Working together for Preemies
Over the last two decades, strides have been made in reducing the under-five mortality rate in Kenya from 108 per 1000 live births in 1995 to 50 in 2015. Nonetheless, a leading cause of deaths in infants, prematurity, has not had an equivalent dent and it is increasingly clear that without addressing prematurity related deaths, further reductions in mortality rates will be marginal.
Approximately 15 percent of babies are born premature in Kenya every year, a situation that puts these babies at risk of short and long term health complications and death. Premature babies face multiple health challenges due to their inability to fight infections, regulate body temperature, breath properly, process bilirubin and even uptake and retain feeds. These predispose them to hypothermia, sepsis, jaundice, dehydration among other conditions. In the long-term, preemies may suffer effects such as mental retardation, cerebral palsy, visual and hearing impairments and poor health and growth. Besides, studies have shown that even as adults, preemies have a higher risk of heart diseases, hypertension and diabetes.
The toll on human development potential of prematurity cannot be overstated. This calls for urgent and concerted efforts to mitigate premature births and enhance survival and quality health of preemies. One proven strategy is to reinforce the continuum of care from the antenatal to perinatal and postnatal care of mothers and babies. Mothers should be sensitized from early pregnancy on causes and preventive strategies for premature labour operating in their environments. For instance, Bungoma County is malaria endemic for which mothers can prevent by using insecticide treated bed nets and intermittent preventive treatment for malaria. Additionally in the event that premature delivery is unavoidable, mothers should deliver under skilled attention to give the baby the best chance at overcoming challenges of prematurity.
The Collaborative Newborn Support Project led by Mount Kenya University under the County Innovation Challenge Fund (CICIF), and working together with local stakeholders and the Kenya Paediatric Association, aims to contribute to alleviating this challenge. The project has innovatively packaged four pillars to mainstream newborn care efficiently. These include; community sensitization and mobilisation using drama and radio, call centre service to promote skilled deliveries and thereafter follow up babies for 28 days for any health problems at homes, telehealth to support clinicians and nurses working with newborns and refurbishment and equipping of newborn units in the county to provide quality spaces for nursing the babies. Over the last 20 months of the project, important milestones have been achieved. Over 7,000 mothers have been engaged over the call centre service, thousands reached over the radio program and drama, 95 nurses and clinicians trained on neonatology and the telehealth platform initiated. More importantly, the project has interacted with mothers and babies at the personal level with very touching stories.
Earlier in the project, Rose Bela, one of the call centre attendants during a routine post-natal, post discharge follow up call on a mother, picked up that the baby had not passed stools for three days, had a distended abdomen, was breastfeeding poorly and had vomited several times. She counselled the mother on the need to seek urgent care at the newly refurbished Webuye Sub county Newborn Unit, which she did. At the facility, the baby was examined and diagnosed with imperforate anus and subsequently referred to Moi Teaching and Referral Hospital in Eldoret where the baby had corrective surgery. At nine months the baby was in great health. Interestingly, this baby was born in a hospital and mother discharged after a day. However, the all-important newborn examination that could have picked out the congenital abnormality was not done. This gap, among others noted in the baseline survey necessitated refresher training of nurses and clinicians working in maternity, post-natal and newborn units.
Mrs. Wanjala a nurse at Chwele Sub county Hospital expressed the lack of confidence among health care workers in managing newborns and especially the premature babies; “Nurses and clinicians quickly refer babies they can manage to Bungoma and Webuye Hospitals even without a diagnosis. Once they establish that the mother is carrying a newborn, they simply ask them to proceed to either of the two units. So this training is very useful in helping us gain more confidence working with premature babies as well.”
The newborn project implementation in Bungoma County has faced a challenge in the past year due to the doctors and then nurses strikes. It is estimated that the newborn mortality rate has doubled in the past 12 months. Even though the strikes have ended, it will take some time to gain lost ground especially in having mothers give birth at hospitals and seek timely newborn care. Nonetheless, this calls for stakeholders to re-double their efforts to save more lives.
As we mark the 2017 World Prematurity Day, it is time we raised greater awareness on the challenges of these little angels, called for more resources towards research and innovations in preventing premature deliveries, complications and deaths and developed sustainable capacities in workforce and infrastructure to better meet the needs of these babies. It is time we built local and global movements working together for preemies.
Dr. Jesse Gitaka, MD, MTM, PhD
Division of Research and Development,
Mount Kenya University,
Mount Kenya University is a grantee of the County Innovation Challenge Fund, managed by Options and KPMG.