Victor Hugo said, “There is nothing more powerful than an idea whose time has come.” That time has come for a life-saving approach to looking after babies who are born too soon called kangaroo mother care. In Kenya, the moment as arrived to accelerate its scale-up for the 200,000 babies born prematurely every year.
Landing in Kisumu airport on a small airliner at the crack of dawn offers a spectacular view over the shores of Lake Victoria. Kisumu, the third largest city in Kenya, is an important economic hub thanks to its strategic location across multiple trade routes in Central Africa. It’s also one of the country’s fastest growing cities. Not that we saw any of it. Our destination – three counties and a 3-hour drive to the north, near the Ugandan border – felt like a world away.
The county of Bungoma has a much poorer, largely rural population of 1.6 million souls subsisting mostly on crops of maize and sugarcane. It’s here that Save the Children has been operating a ‘Signature Programme’ on healthcare for nearly five years. Designed to improve maternal and neonatal health outcomes in some of the county’s poorest communities, this programme is, you might say, an overachiever.
The programme has seen significant increases in the coverage and utilisation of essential services – such as antenatal care visits (+20%) and skilled birth attended deliveries (+17%). As well as that, it has provided a platform to introduce two new approaches to Kenya that have the potential to save many more lives:
- a new formulation of chlorhexidine for umbilical cord care to prevent deadly infection such as newborn sepsis
- kangaroo mother care for premature and low birthweight babies.
Nothing like a mother’s love
Kangaroo mother care is, on the surface, simple enough. In the absence of incubators – expensive, energy-hungry pieces of kit – there is a simple, lower cost and effective solution to make sure preterm infants keep warm and grow: maximising skin-to-skin contact between the baby and the mother (or father) – much like mother kangaroos do with their babies until they’re fully grown.
When coupled with exclusive breastfeeding and medical supervision, this technique is a highly effective way of supporting low birthweight babies through this dangerous time and maximising their chances of survival.
Kangaroo mother care is backed up by a large, global and compelling body of evidence, including substantial amounts of clinical research showing its effectiveness in reducing mortality among pre-term infants in developing countries. Despite this, progress to take this approach to scale in developing countries has so far been patchy at best.
When kangaroos meet wildebeests
It is in the Bungoma sub-county referral hospital that kangaroo mother care was piloted for the first time in Kenya, through a collaborative effort between the Ministry of Health and Save the Children. Rosemary, the head nurse in the maternity wing of the hospital, was involved in the pilot from 2013 when it was first conceived. She described her experience with the passion of someone who felt empowered to save lives that would otherwise have been almost certainly lost.
The maternity wing that Rosemary oversees covers a population of over 200,000 and carries out no fewer than 600 deliveries a month. Of these, nearly 40 are premature. Before kangaroo mother care was introduced – along with the renovation and expansion of the newborn unit and the creation of a ward specially dedicated to kangaroo mother care – babies as light as 1.3kg were discharged. “It was basically a death sentence,” says Rosemary.
With kangaroo mother care, nurses and midwives are trained and receive supportive supervision. Full time care can be provided to eight preterm babies at a time in the specialist ward, and more can be looked after in the newborn unit. The story of one particular premature baby – who weighed 1.3kg at birth and reached 2kg within the space of a few weeks following a strict regime limited to skin-to-skin contact and exclusive breastfeeding – is recounted as a moment of sudden insight, even astonishment.
The hospital is now widely seen as a centre of excellence in preterm care in the county and the whole of Kenya. But it hasn’t been an easy journey. New ideas challenge old norms, some of which are deeply rooted. For example, communities whose experience has been that low-birthweight babies are beyond saving were resistant to the notion that these babies could survive and even thrive.
Mothers of premature babies were also apprehensive. “Won’t I suffocate my baby?” was a recurring concern. For Rosemary and her team, introducing kangaroo mother care required empathy, sensitivity, care and respect.
Time to scale upwards – and outwards
Success brings new challenges. Readers of my blog may remember the story of the paediatric hospital in Delhi, India, which became a victim of its own success, attracting many more patients than it could possible cope with. Bungoma sub-county hospital is going through something similar.
As pregnant women flock down to the hospital to seek the high-quality care they’re unlikely to get anywhere else, the pressure on the hospital has increased. And now, the maternity ward is cracking at the seams. The time has come to roll out kangaroo mother care much more widely, bringing this life-saving service closer to the women and babies who need it and easing the pressure on the health system.
A word of warning. Just because kangaroo mother care – unlike other forms of treatment for preterm and low birthweight – doesn’t require expensive equipment nor drugs, doesn’t mean it’s cheap. Mothers still need a hospital bed as well as near-constant supervision by a qualified nurse or midwife for up to three months. Effectively, that means they need a functioning, adequately staffed health system. The average fee charged for kangaroo mother care is between 7,000 and 10,000 Kenyan shillings (£53 to £76), although poorer patients who can’t afford it can – and quite often do – have their fees waived.
Nevertheless, the case for scale is compelling. Kangaroo mother care is evidence-based, could save thousands of lives every year across the whole of Kenya and is cheaper than alternatives methods of preterm care. At the very least, it should be rolled out in all sub-county hospitals – and preferably in primary healthcare facilities as well, along with adequate levels of supervision and strengthened referral pathways.
Knowledge is power. We know what works.
Now we must do.
This blog post comes from Samy Ahmar, Head of Health in Save the Children UK, and Lynn Kanyuuru, Head of Health in Save the Children in Kenya.