Saving tiny lives, the fight against premature births in Kenya

One of the critical factors contributing to the rise in premature births is the increase in risk factors such as maternal age, multiple pregnancies, infections, and lifestyle choices. [iStockphoto]

At just 17 years old, Chantell Nzula, a Form 3 student from Machakos County, sits quietly in the empty newborn unit of Machakos Level 5 Hospital, cradling her baby. Only two weeks earlier she experienced the unexpected challenges of premature childbirth. Her young body, small and fragile, mirrors the uncertainty she feels as she navigates this new chapter of motherhood.

Her voice is soft, faint, and her eyes reflect the confusion and shock of a journey she never expected to take at such a young age.

“I came to the hospital two weeks ago,” Chantell recalls. “By 10 pm that night, I had already given birth. The doctors didn’t explain why I delivered prematurely, and I didn’t understand what was happening.”

Her mother, Salome Nzuiya, was equally overwhelmed. Facing financial constraints and emotional shock, she pleaded with hospital staff, deeply concerned for her daughter’s well-being.

“I don’t have the means to take her to another hospital,” she says. “I work menial jobs, washing clothes to put food on the table. Sometimes my daughter cries because she can’t afford diapers for her child.”

At the Kenyatta National Hospital (KNH) Newborn Unit, 22-year-old Juliana Mumbua from Makueni sat quietly, reflecting on the ordeal she faced after giving birth to her first child. On August 29, Juliana’s baby was born prematurely at just six months, in the most unexpected way.

She was still in shock as the labour pains began unexpectedly, and she was at home, struggling with the overwhelming reality of her situation. “I had just found out I was pregnant while still in school. My mother had fallen ill, and then I started feeling contractions. My friend helped me deliver the baby at home, and later, she rushed me to the hospital.”

Upon arrival at KNH, Juliana’s baby was immediately admitted to the nursery, where the doctors worked tirelessly to stabilise the fragile newborn. The baby later developed an infection in the stomach, adding more stress and anxiety to an already overwhelming experience.

“I was so worried. I wasn’t expecting to give birth to a premature baby. I thought everything was going well with my pregnancy, but suddenly, everything changed,” Juliana recalled.

For Juliana, the journey was not just about physical recovery but also about learning to care for a vulnerable infant. The doctors at the hospital emphasised the importance of hygiene, as premature babies are highly susceptible to infections.

“The doctors have taught me to be extra careful, to ensure I don’t expose my baby to anything that could harm her. I’ve learned to be meticulous about hygiene,” she explained.

Dr Mary Waiyego, a neonatologist at KNH, explains the critical nature of premature births. “Premature babies are born with organs that are not fully developed, requiring intensive care,” she says. “From respiratory support, specialized nutrition, and infection management, we must tailor every aspect of care to help them survive and thrive.”

The neonatal unit at KNH handles a large number of premature babies. Dr  Waiyego’s team faces the challenge of providing life-saving interventions such as mechanical ventilation, Continuous Positive Airway Pressure (CPAP) machines, and strict infection control measures.

A key component of their care strategy is Kangaroo Mother Care—a method that involves skin-to-skin contact between mother and baby, which helps regulate the infant’s body temperature, promotes breastfeeding, and enhances overall growth.

Premature babies are born with organs that are not fully developed, requiring intensive care. [iStockphoto]

According to a study by Unicef, Kangaroo Mother Care has been proven to reduce the risk of infection and mortality, and improve neurodevelopmental outcomes for preterm infants. “We encourage mothers to embrace this practice. It’s not just about saving lives; it’s about ensuring these babies grow and develop as normally as possible,” Dr Waiyego adds.

The experience of Kangaroo Care, which involves skin-to-skin contact between mother and baby, was transformative for Juliana. “This is my first child, and I didn’t know what to expect. Kangaroo care has been so important in helping me bond with my baby. It has taught me to love her and accept her as she is. I’ve learned to cherish every moment,” she said.

Juliana had planned to start her antenatal clinic visits, but her labour came unexpectedly at six months. “It was a shock, and I wasn’t ready, but now I understand how important it is to take proper care of my baby, especially as she grows,” Juliana added.

Despite these advancements, the healthcare system faces significant challenges. The neonatal unit at KNH, for example, often operates at full capacity. Preterm infants require a level of care that demands highly trained staff, specialised equipment, and extensive medical support. These resources are often stretched thin, particularly in smaller hospitals and rural areas.

One of the critical factors contributing to the rise in premature births is the increase in risk factors such as maternal age, multiple pregnancies, infections, and lifestyle choices.

According to a report by the Kenya National Bureau of Statistics (KNBS) and the Kenya National Health and Impact Survey (KNHIS), several socio-economic factors also play a significant role. Teenage pregnancies, for example, have increased in recent years, with many young mothers failing to access adequate prenatal care, increasing the risk of premature delivery.

Dr Supa Tunje, a consultant pediatrician and neurologist at Machakos Level 5 Hospital, adds, “The challenges of prematurity are exacerbated by underlying conditions like hypertension, preeclampsia, and infections, which can cause early labour. Unfortunately, teenage mothers face additional barriers, such as late recognition of pregnancy and difficulty accessing medical care.”

In Machakos Level 5 Hospital, approximately 150 to 200 newborns are admitted monthly, with 30 per cent of those being preterm. The hospital’s neonatal unit is equipped with Kangaroo care and respiratory support systems. However, as Dr. Tunje explains, the demand often exceeds capacity, and there is a critical shortage of trained neonatal nurses.

While healthcare interventions are crucial, the emotional journey of mothers who give birth to premature infants is equally significant. For many, the shock of a preterm birth can be overwhelming, as they navigate the uncertainty of their baby’s survival.

A nurse attends to Susan Muraya a mother of seven months baby born prematurely  during interview on premature babies at Kangaroo care in Kenyatta Hospital marking Prematurity day on 15th November 2024 [Benard Orwongo,Standard]

Susan Muraya, a 29-year-old mother of three and a resident of Nairobi, gave birth prematurely on October 11. Her baby arrived at seven months, unexpectedly.

Susan’s journey to acceptance has been long and difficult, but she is now learning to care for her child. “I never realised how much work it would be. Preterm babies need constant care, especially with hygiene. I had to learn about Kangaroo care and the importance of warmth. It’s not easy, but at the end of the day, this is my child,” Susan explains.

Through the support of the medical staff, Susan has started to accept her child fully. “At first, I didn’t know how to feel. I was in denial, but now I have learned to accept my child,” she says, advising other mothers in a similar situation, “Motherhood is not easy, but accept your child, no matter what.”

The financial strain on families with preterm babies is another significant issue. For many mothers, the cost of extended hospital stays, medical care, and the need for specialized equipment can be overwhelming.

Mercy Phillips, a 28-year-old revenue collector from Machakos, reflects on her own challenges. She gave birth to a baby weighing just 500 grams at 23 weeks. “I was in pain and bleeding when I went to the hospital. I had no idea my baby would come early, and when I gave birth, I was terrified,” she says.

“I had to stay in the hospital for three months, and it was tough. I had to do Kangaroo care for three weeks, but I was determined to stay strong for my baby,” she recalls.

Mercy’s story is one of resilience, but also of the harsh realities of being a mother to a premature baby in Kenya. “I watched some mothers give up on their children, but I knew I had to keep fighting for my baby. Every day, the doctors told me that my strength was helping her grow,” she explains.

Dr Laura Oyiengo, a UNICEF Health Specialist in Maternal and Newborn Health, emphasizes that understanding and addressing premature births requires a multifaceted approach. Globally, over 13.4 million babies are born preterm annually, with sub-Saharan Africa and South Asia bearing over 60 per cent of this burden.

“In Kenya, prematurity accounts for one-third of all newborn deaths, alongside birth asphyxia and infections. These vulnerable infants face significant health risks due to their underdeveloped body systems, lacking fully formed immunity and sufficient body fat,” she says.