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The Healthy Newborn Network Blog provides timely information and insights from the global newborn health field and seeks to promote dialogue on important newborn health issues. The blog is a platform for the HNN Editors and guest contributors to post commentaries on current happenings in the newborn health field. The content of each post and comments expressed on the HNN blog are those of the individual contributors and do not necessarily represent the views and opinion of the HNN or its Partner Organizations. >>Read a note on leaving comments
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The following piece was written by Gary Darmstadt and Wendy Prosser for Impatient Optimists.
The Ministry of Health in Brazil has taken enormous strides to improve maternal and newborn health and adopt a humanized care approach for moms and newborns. They adopted "Kangaroo Care," also called skin-to-skin contact, the practice of holding a baby close to the skin, as a national policy for low birth weight babies over a decade ago.
And there is one woman in the country who could be called the "Kangaroo Care Champion."
Brazil’s own Dr. Zeni Carvalho Lamy has engaged in long-term research on this type of care, which demonstrates the extraordinary benefits for newborns—and their parents. Her research has been invaluable to the larger push to get Kangaroo Care adopted worldwide.
Dr. Lamy is working in a variety of ways to improve the chance that small babies have to survive. Though Gary Darmstadt, one of the writers of this post, has written several posts about this deceptively simple practice, Dr. Zeni Carvalho Lamy and her research on this life-saving method inspired him to write another.
A mom with her Kangaroo Care baby at the University Hospital of Federal Maranhão, in Brazil.
Skin-to-skin care has been shown to have incredible benefits. In addition to the fact that it promotes breastfeeding, normalizes the baby’s temperature, increases weight gain, reduces the incidence of infections, and facilitates bonding between baby and parents, Dr. Lamy’s own study at the University Hospital of Federal Maranhão confirms that skin-to-skin care actually reduces pain responses for the newborn.
It’s a force of nature that can save lives.
In fact, Kangaroo care is proven to be one of the most effective means we have to save the lives of preterm (premature) infants.
Kangaroo Care began as an ideal method for low-resource (poor) regions of the world, where technological advances such as incubators, the typical method of treating preterm infants, aren’t available. But what Brazil is showing is that this simple, basic method of care is for all babies—those in the best neonatal intensive care unit available as well as those who may not even have had access to a midwife during delivery.
The University Hospital where Dr. Lamy is based teaches moms and dads how to provide skin-to-skin contact for as much time during the day as possible.
Kangaroo Care allows for the mother and baby to reconnect after an often alarming preterm delivery. Practicing Kangaroo Care while still in the hospital also gives parents a chance to overcome their reservations and fears of caring for a preterm baby while having constant support from health care workers.
Once released from the hospital, parents have more confidence in caring for their child. As a result, these mothers are more likely to exclusively breastfeed (feeding the newborn nothing but breast milk for the first six months of an infant’s life) and are more able to recognize and respond to their baby’s needs.
Seven-year-old former KC babies, celebrating life. The t-shirt says, “I was a Kangaroo Baby.”
For the first several weeks at home, frontline health workers, community health providers including peer counselors, skilled birth attendants, and others, conduct a weekly home visit until the baby reaches an acceptable weight. Routine follow-up for both preterm and full-term babies, including support for the practice of Kangaroo Care, also continues at health care clinics.
The hospital follows-up with these low birth weight babies through the years, until their seventh-year birthday party. Each year, the nurses and doctors get to celebrate with these children and their parents, celebrating both their birthdays, and the enormous benefits of a simple practice that helped them survive the first perilous days and weeks of life.
Kangaroo Care has been adopted across Brazil for preterm and low birth weight babies, thanks in large part to Dr. Zeni Lamy’s amazing research on the practice. It can and should be adopted by all parents all around the world. The benefits are enormous. Every baby deserves a seventh-year birthday celebration.
Interested in learning more about Kangaroo Care and what you can do to help spread the word and raise awareness? In December 2011, the first Kangaroo Care Conference for Latin America and the Caribbean was hosted by USAID. The United States was there as well. Information was shared with the goal to learn about and connect across borders to promote Kangaroo Care as a life-saving tool. Read up about this amazing practice on Impatient Optimists, or on the Healthy Newborn Network. Read the stories of families who have adopted this practice, watch the video below, and spread the word about the benefits. And if you have a story to share, please do so in the comments.
Continue the conversation on Twitter, with Gary Darmstadt, Director of Family Health at the foundation! Follow him at @gdarmsta.
Waraka and her newborn baby are surrounded by their family at home in Katsina, Nigeria. She gave birth to twins, but one of them died from malnutrition after 13 days of being born. Waraka has given birth to 16 children but has lost six from preventble diseases such as malaria, fever, measles, malnutrition and infections.
Breastfeeding is the best way to provide newborns with the nutrients they need, and one of the most effective ways to ensure newborn health and survival. Optimal breastfeeding together with complementary feeding and adequate support for mothers and families helps prevent malnutrition and saves newborn lives.
The World Health Organization recommends immediate and exclusive breastfeeding until a baby is six months old, and continued breastfeeding with the addition of nutritious complementary foods for up to two years or beyond.
Photo by Pep Bonet / Save the Children
The following blog was originally posted on Impatient Optimists. Written by Gary Darmstadt, Aarti Kumar and Vishwajeet Kumar.
Laldai's 5-day-old child receiving the polio vaccine at their dwelling at a brick kiln near Bishanpur in Darbhanga district. Photo: The Bill & Melinda Gates Foundation
Family health programs in developing countries have conventionally targeted women. With deeply entrenched gender-based roles, the health of mothers, newborns, children and their nutrition squarely falls within the purview of women.
Female health workers have also traditionally delivered interventions, particularly those directed toward women. Women are thus both agents and targets of change, and have created phenomenal value for family health. As the world celebrates International Women’s Day, we stand in solidarity with a deep sense of gratitude.
We also continue to challenge ourselves to think of novel approaches to empower women and accelerate progress toward improved survival, health and the well-being of women and children. We are tempted to share a seemingly paradoxical yet integrative approach of “harnessing the power of men to empower women” that we experimented with in rural communities in Shivgarh, India.
In Shivgarh, newborn care practices were entrenched in social norms and traditional knowledge that was passed on from one generation to another, primarily through the discourse and actions of women, as a form of “cultural inheritance.” Some of these practices, such as scrubbing the baby clean with detergents and mud to remove the vernix (a protective layer of lipid-based substances on the skin at birth), carried significant risk to the baby. The challenge before us was to enable mothers to adopt changed practices that were favorable to their newborns. But we realized that changes to these deeply entrenched practices entailed a perceived risk, and therefore, we would have to gain the trust of the family and the community—both men and women. Men, having greater exposure to the outside world and appearing to occupy a more central position in social networks, presented an opportunity to act as change catalysts and resource mobilizers.
An interesting aspect of the Shivgarh experiment was the involvement of male community health workers (CHWs). Male CHWs set a living example and were instrumental in breaking role barriers, and demonstrating that men could and should care for newborns as well.
So began a conversation with the community, bringing men and women together around a shared responsibility and desire to ensure that pregnancy, childbirth, and postpartum periods were safe for mother and child. The initial reactions of “this is a woman’s job,” “not our concern,” etc., were soon replaced by fascination and an appreciation of what it entailed to bring a newborn into the world, and the skill and coordination needed to care for newborns and protect them from illness.
We had the men on board. Barriers were broken and a team was formed around the newborn that transcended divisions of gender, age, and caste. Men partnered equally with women in their shared mission to save newborns. Community leaders became strong advocates, poets composed songs about the intervention, grandfathers reinforced intervention practices, and fathers gave skin-to-skin care to their babies.
This strategy indeed paid off—in sixteen months, practices changed and neonatal mortality in the intervention villages was cut in half. There were some important collateral gains as well. The health care spending on newborn girls rose three times to equal that of boys. Maternal health care resources improved significantly, which could not have happened without the support of men.
The Shivgarh experiment has important insights for family health programming. We discovered that men can act as force-multipliers in initiating, spreading, and supporting behavior change. Participation by men in family health matters makes them receptive, responsible, and appreciative of the role of women.
Ultimately, it is not a zero-sum game: men and women complement each other and can unlock a greater power together, to create better health for their family and community. Men empowering women empowers whole communities.
Photo: Ritam Banerjee/Getty Images for Save the Children
In India, over 900,000 babies die in their first month of life every year. Rekha Samant is a senior staff nurse in the Neonatal Intensive Care Unit at King Edward Medical Hospital and Seth Gordhandas Sunderdas Medical College in the megacity of Mumbai. With 15 years experience as a senior staff nurse she is also one of a rare breed of nurses: she has a one-year diploma in neonatal nursing, which she obtained at SNDT University in Mumbai. Samant is a national trainer in Kangaroo Mother Care (KMC) and the KMC Unit at her hospital is internationally recognised as a centre of excellence.
Despite the fact that nurses provide the majority of care to sick newborns in health facilities, there are very few nurses like Rekha Samant who dedicate themselves to newborn care, which is a major chalenge for neonatal units worldwide. There is an acute shortage of neonatal nurses internationally and particular in resource-limited countries where there is a desperate need for accredited training in advanced neonatal nursing practice.
"I sincerely believe we, the neonatal nurses, owe imparting tender care to our babies as they trust us with closed eyes," said Rekha upon receiving the first ever International Neonatal Nursing Excellence Award in 2010.
The power of video: Bringing care to life on a mobile phone, Nigeria
Global Health Media Project is merging the teaching power of video with the dissemination potential of current and emerging communication technologies to make videos accessible to frontline health workers even in remote settings. By capitalizing on expanding Internet access and the proliferation of mobile devices throughout the developing world, far more people can be reached, at significantly lower cost, and with much better health care information than was conceivable only a few years ago.
Global Health Media Project is designing and producing videos that bring lifesaving health care information to frontline health workers in primary care and district facilities. A number of videos will be useful for community workers and for the needs of the general population.
Health worker in Nigeria views video on danger signs.
The first video series, a set of 35 brief vignettes, aims to bring alive newborn care clinical guidelines. The videos go to the heart of topics in a simple and concise way with “need-to-know” information. The series will cover topics ranging from skill building for newborn care, managing newborn complications (including sepsis, asphyxia and cord infection), breastfeeding instruction, and also depict home visits for newborn care and referrals. They feature high-quality footage filmed in developing countries, voiced over to enable narration in many languages, and animated where needed to illuminate key teaching points. These videos can be used as complementary teaching tools in pre-service and in-service training sessions, and given to health workers as job aids to review as needed. They can also serve as stand-alone health care references for those who do not have access to organized training programs.
Filming the "newborn physical exam," Nigeria
The videos will be disseminated as broadly as possible—free of charge—to reach those who desperately need this health care information. Global Health Media Project is partnering with HealthPhone in India, (who is working with UNICEF and the Government of India), to distribute their videos on a memory card used in mobile phones, thus giving health workers access to visual training tools in 15 Indian languages without the need for Internet connectivity. This innovation has the potential to reach over two million health workers in India.
The Perinatal Education Program in South Africa will be embedding the videos into their eBooks. These are free-of-charge self-managed learning programs for nurses and midwives to be used by universities, hospitals and training programs around South Africa and in several other countries in that region.
Deb Van Dyke, founder and director of Global Health Media Project, examines a newborn in Nigeria.
Their first 10 videos are now out for review and field-testing at more than a dozen sites around the world. Following final edits they’ll be promoted worldwide and available for free download on Global Health Media Project’s website.