More funding for preterm care is what can create impact and reduce mortality in the global south
I recently learnt that in Jinja Hospital, 31percent of the preterm babies that were born in December 2015 died within the facility. This hospital serves a nucleus of ten districts. But like most public health facilities in Uganda, there is insufficiency of funds. Severally, the hospital has received a shot in the arm from well-wishers coming with donations ranging from equipment repair works on the preterm care unit.
Question is; if this number could die in a hospital setting within one month, what happens in the community? It is bizarre.
According to World Health Organisation, fifteen million children are born prematurely every year with 60% occurring in low income countries. These also have a six times death magnitude compared to their counterparts born in high income countries.
In Uganda, prematurity leads as a cause of death among neonates accounting for 38% of the deaths whose mortality rate is 27 per 1000 live births. There has not been a prominent change in neonatal mortality, over the years as evidenced from the UDHS data; it declined from 33 deaths per 1000 live births in 2000 – 01 to 29 deaths per 1,000 live births in 2006, and it declined only slightly to 27 deaths per 1,000 deaths in 2011 to date.
Currently, the WHO recommends Kangaroo Mother Care (KMC) as a cost effective strategy in caring for preterm babies since it doesnâ€™t require sophisticated equipment and suitable for most of the low and middle income countries. KMC is only done for stable infants though, and if not stable, infants go through intensive care which calls for more resources and involves use of equipment and training of those who offer the care, BUT, training of mothers on KMC is also crucial lest preterm survival is at stake.
When KMC is compared to other strategies like incubation, it is clearly cheaper. But why is its coverage low? Probably cheap is relative.
Survival for preterm infants solely depends on costs involved in the care, which could be financial or economic. That is why KMC has not been achieved as anticipated. Evidence has shown that universal KMC coverage could save approximately 450,000 preterm newborns annually, yet the current global KMC coverage is lower than 1% (Furdon et al, 2016).
There are variations in survival of preterm infants depending on where they are born, for instance more than 90% of the babies born less than 28 weeks of gestation die in low income countries, yet less than 10% die in high-income settings (WHO, 2016). This is clearly to do with resources involved in the care and so the costs. That explains why the magnitude of death for preterm babies in low resource settings is 6 times compared to their high income counter parts (WHO, 2009).
If we consider a situation where a woman is the bread winner, and has to do KMC, other spheres of her life will definitely suffer. KMC should be given ample time for a baby to survive.
How then does a rural based woman who spends time in the garden or in the market stay in the house doing KMC? How about the other children? How about her feeding? What about rent and others if these have to be met? What does she then do to strike equilibrium? There is certainly a conflict of interest which is a challenge.
To this, policy makers and other stakeholders ought to critically think about care for preterm babies with relation to costs involved. This should involve a wider scope of costs not only the financial bit, but, others as well, so as to devise a way for KMC scale up. One way could be through social support of those doing KMC, rather than saying KMC should be adopted since it is cost effective, lest its coverage remains low.
Whatever the intervention, there are costs which need scrutiny by the team concerned before any implementation ensues.
*** Blog by Ms Babirye Ziyada who is currently a Masters of Public Health student at MakSPH and one of our 2016 research grant awardees.