Preventing Premature Newborn Deaths: The KMC Approach
Bangladesh has made tremendous strides in improving neonatal health status and achieved the United Nations' Millennium Development Goal (MDG) related to reducing child mortality (MDG 4) in 2010, five years ahead of its target year, 2015. The transition from MDG to the Sustainable Development Goal (SDG) in Bangladesh is set to reduce neonatal mortality from 28 newborn deaths per 1,000 live births in 2012 to 12 or less by 2030. Eighty percent of newborn deaths are preventable, and the government has declared its commitment towards reaching the Sustainable Development Goal (SDG 3.2).
Prematurity is one of the leading causes of newborn mortality in Bangladesh, which contributes to 19 percent of all newborn deaths in the country. Prematurity is defined as babies born alive before 37 completed weeks of pregnancy. Every year in Bangladesh, around 600,000 babies are born prematurely, and among them, around 17,000 babies die. This is the reality as Bangladesh observes World Prematurity Day today.
A simple technique, skin-to-skin contact of a premature baby with parents or caregivers, can save a lot of newborn lives. The method is widely known as Kangaroo Mother Care or KMC.
Premature babies with a birth weight below 2,500 grams are likely to be physically immature and more prone to die. Birth at adolescent age, malnutrition, infections, high blood pressure, short inter-pregnancy interval, and LINC factors (lifestyle, infection, nutrition, and contraception) are the prime factors for premature birth.
Conventional neonatal care of low-birth-weight infants is expensive and needs both highly skilled personnel and permanent logistic support. Conventional neonatal care is the type of care a prematurely born or sick baby receives in a special area of the hospital called the neonatal intensive care unit (NICU). The NICU has advanced technology and trained healthcare professionals to give special care to premature babies. Evidence suggests that KMC is a safe, effective, and low-cost intervention to reduce morbidity and mortality in premature and low-birth-weight newborns. In KMC, the continuous skin-to-skin contact between the newborn and the mother (or other family members) helps the baby maintain warmth, facilitates breastfeeding, helps prevent infections, and strengthens the child-parent bond.
On a personal anecdote, I met Aklima Akter and her husband Fahad at Lakshmipur District Hospital. Aklima prematurely gave birth to a baby weighing only 1,700 grams; any baby who is born weighing less than 2,500 grams is considered a low-birth-weight baby. The paediatric consultant at the hospital referred the baby to the hospital's KMC unit for the next course of management. There, Aklima and Fahad, with the help of trained service providers, learned how to follow the KMC protocol to maintain the body temperature of the baby, as preterm, low-birth-weight newborns are unable to efficiently maintain their body temperature on their own. Basically, in KMC, parents transmit their body temperature to their baby by maintaining skin-to-skin contact. After two weeks of providing KMC to their baby for more than 20 hours a day every day, Aklima and Fahad were discharged from the hospital when the baby started gaining weight regularly, and the parents were confident enough to give KMC at home. The couple continued giving KMC to their baby at home and came for weekly follow-up check-ups for the next three weeks, until their baby's weight reached 2,500 grams.
In Aklima and Fahad's story, one more child survived a preventable death, thanks to the service providers both at the upazila level facility and at the district hospital who are well-trained and equipped to manage such cases with the technical support of USAID's MaMoni Maternal and Newborn Care Strengthening Project (MaMoni MNCSP), implemented by Save the Children and consortium partners. Also, other newborn health stakeholders—World Health Organization (WHO) and the United Nations Children's Fund (Unicef)—offer financial and technical assistance to the National Newborn Health Programme (NNHP) of the Directorate General of Health Services (DGHS) to establish KMC units in the facilities. Currently, a total of 250 KMC units are available in Bangladesh.
However, even with all these efforts, the KMC facilities are yet to be available nationwide. There has been some progress, but challenges remain in the scaling-up of Kangaroo Mother Care. From the service provider's perspective, key challenges include the rotation of KMC-trained nursing staff, as it hinders capacity-building efforts, engaging the designated nursing KMC focal person with other activities. On the other hand, keeping the baby in KMC position during hot and humid weather, staying in the facilities, feeding smaller babies, continuing KMC, and follow-up visits after discharge are the key challenges from the KMC mother and her family's perspective. These challenges need to be addressed to make the KMC method successful.
This year, the theme for World Prematurity Day is "Zero Separation. Act now! Keep parents and babies born too soon together." This theme reflects on supporting families with premature babies and addressing the separation of parents and babies during their early hours and days. This has become even more important as since the Covid-19 pandemic broke out, many facilities, as part of hygienic measures, have restricted contact between parents with the newborns, and many parents are separated from each other for being in isolation and unable to have family time as a couple. The message of this year's theme is that family-centred developmental care for babies born too soon, too small, or too sick is safe and possible, even in the times of a global pandemic.
Kangaroo Mother Care is a powerful, easy-to-use method to promote the health and well-being of newborns born preterm and/or low birth weight. KMC is a part of government efforts to reach SDG targets. The KMC approach has been included in the newborn action plans in Southeast Asian countries and health sector programmes in Bangladesh. The KMC method will play a vital role in significantly reducing newborn mortality in Bangladesh. However, there is a long way to go till we can ensure that no child has to die from prematurity and the related complications.
Dr Umme Salma Jahan Meena is a public health expert and is currently leading USAID's MaMoni MNCSP and emergency response to Covid-19 as the chief of party.