20 to 25 per cent of babies at the new-born unit at Muhimbili National Hospital (MNH) were born premature or with low birth weight in 2016, a reality that needs attention and solution.
Most mothers dream of the moment of holding their child only seconds after the birth. But for Ruby Kimondo, it was a very long time before she snuggled or gently caressed her first born.
Mother of three and founder of Preemie Love Foundation, Ruby’s first baby was born early, premature. “My baby came at 28 weeks. I had to stay at the hospital for a month and a half after birth,” she tells Your Health. From the simplest questions about clothing to the tough medical treatments, Ruby was overwhelmed as she never expected to see her child breathe life through a machine.
Due to the struggles she went through with her first birth, Ruby was encouraged to champion the cause of helping mothers who give birth preterm through her foundation.
Preterm birth, also known as premature birth, is when the baby is born too early, before 37 weeks of pregnancy have been completed.
These babies are known as preemies. Ruby started the foundation at the clinic where she was being nursed, by providing psychosocial support to mothers of preterm babies.
Today, working together with volunteers of her foundation based in Kenya, she visits different hospitals such as Kenyatta National Hospital (KNH) and Pumwani. She also connects with mothers with similar cases through social media including home visits. Ruby has so far reached out to more than a thousand mothers, helping them know more about handling their preemies.
Numbers don’t lie
Premature birth is the leading cause of death in children under the age of five worldwide. Babies born too early may have more health issues than babies born on time, and may face long-term health problems that affect the brain, the lungs, hearing or vision.
As the world marked Prematurity Day earlier this month with the theme ‘March of Dimes’, let’s take a look at the state of preterm births in Tanzania.
According to United Nations Children’s Fund (UNICEF), Tanzania has made laudable progress in reducing child mortality over the past decades.
Data from Muhimbili National Hospital (MNH) shows that there has been significant improvement in the death rate of children born premature especially in the last five years (2012-2017). However, neonatal mortality has stagnated, remaining at 29 per 1000 births between 2005 and 2010. Yet the number is too high and unacceptable. No child should die during birth.
Neonatal causes account for 40 per cent of all under-five deaths and are intimately linked to the conditions of the mother, as well as the quality of care received during pregnancy and delivery. Most of the deaths are from birth asphyxia, preterm birth complications, and infections such as sepsis.
Dr Jose Hernandez, an obstetrician-gynaecologist working at the Kangaroo Unit at MNH tells Your Health that 80 per cent of the causes of preterm births are preventable only if the mother of the child plans for the pregnancy six months prior to conceiving and is taken good care of throughout the pregnancy.
The health experts further cautions against the use of unprescribed medicine, intake of alcoholic beverages and using other forms of illegal substances. These all contribute to the increased rate of preterm births.
Head Nurse at MNH special unit for premature babies, Cleopatra Mtei says that eclampsia is the major reason for preterm births, a condition that Ruby also suffered.
The nurse also attributes frequent abortions by women as a factor leading to babies being born preterm due to the weakening of the cervix.
Other possible causes include short intervals between pregnancies, malaria and malnutrition.
Low weight and age of the mother also plays a role as causes of preterm birth.
According to the Director of Nursing at MNH, Agnes Mtau, 20 to 25 per cent of children at the new-born unit at MNH were born premature or with low birth weight in 2016.
Mtau adds that health data in Tanzania indicates 13 per cent of children are born with low birth weight, accounting for 86 per cent of premature deaths. This is due to the fact that babies born premature are more susceptible to health complications which deter their growth.
What’s our situation?
Preterm babies need specialised treatment until they are stable - above two kilogrammes - and healthy enough to go home. But the availability of superior care is a mere reality in Tanzania, mostly existing in top private hospitals.
One infant incubator [a rigid box-like enclosure in which an infant, mostly premature, can be kept in a controlled environment for observation and care] is meant to house one baby, but because of the shortage, babies spend less than the normal amount of time in the incubators to make room for new arrivals.
The acute shortage of incubators in public hospitals in Tanzania has led to the risky practice of babies sharing this medical equipment. As a result, new-borns are put at risk of contracting deadly infections.
MNH also faces an acute shortage of incubators. As a result, due to the rising number of preterm births, the new-born unit at MNH has been modified to be conducive to them. This has been done through increase of room temperature to the same level as that found in incubators.
According to World Health Organisation (WHO), preterm babies in Tanzania can be saved in large numbers if there’s better handling of mother and child during delivery and during the post-natal period.
Mortality due to prematurity and low birth weight can be reduced significantly through low cost high impact interventions.
Skin to skin contact, a miracle
Tanzania adopted a low cost intervention method as an alternative approach for premature baby-care.
Kangaroo Mother Care (KMC) which was initiated in Tanzania in 2011 is an effective way to meet baby’s needs for warmth, breast feeding, protection from infection, stimulation, safety and love. Thanks to KMC, mothers who can’t afford private health care treatment are able to take care of their preterm babies through skin-to-skin contact.
This is one of the things that Ruby and her foundation do as well, helping the mothers know more about KMC and how it helps with their babies born preterm.
KMC is an idea that was born out of desperation back in Colombia in 1978. It is early, prolonged continuous skin-to-skin contact between a mother/surrogate and her preterm baby. It should be done for a minimum of 20 hours per day. It is a key component of care for preterm and low-birth-weight babies and was introduced to deal with overcrowding in new-born units and inadequate incubators.
Dr Sudha Sharma, Chief of the UNICEF Tanzania Health and Nutrition programme tells Your Health that KMC is the safest place for babies to be nursed in close contact with their mothers – in a similar way to a kangaroo nursing her baby in a pouch.
According to Tanzania Ministry of Health’s Kangaroo Mother Care guideline, KMC for preterm and low birth weight babies is one of the evidence-based and cost-effective child health interventions that contribute to reduction in neonatal morbidity and mortality when implemented at high coverage.
Kangaroo unit at MNH houses preterm babies weighing 500 grams to 1.5kg, even though the number of premature births is very high.
Key elements of kangaroo care
• Positioning: The baby is placed on the mother’s chest between the breasts in an upright position.
• Nutrition: The baby is fed through exclusive breastfeeding. This enhances weight gain.
• Release: The baby is discharged only if she/he meets set criteria, and KMC is continued at home, follow up is done at a nearby hospital.