UG@60: Kangaroo care saved many Ugandans

 Agnes Kyotalengerire looks at the Kangaroo Mother Care (KMC), which brought down preterm deaths at a very affordable cost. 

In 2001, Dr Margaret Nakakeeto, a consultant neonatologist working with the Ministry of Health championed the introduction of a cheaper practice in Mulago Hospital after she attended training in Colombia. It is known as Kangaroo Mother Care (KMC). It is a simple and cost-effective process.

All it requires is a clean mother, wrapping a clean lesu or sheet to securely strap the premature baby on her chest while she goes about with her domestic chores. The body-to-body contact is important to keep the baby warm.

“I encourage parents to practice the skin-to-skin method for uninterrupted 60 minutes during the first 12 weeks and beyond,” Nakakeeto says.

Susan Katende sits on the bed with her little bundle of joy wrapped around her chest.

She constantly checks on the baby, adjusting the small hat and making sure the head is completely covered. The baby also has feeding nasal tubes. 

“I delivered her at 32 weeks, just a few weeks to the delivery date, and the doctors said she was premature. Instead of putting the baby in an incubator, they advised me to keep her close to my chest, a practice termed as Kangaroo and assured me that it would greatly improve her health,” Katende narrates. 

Babies born too soon when the lungs, brain and other organs have not developed, are highly vulnerable. 

Dr Nakakeeto, a consultant neonatologist working with the Ministry of Health, defines preterm as babies born alive before the 37 weeks of pregnancy are completed.

She says about 10% of babies born annually in Uganda are premature or born before their expected date of delivery, with some weighing only between 700 and 800 grammes.

“When a baby is born premature, the three major concerns are ensuring it feeds, breathes well and its body temperature is regulated. This is because they often have underdeveloped immune systems and experience metabolism problems due to underdeveloped body organs such as the liver and heart,” she says.

Hospitals have neonatal intensive care units for specialised care of newborn babies with serious health problems. 

They have special equipment and specially trained nurses who provide around-the-clock care for preterm babies who need extra support to keep warm, breathe and be fed, or who are very sick. In Uganda, it may cost above sh50,000 per day. 

Reduced deaths

Dr Nakakeeto says KMC is recommended for premature and low birth weight newborn babies of less than 200g, who are clinically stable, as per World Health Organisation (WHO) newborn care guidelines.

Dr Harriet Ajilong, a paediatrician working with Gulu Regional Referral Hospital, says KMC should be initiated right from the time a mother is attending antenatal care.

By the time a mother goes into labour, she should know how to do KMC.

According to Nakakeeto, KMC effectively reduces deaths in premature babies.

A report, titled: ‘The Born Too Soon’ by Save the Children, estimates that over 400,000 newborns could be saved every year if KMC was brought to scale in countries (mostly third world countries) facing high preterm birth rates.

In KMC, the infant typically snuggles into a mother’s breasts and falls asleep within a few minutes.

The breasts themselves have been shown to change in temperature to match your baby’s temperature needs. 

In other words, the breasts can increase in temperature when the baby’s body is cool and can decrease in temperature when the baby is warm.

Additionally, Prof. Joy Lawn, the director of Maternal Adolescent Reproductive and Child Health (MARCH) Centre London School of Hygiene and Tropical Medicine, says when the baby is on the mother’s chest during the KMC, the breathing of the mother and, especially her heartbeat, stimulates the baby. Consequently, this reminds the baby also to breathe. 

Ajilong adds that KMC provides bonding for both the baby and mother.

Limited uptake

The commissioner for community health at the Ministry of Health, Dr Jessica Nsungwa, says KMC is a key intervention in saving life for preterm and very small babies.

However, there is still a critical gap in the lack of a pool of trained people to support mothers to do KMC.

The principal assistant nursing officer, at Masafu general hospital, Esther Babirye Alitubera concurs with Nsungwa.

“Hospitals should teach mothers to practice KMC because the traditional way of covering the preterm babies in cotton clothes is less effective. We lose about four preterm babies partly because of the failure to practice simple innovations such as KMC,” she says.

Dr Peter Waiswa, the associate professor at Makerere School of Public Health, also says there is a need to train health workers on the components of KMC, and how to care for, feed and monitor the baby. 

Kangaroo innovation 

KMC allows for skin-to-skin contact between a mother (or a father) and her/his baby. A baby is placed (naked except for a diaper and hat) on a mother’s chest (also bared to allow skin-to-skin) for up to a few hours.

It was established that holding your baby skin-to-skin, can stabilise the heart and respiratory (breathing) rates, improve oxygen saturation rates, better regulate an infant’s body temperature and conserve a baby’s calories.

The KMC was first noted in Bogota, Colombia in the late 1970s. The community there responded to a high death rate in preterm babies, which was approximately 70%, and innovated a method that would be affordable and practical. 

Researchers found that babies who were held close to their mothers’ bodies for large portions of the day not only survived but thrived.

Nakakeeto studied KMC in Colombia in 1999 and returned to introduce it in Mulago.

After a slow start-up in 2006, advocacy for KMC was made prominent in the policy environment with the formation of the Newborn Steering Committee, in documents such as the Standards for Newborn Health Care Services (2010) and the Health Sector Strategic and Investment Plan (2010/11 – 2014/15).

In 2012, Uganda was one of four countries selected for an in-depth evaluation, using standard measurement tools, to systematically measure the scope and institutionalisation of KMC services.