Kangaroo mother care

Nuru Mwakitalima (29) holds baby Mirabelle against her chest for warmth in their bed at the Regional Referral Hospital in Mbeya. Using her free hand, she dips a clean syringe into a plastic cup of expressed breastmilk and feeds the tiny girl 10 cc at a time. Mirabelle is two weeks old and weighs 1.5 kg.

Mirabelle wasn’t expected until late October, but arrived in mid- August, weighing only 1.3 kg at 31 weeks. She was born with a fever and was too weak to take breast milk.

Nuru lives in Rukwa, which is six hours away from the hospital, and says it was a “blessing in disguise” that she went into early labour while visiting her parents who lived within reach of the hospital. “I think I would have lost the baby otherwise,” she says.

While gaps in registration and reporting provide incomplete data, estimates indicate 85 per cent of newborn deaths in Tanzania are due to three main causes—severe infections, primarily sepsis and pneumonia, complications of preterm births, and asphyxia. Approximately 39,000 babies die annually, of these 17,000 in their first day of life, and about 47,550 babies more are stillborn. This can be attributed to the fact that only 63.7 per cent mothers have a skilled attendant at the time of delivery41. And 312 children under-5 die daily due to diseases like malaria, pneumonia and diarrhoea42.

Yet, only 20 per cent of dispensaries and 39 per cent of health centres in Tanzania provide delivery services with all signal functions- the key interventions comprising basic emergency obstetric and newborn care, or BEmONC.

UNICEF has supported hospitals in Tanzania with training and equipment including Newborn Care Units, which have helped shape the referral system from health facilities in communities throughout the region, and has donated 6 ambulances in Mbeya. Prior to this, these specialized services were available only at the Meta maternity ward, which was extremely congested and unable to provide quality services.

Dr. Monika Frey of GIZ, the German Development Agency, and the hospital’s head neonatologist, explains that 10-15 per cent of babies are premature. The cut-off for viability is drawn at 28 weeks, although sometimes babies that are born earlier do survive.

According to UNICEF data, over 200,000 children are born prematurely in Tanzania every year, and approximately 9,500 of them do not survive. UNICEF and GIZ cooperate to improve newborn care at the hospital. While UNICEF has trained staff and donated essential equipment, GIZ has been providing on-job training and mentoring to staff in the neonatal care ward.

“The first priority is shots for maturing of the lungs,” says Dr Frey. Since premature babies suffer low birth weight and body temperature, they have difficulty breathing and often have a low suckling reflex so they cannot breastfeed well. Low birth weight babies are also at risk for hypoglycaemia, low blood sugar.

The mothers need care too. Once their milk comes in, they are counselled on nutrition and practices for establishing good supply, and manual techniques for expressing milk to feed the babies who are still too weak to breastfeed. When both babies and mothers have grown strong enough, they can begin Kangaroo Mother Care, or KMC.
 

Nuru lives in Rukwa, which is six hours away from the hospital, and says it was a “blessing in disguise” that she went into early labour while visiting her parents who lived within reach of the hospital. “I think I would have lost the baby otherwise,” she says.

KMC is an approach that uses skin-to-skin contact to help premature babies by wrapping them with a cloth close to their mother’s skin, mimicking a Kangaroo pouch. This method has many benefits, and has been proven to significantly raise survival rates. Skin-to- skin contact helps the baby gain warmth, it calms them and helps regulate their heartbeat, enhances bonding, and helps establish good breastfeeding practices, Dr. Frey explains. It also allows the mother to detect health changes in the baby’s condition; the mother’s heartbeat can stimulate that of the baby in case of breathing difficulties. KMC can be practiced by any caretaker, anywhere.

“Fathers are trained and encouraged as well,” says Dr Frey. For babies who cannot nurse yet, the KMC allows the frequent hand feeding by syringe as premature babies need to gain weight.

Nuru’s baby Mirabelle needs 45 cc every two hours. Every syringe contains 10 cc of expressed breast milk, and the KMC gives both the environment they need for the constant contact, lactation and feeding. Dr. Frey says data shows KMC is already making a difference in improving survival rates of premature babies in Tanzania. Before implementation, complications of preterm birth were the leading cause of neonatal death in the region.

Data shows that reaching all preterm babies in Tanzania with KMC alone can save the lives of at least 5,000 newborns every year.