Life-saving initiative for newborn babies

Struggling with one of the highest child-mortality rates in the world, Malawi has launched an unconventional care programme aimed at saving the lives of newborn babies. Malawi has a childhood mortality rate of 104 deaths for every 1,000 live births. The Kangaroo Mother Care (KMC) programme intends to halve that rate. "Ideally we would love to have a below-20 percent level. The acceptable standard is that children should not die," said Henry Chavura, the project coordinator for Save New Lives (SNL), which supervises the KMC programme. KMC, based on skin-to-skin contact, is an alternative method for caring for pre-term and/or low birth-weight newborn babies after initial stabilisation. The idea is to emulate the way a kangaroo cares for its "joey" in her pouch. Rosemary Nyirenda, a KMC supervisor and trainer, told IRIN that the project started in earnest in April at the Zomba government hospital, near the southern city of Blantyre. Zomba District has one of the country's highest child-mortality rates, with 171 deaths for every 1,000 live births. "We put the baby between the mother's breasts so that there is skin-to-skin contact, because we want the mother to transfer the body heat to the baby," Nyirenda explained. She said a newborn baby cannot maintain its own temperature, but research has shown that it can be regulated by its mother's temperature. The KMC method was first adopted in Columbia in 1979, and has since spread in the developing world. KMC was introduced in Mozambique in 1984, and was launched in neighbouring Zimbabwe a decade later. In Malawi, it is being pioneered by Save the Children Fund-United States, and will initially run for two years. Under KMC, three basic needs are met. These include thermal protection of the baby through the mother's warmth, nutrition provided exclusively through breast-feeding, and love, facilitated by the bonding between the mother and child. Breast-feeding is insisted on, because mothers' milk is not only nutritious but also contains natural antibiotics. Mothers or guardians are trained to sit or lie in a specific position, making the baby comfortable, while it enjoys the body heat. The average weight for a newborn baby is around 2.5 kg, and anything below that is considered underweight. Among the advantages of KMC are that undersized babies gain weight at a rate faster than that achieved with conventional incubators. "They gain 10 mg per day. First and foremost, we look at the warmth," said Isabella wa Msolomba, a programme officer for SNL. "The aim is to keep the baby warm so that they don't lose weight." "Since the babies are small, they fail to suck, so we encourage the mother to breast-feed," Msolomba added. Under KMC, infections such as coughs and diarrhoea are reduced, because sometimes three babies from different mothers can be placed under one incubator. No expensive technology is required for KMC. "On average, KMC reduces the length of the stay [in hospital] to nine days," Nyirenda said. "It's less costly on the family and the institution, because there is a faster family reunion. The death rate is reduced, because babies have less [clinical] complications. Research has shown that KMC never hurt a baby or mother." "When they are in the ward, we're preparing them for home. Anybody can do it - mother, grandmother, father or aunt can participate in that type of care," she said. But Nyirenda said some challenges remained. If babies are discharged at 1.8 kg, mothers are required to return to the clinic for check-ups, but sometimes those visits are missed. "We are conducting a dropout study to establish why some mothers don't come back for clinical visits," she said. KMC is also tiring for the mother, as the baby has to be strapped between the breasts continuously. In some cases, cultural barriers have been a stumbling block, as babies are sometimes traditionally separated from their mothers for the first days after delivery. However, Nyirenda said the main focus of the project was to ensure that KMC spread to other hospitals by way of training personnel in antenatal care, preparations for a "kangaroo" ward, and counselling of mothers in the labour wards. Mzimba hospital in northern Malawi, Mangochi and Mulanje in the south, and Lilongwe in the centre, have all been earmarked for KMC.