Hospitals face acute shortage of incubators

By Maore Ithula

There is an acute shortage of incubators in hospitals The Standard investigation has found out.

As a consequence, many of the 53,000 babies born prematurely annually die from preventable causes.

Some infants are sent home early before they acquire the right weight, while many more are forced to share incubators, exposing them to infections.

Premature babies in an incubator at Kenyatta National Hospital.

So desperate is the situation that health workers at the Kenyatta National Hospital (KNH) have resorted to using their own naked bodies to keep the new-borns warm, a method technically known as ‘kangaroo’, as it imitates how the desert animal uses its pouch to carry its offspring until it’s strong enough to be on its own.

At Pumwani Maternity Hospital, which is the largest facility of its kind in East and Central Africa, nurses share incubators between children, as the 10 facilities available are not enough for the up to 15 babies born prematurely there daily.

Upright position

An incubator is a special transparent plastic cot.

It stimulates an environment that is almost as good as inside a mother’s womb, because premature babies lack body fat, which is necessary for maintaining their body temperatures even when swaddled with blankets.

Sister Alice Karanja, KNH’s Newborn Unit matron, says at least 50 incubators are needed for the hospital to offer effective services to the rising number of premature infants at the institution.

Presently, it has only 20 incubators to serve an average of 30 preterm babies born there daily.

To save the babies, KNH staff have embraced the kangaroo nursing care, which entails placing a premature infant in an upright position on a mother’s bare stomach and between her breasts.

The baby’s head is turned so that the ear is above the mother’s heart. Where the mother is not healthy enough to offer this crucial service, the infant’s father or a close relative can nurse it.

KNH Newborn Unit also includes the country’s only Neonatal Intensive Care Unit and Neonatal High Dependency Unit in a public health institution.

Before 2001, when the kangaroo nursing method was adopted at KNH, Karanja said premature infants shared incubators — with as many as three to a machine.

But things took a dramatic turn after Sister Margaret Mukanzi took up a kangaroo nursing care course at the Kangaroo Foundation in Bogota, Columbia. After a month’s rigorous training, Mukanzi emerged with a certificate in Kangaroo Mother Care.

Armed with this knowledge she started a kangaroo nursing programme at KNH, making the institution the first to offer such services in East Africa.

Sharon Mwikali nurses her premature newborn using kangaroo method at Kenyatta National Hospital. [PHOTOs : JENIPHER WACHIE/STANDARD]

"On an overstretched day, two babies share an incubator in KNH. Otherwise, the kangaroo care has eased congestion at this unit," says Karanja.

Mukanzi says the method is slowly rolling out to other institutions. Jamaa Hospital, a private institution in Nairobi’s Eastlands, has earnestly embraced the method, she said.

Karanja says the technique helps to decongest the hospital and reduce bills incurred by patients.

Cost effective

"To make it cost effective, we teach parents how to nurse their preterm babies using kangaroo style and then discharge them," says Karanja.

Incubator service for a preterm infant for one month costs between Sh80,000 and Sh100,000 at KNH.

The bill could run to a million shillings in private institutions.

She also says since the introduction of kangaroo nursing, survival rates have improved to 70 per cent.

At Pumwani, it costs up to Sh1,500 per day per preterm baby, but few parents who seek treatment there are able to afford this.

Pumwani Superintendent Charles Wanyonyi, says that between 60 and 100 babies are delivered at the institution daily. Out of this, between 12 and 15 are born prematurely.

With only nine or ten incubators working at a time, as many as four and sometimes five of these fragile lives share a machine, says Dr Fridah Govedi, Pumwani’s Head of Newborn Unit.

When The Standard visited Pumwani, most of the incubators were serving three preterm infants each.

Kangaroo nursing has not been introduced at Pumwani yet, but they have improvised by heating four rooms to serve as incubators. Here, the babies are placed in canvass cots.

Govedi is contemplating introducing the new kangaroo to Pumwani. Apart from the many health challenges that plague preemies in childhood and adulthood, Govedi and Wanyonyi agree that when put together in one incubator, premature infants are likely to suffer from "close infections".

These are contagious diseases that can be transmitted from one infant to another and can substantially affect their survival chances.

Both concur that although there are many causes of premature births, a few conditions are unique to Kenya and other sub-Saharan countries. These include malaria, poor eating habits caused by poverty and abuse of drugs and other substances.

And since an incubator is made with only enough accessories to serve one infant at a time, Wanyonyi’s immediate appeal is for the provision of at least five more machines.

Medical bills

"With an extra five machines, Pumwani can have two preterm babies sharing an incubator. That way, we will be able to offer better services," says Wanyonyi.

Wanyonyi says: "When I joined PMH in mid 2004, there were only two working incubators. The numbers of preterm deliveries per day were still high. You can imagine the crisis we were going through then."

Govedi adds that although an infant is considered preterm if weighing 2.5kg, infants are discharged when they attain only two kilogrammes, to ease congestion and keep medical bills down.

"Some mothers are allowed to take their infants home when they attain as little as 1.8 kilos in weight, if they (children) don’t have any health complications", Govedi says.

"At Pumwani, preterm babies have between 50 and 70 per cent chances of survival if their birth weight is between 0.9 and 1.5kg. Their survival chances is less than 30 per cent if the weight is less than 900g," says Wanyonyi.

Most human pregnancies last about 40 weeks. A birth prior to 37 weeks is classified as preterm. At this time of gestation, the infant almost always weighs less than 2,500g.