The recent spate of baby deaths in Gauteng and the Eastern Cape has alarmed the public, resulting in calls for more nurses and bigger neonatal intensive care units. But behind the headlines lies a crisis in infant health.
About 70 000 babies die in South Africa each year, one-third of them in the first weeks of life. HIV is a factor but, thanks to antiretroviral therapy, a decline in mother-to-child transmission of HIV is expected. Now experts say preterm birth and infection may soon become the biggest threat to newborns.
A recent paper in the International Journal of Epidemiology showed that Kangaroo Mother Care (KMC), a low-tech method of care for preterm babies, substantially reduces mortality among preterm babies in hospitals and reduces severe illness, particularly from infection. The authors recommend the routine use of this method of care in facilities for all stable babies — those who don’t need further medical intervention — who weigh less than 2kg.
“For a stable baby, it is actually better than incubator care,” said Joy Lawn, the director of global evidence and policy at Save the Children and one of the authors of the paper. The technique is simple. Babies, wearing just a nappy, are tied to their mother’s chests.
The continuous skin-to-skin contact helps regulate the baby’s temperature and breathing. Nurses support mothers with exclusive breastfeeding or other appropriate feeding and watch for and respond quickly to early signs of illness. “It’s not expensive but you have to be committed. If you train [nurses] you have to make sure you don’t transfer them away afterwards,” said Lawn.
‘You make the system more efficient if you keep intensive care for the babies who are really sick. We have the resources. We need to rationalise them.” Although South Africa is one of the leaders in using KMC on a large scale, Lawn believes more can still be done to increase its use.
Of the more than 2 000 centres across the country in which women give birth, only about 80 practise KMC. Proponents of this form of care believe that bringing the method to more hospitals could cut down on the number of vulnerable babies in overcrowded, high-care neonatal units and prevent the spread of infection among newborns.
“KMC would decrease the number of invasive episodes with potentially pathogenic bacteria,” said Keith Bolton, the head of paediatrics at Rahima Moosa Mother and Child Hospital. This was because breastfeeding allowed babies to benefit from their mother’s antibodies, which were passed on in breast milk.
Bolton pointed out that none of the babies who died of hospital-acquired infections at Charlotte Maxeke hospital in May this year were breastfed. But he pointed out that KMC was not practical in all situations.
Extremely premature babies — born at 28 to 31 weeks — and babies with complications would still need to be cared for in high care or intensive care units. But even so, he said, “we need to keep mothers with their babies wherever possible”.
In many state hospitals, mothers of premature babies have restricted access to their children and are not encouraged to breastfeed or to provide
expressed milk for their babies.