Child Survival and Development in Nairobi Slums

$18,827 $5,173
Raised Remaining

During this past year of 2011, the OVC Project in Africa, located outside of Nairobi became aware of the many children in numerous baby care centers in the three communities of Mlolongo, Sophia and Bondeni that were not included in our services to children under 5 years of age.

A baby care center is an ordinary home (a 10x10 room) set-up where children are left as their parents or guardians go to work and then are picked up later in the day as parents go home from their work places. Children who are left in the baby cares are aged between 4 months and 3 years. Parents’ fees range from 20 to 50 Ksh, depending on the number of hours in the center. The caregivers in the baby care centers are familiar with the parents of the children or reside within the same community and are trusted by the parents and the local community people.

Under the leadership of Project Coordinator, Racheal Nduku, a visit to almost all the centers was carried out by Racheal and several Community Health Workers (CHWs). While collecting information about each center, the CHWs carried out primary health care elements, such as growth monitoring for determining malnutrition, hand washing practices to prevent diarrhea, and observing food preparation and general hygiene.

A total of 67 baby care centers were visited early in 2011; 31 in Mlolongo, 19 in Sophia, and 17 in Bondeni. The findings included:

Centers visited – 67

Age of children – 4 months to about 3 years

Number of children – 1099

Number of children disabled – 30

Number of children under weight for age – 109

Number of children orphaned – 32

Number of children from single parents – 204

Number of children in each center, range – 3 to 61

Number of caregivers per center – 1 each for 61 centers and 2 each for 6 centers.

Room size; small – 44, spacious – 23

Challenges faced by the baby care centers include:

Congestion  Most rooms are very small with many children. This leads to easy disease transmission like colds, coughs and skin diseases. Children can not crawl or walk around freely to explore their environment. They spend most of their time sitting or sleeping.

Food Insecurity  Most parents bring packed food for their children, but often this food is insufficient and unbalanced. Some children refuse to eat and cry all day until picked up by their parents. These conditions have resulted in numerous under weight children.

Lack of Play and Play Materials   Almost all baby care centers visited were not baby friendly. They lacked play toys, coloring books and paper, books, etc. This lack of stimulation forced them to sleep or sit down for long hours and sometimes resulting in signs of aggression, worry and sadness.

Poor Hygiene  Clean hygiene practices were not observed in most baby care centers. Environmental sanitation was poor due to lack of water. Unwashed dishes, soiled children’s clothing and flies were everywhere.

High Poverty Levels  Baby care centers are situated in slum settings where the caregiver of the center and the parents are both poor. Some times, when the parent cannot find a casual job, and she has no money to feed her child or pay the center, she will leave the child overnight at the center. This is a burden for the caregiver of the center, since she depends on the fees to feed her family.

Low Caregiver – To-- Child Ratio  Having only one caregiver for 10-15 children leads to poor interactions with the children and also lack of warm and responsiveness to children’s needs. The early development of cognitive skills, emotional well being, and physical and mental health needs are not met, greatly compromising early child development.

Low Skilled Caregivers  Most caregivers lacked expertise or training in early child development and were not able to meet the needs of  infants and toddlers in the overcrowded settings of their homes.


Follow-up Visits

The OVC Project staff and CHWs realized that the baby care centers were in great need of assistance and began by conducting a follow-up visit to each center. CHWs and Public Health students from the University of Tennessee visited each center in June, July and September and October 2011.

Actions taken during the visits were:

  • Advised caregivers about the importance of having spacious ventilated rooms to prevent disease transmission and permit children to move about and play.
  • Held workshops with the parents and the caregivers on food preparation, food storage, and proper balanced diet.
  • Caregivers were taught the importance of play as a medium of communication, self expression, experimentation and learning. Play things were donated by a family in Charlottesville, VA and distributed in Oct/Nov to almost half of the centers after they improved the cleanliness of their centers.
  • Help was given to the caregivers of some of the dirty centers in cleaning the center and encouraging them to keep children’s clothes in order and covering the food. They were also given liquid soap to encourage handwashing before handling/eating food and after visiting the toilet.
  • Most parents were encouraged to join support groups where they can get some help to buy food for their children when their casual jobs fail.
  • Most caregivers were advised on the importance of establishing a secure interaction/attachment with the children and to determine how many children they can adequately care for.
  • Some caregivers agreed to attend children’s workshops, sessions and conferences for capacity building.

Additional information was obtained during the follow-up visits concerning the number of baby care centers that had closed (6), the fact that the orphan children had been taken to live with family members in the rural areas, identifying the specific disability that each child had after referral, the increase of 7 underweight children, there are no longer any “spacious “ centers and 4 new centers have opened. Many centers have raised their rates, which is probably due to inflation and the poor economy.

The task of helping Working Moms and their Babies is one that the OVC Project wants to continue in order to fulfill our mission to improve the health and wellbeing of children under 5 years in the slums. But we cannot do more than has already been done without additional funds. Our plan is to work with parents and with the caregivers of the baby care centers. We will address the challenges faced by the centers as listed above and work with the parents/guardians to help and educate them about the issues of early child development and how they can promote a secure, stimulating, nurturing environment for their children, even in a poverty setting. Lastly, we want to improve the quality of the baby care centers, but still have them affordable to the parents.

We are requesting donations to reach a goal of  $1,000. by the end of 2011 and $10,000 by the end od 2012. .

Since the last report, there has been a very destuctive pipe line explosion that destroyed many homes in one of Nairobi's slums. It caused numerous deaths and serious injuries and burns. As a result the Kenyan government has advised many slum dwellers to move to safer places. Although the accident was not close to our project, a squatter settlement in Kanaani, most of the residents have left their homes and moved to other communities.

Therefore, we will no longer be able to continue to work in Kanaani. Instead, The OVC Project in Africa has turned its efforts to helping to improve the conditions in the 70 plus Baby Care Centers in the other three slum communities of Mlolongo, Sofhia, and Bondeni.

Our next report will include the survey of these centers and the tremendous needs of the children who attend them  while their mothers work. .

In April 2011, a survey was conducted by the Community Health Workers (CHWs) of the Orphans and Vulnerable Children's (OVC) Project in Africa to determine the health and well being of the children under 5 years of age in the squatter settlement of Kanaani in Athi River County, Kenya. The results of the survey are as follows.

The total number of children under 5 years of age was 80. Out of this number, 36 (45%) were males and 44 (55%) were females.

70% of the survey respondents were mothers, 14% were fathers and the remaining 13% were grandparents, other relatives or non-relatives.

When asked about the general health of the child, respondents indicated that 50% were in good health, 40% were in average health and 10% were in poor health. Even so, 58% of the children had been ill during the past two weeks and care was sought for 70% of them.

Health Behavior

Over 50% of the households had bednets which are essential for the prevention of Malaria and 55% of the children in the households with bed nets sleep under them.

Hand washing with soap before eating, which is the major method for interrupting the transmission of bacteria causing diseases such as diarrhea, respiratory infections, and trachoma, was practiced by 69% of the children over 2 years of age.

Each child is issued a government Health Card at birth which records the immunization status and records their weight for age for the first five years. Immunizations prevent the spread of disease such as diphtheria, mumps, measles, tetanus, etc., which are important causes of under 5 mortality. Weight for age indicates if the child is normal, under or overweight. Malnutrition is one of the leading causes of deaths in children under 5 in sub-Saharan Africa.

Respondents reported that 61 (76%) children had health cards, but only 37 (46%) had the cards available. Therefore, it was not possible for the interviewers to determine if their immunizations were up to date nor if they were of normal weight.

The results of the survey provide an informative data base for planning action concerning the health, well being and problems of the children under 5 in Kanaani.

Child Survival and Development in Nairobi Slums Project was begun in March 2011 when we arrived in Nairobi to plan for a survey in the squatter slum community of Kanaani. Before arriving we modified the survey from that we had used in other slum communities. The purpose of the survey was to learn about the health and well being of the children under five years of age. We first visited the community to locate the elders and important leaders and gain permission to conduct the survey. They welcomed us and were willing to help. Our next step was to arrange for a group of our Community Health Workers (CHWs) from our OVC Project in Africa to walk the community and count and map the 145 houses.

Plans were made for training the CHWs from nearby slum communities to conduct the survey. Three resident of Kanaani were also included. Then we conducted a pilot survey to test the questionnaire. On April 2nd a group of 20 CHWs and three Kanaani residents formed ten teams and conducted interviews in households with children under five. A total of 80 children were identified and a questionnaire was completed through interviews of parents and other caregivers. The survey was successful and the Information Technology person is preparing to enter the data from the questionnaire into the computer for analysis.

The results of the survey will help us to plan interventions where needed to benefit the health and welfare of the children.

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Project Leader

John H. Bryant, MD

Project Director
Charlottesville, Virginia United States

Where is this project located?

Map of Child Survival and Development in Nairobi Slums