More work needed to tackle infant deaths

Kenya continues to record an unacceptably high infant mortality rate, with increased calls to address causative factors so as to bring the numbers down.

The rate is currently at 30.629 deaths per 1,000 live births, a 3.59 per cent decline from 2022, which had 31.771 deaths per 1000 live births according to the United Nations: World Population Prospects.

Neonatal deaths in the country contribute to about 40 per cent of all under-five mortality rates, making it a crucial health priority.

The situation has been linked partially to poor maternal nutritional and health status.

These are influenced by socioeconomic, demographic and biological factors.

Other maternal-related factors, such as age and level of education, have also been shown to significantly impact neonatal birth outcomes.

Dr Ismael Kizito of the Tropical Wellness Centre in Kakamega defines neonatal mortality as the death of a newborn within the first 28 days of life, a period where the child’s survival is most vulnerable.

According to the World Health Organisation, neonatal mortality remains a significant public health problem worldwide and accounts for 60 per cent of newborn deaths in middle and lower-income countries, Kenya included.

“Kenya must rethink every possible strategy,” Kizito says.

"Right from how pregnant mothers are handled all the way to ensuring facilities are well equipped to handle seamless birth processes, be it natural or by Caesarean section."

Whereas there has been a recorded decline in neonatal deaths globally and even in the country, he says, the reduction of neonatal mortality is much slower compared to the other child mortality indicators among children between 1 and 11 months old and those between 12 and 59 months.

Kizito says for Kenya to stay on track towards achieving Sustainable Development Goals on child mortality, the reduction of neonatal deaths must be prioritised.

REASON FOR RATE 

The medic says whereas the Kenya government has established a health framework aimed at reducing both neonatal and under 5 mortality rates, the reduction in childhood mortality, especially for children in the neonatal period, remains insignificant.

He says Kenya has some of the highest rates of maternal and neonatal mortality in the world at 360/100,000 and 22/1,000 live births respectively. 

“Translated into numbers, this equates to about 7,000 maternal deaths and 29,000 neonatal deaths per year in Kenya,” he says.

Kakamega paediatric specialist Manni Luhongo says common causes of neonatal mortality include pre-term birth complications, intrapartum growth restrictions and infections such as tetanus, low birth weight, congenital malformations and neonatal sepsis.

Luhongo says there is a close relationship between maternal health and neonatal survival, which means poor maternal nutritional and health status will most definitely result in an equally poor neonatal outcome.

He says some cultural practices restrict access to health facilities after a mother gives birth and hurt neonatal outcomes.

“We equally have factors related to maternal health, like lack of essential antenatal care, inaccessibility to emergency obstetric care and skilled attendance at birth, inadequate maternal nutrition, lack of postpartum care and neonatal care, and late initiation of breastfeeding,”Luhongo says.

The medic says many mothers who have no formal education have a tough time making reproductive health choices and fertility preferences, such as uptake of contraception, better health-seeking behaviours and better nutrition knowledge.

“Yet all these practices increase the likelihood of neonatal survival if well understood by the mother," he says.

Luhongo says babies born of uneducated mothers have an elevated risk of dying in the neonatal period two times higher than mothers who have primary, secondary and tertiary education levels.

He says many infants born with low birth weight succumb mostly due to lack of specialised care.

“Low birth weight neonates are three times more likely to die compared to normal birth weight neonates,” he says.

Despite free maternal clinics being offered in most hospitals and dispensaries, mothers in some areas, especially marginalised counties, are still unable to access these services, forcing them to miss out on the crucial antenatal care.

“Early commencement of prenatal care enables the detection of possible health concerns, which are likely to result in complications for both the mother and the child. There is a significant connection between the number of ANC visits and neonatal deaths in the country,” Luhongo says.

The paediatric specialist says to a large extent, women who are consistent with their prenatal appointments and receive the requisite minimum of four ANC visits are more likely to be healthy and deliver healthy babies.

Their neonates have a higher chance of survival attributable to care received at the health facilities, he says.

CHANGING THE NARRATIVE

Dr Rose Malangachi, a senior paediatrician at the Kakamega Teaching and Referral Hospital, calls for a multi-sectoral policy action that ensures community sensitisation to increase uptake of antenatal care and to make it easily accessible for expectant mothers.

She also advises on the urgent need for promotion of basic education and improved health and nutrition, which she says is crucial to reducing neonatal deaths.

Malangachi says the government, through the community health strategy, should facilitate continuous sensitisations and referral mechanisms on the uptake and follow-up of prenatal care to at least meet the recommended threshold of a minimum of four visits.

“That every pregnant mother must strive to ensure they attend at least four out of the required antenatal visits to proper monitoring of the foetus and early detection of any anomalies,” Malangachi says.

She acknowledges that whereas the Kenyan government is implementing free primary education, cultural inclinations and practices such as female genital mutilation predispose girls to early marriages, thus pushing them out of school.

“We need to continuously educate communities on the importance of girls’ education so that we don’t have cases of little girls going into marriages and having to suffer such misfortunes,” she says.

She calls for a focus on improving the knowledge and skills of health workers to enable them to provide emergency obstetric and neonatal care in the various health facilities across the country.

The doctor says most neonates die due to the lack of simple yet basic facilities like newborn ICUs, and urges that such be installed in all health facilities in the country.

“Can you imagine having to watch a baby die from birth asphyxia because we do not have the facilities to care for them?” Malangachi says.

“Most of the times, the neonates get substandard care than they need and they don’t service.”

STATE INTERVENTIONS

In 2006, the government launched the Linda Mama cover, a publicly funded healthcare scheme under the National Hospital Insurance Fund and targeting expectant mothers who are otherwise unable to pay for healthcare services.

The free maternity service aims to increase access to skilled child delivery services and hence reduce maternal and infant mortality.

This by far remains the major beneficial input by the state, especially to low-class mothers who can barely afford the flashy hospital schemes in the country.

The objective of the scheme was to ensure pregnant women and infants have access to quality and affordable health services.

The goal of the scheme is achieve universal access to maternal and child health services and contribute to the country's progress towards universal health coverage.

The cover has been of great help to many women, who have been able to access public health facilities both for maternal and infant healthcare for six months after delivery at absolutely no cost on their part.

The scheme also offers a comprehensive antenatal care package, which comes with various services, including the prevention of transmission of HIV from HIV-positive mothers to their unborn baby. Mothers who test HIV positive receive ARVs as required.

Paediatric nurse Angeline Mayavi of the Malava Subcounty Hospital in Kakamega says the scheme also enables expectant mothers to receive a range of healthcare services.

These include preventive services, including tetanus vaccinations, malaria prophylaxis and the basic antenatal profile for healthcare.

She says the scheme also provides postnatal care, which means the package extends from the time the placenta is expelled up to six weeks after delivery.

“The package also comes with four personalised visits and assessments after birth,” Mayavi says.

For the newborn baby, this package is inclusive of timely immunisations and a Vitamin A supplement. For the mother, it comes with various check-ups to monitor her progress after birth.

The national health insurer had to recently come out and dispel rumours that the programme had been scrapped.

In a statement on January 2, the National Health Insurance Fund said the programme is still running.

“Attention is drawn to recent false social media messages purporting the discontinuity of the government-funded Linda Mama programme. NHIF wishes to assure the public that the cover is still active as mothers continue to benefit massively,” the notice said.

According to the insurer, more than six million women have benefited from the programme since it was launched in 2013 by former President Uhuru Kenyatta.

“The programme, funded by the Government of Kenya, targets expectant women and aims at reducing maternal and child deaths,” NHIF said.

“In addition, the programme ensures mothers do not struggle with paying medical bills during pregnancy and childbirth and encourages them to seek the services of a skilled birth attendant.”

There have been calls for more effort to be put in to ensure the numbers are brought down even further and that every mother gets to nurture their baby and see them grow.