Enhancing Maternal and Child Health using a Combined Mother & Child Health Booklet in Kenya.

Under Kenyan guidelines, HIV-exposed infants should be tested for HIV DNA at 6 weeks or at first clinical contact thereafter, as infants come for immunization. Following the introduction of early infant diagnoses programmes, however, many infants were not being tested and linked to care and treatment. We developed the Mother & Child Health Booklet to help relate mothers' obstetrical history to infants' healthcare providers to facilitate follow-up and timely management. The booklet contains information on the mother's pregnancy, delivery and postpartum course and her child's growth and development, immunization, nutrition and other data need to monitor the child to 5 years of age. It replaced three separate record clinical cards. In a 1 year pilot evaluation of the booklet in Nyanza province in 2007-08, the number of HIV DNA tests on infants increased by 34% from 9966 to 13 379. The booklet was subsequently distributed nationwide in 2009. Overall, the numbers of infants tested for HIV DNA rose from 27 000 in 2007 to 60 000 in 2012, which represents approximately 60% of the estimated HIV-exposed infants in Kenya. We believe that the booklet is an important strategy for identifying and treating infected infants and, thus, in progress toward Millennium Development Goal 4.

Perceptions of child discipline and its contributions to child abuse in a low-income community in Nairobi, Kenya.

BACKGROUND: There is a fine line between child discipline and maltreatment. Perceptions of child discipline in three tribal groups living in an informal community in Kenya are reported. METHODS: Child disciplinary practices in the Kibera community of Nairobi were surveyed among three tribal groups (the Luo, Luyha and Nubi) to determine perceptions and modes of discipline and what was perceived as excessive. RESULTS: A random sample of 538 adults with children <18 years; 73% were mothers and 20% fathers. Overall, 98% had ever disciplined a child; 376 (70%) understood discipline to mean showing love and praising children when they do good but punishing wrong-doing, and 108 (20%) understood it to mean beating children whenever they do wrong. The majority said children should be disciplined by the mother (62%), father (47%) or whoever is around at the time of the offence (57%). It was deemed acceptable that teachers discipline children by 11% of the Luos, 23% of the Luhya and 34% of the Nubi. The most commonly used method was caning, used by 520 (97%), then pinching (40%), slapping (33%), pulling ears (20%) and denying food (19%). Sixty-three per cent of parents recognized that excessive punishment could cause fainting, and 64% that it could cause death. Factors reported as contributing to excessive discipline were domestic tension, poverty, stress and 'difficult children'. CONCLUSION: There were consistent patterns of child discipline in three tribal groups living in Nairobi. There was a high prevalence of excessive discipline in the form of physical abuse, and clinicians should be aware of the signs of excessive discipline and be prepared to act in the interests of the child's welfare.