Zimbabwe: Kangaroo Care - Improving Survival of Premature Babies

23 April 2019
opinion

The temperature in the room is sweltering, ranging between 21 and 32 degrees Celsius.

To ensure no heat escapes, all windows are tightly closed, a heater is always switched on and the door closed.

The room has saved the lives of babies born either prematurely or underweight at Maphisa District Hospital, Matabeleland South, about 110km from Bulawayo.

Welcome to the Kangaroo Care Ward, a special section in the maternity ward at the hospital. Babies born too small for the world further stay here with their mothers as they undergo Kangaroo Mother Care (KMC), and have to first reach 2500 grammes before being discharged.

Today, young bare chest mothers aged 16 and 34 years sit on hospital beds, their babies wearing woollen hats and booties and covered with a blanket on their chests.

The babies are delicate and the mothers and hospital staff treat them with extreme caution as they want to deliver them home in perfect condition. There are eight beds in the ward, and on this day only two are occupied.

Two other young mothers aged 15 and 17 have been discharged and are packing their bags. Their babies, now 2 500g lie quietly on the bed, as if plotting how they will finally make their grand entrance of the outside world. It seems they are also eager to share their success stories and inspire new arrivals in the ward.

In the ward, nurses do their rounds teaching the new mothers to hold their babies firmly into a pouch position. They patiently take the new mothers through the steps of Kangaroo Mother Care (KMC) to support and hasten the growth of their prematurely born babies and those born underweight.

In the maternity ward of this hospital, the sad reality is that most cases of premature and underweight births are as a result of teen pregnancies. Once such case is that of 15-year-old Sadile Mlatazi of Mbembeswa in Kezi.

She became pregnant in March this year, trading her school uniform for motherhood.

However, her wish is to go back to school. Iyapa, the father of her baby is 17 years old, not employed and stays with his parents in another village in Kezi.

Mlatazi had a normal delivery and gave birth to an underweight baby at nine months. The baby weighed 2 200 grammes.

During her stay in the KMC ward, she now knows how to care for her baby. This includes placing the baby on her bare chest and properly feeding her.

"I was taught enough and not scared to take care of her. When I return home, my 19-year-old sister Precious will help me take care of the baby, who is yet to be named."

She hopes to name her Nompilo, loosely translated to "with life".

Polani Moyo (17) of Tjewondo Village, Kezi about 19km from the hospital also had a normal delivery. Her baby weighed 2 300g and she had no complications during pregnancy.

She says despite the unbearable heat in the room, the KMC saved her baby's life and has also taught her to take care of her.

"The heat in the room was initially intolerable. I would sweat a lot. I thought the baby would be affected. With time I got used to the temperature.

I was also initially afraid of holding the baby as she was small. The nurses taught me how to properly put my baby on my chest so that she gains weight. They also taught me how to breastfeed," she explains.

Thirty-four-year-old Ethel Ngwenya is the oldest in the KMC ward.

She gave birth to an underweight baby weighing 2 000 grammes through a normal delivery.

"I was told that the baby should always be on my chest so that she gets warmth from me.

"I can also easily detect abnormalities that may arise. My baby is now 2 250 grammes and I will leave the hospital when the baby is 2500 grammes," she points out.

Ngwenya, who is in a polygamous union, has two other children aged 12 and four back home.

The 12-year-old daughter dropped out of school as her husband who works at a close by mine says he cannot afford to pay fees as he has other children to take care of.

The 12-year-old will assist in taking care of the new baby when she goes back home.

Deputy sister in charge in the maternity wing, Tracy Ncube and her team have been ensuring that the mothers and their pre-term babies receive the best of care.

She says most pre-term babies in the KMC ward are born to mothers who experience various complications during pregnancy.

The complications include, but are not limited to pregnancy induced hypertension, teenage pregnancies, malnutrition as a result of poor diet, working too much in the fields or housework when pregnant and not attending to antenatal classes.

She, however, confirms that teenage pregnancies are worryingly the biggest contributor of pre-term and underweight babies at this hospital.

"Three quarters of the pre-term babies here are a result of teenage pregnancies.

"Teenage mothers' bodies are not fully mature to carry a baby to full term. The teens are aware of pregnancy preventative methods, but because of cultural issues and that they are usually still in school, they do not use. The same girls are sexually active at the same time," Sister Ncube expounds.

From what Sister Ncube and her team have observed over the years, the month of September is always their busiest in terms of deliveries.

"Most women would have conceived around November and December, so around 100 babies are born at the hospital in September. About 15 percent of the babies are either pre-term or underweight," she points out.

In some cases, she further explains, some of the women in the ward also live in poverty and their access to food, its availability, and utilisation is poor. As a result, the pregnant mothers lack a balanced diet and what they eat cannot cater for both mother and child, resulting in underweight babies.

"Weight at birth is a good indicator of a newborn's chances of survival, growth, long-term health and psychological development. Low birth weight carries a range of grave health risks for children.

"In the absence of proper care, low birth weight babies risk physical or mental delays or impairments in life. They also risk death if specialised care and support lack," she notes.

In the maternity ward at Maphisa Hospital, the only three incubators have not been working since June last year.

However, in the absence of incubators, Sister Ncube adds, KMC has come in handy as it has proved efficient.

"It is cheap and readily available alternative to putting babies in incubators. Babies under 1 500 grammes are referred to Mpilo Hospital in Bulawayo for further care.

"When it is cold, we switch on heaters and ensure the room is between 21 and 27 degrees Celsius. It becomes difficult in the rainy season as power cuts are more frequent. The maternity ward is not connected to the hospital generator, so nurses ensure that mothers are on KMC throughout. We also provide the mothers with more blankets so that they stay warm," she adds.

Since the KMC programme was rolled out in the country in 2014, two nurses from Maphisa District Hospital attended a workshop in Harare where they gained new knowledge and skills through training. Upon their return, they have transferred the knowledge to their colleagues in the maternity ward and the KMC has been running smoothly.

Sister Ncube is excited by KMC results.

"It has reduced neonatal mortality. If someone delivers outside the hospital, the baby is already hypothermic, but if kangarooed, they are fed on time. If delivered, a newborn should be fed within the first hour of life. At the hospital, we teach the women how to breastfeed and also express milk where cup feeding is required, especially those under 1500 grammes," she reveals.

When the babies are eventually discharged and ready to face the world, follow ups are made when they return for weighing.

"When they go home, we ask their mothers to bring them back for the first review after one week. When we see progress of the baby, we then give reviews accordingly.

"We also encourage the mothers to continue doing what we taught them," she explains.

Sister Ncube shares the success stories from the hospital. We always see those who stay around the hospital at the growth point. The most humbling moment is when the mothers recognise us, our work and thank us for saving their babies. If you have taught them well, you will find out what they would have done a lot on their own daily.

"Besides the heat in there, its very good to work with the women. I feel happy when this happens. Then there are sad very few cases when some babies aspirate and die," she says. The nurses and mothers in the ward seem to have bonded quite well. Nurses go out of their way to assist them. The KMC wing sometimes faces water shortages. The wing has not been receiving water from the main hospital supply and the nurses take turns to carry the water for the women.

"They need about 100 litres a day. We have several buckets in the ward with soapy water, disinfected water, water for drinking and also to clean the cord etc. The one general hand we have cannot do all this by her own, so we help with carrying the water so that the mothers and babies stay in a clean environment," she adds.

The KMC programme is supported by the Health Development Fund (HDF), which is a multi-donor fund, that seeks to support the Government of Zimbabwe to provide equitable access to high quality health services for women and children. Managed by Unicef, HDF is funded by the European Union, the United Kingdom's Department for International Development (DFID); the Irish Government's Irish Aid; the Swedish Government and GAVI.

A reproductive health officer with the Ministry of Health and Child Care Mrs Esther Ngaru (who spoke on behalf of Director of Family Health Dr Bernard Madzima) said all 60 district, eight provincial and five central hospitals in Zimbabwe had implemented the KMC.

The programme, she pointed out, had a positive impact in reducing neonatal mortality. Before its introduction, most babies were dying from hypothermia.

"The kangaroo keeps its baby on its bosom and that way the baby is always warm. Pre-term babies lose heat easily and when you put the baby in this position, the baby adopts the mother's temperature, keeping it warm.

"The incubator is just an artificial way. They help keep the baby warm, but sometimes babies forget to breathe on their own.

"When using the KMC, the mother's heartbeat reminds the baby to breathe, it wakes up the baby" she said.

According to Mrs Ngaru, six midwives from each province were trained under the trainer of trainers programme and now mentor their peers.

She added that when at home, village health workers usually look out for the women and their new babies.

"The village health workers know all the pregnant women in their village, those who have delivered full term or pre-term or underweight babies. They always remind them to go back to the clinic to have the baby checked out. Headman also help us in ensuring women give birth in health facilities to ensure that pre-term and underweight babies receive the best care immediately. Headman have been fining those who give birth at home goats. Our motto is no woman should die while giving birth. We feel happy when we see a woman and their baby go home," she says.

According to the Multiple Indicator Cluster Survey (MICS 2014), the leading causes of under-five mortality in Zimbabwe are causes during the neonatal period comprising premature birth complications, birth asphyxia and neonatal sepsis among others.

As mothers and nurses in the KMC ward watch the babies grow each day, the sweltering heat seems not to deter their goal of delivering healthy babies back home.

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