Thursday, October 2, 2014

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Close For Comfort: Rolling Out Kangaroo Mother Care in Nigeria

With over a quarter of a million newborn babies in Nigeria dying before they reach one month, could Kangaroo Mother Care be part of the solution?
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A woman in Nepal practising Kangaroo Mother Care for new prematurely-born baby. Photograph by Save the Children.

Abuja, Nigeria:

At Maitama Government Hospital in Abuja, a newborn baby lies surrounded by its mother and other female family members. With nearly a fifth of children dying before the age of five in Nigeria, the child needs all the help it can get.

Reducing childhood mortality is a millennium development goal that often gets overlooked. In Nigeria, according to UN mortality estimates, there has been only an average of 1.2% reduction in under-five mortality per year since 1990. Insufficient support for babies born prematurely, which includes children born at 37 weeks or earlier, is one of the main causes of newborn death.

In more developed countries, the protection and support of prematurely born children is commonly achieved through the use of incubators. However, in Nigeria, where lack of funds and unreliable power supplies are a problem, incubators are not a viable resource for the care of premature babies.

Roo to the rescue?

One solution to this is Kangaroo Mother Care (KMC). The method originated in Colombia in 1978, and has since proved successful in countries ranging from Haiti to Vietnam. Using mothers as natural incubators, it involves skin-to-skin contact between mother and child 24 hours a day in a strict vertical position with the child held between the breast of the mother and her clothes. It has recently been implemented in Nigeria as part of the UK Department for International Development-run ‘Partnership for Reviving Routine Immunisation in Northern Nigeria; Maternal Newborn and Child Health Initiative’. This partnership aims to address the prevalence of polio and problems with primary healthcare. The introduction of Kangaroo Mother Care is therefore one part of a wider initiative to improve maternal and newborn health, from immunisation to available transport to health services.

KMC is a successful aspect of the project, and it has been found that reaching all premature babies with Kangaroo Mother Care would save 19,000 lives by 2015. It is also cost-effective and accessible, as it does not require complicated facilities. Another benefit is that mothers suggest it makes them feel closer to their child, and it also increases the likelihood of continued and successful breastfeeding, which in turn has other health benefits for the child.

Nevertheless, the demands of holding a baby 24 hours a day are understandably found to be difficult for some mothers. And, for a method which appears fairly straightforward, even natural, there are still particular requirements that must be followed. These include training regarding how to hold the baby in a way which achieves the most thorough insulation and support, breastfeeding every two hours, and special clinics to introduce the method to mothers and families. This means the method is in fact less accessible than it could be across Nigeria. The requirement for mothers to stay in clinic until their baby has grown to a more acceptable weight, can also be problematic as mothers often like to leave the hospital and return home soon after giving birth.

Even so, Kangaroo Mother Care is something which mothers can practise without expensive equipment. It is also possible to use a surrogate, giving the mother a break while the baby’s temperature remains regulated and its body supported. Although it is not yet a policy itself, it has been included recently in the national child health policy, as well as infant and young child feeding guidelines. With increased awareness and accessibility, KMC could help more premature children through the earliest stages of life, thereby significantly reducing Nigeria’s newborn mortality rate as a whole.

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