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April 2013. Issue: 01ALIVE&HealthyUganda

ForewordAccording to UNICEF (2009), globally over 7.7 millionchildren under the age of five years die each year. Ninetypercent of all these child deaths occur in developingcountries- Uganda is no exception. These are not merestatistics. They are children with names, an identity andfamilies.Gilbert KamangaNational Director, World VisionMost child deaths are easilypreventable hence intolerable.They are treatable conditions suchas acute respiratory infections,pneumonia, diarrhea, malaria,malnutrition and neonatalcomplications. Inconstancy inflow of information and lackof improved technology inthe medical field to treat suchconditions is unacceptable.Health for the Under- fivechildren is a big challenge inUganda especially in the ruralareas. According to the 2011Uganda Demographic HouseholdSurvey, One in eleven childrendies before their fifth birthday.Almost all child deaths couldbe prevented using simple,proven - inexpensive solutions.For children living in ruralcommunities, the statistics areworse than the national average.Given these realities, improvingchild health is very important toGovernment and every Ugandan.World Vision Uganda (WVU) in2010 launched the Child HealthNow campaign (CHNC) in orderto ramp up support and actionfor child health. World Visionas an organisation is glad to becontributing to the reductionof Child deaths in Uganda andglobally.WVU working through strategicpartners and coalitions hascontributed to policy changesat National level that aredirectly aimed at improvingchild health. For example,WVU and its partners played asignificant role in; drafting ofthe Uganda National NutritionPlan, supporting Membersof Parliament to lobby for anincrease in the Health sectorfunding by 49 billion Ugandanshillings and influencing the126 th Inter- Parliamentary Union(1PU) to adopt a resolution onMaternal and Child Health.Integrating Citizen Voice andAction, an approach to locallevel advocacy in Child HealthNow campaign has led to somedistricts to pass ordinances thatpromote child health. Theseinclude; Tororo, Bundibugyo andHoima. In the communities,health seeking behavioursare changing for the better.Pregnant mothers are seekingantenatal services while motherswith children seek early medicaltreatment when their childrenfall sick.The Global Week of Action heldin November 2012 demonstratedthat more Ugandans are nowcommitted to working towardsthe improvement of child health.As one of the activities during theweek, WVU visited 29 districtsacross the country gatheringevidence on child death usingthe Under-five mortality quilt.The quilt was used a lobbyingtool to influence decision andpolicy makers to take action inimproving child health in UgandaEven though strides have beenachieved, a more deliberateconcerted effort is needed byUgandan individuals, policypromoters and makers toensure that the Governmentsand districts adequately anddeliberately plan for maternaland child health but also work atimproving the health system tofunction effectively.I thank the Governments, CivilSociety Organisations, churchesand faith-based organisationsand other stakeholders incommunities where thecampaign is implemented forsupporting CHN. Special thanksto World Vision Uganda staff fordriving the campaign.I call upon everyone to promotechild health because together wecan end child deaths. For moreinformation about CHN visithttp://www.childhealthnow.org, follow us on Facebook:ChildHealthNowUgandaandTwitter:@ChildHealthNowUganda andon our blog: http://chnuganda.wordpress.com/God bless you!Alive and Healthy3

CONTRIBUTORSAdvocacy and Justice for Children UnitBuikwe ClusterBundibugyo ClusterBusiness Day CommunicationsGulu ClusterHoima ClusterKasangombe Area Development ProgrammeKiboga ClusterMpigi ClusterRose Mary MayanjaSoroti ClusterPHOTOGRAPHYCourtesy of World Vision UgandaPUBLISHERWorld Vision UgandaGRAPHICS DESIGNERNaama Phyllis Erinahphylliserinah@ymail.comshylconcepts2013@gmail.com+256 784 675 164COVER PAGELucky Mark Rwigyema from Mukonodistrict.ADDRESSWorld Vision UgandaPlot 15B Nakasero RoadP.O.Box 5319 Kampala-UgandaTel: +256 414 345758/ 340395Website: http://www.wvi.org/ugandaDavinah NabiryeMy inability to do or saysomething suddenlymade sense; I finallyrealized why advocates aroundthe world are now taking childhealth. Mercy’s baby hadbecome one of those statistics Ialways quote in my work. It isthen that I fully understood thesignificance of World Vision’sChild Health Now Campaign(CHN) in contributing to thereduction of child deaths due topreventable and unacceptablecauses like malaria.And because we live withthis silence emergence in ourcommunity, WVU’s advocacyteam has produced thismagazine entitle “Alive andHealthy” as a channel throughwhich you can learn more aboutCHNC and children who havebeen saved.Early this year Igrieved the loss of onebeautiful baby whoonly lived for two days.I sorrowfully watchedas its mother Mercymourned during thefuneral service. Afterthe service, I had anopportunity to interactwith her but could notfind the right words ofcomfort to say.In this issue, you will learn aboutthe genesis of the campaign,actions taken by the districts,and stories on improved childnutrition and the protectionof children from disease. Thestories bring to life testimoniesof people across the Ugandawho are promoting child healthissues.I am sure after reading themagazine; you will be inspired tobecome a child health promoterin your community.Have a great read!Editor4Alive and Healthy

However, maternal andinfant mortality andmorbidity althoughdeclining, remain unacceptablyhigh. According tothe 2011Uganda DemographicHousehold Survey (UDHS), maternalmortality remains high at438 maternal deaths per 100,000live births even though it showsa decline from the 2000 UDHSfrom 505 deaths per 100,000 livebirths. This translates to about6,000 women dying every yeardue to pregnancy related causes.Compared to non-maternaldeaths, maternal deaths havefar more consequences on thesurvival of children. A study on“Maternal mortality and the consequenceson infant and childsurvival in rural areas” by AndersonFW et al from the, Universityof Michigan Medical Schoolshows that, “when a family experiencesa maternal death, thatfamily has a 55.0% increasedodds of experiencing the loss of achild less than 12, whereas whena non maternal death occurs, noincreased odds exists.”The findings are not differentfrom the Ugandan context; thesurvival of children whose mothersdie due to pregnancy relatedcomplications are low. Accordingto 2011 UDHS, Infant mortalityhas reduced from 67 in 2006 to54 deaths per 1,000 live births.Under-five mortality rate standsat 90 deaths per 1,000 live births.This simply means that one in every19 Ugandan children dies beforetheir first birthday, and onein every 11 children dies beforetheir fifth birthday. The neonataland post-neonatal mortalityrates are at 27 deaths per 1,000live births each.The occurrence of maternal, neonatal,perinatal and child deathsin Uganda is a major concern toeveryone including Governmentand all stakeholders. Three quartersof the neonatal deaths occurin the first week of life whilethe highest risk of death is in thefirst 24 hours of life. The majorcauses of newborn deaths includeasphyxia, infections andcomplications of preterm birth.Generally, perinatal mortality hasA happy mother and childContributing to the reduction ofUnder-five deathsOver the last 15 years, Uganda has made great progress in terms of development. Peaceand security have been restored in most parts of the country. The Government has putin place key priority programmes and as a result, Uganda is experiencing considerabletransformation in education, agriculture and poverty reduction.been linked to poor quality of intra-partumcare.Maternal death is caused by eithera complication that developsdirectly as a result of pregnancy,delivery or the postpartum periodor due to an existing medicalcondition. Major direct obstetriccomplications responsiblefor maternal deaths in Ugandainclude; bleeding, infection, obstructedlabour, unsafe abortionand hypertensive diseases.About 15% of all pregnanciesdevelop life-threatening complicationsand require emergencyobstetric care. If these mothersdo not access appropriate medicalattention in time, they die.The current maternal and childhealth statistics are a clear indicationthat Uganda is lagging behindin achieving Millennium DevelopmentGoals 4 and 5 aimedat reducing child mortality andimprove maternal health by 2015respectively.Finding effective solutions to reducematernal and child morbidityand mortality is worsened byAlive and Healthy5

the fact that the legal frame workin Uganda is not strong enoughdespite the fact that Uganda is asignatory to many internationalinstruments which recognize theright to health. For example, theUniversal declaration on HumanRights (UDHR 1959), the internationalCovenant on Economic,Social and Cultural Rights (1966)and the Convention on the Rightsof the Child (CRC 1989). Ugandaalso has the Children’s Act (CAP59) which has a provision for theprotection of children’s rights tohealth.Despite the challenges, the Governmentand several other actorsthrough the Health Policy and theHealth Sector Strategy and InvestmentPlan (HSSIP) which arethe within the National DevelopmentPlan, the Ministry of Healthexplicitly defines the strategiesand structures needed to provideinternationally accepted interventionsto reduce maternal andchild morbidity and mortality.However, the Civil Society inUganda finds itself constrainedto optimally support the government’seffort to reduce childand maternal morbidity andmortality. This is because of theinadequate financial resourcesto operationalize the HSSIP,Health and Nutrition Services donot reach the people who needthem. Little investment is beingput to address the high prevalenceof nutrient deficiencies inthe country and there are gapsand implementation challengesin the policy and legal framework.The Child Health Now CampaignIn August 2010, World VisionUganda (WVU) launchedthe Child Health Now Campaign(CHNC). The campaignis World Vision’s first organizationglobal campaign aimed athelping the world achieve MillenniumDevelopment Goal 4 byreducing preventable deaths ofchildren under-five years by twothird; an equivalent of 8.1 millionlives saved each year until 2015.In Uganda the campaign aims tocontribute to the reduction ofunder-five mortality from 90 to56 deaths per 1000 live births by2015 by:Ensuring equitable access toquality health services to effectivelyaddress maternal, newbornand child healthAdvocating for increased allocationto the national health sectorbudgetEncouraging children, familiesand their communities to practicedisease prevention and riskreduction behaviourIn the last two and half years, thecampaign has been implementedin 16 districts including; Amuria,Bugiri, Buikwe, Bundibugyo,Busia, Gulu, Hoima, Kiboga, Kitgum,Mpigi, Mukono, Nakaseke,Nakasongola, Ntoroko, Sorotiand Tororo. However, with effectfrom June 2013, the campaignwill be integrated in all WorldVision Uganda’s Area DevelopmentProgrammes implementinghealth.Through the campaign, WVU hasactively worked with Membersof Parliament especially the ParliamentaryCommittee on SocialServices, District Local Council VCouncilors, District Health Teams,Community Health Workers (especiallyVillage Health Teams),Community Based Organisationsand mothers (pregnant womenand those with children belowfive years).The CHNC promotes 12 provencost effective interventionsthat could save millions of children’slive if implemented athousehold level; These include;Growth promotion and monitoring1000 days plus nine monthof pregnancy, Promoting thelife saving practice of exclusivebreast feeding, Access to zincand oral rehydration particularlyin areas with poor water qualityand sanitation levels, Supplyingand educating communities tosleep under Long Lasting Insecticide-TreatedNets (LLITN) toprotect against mosquitoes andmalaria infection, Proper handwashing and disposal of wastematerials, Training and providingaccess to skilled attendance atbirth, Ensuring access to age appropriateImmunization, VitaminA supplement, Mobilizing mothersfor Antenatal Care (ANC) andPrenatal Care (PNC); at least fourANC attendance, Communitybased family planning educationand commodity dispensing, Systemstrengthening especially ensuringfunctional Village HealthTeam (VHT) that is motivated andsupervised, and Local level advocacyat village level to promoteaccountability in the delivery ofhealth services6Alive and Healthy

Delegates sign-up for the survival of children at the CHNC launch.Campaign HistoryThe CHN shuttle- asymbol of the campaignBefore the August launch,various pre-launch activitieswere carried out toraise awareness among staff andin 10 selected districts across thecountry.The shuttle, commonly referredto as the campaign symbolplayed a significant role in introducingthe campaign in Uganda.Wherever it went, communitymeetings with mothers andchildren, interactive radio talkshows, district symposia on childhealth with policy makers wereorganised. Staff moving with thevan put their advocacy and marketingskills into play by precisely,accurately and clearly explainingwhat CHN was about.This shuttle was vigilantly brandedwith dazzling World Visioncolours - orange and white andcatchy images, short messages,the campaign slogan and bothWorld Vision and Ministry ofHealth logos.As a result, various districts welcomedthe campaign and wereoptimistic that it would promotechild health in their communities.Awareness about the maternaland child health problemwas raised.Today most communities inthe 10 districts are more awareabout child health issues. Thestaff appreciate and promote thecampaign’s agenda in their dayto-daywork.Uganda launches theChild Health NowCampaignOn August 12, 2010 Governmentofficials pledgedtheir commitment tofight malaria and malnutritionthrough during the launch of theCHNC in Uganda.With malaria and malnutritionresponsible for more than twothirdsof child deaths in thecountry, health officials and civilsociety leaders expressed deepconcern at the high mortalityrates attributed to preventablecauses.Ms Stella Ayo, Executive Directorof the Uganda Child Rights Networksaid she was “ashamed thatchildren are allowed to die ofdiseases like malaria” and challengedall stakeholders presentto “eradicate malaria in the sameway as we did for polio”.Guest of Honour and Director ofHealth Services in the Ministry ofHealth Dr. Nathan Kenya-Mugishaunderscored the need to empowerfamilies to take personalresponsibility for their health oftheir household - such as takingproper medication and using insecticidetreated bed-nets.In support of World Vision’s campaignstrategy, parliamentariansand civil society leaders alsoagreed that adequate preventivemeasures such as effective publiceducation would have a significantimpact towards reducingchild deaths.The event brought together keystakeholders including othernon-government and faith-basedorganisations and local mediaAlive and Healthy7

Lobbying Members of Parliament tofocus on maternal and child healthIn 2011, organizations focused on improving maternal, newborn and child healthformed a coalition called the Civil Society Coalition onMaternal, Newborn and Child Health (CSO-MNCH). World Vision sits on thesteering committee.The coalition was formedout of the urgent needfor CSOs to harness theirefforts and work strategicallyto increase attention andaction towards achievement ofMDGs 4 and 5. The coalition iscurrently comprised of 33 CSOs.James Kintu, Associate Director,Advocacy and Justice for childrensays it is important to workthrough coalitions because differentcivil societies have differentstrengths and comparativeadvantages which are importantin the promotion of maternal,newborn and child health with afocus on agreed upon priorities.The civil society in Uganda hasgrown and is very active in raisingawareness and acting as a watchdog for human right, policy anddelivery of essential services.One of the highlights of this coalitionwas the participation in the126th Inter- Parliamentary Union(IPU) Assembly as seen in thestory below:WVU participates in the 126th Inter-Parliamentary UnionWorld Vision has an observerstatus at the InterParliamentary Union Assembly(IPU). This is an opportunityfor WV to participate in the internationaladvocacy agenda.An example of such opportunitieswas working with legislators to prioritizematernal, newborn and childhealth during the 126th IPU meeting.WVU engagements kicked off asearly as February 2010 through UC-COSUN. Under WVU’s leadership,UCCOSUN lobbied the Deputy HonorableSpeaker of Parliament togetherwith others Members of Parliamentto prioritize MNCH at IPU.UCCOSUN presented a policy briefto the Ugandan delegation whichwas used to influence legislators atthe 24th IPU assembly in Panama,Central America.Engagements in Panama and otherprocesses influenced by the coalitionculminated into a decision forUganda to host the 126th IPU conferencefrom 31st March to 5th April2012 under the theme, “Parliamentand the People: Bridging the Gap”.Among other issues discussed, “Accessto health as a basic right: Therole of parliaments in addressing keychallenges to securing the health ofwomen and children’’ was high onthe agenda.Prior to the 126th meeting, WVUthrough the Civil Society Coalitionon Maternal, Newborn and ChildHealth (CSO-MNCH) organized sideevents including; three panel discussionsand an exhibition. The paneldiscussions were attended by anaverage of 150 people including keypolicy and other decision makerson addressing maternal and childhealth and members from the generalpublic.All the engagements contributed toinfluencing the 126th IPU assemblyadoption of the resolution, “Accessto health a basic right: the role of theparliamentarians in addressing keychallenges to securing the health ofwomen and children.”This achievement encouraged WVUto boost efforts in strengtheningcollaborations with the NationalParliament in profiling MNCH issuesand sustaining pressure of the legislatureto take action on. Through theCSO-MNCH, WVU is keeping trackon the implementation of the IPUresolution especially allocation ofresources and accountability in theMNCH context.Today, WVU has continued strengtheningits linkages with the RegionalMNCH and Partnership for Maternal,Newborn and Child Health(PMNCH) initiatives for support intracking commitments made by thestate under the United Nation’s EveryWoman Every Child initiativesAlive and Healthy9

An end to UgandaNational Budgetapproval deadlock, butstill failing healthworkersSince its formation in 2011, the Civil Society Coalition on Maternal,Newborn and Child Health (CSO-MNCH) where WVU is a member of thesteering committee) has been advocating for an increment in the HealthSector budget.Although these effortshave not resulted intothe desired target of 15per cent of the NationalBudget going to the health sectoras per the Abuja declaration,smaller but significant strideshave been achieved.In 2011, the Ministry of Healthdeclared the shortage of healthworkers in Uganda, particularlyrural areas, a ‘crisis’ while activistsreported that expectantmothers were bearing the bruntof the country’s staffing deficiency.Then only 58 percent of Uganda’savailable health positionswere filled instead of the recommendedminimum 65 percent byWorld Health Organization.According to the World HealthOrganization, any country withless than three health workersper 10,000 people is said tobe facing a severe shortage ofhealth workers to meet its healthneeds. This is a critical necessityfor the improvement of maternaland child health in Uganda witha huge population of 34 millionpeople.However, the 10 June 2012 readingof the financial year 2012-2013 National Budget left manycivil society organisations perplexedwhen out of the Ush.761.6billion (USD. 299,842,519) allocatedto the health sector; onlysh.125 (USD 49,212,598) billionwas allocated to run all the Ministryof Health operations, with ameager proportion towards addressing‘the crisis’ of few professionalhealth workers particularlymidwives and nurses who are atthe frontline on duty.This prompted Parliament’s refusalto pass the health sectorbudget until funds were relocatedto the escalating human resourcecrisis.On 25 September 2012 Parliamentfinally passed the 2012-2013 National Budget after abouttwo weeks of negotiation with theExecutive. This caused more discontentmentamong civil societyorganizations with government’sexecutive decision to ignore thereports from the ParliamentaryBudget Committee who originallyproposed that an additionalsh.260 (US$.102,362,204) billionbe reallocated from the Defensebudget to support the recruitmentand enhancement of professionalhealth workers at allcadres in health centre facilities.Instead government committedan additional sh49.5b to thehealth sector with a paltry sh6.5(US$ 2,559,055) billion for therecruitment and enhancementprocesses; which according toPrime Minister Amama Mbabaziwas “seed money to kick startthe effort of recruiting 6,172 newhealth workers at Health Centre1V.”Although the increment wasmeager, it showed Ugandansthat the CSO and members ofparliament were concernedabout maternal and child healthchallenges are doing somethingto avert the situation10Alive and Healthy

Implications onmaternal and childhealthMaternal and Child Healthactivists point to thelack of trained nursesand midwives, and poor facilitationof those who exist as thekey factor behind the fact thatan estimated 16 women die dailywhile giving birth in Uganda andone in one in 11 children dies beforefive years.Yet the government has ignoredthe importance of frontline cadresof health workers- midwivesand nurses who take home a pittancefor their lion’s share of dutiesin health centre IIIs and IVswhere there are few or no doctors.Therefore, the likelihoodthat such decisions outrage thefrontline cadres with seriousde-motivating effects cannot beunderestimated.“The budgetary provision to recruitadditional 6,172 healthworkers is a good political gesture,but it falls far short in termsof addressing the current humanresources crisis in the health sector.An additional UShs.200 billionis urgently required to savelives of especially mothers andchildren”, as observed by JamesKintu from WVU.Mr. Wicliff Aliga, the deputypresident for Uganda Nurses andMidwives Union, described themove as “completely misplaced…the government had made a verybig mistake by creating differencesbetween doctors and nurses.”“There will be no motivation fornurses who earn UgSh 300,000compared to medical officerswho will earn UgSh.2.5million.There will be no team work andthose doctors cannot work withoutthe majority nurses,” MrAliga added.In 2011, the International MonetaryFund also reported thatZambia and Uganda have similarGDPs, but World Health Organisationfigures show very differentdeath rates for mothers in thetwo countries: 7.8 percent of alldeaths of women of reproductiveage in Zambia are related tochildbirth, against 11.3 percentin Uganda.Children, especially those withinthe vulnerable group, are affectedwhen health facilities are notfunctioning effectively due tolack or absence of health workers.Uganda’s national budget for2012-2013 is sh.11.157 trillion.About only 7.8 percent of thetotal budget is allocated to thehealth sector.Therefore, if Uganda is going tomake major strides in improvingmaternal and child health beforethe phasing out of the MillenniumDevelopment Goals in 2015,the government must invest inthe recruitment and retention ofall professional health workers atHealth Centers II, III and IVAlive and Healthy11

Ugandaparticipates in theGlobal Week ofActionStaff participate in the Keep Kampala Clean exerciseWorld Vision’s first ever global popular mobilisation, the Global Week of Action (GWA)exceeded all expectations, as citizens in more than 80 countries united in support of theUN’s Every Woman, Every Child Initiative and raised the profile of World Vision’s ChildHealth Now campaign.Initial analysis shows that thecampaign reached more than48 million people, with 2.55million actions taken by morethan 2 million people from 82countries.The GWA brought peopletogether across the Uganda toshow support for the millionsof children at risk of illnessor death from these kinds ofpreventable causes such asmalaria, diarrhoea, pneumoniaand others. It showed the public,other organisations and politicalleaders that World Vision has thebreadth and capacity to mobilisea large number of peoplearound one goal. ConsequentlyWV learnt what a popularmobilisation is and how to do it,including the benefits it can bringto communications, branding,media, community/ child/youthparticipation and marketing aswell as advocacy, opening upmany opportunities for futureplanning and integration.WVU organised a series ofadvocacy events which resultedin 8,574 Ugandan (both childrenand adults) supporting thecampaign. Below are stories ofhow WVU mobilised masses.Staff mobilizationThe advocacy team raisedawareness and garnered staffsupport during devotions onMonday. After learning aboutthe importance of the GlobalWeek of Action, staff raised theirhands in support of the call thatchildren and women around theworld are still dying needlesslytherefore leaders need to knowtheir citizens care about this.Staff become ambassadors of theGWA.Keep Kampala Clean exerciseKampala Capital City Authority(KCCA) in partnership with WVUorganized a cleaning exercise tokeep Kampala clean. On October26 th , 2012 the exercise took placein Mulago- a suburb in Kampalacity. Participants including WVUstaff, KCCA officials took and themembers of the community inMulago participated in exercise.The aim of the exercise was topractically demonstrate to thecommunity how to keep theirenvironment clean. Staff gotan opportunity to promote theCHNC by interacting with thecommunity.At the end of the day, Hands wereraised to promote the survival ofchildren.Uganda makes a“quilt” ofmothers’ memoriesThe advocacy team travelled tofour regions across the country in29 districts, each facing their ownset of challenges round maternaland child health services. Theteam invited mothers who hadlost children in the last year tocreate a “memory quilt” on theirbehalf. In total, 1180 womencontributed a square to the quilt.Several mothers also told theirstory on film with the testimoniesuploaded to World VisionUganda’s Youtube account:ChildhealthnowUganda.The quilt was later presented tothe decision and policy makers asevidence of the huge numbers ofpreventable child deaths. 6,606supporters came on board duringthis activity.Breakfast meeting withCSOs, mediaIn order to bring more supporterson board, WVU organised abreakfast meeting with otherlikeminded child-focused12Alive and Healthy

Quela Band sings the “Survive 5” song during the Child Health Now Concertorganisations. At the meeting,CSO members discussed thechallenges Uganda is facing inaddress maternal and child healthissues. The CSO developed a CSOstatement which was presentedto decision and Policy makers ata GWA-Health Policy Dialogue on20 th November, 2012.The policy dialogue onmaternal and child healthheldThe Policy Dialogue on Maternal& Child health was organizedand hosted by WVU at HotelAfricana on November 20 th 2012to commemorate the UnitedNations’ Universal Children’s’Day. It also marked the climax ofthe Global Week of Action.The was attended by ChiefGuest and chairman of theParliamentary Health CommitteeHon. Dr. Sam Lyomoki, Ministryof Health Officials, Members ofthe Parliamentary Committee onHealth, the media, and the CivilSociety Coalition on Maternal,Newborn, And Child Healthamong other partners.WVU and other CSOs calledupon Government to priorityPolicy Advocacy Strategies torealize commitments madeby government of Uganda inthe Every Woman Every ChildStrategy (EWEC) – Representativefrom MOH.In 2011, the Ministry ofHealth made the followingcommitments;• To increase emergencycare of newborns bymore than 50%• To ensure the availabilityof basic EMOC servicesin all health c enters• To see that health serviceproviders are availablein hard to reach areas,especially by hiring moredoctors and nurses inHealth Center IVs.• To increase ante-natalcare from 42% to 75%with emphasis onPMTCT.• To ensure that 80% ofchildren under the age offive years have access toORS and treatment.• To avail one net for everytwo people in order tofight Malaria.• To introduce a vaccineto people vulnerable todiarrhea. (This has beenintroduced already)• To formulate a Malariavaccine (Research isongoing)• To pilot the immunizationof women against cancer.The CSO’s concerns were wellreceived by .Dr. Sam Lyomoki whoat the beginning of his speechasked participants to observe amoment silence to rememberchildren who continue to die ofpreventable causes. He said thisdialogue will only be consideredsuccessful if one year later,indicators show that child healthhas improved in the country.He pledged commitment onbehalf of the ParliamentaryCommittee on Health to partnerwith different stakeholders tocome up with a solution to themissing link. He gave an examplethat the committee has beenmaking recommendationsregularly until finally they madea resolution to not pass thebudget unless something is doneto address the financial holdup inMinistry of Health.Child Health Now ConcertThe dialogue culminated in a freepublic concert by Qwela Banddubbed the Child Health NowConcert, which attracted a bignumber of revelers. The Guest ofHonor was Sarah Opendi AchiengSarah Opendi Achieng, the StateMinister for Primary CareAlive and Healthy13

Working with othersRafiki Theatre Participates in CHN: Maria’s storyBy: Rose Mary Mayanja- a member from Rafiki TheatreIt is rare that a partner takesyou through a residentialworkshop to explain whatthey need from you. In July2011, World Vision invited RafikiTheatre group for a workshopwhere CHNC was introducedto the team. We learnt that thecampaign was aimed at reducingmother and child mortality ratesin Uganda.Rafiki Theatre was tasked withproducing a play on basic familyhealth practices. The most memorablemoment was integratingof puppetry into plays and mobilization.Rafiki also participatedin community mobilization usinggiant puppets which are huge attentiongrabbers.It was a good innovation for WVUto use the participatory theatreapproach to reach out to communitymembers with behaviorchange messages. It was also aprivilege for Rafiki Theatre Limited,a specialist and a professionalgroup to partner with WVU inone of the most essential life savingcampaigns in Uganda.‘Happier Tilapia’ is the nameof the play that Rafiki Theatredesigned for the Child HealthNow campaign. The messagesin the play relate to nutrition,sanitation and hygiene, malariaprevention and how male dominanceinfluences family decisionson health issues.As the Rafiki routine, the play isvery authentic and provocative.I get to act as a health workerwhocares so much about hercommunity and would like to endpreventable deaths by spreadingmessages of hygiene, early treatment,importance of breast feedingbut the masses don’t what tolisten to me. The people call mea stranger whose intention is tocreate chaos in the community.The play ends with the death ofa two-year old son dies becausehis parents refused to seek earlytreatment.Even though Rafiki theatre hasperformed at many functionsduring the campaign implementation,I still get nervous beforegoing onto the stage but I alwaysremember my colleague tellingme once that a little credence isall I need to save me from gettinga heart attack duringDuring performances, l look outfor a mother with her child attendingthe event and I worryif there was no mother or childbecause without them then themessage in the play becomesirrelevant. This does not meanthat father are not relevant, theytoo are because they make mostof the decisions in the homes.Besides performing and mobilizingmasses in over 10 districtsfor various campaign activities,Rafiki has partnered with WVUto build capacity of local dramagroups in plays with messages onfamily health practices14Rose Mary Mayanja Alive performing and Healthyat a communityhealth fair

Networking for child healthin Soroti districtBy: Mr. Joseph Eliau, TUSANET ChairpersonIn 2011 WVU trained community-based organisations in local level advocacyusing the Citizen Voice and Action approach. The objective of the meetingwas to establish a district advocacy network that would pursue the advocacyagenda at district level for policy influence.At the end of the training,an action plan wasdeveloped with an actionof establishing awell coordinated district advocacynetwork. Consequently, TuburSub-county Advocacy Network(TUSANET) was formed in Maythat year.During the training we learntabout the health policies andservice standards which made iteasy for us to identify health servicesdelivery as our communitychallenge. TUSANET embarkedon massive sensitization of thecommunity on their rights andthe kind of services they areexpected to receive from thehealth unit.Initially Tubur Health Centre IIIhad only five staff; one clinicalofficer, one midwife, one nursingassistant, one laboratory assistantand one records assistant,which is far below the requiredstandard of a minimum of 17staff. Most patients would goto the unit and never attendedto due to high patient-medicalworker ratio. This caused a numberof deaths of children in thecommunity.TUSNET’s experienceIn July 2010, TUSANET membersattended a community healthfair organised by WVU’s Soroticluster where we presented ourchild health issues on behalf ofthe community. Some of theissues identified included; understaffingat the Tubur HealthCentre III leading to the highpatient nurse ratio hence highdeaths reported (on average twochildren die every month in thecentre according to health managementreports), negligence bythe health centre staff and lack ofvaccines.We were happy that some of ourissues were included in the policystatement that was presentedto the District Council duringdistrict policy dialogue. At thedialogue I spoke on behalf of thecommunity and explained to thedistrict councilors the implicationof limited health care personnelto maternal and child health.After the dialogue, the networkworked together with healthcentre management committeeto lobby for improved service inthe facility. A letter was written toremind the District Health Officer(DHO) about the identified issuesand several follow-up meetingswith the District Leadership andDHO were held.In September 2011, the healthfacility received five additionalstaff; two clinical officers, twomid-wives, two nursing assistants,two enrolled nurses, onelaboratory assistant and one recordsassistant. Today there isan improvement in reporting onhealth service delivery at the unitpartly due to reduced work loadof health workers. Child deathshave also significantly reducedAlive and Healthy15

Pupils at attend a class session in Hoima districtHoima’s district promotes school feedingThe idea of sending children to school hungry is now tantamount to breaking thelaw in Hoima district, thanks to World Vision. Hoima Local government is urgingevery parent to pack break and lunch time bites and safe drinking water for each oftheir school going age children.“Feeding at school wasboosted by WVU whichargued that pupils needsome food to eat while atschool,” recounts the Hoima districtvice chairperson Fred Kakoraki.“World Vision brought differentplayers, parents, NGOs anddistrict leadership, to a round table.That is when we discovered amissing link between the universalfree primary education standardsand parent behaviours.”Under the Universal Primary Education(UPE) framework, theGovernment of Uganda offersfree tuition education but parentsmust meet the school andlearning requirements like feeding,scholastic materials amongother needs.Hoima district, like in many variousother semi-illiterate villagesof the country, did not quicklyappreciate the details of theframework therefore did not provideschool feeding to children.Parent compliance to schoolfeeding requirements remainedlow, although the teachers continuouslyurged pupils to carrypacked lunch.“Attaining 70 per cent compliancehas been no easy achievement.There were children whoused to carry their plastic containersstuffed with stones to beallowed school attendance. OnWVU’s invitation, I personallywitnessed a child at ZirantumbePrimary school who had stuffedthe container with stones. Thiswas the case because the teacherswere tough on the issue butthe parents still didn’t get it,”revealed Kakoraki adding that,“We had to go back to the drawingboard with the parents anddiscussed lunch issues to detail,says Fred.“Honestly, we were kind of givingup on the issue but World Visionrevived our synergy. It brought usin a big meeting with my councilorsand I”, he said.Prior to pressing for a councilmeeting, World Vision had sensitizedparents on the schoolfeeding requirements. The parentshad agreed to adhere andaccepted the district leaderships’monitoring on the same.“I and my councilors signed acommitment charter. It is displayedin the Local Council V’soffice for the last two years. Weagreed to enforce school feedingfor all children” he said.The council has initiated ‘HoimaDistrict School Children DropoutOrdinance 2012’ as an instrumentthat will support sustainablecompliance to the packed lunchrule for each individual child. Itwill tantamount to child neglectfor non-compliant parents whenthe ordinance is passed within 12months according to the districtcouncil meeting schedule.A tour to Bambya Primary Schoolin Hoima is revelation of how acontainer and water bottle havebecome part of each child.“After a hard day of Mathematics,English and Geography, whenI carry food, I still have somestrength to play dodge ball beforegoing back home,” confidesJane Nankunda 10.“You cannot believe the ArchbishopNtegeriya was once ateacher in this school,” boasteda teacher in Bambya Primary16Alive and Healthy

School. “We are a small unit butcapable of achieving big goals.Our goals will be bigger nowthat the parents are consistentlypacking food for the children”At the school, every child bringssomething to eat. The variety iscomprised of cassava, rice, poshoor bananas with beans forsauce according to the teachers.The effect of food on each classroomis double. The pupils concentratefor longer hours, theyare happier even in the afternoonand have the strength toplay games after classes.”During the earlier months ofthe enforcement, some boys inhigher primary classes felt verysuperior and did not want to carryfood to school like the littleones. “But portions often wentmissing. They were the first suspects,carrying food even forbigger boys became compulsoryand the food disappearing hascompletely stopped,” said headteacher, Justus Kasenene.Hoima’s ordinance was one ofthe actions by the district topromote health after the districtdialogue on heath was heldEarly malnutrition and/ ormicronutrient dddeficienciescan negatively affectmany aspects of child anddevelopment. School feedingprovides food to hungrychildren which improvestheir physical, mental andphychosocial health.Bundibugyo District Council spearheadingSanitationIt cost Ug.Sh.22 Million for Bundibugyo district, World Vision and a concerted enforcementof the district council to implement Operation Latrine, in August andSeptember, 2011. For thirty days each of the 30 councilors went to their constituentsand enforced latrine construction before the deadline.This thirty-day actionwas preceded by WorldVision’s two weeks radiosanitation sensitizationsprogrammes. The actionincreased the number of toiletsfrom a small coverage of 45 percentto 78 percent today.“The operation was enforcedshortly after 30 people includingchildren died of preventablesanitation related diseases in ourdistrict,” said Bundibugyo districtVice Chairman, Godfrey BalukuMbalibulha. “The tragedy happenedbetween July and August2011 after several patients werediagnosedwith diarrhea, typhoidand intestinal perforation.”“Towards the end of the operation,I remember climbing up themountain to visit three far-offhomes on the ridges of Bukangama,Irambula and Busambavillages. I saw water sources thathad been cleaned up during theoperation and they were adorable”,recalls Godfrey.Godfrey represented the districtChairman, John Tibemanya inleading the 30-day latrine operation.“It was established that, 75 percentof the 22 deaths that occurredwere children less than sixyears of age,” lamented Godfrey.“Their sudden deaths had earlieron been attributed to water poi-soning and juju (black magic) bythe residents.” But thorough investigationand laboratory testsdone in Kampala it was establishedthat the cause was sanitaryrelated.The tragedy coupled with WorldVision’s earlier warning to thedistrict and partners, triggered“Operation Latrine” which hasresulted in a decline in the frequencyof sanitation relateddiseases.” Godfrey adds that,“Better still with the tippy-tappractice and toilets constructedin schools we expect a long timetrickle-down effect in the communities.Pupils will, when theygrow up, replicate this good sanitationpractice in their individualAlive and Healthy17

homes.”“Operation latrine was implementedshortly after the presidentialelections,” narrates Godfreyin a flashback. “We laboredto explain to the citizens that agood toilet benefits you and yourimmediate family not your preferredpolitical candidate as detractorshad framed it.”Reluctant family heads were apprehendedby the police and onlyreleased after their colleagueshad constructed toilets in a givenlaw breakers homestead.To ensure sustainability of sanitationprogrammes in the district,the council has drafted “Protec-tion of Bundibugyo water sources”bill that regulates humanactivity on and along the watersources. The Secretary for SocialServices, Justus Nkayararwa willpresent the bill to the council fordiscussion and endorsement in2013.The instrument prohibits pollutionof water sources throughhuman activities which renderit unfit for use. A fine ofUg.Sh.200,000 or imprisonmentfor two weeks is proposed tobe levied on law breakers. Ownersof domestic animals suchas pigs, sheep, cows and goatsfound drinking water or strayingin sources of water face imprisonmentor a fine of betweenUg.Sh50,000-60,000. Also outlawedis fermented cassava inwater sources used by the public.Turning springs into car washingbays and contaminating themwith oils is a common occurrenceas Bundibugyo gets more urban.This will also be punishableby paying between sh50,000-150,000 if not done in designatedplaces that are permitted bythe local authority.Finally, all the water facility userswill be charged a minimal fee toenable foot the maintenance andsustain the utility. Any failure topay will lead to a halt in using thefacility, only renewable by payingUg.sh10,00018Alive and Healthy

Nakaseke’s VHTs promote HygieneUnlike their counterparts operating in the rest of the country, a groupof 253 members have formed Nakaseke Village Health Team Association(NVHTA). Beyond the health related tasks that Village HealthTeams perform in other districts, the Nakaseke association has createda leadership team that monitors WVU programmes at householdlevels. The team ensures maximum benefit of its community from theChild Health Now campaign by sensitizing households through voluntaryhome visits.“Recently we hosted theQueen of Buganda, HerRoyal Highness, NabagerekaSylvia Nagginda,” saysNakaseke NVHTA chairman EricMigade. “This gesture endearedus more to the populace thatcherishes traditional leaders.Nagginda’s positive speech aboutour role in society has since elevatedus (members) to celebritystatus.”“The negative reception of homeowners chasing us while mummuring‘twakowa’ (we are fed up)is no more. It has been dramaticallyreplaced by mobile phonecalls of inquiries about malnutritionand other information needslike advising an expectant motherfor ante natal,” says Eric.Asked about NVHTA’s achievements,one of the top leadersDavid Sozzi cannot hold back asmile of satisfaction.“Being able to juggle our timebetween voluntary work andour personal occupations is noteasy,” said Davis. “We have familiesto support and homes tosustain. But like me, the NVHTAmembers are able to apportiontheir time effectively for thegood of our children and thoseof our neighborhoods.”Another member Robert Sewanondasays, they are now theeyes and ears of governmentin their locality for health campaignslike male circumcision,eradication of polio or cholera.The group is the right channelthrough which important messagestrickle down to the people,breaking it down into a languagehouseholds can understand.“Kimansa mazi” is the highlightsuccess of the group so far, sinceits inception 2011. “We successfullyde-campaigned the carelessdisposal of human waste. Householdsdidn’t have toilets and theirchildren would defecate anyhow.Flies would hop from poop to baby’sfoods or lips, saturating villageswith diarrhea among otherdiseases,” Eric said.The association is lobbing Nakasekereferral hospital for a permanentoffice for which permissionhas been verbally permittedso far. Membership Identificationcards are in process and the associationmeets all financial needsof its meetings and activities.Revolutionizing lifestyles for affordablebalanced dieting, successfulsensitizing of district tobuild latrines and urging residentsto visit health centers arethe highlight achievements so farof Nakaseke Village Health TeamAssociation (NVHTA) .Child health, aPriority in SorotiDistrictWorld Vision’s relevance inSoroti District is very visiblein as far as the maternal tochild health programme isconcerned. It has been instrumentalin mobilizing mothers,airing programmes on local radiosand facilitating differentrelated programs.The District Local GovernmentHealth EducatorMartin Amodoi saysWVU has done a remarkablejob in promoting breastfeeding, improving the nutritionof mothers and their children.“For instance, we recently hada breast feeding competitionweek. The goal is to encouragecareer mothers to breastfeedtheir children,” says Martin. “Amother is supposed to feed thebaby in the first thirty minutesafter birth. The right positioning,while breast feeding a baby enablesbonding with the mother.Breast milk remains the perfectdiet for the newly born.”The worst breast feeding offenders,according to Martin, are thecareer women who believe it reducestheir ‘visual appeal’.“It is one thing having the foodbut it is another preparingand eating it,” stresses Martin.“Mother care groups teach themAlive and Healthy19

pregnant women annually fromwhich 15, 617 live births are expectedaccording to the Sorotidistrict Bio Statistics office.Benefiting the child is the HIVand AIDS component which encouragesmothers to voluntarilytest for the virus and preventmother-to-child infection.A nurse uses a pinard to listen to the fetal heartbeathow to mix the food and howmuch to serve.”Immunization coverage in thedistrict’s hard to reachcommunities has been possiblefor the last three years whenWVU started financial support tothe Child Days Plus campaign inSoroti providing transport to theimmunizing teams. With WVU’scontinuous mentoring, SorotiDistrict’s community workers aremore participative and self driventhan in neighbouring sub-countieswhere the organization’s activitieshave not yet reached.“I know for sure that World Visionhas revived communityparticipation for child healthprogrammes. Somehow, thecommunity treasures the wholehealth related venture and theyown it as their own initiative.”says Martin.Mothers have mobilized eachother into voluntary care groupsthat move from door to door disseminatingvital information onnutrition and immunization.“Mothers no longer take ailmentslike measles, bukalism (malnutrition),diahoreah and choleralightly,” says Martin. “Even therural mothers can now identifythe symptoms. They know thefatal danger involved if not addressedappropriately. Mothersare empowered to save lives.Thanks to the tool kit that WorldVision availed to supplementtheir knowledge. ”The Soroti district’s Bio Statistician,Stephen Areke says with ageneral population of 322,000,the birth rate stands at 5.2 with aMaternal Mortality Rate improvingto 284 out of every 100,000.“World Vision has done a lot tobring urban and ruralleaders to the forefront of decisionmaking,” says Areke. “Themobilization was very good in Tubur,Arapai, Gweri and Kamudasub-counties. As a district leadership,we are mindful of ourresponsibilities and our communitieshave learnt to demand ofus all the child health services.This platform for feedback is newand appreciated by thepeople.” Stephen said.The district has a child populationof 66,010 delivered by 16,100“This is a dramatic transformationfrom what was a horror inthe recent past,” says Martinadding that. “Patients now knowhow to balance diets and tochoose positive social behavioursfor their unborn babies to have agood life.”Although significant strides havebeen taken to improve childhealth in the district, there arechallenges due to inadequatefamily planning according toMartin.“Amorphous families are thecause of endemic poverty in thepopulace. The Soroti District LocalGovernment Health teamwants the council to pass a bylawagainst big families that individualparents cannot handle.” saidMartin.Child birth in Soroti district remainsa celebratory issue for theentire community. The occasionis marked with feasts that arecrowned with dancing, singingand the child’s forehead beingsmeared with millet beer insome families. World Vision incollaboration with the local authoritiesand other health serviceproviders like Save the Children,are enabling these babies to attaintheir fifth birthday at fullpotential20Alive and Healthy

Mothering GoneCommunalA Mothers Care Group (MCG) in Soroti hascontributed to reduced number of visits to thedoctors. Consequently, families are savingmoney that would have been spent ontreatment, babies are gaining weight and scarceresources are being spent on other equally bigfamily requirements.This follows governmentand WVU’s initiative totrain community-basedvolunteers popularlycalled MCGs in child nutrion.Talking to the members was arevelation of their achievementsand ambitious goals in their individualcommunities. The energeticwomen move on bicyclesor walk on foot from one houseto another educating the communityabout nutrition everyThursday. The oral lessons arecarried out under tree shades orin homes very often in the presenceof host home husbands.In Tubur sub-county, there are15 MCGs serving a population of22,700 adults with 4,585 childrenin their midst. The economic activityis mainly subsistence farmingand petty trade. Each MMGmember has a personal story totell as below.Margaret Alupot, 37I am a mother of seven fromPaleat sub-county. Since I joinedthe Mother Care Group, the appearanceand health of my childrenhas changed drastically.They do not suffer from malaria,cholera or diarrhea as regularly,as it were.Having taken them for immunization,they are safe from the killerdiseases that still claim lives inour midst before a baby celebratestheir fifth birthday. I discoveredthat the nutritious foodproducts are within our reachbut preparation matters. Sincejoining MCG I have managed tomake the dishes more palatableand rich in diet with silver fish,soy bean and milk.Life has never been the samesince I was taken for a two-daytraining sponsored by World Visionand the Ministry of Health. Ilearned how to make vegetablesmore palatable to the children.The porridge can be spiced withsoy milk, ‘mukene’ (silver fish)and ground nuts. My youngestson, Rapheal Ekiring, is growingup in a different way from theway I brought up his siblings. Iwish I had that knowledge before.Stella Ariokot, 22I am a house wife. To supplementour farming income, I bake‘kabalagala’ (pan cakes madefrom cassava and sweet bananas)which earn me sh15,000 ($6)on a good day. I have no regretshaving joined the Mother CareGroup.I was taught how to preparevegetables, porridge and milletbread to suit the preference ofchildren. You cannot believe it,children who used to hate eating‘eboo’ (cowpea leaves) are nowask for more whenever I preparesuch food. Their weight is proportionalto their individual agesand height.Alive and Healthy21

To my surprise when the family ishealthy, our marital relationshipis smooth. My husband is notstressed by treatment expenseson the children. We laugh a lotand even go to Church on Sunday.Modesta Alupo, 28I am a mother of four children.I joined the Mother Care Groupthree years ago and it has beenan eye opener. How I wish I hadthe same knowledge as I broughtup the three children who camebefore Catherine Anyigo whoweighs 5kg at one month of age.She has not suffered from bukalism(malnutrition). There is nocurly hair, extensive bellies andwhite eyes. It is upon MCG membersto have every baby in the 89families found in Tubur sub-countyenjoy life to the fullest.The nutritious foods are withinour reach. They are affordable orcan be planted within the compound.Some of these vegetables,I have learned, do not needperennial rainfall. You can harvestthem throughout the year.Twenty liters of water is enoughper day for one to harvest sukumawiki (borecole) ebbo (cowpealeaves) or entula (bitter berries)throughout the year.Grace Akello, 36My life has never been the samesince I joined the Mother CareGroup. Recently I won the breastfeeding competition organizedby World Vision. I took home abasin, a towel, sauce pans andnumerous kitchen utensils. Itmade me the happiest mother. Iremember ululating with joy.The judges considered the healthstate of the baby by weighing,checking the texture of the skinand I was given some oral interview.I told the judges I had breastfed exclusively for six months.They asked me to demonstratethe right angle to breast feed ababy. Then I demonstrated howto keep the breast hygienicallygood for the baby.Being a mother of seven children,we are considering familyplanning to be able to cater forthose we have already had. I andmy husband are yet to agree onthe method to apply. We havediscussed the pill, condoms andan implantMembers of the Mother Care Grouphaving light conversation22Alive and Healthy

Improved medical servicesin HoimaThe state of health services and the infrastructure in Hoimadistrict are a lot better thanks to World Vision Child HealthNow Campaign.“The immunization ratioshave shot up lately. Thishas sent the Infant MortalityRatio from 103/,000 to87/1,000 currently due to governmenthealth service provision,NGO activities and TullowOil roles in development activities,”revealed District HealthOfficer, Dr. Joseph Luyanga addingthat, “Nobody has supportedour health infrastructure likeWorld Vision has and you cannotbelieve the National MedicalStores (NMS) now delivers somuch medicine on regular basis.We even refuse to take some ofit because it will expire beforeuse, given our monthly capacityof operation.”World Vision supported the constructionof facilities at KihukyaHealth Center 11, BakyayangaHealth Center 11, Kasiiha HealthCenter 11 and Buhimba HealthCenter 11.Protection of water sources andcreation of new ones that WorldVision has done is important toHoima district that has in thepast had bouts of Ebola and Choleraonce killing up to 20 people,although 700 cases were treatedsuccessfully still due to WorldVision’s district emergency programsincluding radio sensitiza-tions and distribution of Choleramanagement kits.World Vision’s community facilitationsinclude distribution of300 bicycles to Village HealthTeams whose government institutedmajor role is to monitorchild well-being among otherhousehold health issues. Toboost family nutrition and income,World Vision continuouslygives cows, goats, piglets to democraticallyand communally identifiedfamilies. Other facilitationsinclude solar panels, mosquitonets and child de-worming kitsto various households.“However, the challenge is uponus to make people use of mosquitonets to prevent malariaamong vulnerable children. Unfortunately,many of our peoplestill use the mosquito nets forcatching fish, curtaining windowsor other things like bridal gowns.The sensitization struggle stillcontinues and I can say that withWorld Vision, we have support”Dr. Luyanga said.Hoima district is currently operatingon 50.8% staffing capacitybut the central government hasadvised for recruitment of healthworkers in all districts, which willfill staffing percentages to 89% ifthe recruitment exercise is successfullycompleted.“Hoima district has come a longway. Children used to die becausethe community road networkswere in such a sorry state.Taxis would operate once a day,”recounts Dr. Luyanga. “I remembera baby dying in my handsbecause the parents didn’t geta taxi to bring the baby to thehealth facility early enough. Thatis why as a district, we really appreciateorganizations like WorldVision that enable better opportunitiesfor children and entirecommunity.” Dr. Luyanga said.According to his Health Educationist,Solomon Kwebiha theWorld Vision’ sponsored radiotalk shows and discussions haveeased his mobilization workagainst immunization and nutritionAlive and Healthy23

Improvement in medical services;key to child health in BundibugyoShe screams and cringes in pain when she sees a group ofpeople approach her bed. She probably imagines we areabout to touch the hurting wounds on her right leg.For over two weeks now,baby Agnes Tungwe, whois a year-and-eight monthsold, has been for a weekwriggling in pain in Kikyo HealthCentre IV in Bundibugyo district.Her mother, Jessica Muhindo ofBuyaaya One village in NgambaParish, rushed her to the healthcentre following an injectionabscess which resulted from apoorly administered quinine injection,burning all her upperthigh muscles.“I took baby Agnes to a local clinicin our village when she showedsigns of malaria. After a few days,I noticed that the injection spotwas oozing pus and was becomingsmelly. I tried to treat it locallywith salt and hot water, but itonly worsened. So, I rushed herto this Health Centre as a last resort,”sadly explains Jessica.Unfortunately, that is all Jessicacan say about this misfortune.The fear of the likely stigma andcommunal rejection that mightbefall her in case she reveals thequack doctor who brought thisunwarranted pain to her firstborn child, is overwhelming yetthe culprit remains such a guardedsecret.Worrying though is the thoughtthat this secrecy may not be limitedto Buyaaya One village – onecan conclude that many otherchildren, have either suffereddeformities or death, especiallyin the hard-to-reach areas ofthe district and in other partsof Uganda, as they seek medicalhelp from untrained and unauthorizedpeople.What is even more disturbing isthe fact that the mothers unintentionallyhand their children todeath.They cannot access professionalmedical services due to costsand long distances. Most ruralhealth centres are kilometresaway from most homes in ruralareas which is beyond theWorld Health Organisation recommendeddistance within 5kmwalking distance.But, Jessica is quite lucky. She didnot see her daughter succumbto death the way other mothersdid three years ago due to lack ofaccess to basic medical services.Three years back, Jessica wouldhave had to run all the way toBundibugyo Hospital about awhole day’s walk away for herdaughter’s treatment. Fortunately,with the extension of healthservices, she dashed her daughterlate in the night to a World Visionsupported Kikyo Health Centre,half-a-kilometre away uponrealising that the baby neededurgent medical attention.She was fortunate that skilledmedical personnel were availableat that time of night to giveher baby first aid and immediatetreatment.Emmanuel Muhindo, the headofficer in charge of the healthcentre, at that time says BabyAgnes was received in a criticalcondition she could have lost herleg if nothing had been done.“She is a lucky baby – if her motherhad delayed any further, shewould have lost her leg. The rottenwound was quickly treatedher with antibiotics after cuttingoff the rotting skin,” Emmanuelsays, “She is responding very wellto treatment,” he adds.Emmanuel says this is one of themany similar cases they receivedaily, attributing the problem tothe mothers’ poor attitude.“Most mothers are reluctant tocome to health centres. Theythink it is expensive and timeconsuming since most centresare distances away from homes,”he says.24Alive and Healthy

Subsequently, Emmanuel says,the mothers go for the cheapbut deadly options in the longrun -unauthorised local clinicsmanned by unqualified people.According to Rogers Baluku, thechairman of community managementat Kikyo Health Centre,three years ago the centre hadtent as a general ward for admissionof the critically ill. Fewpatients came for treatment becausethere were no drugs andmedical personnel.“It was not easy to retain staffbecause the place is remote.We also lacked accommodationfor medical staff posted to workhere. So many would report anddisappear immediately oncethey found these unfavourableconditions,” he explains.Currently, however, Rogers has adifferent and visibly different storyto tell.“Thanks to World Vision for constructinga block of staff quarterswhich accommodate 12 staffmembers. This has helped retainstaff at the centre,” he appreciates.“We are no longer operatingunder a tent because wehave a new block where the generalward is located which wasconstructed by the communityand World Vision.Consequently, according to Rogers,the number of patients hasgreatly increased because theyare assured of medical attentionfrom available staff and acomfortable room in the generalward.The new block comprises anout-patient department, a dentalclinic and a maternity ward.“On average, we receive about50 mothers for delivery amonth,” says Emmanuel.Apart from handling children-relatedsicknesses, the health centrehas for the last three yearsmobilized and sensitised motherson the need for antenatalcare.More mothers are now seekingantenatal care services at leasttwice during their pregnancy.“World Vision trained villagehealth teams who carry out thisexercise in villages. They mobilisemothers to come early forantenatal care to detect levels ofhemoglobin and rectify any problems”Emmanuel says.He adds that most mothers handledand show signs of malnutritionand anaemia, thus likely todeliver low birth weight children(weighing below 2.5kg).As a remedy, Emmanuel saysthe mothers seek antenatal careservices where investigation onhaemoglobin level, blood group,blood sugar, presence of syphilisand HIV are done. Mothers arealso advised on better nutrition.The work by the VHTs has registeredsuccess going by 17-yearoldSaada Musooki’s experience,a resident of Buyaya Three,Ngamba Parish.Saada who is 24 weeks into herfirst pregnancy says VHTs encouragedher to attend early antenatalcare.“This is my second visit and I ambeing checked for my blood pressure,blood group, and urine test,to determine that my pregnancyis progressing well,” she comfortablystates.The significance of seeking antenatalcare services is also explainedby 21- year-old JenifferBokota who is also 24 weeks intoher second pregnancy. Jenifferlost her first baby at birth due tolow weight and weakness. Sheattributes the loss to irregular attendanceof antenatal care.“I attended antenatal care in thelast trimester. So, I was unableto rectify the related problemsthat developed, hence losingmy baby,” she sadly says, adding:“This time I started as earlyas three months to avoid lossesagain.”Apart from supporting KikyoHealth Centre, World Vision hasbeen in Bundibugyo district since2004 carrying out projects in education,health, WASH (Waterand Sanitation), HIV/AIDS, andsponsorship of various other programmesAlive and Healthy25

Kiboga’s pioneer babyAt about 9.00am on 1 st July, 2012 Ronald Ssenkoomi was delivered atNaalinya Ndagire Health Center III, Mulagi sub-county in Kyankwanzidistrict. He was the first baby to be born at the facility; 30 days after thevillage received its first midwife.“We were exactly one monthold in this village when wereceived our first delivery.Ronald is our 30-dayanniversary gift,” reports ScoviaAmpiire, the Health Centre InchargeIn its entire life, Mulagi subcountyhad never had a midwifeeven when it received its NaalinyaNdagire Health Center in 1998.It had been operating with twomedical staff; a Nursing Assistantand a Laboratory Attendant. On28 th May 2012, Scovia Ampiire- aClinical Officer, Aketch Teddy- anEnrolled Nurse, Tashobya DinahaMidwife and Susan Akiny-another Enrolled Nurse arrivedat the Health Center, so muchto the relief of the over workedGoretti Kabengano- NursingAssistant and Nasaazi Placxerdaa Laboratory Attendant.The arrival of the four newlyposted medical staff excited thehealth center but not as much asit did to the mothers in variousvillages of the sub-county. Underdifferent circumstances, babyRonald would have been underthe risk of village home deliverieswhere chances are that both babyand mother, Dafolooza couldhave died due to mismanageddelivery, or picked infectionsamong other complications.But because Dafolooza had herchild delivered near her home,approximately 2.5kms away, shewas able to have three warmhomemade meals daily broughtin by her husband, BernadoMudogo. She did not have toworry about transportation tothe health center because it wasaffordable as she simply walkedto and from the facility untildelivery time.It was heroic moment forDafolooza to bring forth a newhuman life due to the adequatemedical attention she receivedduring delivery of her fourth baby,Ronald at the Health Centre.“I was so surprised with theMusawo (Nurse) at Nnaalinya. Ididn’t know I was supposed to betreated with deep kindness likeshe gave me. She attended to meall the time and even though mylabor delayed for days, Musawoencouraged me until I deliveredsmoothly,” Dafolooza explained.This was a different experenicefor Dafolooza who had her threeolder children; Sylvia Nampijja,three, Edisa Nakyesero, fiveand Damaseri Kasigwa, sevenat Kiboga district hospital whichis 10Kms away. The hospitalwas always crowded with anaverage of 350,000 patientsmonthly coming from a radiusof up to 80kms according toHospital Medical Superintendentof Kiboga district hospital, Dr.Michael Musiitwa.Due to long distances coupledwith bad road networks, mostparents choose home deliveries.“During our communityimmunization outreaches, wehave discovered that almost 90% of mothers deliver at home”Scovia Ampiire reports. Scoviaand three medical staff wereposted at Nnaalinya HealthCenter after a communitydialogue was held to assesscommunity development underthe CHNC initiative.Previously only two nurses hadbeen handling patients at thecenter, and on several occasionsonly one was available for allincluding children and mothers.The situation remained baduntil WVU through the KibogaCluster project intervened usingthe Citizen Voice and Actionapproach- a local level advocacymethodology that transforms thedialogue between communitiesand government in order toimprove services which impactthe daily lives of children andtheir families.On April 11, 2012 through acommunity gathering, residentsreported that their biggestproblem in this center wasinadequate staff to providethe required services. Localsreported that the two nurseswere too few to handle the bignumbers and on many occasionspatients returned home without26Alive and Healthy

treatment. Lack of a midwifewas another challenge becausemothers found it cumbersometo trek 10kms to Kiboga Hospital.The center also closed over theweekends- on Saturday andSunday due to inadequate staff.She could have lost her leg if nothing had been doneRonald’s siblinngsThe World Vision team forwardedthe residents’ concerns tothe sub-county council for adialogue, which resulted intocouncilors passing a resolutiondirecting the center to remainopen, seven days a week. Thislater culminated into postingof the additional four medicalworkers at the Health Centre.Today Naalinya Ndagire HealthCenter III’s number of patientshas shot up since the new staffwas posted. This is an indicatorthat there is increase in thedemand for services leading toa healthier and more productivecommunity. At seven weeks,Dafolooza was healthy andproductive enough to be in thegarden under the protectivehands of her husband.In May 2012 according to hospitalrecords, 349 patients receivedtreatment from the center butthe number more than doubledto 1,128 after the additional staffreported in June. The center nowremains operational both onweekends and at night, giving a24-hour service throughout theweek.For the children below five years,the center offers immunization,Vitamin A supplements, nutritionguidance and education tomothers, health education, andantenatal services among others.Pregnant mothers are tested forHIVAlive and Healthy27

A grandma’s mouth-wateringmealEven before lunch, Joram Kawumi, five, and Catherine Nsonyiwa,nine, are go about playing as they exhibit a lot of energy. Part of theirenergy is got from eating fruits such as paw-paws and sugarcanes inbetween meals.The duo is joined bytheir relative, SamuelSserwanga, 10. Togetherthey sing and jumpas they play the ‘sipolingi’game as they wait for lunch.“Sipolongi, my father, sipolingimy mother…,” the children singon happily as they play.At the signal of their grandmother,Samuel runs to thehouse and emerges with alarge tarpaulin. He lays it halfopen while Catherine places astack of plates on it.Meal time is a special event inthis household. Seated at thein the circle with the childrenis Lydia Namuli, 50, the grandmotherand family caretaker.She seems pleased to seethe children munching awaya healthy and colourful mealof ‘Nakati’ and ‘dodo’ (localvegetables), groundnut sauce,matooke (green bananas) andcassava.Lydia who lives in Nakigga village,Muwanga sub-county inKiboga district has been a widowsince 2008 and has some ofthe well-nourished children inthe community.Her family is one of the 200families that were trained onbalanced diet and other nutritionbasics which have so farbenefited 548 children in Muwangasub-county.After the death of her husband,Lydia struggled to performboth the motherly andfatherly roles. Single handedly,she continues fulfilling her responsibilityof paying universityand secondary fees for herfirst born, Daudi Ssewakiryanga,16, two of her other schoolgoing sons and daughter IreneMbatudde.In addition, she also meets thehome welfare needs of herfore mentioned grandchildren,nephews and nieces.Having agreed with the communityopinion leaders thatchild malnutrition was a bigchallenge in Kiboga district;WVU started a health and nutritionprogramme in the area,training mothers and caretakersin basic skills of preparingnutritious meals for their familiesusing community availableresources.Watching Lydia and her familyprepare a day’s meal is interesting:She goes with Irene and Samuelto pick matooke from thegarden.The children also joyfully participatein preparing the mealby peeling matooke and preparingthe fire. Lydia stocksenough firewood, which shesays is vital in preparing a quicknutritious meal. Catherine andJoram go to the nearby gardento pick green and red vitamin-filledvegetables. Otherchildren help pound roastedsoya beans and ground nuts inlocal wooden mortar.The ground nut paste is boiledfirst which when ready, Lydiaadds two spoons of soya flourand boil for another 10 minutes.She prefers to steam ratherthan boil the matooke topreserve nutrients which shelearnt are good mainly for potassium.“I never feel comfortable cookingone type of food. Thesechildren and I have diverse28Alive and Healthy

Lunch time at Lydia Namuli’s home in Kiboga districttests. We grow these foods andwe do not see why we should notenjoy a variety at every meal,”she says, adding: “I am carefulto provide vitamin and proteinfoods at every meal. The childrenhave learnt this drive and are activein integrating vegetables inour recipes.”During meals, she carefullywatches the children eat whichhelps her monitor their eatinghabits. Loss of appetite from thechildren calls for alternatives atsubsequent meals or medicalcheck-up.Lydia has a vibrant matookegarden of 412 suckers receivedfrom the government NationalAgricultural Advisory Services(NAADS) program. She raises thechildren’s school fees from saleof surplus matooke. She boughta Fresian cow which providesmilk that boosts the protein dietfor her family. It’s dung is used tofertilise her gardens.With WVU’s support, Muwangaand other sub-counties countrywideuse Ekitoobero (a mixerof proteins, carbohydrates,fats and vitamins foods) diet tocurb severe malnutrition amongchildren below five years. Kibogadistrict has 14 model villagesfor Ekitoobero diet to help slowlearning child caregiversWorld Vision uses community-based approaches to address nutrition-relatedcomplications that affect the child’s well-being.The approaches aim at causing sustainable behavioural changeamong mothers and caregivers. Mothers and caregivers aretrained on improved nutrition and hygiene practices. The trainingsencompass demonstrations on the preparation of nutritiousmeals tailored for children and how children should be fed.Emphasis is placed on providing elementary knowledge to participantson the different food groups and how these can be combinedto form a balanced diet. The use of locally available foods isthe major focus here.The media such as radio is also a major channel through which wepass on nutrition information to mothers and caregivers. The radiotalk-shows are interactive and panelists sometimes are comprisedof mothers practicing a given behaviour we are promoting.The essence is to encourage other mothers to adopt the bestpractices.Five year old Joram Kawumicarrying a pumpkinBy: George Waliwomuzibu, Nutrition Officer-World VisionAlive and Healthy29

Grace’s trick tohaving healthybabiesAt the age of five, Ronald Kagame goes to Springsof Knowledge Nursery and Primary School in Kasawosub-county Mukono district located about 50kmNorth of Kampala city. The school is located in a busyrural trading center, about 200 meters from his home.Pupils in the nursery section return home at 1.00pm.The day is very hot, Ronaldlooks tired but hewears a wide smile andopens his arms as he isreceived back home by his oneand half year old younger brother,Lucky Mark Rwigyema. Ronaldresponds joyfully to the warmwelcome.Their mother, Grace Nakityo, 32,a housewife and shop attendantis amused and looks on withthrill. She has just been breastfeedingMark who looks satisfiedand happy.The mother of five says she expectsto breastfeed Mark for twoyears or more, just like she did toRonald and her other children.“I like breastfeeding. My childrennormally wean off by themselvesor after people start teasingthem to stop but after attainingtwo years and above,” she said.Grace says she attended severalWVU education seminars onhealth and nutrition where shelearnt about child nutrition anddiscovered that exclusive andlong breastfeeding was the bestway to have a healthier baby.She says she also uses the ‘trick’as a family planning method toattain child spacing. Her eldestson, Frank is 13 years. He is followedby Derrick who is 10 years.Resty her third born is eightyears. Since Mark is her last bornand does not plan on havingmore children, Grace is planningto use a modern family planningmethod to prevent unwantedpregnancies.“Ever since I decided to breastfeedexclusively, I get enoughtime to look after my babies whoare healthy and rarely get sick,”she said with a wide smile.During my conservation withGrace, Mark interacts with mostcustomers who know him. Occasionally,he responds and waves‘goodbye’ to whoever buys fromthis shop.Most ordinary busy mothers findit weird that Grace has continuedbreastfeeding Mark even at hisage but Grace is not discouragedby what people have to say.“I can’t see any reason why Ishould stop breastfeeding offsince I have enough breast milk.When I stop breastfeeding, I feelsick so I use this as advantage tocontinue breastfeeding” she explained.She breastfeeds at leastfour times a day and wheneverMark feels hungry.The other trick Grace learnt fromthe WVU seminars is that she hasto give enough time to the babyat each breastfeeding interval. “Imake sure nothing interrupts hisfeeding, I have a lot of milk andI let him feed until he stops byhimself,” she said.To ensure constant flow of milk,Grace eats well and takes a lot ofmaize and millet porridge. Sheeats ordinary foods like bananas,sweet potatoes, cassava andgreen vegetables.“My babies give mepeace and I feel happyseeing them satisfied”.30Alive and Healthy

Ronald Kagame and his classmatesat Springs of Knowledge Nurseryand Primary School in MukonodistrictGrace Nakityo carrying herlast born Lucky Mark RwigyemaAt this age, when Mark feels hewants to feed, he does not cry likeother babies. According to Grace,he normally comes around her,clings onto her leg when she isstanding or opens the chest buttonby himself and pulls out thebreast when she is seated. Shecan tell when he wants to sleepor finds out the problem when hegets moody.When she is not available, thebaby is fed on porridge by thefather or by any other person athome. Following advice fromnutritionists trained by WorldVision, Grace has also startedfeeding Mark on special preparedmeals locally known as ‘ekitoobero’(a mixture of different foodprepared together).World Vision facilitates healthworkers from the health centerto conduct outreach programmesat village and parish levels andat the health facility during immunizationdays under a specialnutrition programme called PositiveDeviance Hearth. Amongother things, mothers are taughthow to prepare baby nutritiousmeals using available food like silverfish, groundnuts, soya amongothers.The ‘ekitoobero’ formula has becomeso popular in most WorldVision operational areas thatmost mothers who have taken itup have reasons to smile.As a result of longer breastfeedingaddition to providing a balanceddiet to her children, Grace’s babiesperform well at school.Teopista Babirye, the headmistressof Springs of KnowledgePrimary School where Ronaldstudies reports that Ronald heldthe third position in his class lastterm.She says the boy is always amongthe top performers and is fastat grasping what he is taught inclass and outside. He participateswell in co-curricular activities andlikes playing. “He is generally social,happy and gets on well withpeers,” she said.Erick Walugembe, a child sponsorshipand development assistantin WVU acknowledges thatWVU conducted several trainingseminars for mothers on the bestnutrition practices for childrenincluding exclusive and longerbreastfeeding.“Our trainings have been able tochange many mothers’ attitudesand we have reduced cases ofmalnutrition amongst childrenunder the age of five, which inturn has saved families from overspendingon medical treatment,”Erick says.Under the CHNC mothers likeGrace whose life style and behaviourschange positively afterlearning the importance of a givenpractice such as breastfeedingare considered role models. Theyplay a tremendous role in teachingother mothers to emulatethemAlive and Healthy31

Facts about BreastfeedingBreastfeeding a baby exclusively for the first 6months, and then continued breastfeeding in additionto appropriate solid foods until 12 months andbeyond, has health benefits for both the motherand child.Importance of breastfeeding forbaby* Babies who are fed breast milk have a lower riskof gastro-intestinal (gut) illness, allergies, asthma,diabetes, obesity, some childhood cancers, respiratorytract (chest) infections, urinary tract infections.* Breastfed babies are less likely to be hospitalised.* Breast milk has important ingredients that arenot found in any infant formula, to build the baby’simmune system. Breast milk changes from feed tofeed to suit each baby’s unique needs, making it theperfect food to promote healthy growth and development.* Breast milk is more easily digested than infantformula. Breastfed babies are rarely constipatedand are less likely to get diarrhoea.Going Against DeathTrendScovia Mahoro would be alive today had thePrevention of Mother to Child Transmission(PMCT) programme been in place at NabyewangaHealth Centre II.Unfortunately, it was not there – Scoviasuccumbed to AIDS at the age of two,missing enjoying life with the rest of herfellow young ones. She was the secondborn to 28-year-old Consolatta Nyirantezimaana,a Rwandan refugee mother living at the peripheryof Nabyewanga trading centre near the shores ofLake Victoria – about 100km south-west of Kampalacity.Scovia was infected with HIV at birth and perseveredwith the virus until she succumbed to thedisease in August 2010 two year later after herfather’s death. Little happiness is told in Scovia’sshort life because she lived amidst prickly povertyand spent most of her life sick. By the time of herdeath, her mother was expecting another child,Hamza Kiyega (now aged two), from her secondhusband, Bashir Ssesimba.* Breast milk has no waste products and leaves nocarbon footprint.* Breast milk is FREE, convenient, clean and safe –always available at the right temperature anytimeImportance of breastfeeding formother* Assists the uterus return to its pre-pregnant statefaster* Can help women to lose weight after baby’s birth* Reduces the risk of ovarian cancer and pre-menopausalbreast cancer* Reduces the risk of osteoporosis* Reduces the risk of mothers with gestational diabetes developing Type 2 diabetesHamza too would have lived a life similar to his sisterScovia hadn’t WVU introduced PMCT servicesin Mpigi district at Nabyewanga Health Centre. Thehealth centre is located in a highly populated areawith several landing sites on the shores of LakeVictoria. Most of the residents fish mongers andpeasant farmers.-However, Hamza too has a story to tell. He was deliveredat home late in the night. Earlier that day(during the day) Consolatta visited a nearby healthcentre located a quarter-a-kilometer away duringthe day because she was in labour. On arrival, anunskilled health worker who examined asked herto return home because she could not help her.When the labor pains intensified later that night,Consolatta delivered a baby boy from her homeunattended too.“I was surprised by the nurse who examined me.I was sure the baby was about to come because Ihad counted my days well and I could feel the la-32Alive and Healthy

our pains. I delivered by myselfthat night,” she narrates.Catherine Birabwa, a registerednurse and the in-charge at NabyewangaHealth Centre II, confirmsthis. She says the centre didnot have a midwife at the timeand the person who handled themother was not qualified.“The situation was bad. ThePMCT programme was not yethere, only two people mannedthe center and none was qualifiedto handle mothers yet it wasthe only available health facilityin the area,” she said.World Vision introduced thePMCT programme at the centerin September 2010, two monthsafter Hamza was born. Fortunately,Consolatta had been sensitisedabout PMCT. Frustratedby the nurse at Nabyewanga, shetook baby Hamza to Nkozi Hospitalthe next morning for vaccinationand management againstHIV infection.After the introduction of thePMTCT programme at Nabyewanga,Hamza continued gettingtreatment from there. WhenHamza made one year and sixmonths, he was tested declaredHIV free.The battle to prevent HIV transmissionhad not ended. Monthsdown the road, she discoveredthat she had conceived again.Later she gave birth to CraishSsesanga. Even though the couplewas taking antiretroviraltreatment (ART) drugs, Consolattaworried that the baby couldget infected with HIV.Throughout this pregnancy shewas on preventive treatmentprovided by Nabyewanga HealthCentre II. After delivery, nursesinstructed her to breastfeed thebaby and give him syrup until hewas nine monthsAt one-and-half months, Craishwas tested and was HIV negative.He is now 11 months and nursessay they will test him again beforehe graduates to a free HIVbaby.Today Consolatta who is 28weeks into her last pregnancy istaking careful steps to ensure thebaby too HIV free. She has beenattending meetings organised bythe Mama Club where she hasbecome more aware on the prevention,care and treatment ofHIV and AIDS.To avoid another pregnancy, Consolattaand her husband are nowcontemplating the best familyplanning method to utilize. Herhusband agrees that spacing hasbeen a problem and has droppedhis quest for a baby girl.“Since the introduction of PMCTservices here, all babies deliveredhere by positive mothers are freeof HIV,” Catherine says, declaringthe programme a success so far.Hamza is among the eight childrenwho have so far graduatedsince September 2010. Thirtythree children are still on earlyinfant diagnosis.“At least 21 mothers have deliveredfrom the centre since July2012. At least between 600 and700 patients receive treatmentat the centre every month,” reportsCatherine.Despite the horrible povertyaround this home, Consolattacontinues to put up a spiritedfight against HIV/AIDS. She livesin a tiny iron-roofed house withfive people including her eightyearelder daughter.For today’s lunch, Consolattta ispeeling tiny potato tubers whichwill be accompanied by a cup ofblack tea.“Sometimes I cook this foodand prepare just dry tea for thebabies, but when I get money, Iprepare porridge for the childrenbecause I know it is good forthem,” she says, at least affordinga smile.She fled her country during thecivil war and settled in Ugandawith her late husband. Hopesof returning to her homelandseem to be fading as she hopelesslysearches into the future.With few relatives to lean on, shemanages to remain a strong andself-driven woman.Her perseverance in learningnew methods on how to takegood care of her children hasgained her favour from some ofthe health workers in her village.“She is very active; she doesnot miss any of our sensitisationmeetings and reports tothe health centre in case of anyproblem,” says Stephen Kiganda,a VHT volunteerAlive and Healthy33

About PMTCTThe risk of mother-to-child transmission of HIV can be reduced to less than 5 percent through acombination of prevention measures (PMTCT) , including antiretroviral therapy (ART) for the expectantmother and her new-born child, hygienic delivery conditions and safe infant feeding.According to new guidelines issued by the World Health Organization (WHO), a woman with HIV canbreastfeed her baby in settings where it is judged to be the safest infant feeding option. She must,however, breastfeed exclusively and she or her newborn need to receive ART at the same time.Although many countries have made great efforts to establish PMTCT services, many pregnant womenin rural areas do not have the means to reach them. Among those who attended antenatal care in 2010,less than a half received an HIV test (WHO, 2012).A caring husband savesboth mother and babyLaden with his four-day-old baby and his dry-lippedwife in a small trading centre, this family portrays adifferent picture from the norm as they trekked backhome from Nakaseke hospital.This scene is a tip of theiceberg of how Nyandamura28, got involvedin supporting his wifewhen her labour pains began at8:00pm. During the day, Nyandamura’swife, Sadrini Akimanaignored abdominal pains andwent ahead to beat the chaff outof the soya bean harvest, whileconsistently writhing as she wentabout her work. Little did sheknow that the baby was due fordelivery.When emergency stuck, “I had tohurriedly get a bodaboda (motorcycle)at sh5,000 to take thetwo of us to Nakaseke Hospital.Just as we arrived, the baby’shead began popping out. Shewas rushed to the labour ward,”recounts Nyandamura.“At the hospital, I realized wedid not have requirements suchas hand gloves, a basin, polythenepaper and cotton woolwhich I had to buy immediatelyat UgSh.65, 000. But what matteredwas seeing both my wifeand baby healthy”After what seemed like eternityin waiting room, Nyandamurawas able to see both his wife andsecond born child, Anania Iyunvasafe and in good health.However, pressed by financial insufficiencyto cater for the motherand baby while in the healthcentre, he requested the authoritiesto discharge the duo beforevaccination was done. Back athome, their first born child, PaulIranzi, was at a priest’s homefor temporal care. The next day,Nyandamura escorted both hischild and wife back to the healthcentre for vaccination.The financial constraints did notdeter Nyandamura from ensuringhis wife and baby was healthy.In 2011, Nyandamura attended aChild Health Now campaign fairwhere he learnt about the importanceof men being involvedin maternal and child health issues.Even though, the couple had notproperly planned for the birth oftheir baby, Nyandamura decidedto dedicate his effort to supportinghis family.“Now that we are back at home,I am doing the cooking as Sadriniheals. I fetch water from the welland sweep the house – we sharethe responsibilities. But, I reallyappreciate the care that the hos-34Alive and Healthy

pital staff accorded us. They wereso tender with my wife!” Nyandamuraappreciates.Despite the engagement in homechores, Nyandamura did not neglectthe importance of vaccination;he still has it at heart. Today,the couple had another visitto the health centre for anotherdosage of vaccination.“ Today, we have walked 13 milesto the hospital to get vaccination,although it means both of us beingaway from 8:00am and gettingback home at 8:00pm on anempty stomach,” Nyandamurasays, adding: “I have spent all mysavings of sh80,000 on footingthe hospital bills, but God is thegiver, he will replenish.To confirm Nyandamura’s story,I cross-checked the hospitalrecords where I found his wife’snames written in blue ink.The nurses say their efforts tourge him to stay for one moreday and have the baby vaccinatedwere futile because he did nothave the finances to sustain hisfamily. But they were glad whenafter three days he took the babyfor vaccination.Tracked down to his rural homewas a revelation of why he preferredto be home other thanhospital. He has taken over managingthe home until his wife iswell enough to resume her duties.He is more than caring goingby what he does and the zealwith which he does his work.He lights a wood fire, preparesporridge and boils cabbage andbananas for his family.“I have brought Paul (first born)back home and I am able to goand do my lejaleja (odd jobs) toearn small money and buy essentialslike soap, salt, sugar andbeans,” he says with resolve.Now that the family has two children,Nyandamura plans to usefamily planning methods to preventunwanted pregnancies.“We are going for family planningbecause of our low income. “Wecannot manage to support anothermouth right now,” NyandamurasaysA mother’s confessionBy Norah NakabuyeMy name is Norah Nakabuye, from Nakaseke district. Before Igot positive-parenting lessons, I was such a cruel mother. I usedto bark at the children and never used to hug or clasp theirhands in affection.Iwould cast them a cruel eyeand no a child’s crying wouldmove me.On the inside, I would get theurge to pick up a crying a child,soothe and cuddle them. But, myoutside seriously resisted – alwayspretending like “your cryingdoes not move me. I want youchild to see my point of view andI will not care what yours is”.My intentions were not to hurtany of them. I just thoughttoughness is the path to parenting.I still recall that I never hadthe time to investigate why mychildren were crying.There was no time to waste onsuch petty issues – as I thoughtso then. Playing with thechildren was an alien practice. Isimply assigned each daily household chores followed with strictdeadlines.Very often, my wrath overflowedwhen the chores were not accomplished.As a result, I noticedthat a cemetery silence engulfedthe house whenever my voicewas heard. My children’s playmatesfrom the neighbourhoodwould sprint back to their ownrespective homes the moment Iwas sighted back home.Worse still, none of my childrenseemed to confide in me, and IAlive and Healthy35

now wonder how I never evensensed the widening gulf that existedbetween my children and I!Honestly, I regret having terrorisedmy children to that dangerousmagnitude. I have learntthis is why teenagers get rebelliousand flee from their parentalhomes, some of them becomingstreet children and others drugaddicts.With this realization, I regret havingprovided a hostile home tomy children. I urge every parentto think about the effects of theirbehavior either a slap or hashwords to their little ones. I adviseparents to get time to chat withthe children or send them messageson the phone remindingthem about your unconditionallove, eve lasting care and howyou wish them the best in life.I also urge parents to alwaysmonitor their children’s healthinstead of assuming that is theircharacter or ignoring their moodswings. If I were given a secondchance to mentor my children,I would make them toys,play kawuna (hide-and-seek) orkwepena (dodge ball) with them.I know this would double as anexercise or physical fitness forme. If I didn’t have the moneyfor buying toys, I would locallymake toys for example bywrapping a fiber ball or makinga fibre baby for the girls. Thisis what makes parenting fun.Today, the way I relate with childrenhas definitely changed.When I return home from work,unlike as it were in the past, I receivewelcome hugs, cheers andbig smiles from my grandchildren.Instead of running away fromme, they are attracted to melike grasshoppers to light in theirseason.None of them ever hides behinddoors, in the toilet or fleesaway. I even want to know theirfriends. Our home is peacefulwithout any inferiority or superioritycomplexity.If I were to conceive now, I wouldstart to sing for my baby in thewomb at zero age! Doctors saythe atmosphere in which a fetusis conceived determines thecharacter of a child.A fetus is affected when themother smokes, take alcohol orwhen a mother is being battered.I have also learnt that loving achild is not a preserve of mothers.Fathers can also do a goodjob when it comes to parenting.Even if the baby is still in thewomb, it can interpret phrasesof endearment or a tender touchon the stomach.Relationship misunderstandingsgreatly affect the baby in thewomb. The moment a motheris not happy, the sad moodis relayed to the baby who haschoice, but to sulk like the motherto whom it is connected.Mothers should feed well, betreated for any ailment and bepampered, while pregnant ifthey are to bring forth a healthynew born(Top) Owen Onyali washing his handsfrom a tippy tap. (Below) Owen’s sisterMaimuna washing her feet from thebathroom.36Alive and Healthy

Basic hygiene practicesenhance family happinessOwen Onyeli is an eight-year-old jovial boy in Primary One at BundimasoliPrimary School in Bundimasoli trading centre in Bundibugyodistrict.He is the fifth born ina family of eight childrenliving with theirgrandmother EvakateKyarukale, 53. His father, BoscoOboth was a policeman whopassed away last year after ashort illness. To make endsmeet Onyeli’s mother does oddjobs in Fort Portal town.Approaching their homestead,one cannot help but noticethe clean environment; a wellswept compound, dishes andutensils tidily kept away outsidethe kitchen on a drying rack.As the children see strangersbranching to their compound,out of curiosity they come runningtowards them. All the childrenare well-dressed in rubbersandals – they are on their wayto fetch water at the nearby tapthat was constructed for themwith support from WV’s UgandaWater Sanitation and Hygiene(U-WASH) Project.The children are notably smartand clean, even when the floorof their house is not cemented.Owen is quick to respond thattheir grandmother always encourageseach child to be cleanto avoid diseases.“Before, we used to run aroundbarefooted and would oftenfalling sick with cough, flu andmalaria, but since grandmawent to those teachings (trainingsby World Vision), she isalways teaching us new things,like safe hand washing usingthe toilet which we never didbefore,” says Owen.Owen’s grandmother, Evakatelearned a lot from attendingtrainings on improving health.As the immediate guardian ofher grandchildren, she Evakateused to spend money monthly,either on treatment of rashes,scabies, cough, flu and diarrhoea,among other communicablediseases. She did notrealise her little ones could behealthier until she attended thevillage hygiene campaigns thatare regularly conducted by VillageHealth Teams (VHTs).“I learnt that children andadults must wash hands everyafter toilet use. It helps to reducesickness,” she says, addingwith a smile loaded with satisfaction:“I can now save mymoney for the so many needswe have at home, for instance,I buy them milk every Sunday.”Use of proper bathing facilitiesis the other household hygieneEvakate learnt and is now practicingit with the children.“Before we constructed a bath-ing shelter, the children usedto bathe from outside. So, thecompound was always wet andfull of stagnant water – it wouldbreed mosquitoes which causemalaria,” she says.“Now the children rarely fall sickwith malaria,” Evakate adds.Owen often helps his grandmotherwith washing utensilsand spreading them on the dryingrack.“We used to wash the utensilsand spread them anywhere likeon the mat on the floor, butnow grandma constructed thisrack to keep our utensils cleanafter washing to avoid germsand diseases,” he explains.One cannot help but notice thehappy faces of the children asthey run around, which is a signof the absence of ill health.Their grandmother acknowledgesthat it is the teachingsshe heard from the VHTs thathave helped improve the children’shealth.Clean homes, hand washing facilitiesnear toilets, bathroomshelters and dish drying racksare evident in 75% of the householdsaccording to communityreports at World Vision’s clusterin BundibugyoAlive and Healthy37

Clean and safe Water, a right for AllChildrenAs I walk along the village paths of Nyabulenge village, Ngambasub-county, Bundibugyo district, I hear the endless sound of flowingwater and the laughter of children as they play and run alongthe paths on their way to fetch water for their homes.Afaster walk towards thesounds leads me to awater source, a protectedspring called NyamujunaSpring as I later learn fromthe locals. I follow one of thechildren after they have fetchedtheir water and it turns out herhome is just a hundred metersaway from the protected spring.After exchanging greetings I askher if she enjoys fetching waterand her answer is an enthusiasticyes. On enquiring why, she says,“Because the water is very cleanand very near home. Before mysisters and I used to fetch waterin an open spring, it was regularlydirty and I never liked the experiencemost of the time.”She adds after a short pause,“We also often used to fall sickwith stomach aches, diarrhoeaand skin rashes because of drinkingthe dirty water.” When askedwhy she thinks it’s the waterthat caused the sicknesses shesays she heard about it whenthe village health team memberscame to sensitise the communityagainst drinking water from exposedand dirty springs.During the conversation, motherJemima Mwana Mwana, 30,comes to welcome us to herhome and joins in the talk. “Yesit’s true. I was always treating mychildren for endless water bornediseases before the constructionof the protected spring. The VHTsalso came and talked to us aboutthe dangers of drinking dirty waterand encouraged us to use waterfrom the protected springs.Since then my children never fallsick of any water borne diseaseslike before and we drink cleanand safe water,” she reports.During the time of the visit, therewas cholera outbreak in the areabut according to World Vision’sstaff Franklin Masereka says,“but I have never heard of anyonein Ngamba sub-county fallingsick,” He attributes this to theavailability of protected springsin the villages.According to Franklin, WVU hasso far constructed 19 protectedsprings in Kasitu Area DevelopmentProgramme which are providingclean and safe water. Ofthese, Nyamujuni Spring is justone of them and serves about200 households of Nyabulengeand Buyaya Two villages, bothfound in Ngamba sub-ounty38Alive and Healthy

Improved health services; anincentive to seeking health careOn a bed at Tubur Health Centre III in Aparisa village, Tubur sub-county in Sorotidistrict, Jennifer Amollo, 22, and a mother of three, sits calmly.She is carrying her sleepingbaby, Timothy Eleu, whowas diagnosed and immediatelyadmitted in thechildren’s ward the day beforewith malaria. He has a drip in hisright arm.Jennifer says she always bringsher children to the health centrewhen they fall sick.“I used to sit home helplesslywhen my children fell sick until2010, when the children’s wardwas officially opened,” she says,adding: “Since then, I know thatwhen I bring my children here,there is always a medical personnelto attend to them, thereis medicine and if they are veryill then they will be admitted andwill taken care of.”As a norm, the health centremanagement gives mosquitonets to mothers upon delivery ofbabies to prevent both the motherand the baby from getting malaria.“Indeed, when I gave birth toTimothy, I received a mosquitonet under which he sleeps everynight,” attests Jennifer.She also says that unlike her twoolder children, Joshua Oriuna,seven, and Sharon Agello, four,who never slept in mosquitonets when they were younger,Timothy rarely falls sick. Effortsto seek medical treatment inthe past were frustrated by lackof doctors and medicine at thehealth centre.Today, the health centre hasimproved its service provisionhence the only reason why Jenniferdecided to bring Timothyto the hospital as opposed to administeringlocal herbs at home.Besides providing mosquito netsto new mothers, the health centrenow has a skilled health workerswho provide treatment to thepatients when needed.For example, the nurse in chargeat the time Timothy was admitted,Christine Asalo, says, “WhenTimothy came in; he was lethargicwith a high fever. We put ona drip of quinine and dextrose,which he will have to completein the next two days. Now he ismuch better and is ready to bedischarged tomorrow,” she says.Esther Amallo, 22, who hails fromAwesi village, Tubur sub-county,is another happy mother at thehealth centre.“I saw my child’s eyes glazed overand had a high fever – I rushedhere immediately because Iknew these were signs of malarialike the VHTs had told us in manyof their sensitizations,” she says.She adds that, “VHTs advisedthem to rush to the health centrewithin twenty-four hours to savetheir children from deaths.”“He was treated and we wentback home. I have just returnedfor review like the doctor askedme to,” Amallo explains.The former chairperson of Tuburhealth unit managementcommittee at the health centre,Joseph Eliau, says services havegreatly improved since the interventionof World Vision in 2007.“Before, we only had three medicalpersonnel – today we boastof 11. World Vision has greatlyimproved health care servicesbecause this is the healthy centrein sub-county and neighbouringsub- counties like Arapai, Katinein Soroti district and Orunga andAkeria in Amuria, a neighbouringdistrict,” reports Joseph.Josephs recounts that the centreused to have as many as 400patients per day, but with WorldVision training and support to 15VHTs who were trained and givendrugs to administer at HealthCentre I only about 200 patientsare received daily at Tubur HealthCentre III.“We are also able to provideoutpatient services, laboratoryservices, in-patient and children’sward admissions. Thanksto Word Vision – we have a children’sward which was donatedto the health centre in 2010 tohelp with child-related diseases,especially malaria,” he appreciates.Alive and Healthy39

The ward, according to Eliau,was equipped with 25 beds, 25mattresses, 25 blankets, 25 bedsheets, furniture nets and drugs.“We also have static immunizationeveryday at the healthcentre and 12 VHTs trained ascommunity-based vaccinators goout for daily immunization,” heexplains, observing: “Before, thesub-county was poor at immunisationwith only 24% immunized,but today it has risen to 95%.”Joseph recalls that as part ofWorld Vision’s Child Health NowCampaign, in February 2012,12members of the health unitmanagement committee weretrained to sensitise and educatethe community on the need tobring their children to the healthcentre for treatment and otheravailable services.“For long, people always knewthat would not get services andmedication if they went to thehealth centre. This has, however,changed due to World Vision intervention,”he says.It is therefore no wonder, thateven with a child still admitted inhospital, Jennifer is calm becauseshe knows all is wellWhy Butangira Mothersimmunize BabiesGrace Alata, 38“I am a mother of eight children,unfortunately, one child died.His death was a big lesson. If Ihad taken him for immunization,he would still be alive. Today immunizationis the fortress I buildto protect my kids. I under takeit religiously in order to guardmy children from killer diseaseslike cholera, measles and polio.Some people tried to discourageme against vaccination becauseit subjects the children tointense pain. I took their pointseriously, but, opted to reducethe inflicted pain by having themswallow pain killers like aspirintablets.”Akong Jackline, 23“I took my child to Coope forimmunization, because, that iswhere I gave birth. The nursesadvised to me to take AtimAmong now two years old, forimmunization, if I wanted himalive. Atim is my third child. Immunizationhas always protectedmy children against diseases.The nurses caution that we riskhaving the children crippled, bypolio or mentally degenerated, ifnot checked medically.”Pamela Akello, 19“My oldest son Brian Kakanyerois 18 months old. He is left withone immunization doze. It is thesolution to stop children fromdying before they celebratetheir fifth birthday. After hav-ing four children I want to stopconceiving completely. I am toldit wears out the body. Besides Iam in a polygamous marriage, Idon’t want to burden the breadwinner (husband). We (wives)love our husband so much andwould not care if he married athird woman. She will help withlabour and child bearing whichmakes women age very fast.”Lucy Oyela, 20“I gave birth four days ago. Thechild has not even been givena name. My first born is MercyApio who is two and a half yearsold. Immunization is good becauseit protects children fromkiller diseases like polio.”40Alive and Healthy

A child receiving Polio vaccinationImmunization at Coope HealthCenter in GuluThere is a steady increase in the immunization data at Coope Health Centre.Mothers are increasingly appreciating the benefits of immunization to thefamily health.Ironically, the figure plummetedfrom 89 babies in January2012 to 68 in February, 78in March, 77 in April, 55 inMay, 50 in June, 39 in May, 39by July and 91 in August. Thefall in immunization numbers ispartially attributed to the returnof peace to villages and cessationof Internally Displaced People(IDP) camps in the area.“At the peak of the Lord’s ResistanceArmy (LRA) civil war Coopewas the safest place to be,” saysJohn Okeny, a VHT “That wayit was easy to mobilize all thechildren and have them immunizedagainst killer diseases.”“To cope with changing post warsettlements, other than urgingmothers to take their childrenfor immunization – there are mobileimmunization out reaches.”“Another explanation for fallingnumbers being is that it was onlyCoope with refrigeration gear tokeep the medicine before beingtransferred to various healthcenters, so instead of going toother posts and bounce, motherspreferred communing Coope.”Besides immunizations, In October2012, Coope Health Centercarried out a communal sprayingto kill misquotes that spread malariain the area. 1,200 benefittedfrom the initiative.However, HIV is still mystic inCoope especially among discordantcouples, where people continueto live in denial and somewomen fear to tell their spousesabout their status. Stella Achieng,a mid-wife observes that, thenumber of mothers tasting HIVpositive is comparably very low.“You find that in January twomother tested HIV positive and 15were negative. The trend continuedwith 4:16 in February, 0:10 inMarch, 1:18 in April, 3:16 in May,3:16 in June, 1:23 in June and 1:15in August,” says Stella. “Unfortunatelythose found positivevanish and secretly continuetheir lives in denial. There is stillneed for sensitization among thepopulace-on how to prevent thebaby from HIV infection fromtheir mother.”The prevention of mother tochild transmission of HIV difficultto implement because manymothers do not reveal their statusto their spouses due to fearof breaking up their marriages.“The man will simply chase herout of the marital home and marryanother woman. Promiscuityhere is prestigious among theyouth who are not so religiouspeople.”Alive and Healthy41

Stemming HIV andAIDS in the BudFour years ago, Jackline Kyalisima, now 25 years old,was a confident young lady ready to conquer the world.But her dream was boorishly cut short when she wasabout to complete her one- year catering course atMillenium College in Hoima district. She fell in lovewith a young man who three months down the roadmade her pregnant and she had to drop out of school.“My mother was disappointedbecause she hadsolely paid for my schoolfees up to senior four andthen college.” She narrates. “Afterdiscovering that I was pregnantand dropped out of school Istarted living with my boyfriend.“At three months, I went for aroutine antenatal checkup at KikubeHealth Centre IV and discoveredthat I was HIV positive.I was shocked and too scared totell anyone, not even my boyfriend.For over a month afterthat I felt so weak. The midwifegave me some tablets and encouragedme to take them daily.I was later given one more tabletto take at the onset of labour. Iwas told that it was to preventmy child from getting HIV fromme at birth.”Asked why she never revealedher status to her boyfriend, shesays, “I had just moved in withhim and did not know how hewould react. The midwife askedme to come with him for the nextantenatal checkup so we wouldbe tested and counseled together.”“When I told him that the midwifehad asked me to go withhim for my next antenatal visit,he refused without giving me anyreason which made it even harderfor me to tell him what washappening to me.”Jackline strongly believes shecontracted the virus from her42Alive and Healthy

oyfriend because when shetook a routine HIV test after apregnancy test, she was found tobe negative. It was only after herfirst antenatal visit that she wasfound to be HIV positive.“He has never discussed with mehis status but I believe he is awareof it because in October last year,he underwent police training andregistration and one of the conditionsto qualify was to undergoa routine medical checkup whichincluded HIV testing. After testing,he never proceeded with thetraining. I believe it was becauseof his positive status but has nevertold me anything about it”.Jackline plans to talk to onemember of the village healthteam or health worker to talk tothe couple about HIV and AIDStesting so that both can revealstatus and employ the best careand treatment.Fortunately for Jackline, exceptfor occasional headaches whichrespond to painkillers almost immediately,she has never fallenseriously sick with any opportunisticdiseases. It was only duringher second pregnancy that shefelt weak for about three monthsbut later became strong andcontinued with her normal life tillshe gave birth.She now has two children, GodwinKyomuhendo, three and ahalf years old and Patience Gumisiriza,10 months old. Bothbabies were tested and declaredHIV negative. The first born hasalready undergone the Early InfantDiagnosis (EID) process andfully declared HIV negative butthe younger child is yet to undergoother tests to confirm if she istotally HIV free.“I don’t intend to give birth againbecause we were taught at thePrevention of mother to childtransmission (PMTCT) centre thatthe more we give birth, the morethe chances of getting weakerand get opportunistic disease. Iam currently using Depo-Proverainjectable as my family planningmethod. Luckily my boyfriend isalso in support of child spacingand wants us to have anotherchild after five years.”For now, Jackline, a housewife,is trying to make the best of hertroubled life. She loves tailoringand would like to grow rice andother foodstuffs so she can sellthem off to buy a sewing machine.“I regret dropping out ofmy catering course, but I alsohave a talent in sewing and infuture I would like to set up mycloths shop to keep me busy as Ilook after my children,” she says.The PMTCT centre was set up atKikube Health Centre IV HoimaDistrict two years ago with fundingand support from World VisionUganda. It targets pregnantmothers and their babies beforeand after birth.World Vision Uganda supportsoutreaches carried out in theADP areas in the district and encouragesmothers through villagehealth teams to come for earlyHIV testing and antenatal careservices at the health centre.The head of the PMTCT centre,Bright Kagimu, says mothers aretested for HIV at thirteen weeksof pregnancy and if found positive,immediately start treatmentby taking ARTs and Septrin up todelivery. Nevirapine is providedat the onset of labour to preventthe child from contracting thedisease from the mother duringdelivery.During outreaches they usuallyencourage mothers to deliver atthe health centre to access theseservices especially Nevirapine tostop the child from acquiring thedisease from the mother at birth.The mother then continues withmore ARTs after birth.According to Bright babies thereis a program called Early InfantDiagnosis (EID) where a childof HIV mothers is tested at sixweeks after birth to confirm theirHIV status. The babies are thengiven a daily dose of Septrin tabletsand Nevirapine syrup up toone and a half years on whenanother test is done one weekafter stopping breast feeding.A child is declared HIV negativeonce this last test is done and thechild is found to be negative andfree of the disease. If a child isfound to be positive it then startsa dose of ARTs as prescribed bythe doctor.Many mothers still fear beingstigmatized for having HIV. To ensurethe mothers access PMTCTservices for their children, Brightsays the centre has combined theimmunisation and Child Days togetherwith the PMTCT and EIDactivities so that mothers comemore regularly for all these activities.He has noticed that few men arewilling to come and test for HIVand many mothers who attendhave never told their partnerstheir status. Out of ten partnerswe usually receive only threecouples who attend together butwe keep on encouraging them inthe outreaches,” he concludedAlive and Healthy43

Grandmother tale of herorphaned little onesIn Uganda, According to the Uganda Demographic HouseholdSurvey (UDHS) 2011, twelve percent of children under age 18are orphans. Most orphans have either lost a parent or bothto HIV and AIDS. Although the Uganda Government has beenkeen on promoting Prevention of Mother-to-Child Transmissionof HIV (PMTCT), today a many children are born with theinfection.Felista Nakimera and her grandchildrenFifty- six year old FelistaNakimera who lives in Nakasekesub-county is caretakerto two orphanedchildren living with HIV. Her attitudetowards children has madeher a darling to many NakasekeHospital patients, staff, strangersand visitors. She is warm-hearted,has ably sustained a familyof eight orphaned grandchildrenand continues to brave bitingpoverty and incurable diseases.“I never gave up on life after thedeath of my daughter Novisa Nakimuliin 2006,” reports Felista. “Iinherited taking care of my eightorphaned grandchildren. My biggestchallenge was when I discoveredthat the youngest, SuzanNakigudde, who was then twomonths, was infected with HIV/AIDS at birth.”The discovery did not only hither hard, but made her feel theworld crumble. Overwhelmed,Felista sought counsel from oneof the members of her villagehealth team, Alice Nakubuye. Aliceencouraged her to stand firmto overcome the problem.Alice gave her hope when sheexplained that HIV and AIDS isan opportunistic disease whichrides on the back of other ailmentslike malaria, tuberculosisand cholera, which if treated intime with a changed lifestyle,one can live longer.According to Alice, as reportedby Felista, early victims of HIV/AIDS could have lived a little longer,had they known what wenow know about the epidemic.“Following her strict diet guidanceI have seen Susan transformfrom a bag of bones, she was,into a chubby strong girl. Thecurly hair is no more. Her skin issmooth textured. I spend sh500on an egg and a cup of milk everyday,” whispers the elderly Felistaas she cracks her fingers withnervousness.“I want to see her blossom likeany other child. She loves booksand has promised to build mea decent home when she getsa job in future,” tells Alice.At this moment, one wonders,how granny and her beloved Susanavoid transmission of the fatalailment to each other. In theirmodest home, they have to liveunder very strict rules and copingmechanisms without feelingoffended.“For example we do not share razorblades, needles, tooth brushesand safety pins,” confides Alice.“Taking oral ARVs has becomeSusans way of life. She alwaystells me Jaja ngenda kwebakanaye edagala lyange. (Granny Iam going to bed but I have nothad my medicines),” says Nakimera.The same is repeated beforeclutching her bag and going toNakaseke Primary School. Shenever forgets to take her prescriptionof a half of a septrintablet.“With advice, she had all thevaccinations against killer diseaseswhich is done daily atthe hospital,” explains Alice.The VHT has also equipped Nakimerawith parenting skills liketalking to the child, avoidingspanking and sharing qualitytime.“Teenage is the worst part ofa child. They are so rebellious,adventurous and confident. TheVHT told me to fore warn themagainst the dangers of STDs (sexuallytransmitted diseases), defilementand unwanted diseasesin order to enable them makeinformed decisions,” she says.Asked what she does to makeends meet, the revelation of heringenuity to earn a living is ratherencouraging. She is a cleanerat the hospital, earning sh45,000per month. She also washes andirons clothes for patients to supplementher income and fetcheswater for homesteads.44Alive and Healthy

Her rent is sh5,000 per monthand to keep the doctor away, Alicehas adopted strict rules in herhome, where washing hands isa compulsory. Her use of energysaving stoves has reduced theexpenditure on charcoal and harvestof rain water reduced labourwasted to fetch water from longdistances.To eat well, one does not havego for expensive fatty food inmulti-continental fast food joints,snacks, hot dogs or burgers.“Our VHT says a child feeding onmukene (silver fish) flavouredporridge, a piece of avocado,ground nut butter and vegetablesare as healthy as or much betterthan his counterpart feasting onyoghurt and chips,” says Alice.Lack of this knowledge, accordingto Alice, is the reason mostpeople take obesity for a sign ofwealth.When everybody thought Alice’splate was full, she surprised themby taking care of a two-year-oldKirabo, who was abandoned inNakaseke Hospital.A man brought the underweightbaby with a bag of few cloths,kicomando (junk food of beansand chapatti) and dumped her atthe cement seats at the hospital.“Like Susan, Kirabo was moodyand skinny in the beginning. Thedoctors took her for HIV testingand she was positive. Medicinewas prescribed and I am alreadyseeing positive changes in her.She (Kirabo) now smiles, eats voraciouslyand crawls,” Alice narrates.The people in Nakaseke suspectthat Kirabo’s mother could havedies and her father could not takecare of her singly, opting to abandonher here where she could getmedicalcare, food and company.According to data at the hospital,140 mothers were foundHIV-positive from January toJune. One wonders how manytook the necessary steps to avoidmother-to-child infection, leavealone being able not to breastfeed, but afford supplementaryfoods.The Child Health Now campaign,through dialogues with communityleaders, district health teamsand with support from the villagehealth teams is promoting thePMTCT services to give childrenwhose mothers are HIV positivea chance to live healthy full-fillinglivesWilson a fighteragainst malariaThe death of his five-year old son was a turning point in hislife in 2008. Seated under a verandah at his home on a sunnyday, Wilson, 36 can ably remember the full names anddates of birth of all his eight children and perhaps describethe circumstances surrounding each one’s birth.His fingers fiddlenervously as talksHenry Kiguli’s fiveyearshort journeyof life. As he narrates’ situationssurround Henry’s death, he closeshis eyes and carefully chooseshis words. It is clear that Wilsonis still devastated by his loss.Henry was the sixth child in thisfamily that lives at Bukalungavillage in Ggolo parish, Nkozisub-county in Mpigi district. Thearea lies along the Lake Victoriashores, approximately eight kilometerssouth of the Equator.Given the warm tropical temperaturesthat favor the mosquitoesto thrive, malaria, which isspread by this vector, has beenand continues to be one of thekiller diseases in the area.“He fell sick, vomiting and developeda high fever. I took him toMasaka Hospital where he receivedtreatment and returnedhim home but his conditionworsened a few days. I rushedhim to Nkozi hospital where hedied from,” Wilson said. “His lifewas short lived by malaria,” headds.Wilson had seen and heardabout people who died of malariabut losing his own child was awake-up call. Together with hiswife Norah Namata, 35, they becamefidgeted and feared losingthe rest of their children; WilsonSserubiri, 17, William Ssekadde,16,Fred Ssebalirira, 14, AgnesNakaweesa 11, Olivia Nakiyingi,Alive and Healthy45

eight, and Sarah Namitala, agedtwo.Ggolo is one of the parishes mostaffected by malaria. Childrenespecially those of school goingage have been most affected.Disease among the children hastherefore contributed to poorhealth and poor school performancedue to the high rate ofabsenteeism when children aredown with malaria attacks.The malaria attacks were frequentthat one family headed byMuhammad Kalule, 60 shifted toBugonja, a nearby village. Muhammadleft Bukalunga after twoof his daughters, three- year-oldJalia Nakubulwa, and one-yearold-Aisha Nakawooya were killedby the disease.Overwhelmed by the deaths andsickness, World Vision throughNkozi Area Development Programmeintervened. The organisationsconducted bi-weekly sensitizationseminars at St. KizitoPrimary School- a central point inthis parish.According to Wilson, over 200people attended each of the seminarsthrough which the communitywas educated on preventive,control measures and scientificexplanations of the real causesof malaria.“It exciting to see so many peopleturn up for the seminars;even the fishing community thatnormally shuns such activitieshas been keen on attending inbig number,” reports Wilson.At the seminars, the communitymembers learnt that lake waterespecially during heavy rains createdsmall ponds with stagnantwater all along the shores, whichbecame breeding sources formosquitoes.Majority of the homes had bananaplantations around theirhouses which if not well trimmedcreate good hideouts and breedingsources for mosquitoes.Other sources that facilitatorspointed out included coffee, dryleaves left open around people’shomes, bushes and stagnantwater. They also advised localsto close windows and doors inthe evening. Malaria cases hadbecome so rampant that fewtraditional witch doctors tookadvantage by relating the casesto witchcraft hence misleadingpeople in the community“We were a well advised to trimour banana plantations regularly,destroy all stagnant water points,clear or burn bushes around usand spray around our houses,”he explained.People were also advised to stopbelieving in witchcraft as thecause of malaria because thisdiverted them from solving thereal problems related to malaria.World Vision’s immediate remediesincluded supplying mosquitonets to all families-givingpriority to children and pregnantmothers. Residents were alsoadvised to immediately go to ahealth facility in case one developedmalaria symptoms.Wilson’s family received two netsbut these were not enough forthe big family. He bought four extranets himself, his wife, and twochildren who had not receivedany.Because of his frequent visits tothe health center, active participationand collaboration withthe World Vision team, Wilsonwas identified as a strong localresource person. He was recentlyrecruited as a VillageHealth Team (VHT) leader forthe entire parish.One of his major roles is to mobilizeand sensitize other peopleabout malaria control and helpin identifying families with malariaproblems. This gained himrecognition by Malaria Consortium,another NGOs whichprovide further training on thedistribution of simple malariadrugs.He acquired skills in describingdosage, usage and storageof the drugs and when to referone to a health facility forfurther examination and treatment.Each village has a VHTwho provides the same servicesand gives frequent updates toWorld Vision.From his talk, you could tell thatWilson has never looked back.“I joined the seminars becauseI had problems in my family especiallyafter losing my son…since I got involved in the malariafight, we have all remainedhealthy,” he explained.At least between 15,000 and20,000 residents in the parishhave been sensitized and othersbenefited directly or indirectlyor both from the WorldVision fight towards malaria.Today, Wilson’s community isaware of the prevention andtreatment of malaria. A bignumber of the community nolonger believes that witchcraftis the cause of the rampantsicknesses. Most of mosquitobreeding grounds have beendestroyed46Alive and Healthy

Hon. Amelia keen on promotingmaternal and child healthWith a cheerful poise she talks about the piped waterprojects, education subsidies, maternity wards shehas supervised in Mawokota North, Mpigi district.She has been at KampiringisaHealth Center tovisit mothers and at KammengoHealth Center, shesaw a child mother crying in labor.She has been at Moslem, Catholicand other religious meetingshence proving that developmentis non-sectarian. Visibly, Hon.Amelia Anne Kyambadde is anadvocate of development. Sheis the Member of Parliament forMawokota North, also the CabinetMinister for Trade, Industryand Co-operatives.“I once saw a girl in labor in myconstituency who said she was 15years but she looked like 13. Shecrying like a child as she lookedup to her mother who seemed tobe in the range of 27-30 years,”Hon. Amelia said explaining childmothers and the related reproductiveissues.In 1989 World Vision started activitiesin the then huge districtreaching out to the communitieswith education, health, incomegeneration, food and nutrition,water and sanitation, amongother programs. In November2009, Twezimbe DevelopmentFoundation where is Hon. Ameliais the patron launched activitiesin Mawokota North joining governmentand NGO efforts in thedistrict. With support from WorldVision and Twezimbe, Mpigi districtcommunities are movingforward in various developmentaspects but the need that remainscannot be undermined.At Muduuma Sub-county, whereWorld Vision has recently extendedprogramme, Hon. Amelia hasagreed to continuously mobilizewomen and children to participatein development. “Mother toChild Transmission of HIV is not ajoke. It is a serious matter and usin power, just like other citizensneed to ensure that children livefree of the HIV,” she said emotionally.“Similar to all districts in Uganda,male and father involvementin community development andpromoting maternal and childhealth has remained elusive. Fathersare yet to adequately participatingin immunization, preand post natal programs, amongothers.”Stakeholder Opinion“Fathers fear showing favoritismbecause they have morethan one wife. Fathers thathave one wife are attachedemotionally to their childrenand wife. Polygamy is a problem.By the way, women insuch polygamous families arebusy competing to deliver babiesfor their husbands,” –Hon.Amelia Kyambadde, Memberof Parliament for MawokotaNorth, Mpigi district also CabinetMinister for Trade, Industryand Co-operative.Alive and Healthy47

48Alive and Healthy