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‘Miracle women’ help combat under-five mortality in Nepal

UNICEF Image: Nepal, Health
© UNICEF Nepal/2007/Panday
In Kavre, Nepal, community health volunteer Nanda Kumari checks 19-month-old Sanju for signs of pneumonia.

By Rabindra Giri

Here is one in a series of stories on successful initiatives to promote healthy lives, provide quality education, combat HIV and AIDS, and protect children against abuse, exploitation and violence – all part of a special edition of 'Progress for Children', UNICEF’s flagship publication on advances towards the Millennium Development Goals. The report will be launched on 10 December.

KAVRE, Nepal, 6 December 2007 – Nanda Kumari trudges through hillsides blanketed with the colours of ripening maize, trying to steer clear of buffalo as she passes along a narrow trail.

Her destination: the home of Sarita, mother of a 19-month-old child suffering from a persistent cough.

Volunteers provide life-saving advice

Ms. Kumari, 43, is one of 48,500 community health volunteers known in Nepal as ‘miracle women’. Though many are illiterate, like Ms. Kumari, the volunteers have been trained to detect and treat a range of childhood illnesses, such as pneumonia and diarrhoea, and they often provide life-saving advice where no other health services exist.

In rural Nepal, access to health services or personnel often involves walking several hours or, in some districts, several days.

When she arrives at the house, Ms. Kumari is immediately offered a cup of tea and ushered to the best seat – the sort of welcome normally reserved for visiting dignitaries and revered family members.

“Let’s have a look at your daughter,” Ms. Kumari says. The child’s nagging cough has worried the family, who think the baby may have contracted pneumonia. Across Nepal, respiratory infections like pneumonia caused the deaths of 11,000 children under age five in 2004.

UNICEF Image: Nepal, Health
© UNICEF Nepal/2007/Panday
Using a simple stopwatch, Ms. Kumari can recognize the type of fast breathing that is often a symptom of pneumonia.

Serving remote communities

The Female Community Health Volunteer programme was launched in 1988 by the Government of Nepal, with support from UNICEF and other development partners.

Serving rural communities, the volunteers lead awareness efforts for national immunization campaigns and administer polio vaccinations, vitamin A supplements and deworming tablets. They provide advice and iron supplements to pregnant women, and in cases of severe childhood diarrhoea they provide oral rehydration therapy and zinc tablets.

Ten years ago the programme only operated in one district of Nepal, but it has now expanded to 33 districts across the country – covering 60 per cent of the under-five population in those regions.

Child respiratory infections reduced

Pneumonia kills more children around the world than any other illness. Many caregivers, however, do not know the key symptoms – fast and difficult breathing – that indicate when a child needs immediate treatment. Using a simple method, Nepal’s community health volunteers can identify cases of pneumonia and administer antibiotic treatment, helping to greatly reduce the incidence of childhood respiratory infections in the country.

Pulling out a simple timer, Ms. Kumari places her finger on the baby’s abdomen and begins to concentrate, counting the number of breaths the child takes as the timer ticks away. After a minute, she looks up with a smile.

“Your daughter does not have pneumonia,” she tells the relieved mother, offering advice on a home therapy to treat the child’s cough.



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