In Kenya, 1 in every 8 babies are born premature each year. These babies face an uphill battle from the moment they enter the world, including the risk of breathing and intestinal disorders, and long-term developmental disabilities. Many of these babies do not receive the care and support needed to survive. In Kenya, many communities believe that having a premature baby is a bad omen, or will bring bad luck to the family.
This year’s World Prematurity Day theme is ‘Let them thrive!’ While standard treatments for premature infants are well known, innovations are needed in resource poor settings to bring these treatments within reach of poor families, and to push the boundaries of what is possible.
Through the County Innovation Challenge Fund, important learning and evidence is emerging on local ways to improve care for the smallest babies.
Kangaroo Mother Care
Kangaroo Mother Care (KMC) is continuous, prolonged early skin to skin contact between a mother and her newborn for up to 24 hours per day. It is the recommended care for stable preterm and low birth weight babies who do not require incubator care. It can be challenging to implement, and women require a support system to be successful:
“Before my baby was born, I had never seen such a small baby. I was sure she couldn’t survive. But I was reassured when health workers showed us a film where a baby was born so small and yet survived after KMC. I got courage and resolved to support my wife to give KMC to our baby.” Kevin, a kangaroo father in Bungoma, Kenya
While there is strong evidence for the role of KMC is saving preterm lives, it has not yet reached scale in Kenya: less than half of the Kenya’s 47 counties are implementing KMC in some format. Save the Children has successfully taken KMC to scale in Bungoma county, demonstrating that with start-up financial support, county leadership, and technical input, KMC can save lives in rural settings.
Preterm care along the continuum
In many parts of Kenya women still deliver their babies at home without professional care, and premature infants with complications often don’t reach health facilities in time. Women who decide to deliver in health facilities can also face challenges; health workers might not be knowledgeable about all aspects of new born care, and delays or errors can lead to the loss of newborns’ lives. Once women are discharged from the hospital with their newborns, they may take too long to return to the facility when their babies develop complications.
"Most health workers fear dealing with premature newborns. They keep referring babies to me even when it is a simple infection they can deal with. And when I am not there, they refer clients to the County Referral Hospital. The majority of the staff have not been trained to handle new born infections." Clinical Officer (Paediatrician), Kimilili Sub-County Hospital
Mount Kenya University is improving the continuum of newborn care available in Bungoma county, increasing the quality of health services that are available for newborns, providing follow-up support for discharged families, and sensitising communities that this care is available. The project has reached over 7,000 mothers through its call centre, where staff follow-up with the mothers of discharged newborns during their first month of life and identify problems early. It has also trained 95 health workers on a telehealth platform that enables virtual consultations between health workers on the ground and remote paediatricians, improving the local provision of specialised care. Read more about the project here.
Human milk banking
Breastfeeding is recognised as the single most important intervention available to prevent child deaths, and is widely promoted for all infants. However, access to breast milk is not always possible for premature babies who need it most. This could be due to an illness or the death of the mother, abandonment, because some mothers are unable to breastfeed, or because the baby cannot suckle.
When breastfeeding is not an option, the World Health Organization recommends donated human milk as a lifesaving alternative for vulnerable infants, including those who are preterm and/or low birth weight. Human milk banks can be used to collect, pasteurize, test and store safe, donated breast milk from lactating mothers and provide it to infants in need, ensuring that even if babies cannot breastfeed, they still receive human milk as soon as possible.
Human milk banks are well established in high income countries, and have been proven to work in some low and middle income contexts such as Brazil and South Africa. In Kenya however, this novel solution has never been tried. Through formative research with Kenyan policy makers, practitioners and the general public, PATH has found that this solution is feasible and acceptable for the Kenyan context. With interest peaked from policy makers, health workers and the media, Kenya is now positioned to pilot the region’s first human milk bank in Nairobi.
As we mark World Prematurity Day this year, the country’s leading paediatricians know what is needed:
"It is time we raised greater awareness of the challenges of these little angels. We must call for more resources for research and innovations to prevent premature deliveries and preterm deaths. We must develop sustainable capacities in workforce and infrastructure to better meet the needs of these babies. It is time we built local and global movements working together for preemies." Dr. Jesse Gitaka, Mount Kenya University
The County Innovation Challenge Fund is supported by UKAid from the UK government. The fund invests in innovative interventions, products, processes, services, technologies and ideas that will reduce maternal and newborn mortality in Kenya, and is managed by Options and KPMG.