Kenya struggles to tame rising cases of newborn deaths

Two years ago, Scola Mueni was excited to become a mother, but what she is holding onto now is a memory— 30 minutes cuddling time with her son.

Ms Mueni rushed to Mbagathi District Hospital immediately labour started. She had taken care of her pregnancy as she was advised by the doctor, she had no reason to worry, but her child died a few minutes after being born.

Every year, 40,000 newborn babies die in Kenya within the first month of life, according to new statistics from the 2014 Lancet Every Newborn Series report. Worse still, another 33,000 children die in their mothers’ womb, medically referred to as stillbirths.

These figures translate to 200 deaths daily in Kenya. These are children who would have been future innovators and drivers of the economy. Yet, they die before their potential can be harnessed.

These damning statistics have put the country high up the ladder of shame. For newborn or neonatal deaths alone, Kenya is ranked 10th globally, making it one of the riskiest places for mothers to deliver in.

The type of hospital determines to a large extent the survival chances of a mother and the child. In high and middle income countries, mothers have access to equipped intensive care units and sophisticated medical equipment which come in handy during delivery.

In low-income nations however, where a huge proportion of births take place, many women deliver at home thus risking their lives and of babies in cases where complications arise.

One million deaths

Those that deliver in public hospitals are better off, but they have to contend with sharing beds, few doctors and nurses and lack of equipment.

Ms Mueni was among the women that have become victims of the healthcare systems gaps common in developing nations such as Kenya.

“I was in labour for two days and the baby wasn’t coming out no matter how hard I pushed. The pain was intense, but no one could help me because doctors were on strike demanding for better pay,” she said. By the time her husband decided to transfer her to a private clinic, she was unconscious and her body was turning pale.

Even though doctors at the clinic managed to deliver the baby, he died 30 minutes later in Ms Mueni’s arms. While talking, Ms Mueni’s voice kept breaking at various intervals. She tried unsuccessfully to mask the pain that was evident on her grief stricken face.

Her pain is shared by thousands of women in the world.

The World Health Organisation (WHO) estimates that there are about 1.2 million stillbirths, one million newborn deaths and more than 100,000 maternal deaths occur during labour.

The world takes pride in taming infectious diseases such as malaria and pneumonia that initially claimed young children at alarming rates. “Most children are now living past their fifth birthday,” says Kim Dickson, senior maternal and child health expert at the United Nations Children Fund (Unicef).

Unfortunately, she notes, conditions affecting newborns, children below one month old, have largely been ignored. Newborn deaths now account for 44 per cent of all deaths among children below five years worldwide.

Focus shifts

Focus is now shifting to this delicate age group to accelerate progress towards attainment of the third millennium development goal (MDG 4) target, aimed at reducing global child mortality.

The situation is not any different in Kenya. Whereas fewer children are dying at the top of the under-five year-olds pyramid, many at the bottom are still losing their lives.

“This waters down any gains made in fighting child deaths,” says Dr Nicholas Muraguri, the director of Medical Services.

This disparity is a major contributor to Kenya’s inability to its meet MDG 4 target. The current child mortality rate is 72 deaths per every 1,000 live births against the 2015 MDG target of 32 deaths for every 1,000 live births.

The three leading causes of newborn deaths in Kenya, just as is the case globally are preterm deliveries, birth complications and infections.

Even though premature babies require intensive care to weather through these conditions, studies have shown that over 80 per cent of newborn deaths can be prevented through the use of simple low-cost interventions.

These interventions are highlighted in the 2014 Every Newborn Action Plan (ENAP) book launched this year. “Most of the ENAP interventions are already in our national guidelines. We are implementing them, but we need to scale up our efforts to have impact,” says Dr Rachel Nyamai, head of the Child Health Unit at the Ministry of Health.

Dr Muraguri said that the country should not lose even a single life out of preventable causes. Government statistics indicate that Kenya loses more than 13,000 children annually from direct complications arising from prematurity (babies born before the recommended nine months).

As their immature bodies cannot function optimally, the standard practice is to put these children in incubators until they are mature enough to survive on their own.

“But such equipment is expensive and lack in most health facilities in developing nations like Kenya,” Dr Dickson says.

At Kenyatta National Hospital, for instance, there are very few incubators and babies are forced to share, increasing risk of disease transmission. Yet, this is the country’s highest level public health facility.

To address these technological challenges, experts are pushing for an alternative inexpensive technique known as kangaroo mother care (KMC).

“This is whereby a tiny infant is held skin to skin on the mother’s chest. This keeps it warm, eases breastfeeding and wards off infection. As a result, the baby matures fast and is able to go home,” said Florence Ogongo, head nurse at the KNH newborn unit.

The WHO estimates that the use of KMC can prevent close to 450,000 newborn deaths annually, especially among preterm babies.

Although it is being practised in certain hospitals, Dr Muraguri notes that KMC is under-utilised in Kenya.

“Plans are underway to roll it out everywhere.”

To further reduce neonatal deaths, Dr Nyamai said that mothers in preterm labour should receive steroid injections (antenatal corticosteroids). The injection speeds up lung development in premature babies, preventing them from having breathing problems once born.

Whereas 95 per cent of pregnant women can access it in the developed world, only a paltry five per cent can in developing nations like Kenya.

Low cost interventions

Lack of oxygen can also cause irreversible brain damage to a child and destroy other critical body organs like the liver and kidneys.

“In instances where newborns are unable to breathe by themselves, time is of essence and healthcare workers assisting in delivery should have the skills to resuscitate the child within one minute,” says Dr John Wachira, a paediatrician at Gertrude’s Children Hospital.

To do this, he notes, requires the use of yet another low-cost technology known as a bag valve mask (BVM) which stimulates the baby to breath. But not all health facilities in the country have it.

To prevent infections, exclusive breast-feeding for the first six months of life is recommended. Yet, just about 30 per cent of nursing mothers do so.

“Doing this costs nothing yet it boosts the baby’s immunity, protecting it from deadly diseases like diarrhoea and pneumonia,” said Ms Jane Munge, a clinical officer at Doctors Without Borders (MSF) which implements maternal and child health programmes in high risk areas such as Kenya’s informal settlements.

Dr Nyamai notes that deadly infections can get into the baby’s system through the umbilical cord which should thus be kept clean at all times.

The ENAP recommends the use of a low-cost antiseptic know as chlorhexidine. Its application reduces the risk of newborn deaths by up to 23 per cent whilst eliminating two-thirds to three-quarters of serious umbilical cord infections.

This life saving intervention is yet to be rolled out in Kenya due to the lack of local suppliers. However, plans are underway to set up a manufacturing plant in Kenya and Nigeria to produce chlorhexidine for the entire Africa.

Ms Munge said that child immunisations and antenatal care visits are also significant in the fight against maternal and child deaths.

“We also need to increase healthcare finances, specifically targeting the newborns,” says Dr Muraguri.