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“Everybody said she wouldn’t survive”

Amiya Halder

Matuail, Narayanganj, November 17, 2017: Afiya is nine months old and the most rambunctious of the preemie kids back for their monthly checkups at the Institute of Child and Mother Health in Dhaka. Bouncing about on her mother’s lap, you couldn’t tell that she’s been in and out of hospital every month since her birth, which was 11 weeks early. She weighed in at 870 grams—the same weight as a basketball.

With 23,600 preterm deaths per year, Bangladesh has the third highest rate of preterm mortality in South Asia and the seventh highest in the world. Every hour, 7 newborns die due to preterm birth complications in Bangladesh. While specific causes are not known and more research is underway, experts attribute adolescent pregnancy, short birth spacing, hypertension, diabetics, obesity, STIs, previous history, HIV/AIDS, tobacco use, domestic violence and pollution to it.

“Everybody said she wouldn’t survive,” remembers Shima Islam, Afiya’s mother, “I’d had a painful pregnancy. So when my water over a month before I was due, we took an ambulance to a hospital in Dhaka for the birth. But when Afiya came, our hearts sank—she was tiny, crinkled and blue. She could hardly breathe.”

The infant had respiratory distress—the leading cause of death in babies born prematurely—but luckily, was taken to IMCH within an hour of her birth. They put in an incubator and got her lungs working. She was reunited with her mother only after a full 10 days in the ICU. They named her Afiya, meaning good health, in hopes that all would be well at the end of this trial.

But at 1.3 kg, she was still woefully underweight, and premature babies with low birth weight cannot regulate their body temperatures. The doctors recommended Kangaroo Mother Care to Shima, which involved carrying baby Afiya with skin-to-skin contact. This was vital because, with Afiya in the ICU, the mother-child bonding had been delayed.

The KMC centre at IMCH, launched on October 31, 2016, is the largest of its kind in Bangladesh and has had 206 preemie patients till date. They’ve had excellent results, in that KMC had had to be discontinued in only 11 infants—either because the mother didn’t take to it or the baby didn’t take to it. This is because the simple act of skin-to-skin contact transfers warmth from the mother to the child and promotes exclusive breastfeeding.

Identifying expectant mothers at risk

Shima was married at the age of 15 and conceived in her teens. At 19, she is not only a young mother but a difficult case. She’s had high pressure during both her pregnancies—the first of which ended in a miscarriage. The doctors have warned her that she will experience the same complications if she is with child again. But Shima and her husband want to have a baby brother or sister for Afiya, once the father is back from work overseas and Afiya’s turned one. “I’m aware of the risks. I’ll just have to be extra careful,” she says.
Health checkups and early testing of expecting mothers are crucial in detecting preterm cases. Identifying high-risk mothers and encouraging them to have hospital deliveries or with a trained mid-wife are musts if Bangladesh is to reduce prematurity related deaths and end all preventable newborn and child deaths by 2030.

But unlike Shima, not all mothers can afford or have access to these life-saving services. To this end, IMCH, with support from UNICEF, has been training doctors and healthcare professionals from district hospitals in KMC. Other cost-effective, proven interventions—such as essential newborn care (warmth, cleanliness, feeding), early breastfeeding and alleviating respiratory troubles—must reach more women to prevent complications and deaths.

The struggle ahead

Shima tries to keep a firm hold on Afiya as she makes a dive for the nurse’s lap. “She’s always trying to get into other people’s laps,” laughs Shima. Tomorrow, they have another appointment at Ispahani Islamia Eye Institute and Hospital. Afiya has been developing abnormal blood vessels in her eyes—a common complication amongst preemies—which if left untreated, can result in blindness. The mother and daughter duo must make 3-4 visits to Dhaka every month from their village in Munshiganj to see the doctors.

When asked what she desires most for her daughter, Afiya’s mother does not need to pause to contemplate. “I do not want her to be like me,” she confides, “I want her to choose whom she marries.” Her smiling eyes, lovingly fixed on her daughter, seem to say she is not afraid—good things come to those who persevere.



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