Poor health services to blame for half of Nairobi child deaths

Nearly half of newborns in Nairobi lack access to quality healthcare, resulting in high mortality rates of an average 39 deaths per 1,000 live births, according to a new report.

This despite the fact that the county hosts a tenth of the county’s healthcare workforce and facilities — raising concerns about the quality of services rendered.

A study by the Kenya Medical Research Institute (Kemri) Welcome Trust showed that only about 44 percent of 24,000 seriously-ill children in Nairobi get access to quality healthcare.

“This means about 44 per cent of all seriously-ill newborns are given care in a facility that is not suitable at all or do not reach a facility at all — perhaps helping to explain Nairobi’s high neonatal mortality,” the report says.

The neonatal period — the first 28 days of a child’s life — contributes nearly 45 per cent of the death of children under five. Kenya’s child mortality is currently at 22 deaths per 1,000 live births and Nairobi records the highest number.

The study showed that only 33 hospitals are able to offer care to the babies, but this is not even encouraging because “of these 33 facilities only four are public but they provide 71 per cent of all existing inpatient neonatal care”.

Neonates — babies in this delicate period — need specialised care.

Earlier, Rachel Musoke, a professor of neonatal health at the University of Nairobi’s paediatric department to the Business Daily: “At that stage, they cannot regulate their own body temperature, so they lose all the water through the skin and die of dehydration. They cannot eat so food has to be given through a pipe and they pick diseases very fast.”

There are in electric cots (incubators), which must keep the temperature and humidity within survival range so they do not die of dehydration and fed through their veins.

The babies also “forget to breathe” because their brains are not fully developed to coordinate these functions. They turn blue, start foaming and a nurse has to be there at that very moment to “remind him to breathe”.

“They are stimulated by touching, and sometimes resuscitated if they do not remember to breathe,” explains Prof Musoke.

According to the study, Nairobi records 132,025 births annually, and one in each five of these children would need neonatal care to save their lives until they move past this dangerous stage.

The authors noted: “Most births and episodes of serious neonatal illness occur in the densely populated, low-income areas in Nairobi.”

Children end up in this stage for many reasons that can be traced back to a failed health system, which includes improper management of pregnancy where the mother has long labour.

“They stay long in the tummy, and swallow meconium (their own poisonous poop) that gets into their lungs, and has to be painfully removed by a doctor.

Upgrading facilities

The study looked at these areas of survival for hospitals and the healthcare workers (mostly nurses) who are to handle these babies in three key areas: are they able to take care of a pregnant woman who is just about to deliver? When the baby comes are they are able to feed, nurse and keep it alive? When the babies get sick, can they look after them?

The paper reads: “Hospitals varied in the knowledge of their nurses and almost 40 per cent of seriously sick babies were admitted to hospitals with low knowledge scores.”

Between 1990 and 2009, 79 million neonates died globally, according to data from an agency dealing with child-related issues United Nations Children’s Fund (Unicef). Ninety-eight per cent of these deaths occurred in low-income countries such as Kenya.

Between November 2017 and October 2018, according to data drawn from the country’s health information system, Kenya lost about 10,241 newborns.

Counties that are part of the most 15 to deliver in according to the United Nations grading — including Migori, the northeastern region — do not have a neonatal above 19 per 1,000 deaths.

The solution to these challenges, the experts recommend, is “upgrading some facilities so they can provide standard category neonatal care” as well as ensure that the few that can offer the care are supported.

“Establishing a countrywide referral strategy and system” was also another strategy fronted, which has been fronted for the last decades and very little progress in that area to ensure women whose children are likely to risk their babies such as those who are hypertensive have access to instant care.

The Unicef urges for universal health coverage to help deal with infant mortality with focus on four main pillars including; functional health facilities, with electricity and clean water, midwives and other health workers equipped with training and tools, life-saving drugs and equipment.

In December 2018, Kenya rolled out a pilot for universal health coverage (UHC), aimed at providing quality and affordable healthcare to all by 2022.

Kisumu, Nyeri, Machakos and Isiolo are the pilot regions where an estimated 3.2 million are targeted for coverage before it is rolled out to the other 43 counties.

The four counties are scheduled to get a Sh3.17 billion conditional grant with each devolved unit receiving Sh800 million.

The counties will match that by their own investment and 80 per cent of the money will cater for drugs and basic medical equipment.

Universal health coverage is expected to consume Sh47.8 billion in the 2019/20 budget, which also includes donor funds.

The Treasury has allocated Sh6 billion for scaling up the programme.

Other projects being targeted under health include managed equipment services (Sh6.2 billion), vaccines and immunisation (Sh3.3 billion) and conditional grants to Level Five hospitals (Sh4.3 billion).

The State and donor agencies have customarily financed public healthcare in Kenya through grants and related funding. It is primarily extended through subsidies and insurance schemes.

Kenya has also adopted the traditional approaches such as the National Hospital Insurance Fund to improve access to health services at the grassroots.