For babies born too soon
Kangaroo Mother care provides a lifeline in the city of Mosul, Iraq
Mosul city located in Ninewa governorate, northern Iraq, is still in process of revitalizing essential Maternal, Neonatal, and Child Health (MNCH) services, following the violence that gripped the city for years and destroyed much of its infrastructure. According to Ministry of Health data, around 80,000 babies are born every year in the city. in 2019, however, 1,100 babies died in Mosul before reaching one month of age.
Prematurity is the leading cause of newborn deaths all over Iraq, including in Mosul. To overcome preventable deaths from preterm births, UNICEF supported three maternity hospitals to start intermittent Kangaroo Mother Care (KMC) for small stable premature babies, as the best recommended intervention to improve their survival.
Prematurity is defined as a baby born preterm, before the mother has completed at least 37 weeks of pregnancy. Preterm babies are especially vulnerable to complications, including death, as their bodies are not ready to maintain body temperature and not ready to breast feed. Many have breathing difficulties and are susceptible to infections.
These babies need special care for warmth and feeding. Those weighing more than 2000 gm, with no complications usually survive with breast feeding, proper home care, and hygiene. KMC is evidence-based and involves skin-to-skin care, provided by mothers to premature babies with no complications, and weighing less than 2000 gm. KMC can be provided intermittently for a few hours per day or continuously during most of the day. KMC provides effective thermal control for small bodies, promotes breast feeding, protects babies from infection and improves bonding between child and mother .
The first start of KMC in Iraq
Intermittent KMC was established in 7 maternity hospitals in 5 cities across Iraq, as part of country plan for better newborn care survival implemented during 2018-2019, through UNICEF support to local counterparts in selected vulnerable areas with high neonatal mortality.
The KMC program proved successful in improving preterm newborn outcomes, with early discharge of preterm babies from hospitals after satisfactory weight gain. Iraqi pediatricians recognize KMCa successful intervention, and has been well-received and practised by women.
Progress in 2020:
Despite the challenges posed by the COVID-19 pandemic in Iraq, health authorities and professionals continue to work in the main maternity hospitals of Mosul city and they intend to incorporate the KMC initiative in the health care that they are providing for their communities.
Three hospitals in Ninewa, Al-Khansaa Hospital, Mosul hospital, and Hamdania Hospital were identified by the local Directorate of Health (DOH) as suitable for starting KMC for local communities. The total case load of deliveries in these hospitals ranges between 600 – 2000 deliveries per month, with on average 15- 35 small and preterm babies admitted monthly to the Newborn Care Units (NBCU).
UNICEF assessed and fulfilled the hospitals’ needs to enable KMC, such as ensuring the availability of dedicated well-equipped rooms at NBCU for mothers to provide KMC comfortably and in privacy .
Equipment and essential supplies for the KMC room were procured locally by UNICEF, including locally produced mother-baby binders for holding babies in close skin to skin contact by their mother.
In addition, UNICEF provided support to establish teams well-trained on KMC concepts in each hospital. The teams were enabled to counsel and support mothers to provide intermittent KMC, and to feed their babies with breast milk either directly if they can suckle, or with expressed breastmilk.
All hospitals successfully introduced intermittent KMC by September and good results followed soon after with 27 out of 35 preterm babies weighing between 1550 gm -1800 gm admitted to the NBCUs in one month, and surviving well with KMC. All babies were discharged from the NBCU earlier than expected after reaching satisfactory weight of 2000 gram plus.
The profile of mothers who benefit from KMC, are mainly those residing in remote areas of Mosul city. KMC rooms facilitate their stay and provides them ample space with their babies where they provided intermittent skin to skin contact, and fed them breast milk until the babies passed the critical period without any complications and gained satisfactory weight to thrive.
Partnering for newborns
UNICEF continues to work with its main partners to deliver results for the children in Iraq, especially vulnerable newborns born in areas recently recovered from conflicts. The context of COVID-19, requires more efforts to introduce and maintain essential services and lifesaving practices for ending preventable newborn deaths.
The Czech Republic is supporting a program focused on new-born survival and wellbeing in Iraq, through in-kind donation to address basic needs of new-borns and their mothers. Their contribution is utilized by UNICEF Iraq to revitalize essential services in vulnerable areas, including areas recovering from conflict in Mosul city. Part of this donation has been used to support establishment of KMC at the three maternity hospitals of Mosul.
The writer Dr Shaimaa Ibrahim is a Health Specialist focusing on Maternal and Neonatal Health (MNH) for UNICEF in Iraq