Hospitals adopt kangaroo technique to save babies as incubator shortage bites

Patients at the kangaroo mother care unit, Busia Referral Hospital. PHOTO | TONNY OMONDI 

By ANGELA OKETCH, Aoketch@ke.nationmedia.com

In Summary

• The name of this practice, also known as skin-to-skin contact, is derived from the way kangaroos carry their young ones in pouches after birth.
• The technique started in Colombia more than 30 years ago due to a shortage of incubators.
• Faced with a shortage of incubators and the rising number of women delivering from hospitals following the introduction of free maternity services, most public hospitals are adopting the kangaroo method.

Ms Maureen Akinyi lovingly clutches her twins, a bundle of joy that she considers a miracle, at the Busia Referral Hospital maternity ward. The two were born prematurely and she did not expect them to live.

“Feeling their heartbeats is such a delight to me,” says the 24-year-old mother.

At 27 weeks, the twins are among the 17 early-term newborns struggling to survive at the hospital. A full-term pregnancy lasts for 40 weeks.

According to the World Health Organisation (WHO), pre-term birth complications are the leading cause of death among children under five years of age, responsible for nearly one million deaths in 2015.

Every year an estimated 15 million babies are born pre-term (before 37 weeks of gestation) and the number is rising, according to WHO.

Three quarters of the babies can be saved with current, cost-effective interventions including kangaroo mother care; where a baby is carried or closely wrapped around the mother’s chest.

The name of this practice, also known as skin-to-skin contact, is derived from the way kangaroos carry their young ones in pouches after birth.

The technique started in Colombia more than 30 years ago due to a shortage of incubators.

The effort paid off and has quite a following today. The technique also reduces the need for highly skilled staff in the neonatal unit.

After seeing how tinny her children were at birth, Ms Akinyi had little hope that they would live.

The two weighed 1.9 and two kilogrammes respectively. Their internal organs were not fully developed.

They were placed in incubators for three days, but given that the equipment are few they were discharged and introduced to the kangaroo technique so that others could use the incubators.

Ms Akinyi says the effect the technique had on her sons surprised her and was an eye opener.

‘‘Within two weeks my sons had added weight to 2.1 and 2.4 kilogrammes respectively. From the stressed sons they initially were, they became very relaxed. The intimacy, comfort and safety a wrap offers babies is excellent. I love the fact that it allows skin-to-skin contact with my babies and frequent breast-feeding,” she says.

Luckily for Ms Akinyi the hospital is among those in Kenya that have adopted the technique which eliminates the need for expensive equipment in resource poor areas

The practice which Dr Ojwang Lusi, the Chief Officer of Health in Kisumu County, says is “as effective as an incubator” has gained traction all over the country.

At the Jaramogi Oginga Teaching and Referral Hospital in Kisumu 30 mothers can be seen hugging their tiny newborns wrapped up and wearing wool beanies.

The same applies to Kericho District Hospital, Kombewa Sub County Hospital, Siaya Referral Hospital and Mama Lucy Kibaki Hospital.

Faced with a shortage of incubators and the rising number of women delivering from hospitals following the introduction of free maternity services, most public hospitals are adopting the kangaroo method.

Babies have been sharing incubators in most of the facilities, exposing them to communicable diseases and other risks that often lead to death.

Kenyan public hospitals have 93 incubators meant to cater for over 500 daily births. There is also the problem of shortage of space for incubators.

In some instances an incubator, which ordinarily is meant for one baby, holds two or more.

“An infant may be okay, but things start going wrong after placing another baby in the same incubator. Eventually you lose both of them to infection,” says Dr Lusi.

The crisis, if not averted, increases child mortality in public hospitals, he adds. This is why hospitals are adopting the kangaroo system in an attempt to avert deaths and ease demand for incubators.

Save the Children International has been fronting the technique in East Africa.

“We train healthcare workers in Kenya, Tanzania, Uganda and other developing countries to increase chances of infant survival and reduce mortality in disadvantaged communities,” says Ms Teresa Akun, the Save the Children International kangaroo mother care co-ordinator for Kenya.

She says they deal with counties with high maternal and new born deaths which include Bungoma, Migori, Busia and Kisumu.

According to UNICEF, prematurity is the leading cause of newborn deaths in Uganda, accounting for 38 per cent.

With the introduction of the technique, neonatal mortality decreased by 20 per cent between 2000 and 2010.

The technique has lowered child mortality at Mama Lucy Kibaki Hospital from 20 per cent to 3.2 per cent, according to Ms Magdaline Njeri Waihenya, a kangaroo mother care expert at the hospital. The hospital receives an overwhelming number of mothers seeking delivery services.

“Several newborn cases are referred here. Our resources are increasingly becoming meagre hence the importance of the technique,” said Ms Waihenya.

Ministry of Health statistics indicate that of the 1.5 million Kenyan live births annually, 188,000 babies are born too soon; below 37 weeks.

This means that out of every eight children one is premature. Kenya is among countries with the highest rate of premature babies worldwide.

“This is worrying hence the need to adopt and implement the technique in all facilities to bring down the number,” says Dr Nicholas Muraguri, the Principal Secretary for Health.

“Kangaroo care is the way to go because it keeps the child warm and infections that are inherited in wards are reduced. We are going to include the technique as part of maternal and newborn care initiatives. We will mobilise resources to scale it up in all facilities.”

Dr Deo Mtasiwa, Tanzania’s Health ministry Deputy Permanent Secretary, says 16 per cent of babies are born prematurely with 45,000 neonatal deaths recorded every year.

“Kangaroo mother care is one of the evidence based interventions that will contribute to the reduction of neonatal mortality. It is less labour intensive and requires limited resources,” says Dr Mtasiwa.

Through the technique, he says, Tanzania has reduced mortality in under-fives by 24 per cent.

The 2010 Tanzania Demographic and Health Survey (TDHS) indicates that child mortality has been reduced by almost half, dropping from 96 deaths per 1,000 births in the 1996-2000 period to 51 in 2010.

A 2015 report by Save the Children International says the technique is prominent in Uganda. Prematurity is the leading cause of newborn deaths in Uganda, accounting for 38 per cent.

With the introduction of the technique, neonatal mortality decreased by 20 per cent between 2000 and 2010.

Dr Lusi says the comfort and interaction afforded by the kangaroo technique enables babies to grow and develop faster.

“The technique also reduces staff workload since mothers are involved. It also eases congestion in incubators,” says Dr Lusi.

‘‘The method is cost effective and efficient in that when modern facilities are not available, or due to shortage of skilled labour or lack of power, mothers can continue taking care of their babies.

Specialised follow-up

‘‘The method is simple, it is initiated in hospitals but can be continued at home with frequent visits for specialised follow-up.”

Additionally, the method bonds mother and child and reduces hospital stay as well as infections. Incubators separate babies from their mothers, depriving them of the necessary contact.

“One method that has worked to reduce neonatal deaths in Africa is kangaroo mother care,” says Dr Tigest Ketsela Mengestu, director of the Health Promotion Cluster at WHO’s Africa office.

The technique can prevent close to 450,000 newborn deaths annually as it keeps them warm, which is especially important because tiny bodies lose heat rapidly making them highly vulnerable to illness, infection and death, Dr Mengestu says.

Initially considered an “alternative for the poor,” WHO gave the practice a boost in 2004 when it recognised it as a way of promoting breast feeding and stimulating a child’s cognitive development.

The method has since been shown to reduce mortality among pre-term babies in hospitals by 51 per cent if started in the first week of life.

WHO confirms that Malawi is a prime example of where the technique has been successfully used.

Infant mortality among newborn babies in the country was reduced from 40 deaths per 1,000 births in 2000 to 24 deaths per 1,000 live births in 2012.

Malawi is among the few African countries which achieved the 2015 Millennium Development Goal 4, which targeted to reduce the under-five mortality rate by two-thirds.

In an interview with the Business Daily, Dr Walter Otieno, a leading pediatrician in western Kenya, says the leading cause of death in premature babies is hypothermia (low body temperature).

Most public hospitals are struggling with a shortage of facilities including incubators, necessitating the technique.

“Most pre-term births are either because of early induction of labour, infections or chronic conditions such as diabetes and high blood pressure. No child should be separated from her mother for faster growth and development,” says Dr Otieno.