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ABOUTZiMBA is an evaluation project of Philani Health Nutrition Trust's Mentor Mothers program that operates in Eastern Cape. The Mentor Mother Program's goal is to combat the health challenges that pregnant mothers face in this rural, economically challenged area of South Africa. The Mentor Mothers program recruits and trains women in the communities who have been identified as model mothers and have raised strong and health children. Through home visits the mentor mothers are able to teach other mothers from their community about healthy child rearing practices. The goal for this program is to rehabilitate underweight children, support pregnant mothers to improve birth outcomes, decrease the number of children born with a low birth weight and assist in the prevention of mother-to-child HIV transmission.
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The StudyThe ZiMBA Study compares the health outcomes of mothers and infants in an intervention area, where the Mentor Mothers Programme has been running for at least a year, to a control area where the program is not active. The areas were selected based on similar characteristics in terms of number of children born, proximity to health care, HIV rates etc. The results will be used to learn about the effectiveness of the Mentor Mother Programme, with the hopes that it will allow a larger discussion to develop about the way maternal and infant health care can be improved in rural areas.
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Stories From The Field
Names have been changed for confidentiality
Ntombi’s Family
Ntombi is an 18-month-old girl cared for by her grandmother, with whom her mother left her when she was a baby. She was never breast-fed, and now lives on a diet of isidudu (watery maize porridge). The grandmother does not yet receive a pension and cannot apply for a child support grant (CSG) for Ntombi, as the child has no Road to Health Card. There is no regular household income, although the grandmother occasionally gets “piece jobs” helping neighbours do washing and make bricks. Ntombi, her two older siblings aged three and five, and her grandmother frequently go hungry.
A Mentor Mother visited the family and immediately referred Ntombi to the clinic for being underweight. She was dewormed, diagnosed with TB, and started on treatment. The Mentor Mother provided the grandmother with information about healthy food and hygiene, but the family did not have the necessary resources to follow her advice. Following up with Ntombi, the Mentor Mother noticed that the child had diarrhoea, was listless, and showed signs of swelling of both legs. She phoned her supervisor, who discussed the case with a doctor at the hospital. It was agreed that the child should come in to the hospital, and the Mentor Mother wrote a referral note for her. On examination, the doctor diagnosed Ntombi with early kwashiorkor and admitted her to the ward, where she stayed with her grandmother for two weeks, while a relative cared for the other children at home.
While Ntombi was in the ward, the hospital arranged a replacement for her lost Road to Health Card, and her grandmother was able to apply for a birth certificate when Home Affairs visited the hospital on its weekly outreach. She was subsequently able to apply for the CSG, and the Mentor Mother advised her on alternative documentation needed to get birth certificates for the older two children, who also did not have Road to Health Cards. On discharge, Ntombi was referred back to her local Mentor Mother for follow-up and was visited within a week. A food parcel was delivered to tide the family over until the CSG grant was paid. Eventually all three children were receiving grants. The Mentor Mother helped the grandmother to include nutritious food in their monthly budget and make sure Ntombi finished her TB treatment.
Although it was some time before Ntombi reached a normal weight, her growth was sustained from the time of her return from hospital. Having been taught good hygiene by the Mentor Mother, the grandmother was able to prevent Ntombi’s diarrhoea from returning too frequently, which also supported her growth. Ntombi’s family outlines a typical case, in which a range of factors are seen to impact the child’s health. As can be seen, she was transferred smoothly and quickly to a higher level of care as needed and followed up at the community level on her return. The immediate medical needs as well as long-term social challenges were dealt with, and the result was a healthier, normal-weight child and the prevention of repeat admissions.
Mrs Dyakophu
Mrs Dyakophu is HIV-positive, suffering from spinal TB, and bedridden. She is the mother of a 17-year-old daughter, Masini, and has a granddaughter, Anelisiwe, who is seven months old. Their one-room hut had holes in the roof and was in a state of disrepair. Masini did not have enough clothing to keep her daughter warm, dry, and clean, and she was not coping well. A Mentor Mother visited the household and weighed Anelisiwe, who looked hungry and wet. Anelisiwe was suffering from kwashiorkor, TB, asthma, had sores all over her body, and her feet and face were swollen. She was taken to hospital and admitted. The Mentor Mother also discussed Mrs Dyakophu with the hospital staff, and was encouraged to bring her in for assessment. Both the grandmother and grandchild were in the hospital for two months.
Mrs Dyakophu had no ID book and no means to support her family. The Mentor Mother connected her with a social worker who helped her get a birth certificate and ID and apply for a disability grant. Masini also applied for her birth certificate and ID, and a CSG for Anelisiwe. With this income they have been able to improve their hut and are now living in better conditions. They have applied for a house closer to the road to be able to get to the clinic more easily to collect their treatments. Mrs Dyakophu now has a wheelchair and is looking healthy. Anelisiwe is no longer malnourished, and Masini is coping much better.
The Makhwenkwana family
The Makhwenkwana family lived in a single-room home in the remote rural village of Sizendeni. A pregnant, HIV-positive, 20-year-old woman taking ARVs, a 16-year-old with TB, and a small child suffering from TB lived with both their mother and a violent and abusive father.
A Mentor Mother visited the family and started to open folders for the pregnant woman and the child but could not finish on that day because the daughters were nervous their father would arrive home. He did not want any people entering the house, especially if they were perceived to be part of the health department. However, the Mentor Mother returned with her supervisor the next day, and they were able to admit both daughters and the child to the Philani programme.
The 20-year-old woman had multiple health problems and was referred to the hospital, where she was admitted and stayed for more than two weeks. On the follow-up visit she appeared healthier and looked less pale and weak. On another visit, the 16-year-old disclosed she had defaulted on her TB treatment due to lack of money to get to the clinic, and her child was discovered to be underweight for its age. Through the Philani programme, the Mentor Mother arranged and paid for her transport to the hospital. There, the teenage mother was restarted on TB treatment, and the child was admitted for 10 weeks.
Finally, arrangements were made and funding provided for the mother, her two daughters, and grandchild to move to Zidindi, the village where the mother had grown up, and over an hour away from the abusive father, who did not want anything to do with the Philani programme or Department of Health. The women are now taking their treatment, no longer defaulting, and have a chance for a normal and healthy life.
Nosiphelo
A Mentor Mother was phoned in the middle of the night by the family of Nosiphelo, who had just delivered at home and was bleeding heavily. At this time of night, there was no transport available to the woman at all. The Mentor Mother woke up the Philani programme manager, and they drove to Nosiphelo’s house and brought her to the hospital. Once there, doctors attended to her urgently, and they were able to stop the blood loss. Her life was saved, and her baby now has a mother and a better chance to live a healthy life.
Ntombi is an 18-month-old girl cared for by her grandmother, with whom her mother left her when she was a baby. She was never breast-fed, and now lives on a diet of isidudu (watery maize porridge). The grandmother does not yet receive a pension and cannot apply for a child support grant (CSG) for Ntombi, as the child has no Road to Health Card. There is no regular household income, although the grandmother occasionally gets “piece jobs” helping neighbours do washing and make bricks. Ntombi, her two older siblings aged three and five, and her grandmother frequently go hungry.
A Mentor Mother visited the family and immediately referred Ntombi to the clinic for being underweight. She was dewormed, diagnosed with TB, and started on treatment. The Mentor Mother provided the grandmother with information about healthy food and hygiene, but the family did not have the necessary resources to follow her advice. Following up with Ntombi, the Mentor Mother noticed that the child had diarrhoea, was listless, and showed signs of swelling of both legs. She phoned her supervisor, who discussed the case with a doctor at the hospital. It was agreed that the child should come in to the hospital, and the Mentor Mother wrote a referral note for her. On examination, the doctor diagnosed Ntombi with early kwashiorkor and admitted her to the ward, where she stayed with her grandmother for two weeks, while a relative cared for the other children at home.
While Ntombi was in the ward, the hospital arranged a replacement for her lost Road to Health Card, and her grandmother was able to apply for a birth certificate when Home Affairs visited the hospital on its weekly outreach. She was subsequently able to apply for the CSG, and the Mentor Mother advised her on alternative documentation needed to get birth certificates for the older two children, who also did not have Road to Health Cards. On discharge, Ntombi was referred back to her local Mentor Mother for follow-up and was visited within a week. A food parcel was delivered to tide the family over until the CSG grant was paid. Eventually all three children were receiving grants. The Mentor Mother helped the grandmother to include nutritious food in their monthly budget and make sure Ntombi finished her TB treatment.
Although it was some time before Ntombi reached a normal weight, her growth was sustained from the time of her return from hospital. Having been taught good hygiene by the Mentor Mother, the grandmother was able to prevent Ntombi’s diarrhoea from returning too frequently, which also supported her growth. Ntombi’s family outlines a typical case, in which a range of factors are seen to impact the child’s health. As can be seen, she was transferred smoothly and quickly to a higher level of care as needed and followed up at the community level on her return. The immediate medical needs as well as long-term social challenges were dealt with, and the result was a healthier, normal-weight child and the prevention of repeat admissions.
Mrs Dyakophu
Mrs Dyakophu is HIV-positive, suffering from spinal TB, and bedridden. She is the mother of a 17-year-old daughter, Masini, and has a granddaughter, Anelisiwe, who is seven months old. Their one-room hut had holes in the roof and was in a state of disrepair. Masini did not have enough clothing to keep her daughter warm, dry, and clean, and she was not coping well. A Mentor Mother visited the household and weighed Anelisiwe, who looked hungry and wet. Anelisiwe was suffering from kwashiorkor, TB, asthma, had sores all over her body, and her feet and face were swollen. She was taken to hospital and admitted. The Mentor Mother also discussed Mrs Dyakophu with the hospital staff, and was encouraged to bring her in for assessment. Both the grandmother and grandchild were in the hospital for two months.
Mrs Dyakophu had no ID book and no means to support her family. The Mentor Mother connected her with a social worker who helped her get a birth certificate and ID and apply for a disability grant. Masini also applied for her birth certificate and ID, and a CSG for Anelisiwe. With this income they have been able to improve their hut and are now living in better conditions. They have applied for a house closer to the road to be able to get to the clinic more easily to collect their treatments. Mrs Dyakophu now has a wheelchair and is looking healthy. Anelisiwe is no longer malnourished, and Masini is coping much better.
The Makhwenkwana family
The Makhwenkwana family lived in a single-room home in the remote rural village of Sizendeni. A pregnant, HIV-positive, 20-year-old woman taking ARVs, a 16-year-old with TB, and a small child suffering from TB lived with both their mother and a violent and abusive father.
A Mentor Mother visited the family and started to open folders for the pregnant woman and the child but could not finish on that day because the daughters were nervous their father would arrive home. He did not want any people entering the house, especially if they were perceived to be part of the health department. However, the Mentor Mother returned with her supervisor the next day, and they were able to admit both daughters and the child to the Philani programme.
The 20-year-old woman had multiple health problems and was referred to the hospital, where she was admitted and stayed for more than two weeks. On the follow-up visit she appeared healthier and looked less pale and weak. On another visit, the 16-year-old disclosed she had defaulted on her TB treatment due to lack of money to get to the clinic, and her child was discovered to be underweight for its age. Through the Philani programme, the Mentor Mother arranged and paid for her transport to the hospital. There, the teenage mother was restarted on TB treatment, and the child was admitted for 10 weeks.
Finally, arrangements were made and funding provided for the mother, her two daughters, and grandchild to move to Zidindi, the village where the mother had grown up, and over an hour away from the abusive father, who did not want anything to do with the Philani programme or Department of Health. The women are now taking their treatment, no longer defaulting, and have a chance for a normal and healthy life.
Nosiphelo
A Mentor Mother was phoned in the middle of the night by the family of Nosiphelo, who had just delivered at home and was bleeding heavily. At this time of night, there was no transport available to the woman at all. The Mentor Mother woke up the Philani programme manager, and they drove to Nosiphelo’s house and brought her to the hospital. Once there, doctors attended to her urgently, and they were able to stop the blood loss. Her life was saved, and her baby now has a mother and a better chance to live a healthy life.
