Premature birth contributes to more than a quarter of deaths in newborns as key child health indicators show that Kenya still fails to achieve most of the interventions recommended by the World Health Organization to improve preterm birth outcomes.
Preterm births are deliveries that occur before the full pregnancy period of 37 weeks, and in most cases, the babies also weigh less than 2.5kg.
Kenya is among the 15 countries that account for two-thirds of the world’s preterm births, according to the March of Dimes.
It has many causes that include having a baby before age 20 or after 35, having closely spaced pregnancies of less than two years and physical stress, severe anaemia, drug and substance abuse, foetal infection and multiple pregnancies (twins or more).
“We are still performing poorly in simple interventions such as kangaroo mother care (KMC), avoiding infections and monitoring babies with respiratory issues, most of which are quite achievable, said Dr Phelgona Otieno, the principal investigator and programme director for the Preterm Birth Initiative (PTBi) at the Kenya Medical Research Institute (Kemri), in an interview with Nation Newsplex.
As the world marks World Prematurity Day today (November 17), the Ministry of Health reports that the dangers of prematurity continue to follow even babies that make it past the one-month danger zone, accounting for one in eight (12 percent) deaths among babies under five years old. It is surpassed only by pneumonia and asphyxia, which claim 14 percent of these deaths each.
Out of the 1.5 million babies born in Kenya annually, around 134,000 come too soon, according to the Ministry of Health’s Division of Family Health.
“Neonatal deaths (within the first month of life) contribute about 45 percent of the under-five mortality, and preterm is one of the leading causes, so around 11,000 babies die because of preterm-related complications every year,” explains Allan Govoga, programme officer in the ministry’s Division of Family Health.
Globally, the World Health Organization estimates that each year one in 15 (15 million) babies is born too early or dies due to prematurity-related complications. Prematurity is also the leading cause of death among children under five worldwide.
Kenya and the world
There is a huge disparity in chances of survival around the world.
WHO data indicates that in low-income countries, half of the babies born at or below 32 weeks (two months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In contrast, in high-income countries, almost all of these babies survive. Kenya was ranked 51, with 12 preterm cases in every 100 births, but the rates could be higher due to poor documentation of such cases, according to the March of Dimes Foundation, a US-based organisation dedicated to improving child health. Malawi has the highest rates of preterm births globally, with 18 per 100 live births, followed by Comoros, Congo, Equatorial Guinea and Zimbabwe, with 17 each.
Kenya is also among the 15 countries that account for two-thirds of the world’s preterm births, according to the March of Dimes.
The country’s poor performance is, according to Dr Otieno, due to “various challenges, such as the lack of adequate staff, inadequate equipment specifically for preterm babies, lack of expertise as well as insufficient diagnosis of prematurity.”
It has been proven that improvement in the quality of care has a huge effect in saving lives. For instance, the rate of deaths for babies under one month old in the United States and the United Kingdom reduced from 40 in 1900 to 15 deaths per 1,000 live births in 1970 due to better obstetric care and simpler improvements in newborn care, such as providing warmth, feeding and preventing infections. This was a decline of almost two-thirds.
Lack of adequate skills to handle preterm babies among nurses, clinical officers and doctors is attributed to lack of exposure, which results in healthcare workers lacking the confidence to handle premature babies. Dr Otieno also explains that improper diagnosis of prematurity is a major setback that is usually brought about by the inaccurate documentation of a mother’s last menstrual period before pregnancy, leaving the nurse to make guesses.
The Preterm Birth Initiative, launched in 2015 and currently being piloted by Kenya Medical Research Institute (Kemri) in Migori County, is one of the programmes the government has lined up to help curb preterm deaths. It uses four intervention approaches, which include additional use of quality data, training of health providers using simulation models, a safe childbirth checklist and regular evaluation of the quality of services rendered.
The government expects that if the interventions are carried out well, the rate of neonatal deaths would dip by 20 percent.
Whatever the outcome of the pilot, arresting preterm deaths will have to take a great deal of innovation. The kangaroo mother care is one of the simple and cost-effective initiatives that have been recently introduced.
Conceived in 1978 in Colombia to complement incubators, the innovation has helped save the lives of many preterm babies for the five or so years it has been used in Kenya.
According to Pediatrics, the official journal of the American Academy of Pediatrics, there is more than a third (36 percent) reduction in mortality of low-birthweight infants (<2kg) who receive kangaroo mother care compared to conventional neonatal care.
The practice involves maintaining continuous skin-to-skin contact between the mother and the baby to ensure the baby stays warm, and is breastfed on demand until they attain 2.5kg weight. The practice is also hailed for boosting the bond between the mother and the child, lower risk (55 percent) of severe infection and hypothermia (66 percent).
Currently, 30 counties have at least one KMC unit, an increase from 21 in 2017.
Despite its strengths, KMC is yet to be fully embraced by not only the health facilities, but also the mothers as well. “At times mothers are not willing to opt for it because it is tedious and it confines them to a given place. There are also health workers who still believe that incubators are the best, and haven’t fully embraced KMC,” explained Govoga.
However, the success of any innovation products introduced into the sector will largely depend on the level of skills of maternal healthcare workers.
Most of the practical skills possessed by many of the health practitioners implementing the new interventions occur while they are in service, hinting at an existing skills gap that needs to be addressed through more in-service trainings.
“The training duration is too short for that type of training in school, and they are taken in a hurry. A training for a week is not adequate as there are other units to do and be examined on. Second, there are no adequate materials for training, while for in-service, this is possible due to the support from partners,” explained Govoga.
In the long term, the Ministry of Health intends to ensure that they improve practical trainings in schools instead of having to wait for in-service opportunities.