The Nyeri County Referral Hospital recently opened a newborn unit. In most cases this would have passed as an in house ceremony. The project attracts attention because of two things; the homegrown solution to neonatal care and its unique intervention in trying to bring down deaths of newborns.
According to the 2014 Kenya Demographic Health Survey, neonatal mortality is at 22 deaths per every 1,000 live births. For those who survive, they face a lifetime of disability, including learning disabilities and visual and hearing problems. Nairobi’s mortality is nearly double the national number at 39 neonates dying per 1,000 live births.
These tragedies can be largely averted with highly effective, cost-effective interventions. One of the highlights of the Nyeri project is that its approach seeks a holistic intervention in caring for newborns, as it addresses the issues of training and posting medical personnel, supply of essential medical equipment and maintaining adequate levels of drugs.
It also adopts simple technologies such as the portable Pumani Bubble CPAP, which delivers a blended flow of oxygen and room air to infants in respiratory distress. The device has been tested in Malawi for the past ten years with remarkable success.
It is a robust, inexpensive machine and technology specifically for African hospitals. The equipment was selected to address preventable illnesses that kill newborns – including breathing difficulties, jaundice, infection and hypothermia.
The county was picked, alongside Nairobi’s Mama Lucy Hospital and other sites in Malawi, Tanzania and Nigeria to pilot the multi-billion shillings project dubbed NEST360.
In a typical hospital in Kenya and the continent, there are many babies but few nurses. Secondly, even when they have the personnel, they do not have adequate lifesaving equipment.
A recent systematic review of maternal health interventions in resource-limited countries showed that programmes integrating multiple interventions including training; placement of providers; refurbishment of existing infrastructure; and improved supply of drugs, supplies, and equipment are likely to have a significant positive impact on maternal and newborn health.
Utilisation of skilled health care is effective in reduction of maternal and newborn morbidity and mortality. Sufficiently trained health workers can competently handle and manage obstetric complications.
Health workers, despite having undergone formal training, require regular refresher sessions to keep up to date with new, evidence-based information.
In much of Africa, neonatal care units rely not only on devices that have not been designed for the local context, but on a random selection of donated medical equipment – often provided without adequate training on how to use and maintain the technology.
Sudden increases in power are a relatively regular occurrence, yet because the state-of-the-art technology is manufactured to Western specifications, the surge protectors cannot withstand the unexpected high voltage.
The machines are relegated to the “equipment graveyard” – a room nearly every African hospital has, full of machines, often donated by well-meaning charities, rendered useless because they could not cope. Our hospitals have not been able to maintain [the equipment] as we cannot replacements for the pieces that were burned.
It is, in my view, that low-cost homegrown solutions hold the key in reducing neonatal health in the face of inadequate resources.
The writer is executive director centre for public health and development.