others.

Save the Children provides much-needed help through its Sponsorship Programs. Through partnership, the sponsorship programs support schools and communities. The programs facilitate the delivery of basic needs such as clean water in schools, train teachers, advocate for public funds for children, develop school disaster preparedness plans, and provide assistance to children’s groups. Also through the programs, healthy habits for children, child rights, and positive discipline are promoted among the members of the community.

Stanley taking a photo of Honey Jean for the Annual Family Update

Today, Stanley says he has seen much improvement among parents and children alike. In schools, pupils wash their hands regularly, teachers conduct tooth brushing activities, and children teach proper grooming habits to their peers. Parents have refrained from hurting and humiliating their children. Students and their communities now enjoy clean drinking water in schools. Children who were trained by Save the Children have gained much confidence and have become more participative in school.

“I hope our sponsors will continue to extend help because I have personally witnessed the good impact of our interventions. My commitment to the work that I do stays strong because I see that children are happy, learning and protected,” says Stanley.

Learning to Have Fun in the Library

By: Ruth Carola Zambrana, Sponsorship Assistant, Save the Children Bolivia

“Teachers used to send their students to the school library as punishment (detention) but now students who are rewarded are sent to the library”, says Mariel a school librarian in Cochabamba, Bolivia.

Mariel’s school library has been growing thanks to the support of Save the Children, who began working with her school in 2012. Encouraging children’s literacy and love for reading was one of Save the Children’s objectives and to do so, teaching materials, posters, and books were donated in order to make this space welcoming and exciting for children. A year later, the longed-for library began to operate.

Genesis, Mariel & Samir in the library

Mariel shares with us: “When I first started working here, I simply worked in the library and didn’t know what I had to do to make children want to come to the library”. Given the need to make the library an attractive place for children to be in and start reading and learning new things, Save the Children held Socialization and Library Implementation guideline workshops with the specific objective of arising the curiosity in children on what the school library may offer them.

After participating in these workshops, we now see children at Mariel’s school during school recess run to the library faster than to the kiosk. Children really started to enjoy being in the library and this was thanks to Mariel’s dedicated work of applying everything she has learned to improve her library. She explains: “The library implementation workshop has taught us how to give life to the stories children read. We have done this with our children by working with them to develop their own stories, practice origami, organize story time sessions, act out stories and also create a story roulette for children to pick out a book”. Children enjoyed working on stories so much that during the presentation of the school’s library to the whole school, children’s work was highlighted and they were able to demonstrate their work. Children themselves have talked about how the library has improved and how they loved how we have taken advantage of the materials that Save the Children has given them.

Mariel at her desk in the library

Ashly, on of Mariel’s students and also a sponsored child girl remembers: “Ms. Mariel encouraged us to make our own stories… mine was about a toad.” “Mine was about a boy and it was shaped as an accordion. Ms. Mariel has motivated us to invent our own stories” points out Alira (Ashly’s classmate) who also is enrolled our Sponsorship program.

The Power of a Letter

By: Tara Joseph, Sponsor Servicing & Quality Coordinator 

Claire-Rose is a 14 year old girl, living in Davenouce, a small community in Dessalines, Haiti. The youngest of her siblings, she has a special bond with her father; during her summer breaks she enjoys walking to the nearby rice fields to bring him a cold drink to refresh. In 2013, after a community mobilization campaign organized by Save the Children, Claire-Rose’s mother decided to enroll her in the Sponsorship program in the hopes of getting her to express herself more and learn about other cultures.

Shortly after her enrolment, Claire-Rose became sponsored and started exchanging correspondences with her new pen-pal. “When I received my first letter, I was very happy. It made me feel special to have someone that far away thinking of me”, she explains during her short interview.

Claire-Rose writing her response

The Save the Children field agents assisted her at first with reading and writing her letters, but gradually she was able to respond on her own. Today she can write her own letters and is always eager to receive packages and letters from her sponsor. Her latest package this year contained a bright pink sequined notebook: “My best friend was with me when I got the package she begged me to let her have this notebook, I didn’t give it to her, and I love it so much that I will use it as my diary to write all of my secrets”.

Claire-Rose writing

A previously shy and introverted child, Claire-Rose started making new friends when she became sponsored, since children are very curious. As she is receiving her sponsor’s letters, she’s becoming more talkative: she has a bigger view of other cultures, she created a strong friendship with someone that she hasn’t physically seen but who cares about her well-being and she gained more friends because they became interested in her exchanges with her sponsor. Besides attending school, playing and gardening, she added a challenging but exciting activity to her routine. Thanks to sponsorship programs and regular correspondence exchanges, children in Dessalines such as Claire-Rose are now getting a major literacy boost!

Claire-Rose showing her letter

Diary of a Girl Champion: Bringing the Stories of Malawi’s Girls to the U.S.

Written by Cecelia, age 16

This blog was originally published on Save the Children’s UK blog, Voices for Change

Introduction
I am Cecelia, 16, from Malawi and a champion for girls rights on health and education. I believe that girls deserve opportunities to reach their fullest potential. I talk to leaders in my community and my peers about girls needs and rights. I want girls to stay in school and complete their education and to see harmful cultural practices that lead to early marriage and teenage pregnancy to end. I desire to become a doctor to serve and inspire young girls.

I was selected by Save the Children to represent girls from Malawi and the region in New York and Washington DC to talk about our lives and advocate for them.

October 8, 2019
The long-awaited trip to the United States finally arrived. I was so excited and looked forward to my first experience on the plane and to explain to them [immigration officers] about my mission in New York.

After landing in New York, we checked in and went on a small tour around New York City. I saw Times Square and Central Park and they are really beautiful! Back at the hotel, I met Anxhela, another girl champion from Albania.

October 10, 2019
That night I kept waking up not believing I was actually here. I prepared for the day and went to the Save the Children offices to meet Anxhela and others.

We got a briefing on the Child Safeguarding Policy and the UN and then we went to UNICEF offices for a panel discussion on Preventing Families from Separation and Protecting the Rights of Children Without Parental Care. A young girl panelist impressed me for ably expressing herself. I rehearsed more to do the same the next day.

October 11, 2019 
Today I have my first big task here in New York, I was going to speak at the annual Girls Speak Out at the UN headquarters. We walked to the UN building and went through security checks. We each got a t-shirt for the event and we rushed to the washroom to change.

As guests arrive I felt a little nervous. I scan the crowd trying to locate my chaperone, Alinafe, who I spot smiling at me and I happily wave my hand to her.

The program starts and girls narrate their country stories that affect them such as trafficking, teenage pregnancies, early marriages among others. My turn came to tell the Malawi story: Everyone is listening attentively as I tell them what to be a girl in my country means, issues affecting my fellow girls and I ask for support from government, policy makers and my peers to work together in order to bring change in the lives of many girls. I also spoke about the work I do in my community to promote girls’ health, particularly girls’ sexual and reproductive health needs, so that they are able to stay in school.

October 12, 2019
Today’s event is “Bridge the Gap for Girls” and we are at Brooklyn Bridge. Everything is colorful here. Cameras are everywhere and it seems everyone wants to take pictures of me, Anxhela and Karen-another girl champion from Peru.

Save the Children US CEO, Carolyn Miles officially opens the meeting and she invites us to the stage. Karen goes first to give her remarks and I am next then Anxhela. I talk about girl’s health, and emphasize that if girls are given opportunities they can reach their full potential. Next, we cut the ribbon to mark the beginning of the bridge walk. We all walk across the Brooklyn Bridge which is very long and beautiful.

October 14, 2019
Monday morning we reach Washington DC and more activities are lined up. I am excited and I look forward to going to Capitol Hill and meet many important people.

October 15, 2019

Today I am part of an all-girl panel discussion at the Senate House with Anxhela, as well as Fatima and Vishwa, two other girl champions supported by Plan International. Somehow, I am nervous yet confident that I will deliver. I spoke about the importance of girls’ voices and the meaningful participation of girls in policy spaces. I got good feedback after my speech.

I met some members of the Congress and my message to them was that most girls don’t get to finish school due to teenage pregnancies and child marriage and this is a situation that needs to change.

 

My advocacy journey here is almost reaching the finale but not until Anxhela and I have participated in a breakfast round table discussion with the women caucus at the Capitol Hill office. What a rare chance to meet and interact with women leaders. I was excited to receive any pieces of advice they would give to a young girl like me. I feel very happy after the meeting as I have learnt a lot from this encounter.

Finally, we meet Congresswoman, Lois Frankel in her office. Talking to her directly about my work and then asking for support for my fellow girls back home and across the region makes me feel like I am doing real advocacy. Mission well accomplished.

 

To learn more about Save the Children’s work, visit our website

The Annual Family Update Experience

By: Daisyderata Chitimbe, Sponsorship Servicing Facilitator

Edited by: Memory Mwathengere

From a distance, as I rode towards one of the primary schools I facilitate on my motorbike, the sight of pupils wearing white and blue uniforms lit up my spirit. Slowly, as I got closer the pupils burst into a song that went: “Aunty Daisy tiwalandile tiwalandile” in our vernacular meaning “Aunty Daisy we welcome you”. For years, they have familiarized themselves to the sound of my motorbike and married it to my name.

Every day is an opportunity to make a difference and this is what I live for. Having clocked ten years working with Save the Children, one would think the passion of being a Field Facilitator would have died. But it seems as years are going by, the more I fall in love with my job like a beautiful story wine that becomes mellower with time.

Aunty Daisy

It was that time of the year again we do Annual Family Update (AFU). Annual Family Update is an exercise we conduct annually to update child records and photographs of children enrolled into sponsorship. Young boys and girls were excitedly waiting for Aunty Daisy to capture their photographs. They were neatly seated under a mango tree whilst waiting for me to get my camera and tablet out.

Having gotten my gadgets ready, I began orienting them in readiness for the photo taking session. They were already smiling in eagerness- grinning from ear to ear. One after another they came. “Can I see myself please”? They would ask and at the sight of their photograph they would burst in laughter. “Ah I want another photo.” In no time, the day was already over having captured 100 photos of learners. My arms were aching and the feet got swollen, having stood for long the whole day.

Daisy showing Angella her picture

It was like this each and every day for three months. Regardless of the hurdles, the beauty of the smiles was my consolation and knowing these the lives of these children will be greatly impacted. Thank you to sponsorship for giving me an opportunity to make lasting changes.

Cradle Ceremony for First Baby

By: Jamila Matin Aziz, Education Senior Officer , Saripul Province

Freshqan-e Meyana is one of the villages in the Sancharak District of Sar-i-Pul province. Sponsorship programs started working in Freshqan-e Meyan in 2009. People in the Sancharak district have similar costumes and traditions but it differs slightly from village to village, it happens sometimes that one tradition is only for one village and the neighboring village does not do that.

One of the traditions in the Freshqan-e Meyana village of Saripul province is a cradle ceremony for the first baby. This story is about Bushra, the first baby girl in the family, whose grandmother, Bi Bi Zahrakhal, wants to make her cradle and do the celebration. Bushra is the first baby in her family and according to the custom, her grandmother (mother of Bushra’s mother) should prepare the baby’s complete bed set with the cover-up sheet made of expensive handmade velvet.

The grandmother also prepares several sets of winter and summer clothes, towel, toys, and a bathroom set including, soap, shampoo, and baby powder. BiBi Zahrakhal also prepares clothes for all of her son-in-law’s family members.

Bushra’s father needs to host a party on the day of the ceremony for women who accompany her grandmother. Women of the village first go to Bushra’s grandmother’s house and then take all the things her grandmother prepared including the cradle and bring them to Bushra’s house. Whoever is interested, takes the cradle and sings and dances, and then Bushra’s family welcomes the guests. The singing and dancing takes place in the yard and then they go inside. The guests drink tea and eat candies.

(Right to Left) Zahrakhal, Mahboba, Fatima, and Karima singing and clapping

After singing and drinking, tea time occurs where the gifts are shown to the woman in the room, and then lunch is served. After lunch they put the baby in the cradle and her grandmothers says, “Bushra don’t be afraid of cats’ mews, don’t be afraid of dogs’ barks, and don’t be afraid of motorcycle’s noise.” Usually, in this session, the baby falls asleep and all the guests congratulate the baby’s mother and father. Family members pray for the baby’s wellness and then they leave the baby’s house.

Bushra sleeping inside the cradle