Cardboard crib gives new lease of life to newborns

Monday, March 16th, 2020 00:00 |
Susan Mutono with her newborn baby at home. PD/Photo credit.

Ann Nyathira

When Susan Mutono delivered her last born child a few months ago at Lengo Hospital in Mukuru Kayaba, Nairobi, a cardboard box was the first gift she received.

That simple box would give her newborn child high chances of survival and better beginning to life.

The box is a starter kit for infants and mothers and contains 18 essentials including a mosquito net, clothes and nappies.

Fitted with a mattress, the box becomes a child’s first bed giving children from all backgrounds a safe environment to sleep.

This innovation by Toto Care Box Africa is lauded for helping reduce child mortality.

Mutono, a mother of three, was initially skeptical about the idea of her child sleeping in a carton box.

Having nursed her other children without the box, the stay-at-home mother says the box has played an important role in ensuring her child has a better beginning in life.

“After I gave birth at the hospital, I was given the box and trained how to use it.

There is no difference between the box and the baby cot; the box came with a mosquito net, water guard for drinking water, some clothes, nappies and a mattress.

I strongly believe the box has given my child a high survival chance,” she says.

Decreased deaths 

In 2012, Wambui Kaigutha, a public health researcher and Toto Care Box founder, was inspired to come up with the idea by Finland, one of the country’s with the lowest maternal and child mortality rates. 

Since 1938, the government of Finland has provided mothers with cardboard boxes with essentials to give every child an equal start in life.

For some families, especially those from poor backgrounds, the contents of the box would otherwise be unaffordable.

This tradition that has been carried on for generations successfully helped the country lower its maternal and infant mortality.

According to the United Nations Children’s Fund (Unicef), Finland has an infant mortality of only 1.7 per every 1,000 births.

Today, Toto Care Box in collaboration with the health workers at Lengo Hospital have developed a programme in Mukuru Kayaba slum that hopes to give babies higher survival rates. 

Chris Columbus of Toto Care Box Care says that the four major causes of the grim infant mortality in informal settlements are malaria, typhoid, cholera and neonatal sepsis.

“When a woman delivers at Lengo Hospital, she is given a Totobox that comes with 18 essentials for newborns and mothers.

It comes with a DTS-Z kit that helps in case of diarrhoea and the chlorohexidine used for the chord care, among other essentials. These boxes will effectively reduce the risk of infant mortality,” says Columbus.

Statistics by the World Health Organisation (WHO) and Unicef indicate that since the year 2000, child deaths have remarkably declined by nearly a half and maternal deaths by over one-third, mainly due to improved access to affordable and quality health services.

Since 1990, there has been a 56 per cent reduction in deaths of children under 15 years from 14.2 million deaths to 6.2 million in 2018.

Health care experts say countries that provide everyone with safe, affordable, high-quality health services, women and babies survive and thrive.

Investment in universal health coverage remains paramount; skilled pair of hands to help mothers and newborns around the time of birth, along with clean water, adequate nutrition, basic medicines and vaccines can make the difference between life and death.

Dr Sheik Mohammed, Head of Family Department at the Health ministry concurs that child mortality rate is decreasing in Kenya.

The decline, he says, is because of more readily available basic health care, more effective vaccinations and locally-trained volunteer health workers.

He notes child mortality is measured using three parameters; the child who happens to be less than five years, an infant is less than one year while neonatal is less than 28 days.

“More mothers are having babies at the health facilities. Immunisation rates have improved due to the high impact interventions to lower child mortality,” says Mohammed.

He, however, notes that there is need to equip the few available health workers with the necessary skills and equipment to serve more mothers and children.

According to him, quality of health care is paramount to achieving universal health care coverage. Getting the right health service at the right time and given by skilled personnel gives a child a high survival chance.

He notes diarrhoea, pneumonia, and malaria are some of the leading causes of child mortality under five years.

According to Mohammed, most child mortality cases come from the hard to reach places such as Turkana, Mandera and Marsabit.

Innovations such as the Totobox are contributing to low infant and maternal death rates to underserved communities in the country.  

“I feel my child has had a better survival chance in life. With the other children, accessing some of the essentials for newborns was a struggle; the box lifts the burden from you and you can focus on raising your child,” says Mutono.

She adds that the hospital not only issues the package, but also follows up to track the progress of the baby. To date, more than 1,400 babies have benefited from the free Totobox in an effort to improve the health indicators of both babies and mothers.

Cultural challenges 

Currently, access to quality and affordable health care continues to burden the pastoral communities in remote arid and semi-arid areas.

Underpinning factors include greater difficulty in travelling to health facilities, less diversity in healthcare resources to choose from and high illiteracy levels and culture.

Culturally, Samburu women prefer delivering in a crouching position instead of lying on their backs as is done in most hospitals.

In 2018, the WHO recommended that for women without epidural analgesia (anaesthetic injection), encouraging the adoption of a birth position of the individual woman’s choice, including upright position, is recommended.

To encourage more women to come to the hospital on time and safely deliver their babies, Afya Timiza—a United States Agency for International Development (USAID) initiative— constructed a maternal shelter adjacent to the hospital and innovated the birthing cushion, a low-tech, cheap innovation that mothers can sit on while delivering to help reduce child and maternal mortality rates in the arid and semi-arid areas.

According to USAID, the birthing cushion is an innovative model now being used to encourage women to deliver in hospitals while conserving their cultural beliefs.

As more women choose this option, the stigma around hospital delivery continues to decrease and as does the maternal and child mortality rate.

USAID adds since the inceptions of the birthing cushions in 2016, more than 8,741 women have accessed skilled delivery services, 11,847 children under one year have received full immunisation and more than 46,300 children less than five years (0-59 months) through nutrition-specific interventions.

According to the Kenya Demographic Health Survey 2014, the infant mortality rate is 39 deaths per 1,000 live births, and under-five mortality is 52 deaths per 1,000 live births.

At these levels, about one in every 26 Kenyan children dies before reaching one year, and about one in every 19 does not survive to their fifth birthday.

The KDHS survey indicate all early childhood mortality rates declined between the 2003 and 2014, notably neonatal mortality has exhibited the slowest rate of decline (33 per cent).

The survey shows a child born in the Nyanza region is almost twice as likely to die before age five as compared to a child born in the Central region.

Nairobi has the second-highest under-five mortality rate, following Nyanza (72 deaths per 1,000 live births).

The survey concludes male children are more likely than female children to die during their first year of life (44 deaths versus 37 deaths per 1,000 live births).

Once past infancy, male and female children 1-4 years of age experience the same level of mortality (16 deaths per 1,000 live births).

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