The critical first few minutes
Some 45,000 newborn babies die every year in Tanzania due to inadequate
medical care. In a three-year project, SolidarMed is improving the
survival chances of premature and low birth weight babies in the rural
Morogoro region and is relying on an established method to do so.
The hilly town of Mahenge is still cloaked in morning mist, while a humid breeze blows through the lush green trees. The maternity ward at the District Hospital is already a hive of activity. A young woman has just given birth to a baby boy but there is no newborn cry. Nurse and midwife Leticia Mwamlambo realises straight away that something is wrong with the baby’s breathing and that the situation is critical. The team needs to act fast as every minute wasted can mean the difference between life and death for newborn babies. With the aid of a ventilator, which was recently purchased by SolidarMed, she manages to stimulate and stabilise the child’s breathing.
“The worst thing is when you know what needs doing but you don’t have the equipment. That’s sad and frustrating.”
Leticia Mwamlambo, nurse and midwife at the district hospital of Mahenge
“A few weeks ago, I wouldn’t have been able to do much in this situation as we didn’t have any equipment,“ says the 36-year-old. She has been looking after mothers and their new babies for over ten years. It is a challenging job, she explains, as there is a lack of medical infrastructure and adequately trained staff in many places.
A safe arrival
Thanks to SolidarMed, the situation at Mahenge Hospital has already improved significantly. It is one of three hospitals in the rural Morogoro region where neonatal wards have been expanded with SolidarMed’s support. Medical equipment has already been procured, like the ventilator mentioned above, while the ward extension is still under construction. Previously, the infrastructure needed to treat premature and low birth weight babies was lacking. But it is not only medical equipment that is crucial, knowledge and expertise are vital, too. Healthcare professionals at the hospitals are therefore being trained in the care of premature babies with low birth weight. This will noticeably improve the survival chances of around 12,000 newborns a year in the catchment areas of the three healthcare facilities.
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This is urgently needed as neonatal mortality in Tanzania is shockingly high, at 20 deaths per 1,000 live births. By way of comparison, in Switzerland that figure is three. The rate is even higher in rural and remote areas of Tanzania. Although the government affirmed its commitment to reducing the neonatal mortality rate in its current health strategy, the country is still a long way from achieving the UN Sustainable Development Goal of no more than 12 deaths per 1,000 live births by 2030. The inadequate care of premature babies and newborns in the first few hours after birth is a key reason as the risk of dying of birth asphyxia, hypothermia or other complications is high during this period. The professionals at these health facilities therefore need to be able to respond rapidly if needed.
Continual skin-to-skin contact
A simple yet life-saving method to combat hypothermia and infections in low birth weight and sick newborns is Kangaroo Mother Care (KMC). SolidarMed has already achieved positive outcomes using KMC in comparable settings and clearly highlighted its effectiveness in a pilot project at Lugala Hospital (see ‘Scaling up an approach that works’). A neonatal ward was also completed several months ago at the Morogoro Regional Referral Hospital. The new mothers being looked after at the hospital delivered their babies very early and now, thanks to the specialised ward, they are able to spend a few days in hospital after the birth. To protect the privacy of labouring mothers, the neonatal unit for premature babies is a spacious and calm area that is separated from the rest of the labour ward.
“Many of the mothers here had birth complications. They are afraid of getting things wrong and need support to feel comfortable caring for their low birth weight babies.“
Lilly Rwabutembo, nurse and midwife at Morogoro Regional Hospital
Midwife and nurse Lilly Rwabutembo looks after and supports women and passes on her knowledge. “Many of the mothers here had birth complications. They are afraid of getting things wrong and need support to feel comfortable caring for their low birth weight babies,“ she says. As she talks, she is dressing a several-day-old baby that she has just bathed. She also explains the principles of Kangaroo Mother Care to the new mothers. Ideally the mother – or another caregiver – should carry the newborn with direct skin-to-skin contact for at least eight hours a day for several weeks. Lilly Rwabutembo is well aware that this is a challenge for many women: “Many new mothers do not systematically practise Kangaroo Mother Care at home,” she says. The weekly check-ups after discharge from hospital are therefore all the more important. The mothers come back to the ward every Friday to have their babies weighed and their state of health monitored.
“I too used to think that you should cover premature babies with as many blankets as possible to keep them warm.”
Mariam Ongala *, mother of a premature girl
One of these women is Mariam Ongala*. Her daughter was born at six months gestation, weighing just 600 grams and had to spend several days in the neonatal intensive care unit. It is Mariam’s only child as she already suffered five miscarriages. “She is our gift, which is why we named her Zawadi,” she says as she gently strokes her baby girl’s forehead. Zawadi means gift in Swahili. Mariam’s devotion is also shown by her patience and persistence in practising Kangaroo Mother Care. “My friends and family were amazed at first as they didn’t understand it,” she recalls. “I too used to think that you should cover premature babies with as many blankets as possible to keep them warm.”
She has since learned that this in fact has a negative impact on development as babies are unable to regulate their body temperature through the thick blankets. Mariam’s persistence with Kangaroo Mother Care is now paying off – at her 12-week check-up, Zawadi is doing well and is already tipping the scales at 2.6 kilos. “I’m pleased about every single gram,” Mariam says, visibly emotional.
Ward soon to be operational
In Mahenge, over 250 kilometres away, Leticia Mwamlambo’s working day is slowly coming to an end. She has stayed late today to monitor the newborn baby boy with breathing problems. “He is now stable. I was able to take him off the ventilator just now,“ she says, beaming. As she speaks, she enters another room from which a blue light is emanating. On an elevated table, a newborn baby is lying under a bluish green light. “Little Samuel* was born too early and developed severe jaundice,” the midwife says as she examines the baby boy. The new lamp means that he can be treated effectively. Before, all we could have done was advise mothers to take their babies outside in the sun several times a day – hardly an ideal solution.
The extension work at the district hospital is making good progress and the new ward for premature and low birth weight babies is starting to take shape. The extension means that in the future there will be enough space for mothers to learn and practise Kangaroo Mother Care under expert guidance, and for newborns to receive optimal care. “The unit will quickly fill up,” says Leticia, adding; “I hope that we’ll be able to save many lives.”
* Name has been changed to protect identity.
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