Child Survival and Development in Nairobi Slums

This report is coming from Nairobi, Kenya where we have just completed a 4 day conference with representatives of the Orphans and Vulnerable Children's Project (OVC) directors and staff, the University of Tennessee, Knoxville departments of Public Health and Child Development and Kenyatta University departments of Public Health and Child Development.

These three organizations are developing a collaboration that will provide expertise and strengthen the work of the OVC Project and give faculty and students the opportunity to obtain field work in their fields of study.

At the same time the OVC project is making plans and beginning work to help improve conditions in the over 70 Baby Care Centers in our three communities of Mlolongo, Sophia and Bondeni. Your most recent generous donations will be used in the Helping Moms and their Babies project that we reported on in our last report. The next report will have more details about the work that is proceeding in the Centers.

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. .