Socioeconomic realities of kangaroo care in rural Uganda
In Uganda, there is a high rate of preterm births (babies born alive before 37 weeks), with 226,000 babies born prematurely per year. More than 80% of the newborn deaths in the country are caused by infections, asphyxia, and preterm births. The probability of a baby dying within the first month of life has not decreased much over the years, and is currently at 27 deaths per 1,000 live births.
Kangaroo Care (KC) is among the methods used to save lives of stable preterm babies. It is a low cost method that involves continuous Skin to Skin contact between the parent (in most cases the mother) and baby; early and exclusive breastfeeding; and early discharge and follow up. It has been proven to lower the risk of death and infection among these babies and increase their growth. It also had other benefits like emotional relief and increased esteem for the mother. It is recommended that KC should be practiced for up to 18 hours per day of the mother’s time in a bed or chair, with limited movement.
As part of a study assessing factors influencing uptake of KC, we spoke to mothers who had preterm babies, to understand their experiences with the practice. We realised that the ideal KC as recommended, and the reality of KC for a rural woman in Uganda, are two different roads that barely intersect. These mothers revealed to us several challenges that make them do KC for just a few hours a day, if at all. For instance, having a preterm baby requires a longer stay in the hospital, which is expensive for the mother and the family because the public hospitals do not provide meals so mothers must get their own food. This means that if they do not have attendants to help them (as happens sometimes), they need to put the baby aside to cook, wash clothes, and other work. Those who are extremely constrained end up asking to be discharged early.
Once back home, the situation is even harder. Many of the mothers have to do domestic chores, including looking after other children and their spouse/partner, without anybody else to help them, so they can only do KC when free. The luckier ones may have a sister or mother to help them for the first few days only. Although the father of the baby may help her, male involvement is often limited to financial support, if any. This means that they may practice KC for a few hours or so per day and possibly at night, thus the baby misses out on the benefits. Additionally, a mother with a preterm baby often cannot immediately engage in productive work that she was doing previously, resulting in a loss of income, a situation that is made worse when she is the bread winner. With the need to observe better hygiene, the woman needs to buy things like soap to wash clothes more often, which is an expense to many in these settings.
As one mother in Jinja District explained:
“Lack of enough feeds and having little funds and cannot even do my house work efficiently because of the baby and my husband thinks I’m not giving him enough time yet I’m not feeding well and I’m very weak.”
What then could be done to help reduce some of these socio-economic burdens? One of the key things is the need to provide meals in public hospitals by the Government, to lessen the burden on these mothers.
Counselling of mothers and their families/attendants while in hospital is important, to properly explain the benefits of KC so that they can prioritise it even in the face of challenges. Families, including men, should be involved in these sessions so that they are more convinced to support the mothers. The counselling should outline the reality of what doing KC continuously requires, highlighting both the challenges and benefits.
Using community health workers to follow up these mothers after discharge would help. This may encourage them, answer any questions they have, and ensure that they try to do KC as much as possible. Additionally, continuous sensitization of communities about the importance of KC for instance through radios and community meetings, could make a difference, with the aim of increasing support for those practising it.
Clearly, KC is cheap to the health facility but not to the mother. While we promote certain health interventions, we need to be alert to the other determinants that may prohibit their success, and realise that the health system does not operate in a vacuum from community, social and economic influences.
*Blog by Doris Kwesiga (left), a Researcher at Makerere University School of Public Health.