English | Dzongkha Wednesday, September 19, 2018

Kangaroo Mother Care makes strides, but still a long road ahead

Phub Gyem, Thimphu
Apr 16, 2018

Early Essential Newborn Care (EENC) and Kangaroo Mother Care (KMC) have picked up well with an assessment report showing EENC and KMC being given to over 90 per cent of all newborns. But when to comes to preterm babies, only 50 per cent of them received KMC.

Kangaroo Mother Care is important for all newborns, more so for preterm babies.

The care consists of prolonged skin-to-skin contact and exclusive breastfeeding. It is found to keep babies warm, calm and healthy.

It also helps in breastfeeding and improving the weight of babies.

The health ministry with WHO and UNICEF started KMC in 10 hospitals last year in an effort to reduce newborn mortality rate.

An assessment done in three regional hospitals in March found that term babies received the care better than the preterm newborns.

“But within one year, I think it is a good progress. From zero to 50, it is excellent,” Rudolf Schwenk, a UNICEF Bhutan Representative said.

“But, of course, we want to make sure we achieve 100 per cent. We want to make sure that every child survives and thrives, that every child is alive. So, we will follow up on the findings of the assessment and work with our partners to ensure that the training is strengthened with procedures and processes so that it is clear to all the health workers that have been trained and train new health workers who can then implement this in other hospitals.”

A 2016 review by Cochrane, a UK based NGO, says KMC reduces mortality by 40 per cent, severe infections by 50 per cent and hypothermia by 72 per cent.

“We have a sheet called KMC scoring that we keep daily. It shows baby’s weight gain after initiation of KMC. It also shows decrease in a baby’s breathing problem,” Yeshi Lhamo with JDWNRH’s Neonatal Ward said.

Phub Dem from Punakha has given birth to a preterm baby. She’s been nursing her seven-month old baby, now eight months, with Kangaroo Mother Care. She shared firsthand accounts of how KMC has proved helpful.

“The sisters ask me to put the baby on my chest when the baby’s body temperature drops and I can feel the temperature increasing,” she said.

“I think there is an increase in the weight too. The baby is now 1.770 kg from 1.300 kg when I moved here to KMC unit.”

Kangaroo Mother Care giving is not confined or restricted to mothers. Fathers can take on the role as well.

“When we have the baby on our chest, we can feel the heart beat, and it is a good bonding between us and the baby,” Sangay Thinley, a father of another preterm baby says.

“If we give KMC, it is natural incubation, so it is likely that the baby will gain weight and we will be able to go home fast.”

WHO Country Office said most newborn deaths in the WHO South-East Asia Region occur within the first few days, mostly from preventable causes.

The high mortality rate is related to delayed adoption of simple but effective practices such as KMC. “We would like to appeal that each and every Bhutanese should play a role in Kangaroo Mother Care and Early Essential Newborn Care at family level, at facility level and at community level,” Dr. Rui Paulo de Jesus, a WHO Bhutan Representaive said.

“For example, health workers at every level must be trained and subsequently and appropriately train expecting mothers. WHO, together with partners, stand committed to work with the government to reduce neonatal mortality rate.”

The assessment of the Early Essential Newborn Care and Kangaroo Mother Care recommended that national policies and guidelines be developed to achieve hundred per cent EENC and KMC to prevent newborn deaths.

“It has just been a year. We need to roll out at least ten health centres in other districts,” Karma Lhazeen, the Director of the Department of Public Health said.

“There is plan to train them. When we started this training, we had used the WHO protocol for KMC. We need to adapt the guidelines in Bhutanese context and also develop easy to use guidelines like pocket books for the health workers to easily access this information and guidelines.”

In Bhutan, over 270 newborns die every year. The lives of these many newborns could be saved if Bhutan achieves 100 per cent Early Essential Newborn Care of which Kangaroo Mother Care is an intrinsic part.

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