She owes her baby's life to kangaroo care

For most pregnant women, the Due Date is usually a moment of excitement. However, this hasn’t been the case for Jennifer Samwel, a resident of Bunda District, Mara Region, whose 15 pregnancies ended up in disappointments. For 17 years, she either gave birth prematurely or miscarried.

Today, as she narrates her ordeal to Your Health, what puts a smile on her face are the memories of medics struggling to rescue the life of her 16th baby--who was born prematurely at 6 months of gestation, weighing 750grams.

Jennifer recalls how the medics tried all sorts of interventions, such as Kangaroo Mother Care (KMC) and scheduled feeding in frantic efforts to ensure the survival of the baby—Neema (meaning a blessing).

Researchers say that by using KMC, the risk of death among newborns is reduced by 50 percent. It involves keeping the baby warm through skin-to-skin contact with the mother and also feeding the baby regularly using a schedule.

How Jennifer’s story started…

Her story dates as far back as 2002 when she got married to one, Mr Samwel Nyamani, in Kiangasaga village, Bunda District. By then, she was aged 17. Later, another journey began—17 years of the search for a child.

“I kept trying. There was no time I gave birth at the right time. During my 6th pregnancy, my mother-in-law gave me herbs. She believed they could work for me but they didn’t. I got a miscarriage instead. Most of my pregnancies had a bad ending,’’ recalls Jennifer.

Until today, Doctors say Jennifer, 34, has a weak cervix and her womb cannot hold a pregnancy to full term. That’s why, they say, whenever she tried to conceive, she either ended up with a miscarriage or a premature delivery.

Dr Godlisten Martin, a general physician in Mara Region is aware of Jeniffer’s case. He tells Your Health that she could have avoided the pregnancy losses if she attended Antenatal Clinic visits early. Then, he advises women who might be experiencing the same situation in communities to seek care.

Dr Martin, the USAID Boresha Afya Regional Clinical Advisor for Mara Region, believes that when pregnant women such as Jeniffer attend clinic visits, they can save their babies in cases where they deliver prematurely.

“Those with premature babies should [also] get support from the community to stay at the facility for Kanagroo Mother Care,’’ says Dr Martin who is part of the USAID Boresha Afya program that is working with the government through JHPIEGO, to address health challenges in the Lake and Western zone of Tanzania.

Role of communities

During her struggles to become pregnant, Jeniffer once went to Shirati Hospital in Mara Region. “When I went to Shirati, doctors told me that my womb could not hold the pregnancy up to delivery time. They tried to fix it. But, may be it didn’t work,’’ she recalls.

In medical terms, Dr Martin says women with weak or incompetent cervix, like what Jeniffer was suffering from, can be treated through a procedure known as cervical cerclage.

But, for Jennifer, the doctor says, “I think [she underwent the procedure] but the cerclage was failing because she was not having total bed rest at [home…]”

“This is because of the culture surrounding her and the role of women. A woman in her community is required to do all domestic work regardless of her illness,’’ says Dr Martin, emphasizing on the role of the community in helping people access healthcare services.

Community-based interventions have also been suggested by local researchers, yet cases of women losing their pregnancies prematurely are not new in Tanzania. But, the causes and risk factors vary.

“It is important that planners design community-based interventions to address complications from pre-term birth,’’ says a 2016 study in the Tanzania Journal of Health Research, titled: Risk factors associated with pre-term birth in Dar es Salaam, Tanzania.

The researchers have pointed out cervical incompetence as one of the factors. Others may include multiple pregnancies, untreated vaginal discharge and urinary tract infections.

Victim of traditions

As Jeniffer went through trials and tribulations, her mother in law was bitter.

“My mother-in-law kept on pressurizing me; she used to say, I want grandchildren… My son didn’t marry you to stay here and eat only….. It reached a time when she decided to find another woman for her son [my husband].”

Jennifer says she continued staying in the same house, with the husband having two wives. She tried every option to have a baby, from visiting traditional healers to attending church services, but none of them worked out.

No more taking chances

When Jennifer realised that she had conceived for the 16th time, she travelled from her home in Kiangasaga village (where she lived with her husband) to her aunt’s place at Mwitende village in Bunda District. She thought that her aunt would help her solve her problems.

In January this year, while at her aunt’s place, she experienced labor pains and her aunt’s family rushed her to Kibara health facility. However, the expected date of delivery hadn’t come yet. She was only 6 months of gestation.

Medics at Kibara Health facility in Bunda District did not want to take chances; after knowing Jennifer’s medical history and the terrible moments she had gone through. This time, the focus was on how to rescue the newborn.

Through the maternal and newborn and child health interventions initiated by the USAID Boresha Afyaproject at the health facility, medics kept Jennifer under close monitoring until she yet again gave birth to a premature baby weighing 750 grams.

According to medical sources, babies weighing less than 1,500 grams at birth are considered to have Very Low Birth Weight while those with less than 1,000 grams have Extremely Low Birth Weight.

At 750grams, Jennifer’s baby, Neema, had extremely low birth weight but that wasn’t the big deal to her by then. She had waited for several years to hold a live baby.

“I had lost hope, but I had kept praying so that I could get my first child alive,’’ she narrates to Your Health during an interview at her aunt’s place in Mwitende village; where she is now living. Her husband left her for another woman in 2009.

Mr Dominick Nyamima, a Midwife at Kibara health facility tells Your Health that if close attention was not paid to Jennifer’s newborn, it was difficult to make it survive.

“That baby was very small…That was the first time I saw such a newborn survive at our health facility,’’ he says, explaining how a similar intervention is being applied on other children at the facility.

“In the past, we have lost a number of premature newborns because we didn’t have enough skills and facilities on how to handle them,” he reveals.

“Recently, I received training through the USAID Boresha Afya project that, as health workers, we are not supposed to give up on such premature babies,’’ he says.

“Here at the facility, we did not have baby warmers and well calibrated weighing machines to help premature babies survive,’’ he narrates his past experience at the facility.

Life on the Kangaroo

“What usually kills such premature babies is low body temperatures and lack of good feeding techniques,’’ he says. “Since we were trained and given facilities how to handle premature babies, the chances of survival have improved.” “Jennifer’s case is a typical example,’’ says Mr Nyamima. “We ensured that we kept Jennifer’s baby on proper feeding and boosted its weight up to 2.5kilograms in three months,’’ he says.

“But we also trained the mother on how to maintain the baby’s body temperature using Kangaroo Mother Care,’’ he says.

KMC, if coupled with other interventions, has been found to be affective in reducing both infant mortality and the risk of hospital acquired infection, and increasing rates of breastfeeding and weight gain.

Men are also being encouraged to apply it on their newborns, as part of male involvement in child health but also for promoting bonding. It can also be referred to as Kangaroo Father Care.

Currently, the government through collaboration with the USAID Boresha Afya and JHPIEGO is supporting 25 KMC sites in Mara and Kagera Regions. The target for this year is to reach 35 KMC sites.