Community Media/STORY WORKSHOP/Workshop Report/April 3 09 Appendix 1

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Appendix 1: Messages Matrix

Messages Matrix for Mother and Child Health Issues

The first column lists the issues. The second columns list negative behaviors/practices while the third column lists the possible consequences of the negative behaviors. The fourth column listed the positive or the expected behaviors while the last column lists the benefits of practicing the positive/expected behaviors.

Bad practices
Good Practices
Family Planning Getting pregnant below the age of twenty
  • Getting pregnant more that four times
  • Ignorance of family planning issues.
  • Myths and misconceptions on family planning
    • They say when you practice family planning the body Cools off (You are no longer able to perform sexually)
    • You become dry(you are no longer able to conceive, you become impotent or infertile
    • You give birth to premature babies
  • Some religions preach against and stop followers from practice family planning

Labour complications
  • Complications during labour due to immature pelvic bones
  • Long, painful and protracted labour
  • High blood pressure
  • Severe bleeding
  • Hemorrhage
  • Bursting of the uterus
  • Not spaced pregnancies
  • A risk to the life of the mother and the child
  • Leads family into Poverty

Women conceiving after their bodies mature i.e. after 20 years
  • Women not conceiving for more than four times
  • Families seeking information on family planning from health workers
  • Families should be well informed about family planning issues.

Few or no complications during child delivery
  • Reduced mother and child mortality
  • Healthy babies
  • Healthy mothers
  • Wives and husbands have time to be together as family
  • The family has time and resources to develop and educate children

Nutrition Being picky as regards food
  • Ignorance of balanced nutritious diets
  • Favouring the father when sharing out food in family
  • Selling nutrious foods
  • The tendency to eat just one type of food i.e nsima only

  • lethargy
  • malnutrition
  • underweight babies
  • sick mothers
  • Women may not be able to conceive

Eating food from all the six (6) groups
  • Diet diversification
  • Not selling all nutritious foodstuffs after harvests
  • Considering children first when sharing food in the family
  • Women to be taught how to prepare nutritious meals from locally available foodstuffs

Healthy mothers
  • Healthy babies
  • Helps mothers conceive
  • Helps reduce chances of mother to child transmission of HIV
  • Reduced cases of anaemia

Antenatal Clinics Not visiting health facility for antenatal clinic due to:
  • Fear of being shouted at by the health workers
  • Laziness
  • Ignorance of the importance of antenatal clinics
  • Long distances to health facilities
  • Fear of testing for HIV
  • Traditional and religious believes
  • Starting attending antenatal clinics late
  • Going for antenatal clinic late
  • Going for antenatal clinic less than four (4) times

The mother does not know about his health status and that of the baby
  • Both mother and the baby cannot get the right treatment at the right time e.g. All immunizations for the baby and malaria prevention treatment for the mother
  • Mothers miss important counseling and advice from the health workers
  • Complications during pregnancy and labour.
  • Mothers waste time visiting witchdoctor for remedies that can they can access free of charge at government health facilities

Mothers visiting the health facility as soon they know that they are pregnant.
  • Going to attend the antenatal clinic sessions in time
  • Women attending at least four antenatal clinic sessions
  • Women to report all cases of abuses and abusive health workers to the District Nursing Ombudsman
  • Women to learn the benefits and importance of attending antennal clinics before they conceive
  • The community to be informed about the centres for mobile antenatal clinics.

Mothers receive counseling, tips and advice for maternal and child health.
  • Mothers receive medicines to prevent, malaria and worms
  • Women receive optimum medical attention
  • Possible danger signs are identified and the woman and the medical personnel are well prepared to handle them
  • Mothers with HIV are able to protect the baby from HIV
  • Undernourished women are able to receive vitamin and food supplements

HIV Prevention Not going for HIV Testing and Counseling due to;
    • Myths, and religious believes
    • Women fear losing their husbands if they are the first to be diagnosed HIV positive
  • Ignorance on the benefits of testing
  • Mothers conceiving before They know their HIV status
  • Mothers conceiving knowing they are HIV positive
  • Lack of disclosure of status
    • Fear of marriage breakups in case of an HIV positive result
  • Not going for HIV testing and counseling as a couple
  • Not following health worker advice e.g.
    • Not adhering to ARV treatment
    • HIV positive couples and discordant couples not using condoms

HIV positive mothers cannot prevent mother to child transmission of HIV
  • HIV positive mothers cannot receive appropriate counseling and advice
  • Mothers cannot receive HIV treatment putting life and that of the baby at risk
  • Late diagnosis of HIV puts the whole family at risk
  • Couples that are HIV positive but do not know about it risk multiple re-infection
  • Spouses that do not disclose HIV status to each other cannot follow health worker advice
  • Perpetual sickness
  • Unhealthy babies

Couples testing for HIV before they marry
  • Couples testing for HIV when they start thinking about having a child
  • Couples discussing HIV issues
  • Couples that do not know their HIV status to use condoms every time they have sex
  • Women not conceiving when they are HIV positive
  • Adherence to health worker advice e.g.
    • adhering to ARV treatment
    • HIV positive couple and discordant couples using condoms every time they have sex
  • Not stigmatizing and discriminating against each people with HIV
  • Knowledge of how HIV is transmitted
  • Participation in community activities

Healthy mothers
  • Healthy babies
  • Reduced mother and child mortality
  • Healthy families
  • Couples living positively with HIV
  • Reduced cases of mother to child transmission of HIV
  • Adherence to health worker advice and counseling
  • Adherence to treatment
  • Reduced cases of stigma and discrimination

Malaria Prevention Families not sleeping under insecticide treated nets due
  • Ignorance (not believing that mosquitoes transmit malaria
  • Lack of bed nets
  • Laziness
  • Not draining stagnant water around homes and in the community
  • Not slashing down bushes around homes
  • Not visiting health facility when sick
  • Taking of painkillers instead of going to hospital for malaria treatment
  • Pregnant mothers not taking drugs to prevent Malaria

Families suffer from malaria
  • Activities that would have developed the family stall because of illnesses or deaths due to malaria
  • Mosquitoes continue multiplying
  • Lack of good sleep
  • Lethargy
  • Anaemia
  • Miscarriages

Sleeping under insecticide treated nets every night of the year
  • Burying ditches and draining stagnant water
  • Clearing bushes around homes
  • Hygiene
  • Visiting the hospital as soon as one has signs of Malaria
  • Pregnant women taking all malaria preventing drugs
  • Pregnant women attending antenatal clinics

Healthy families
  • Families participating in activities that can help develop their families and communities
  • Reduced incidences of mosquitoes
  • Good sleep during the night
  • Reduced miscarriages
  • Deaths due to malaria are prevented

Recognizing danger signs in pregnant mothers Not visiting health facilities when a pregnant woman has or is experiencing the following:
    • Discharging blood or water
    • High blood pressure
    • First pangs of labour
    • Fainting
    • Sepsis
    • Swelling of limbs
    • High fever

  • Deaths
  • Perpetual sickness
  • Aneamia
  • Complications during labour

Pregnant women visiting health when they have or are experiencing the following:
    • Discharging blood or water
    • High blood pressure
    • First pangs of labour
    • Fainting
    • Sepsis
    • Swelling of limbs
    • High fever

Reduced maternal and child mortality
  • Reduced maternal morbidity
  • Reduced cases of anaemia in pregnant mothers
  • Reduced numbers of miscarriages and still births

Role of Men in Maternal Child health Men beating their wives
  • Men not going for HIV Testing and counseling with their wives
  • Men refusing to accompany wives to antenatal clinics and to hospital
  • Men not helping pregnant wives do heavy household chores
  • Men not allowing women to go to hospital without their permission
  • Men not saving for the women to go to hospital in time, and for the new baby
  • Men not helping in caring for the baby or taking the baby to hospital

Women miscarry
  • Still births
  • Premature births
  • Baby is not protected from HIV
  • Women have unplanned pregnancies
  • Women suffer from hypertension and high blood pressure
  • Men do not know the danger signs in women and children

Men not beating wives
  • Men going for HIV Testing and Counseling with their wives
  • Men accompanying wives to the antenatal clinic
  • Men helping wives with domestic chores
  • Men taking a role in caring for babies
  • Men allowing women to go to the hospital anytime the women feel unwell.
  • Men saving for the wives to go to hospital to wait for their time and for the new born babies

Health mothers
  • Health babies
  • Health families
  • Reduced complications during labour
  • Reduced cases of maternal and infant mortality

Preparing for labour Pregnant women not exercising properly
  • Not preparing for child birth e.g. by buying materials needed during delivery like the plastic paper, basin, and beddings for the baby
  • Not going for Chidikiliro ( Where a pregnant woman goes to hospital in advance and wait for her time)

Woman has problems delivering
  • Mothers delivering along the Road sides
  • Mothers delivering at traditional birth attendants
  • Mothers delivering in dirty environment

Pregnant women doing proper exercises
  • Families preparing for the new babies by buying clothes, bedding for the baby and materials that women need during delivery in advance
  • Women seeking counseling and advice on child birth, labour and others issues
  • Husbands allowing wives to go to the hospital when it is time even when the husbands are not home.
  • Communities to have available means of transport ready to take women to health facilities when their time is due
  • Going to chidikiliro in time

Reduced labour and complications
  • Reduced cases of roadside or traditional birth attendant deliveries
  • Women delivering at health facilities
  • Health worker have time to trouble shoot and seek alternative remedies for complications
  • Health workers have chance to make timely referrals

Women's Empowerment

Stress and depression due loss of spouse, divorce or because the husband has lost his job
  • Women not participating in the families economic activities
  • women Not given chance to be economically independent
  • Alcoholism by men

  • Premature births
  • Poverty
  • Women remain economically dependent

Women becoming economically independent

  • Women taking part in different economic activities
  • Husbands drinking responsibly
  • Girls given the same chance as boys to continue with their education
  • Women able to choose the number of children they want
  • Women empowered to make decisions affecting their lives
  • Participation of women in decision making

Health mothers
  • Health babies
  • Health facilities
  • Well spaced pregnancies
  • Women have right to choose the number of children they want

Women taking alcohol and other poisonous substances Taking labour-inducing herbs i.e. mgudubiza/mfulumiza
  • Taking of alcohol and smoking during pregnancy

Rupturing of the uterus
  • Haemorrhage
  • The child suffocates
  • Woman bleeds heavily before and after delivery
  • High blood pressure
  • Still births
  • Miscarriages
  • Deformed babies

Women not taking labour inducing herbal concoctions like mgudubiza/mfulumiza
  • Avoiding smoking and taking of alcohol during pregnancy
  • Hospitals to be well equipped to avoid suffocation of babies during delivery

Successful and trouble-free deliveries
  • Rupturing of the uterus is avoided
  • Delivery of mature babies
  • Reduced cases of sepsis
  • Delivery of deformed babies is avoided

Respect for and professional treatment of pregnant mothers Understaffing of health facilities are understaffed
  • Health worker generalizations in treatment and handling of pregnant women (without considering that each case is different)
  • Health Worker laziness and lack of commitment to duty
  • Delays in referring complicated cases to district hospitals
  • Not listening to patients (shouting at patients)

Pregnant women shun health facilities when they have a problem
  • Most women deliver at traditional birth attendants
  • Negative image of health workers and hospitals in general
  • Untimely and unnecessary maternal and child deaths

Health workers treating pregnant women professionally
  • Respect for pregnant
  • Health facilities to refer difficult cases to district hospitals in time
  • District health Office and the Ministry of Health to ensure that health facilities are properly staffed and are well-equipped

Positive image of hospitals
  • Reduced maternal and child mortality
  • Safe motherhood
  • More women delivering at health facilities

Recognizing danger signs during labour Woman fainting when labour starts or during child delivery
  • Haemorrhage
  • Baby being born head or legs first
  • Baby lying across the abdomen

Injury to the mother
  • Woman suffers from sepsis
  • Caesarian births
  • Forced labour
  • Still births
  • Death
  • The baby may be born with abnormalities
    • Abnormally shaped head
    • May suffocate

Going to hospital in time
  • Attending antenatal clinics on a regular basis
  • Communities having transport ready to take a woman to hospital when danger signs are observed
  • Health workers diligence in dealing with such complications
  • Wives not to wait for husband or seek permission from husbands before they can go to hospital

Reduced maternal mortality
  • Increased number of normal deliveries
  • Normal babies
  • Reduce complications during labour

Going to Hospital before time Chidikiliro(Maternity Vigil) Labour starting at home
  • Mothers delivering at home
  • Mothers delivering on the way to hospital
  • Mothers delivering at Traditional birth attendants
  • Having no means to get to hospital in time because the husband is not around

Extremely painful labour
  • Mothers suffer from sepsis
  • Untimely and unnecessary deaths
  • Still births
  • Miscarriages

Going to hospital days before delivery to wait for the woman's time
  • Preparing before hand the means of transport to take the pregnant woman to to the hospital before her time is due
  • Saving money for the woman to use during the time the woman will spend in hospital waiting for her time
  • Husband avoiding long trips when the wife’s time is around the corner

The families are not taken by surprise when the woman’s time is due
  • Complications are known before they occur
  • Women deliver at health facilities
  • Reduced maternal and infant mortality
  • The health workers have time to respond to complications and to make necessary referrals

Hygiene Lack of cleanliness
  • Dirty beddings clothes and surroundings
  • Using dirty razor to cut the umbilical cords

Mothers suffer from sepsis and many other infections

Washing clothes and beddings
  • Delivering at health facilities
  • Preparing for child bearing in advance by buying the plastic paper, basins way before the mother is due
  • Not smearing dirty herbal medicines on the babies navel
  • Adherence to health worker advice

Healthy babies and mothers
  • Mother do not suffer from sepsis
  • Reduced maternal and child mortality

Myths and traditional beliefs and customs Women having to go to hospital secretly, so that people should know that their time is due
  • Woman waiting for the husbands permission before they can go to hospital even when their time is due
  • Using concoctions to speed up labour
  • Religions discouraging their faithfuls from going to hospital

Delivering at home
  • Delivering at Traditional Birth attendants
  • Deaths of mothers
  • Miscarriages
  • Still births
  • Deaths of babies

Women going to hospital anytime they feel unwell
  • Women not required to seek permission from elders for them to go to hospital
  • Going to hospital in time (for maternity vigil

Reduced maternal and infant mortality
  • Health mother and babies
  • Health workers have time to deal with any complications and to make timely referrals
  • The mother and child receive proper postnatal care, treatment and support

Exclusive breast feeding HIV positive mothers breastfeeding and at the same time giving supplementary feeds to babies who are less than six (6) months old
  • Breast feeding the baby only when it cries
  • Putting off the baby from the breast before it is fully satisfied
  • Giving the baby raw porridge to open its stomach and intestines
  • Mothers not breastfeeding the baby when they quarrel with their husbands

The child gets malnourished
  • The baby gets diarrhea
  • The baby has stomach problems
  • The baby can get infected with HIV

Women exclusively breastfeeding babies from birth until it is six (6) months old
  • Breastfeeding the baby whenever the baby wants to and whenever the mother feels the baby is hungry
  • Breast feeding the baby at least 8-12 times everyday
  • HIV positive mothers exclusively breasting the baby up to six months and completely stop breastfeeding at six months and introducing itto other foods

Babies grows in good health
  • Babies are s protected from diseases like diarrhoeal
  • Encourages frequent skin-to-skin contact between mother and infant, facilitates bonding between the mother and the child

Feeding the baby after six (6) months and beyond Giving baby foods of same type
  • Not giving baby food from all the six (6) groups
  • Unfair distribution of food in the family by favoring adults(giving the best food to the father of the house)
  • Beliefs that some foods which are nutritious are not good for babies e.g. eggs

Baby gets malnourished
  • Baby has stunted growth
  • The baby is prone to diseases
  • Baby dies

Giving baby food from all six food groups
  • Giving baby a diversity of foods from the six groups
  • Give the baby warm and hygienically prepared foods
  • Giving the baby food at the right time
  • Baby should be served before adults

Health strong babies
  • Babies are protected from diseases
  • Good mental and physical development for the babies

Mental and emotional well being of the child * Any forms of Child abuse
  • Calling child names
  • Not giving the baby any guidance and supervision
  • Not talking and playing with the babies

The child is always unhappy
  • The child lacks self-esteem
  • The child is emotionally detached
  • The child mental development is slowed

Playing and chatting with the baby
  • Teaching the child how to do different things
  • Being gentle with the child when they make mistakes

It fosters Child mental and emotional skills
  • Child develops psychomotor skills quickly
  • Bonding between baby and family members as well as other members of the household
  • Child develops self esteem, self confidence and independence

Caring for the newly born baby Using traditional herbs e.g. putting dirty charms on the child’s umbilical cord
  • Washing the baby in herbal concoction to make him or her strong
  • Not letting the baby suck colostrum
  • Not giving the baby the full course of immunizations
  • Not keep the baby warm

The baby is prone to different diseases e.g. tetanus, measles, coughing
  • The babies navel is infected
  • Baby may die

Child to receive the full course of immunization
  • Avoiding putting dirty charms on the baby’s navel
  • Parents should prepare for the new baby by sourcing warm clothes and beddings

The child is protected from different diseases
  • Heathy Babies
  • Reduced infant mortality rates

Hygiene Not washing hands when preparing baby’s food
  • Careless disposal of babies faeces
  • Not bathing the baby properly
  • Not washing the baby’s clothes and beddings
  • Unclean environment, rodent and insect infested homes

The baby can suffer from different diseases like diarrhea, pneumonia etc.
  • The baby is always irritated.

Wash hands after using the toilets, before preparing baby’s food before giving the baby food, before breastfeeding the baby
  • Washing the babies clothes and beddings regularly
  • Putting the baby in well ventilated places
  • Freeing rooms and houses of rodents and insects
  • Properly disposing off babies faeces

Reduced incidences of diarrhea
  • Reduces baby sickness
  • Reduces deaths due preventable diseases

Malaria prevention Not sleeping under treated nets every night throughout the year
  • Not clearing and draining water containers around the home
  • Not using insecticides to repel and kill mosquitoes

Increased incidences of malaria cases
  • Breeding of mosquitoes is high
  • Sleepless nights
  • Anemia

Sleeping under Insecticide Treated Nets every day of the year
  • Clearing and draining water containers around the home
  • Using some locally available mosquito repellants or insecticides like cow dung and basil

Health family
  • Reduced prevalence of malaria
  • Peaceful nights sleep
  • No miscarriages and deaths due to malaria

Protecting babies from HIV HIV positive mothers need not combine feeding methods before the baby is six (6) months old.
  • Not following health workers’ advice
  • Pregnant mothers delivering babies at home
  • Not adhering to HIV counseling
  • Not adhering to ARV treatment

Child can get infected with HIV
  • Babies with HIV are sickly and may not grow to adulthood

Mothers should follow the only feeding method they have chosen and the one they can afford
  • Mother to follow health worker advice.
  • Mother should always deliver at the clinic and follow all the advice given.
  • HIV positive mothers to adhere HIV treatment

Healthy babies
  • Chances of the child getting HIV through breast feeding are reduced.

Identifying danger signs in children and giving children appropriate treatment Taking children to Health Facilities late
  • Ignorance of danger signs
  • Not giving a child fluids when sick
  • Not following health workers prescriptions and advice for drug use
  • Not reacting timely to danger sign like
High fever, conversions, refusal of eating or breast feeding Child can die
  • Child become dehydrated
  • Child can be anaemic
  • Stunted growth for the child
  • Protracted sicknesses in babies

Follow health workers instructions
  • Give fluids to the child when sick
  • Going to hospital as soon as the baby gets sick
  • Learn about the danger signs in babies

Child gets well quickly
  • Children are protected from sickness
  • Children are treated quickly
  • Facilitates babies quick recovery from illnesses

Prevent child from injury and accident Putting the child near dangerous or objects that can put the child’s life at risk e.g. water, fire, electricity.
  • Leaving the child alone without a guardian
  • Ensuring safety when laying or

Child can be burnt, scalded, drown, shocked etc.
  • Child might die

Not letting children play near water, electricity fire etc.
  • Putting out fires, switching off electricity, putting drugs, poisons out reach of children
  • Always Leave children with someone trustworthy to look after them

Reduced chances of child injury
  • No fatalities due to preventable injuries
Protecting the Child from abuse Child abuse
  • Giving children work beyond their age
  • Giving children abusive names
  • Bullying and beating of children
  • Rape
  • Not taking children to hospital in time
  • Not listening to children
  • Not giving children necessities like beddings, clothes, and other s

The Child can be injured
  • Children grow tired and weak
  • Children can Easily get sick
  • They are psychologically affected
  • Child lacks self esteem
  • Get malnourished
  • The child can be physically deformed

Children have to be given child work i.e. those household chores that cannot cause them any harm and those that can teach them how to look after themselves better
  • Avoid bullying and beating of children
  • Provide for children needs
  • Listening to children

The child has health growth
  • The child grows up respecting and appreciating other people’s dignity
  • Child’s mental health is protected
  • No physical deformities for the child

Male involvement Refusing women to go for Family Planning
  • Men refusing to use Family Planning methods e.g. use of condoms
  • Threatening women with divorce if they insist on following family planning methods
  • Girls not continuing with education
  • Men requiring women to seek permission for them to go to hospital
  • Men not saving for the new baby and for the wives to go to hospital in time

Unplanned and closely-spaced pregnancies
  • Woman get sick
  • Labor complications for Women
  • Women delivering at home or along the way to health facility
  • Scarcity of food and resources in the family

Families discussing Family planning methods
  • Families to agree on family planning methods that suit their life styles
  • Women to be given chance to choose the family planning method of their choice
  • Girls encouraged to pursue their educational aspirations

Families have children at well-spaced intervals
  • Family have time for discussions
  • Woman does not grow old early
  • Less problems during deliveries
  • Girls going far with their education

Following health worker advice Refusing to adhere to health worker advice
  • Not caring for medicines received from health facility
  • Not attending Antenatal Clinics
  • Not getting full course of immunization
  • Not taking full dosage of prescribed medicines

Sicknesses for mother and child
  • Unnecessary and untimely mother and child deaths

Follow advice from health worker
  • Sticking to dosages
  • Making sure that babies get the full course of immunizations
  • Attending antenatal clinics at least four times before delivery

Health babies
  • Health mothers
  • Health families
  • Reduced maternal and infant mortality

Community participation Not participating in development activities
  • No toilets in the community.
  • Not draining of stagnant water and emptying buckets to prevent malaria.
  • Encouraging harmful beliefs and practices like using tradition medicines to induce labor, not allowing pregnant women to eat some easily accessible nutritious foods like eggs.

People get sick in the home
  • No progress on health development

Village members should participate on development activities
  • Abolishing or modifying al beliefs which put at risk the lives of mother and baby

Health community members
  • Village hygiene is maintained
  • Members able to participate in development activities