Women have been encouraged to undergo medical assessment before conceiving to reduce the risk of premature births.
Dr Roseline Malangachi, paediatrician working at Kakamega General Hospital says that visiting clinics will help in detection of chronic illnesses among other predisposing factors and mothers given medication that will ensure the pregnancy is safe from congenital problems.
“Once a mother has discovered that they are pregnant at whatever gestation, we recommend that they seek a healthcare facility and be taken through healthcare assessment as quickly as possible,” she noted.
Speaking in Kakamega as the Globe Marks World Prematurity Day, Dr. Malangachi noted that the biggest challenge in western Kenya that increases the risk of premature babies is that some mothers only attend one antenatal care and fail to turn up for the others until they give birth.
She said other risk factors for premature babies noted in Western Kenya include multiple pregnancies where women give birth to twins, triplets, and sometimes quadruplets and quintuplets since the babies compete for limited space in the uterus leading to preterm deliveries.
The reason for multiples in Western and Nyanza regions, she says, is due to the body size of the mothers and sometimes the use of fertility pills which enhances the level of ovulation, with other times, for the identical twins, being linked to genes running in the family.
“In Kakamega, the number one cause of preterm deliveries is the multiples, so mothers are presenting to us with twins, triplets and quadruplets and so forth,” she added.
Dr. Malangachi explained that those who deliver early in their teenage years and those women delivering late above 35 years of age have higher chances of delivering a preterm baby.
“For teenagers, they are at high risk because of the immaturity of their reproductive systems, while for the older ones, they have other complications that have already set in like fibroids putting them at a risk of delivering a preterm baby,” she noted.
Chronic illnesses like diabetes, hypertension, Congenital Heart Defects(CHD) or even acquired heart conditions also put women at risk of delivering a baby immaturely.
“Other conditions like trauma caused by accident or assault and anything that involves trauma to the abdomen when a woman is pregnant and if she has other infections like urinary tract infections, diarrhea infections, Malaria also puts her at a risk of delivering early,” she added.
“If the uterus has a problem in terms of its shape, you will find that instead of having one big space, it’s divided into two, so it means the child’s space for growth is very limited, there is also risk of delivering early,” she explained further.
Dr. Malangachi said that if a risk of delivering early is detected, medics can administer antenatal steroids to save the baby from death.
“The antenatal steroids are given to the baby to help in maturing the lungs. You remember when this baby is in the uterus they don’t breathe, all the exchange of gas and breathing is done from the placenta by the mother,” she explained.
Normally, the medic says that when babies are born, they are not mature and not able to breath by themselves. “Therefore if you anticipate that this lady is going to deliver prematurely within 48 hours, you are supposed to give antenatal steroids to assist the baby to be able to breath early so that we can mitigate the use of the Continuous Positive Airway Pressure (CPAP)machine,” she added.
In managing preterm babies at the Kakamega General Hospital Newborn Unit, Dr. Malangachi is advocating for Kangaroo Mother Care(KMC) in line with this year’s world prematurity day theme ‘Immediate Skin-to-Skin Care for Every Baby,’due to insufficient incubators.
The KMC involves putting a baby who has been born prematurely, that is before 37 completed weeks, in between the mother’s breasts and the baby is dressed in a diaper, socks and a cap.
“The reason for this kind of positioning is that, when the baby has been born prematurely they do not have enough subcutaneous tissue and it means they are not able to control their own temperature, so they tend to lose temperature,” she added.
She noted that KMC has been studied for a very long time and has shown that babies who have been put in between their mothers’ breasts, are able to control their temperature by getting heat from the mother, the baby is able to feed on demand because they are in close connection with the mother and also enhances bonding between the baby and the mother.
“That presence of the baby in between the mother’s breasts also psychologically helps the mother in terms of improvement in milk production and thereby we find that babies in Kangaroo Mother Care tend to gain weight faster and have less occurrences or less difficulties to breath and therefore tend to go home earlier,” she added.
“KMC is mostly reserved for small children, and the beauty about babies is that, as they grow they also assert their own independence, so it gets to a certain age and a certain weight where you try to put the baby in KMC and they refuse, you try to position and they are fighting you meaning that they have outgrown the KMC and want to interact with the environment,” she explains.
Dr. Malangachi says the World Health Organization and the Kenyan Ministry of Health recommends KMC due to limited resources in developing countries to acquire incubators.
“In a situation where we have a lot of incubators we will put these babies in the incubators, however, now that we don’t have the incubators,we have a mother who needs to help us put this baby in continuous care for about 18-24 hours of skin to skin contact,” she added.
According to a consultant pediatrician at the Kakamega General Hospital Bonface Nyumbile, over 55 percent of the newborns admitted at Kakamega General Hospital Newborn Unit every month are preterm.
He says 50 percent are born within the hospital with the rest being referred from the lower level hospitals including level two and level three facilities.
Dr. Nyumbile says that the Kakamega General Hospital Newborn unit admits over 150 babies every month with over 55 percent being preterm.
“We have an improvement in the number of mothers seeking skilled birth attendants in health facilities with over 60 percent of mothers in Kakamega delivering in hospitals, and that has really improved child survival,” he noted.
The Kakamega General Hospital New Born Unit has been the only one in the county that manages preterm babies for many years and according to Dr. Nyumbile the county government has opened another New Born Unit at Malava County Hospital to tackle cases from nearby sub counties of Lugari, Likuyani and Navakholo.
“We are also completing the establishment of a New Born Unit at Butere Sub County hospital that will help in tackling preterm babies in that region that will help in reducing congestion at Kakamega General Hospital New Born Unit,” he added.