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Fighting their battles—women and immunisation

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Some of the group members captured at Mutugha clinic

26 year-old Judith Simwayi had good intensions for her second born child; had it not been for the stigma and discrimination she went through in 2017.

All this, as well as insults, started when she fell pregnant for a third time while her second born was just a year old. She became a laughing stock because she was not using family planning methods.

The pressure and mockery, which kept piling up, would result in her son missing the sixth and last vaccination for measles.

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“I was not using any family planning methods and because my husband and I engaged in unprotected sex, I got pregnant. It was a bad experience for me because I ended up becoming the talk of the village. The insults were unbearable and I had no option but to restrict my movements that included suspending visits to any public places like health facilities,” she recalled.

This would eventually hurt her young son by virtue of missing out on the measles vaccination.

“I still regret that to date my son is still defenceless from measles due to my cowardice. The decision to stop visiting any health facility also delayed my start for antenatal services with seven months instead of the required three months. It was not surprising that during my first appearance at Msumba Health Centre, I was denied services until I paid K2, 500 fine,” she said.

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Although, Simwayi delivered a healthy baby weighing 2.8 kilogram, on February 12, 2019 she laments the lack of child spacing.

“I had no time to relax and I remember that year I never participated in any farming activities because I had to watch my health as well as that of my son who missed measles vaccine. This affected our output production of both maize and beans and it was not surprising that we faced hunger in that year,” she said.

Fast forward to April 2020, Simwayi is no ordinary person in Mwanjasi Village in the area of Traditional Authority Misuku in Chitipa District.

She is one of the 30 women of Mutogha Mothers Care Group (MCG) who strive to ensure that every child gets vaccinated.

“We meet once a month to check the progress of immunisation in our catchment area. During these meetings we look at the children reminder cards to check who defaulted and try to trace them so that they get immunised. For children whose vaccine is due, we make sure that their parents or guardians are alerted so that they don’t miss the sessions because every vaccine has a role to play in boosting immune system of a child,” she says.

The group’s chairperson, Grace Mbale, stressed that since the group was formed in 2019, the area has made strides in promotion of child health.

“We conduct door to door meetings, especially with families that have pregnant and breastfeeding women, to remind them of the need to visit antenatal clinics as well as taking their under-five children to immunisation sessions. We had over 15 children who could not finish receiving vaccine a month but since our operations, we have managed to reduce the figure down to zero as of February this year,” Mbale said.

Statistics from four immunisation clinics of Munganeghe, Mwambeta, Mutogha and Namwila, all under Mutogha MCG, show that only four children defaulted vaccine between December 2019 to January 2020 and none in February 2020.

Group Village Headman Mwanjasi, who also doubles as patron of the group, hails the women for enduring long distances, coupled with rugged roads and flooding rivers, during rainy season to promote health of both children and women.

“There are so many hard to reach areas like Lameck Village after Kyungu Bridge was washed away. These women make every effort by walking more than 15 Kilometres to ensure that they create increased awareness on child vaccination. Interestingly too, male are getting involved and this is helping families to make informed health decisions concerning children as well as women,” Group Village Headman Mwanjasi said.

Formulated on October 14, 2019 Mutogha MCG has to its credit built an under-five clinic as well as a Health Surveillance Assistant house using local resources like bricks, sand, quarry stones, labour and planks.

“After noting that there is long distance about 5 kilometres to Msumba Health Centre, we mobilised local resources and built Mutogha clinic and a house for HSA. We want immunisation sessions to be taking place within people’s reach.

“We have already written the Director of Health and Social Services at Chitipa to provide us with two HSAs—one at Mutogha and the other at Mwambeta— so that they can help in health delivery services because the one HSA at Msumba is overwhelmed due to the vastness of the catchment area. We have also requested for refrigerators at the two places [Mutogha and Mwambeta] so that we can be able to store vaccines for easy access during immunisation sessions,” Mbale said.

Malawi Health Equity Network (Mhen) with financial support from Global Alliance for Vaccine Immunisation (Gavi), through Ministry of Health and Population, is implementing the project aimed at encouraging families to vaccinate their children, after noting low immunisation coverage in most districts, including Chitipa.

Chitipa District Environmental Health Officer, Sam Chirwa, attests to this, saying the Expanded Programme on Immunisation (EPI) coverage was low at around 69 percent for fully immunised children in 2018.

“These mother groups are really assisting the district in improving the coverage of EPI and within the very short period which we have been implementing the project. What we are fighting for now is full immunisation which was at 69 percent in 2018 but now we are at 79 percent and we are hopeful that by the end of year it will be over 80 percent which is the recommended target set by the WHO [World Health Organisation],” Chirwa said.

According to Chirwa, there are several factors that negatively affected full immunisation uptake, including lack of follow ups on defaulters.

In Chitipa, there are a total of 13 MCGs spread across Senior Chief Kameme and Traditional Authorities Wenya, Nthalire and Misuku.

Mehn Assistant Project Officer, Tumpale Kalobo said the project is operating in 13 districts including Chitipa where they want to boost immunisation coverage.

“To this effect we formulated and trained 13 mother care groups in Chitipa to assist in mobilising and sensitising their communities on the importance of immunisation as well as male involvement in health issues. If males participate they facilitate easy understanding of health issues and this helps families to make informed decisions about children’ immunisation as well as mothers requiring antenatal services,” she said.

Chirwa adds that in the areas where the MCGs are in full force there is increased male involvement averaged at around 50 percent in health related issues.

Meanwhile, Mutogha has asked for more support saying the group needs mobility as well as other equipment in order for them to effectively discharge their work.

“We want bicycles to ease mobility challenges and also rain coats to protect ourselves from rains so that we serve the community all year round,” Mbale said.

Statistics indicate that between 2010 and 2016, the proportion of children who received full immunisation before their first birthday dropped from 81% to 76% in Malawi. The Expanded Programme on Immunisation seeks to boost the percentages.

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