By Fatoumata Namandou Traore and Nathalie Gamache
At 23, Fatoumata Coulibaly, a mother of two, added to her family when she gave birth to twins at the community health center of Didieni, Mali, in April 2017. Born in this rural village, 40km from a district hospital and 180km from the capital city of Bamako, the babies (a girl and a boy, weighing 1860g/4.1lbs and 1910g/4.2lbs, respectively) were small. So small, in fact, that the family did not believe they could survive.
“When my mother-in-law saw the babies, she told me we should go home, that they were too small and not viable. She did not want us to stay at the facility as she thought it would just be wasting time,” Fatoumata recalls.
Despite her family’s reticence, Fatoumata wanted to give her babies a chance, and was willing to try Kangaroo Mother Care (KMC) as advised by the health center nurse. Fatoumata practiced KMC for two weeks at the health center and then was discharged to continue KMC at home, with follow-up appointments at the health center. When the family tried to leave the facility early, without an official discharge, the President of the health center management committee intervened with Fatoumata’s husband, mother-in-law and father-in-law, to convince them to stay. Two and half years later, Fatoumata is proud of her twins, who are alive today in great part to the KMC Services offered at the Didieni community health center.
Fatoumata’s story is one of many in Mali, where babies born too soon or too small are proving that they can survive and thrive.
In Mali, neonatal mortality is alarmingly high at 33 per 1,000 live births (DHS 2018). Prematurity accounts for 33% of the causes of these deaths (Lancet 2012). Among 440,688 births registered in health facilities in Mali, between January and September 2019, 5% of newborns (23,814) were recorded as low birth weight, or under 2,500 grams (Mali National DHIS2).
Although being born too soon or too small might be seen as a death sentence in Mali, stories of success are changing the norms in the country.
Since January 2019, half (46%) of low birthweight (LBW) babies benefited from KMC in the regions of Kayes, Sikasso, and Koulikoro where the USAID-funded Services de Santé à Grand Impact (SSGI) project intervenes. This is a notable increase from 30% in the same regions in 2018 (Mali National DHIS2).
Save the Children has supported the Ministry of Health and Social Affairs since 2002, seeking to understand newborn health challenges and establish actionable plans to eliminate preventable deaths in Mali. In 2006, KMC was integrated into national policies, norms and procedures as a recommended intervention for management of LBW babies, followed in 2007 by the initiation of KMC services at the Gabriel Toure University teaching hospital located in Bamako. However, access to the hospital is incredibly limited for most LBW babies such as Fatoumata’s twins.
Efforts to introduce KMC services in district referral hospitals began in 2008 through the Saving Newborn Lives program. Subsequently, the USAID-funded MCHIP, MCSP and SSGI programs – all led by Save the Children in Mali – supported service expansion. Gradually, KMC was brought closer to families and made available at community health centers (CSComs). Currently, 931 providers in 430 health facilities in 30 health districts supported by Save the Children through the USAID/SSGI project have been trained and equipped to deliver KMC services.
As evidenced by Fatoumata’s story, bringing care closer to communities is the key to saving premature and low birthweight babies. It requires not only health provider training, but also behavior change interventions among providers, families, and community leaders to recognize and support mothers practicing KMC as the primary intervention for preterm and low birthweight management.
As Mali celebrates World Prematurity Day, we salute premature babies like Fatoumata’s twins, who survived, mothers like her, who accepted to practice KMC, family members that support the mothers and even practice KMC themselves, and health workers who have integrated this practice into everyday service delivery.
Read also the story of Manzou Diarra, born at 29 weeks, who survived with the help of KMC.
 Kangaroo Mother Care (KMC) involves continuously carrying a premature or low birthweight baby on the chest, using early and prolonged skin-to-skin contact, combined with exclusive breastfeeding (direct suckling or cup). This practice helps improve health and prevent the death of premature and small newborns by protecting them against infection, regulating body temperature, breathing, and brain activity, and supporting bonding between mother and baby. Once the baby is stable and gains weight, and the mother is confident she can continue KMC at home, mother and baby are discharged. They return to the health facility for monitoring of weight gain, feeding practices and to ensure that there are no signs of infection or other health complications, till the baby graduates from KMC.