Unicef narrates the tale of Zanzibari woman, Khadija Hussein who lost one of her preterm twins but thanks to intervention and in particular advocacy for skin to skin contact referred to as Kangaroo Mother Care (KMC) her second baby was saved and is out of danger.
Of her twins, only Rumaika survived; ‘I cried a lot when I lost the first baby,” she recalls. The baby died of asphyxia, a condition of severe deficiency of oxygen to the body leading to suffocation.
In this superstitious society, such tragedies on the delivery bed are associated with witchcraft; “we are quite superstitious here and I had the feeling I was going to lose Rumaika as well,” admits the mother.
However, thanks to the training on KMC she says; “I have been holding Rumaika against my chest since she was born. I think she enjoys it and is growing strong as a result,” both facts are true and may very well have saved the life of her child.
Kangaroo Mother Care (KMC)
KMC is a time old child care initiative that promotes skin contact between mother and child. However, over time the approach was downplayed and ultimately discarded, now advocacy groups are working to reinstate it.
The programme was initially established in Tanzania (August 2012) by the advocacy group Save the Children. It promotes skin-to-skin contact using a parent’s own body to warm and nurture the child.
It was started at Dar es Salaam’s Muhimbili National Hospital (MNH) as an alternative approach for providing thermal care for low birth weight (LBW) infants and is now rolled out in several national healthcare facilities across the country.
Experts are optimistic that KMC, as a proven intervention, will save an estimated 500,000 newborn infants from dying in their first month of life every year. Furthermore, since its launch, the Kangaroo Mother Care ward at MNH has not experienced a single death thus far.
The KMC approach is one that advocates keeping the baby close to the mother (or father) for body contact heat transfer. In other words, it advocates for parents to hold their babies close to their bodies as a crucial aspect to building maternal connections as well as keeping the baby warm.
There are three main evidence-based interventions that have significant impact on improving the survival of preterm or LBW babies:
• KMC
• Antenatal corticosteroids during preterm labour and
• Incubator care
A recent analysis shows that KMC is actually more effective than incubator care in middle-income countries.
Identification and appropriate management of certain maternal conditions such as pre-eclampsia, eclampsia, antepartum hemorrhage, malaria and syphilis also serve to reduce incidence of preterm births and LBW babies.
Another proven but neglected intervention for preterm births is the use of antenatal corticosteroids (natural and synthetic steroid hormones) to accelerate fetal lung maturation during spontaneous or induced preterm labour as was the case with Khadija, the mother of the twins and/or elective cesarean section (for maternal conditions such as pre-eclampsia or eclampsia).
According to experts at the USAID funded Maternal and Child Health Integrated Programme, if antenatal corticosteroids are provided during preterm labour, it is estimated that approximately 340,000 newborn lives could be saved every year
The threat
“Although this is an amazingly simple concept (KMC), the results are incredible and the practice is endorsed by the World Health Organisation,” says Narelle Tunks, a registered Australian midwife and founder of the Kangaroo Mother Care programme in Tanzania.
Kangacare.org is a portal dedicate to the KMC initiative and it notes that throughout the world over 4,000,000 babies die within the first 4 weeks of life and of this number, 99% occur in low-middle and low income countries like Tanzania.
Kangaroo Mother Care (KMC) is a simple concept that can greatly reduce this death rate, yet is rarely utilized throughout these countries that need it most due to lack of education and facilities to promote KMC.
In countries where modern technology is not available, there is a lack of skilled staff, power is intermittent or non-existent and purchase and maintenance of equipment is costly and difficult, then KMC provides an amazingly effective alternative; it provides the baby with warmth, breastfeeding, protection from infection and offers stimulation and love.
Saving a life
Speaking of the times before KMC was introduced to them, Rozuma Abdulraheem, assistant in charge of the Mwenbeladu ward in Zanzibar where Khadija had her twins, recollects; “before, we had to send preterm babies to the main hospital where they had incubators, but it was risky...kangaroo mother care is the best natural incubator that exists.”
When the baby is wrapped against the chest of the mother, development of her immune system speeds up. It also boosts milk production for breastfeeding mothers and builds a strong relationship with the mother.
According to the KMC portal, in Tanzania every year, 213,500 babies are born too soon and of them 9,400 die from preterm a complication, that’s one in every four newborn deaths.
Tanzania ranks 12th in the world when it comes to the number of preterm babies. Every day in Tanzania, 26 babies die for being born too soon.
Many of those who do survive face a lifetime of challenges from learning disabilities to visual and hearing problems.
Despite the progress that Tanzania has made in reducing child mortality over the past decades, Unicef points out that, neonatal causes account for 40 per cent of all under-five deaths. Most of the deaths are from birth asphyxia, preterm birth complications, and infections such as sepsis.
One of the key priority interventions that has shown promise is ‘kangaroo mother care’, a programme that encourages mothers to wrap their premature babies to their chests using a pouch or simple wrap with skin-to-skin contact – Unicef
Close body contact with the mother has proven to help stabilize babies’ body temperatures, steady their heart rates and help with breathing.
In a country like Tanzania, where incubators are expensive and of limited availability, Kangaroo Mother Care is an alternative approach for premature baby-care. This process encourages the babies to start controlling their own body temperature and warmth, and also strengthens the emotional bond between mother and child.
The KMC training is also given to fathers “...so they can support the mothers and take care of the child at home,” says midwife Rozuma who also notes that it takes only an average of three days and the parents are allowed to take their child home.
“We found that the safest place for babies to be nursed was in close contact with their mothers – in a similar way to a kangaroo nursing her baby in her pouch,” says Dr. Sudha Sharma, Chief of the Unicef Tanzania Health and Nutrition programme. She also attests that; “significant benefits for babies were noted including improved stability, better breastfeeding and earlier discharge home.”
KMC in the Isles
In Zanzibar, 7 per cent of babies are born with low birth weight each year and health providers are teaching parents how to give their babies skin-to-skin contact, protect them from infection, and breastfeed them exclusively.
However, at the moment, Mwenbeladu is the only maternity ward in Zanzibar that offers kangaroo mother care support to mothers.
The effort is one of the maternal- and infant-care services funded by the U.S. Agency for International Development (USAID) through its Mothers and Infants, Safe, Healthy and Alive (MAISHA) Programme. Jhpiego, a global health non-profit and Johns Hopkins University affiliate, works with Save the Children and Zanzibar’s Ministry of Health and Social Welfare to support this intervention.
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