How visiting nurses help prevent child deaths in Kazakhstan

A new model of home visits to pregnant women and families with children under five reaches the most vulnerable

By Zarina Nurmukhambetova
A mother holds a smiling baby, Kazakhstan
UNICEF Kazakhstan/2016/Kim
14 December 2017

KYZYLORDA, Kazakhstan, 14 December 2017 – Early spring seeps through grimy windows, lighting a small unkempt apartment. The place is so dirty that Bibinur begins to feel nauseated. She finds a clear spot to sit down with Almagul, who recently gave birth to a baby boy.

As a home visiting, or ‘patronage’ nurse, this is one of Bibinur’s regular appointments with pregnant women and families with children under the age of five. She starts by spending half an hour asking Almagul questions to better understand whether her son is receiving the right nutrition and care. She then examines the boy and goes over developmental milestones with Almagul.

Bibinur is used to this routine – she typically visits about four to five families per day. But this case is different.

“Almagul behaved as if I were not in the room,” says Bibinur. “She showed no emotion, avoided eye contact and ignored my questions. I had to learn everything about their living situation and the health of the baby through Almagul’s sister-in-law, who was taking care of the child, changing diapers and feeding it goat’s milk.”

A woman smiles at her baby, Kazakhstan
UNICEF Kazakhstan/2016/Kim
A mother of three with her son in Kyzylorda city, Kazakhstan. Her patronage nurse helped her create a safe environment at home and worked with her husband to get him more engaged in child care.
The new role of patronage nurses

Had this encounter taken place a few months before, Bibinur would have stayed for only 5–10 minutes before going back to work. But now, Bibinur is working at a polyclinic that participates in a pilot programme for universal progressive patronage nursing.

With support from UNICEF, the new model of home visits to pregnant women and families with children under five shifted the focus from quantity to improving the quality of these visits. The model also encourages cooperation between social and medical services. Vulnerable families dealing with issues like substance abuse, lack of income, health issues, violence at home and other challenges will receive additional attention – often requiring several specialists in addition to patronage nurses, such as psychologists and social workers.

Trained patronage nurses have become akin to private investigators: they can spot signs of neglect, abuse, poor relationships, economic hardship, hazardous environment and unsanitary conditions. In the past, patronage nurses were primarily concerned with children’s physical development. They now view each child’s development in the context of the wider environment: Is the father present and engaged? Is the mother happy and rested enough to spend time with her child? Is the environment stimulating for cognitive development? Is the food nutritious enough?

Overcoming depression

Equipped with new knowledge gained through UNICEF-supported trainings, Bibinur understands that Almagul needs mental health care. On her next visit, she comes with a psychologist who determines that Almagul is suffering from postpartum depression.

They draw up an action plan and the psychologist works with Almagul four times a week for a month. As Almagul becomes more trusting and receptive to outside help, Bibinur teaches her the importance of bonding with her child, breastfeeding, and interacting and playing with him.

“I told her that if she misses this crucial period of time in the life of her son, she will never manage to repair the damage to their mutual understanding, love and relationship,” Bibinur says.

The idea of the unique opportunities offered by the first 1,000 days of life is at the heart of this new patronage nursing model. During this time, a child’s brain grows and develops at an unprecedented pace. Action or inaction during this period will have lifelong consequences. Improving primary care, helping parents and caretakers provide the best conditions for their children’s development can have a positive ripple effect throughout society, nurturing a generation of healthy, smart, confident adults who give back to their communities.

“I was happy to see things changing. Almagul became more open, she even started laughing!” says Bibinur. “She began breastfeeding, taking care of her son and spending time with him. She now brings him to polyclinic for immunization and regular check-ups; she even calls me to ask things.”

Two women sit with children on a couch, Kazakhstan
UNICEF Kazakhstan/2016/Kim
A patronage nurse visits a family in Kyzylorda city, Kazakhstan. The universal progressive patronage nurse system includes two visits during pregnancy and nine visits until the child reaches the age of 3.
Bringing nurses into more homes

After just 15 months, the pilot project showed remarkable results. In the region of Kyzylorda, fewer children die from preventable causes in their first year of life (from 14.4 to 8.8 deaths per 1,000 infants) and before reaching their fifth birthday (from 17.7 deaths to 12.1 per 1,000 children). The percentage of women who can spot alarming health signs in their children shot up by 63 per cent. More children are exclusively breastfed and no injuries occurred in the homes of families covered by the new model.

On 11 December, UNICEF and the Ministry of Health presented these and other results at the reporting conference in Kazakhstan’s capital city of Astana. Patronage nurses and social workers shared their stories of stopping violence in families, mending relations between spouses and helping caretakers provide more stimulating environments for children. All of the stories, though different in their challenges, were united by a shared desire to make sure that all children have the key ingredients to fulfil their potential: eat, play, love.

In the coming months, UNICEF will continue working with the Ministry of Health to promote the model to other regions across the country. This will require political will and investments – but there is already enough evidence to show that investing in early childhood development yields the highest returns.