Imagine a baby born prematurely in a hospital without incubators. Or one that has them but is hit by a blackout. If necessity is the mother of invention, a hospital in Kakamega county is definitely on the right track.
The Matungu Subcounty Hospital simply borrowed a leaf from kangaroos. It gets mothers, mothers-in-law or even a few fathers to cradle a baby against their bare chest for a considerable duration every day, thus becoming human incubators.
Since the hospital switched to Kangaroo Mother Care in nurturing pre-term babies, the four incubators in the New Born Unit are underused.
The nurse behind this shift is Consolata Mukodo. She’s the maternity in-charge. She says about the NBU unit, “We only bring a premature baby here if it’s sick.”
Mothers now nurse their preterm infants in an improvised KMC care room. Here, beds and chairs are modified for the comfort of mothers, who may be distraught by the delicacy of their underweight babies.
In March last year, there were three women in the room and one, Bathsheba Ochieng’, had twins. Discharge from the hospital depends on the babies’ weight gain. This may take several weeks.
Fifty-seven premature babies were attended to in 2016 at the hospital. Mukodo says all are alive. She regrets that when the programme began in 2015, two babies died shortly after discharge. To date, none has died at the facility.
The KMC room can accommodate seven mothers. Once babies gain the desired weight of 1.8kg, they qualify to be released. One condition is attached, though. “The mother must bring someone to help her care for the baby,” Mukodo says. This would ensure the baby’s needs are met at home. The alternate caregiver may be the mother’s spouse or preferably her mother-in-law.
While a mother is still admitted at the facility, community health volunteer Patrick Namatsi swiftly moves in. He visits the home of the mother to encourage at least one or two members of her homestead to visit the hospital. They are taught the importance of KMC and how they can help at home.
Every morning, Mukodo does rounds, teaching kangaroo skills.
Dr Alfred Ambundo, the Matungu Subcounty medical health officer, says in KMC, “The key factor is providing the right temperature to the babies in the most affordable way.” County Health director Dr Arthur Andere adds that, “What kills premature babies is normally lack of warmth. The mother will provide the warmth that her baby requires.”
BETTER BABY CARE
It is recommended that for 24 hours, the baby remains strapped on its mother with her garments on, and therefore, there is no time the baby would be cold. The babies are to be freed only when absolutely necessary.
Dr Andere says hospital incubators can be a death trap. “When many children are put together, chances of cross-infection are very high. Some of the babies may die.”
Under kangaroo care, “Babies can be taken care of in their natural environment at home, and there will be minimal cross-infection.”
Babies receiving kangaroo care have been noticed to sleep longer and breathe better. They also gain weight faster, medical personnel have observed.
Mother Petronila Awinja recalls being in the KMC ward for six weeks. “My baby was born after seven months at 800gm but is now 1.72kg,” she says. Awinja can tie her baby herself vertically between her breasts. With her baby in that position, she can walk around, sit, lie down or even read, and her baby can be easily breastfed. Due to the skin-to-skin contact, “I can detect if my baby is breathing,” Awinja says.
At the hospital, a mother may not have someone to relieve her for a break. Therefore, she’s allowed to do it intermittently while she cares for other needs.
CRITICS SILENCED
Derogatory expressions are used in this community, directed at a woman who delivers prematurely. It might be said, “She’s given birth to a baby as small as a rat,” Mukodo says. “Many imagine that such babies may not survive because of how tiny they are.”
Initially, the nursery was the most known method of caring for preterm babies. Therefore, when KMC was initiated, the community was appalled. But now due to the higher survival rates of the newborns, the locals have no qualms with this ‘new’ method.
Mother Ochieng says, “I didn’t expect to deliver babies with low birth weight.” She had spent a week in hospital with her twins. “When the babies came, they were 1.9kg and 1.5kg,” she says.
Nurse Mukodo says Ochieng’s babies are gaining weight fast. “Their mother is being retained on account of the lighter baby, who must reach at least 1.8kgs,” she says.
Sometimes, Ochieng’ straps both babies on her chest. At other times, they take turns. “It’s easier to monitor them while in this room, unlike if I had them in the incubator,” she says.
When Mukodo started her implementation of KMC at Matungu Hospital after undergoing training at the Bungoma County Referral Hospital, she had only one bed. “The first baby I attended to was 1.6kg, and that baby died,” she says.
Despite this mishap, she pressed on and started imparting these techniques to other staff, including subordinates and Community Health Volunteers. The hospital offered her invaluable support by providing additional beds and appropriate seats.
Hospital support staff Agnettah Nabalayo was mentored by Mukodo. She says that after the loss of the first baby, they faced the ire of the public and were heavily abused.
“When we resumed, we were afraid of attempting KMC with a baby whose weight was 1.5kg. But now, babies with 600-800gms survive,” Nabalayo says. “Mothers of preterm babies should not be disheartened, because KMC works.”
POLICY FRAMEWORK
Kakamega County does not have its own policy on Kangaroo care but depends on the existing policies developed by the National Government.
Dr Andere says KMC had been there for a long time, even during his training, but it was not adopted as much as it is today.
All the 12 hospitals, 36 health centres and over 100 dispensaries in the county conduct deliveries. Dr Andere is concerned that most mothers with premature and underweight babies have been referred to facilities with incubators. Only five facilities have implemented KMC. He singles out Matungu Subcounty Hospital, as one that has excelled.
Any baby born at less than 2.5kgs is underweight. Some of these are preterm babies, while others were born after the requisite nine months.
Dr Andere says babies might be born underweight if the mother was sick during her pregnancy and so the baby was not getting enough nutrients, leading to Intra-uterine growth retardation.
The other factor is if baby is born before the correct gestation period. The mother could have been sick, causing the uterus to expel the baby before its term. Besides, a condition known as placenta praevia may be responsible.
This refers to the placenta lying unusually low in the uterus. Hypertensive diseases might also contribute.
Dr Andere estimates that every month there are 3,000-4,000 deliveries a month in Kakamega county. Out of these, about one in 20 is born underweight.
Dr Ambundo says the immediate benefit of Kangaroo Mother Care is that “we’re increasing the survival rates of babies born prematurely or are underweight at term at a lower cost”.