Naomi, 18 years old, with her baby at the Kangaroo mother care in Bungoma, Kenya Kangaroo Mother Care is part of the GSK funded Health Signature Programme being implemented in Bungoma County. Save the Children has been supporting the Ministry of Health (MoH) to establish KMC services in Bungoma County since 2014. KMC is now being implemented in 9 health facilities. Save the Children has conducted minor renovations of rooms provided by the county Ministry of Health (MoH) for KMC, provided basic equipment for care of the babies, trained health care workers and established follow-up mechanisms of babies discharged to continue with KMC at home. The County on the other hand has been responsible for ensuring that the KMC units are adequately staffed with sufficient medicine and commodities for care of the babies as well and food and linen for the mothers while they are admitted. 95 health care workers have been trained on KMC and this includes health managers. The project also trained community level service providers on KMC and these are crucial for follow up of mothers practicing KMC at home. Working with community staff has been useful in increasing acceptance and improving family support and involvement even at community level. The project has also conducted sensitization sessions on KMC to 18 KMC mothers who practised KMC and these mothers are now volunteer peer support to other mothers as KMC champions. Their main role is to conduct KMC support group meetings at facility level to encourage other mothers to use KMC and they receive technical guidance from the health care workers. Working with champions has enhanced acceptance of care of the babies through KMC both at facility and community level. The result has been a drop in the proportion of babies lost to follow up. These women have become very popular and are now trusted community resource persons on KMC.

Telling your story: Time to flood Kenya with kangaroos and save premature babies

Victor Hugo said, “There is nothing more powerful than an idea whose time has come.” That time has come for a life-saving approach to looking after babies who are born too soon called kangaroo mother care. In Kenya, the moment as arrived to accelerate its scale-up for the 200,000 babies born prematurely every year.

When kangaroos meet wildebeests

The county of Bungoma is a poor, largely rural population of 1.6 million souls subsisting mostly on crops of maize and sugarcane. It’s here that Save the Children has been operating a ‘Signature Programme’ on healthcare for nearly five years designed to improve maternal and neonatal health outcome.

Kangaroo mother care was piloted for the first time in Kenya at the Bungoma sub-county referral hospital , through a collaborative effort between the Ministry of Health and Save the Children. Rosemary, the head nurse in the maternity wing of the hospital, was involved in the pilot from 2013 when it was first conceived. She described her experience with the passion of someone who felt empowered to save lives that would otherwise have been almost certainly lost.

The maternity wing that Rosemary oversees covers a population of over 200,000 and carries out no fewer than 600 deliveries a month. Of these, nearly 40 are premature. Before kangaroo mother care was introduced – ¬along with the renovation and expansion of the newborn unit and the creation of a ward specially dedicated to kangaroo mother care – babies as light as 1.3kg were discharged. “It was basically a death sentence,” says Rosemary.

Nothing like a mother’s love

Kangaroo mother care is, on the surface, simple enough. In the absence of incubators – expensive, energy-hungry pieces of kit – there is a simple, lower cost and effective solution to make sure preterm infants keep warm and grow: maximising skin-to-skin contact between the baby and the mother (or father) – much like mother kangaroos do with their babies until they’re fully grown.

Tabirtha seated in the middle is mother a who recently gave birth to Hendlina, her newborn baby. She had spent several days at the neonatal ward at Queen Elizabeth Hospital, Malawi. She was being taught the KMC (Kangaroo Mother Care) method to use on her baby.

When coupled with exclusive breastfeeding and medical supervision, this technique is a highly effective way of supporting low birthweight babies through this dangerous time and maximising their chances of survival.

Kangaroo mother care is backed up by a large, global and compelling body of evidence, including substantial amounts of clinical research showing its effectiveness in reducing mortality among preterm infants in developing countries. Despite this, progress to take this approach to scale in developing countries has so far been patchy at best. 

Implementation in Bungoma

With kangaroo mother care, nurses and midwives are trained and receive supportive supervision. Full time care can be provided to eight preterm babies at a time in the specialist ward, and more can be looked after in the newborn unit. The story of one particular premature baby – who weighed 1.3kg at birth and reached 2kg within the space of a few weeks following a strict regime limited to skin-to-skin contact and exclusive breastfeeding – is recounted as a moment of sudden insight, even astonishment.

The hospital is now widely seen as a centre of excellence in preterm care in the county and the whole of Kenya. But it hasn’t been an easy journey. New ideas challenge old norms, some of which are deeply rooted. For example, communities whose experience has been that low-birthweight babies are beyond saving were resistant to the notion that these babies could survive and even thrive.

Mothers of premature babies were also apprehensive. “Won’t I suffocate my baby?” was a recurring concern. For Rosemary and her team, introducing kangaroo mother care required empathy, sensitivity, care and respect.

Time to scale upwards – and outwards

Success brings new challenges. Readers of my blog may remember the story of the paediatric hospital in Delhi, India, which became a victim of its own success, attracting many more patients than it could possible cope with. Bungoma sub-county hospital is going through something similar.

As pregnant women flock down to the hospital to seek the high-quality care they’re unlikely to get anywhere else, the pressure on the hospital has increased. And now, the maternity ward is cracking at the seams. The time has come to roll out kangaroo mother care much more widely, bringing this life-saving service closer to the women and babies who need it and easing the pressure on the health system.

A word of warning. Just because kangaroo mother care – unlike other forms of treatment for preterm and low birthweight – doesn’t require expensive equipment nor drugs, doesn’t mean it’s cheap. Mothers still need a hospital bed as well as near-constant supervision by a qualified nurse or midwife for up to three months. Effectively, that means they need a functioning, adequately staffed health system. The average fee charged for kangaroo mother care is between 7,000 and 10,000 Kenyan shillings (£53 to £76), although poorer patients who can’t afford it can – and quite often do – have their fees waived.

Nevertheless, the case for scale is compelling. Kangaroo mother care is evidence-based, could save thousands of lives every year across the whole of Kenya and is cheaper than alternatives methods of preterm care. At the very least, it should be rolled out in all sub-county hospitals – and preferably in primary healthcare facilities as well, along with adequate levels of supervision and strengthened referral pathways.

Knowledge is power. We know what works.

Now we must do.

This blog is part of the HNN collection, Telling Your Story: transforming care for small and sick newborns. If you have a story to share about transforming care for small and sick newborns, send a 300-600-word blog about your experience or research to info@healthynewbornnetwork.org.

About the Author

Samy Ahmar is Head of Health for Save the Children UK. Lynn Kanyuuru is Head of Health for Save the Children Kenya.


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