By Gift Briton
Over the last three years, Kenyan babies dying within 28 days of birth due to prematurity have been steadily rising.
Nearly four in ten neonatal deaths are attributed to babies born before the completion of 37 weeks of pregnancy (preterm babies), as demonstrated in the Kenya Health Information System (KHIS 2023).
These babies are often born with underdeveloped organs which makes them vulnerable to deadly complications. Any delays in providing specialized medical care significantly increase their risk of death.
Supporting and managing them to thrive requires advanced medical equipment, robust infrastructure, and skilled human resources.
While Kenya has made notable progress in preventing prematurity and safeguarding survival for preterm babies, much more effort is needed to ensure equitable access to quality care across the country.
Proven interventions, including adopting the latest technologies and standardizing newborn care setups, need scaling up to reach those who need them the most.
Unfortunately, many newborn units in Kenya face severe challenges. Patrick Too, a neonatal nurse and board member of the Council of International Neonatal Nurses, correctly observes that most of the newborn setups in the country are not up to the standard.
He notes that overcrowding is common in several newborn units, with some newborns forced to share beds, which can lead to infections—a major driver of neonatal mortality.
Healthcare staffing shortages exacerbate the situation. According to Too, in some neonatal units, a single nurse is responsible for as many as 30 patients. This can compromise the ability to provide quality care.
However, he says that technology can be leveraged to improve efficiency in some of these facilities, including the use of enhanced monitoring machines to ease the burden on workers.
“We need to move a notch higher and ensure that we embrace technology so that we adequately take care of our newborns,” Too adds.
He further urges the need for more specialists, properly categorized levels of care, and an effective referral system, calling on partners to collaborate in ensuring that hospitals have adequate resources to support neonatal care.
Speaking to journalists in commemoration of World Prematurity Day, Steven Mwangi, representing implementing partners in Kenya, underscores the critical role of partnerships in scaling proven interventions nationwide. He acknowledges that the majority of Kenyans seek care in dispensaries and facilities where some of these interventions have not been reached.
He stresses the need for increased investment in neonatal and maternal health, urging the government to create an enabling environment with policies that support these efforts.
Mwangi also points out that while areas like malaria and HIV have received substantial funding, neonatal and maternal health require greater prioritization. He urges donors to focus more resources on prevention and care for preterm babies.
There are varying degrees of prematurity, categorized as late preterm, early preterm, or extremely preterm depending on the week of pregnancy they were born.
Dr Cecilia Kariuki, a Neonatologist at Mama Lucy Kibaki Hospital, notes that seeing a preterm baby can sometimes be hard on a mother. Depending on how preterm the baby is, their skin can appear translucent, most of them are really tiny, some have heads that are a bit bigger than their bodies, they have low birth weight, few or no foot creases, and their private parts may also look different.
This can present immense emotional, physical, and financial challenges to the caregivers, especially to the mother. Dr Kariuki stresses the importance of family involvement and support in the routine care and development of preterm babies, including education and counseling, peer support and home visits.
According to the Ministry of Health (MOH), the cause of prematurity is unknown in approximately half of preterm births. However, several risk factors can be attributed to preterm deliveries, including poor nutrition before and during pregnancy, smoking and drinking alcohol, infections such as urinary tract and amniotic membrane infections, history of birth to a premature baby in a previous pregnancy, extremes of maternal age, and uterine malformations.
The Ministry recommends several interventions for the prevention of prematurity, including ensuring equitable access to high-quality sexual and reproductive health services such as family planning and empowerment of women, a social behaviour change and communication on lifestyle changes to prevent preterm birth such as smoke cessation, and improved nutrition such as increased uptake of iron and folate-rich foods.
Timely diagnosis and treatment of sexually transmitted infections (STIs), screening for STIs, high blood pressure and diabetes for all women, recommended physical activity, medical use of ante-natal corticosteroids to aid in the maturation of the foetal lungs, where the risk of prematurity has been identified, and foetal measurements including use of early ultrasound to help determine gestational age among other prevention practices are other recommended practices for prevention.
