Improve Mother and Child Health in Ghana

P.O.BOX 301 Kasoa Central Region-GHANA
TEL: +0233-276393001 /+233-262639001
Newborn health: an opportunity to save lives worldwide Each year, nearly 4 million newborns die around the world -more than the combined number of annual deaths from AIDS and malaria.

This single statistic threatens the achievement of the United Nations� Millennium Development Goal 4: a 2/3 reduction in the number of children who die from preventable and treatable causes by the year 2015.

Although overall child mortality rates have dropped in the past decade, newborns continue to die at alarmingly high rates. Unless newborn death rates are curbed by at least half, 2015 will be just another year where far too many young lives will be lost for lack of political will.

There is hope: inexpensive, practical health interventions do exist. If programs delivering such interventions were set up in countries with high newborn mortality rates, 60 percent of newborn deaths could be averted each year.
Why, when, and where do newborns die?
Infections, birth asphyxia and preterm birth cause 85% of newborn deaths worldwide.
Three out of four newborn deaths take place during childbirth and the first week thereafter, the postnatal period.
The vast majority (99%) of newborn deaths occur in low and middle-income countries, mostly in poor, remote communities.

The Rural Integrated Relief Service-Ghana for Mother and Child Health (RIRSG-MCH), is known in Ghana, was founded in Accra in 2004. A mother-and-child centre, it provides health, nutrition, education and sustainable skills training programmes for mothers, children and community health workers.

The RIRSG-MCH for Mother and Child Health, Ghana (RIRSG-MCH) as it is known as locally, aims to improve pre and post natal care through health, hygiene and nutrition programmes, improve the health and nutrition of infants and children below 6 years of age and educate children through a tri-lingual preschool in English.We are all committed to help alleviate the suffering caused by poor education, poverty, bad sanitation

Ghana is one of the world's poorest countries, with nearly 70 per cent of its population dependent on small scale farming. Malaria, acute respiratory infections, diarrhoea, malnutrition and measles remain the five leading killer diseases of children, but overall infant and under-five mortality rates are declining.

Nutrition Programme

The RURAL INTEGRATED RELIEF SERVICE-GHANA for Mother and Child Health (RIRSG-MCH) helps undernourished children by:

Offering a nutritious meal three times a week, rich in protein, vitamins and minerals
Conducting regular medical checks and ensuring supplementation of vitamins and minerals.
Providing nutrition education and demonstration for mothers through meetings and cooking classes to improve the quality of home feeding
Providing regular counselling and home visits where follow ups are necessary
A growth chart is used to monitor the children�s progress on a monthly basis.

The chart plots the child's weight against age (weight for age) and is a quick and convenient tool that shows growth over time of an individual child.

It is useful as an initial assessment to show how underweight a child is. At RIRSG-MCH the nutritional status of the children is also determined by comparing how wasted (thin) a child is or how short they are for their age (stunted). Medical reasons behind the slow growth are determined and addressed after the initial check up

There is a continual turnover of children as some become mildly undernourished and eventually discharged and new severely undernourished ones are admitted to the programme.

Current Nutrition Activities
1. Focus on Enriched Porridge
Children under age two are the most vulnerable to malnutrition especially during the critical period (i.e., during the first twelve months of life). This period coincides when the need for optimal infant and complementary feeding practices are crucial. For its undernourished children under age one, RIRSG-MCH has created enriched porridge with local foods namely rice, vegetables, oil and protein sources such as fish, chicken, or liver.
Additional roasted peanut sprinkles are offered to those who do not have allergies to nuts.

2. Focus on High Energy Milk (HEM)
In addition to providing nutritious foods and enriched porridge to moderately and severely malnourished children, RIRSG-MCH also offers High Energy Milk (HEM). The HEM recipe utilized for catch-up growth is the one recognized as the �gold standard� by the World Health Organization to rehabilitate severely undernourished children. RIRSG-MCH receives milk donations for this purpose. Community Health Workers teach mothers how to prepare the High Energy Milk (with powdered milk, sugar and oil) and to offer it frequently over a 24 hour-period.

3. Focus on modified positive deviance project
The positive deviance or Hearth Model approach is based on the premise that within poor communities with the same resources, there are children with good nutritional status and some that are undernourished. An assessment of the families with good nutritional status, involves identification of mothers who are positively feeding their children, care for their children and seek out health care within their community. In assessing these mothers, positive traits that can be used as a model for the rest of the community are identified and used. This approach is considered to be of potential benefit to all underweight children on the programme
The Positive Deviant Inquiry has helped to identify children and families who were positive deviants (i.e children who have remained healthy since birth). They were identified by their growth charts and subsequently observed and questioned regarding their child care and feeding practices. Positive deviant behaviors were extrapolated and compiled and incorporated into health education sessions for the families of malnourished children to benefit from.

4. Focus on micronutrients
Iodine levels in salt:
Iodine is important for mental development and in the prevention of goitre. A lack of iodine can prevent normal growth in the brain and nervous system and lead to poor school performance, reduced intellectual ability and impaired work capacity.

One of the major sources of iodine is salt. Manufacturers and environmental conditions such as heat, light, storage conditions and moisture determine the iodine content in salt. This may explain why 50% of salt samples brought in by mothers for testing this year did not contain iodine. RIRSG-MCH continues to check the iodine content of salt used by the families on the programme on a regular basis and provide advice.Vitamin A:
Vitamin A is essential for a well functioning immune system and the survival, growth and development of children.
Iron and Anaemia:
Nutritional causes of anaemia are usually attributed to deficiencies of iron, folic acid vitamin B12 and vitamin A in the diet. Iron deficiency anaemia (the most common) is a major cause of maternal death and of cognitive defects in young children. It can permanently affect mother development later on in a child�s life and school performance.

Anaemia levels were tested for the children attending RIRSG-MCH and 50% were found to be anaemic. Iron supplements in the form of syrup were provided for those anaemic and borderline cases. The supplementation was effective as there was a reduction in the anaemia level after further checks.

Health & Nutrition Education for Mothers
Undernutrition in GHANA results from a RIRSG-MCH of complex causes only one of which is lack of access to food due to economic constraints. In other words, poverty is only one of many reasons for undernutrition. Often, undernourished children in urban ACCRA live right next door to healthy children of the same income level.

A significant factor in under-nourishment, experts agree, is a lack of knowledge on the part of the caregiver about what constitutes good nutrition. Some mothers just don't know what to feed their children. Another important factor is mothers� behavior during feeding practices.

Basic nutritional education for mothers is therefore one of the most important activities at RIRSG-MCH.

Firstly, three days each week, mothers bring their children for meals at the feeding programme, they observe the different types of nutritious food prepared by the Foundation for their children.

Then, once each week, the mothers learn to cook healthy meals. Community Health Workers (CHWs) facilitate the cooking sessions. Community Health Workers only use equipment the mothers already have in their own urban homes and use ingredients that the mothers can easily obtain and afford.

Mothers also attend weekly general health and nutrition lessons. Through games and other interactive teaching methods, mothers learn about the importance of certain types of food, breastfeeding, feeding practices, how to treat various illnesses such as children's diarrhoea, and amongst other things, the importance of immunizations in preventing common diseases.

Mothers whose children do not need to participate in the feeding programme but have children attending one of the Foundation�s preschools also receive health education and nutrition classes once a week.

Some families with which RIRSG-MCH work, live in very deprived conditions on garbage dumps. Children from these very impoverished areas are offered a place on an RIRSG-MCH early learning centre nearby and their mothers are given access to regular health education and nutrition classes.

The health and nutrition curriculum is the same for every mother whether they have children attending the feeding programme, attending one of our early learning centres or whether living on a garbage dump.
New mothers who have underweight children bring in a sample of food they give to their children on a daily basis. The Health Educators at the RIRSG-MCH then evaluate the food produced and talk through the whole nutrition issue with the mothers.

Modified Positive Deviance Programme

The use of the Positive Deviance or Hearth Model approach has been used in nutrition programmes for many years. It is based on the premise that within poor communities with the same resources, there are children with good nutritional status and some that are malnourished. A critical assessment of the children with good nutritional status, involves identification of mothers who are positively feeding their children, care for their children and seek out health care within their community. In assessing these mothers, positive traits that can be used as a model for the rest of the community are identified. This is typically a community-based project and hence devolves some control to the community. It involves fathers, community leaders and the whole neighbourhood. This method can be particularly effective as the approach involves the community discussing and finding their own solutions.

RIRSG-MCH Approach

Our priority program is community based health care. We emphasize primary health care and home environmental sanitation. We mobilized the community to put up Health Centre, which is currently rendering services. Its activities include

General treatment for outpatients, whereby at least 50 people are attended to daily, especially children and mothers;
Immunization against the six killer diseases;

Home visits and outreaches. These are done to take services nearer to the people and to exactly know what is really happening at the grass roots.
Training and mobilization of the community - whenever mothers come for immunization schedules they are trained on many issues concerning their lives, especially family planning issues.

Our other programs include environment protection (tree, soil and water conservation), sustainable agriculture which emphasizes the use of locally available resources which are not only friendly with the environment, but are also cheap; and small scale busines enterprises which are being supported by the Together-Ghana( national NGO)

to decrease the infant death rate at birth
to decrease women's maternal death rates
to decrease the infant mortality rate
to improve access to pre and post natal services for expectant and child-bearing mothers


We shall mobilize the community to contribute all the necessary local materials, and to construct the maternity ward. It will take about six months.
Rural Integrated Relief Service-Ghana. P. O. BOX 301 Kasoa Central Region Ghana