Source: The Star
When Faith Akoth discovered she was pregnant, she was overjoyed. This was her first pregnancy and she could not wait to be a new mother.

However, seven months into her pregnancy, something went terribly wrong. Her blood pressure shot up. When she visited Kenyatta National Hospital, the doctors told her that she had to deliver immediately, failure to which she would put her life and that of the unborn baby in danger.

The first-time mother had an emergency delivery on the seventh month of her pregnancy.

According to the 2008-09 Kenya Demographic Health Survey, one in every eight babies in Kenya is born prematurely. This places Kenya among 15 countries in the world that account for two thirds of all preterm births.

In 2010 alone, more than 188,000 babies were born premature in Kenya, a figure that is high and requiring urgent intervention. Reasons attributed to preterm births range from contraction of malaria by mother during pregnancy, malnutrition to low weight.

Dr John Ong'ech, a gynaecologist at Kenyatta National Hospital, says priority is given to the health of the expectant mother. He, however, singles out health seeking behaviours of pregnant women as the biggest problem in Kenya.

"Many women don't go for antenatal services; this makes it difficult for health workers to detect a problem during pregnancy, if there is any. This has led to many preterm births," Ong'ech says.

Babies born prematurely require specialised care to keep them alive. The World Health Organization says preterm babies have a hard time staying warm, breathing, feeding and stand a high risk of infections. They are also prone to bleeding in the brain and their eyes can get damaged as a result of abnormal growth.

They have low survival chances as most of them risk death if proper care is not provided.

"With all these challenges, preterm babies need very special care, and that is why most of them are put in incubators, because incubators help them survive," Ong'ech says.

The use of incubators is one of the most effective ways of keeping preterm babies alive. However, there is a huge shortage of the all-important facilities in the country, due to its high costs.

The nurse in-charge at KNH's new born unit Florence Ogongo says one incubator costs Sh2.5 million. The hospital has 15 functional incubators only.

KNH is the largest referral facility in the country, and it is grappling with the ability to effectively offer quality services, as most of its clients come from poor socio-economic backgrounds.

Given the high number of preterm births in health facilities countrywide and the huge cost of procuring an incubator, some health facilities are looking for new ways of keeping the preterm babies alive, at a lower cost.

Kangaroo mother care, a low cost technique of taking care of preterm babies, is being embraced by some hospitals in Kenya. It is an innovative way of keeping premature and underweight new born babies warm.

In the Kangaroo programme, mothers are taught how to cuddle their babies to their abdomens. The babies are carefully tucked under their mothers' clothes on the tummy to keep them warm.

The key is skin-to-skin contact between mother and child. Since preterm babies are unable to keep themselves warm, their mothers serve as a human incubator to keep them alive while they gain weight.

The programme is, however, only applied to preterm babies who are stable.

"Those preterm babies who are unstable are strictly put on incubator care so that at least both, the stable and unstable ones, can benefit from warmth," Ogongo says.

Kangaroo mother care has many benefits. Ong'ech says the method helps the infants grow faster and healthier.

"It's not a question of whether kangaroo care works or not, it's been fully evaluated that it works and it's only a question of scaling it up," Ong'ech says.

KNH is one of the facilities embracing Kangaroo mother care due to the high cost of incubators.

"At Kenyatta, we have more than 100 babies at any given time. Some 50 percent of these are preterms who need incubator care," Ogongo says.

She says despite the high number of preterm births at the busy hospital, it only has 15 working incubators.

"There are 15 incubators in working condition, four or five are not working because they are waiting for spare parts which have to be imported because they are not manufactured locally. This is a big challenge as babies can't wait," she says.

This challenge is not unique to KNH only. A survey conducted in major public hospitals countrywide revealed that there are 93 incubators at national and provincial hospitals.

Due to the shortage, it is not uncommon to find preterm babies sharing incubators; in some cases up to three babies share one at KNH.

Patriciah Mutiso, a nurse attached to KNH's newborn unit, cautions that sharing incubators is very risky for the young ones, as they get exposed to infections.

"Infections are the main and most complicated danger we have here. Babies who share incubators can cross-infect each other because they pass urine, stool and different hands touch them," Mutiso says.

"Infections are so dangerous that some babies even die due to their complications," she says. She attributes half of preterm deaths at KNH to infections.

The WHO developed a practical guideline on Kangaroo care in 2003. Studies have concluded the initiative is as safe and effective as an incubator. Medics have even raised its stakes, saying it could be an alternative for stable young ones requiring incubators.

According to a report by the March of Dimes, a US based nonprofit organisation, more than 500,000 babies who die annually from preterm birth complications could be saved by the Kangaroo mother care technique.

The report says Kangaroo care can help babies maintain body warmth, regulate heart and breathing rates, gain weight, cut infection rates and further improve production of mother's breast milk.

The method has been touted to reduce hospital stay of infants, as they are permitted to go home upon attaining 1.7 kilogrammes. This enables mothers to continue with the technique at home.

Compared to incubators, the method has various merits. Not only is it free, but it also creates a bond between mother and child.

Akoth hails the technique, which she says enables her to hold her baby boy to keep him alive.

"I love it, I get a chance to hold him next to me everyday knowing that my warmth is what is keeping him alive," she says.

Mercy Waswa, a mother who gave birth at eight months at KNH, is undergoing an induction on Kangaroo care.

"I love Kangaroo care because it creates a relationship between me and my baby. Kangaroo care ni poa, inafanya una feel kweli uko na mtoto wako. (Kangaroo care is good, it makes you feel that you are with your baby," a jubilant Waswa says.

Gladys Kayaro, whose baby was born prematurely at seven months at the busy referral hospital, is also being trained on kangaroo care.

"Vile nilifundishwa kutumia Kangaroo care, nilifurahi sana kwa sababu ninaweza kubeba mtoto wangu. (When I was taught how to use Kangaroo care, I was very happy because I can carry my baby)," she says.

Despite the biting shortage of incubators in public hospitals, less than half of provincial and national hospitals in the country offer Kangaroo care.

Dr Ongech is calling for the scaling up of the technique to lower level facilities, especially those in rural areas.

"Kangaroo mother care should be taught to women living in rural areas because these are areas where incubators are hard to find. It is the best intervention and all women in the village should be taught this," Ong'ech says.

If Kenya is to reduce the more than a third recorded newborn deaths, it is vital to look at strategies that will enhance survival rates.

A study of Kangaroo care in Ethiopia and 14 other developing countries established that the method halved deaths among stable premature babies.

Akoth, Waswa and Kayaro are optimistic their babies will develop faster and healthier. They foresee early independence of their loved ones as a result of the technique.

• Kenya