Strengthening Quality of Life by Providing Comprehensive, Quality Maternal and Child Health Care in a Rural Setting
Why maternal child health care is important in the communities that we work in
In Eswatini, 240 women die per 100,000 live births due to pregnancy-related causes. Thanks to quality maternal and child health interventions, the maternal mortality ratio in Eswatini has improved from 588 in 2000 to 240 in 2020, while the maternal mortality in Eswatini is lower than its regional average. The infant mortality rate for Eswatini in 2023 was 34.98 deaths per 1,000 live births, a 3.51% decline from 2022 (36.27 deaths per 1,000 live births), which was a 3.39% decline from 2021. Primarily maternal child health aims to prevent morbidity and mortality in both the mother and the child. It is crucial because it directly impacts the health and well-being of both the mother and child thus laying a foundation for a healthy future generation by preventing preventable deaths, promoting healthy development during pregnancy by addressing potential health risks. Fundamentally it aims to promote the health and well-being of pregnant women and their babies, for mothers from the day of conception to the time when the infant has reached 5-years of age.
In the rural areas where Cabrini Ministries eSwatini (“Cabrini”) works, sensitization on maternal Child Health has become increasingly important due to an increase in the number of pregnant adolescent girls. Some of these adolescent girls give birth at home due to lack of understanding about the necessity of good prenatal and postnatal care, and how it significantly decreases the risk of complications during childbirth and infant mortality rates. Due to high poverty levels, others do not have money for going to the clinic. Prenatal care offers a crucial window to identify and address existing health concerns in women that could impact their pregnancy and future health. Furthermore, through maternal and child health, we empower women to make informed decisions about their reproductive health and participate actively in their own healthcare.
At Cabrini pregnant mothers come to us for antenatal care (ANC), where a variety of blood tests are undertaken with the mother, then growth and development of the child is monitored monthly, so that if there are any abnormalities, they are detected early. We work with a close network of service providers and specialists, and if referrals are needed, they are done timeously. Even the health of the mother is monitored monthly since women experience a lot of changes during pregnancy
period which makes them vulnerable to conditions like non-communicable diseases (NCDs). We promote nutrition, hygiene practices and good breast-feeding techniques through continuous education both in the clinic and in the community during outreach.Supporting women’s and children’s health is an essential investment for the well-being of the communities we serve. At Cabrini, we believe that ensuring quality maternal and child health services is our responsibility, and it is a core way in which we express being bearers of the love of Christ, which is in line with our mission statement which is to “share the love of Jesus Christ by promoting the well-being of individuals and families through comprehensive integrated health care, child care, education and social services to the most poor and vulnerable”.
Programs that we undertake in maternal child health care
From our maternal child health care department, we provide Antenatal Care (ANC), Post Natal Care (PNC), Prevention of Mother to Child Transmission (PMTCT), Expanded Program of Immunization (EPI), management of urinary tract infections (UTIs) and sexually transmitted infections (STIs).
We encourage women to start ANC as early as the first trimester of their pregnancy. At the first ANC visit the client is screened for TB, HIV, NCDs, Malaria and STIs. If she tests positive for any of the diseases, she is treated accordingly. If tested negative for HIV, we enroll her on HIV PrEP prophylaxis medication. The client is then scheduled for monthly visits until she delivers her baby. When they delivery date is close, pregnant mothers are encouraged to visit hospitals since our clinic doesn’t offer delivery services. After delivery, the client comes back to our clinic and is enrolled on our Post Natal Care (PNC) program, which is usually 7 days after delivery. Here we monitor the child’s weight, assess the navel if it’s healing, and assess the healing of the mother’s perineum region. Monitoring goes on until they all both mother and baby are healed. At 6 weeks of age, the child is enrolled with the EPI where she /he is administered vaccines for different diseases till the child reaches 5 years old.
For those mothers who tested positive for HIV they are enrolled on PMTCT at their first ANC, appointment, whereby they are given prophylaxis for their babies. For the past 10 years our PMTCT program has been successful with a 100% success rate (i.e., all the HIV positive mothers enrolled on our program have given birth to HIV negative babies). We screen for STIs and UTIs at every visit for pregnant women, and if a woman screens positive, she is immediately sent for testing, and if tested
positive, she receives instant treatment and advised to bring her partner for treatment to avoid reinfection.
In conclusion, besides our work in MCH, Cabrini Ministries intentionally, impements Gender-Based Violence (GBV) prevention activities in the communities we serve. GBV is a persistent challenge in Eswatini, mostly affecting women and girls whereby approximately 1 in 3 females experience some form of abuse by the time they reach 18 years of age. Main drivers of GBV include gender inequality, weak mechanisms for coordinated prevention and response to gender-based violence, limited integration of GBV in sexual reproductive health and HIV services, and weak implementation of policies that are addressing gender inequality. In 2024 at total 138 GBV cases were reported to Cabrini Ministries whereby 101 were cases of sexual cases. Perpetrators were mostly intimate partners of the minors and family members. Of the 101 sexual abuse cases, only 17 perpetrators were prosecuted whilst 63 cases are currently with DSW, 6 cases were cushioned because the children consented to sexual activities yet they are both minors (both below 18 years old) and 15 cases are with the police.
Gender Based Violence prevention awareness campaigns were conducted as a result 5 schools were reached with GBV sessions reaching over 1000 children. On another note since teachers are not trained on GBV, 37 high school teachers were capacitated on GBV identification and referral. To address issues of gender norms, 3 community dialogues were held with men and women in three different communities.
Maternal and Child Health Patient Numbers by Service Area for 2024:
Some of our challenges, and some of our successes
Challenges
- There was a rise in teenage pregnancy within the communities that we serve.
- A rise in pregnancy in women above 40 years which is considered high risk.
- Gender-based violence cases in pregnant women.
Successes
All the women we serve under our PMTCT intervention are virally suppressed.
Teenage mothers are taking charge of their pregnancies, for example they are booking their first ANC appointment early. Before they used to be shy and only showed up at the clinic when they were about to deliver. We attribute this change to our morning health education talks in the clinic and during outreaches.
More mothers are bringing their children for immunization and honoring their appointments.
SUCCESS STORY: A Sign of Hope through Comprehensive Care
With so many bad things happening in the world, we are glad to share with you the story of Phiwayinkhosi Mkhaliphi, a survivor of severe acute malnutrition. Through this testimony, we can safely say there are still good things happening in our world, we just have to work hard enough.
Giggling and running around the clinic hallways is Phiwayinkhosi, who a year ago had a traumatic home delivery. The delivery was performed by his own grandmother, and unfortunately Phiwayinkhosi’s twin brother died immediately after delivery because they could not take the mother to hospital. The mother, 31 years old, is a client at Cabrini clinic where she receives her antiretroviral medications (ART). She is also diagnosed with schizophrenia, and she receives her anti psychotics medications through our clinic.
When Phiwayinkhosi was finally brought to our clinic, he only had a first name written on his vaccination card, his mother stated that she could not remember who the father was. None of his developmental milestones were achieved, and at 6 months he only weighed 5.8 kg. He had previously been admitted to hospital for 2 weeks doctor for malnutrition and pneumonia, and the doctor had recommended a high protein diet. A lot had to be done, so our Cabrini health team went to work. First Phiwayinkhosi was given all his vaccines as per the schedule, then a supply of ready to use therapeutic food (RUTF) was provided weekly as per his body weight. His grandmother was given an emergency food parcel through a referral to our Family Services department. Another referral was made to our Psychosocial Support office because he had to have a full identity, and his surname was missing from his documents. You might ask yourself where the mother is in this whole issue. The grandmother had to step in because the mother had relapsed, so was sent back to the psychiatric hospital, and the family could not afford formula milk. Under our Family Services we supplied 6 litres of milk every time the baby came for his check-up.
A few weeks into the program, while he was receiving medication and coming in for weekly check-ups, he started gaining weight, from 6kg to 8.3kg. While we were weighing him, his grandmother would put him in the hospital bed and with a smile she would say “he can sit now so I have no problem putting him on the bed”. Our Psychosocial office assisted in tracking the father who agreed to his surname being registered in Phiwayinkhosi’s documents. Today Phiwayinkhosi is still receiving his vaccinations through Cabrini clinic. His health has improved greatly, he is no longer on therapeutic food, and he is healthy with a bright future ahead of him. We can safely say it’s successful comprehensive care stories like this that make life worth living.
Cabrini Health Updates – March 2025
~ Thanks to Cabrini Ministries eSwatini for this article