Local ASHA centres keep a record of the child’s overall growth
Parenting app improves child health with reminders
Usha Rai, New Delhi
EARLY morning, parents of the largely migrant population of Kondli village in Mayur Vihar assembly block in east Delhi and adjoining areas set out for work. The waste mountain at Ghazipur is easily visible at Kondli and often the stench emanating is overpowering. This is one of Delhi’s poorest areas.
Many mothers are undernourished and though they love their children, providing food and shelter for the family takes precedence over child care. But that is changing thanks to the Aga Khan Foundation’s (AKF) concerted effort in training ASHAs (Accredited Social Health Activists) and designing a parenting app called Paalan 1000, that keeps reminding young mothers when and how to care for their babies with colourful pictures and audio recordings.
Fortunately, as Sanjay Kumar, who looks after the AKF programme, points out, over 90 percent of the families have android phones and with the assistance of the ASHAs, around 3,000 users have downloaded AKF’s Paalan 1000 app.
Recognizing that the old lecture-based modules used in government settings were ineffective, AKF worked on an innovative approach for Early Childhood Development (ECD) training. The ECD module was designed as fun activities with standees displaying Vroom messages on parenting tips and a nurturing framework. Activity-based learning, local expressions, and language were used to encourage greater participation.
The Mother and Child Protection (MCP) card was utilized as a tool for group activities to enable understanding of the relationship between parenting tips and milestones in child growth. Special ECD training was given to 404 ASHAs and, where necessary, handholding was done. The home visits became more meaningful with the health workers identifying development delays and monitoring growth of newborns to two-year-olds.
The initiative began with a ‘parent coaching in the first 1,000 days’ campaign through hoardings, banners, posters, messages on e-rickshaws and on radio. Thirty-three health facilities and Anganwadi centres of East Delhi were identified for the project. Families were encouraged to have their babies at the Lal Bahadur Shastri Hospital in Khichripur, East Delhi, and a stimulating environment was created at the hospital for children coming for vaccination or paediatric OPD visits. A special room was allotted for breastfeeding mothers.
As the AKF intervention comes to a close at the end of the year with the Centre taking ownership of the parenting app, ASHAs proudly claim the exclusively breastfeeding percentage has risen from 49 percent to 87 percent.
Mannu, the ANM (Auxiliary Nurse Midwife) at the clean and inviting Mother and Child Welfare dispensary at Kondli, which sees a steady stream of mothers and infants for vaccination, weight and growth checks, says the first 1,000 days represent a crucial phase of rapid physical growth and accelerated mental development. Special attention in that period constitutes a unique opportunity to establish lifelong health. Even in the womb, the baby relies entirely on the mother for nutrition, mental, physical, and emotional growth.
Mannu monitors the work of 10 ASHAs who service the area. Each ASHA has responsibility for a population of 10,000. The ASHAs have been trained so well that Mannu has not seen a single infant death in Kondli in the past three years. This is because great importance is accorded to the first 42 days after birth and the ASHA’s accelerated home visits under Home Based Newborn Care (HBNC).
When Kamini, 32, an IT professional and a working mother, got pregnant for the first time she turned to Manorama, the ASHA allotted to her area. She would come once a fortnight and ensure that she took calcium and iron supplements, more greens in her meals, and fruit. Her baby girl, Bhamini, is now a perky six-month-old and Kamini says the parenting app serves as a substitute for her mother and mother-in-law when they are not around. “It tells me what I should do for my baby and how I should care for her.” Then, in an aside she admits that she has derived more information from the app than from her wise senior family members. Her husband, Kulbhushan, also turns to the app when Bhamini is under his watch.
Seven videos walk a mother through the first 1,000 days of her child’s life
There are seven videos about the first 1,000 days of a child’s life. There is a vaccination reminder and for each month a different activity is provided for the child’s development. To save children from TV addiction, the app tells parents not to watch TV, videos or their phone screens in the presence of the child until they are two years old. Born weighing 2.7 kg, Bhamini is now a healthy seven kg.
Once a month, Manorama visits 450 homes to help and advise pregnant and nursing mothers. She insists on freshly cooked meals for babies who are old enough to eat. Repeating a meal of dal/chawal over three days enables the child to recognize it and begin asking for it. Manorama has developed a special bond with Kamini, Bhamini and their family.
Uzma and her 19-month-old baby, Mahinoor Fatima’s story is one of hope. A resident of Mulla Colony, Uzma is a graduate of Delhi University and was teaching computers to children when she got married to Bablu Khan who deals in jute bags. Her first child, Mariam, now five, was born at the Lal Bahadur Shastri hospital and she had no problems in bringing her up. When she became pregnant again she contacted Dharamveeri, the ASHA who had seen her through the first pregnancy.
Uzma probably did not pay adequate attention to her health and nutrition and Mahinoor was born in the seventh month of pregnancy in December 2021. The baby weighed just 1,200 gm and was placed in the special newborn care unit of LBS Hospital for 24 days. Initially, she was too weak to suckle and was given formula milk. Uzma, with support from Dharamveeri, began breastfeeding her and with proper care and support Mahinoor’s health improved slowly and she came home. Uzma does not have a smartphone and therefore cannot benefit from the parenting app. She does, however, have the MCP card and took all steps to ensure Mahinoor’s well-being.
On her part, Dharamveeri went into fast gear after doing a one-month course on care of weak, pre-term babies. She held consultations with other ASHAs and helped Uzma nurture the child back to health. The kangaroo hug helped the baby immensely. For a year, for an hour every day, Uzma and the baby would be without clothes and Mahinoor would be held close, soaking in her mother’s warmth and love. The kangaroo hug or Kangaroo Mother Care (KMC) is a comparatively new feature that is being given importance in saving underweight and pre-term babies. By the end of her eighth month, Mahinoor was 5 kg 800 gm and speaking a few words. Slowly, her diet improved with khichdi (a smooth mix of rice and pulses), boiled eggs and mashed bananas. Today she sits with the family and eats everything, including meat, and wheels around on her bright yellow horse-shaped cycle. However, she has an aversion to fruit and Uzma is working on overcoming it.
With new awareness about the care of low-weight babies, ASHAs are encouraging young mothers to use the KMC or the kangaroo hug as nature’s way of energizing such babies. In addition, frequent breastfeeding and consumption of iron folic acid (IFA) and calcium tablets by mothers is recommended post-delivery.
Under the Paalan 1000 Days project, fathers too are being encouraged to assist in care of the child. They are asked to sing and recite rhymes and play with colourful toys they bring for them. Parents who were too busy earning two square meals a day are finding time for their babies and enjoying it.