By Steven Adudans
On November 17th, every year, the world marks World Prematurity Day (WPD). (WPD) acknowledges the journeys of preterm infants and their families as well as raises awareness of the challenges faced by children born preterm and their families. This is ever so important as the incidence of preterm birth, worldwide, is increasing rapidly.
According to the World Health Organization (WHO), every year an estimated 15 million infants worldwide are born preterm (over 3 weeks early). Sadly, the complications of preterm birth are among the leading causes of death in children under five. All infants born preterm require immediate and significant medical care posing unexpected challenges-emotional and financial – to their parents and family system.
While neonatal deaths in Kenya stand at 22 in every 1,000 births, 75 per cent of the deaths occur within the first seven days of the infant’s life. But all is not lost. These problems can be solved.
Research and innovation
Investing in research and development is critical to support the design, testing and scaling-up of new and innovative care approaches. Examples of low-cost products and technologies that could positively impact survival rates is the Newborn Essential Solutions and Technologies (NEST360°) initiative, an international group led primarily by female engineers, physicians and health experts which was rolled out in Kenya last month.
Its bold goal is to save the lives of hundreds of thousands of newborn babies each year by providing the tools and training needed to support comprehensive neonatal care throughout sub-Saharan Africa. NEST360° aims at reducing the neonatal mortality rate by optimizing a bundle of effective and affordable devices, training clinicians and biomedical engineers, developing locally-owned data to drive quality of care, and shaping a marketplace that connects device manufacturers with health systems.
Most African hospitals cannot afford the medical devices found in U.S. and European hospitals, but innovators are showing it is possible to design technology for African hospitals that provides the same standard of care at a fraction of the cost.
By developing rugged, affordable technologies combined with new sustainable financing, distribution, training and infrastructure systems, NEST360° expects to contribute to the reduction of newborn death rates in sub-Saharan Africa by more than half – to fewer than 12 per 1,000 by 2030.
Equipment designed for high resource settings fails when it is used in African hospitals not only because of inconsistent power, but also because of heat, humidity, dust and lack of spare parts. Moreover, most hospitals in this region simply cannot afford to purchase existing newborn technologies. To save newborn lives, we need technologies that are effective, affordable, rugged, and easy to maintain.
Out of every 6 machines procured for use around the world for Africa, only one is easy to maintain and are designed to withstand the heat, the dust, the humidity breaks down, we experience all year round. By working with specialists who understand the challenges we face, we have made a major stride in equipping our medical facilities.
To transform inpatient care for newborns, which fits the purpose of saving the lives of small and sick newborns, we should focus on improving care for the conditions that bring the greatest risks of mortality and long-term complications. These include prematurity, neonatal encephalopathy, jaundice, neonatal infections, and congenital abnormalities. Small and sick newborns require high-quality inpatient care delivered by competent and specialized (where needed) professionals in a dedicated space.
Newborns may have different needs depending on their fragility. For example, all newborns require essential care, particularly at the time of birth and during the first days of life, whether in a health facility or at home. Most small and sick newborns can be managed with special inpatient care, which can only be provided in a health facility. Only one in three small and sick newborns requires intensive inpatient care, which can only be provided in a higher-level (district or tertiary-level) facility.
People centered approach
The person at the center of care is the newborn who receives treatment from health-care providers, mother, father, other caregivers, or a combination of these. In some cases, the newborn and the mother may be considered at the center since both may be recipients of care, being treated together or simultaneously.
To minimize the adverse consequences of hospitalization for all, mothers and newborns should not be separated and all interactions should be structured to promote healthy development. Maximizing contact with parents, particularly the mother, encourages bonding, supports lactation and feeding with breastmilk and promotes cognitive development.
Health workers equipped with newborn care skills
Inpatient care for newborns must be available 24 hours a day, 7 days a week. This care should be delivered by a multidisciplinary team of appropriately trained health-care providers with specialized skills in newborn care.
For many countries, building the neonatal care competencies of existing providers, and creating or expanding their neonatal nursing cadres, will be a crucial step. Many have substantial shortages of nurses and midwives, particularly in rural and hard-to-reach areas. Recruiting, training, mentoring and retaining these health-care providers should be a priority for governments.
The principles of family-centered care should be included in this health-care training. This will enable health workers to partner proactively with family members from the beginning of the inpatient experience and help build their confidence and skills to continue care after discharge.
The power of parents
Family-centered care empowers parents by involving them in caregiving for their newborn. It promotes a mutually beneficial partnership among parents, families and healthcare providers to support health-care planning, delivery, and evaluation.
Strengthening parent skills and competence in caring for their small, sick or high-risk infant reduces stress and anxiety, and benefits the newborn’s weight gain and neurodevelopmental progress. Parental skills continue to grow after discharge with the support of in-home visits, outpatient services and ongoing education. Mothers, fathers, families and communities can become powerful agents of change when they harness their passion and commitment positively to influence policies and programmes related to newborn health.
By investing in the health and development of the next generation, countries can build human capital and accelerate economic development. A healthy start is particularly important for LMICs wanting to capitalize on the demographic dividends of young people for the next generation and national prosperity.
Dr. Adudans is the Executive Director, Centre for Public Health and Development , is a Kenyan- and US-registered non-governmental organization engaged in developing, testing, and scaling health system innovations in response to identified challenges in the Eastern African region.