Balaka, Malawi—In the maternity ward at Balaka District Hospital, a new mother firmly swaddles a baby to her chest with a chitenje (cloth wrapper). Mothers of premature and low weight babies born here, and those referred from other health centers in the district, are now being encouraged to pouch their babies, skin-to-skin on their chest, with a cloth. This allows the mothers to keep their babies warm naturally, helping them to feed and gain weight.
This intervention—known as Kangaroo Mother Care (KMC)—was initiated by the Jhpiego-led Support for Service Delivery Integration (SSDI-Services) Project to address high numbers of newborn deaths at Balaka District Hospital in southern Malawi. The initiative, supported by the U.S. Agency for International Development, has enhanced the ability of health care providers to help premature babies thrive and grow.
According to Balaka hospital records, the survival rate for underweight newborns at the hospital has been very low. The facility registers between 100 and 200 newborn cases, including referrals from other health centers in the district. Over the past year, Balaka District Hospital has recorded an average of 10 newborn deaths every month, of which three have been due to low birth weight complications. “Low birth weight accounts for about 20% of newborn deaths as we do not have incubators and there was no one in the labor ward who had the skills to handle cases of low birth weight babies,” says Chikondi Nyson, a nurse in the labor ward at the hospital.
In the past, mothers of low birth weight babies were usually referred to a nearby private clinic for incubation. However, many mothers never showed up with their infants for follow-up.
SSDI-Services supported Balaka Hospital to integrate KMC into maternal care as part of a comprehensive maternal and newborn health services package. Since January 2013, nurses and clinicians have had their skills strengthened in areas ranging from the identification of low birth weight babies to danger signs for these infants to the roles of support staff in promoting the service. Ward attendants and other staff, who largely assist new mothers in post-birth care, also have had their skills updated.
As a result of Jhpiego’s work, KMC services were set up in the maternity area of the hospital. A room was designated within the postnatal ward and two beds reserved for KMC babies. Guidelines for managing low birth weight babies were shared and posted on the walls to guide providers. A third KMC bed has since been added. With Jhpiego’s help and support, “we are now able to care for low weight babies and assured that many babies will be saved,” says Nurse Nyson.
“When I was told my baby was born with very low weight, I was hopeless that she won’t survive. Now she is more [than] three weeks old and I am happily seeing her breathing and stronger and healthier every day,” said one new mother in the hospital’s KMC unit.
KMC services are already having a positive impact at Balaka Hospital. In the first three months of this year, only one low weight birth death has been reported out of the 12 admissions in KMC.
Nurses and midwives in the hospital’s labor ward are optimistic that the immediate, positive results of KMC at Balaka will persuade hospital management and SSDI-Services to provide additional funding to increase the project’s ability to serve more women and babies. The valuable information and lessons from the Balaka KMC experience are expected to assist the Ministry of Health as it considers scaling up KMC services at the hospital and introducing them in other facilities in the district and beyond.