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Kangaroo Mother Care Helping Preterm Babies Survive

By Adresh Laghari

LAHORE, Punjab – March 2017: Komal Fahad (24) had become an expert mother when she had her first baby more than two years ago. During her second pregnancy, she was confident there will be no problems. Unfortunately, her second child was born premature. The doctors at the Services Institute of Medical Sciences (SIMS) Lahore, a teaching hospital, told her that her premature son Afaq had a critically low birthweight of only 1.6 kilograms (kg). Komal did not have a clue of what she was supposed to do next. 

After the usual weight loss that a baby goes through in the first week of life, the weight would go on to be only 1.3kg. He would have surely spent weeks in an incubator at the nursery in the Pediatrics Department at SIMS - if there was a vacant incubator. 
 

Baby Afaq, born premature, at one and a half months. His mother, Komal Fahad has brought him in for his regular checkup with the doctors at the UNICEF-supported Kangaroo Mother Care Ward of the Services Institute of Medical Sciences (SIMS), Lahore. © UNICEF/Pakistan/2017/Adresh Laghari

Pakistan is ranked fourth among ten countries with the highest number of preterm births in the world. More than 100,000 babies born premature in the country die because of preterm complications. 

Dr. Naureen Rasul, an assistant professor at the Gynecology and Obstetrics Unit-II of SIMS, informed Komal that the incubator can be avoided. The baby and the mother could be admitted into the newly established Kangaroo Mother Care (KMC) Ward until Afaq showed signs of consistent weight gain. “At first, like almost all the parents before them, Afaq’s parents were reluctant.” says Dr. Rasul, second-in-charge of the KMC Ward. “It is not easy to convince parents of premature babies to opt for a new approach and a new ward,” she adds. 

Prior to introducing KMC in Pakistan, premature newborns were directly referred to the intensive care units where they were placed in incubators. For Afaq, since his weight was more than 1.5kg but less than the base-weight of 2.5kg, the doctors convinced his parents to opt for KMC.
 

Komal Fahad (23) with her month and a half old son Afaq - preterm baby - who went through Kangaroo Mother Care (KMC). Baby Afaq is now a healthy infant who is being exclusively breastfed. Having gone through his first regular checkup at the UNICEF-supported KMC Ward at the Services Institute of Medical Sciences (SIMS) Lahore, his mother says that she is going to ensure Afaq is brought is for all his required checkups. © UNICEF/Pakistan/2017/Adresh Laghari

KMC is an alternative approach for premature newborns. Continuous skin-to-skin contact between the mother and the baby is the key element of this treatment along with covering the child in a warm blanket. This encourages the babies to start controlling their own body temperature and warmth and strengthens the emotional bond between mother and child. At SIMS, babies having a birthweight lower than 1.5kg are referred to the nursery. However, babies with a birthweight of 1.5kg or higher, but not having the base weight of 2.5kg, are admitted to the KMC Ward. As some of the babies are too weak to be breastfed, their mothers feed them with expressed breastmilk out of a small measuring cup. Babies are kept in the KMC Ward till they develop a base weight of 2.5kgs and are strong enough to be breastfed.
 

All items of a Kangaroo Mother Care (KMC) Kit are provided by UNICEF to the KMC Ward at the Services Institute of Medical Sciences (SIMS) Lahore. Every mother in the ward receive one of these kits. © UNICEF/Pakistan/2017/Adresh Laghari

Every mother in the ward is given a special ‘KMC Kit’ provided by UNICEF. Each kit contains a hand-held mirror that helps mothers in viewing the condition of the babies without disturbing them; a small measuring cup; a thermometer; a hand sanitizer; a sterile gown for the mother; and clothes for the baby including socks and a cap.

The UNICEF-supported KMC Ward at SIMS was established in August 2016. Prior to that, UNICEF sent a team of doctors and nurses from Gynecology and Obstetrics department of SIMS, including Dr. Rasul, to Vietnam for a special, two-week long, training on treating premature babies through KMC. “KMC is gaining pace in the country sooner than expected. After UNICEF introduced KMC at SIMS, various public health institutes are requesting support for establishing their own wards." - Dr. Tahir Manzoor

The KMC Ward at SIMS always has an artificially regulated temperature of 28 degrees Celsius. There are strict hygiene rules and everyone must sanitize their hands and put on special chappals (sandals) before entering the ward - even Afaq’s mother, Komal. Apart from her, there are three other mothers in the ward providing KMC to their babies. One of them is Komal Sajjad, a mother of two whose second child is a premature baby.  

“In the not-too-distant future, basic health centers can also be equipped with KMC at a small cost,” says Prof. Dr. Rubina Sohail, head of the Gynecology and Obstetrics Department (Unit II) at SIMS. “Of course, it is no replacement for intensive care where required.” 
 

Komal Sajjad (30) holds her two-week-old baby girl in Kangaroo Mother Care posture. The baby has not been given a name. The baby, Komal's second child, was born premature. Doctors say the baby is gradually gaining the base-weight of 2.5kgs. © UNICEF/Pakistan/2017/Adresh Laghari

According to Dr. Rubina, in just seven months from its launch, the KMC Ward at SIMS has treated 155 preterm babies, with no reports of complications or deaths after the babies were released from the ward. “This became possible due to UNICEF’s continuous support in training us, helping us establish the ward, and guiding us at every step of the way,” says Dr. Rubina. The ward also has a follow-up mechanism through which contact is kept with mothers after discharge. So far, 85 per cent mothers have been reached. The follow-up includes regular periodic checkups after discharge; inquiring about breastfeeding routines; guidance on immunization; and checking for complications. “The results of the follow-up are 100 per cent positive,” shares Dr. Rasul. According to her, these babies, although born premature, are actually receiving the healthy start to life they deserve. Most importantly, they are exclusively breastfed and their parents are maintaining a good hygiene routine. 

UNICEF Health Specialist, Dr. Tahir Manzoor says, “KMC is gaining pace in the country sooner than expected. After UNICEF introduced KMC at SIMS, various public health institutes are requesting support for establishing their own wards.” Along with the ever-increasing interest in KMC, it is encouraging to see the positive response from all stakeholders. In a country like Pakistan with exceptionally high number of premature births, KMC can prove to be an effective and efficient way to treat and increase the chances of survival for preterm babies.”

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