The Start Strong Project – Year 2 Health Results

We are so pleased to be able to update all our wonderful PHASE supporters with the progress of our Start Strong Project at the end of Year 2. The Start Strong Project was designed at the request of local communities to improve access to maternal healthcare and to reduce malnutrition in children for 1,000 women and their children. Thank you for funding our UKAM Appeal in 2021.

UK Aid Match brings charities, British people, and the UK government together to change the lives of some of the world’s poorest and most vulnerable people. This integrated three-year UK Aid Match project, is working to embed maternal and child healthcare knowledge and skills within the healthcare system and local community while empowering local women with agricultural knowledge, skills, and practical resources to increase their ability to feed their families for at least six months of the year, improving their dietary diversity.

Our focus into Year 2 was to continue to provide improved access to maternal healthcare:

• 338 newly pregnant mothers and new-born children were supported and assessed in Year 2 of the Start Strong Project, (182 mothers and 156 children).
• 139 babies were born. All babies born were weighed and monitored for growth from birth.
• 504 mothers and 473 children (Under 5) from Year 1 continued to receive PHASE support.

Srijana (Rugin ANM) uses her training during an ANC visit to use the USG Machine to check baby’s health

From our baseline survey in 2022, assisted births were reported as 57%, so 43% of women were giving birth without professional ‘Skilled Birth Attendant’ (SBA) support, increasing risks to mother and baby.

Encouraging institutional births is a fundamental policy of the national Safe Motherhood Programme of the Government of Nepal, to reduce risks of mother and babies dying during or after childbirth.

• In Y2, SBA assisted births were recorded at 61.9% (86 out of 139 recorded deliveries).

We are really pleased with this increase but acknowledge that this is below our Y2 target of 70%. There are several factors that contribute to women not attending a health post or a skilled health professional being present, particularly in remote and rural areas such as Bajura, Far West Nepal.

ANM Srijana supporting a mother post-birth in Rugin.

According to our Mid-Term Evaluation Survey, among the 80 respondents who did not deliver at health facilities, 93.7% respondents answered due to health facilities being located too far away. Almost half of respondents in the survey (48.5%) must travel more than 61 minutes, while 32.3% travel less than 15 minutes. Some communities are still a 3 or 4 hour walk from their nearest Health Post in Bajura, so PHASE continues to advocate to the Government of Nepal for more Health Posts and Community Health Units and staff to run them continuously in remote and rural areas.

ANC Orientation for Pregnant Mothers

The aim of the sessions is to explain the importance of antenatal check-ups, communicate danger signs and potential complications to be aware of, and encourage mothers to attend at least 4 ANC check-ups during their pregnancy and give birth at a Health Post with ANM support.

• During Y2, a total of 492 mothers attending the ANC Orientation sessions with an increase in additional attendance of caregivers (husbands and Mother-In Law), seen over the year.

Reducing Malnutrition in Children

Our target for Year 2 was to reduce the number of children identified as malnourished using Mid-Upper Arm Circumference (MUAC) < 12.5 cm reading from 16.99% (measured at baseline) to 15%.

• Y2 Achieved: Only 3.1% children identified as MUAC < 12.5 CM reading. (7/229 children surveyed)
• During Y2 We supported 76 children with nutritious food due to identification of malnutrition, and re-assessed hundreds of children (650 – 930 children per quarter) for Growth Promotion Monitoring.

Antenatal Care (ANC) meetings, nutrition training to Female Community Health Volunteers (FCHVs) and Mothers’ Groups, Door-to Door visits and counselling, Street Drama, Golden 1,000 Days Orientation, demonstration of preparing nutritious food and Sarbottham Pitho ‘Superflour’ – all these combined interventions have come together to make a significant difference in reducing malnutrition.

Healthy Baby Competitions

Healthy Baby Competitions encourage parents to provide their children with nutritious food and promote good health for their children. The healthy children were selected and provided eggs, ghee, and hygiene kit as a prize (incentives). The competitions also allow project staff to further disseminate information regarding maternal and child healthcare, make regular health assessments of babies in the community, and provide children with nutritious food to support their health.

• In Y2, 2 Healthy Baby Competitions were held in each location, a total of 727 children attended with their parents, (357 boys and 370 girls)
• 80 children (50 boys and 30 girls) received the ‘Healthy Baby’ award with a reward of incentive (nutritious food and hygiene kits)

Demonstration of Sarbottham Pitho ‘Super Flour’ preparation and orientation to the mothers of Golden 1,000 Days on breastfeeding practice and food fortification

By improving knowledge and positive attitudes through the Golden 1,000 Days training, mothers are empowered to understand best practice of safe motherhood and encouraged to practice exclusive breastfeeding strategies for the first six months.

Teaching mothers to prepare Sarbottham Pitho’ or ‘superflour’ as weaning food for their children is important as there is often food insecurity and ‘hungry’ months when families struggle to feed themselves. This nutritious porridge is made up of roasted local grains, easily stored in an airtight container and mixed with water, milk (and ghee if available) to feed and nourish weaning children several times a day. This is a more nutritious weaning food than white rice or soft roti when available.

• In Year 2, 672 mothers attended these educational clinics receiving antenatal and postnatal care and child health checkups from ANMs.

Improved Community Health Outcomes

• During Year 2 of Start Strong, 2,061 people were counselled for health issues from 336 visits to different communities in the project area.
• 12 School Health sessions were run with 223 male and female students attending.

Improving Access to at least 4 ANC Visits for pregnant mothers

• We almost achieved the Y2 target of 82% – 81.3% (113 out of 139 women) of all recorded births in Year 2 of Start Strong attending at least 4 ANC visits.

Percentage of women trained that demonstrate correct knowledge of ‘Safe Motherhood’

• Y2 Target: 45%
• Achieved: 69.5% (82 out of 118 women who heard about Safe Motherhood.

Percentage of women trained who have knowledge of at least five components of Golden 1,000 Days ‘Sunaula Hazar Din’

Information provided on Antenatal Care, Child Nutrition, Newborn Care, Family Planning, Immunization, Breastfeeding, Complementary Feeding, Growth Monitoring and Maternal Nutrition.

• Y2 Target: 70%
• Achieved: 89.7% (182 out of 203 women who heard about Golden 1,000 Days)

Percentage of mothers with children aged 6 months+ that practised exclusive breastfeeding for the first 6 months

• Y2 Target: 83%
• Y2 Achieved: 94.8% (217 out of 229 women)

We are very pleased with this achievement as it is higher than the national and provincial average (56% in national level and 62% in the Sudurpaschim province level (Department of Health Services, Annual Report, 2022). This is commendable in a rural area, as our experience demonstrates that there is often a habit of weaning babies early so that mothers could go and work in the fields.

Promotion of Sarbottam Pitho as weaning food

Percentage of women with children aged 6-59 months consistently using super flour ‘Sarbottam Pitho” as weaning food for their children.

• Y2 Target: 65%
• Y2 Achieved: 69% (158 out of 229 women)

Primary health care services

The PHASE team provides patient consultation and treatment services from health posts and outreach clinics. Supporting the provision of primary health care services improves general well-being amongst community members and increases community engagement in health-seeking behaviours.

• 4,623 patient consultations were held and is an indirect benefit of supporting improvements to maternal health and reducing malnutrition in the communities.

Purchase and supply of Medicine Stock for Community Health Posts in Rugin and Bichhaya

PHASE Nepal supplies the essential medicines and equipment twice a year (April and October) for logistical reasons due to Monsoons affecting travel to remote areas. Based on the trend of patient flow and demand from the health workers, PHASE purchased medicines and supplied a six-month consignment twice in Y2. Bichhaya is particularly remote, no road access, so all supplies needed to be hauled in by porter and mule.

 Public Audits

These are the formal mechanisms to monitor, evaluate and provide direct community feedback on project activities and staff. Activities and budget for one year are shared so that community members understand and can ask any questions.

• In Y2, 163 people attended the Public Audit in each location.

 Street Dramas

Street Dramas that are produced once a year in each location. They are an accessible form of interactive storytelling with a public health agenda that benefits those who are less literate and cannot read information, particularly those of lower socio-economic groups such as the Dalit community.

• In Y2, 146 people attended the local Street Dramas by the PHASE Health Staff to promote public health messaging to the community.

Summary:

Outcome: 1,000 families from remote communities in Bajura, Far West Nepal, have improved maternal healthcare and family health

• No maternal deaths have been reported during childbirth or perinatal period.
• More access to ANC 4th visits and promotion of institutional births with a skilled ANM
• Child malnutrition rates are being reduced.
• Understanding of ‘Safe Motherhood is increasing
• Understanding of Golden 1,000 Days is increasing
• Sarbottham Pitho ‘superflour’ is being more consistently used as weaning food
• Exclusive breastfeeding for the first six months is increasing
• Child dietary diversity scores are increasing
• Women dietary diversity scores are increasing
• More families can feed themselves for at least six months than before from kitchen gardens
• Percentage of Traditional Healers and Female Community Health Volunteers who have adequate knowledge of ‘Golden 1,000 Days’ is increasing.

Start Strong Community member with twins born during Year 2.